Influence of Diclofenac Sodium Intracanal Medication on Postoperative Pain and Matrix Metalloproteinase-9 Modulation in Necrotic Pulp Cases: A Randomised Controlled Clinical Trial.

OBJECTIVE: This study aimed to assess postoperative pain outcomes and changes in periapical matrix metalloproteinase-9 (MMP-9) levels following the use of diclofenac sodium (DcS) and calcium hydroxide Ca(OH)2 intracanal medications. METHODS: Thirty patients with necrotic single-rooted mandibular premolars were randomly assigned to DcS or Ca(OH)2 intracanal medication groups. Standard 2-visit endodontic treatment was performed. Postoperative pain was recorded following instrumentation and obturation at 6, 12, 24, and 48 hours, and MMP-9 levels were measured after chemo-mechanical preparation and after placement of intracanal medicament for 1 week. RESULTS: Diclofenac sodium demonstrated a significantly lower incidence and intensity of postoperative pain following the first visit compared with Ca(OH)2, particularly at 6, 12, and 24 hours. Both agents significantly decreased inflammatory biomarker levels from post-instrumentation to pre-obturation in necrotic root canals. Despite this reduction, biomarker levels remained elevated in the DcS group relative to the Ca(OH)2 group. CONCLUSION: Diclofenac sodium used as an intracanal medication significantly reduced postoperative pain compared with Ca(OH)2. Ca(OH)2 demonstrated a greater reduction in MMP-9 levels, although both agents produced a marked decline in biomarker levels from post-instrumentation to pre-obturation in necrotic root canals.