CONSORT Randomized Clinical Trial| Volume 47, ISSUE 10, P1550-1556, October 2021

Postoperative Pain after Use of the WaveOne Gold and XP-endo Shaper Systems: A Randomized Clinical Trial



      The present study aimed to clinically compare the incidence of postoperative pain after endodontic treatment of posterior teeth using the WaveOne Gold (WOG; Dentsply Sirona, Ballaigues, Switzerland) and XP-endo Shaper (XPES; FKG Dentaire, La Chaux-de-Fonds, Switzerland) systems.


      In a single-blind randomized clinical trial, 148 vital teeth with an indication for conventional endodontic therapy for prosthetic purposes were treated by 5 specialists following a preestablished protocol. All participants were unaware of the treatment they received. The teeth were randomly divided into 2 groups (n = 74) according to the instrumentation system used (the WOG group and XPES group). The treatments were performed in a single session. The participants were asked to rate the intensity of postoperative pain on a visual analog scale (no pain, mild pain, moderate pain, and severe pain) after 24, 48, and 72 hours and 7 days.


      The incidence of postoperative pain was higher in the XPES group after 24, 48, and 72 hours compared with those in the WOG group (P < .05). Two participants in the WOG group experienced severe postoperative pain after 24 hours. None of the participants in either group reported pain after 7 days (P > .05, Mann-Whitney test).


      Postoperative pain is expected after preparation of the root canal system with the WOG and XPES systems tested, but it only persists for a short period. Although more common after the use of the XPES system, the pain was classified as mild at all time points.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fernández R.
        • Cardona J.A.
        • Cadavid D.
        • et al.
        Survival of endodontically treated roots/teeth based on periapical health and retention: a 10-year retrospective cohort study.
        J Endod. 2017; 43: 2001-2008
        • Gavini G.
        • Santos M.D.
        • Caldeira C.L.
        • et al.
        Nickel-titanium instruments in endodontics: a concise review of the state of the art.
        Braz Oral Res. 2018; 32: e67
        • AlOmari T.
        • AlThobiti G.
        • AlThobaiti S.
        • et al.
        Incidence of postoperative pain after canal shaping by using Reciproc and Twisted File Adaptive systems: a prospective, randomized clinical trial.
        Clin Oral Investig. 2020; 24: 2445-2450
        • Sun C.
        • Sun J.
        • Tan M.
        • et al.
        Pain after root canal treatment with different instruments: a systematic review and meta-analysis.
        Oral Dis. 2018; 24: 908-919
        • Martins C.M.
        • De Souza Batista V.E.
        • Andolfatto Souza A.C.
        • et al.
        Reciprocating kinematics leads to lower incidences of postoperative pain than rotary kinematics after endodontic treatment: a systematic review and meta-analysis of randomized controlled trial.
        J Conserv Dent. 2019; 22: 320-331
        • Siqueira Jr., J.F.
        • Rôças I.N.
        • Favieri A.
        • et al.
        Incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy.
        J Endod. 2002; 28: 457-460
        • Caviedes-Bucheli J.
        • Castellanos F.
        • Vasquez N.
        • et al.
        The influence of two reciprocating single-file and two rotary-file systems on the apical extrusion of debris and its biological relationship with symptomatic apical periodontitis. A systematic review and meta-analysis.
        Int Endod J. 2016; 49: 255-270
        • Boijink D.
        • Costa D.D.
        • Hoppe C.B.
        • et al.
        Apically extruded debris in curved root canals using the WaveOne Gold Reciprocating and Twisted File Adaptive systems.
        J Endod. 2018; 44: 1289-1292
        • Uslu G.
        • Özyürek T.
        • Yılmaz K.
        • et al.
        Apically extruded debris during root canal instrumentation with Reciproc Blue, HyFlex EDM, and XP-endo Shaper nickel-titanium Files.
        J Endod. 2018; 44: 856-859
        • Keskin C.
        • Inan U.
        • Guler D.H.
        • et al.
        Cyclic fatigue resistance of XP-Endo Shaper, K3XF, and ProTaper Gold nickel-titanium instruments.
        J Endod. 2018; 44: 1164-1167
        • Versiani M.A.
        • Carvalho K.K.
        • Mazzi-Chaves J.F.
        • et al.
        Micro-computed tomographic evaluation of the shaping ability of XP-endo Shaper, iRaCe, and EdgeFile systems in long oval-shaped canals.
        J Endod. 2018; 44: 489-495
        • Bayram H.M.
        • Bayram E.
        • Ocak M.
        • et al.
        Effect of ProTaper Gold, Self-Adjusting File, and XP-endo Shaper instruments on dentinal microcrack formation: a micro-computed tomographic study.
        J Endod. 2017; 43: 1166-1169
        • Arıcan Öztürk B.
        • Atav Ateş A.
        • Fişekçioğlu E.
        Cone-beam computed tomographic analysis of shaping ability of XP-endo Shaper and ProTaper Next in large root canals.
        J Endod. 2020; 46: 437-443
      1. FKG Dentaire. Root canal preparations industry data. XP Endo Shaper. Available at: Accessed May 20, 2021.

        • van der Vyver P.J.
        • Paleker F.
        • Vorster M.
        • et al.
        Root canal shaping using nickel titanium, M-Wire, and Gold Wire: a micro-computed tomographic comparative study of One Shape, ProTaper Next, and WaveOne Gold instruments in maxillary first molars.
        J Endod. 2019; 45: 62-67
        • Adıgüzel M.
        • Capar I.D.
        Comparison of cyclic fatigue resistance of WaveOne and WaveOne Gold small, primary, and large instruments.
        J Endod. 2017; 43: 623-627
      2. Dentsply Tulsa Dental Specialties. WaveOne Gold Brochure. Available at: Accessed May 20, 2021.

        • Neelakantan P.
        • Sharma S.
        Pain after single-visit root canal treatment with two single-file systems based on different kinematics--a prospective randomized multicenter clinical study.
        Clin Oral Investig. 2015; 19: 2211-2217
        • Kherlakian D.
        • Cunha R.S.
        • Ehrhardt I.C.
        • et al.
        Comparison of the incidence of postoperative pain after using 2 reciprocating systems and a continuous rotary system: a prospective randomized clinical trial.
        J Endod. 2016; 42: 171-176
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        2nd ed. Lawrence Earlbaum Associates, Hillsdale, NJ1988
        • Myles P.S.
        • Troedel S.
        • Boquest M.
        • et al.
        The pain visual analog scale: is it linear or nonlinear?.
        Anesth Analg. 1999; 89: 1517-1520
        • Ruddle C.J.
        Cleaning and shaping the root canal system.
        in: Cohen S. Burns R.C. Pathways of the Pulp. 8th ed. Mosby, St Louis, MO2002: 231-291
        • Keskin C.
        • Sivas Yilmaz Ö.
        • Inan U.
        • et al.
        Postoperative pain after glide path preparation using manual, reciprocating and continuous rotary instruments: a randomized clinical trial.
        Int Endod J. 2019; 52: 579-587
        • Arias A.
        • Azabal M.
        • Hidalgo J.J.
        • et al.
        Relationship between postendodontic pain, tooth diagnostic factors, and apical patency.
        J Endod. 2009; 35: 189-192
        • Alí A.
        • Olivieri J.G.
        • Duran-Sindreu F.
        • et al.
        Influence of preoperative pain intensity on postoperative pain after root canal treatment: a prospective clinical study.
        J Dent. 2016; 45: 39-42
        • Velozo C.
        • Silva S.
        • Almeida A.
        • et al.
        Shaping ability of XP-endo Shaper and ProTaper Next in long oval-shaped canals: a micro-computed tomography study.
        Int Endod J. 2020; 53: 998-1006
        • Azim A.A.
        • Piasecki L.
        • da Silva Neto U.X.
        • et al.
        XP Shaper, a novel adaptive core rotary instrument: micro-computed tomographic analysis of its shaping abilities.
        J Endod. 2017; 43: 1532-1538
        • Prados-Privado M.
        • Rojo R.
        • Ivorra C.
        • et al.
        Finite element analysis comparing WaveOne, WaveOne Gold, Reciproc and Reciproc Blue responses with bending and torsion tests.
        J Mech Behav Biomed Mater. 2019; 90: 165-172
        • Pak J.G.
        • White S.N.
        Pain prevalence and severity before, during, and after root canal treatment: a systematic review.
        J Endod. 2011; 37: 429-438
        • Sathorn C.
        • Parashos P.
        • Messer H.
        The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review.
        Int Endod J. 2008; 41: 91-99
        • Harrison J.W.
        • Baumgartner J.C.
        • Svec T.A.
        Incidence of pain associated with clinical factors during and after root canal therapy. Part 2. Postobturation pain.
        J Endod. 1983; 9: 434-438
        • Lacerda M.F.
        • Marceliano-Alves M.F.
        • Pérez A.R.
        • et al.
        Cleaning and shaping oval canals with 3 instrumentation systems: a correlative micro-computed tomographic and histologic study.
        J Endod. 2017; 43: 1878-1884
        • Elnaghy A.M.
        • Elsaka S.E.
        Torsional resistance of XP-endo Shaper at body temperature compared with several nickel-titanium rotary instruments.
        Int Endod J. 2018; 51: 572-576
        • Caviedes-Bucheli J.
        • Rios-Osorio N.
        • Rey-Rojas M.
        • et al.
        Substance P and calcitonin gene-related peptide expression in human periodontal ligament after root canal preparation with Reciproc Blue, WaveOne Gold, XP EndoShaper and hand files.
        Int Endod J. 2018; 51: 1358-1366
        • Pasqualini D.
        • Corbella S.
        • Alovisi M.
        • et al.
        Postoperative quality of life following single-visit root canal treatment performed by rotary or reciprocating instrumentation: a randomized clinical trial.
        Int Endod J. 2016; 49: 1030-1039
        • Zand V.
        • Milani A.S.
        • Hassani Dehkharghani A.
        • et al.
        Treatment of necrotic teeth using two engine-driven wystems and patient’s postoperative pain: a double-blind clinical trial.
        Iran Endod J. 2016; 11: 267-272
        • Keskin C.
        • Inan U.
        • Demiral M.
        • et al.
        Cyclic fatigue resistance of Reciproc Blue, Reciproc, and WaveOne Gold reciprocating instruments.
        J Endod. 2017; 43: 1360-1363