Background: Accurate diagnosis and effective management of acute toothache is one of the important aspects of dental care. In the past, with acute periapical inflamation, 19.4% - 71.2% of the surveyed clinical endodontists would open the space between appointments, however recent literature suggests that this method is prone to complications. Currently, there is a tendency not to open for drainage but to proceed with immediate endodontic treatment.

Objectives: To compare the results of endodontic treatment of acute periodontitis by immediate endodontic debridement and open tooth methods.

Materials and methods: Interventional prospective study on patients with teeth diagnosed with acute periapical inflammation. Patients were randomly divided into 2 groups: group I for immediate root canal treatment and group II for open tooth. Patients recorded pain levels and the number of pain medications used 5 days after the first treatment session. Treatment results are considered successful when the patient has no pain or mild pain after surgery, failure when the pain is moderate or severe after surgery. Comparison of mean time to completion of treatment between the 2 study groups.

Results: In group I, values of pain were recorded lower than in group II during days 3 to 5 after treatment. The immediate root canal treatment group had a higher success rate of 77.8% compared to the open tooth group of 62.9%, with pain levels ranging from no pain to mild pain. The maximum number of pain medication used in group I was 5.44 ± 0.50, in group II was 5.54 ± 0.50. Then gradually decreased in the next 4 days. However, there was no significant difference between the 2 groups in the level of pain medications use. The number of treatment times of group I was mainly 2 and 3 times: accounting for 35.1% and 48.6%, less than group 2, mainly over 3 appointments, accounting for 77.8%.

Conclusions: Patients improved pain symptoms after 5 days in both study groups. The immediate root canal treatment group had a higher success rate than the open tooth group.