Universitat Internacional de Catalunya
Pain Management in Endodontics
Other languages of instruction: Catalan, Spanish
Teaching staff
Introduction
Pain control in advanced Endodontics requires the integration of clinical diagnosis, complementary tests, imaging, anaesthesia, pharmacology, and operative procedures. This course addresses complex clinical situations including anaesthetic failure, endodontic emergencies, postoperative pain, flare-ups, and persistent symptoms after treatment.
Students will develop clinical decision-making strategies for cases with discordant findings and will learn to distinguish odontogenic from non-odontogenic pain. Emphasis will be placed on preventing overtreatment, ensuring patient safety, rational prescribing, and multidisciplinary referral when indicated.
Pre-course requirements
Students are expected to have a solid foundation in pulpal and periapical diagnosis, conventional root canal treatment, and radiographic interpretation.
They should be proficient in rubber dam isolation, basic local anaesthesia, and dental history taking.
Objectives
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Integrate clinical, radiographic, and pharmacological data to diagnose and manage pain of endodontic origin.
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Manage anaesthetic failure through safe, stepwise anaesthetic protocols.
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Address endodontic emergencies, postoperative pain, and flare-ups through causal treatment and sound clinical decision-making.
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Individualise analgesic, anti-inflammatory, and antibiotic prescribing according to diagnosis, procedure, and the patient’s medical profile.
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Differentiate odontogenic from non-odontogenic pain and establish criteria for retreatment, surgery, follow-up, or multidisciplinary referral.
Competences/Learning outcomes of the degree programme
- CN01 - Identify with precision the most advanced technical processes related to endodontics.
- CP02 - Resolve the main endodontic complications through the correct preparation of a treatment plan in the context of daily clinical practice.
- CP03 - Design treatment strategies for endodontic patients with special needs.
- CP04 - Generate work synergies with professionals from other areas and disciplines through the design of joint action strategies.
- HB01 - Carry out an adequate and precise bibliographic search of the different endodontic treatments.
- HB03 - Manage the complexity of each endodontic case.
- HB04 - Classify endodontic cases as easy, moderate or complex.
- HB06 - Quickly and effectively resolve endodontic pain situations.
- HB09 - Act rigorously in complex situations of endo-periodontal lesions, resorptions and pain of non-odontogenic origin.
- HB12 - Plan a defined and appropriate protocol in the event of endodontic failure.
- HB14 - Prepare, through correct prior argumentation, a treatment plan through the presentation of clinical cases and the most relevant literature.
- HB16 - Integrate radiological advances in three dimensions in the analysis of different endodontic situations.
- HB20 - Prepare an appropriate endodontic treatment plan based on an exhaustive clinical and radiographic analysis.
Learning outcomes of the subject
- - Biomedical Sciences - LEARNING OUTCOMES Title – CN01, CN04, HB04, HB16 Subject – Students will be able to: 1. Identify the main anatomical structures of the head and neck. 2. Recognize macro or microscopic anomalies or alterations that cause pathology in the oral cavity. 3. Identify the different pathogenic microorganisms by applying the necessary laboratory techniques. 4. Make a diagnosis of the different pathologies of the oral cavity based on the interpretation of the results obtained. 5. Analyze and interpret the results obtained to determine the impact of other complex systems. 6. Discuss the most appropriate actions or drugs for the treatment of diagnosed pathologies related to the oral cavity.
- - Diagnosis and Treatment Plan in Endodontics LEARNING OUTCOMES From title – CN01, HB03, HB05, HB12, HB14, HB18, HB20 Of matter – The students will be able to: 1. Solve the complications that undergraduate students have during their preclinical practices. 2. Make public presentations of their own clinical cases based on scientific literature, through the correct use of scientific terminology. 3. Debate and reason endodontic clinical techniques before a specialized and non-specialized audience in a clear and unambiguous way. 4. Determine the role of an endodontist within an interdisciplinary team. 5. Successfully plan, through prior analysis, any endodontic problem, as well as those directly related to restorative and aesthetic dentistry. 6. Identify and organize endodontic material and instruments in a precise and orderly manner. 7. Assess different therapeutic options for pulpo-periapical pathology according to the scientific literature. 8. Develop different isolation strategies for the surgical field to carry out a successful endodontic and restorative treatment
- - Scientific Bases in Endodontics - LEARNING OUTCOMES Title – CN02, HB06, HB07, HB11, HB13, HB17 Subject – Students will be able to: 1. Identify the etiology, etiopathogenesis and clinical presentation of pulpo-periapical pathologies in all its variations. 2. Differentiate the patient's pain based on its location, origin, pain and characteristics. 3. Apply a logical sequence of instrumentation, irrigation and obturation of the canal system, regardless of the degree of complexity of the case. 4. Classify the endodontic and restorative prognosis required by the different pulpo-periapical entities. 5. Select the most appropriate emergency treatment for each situation. 6. Design a drug administration plan in relation to pulpo-periapical pathology. 7. Modify your therapeutic strategy depending on the root status of the affected tooth. 8. Schedule the minimum radiographs necessary to perform a successful endodontic treatment without exposing the patient to excessive ionizing radiation.
- - External Academic Practices - LEARNING OUTCOMES Title – CN04, HB07, HB08, HB09, HB10, HB11, HB12, HB13, HB16, HB17, HB18, HB19, CP02, CP03, CP04, CP05 Subject – Students will be able to: 1. Structure a patient's medical history in an orderly and correct manner, as well as perform an oral and functional examination on all patients. 2. Recognize normal and pathological anatomical structures on a panoramic radiograph, a periapical radiograph, a bitewing radiograph, and on a cone beam computed tomography scan. 3. Prioritize the different endodontic treatments to be performed based on a list of diagnostic problems. 4. Correctly diagnose the different entities of pulpo-periapical pathology. 5. Adopt an appropriate therapeutic attitude towards any pulpo-periapical entity that requires endodontic treatment. 6. Explain to the patient the need to perform additional examinations (intraoral scanning, cone beam computed tomography, etc.) to optimize the resources of each endodontic treatment. In this way, you will be able to document clinical cases from photographs and videos of the different treatments carried out in the clinical part. 7. Manufacture different tools in three dimensions based on adequate digital planning of each case.
Syllabus
The course is structured into seven topics integrating the diagnosis and management of endodontic pain, emergencies, clinical pharmacology, postoperative pain control, and digital planning of complex cases.
Each topic includes subtopics, practical activities, and specific learning materials, such as clinical protocols, clinical cases, scientific articles, radiographic images, CBCT volumes, DICOM and STL files, and software tutorials.
- Advanced pulpal and periapical diagnosis through patient history, clinical examination, sensibility tests, and digital radiography.
- Differential diagnosis of endodontic, periodontal, neuropathic, and non-odontogenic pain.
- Complexity classification, prognosis, and diagnostic planning using periapical radiography and CBCT.
- Pharmacology of local anaesthetics, vasoconstrictors, and factors associated with anaesthetic failure.
- Stepwise protocols and conventional, periodontal ligament, intraosseous, and intrapulpal anaesthetic techniques.
- Multimodal, anti-inflammatory treatment, and antibiotic use in Endodontics.
- Manejo de la pulpitis irreversible sintomática, periodontitis apical sintomática, absceso apical agudo y edema.
- Clinical factors associated with postoperative pain, over-instrumentation, irrigation, and extrusion of materials.
- Prevention, diagnosis, and management of endodontic flare-ups.
- Integration of digital radiography, CBCT, DICOM data, and intraoral STL or PLY scans in endodontic diagnosis.
- Three-dimensional segmentation of teeth, root canals, periapical lesions, and anatomical structures at risk.
- Data matching, alignment validation, and preparation of digital planning reports.
- Digital planning of guided access in calcified or obliterated root canals
- Design, validation, and 3D printing of endodontic guides based on CBCT data and intraoral scans.
- Three-dimensional planning and design of surgical guides for endodontic microsurgery, including osteotomy, apical resection, and retrograde cavity preparation.
- Analysis of persistent pain, endodontic failure, persistent infection, missed canals, fractures, and endo-periodontal lesions.
- Integration of clinical, radiographic, CBCT, and digital data to decide on retreatment, surgery, extraction, follow-up, or referral.
Teaching and learning activities
In person
The course is delivered entirely on site through a methodology based on critical appraisal of scientific articles, academic discussion, and practical application of knowledge to highly complex endodontic clinical cases.
Before each session, students will review the scientific literature selected by the teaching staff. At the beginning of each class, a short formative quiz will be used to assess preparation, identify key concepts, and guide the subsequent discussion.
Students will present the assigned articles and analyse their methodological design, results, limitations, and clinical relevance. Faculty-led discussion will focus on translating scientific evidence into clinical decision-making for pain of endodontic origin.
The remainder of the sessions will consist of practical case-based seminars. Students will apply the reviewed content to formulate differential diagnoses, interpret digital radiographs and CBCT scans, select anaesthetic and pharmacological protocols, plan emergency treatment, and develop management strategies for postoperative pain, flare-ups, endodontic failure, and persistent pain.
Where indicated, students will work with digital planning workflows, including interpretation of DICOM data, integration with intraoral STL or PLY scans, three-dimensional lesion analysis, and planning of guides for guided endodontics or endodontic microsurgery.
Learning activities-
Prior reading of selected scientific articles.
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Short formative quiz at the beginning of each session.
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Oral presentation and critical discussion of scientific articles.
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Faculty-led clinical discussion seminars.
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Resolution of complex endodontic clinical cases.
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Interpretation of digital radiographs, CBCT, DICOM data, and STL files.
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Digital planning of selected clinical cases.
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Design and validation of guides for guided endodontics and microsurgery.
Evaluation systems and criteria
In person
Assessment will be continuous and fully on-site, based on prior preparation, active participation, and the clinical application of course content. Short quizzes at the beginning of each session, presentation and critical appraisal of scientific articles, and discussion of complex clinical cases will be assessed. Students must justify diagnosis, treatment planning, and anaesthetic, pharmacological, and digital decisions using scientific evidence. The presentation of each practical activity carried out throughout the course will also be assessed. To pass the course, students must achieve a minimum grade of 5 out of 10 and actively attend on-site sessions.