Effect of calcium hydroxide vs. tobradex intracanal medicament on postoperative endodontic pain: a pragmatic prospective study

This pragmatic study provides preliminary evidence on the effectiveness of calcium hydroxide (Ca(OH)₂) and Tobradex (a tobramycin–dexamethasone combination) as intracanal medicaments for managing postoperative pain following emergency root canal treatment in patients with symptomatic irreversible pulpitis. Forty-three adults participated (27 received Ca(OH)₂ and 16 received Tobradex). Pain intensity was evaluated using a numeric rating scale before treatment and at 24 and 48 h postoperatively. Both groups showed significant pain reduction at 24 h, but Tobradex produced a greater and faster decrease (mean pain reduction from 7.69 ± 3.68 to 1.31 ± 2.36; P < 0.001) compared to calcium hydroxide (median reduction from 7.0 to 2.0; P = 0.006). No further improvement occurred between 24 and 48 h for either group, and demographic factors had no significant influence. Overall, Tobradex demonstrated superior short-term analgesic efficacy, indicating that corticosteroid–antibiotic combinations may enhance postoperative comfort more effectively than calcium hydroxide in endodontic emergency cases. Trial registration The study protocol was retrospectively registered in Clinicaltrials.gov on 13th of Jan. 2026, with ID number NCT07332936.