In patients with irreversible pulpitis in mandibular molars, both Caustinerf and D-Pulp medicaments displayed similar efficacy in reducing postoperative pain.

A double-blind, randomized, clinical trial aimed to compare the effectiveness of 2 different quantities of paraformaldehyde based pulpal medicaments for alleviating pain and controlling hyperemic pulp post-failure of an inferior alveolar nerve block (IANB) and supplementary procedure in irreversible pulpitis patients.

Overall, 82 patients afflicted with severe pain pre-operatively (Visual Analogue Scale [VAS] score > 114 mm) were recruited. Utilizing VAS, recording of the pain responses at various time points was done. The paraformaldehyde based pulpal medicaments (1 out of the 2) were placed and sealed in the pulp chamber of the people feeling pain despite receiving the standard supplemental intraligamentary injection and IANB. To evaluate bleeding reduction and pain, the patients were  recalled after 24–48 hours for a second visit.

A substantial reduction was reported in the severity of pain and bleeding score after medicament placement. Prudent use of pulpal medicaments during a suggested period can be deemed safe. 

Paraformaldehyde-based pulpal medicament can be utilized as an effective and safe substitute for pain management in patients suffering from hyperalgesia and severe irreversible pulpitis.