An endodontic flare-up is defined by the American association of endodontists (aae) as an acute exacerbation of an asymptomatic pulpal and or periapical pathosis

after the initiation or continuation of root canal treatment. Flare ups are unpredictable events with reported prevalence rates varying from 1, ! to 1"!. #he definition of a flare uo has varies among studies. $owever. %n accordance with the current ae definition, the most li&ely predisposing clinical condition for its occurrence appears to be asymptomatic necrotic pulp with periapical lesion. #he flare up etiology is li&ely multifunctorial and dependent on the interactions between the host immunological response, infection and physical damage, with he ma'or causative factor describe as microbial in origin. %ndirect support is found % studies showing het the lowest incidence of flare ups occurred in patiens with out periapical pathosis and when a sinus tract is present the letter presumable permitting some from of drainage. %nterstingly, other factors tat might be expected to contribute to a predominantly microbiological etiology have been reported to have no association with the occurrence of flare ( ups. #hese include incomplete root canal debridement, under filled canals, over instrumentation beyond the apex where extrusion of infected debris might be expected to occure, and the use of antimicrobial intracanal medicaments. )a&teri yang berhubungan dengan ter'adinya flare-ups adalah fusobacterium, prevotella, dan porphyromonas yang merupa&an non motil gram negative anaerob yang termasu& dalam famly bacteroidaceae. Flare up is described as the occurrence of pain, swelling or the combination of these during the course of root canal therapy, which results in un scheduled visit by patient. *ain may occur soon after initiating endodontic treatment for an asymptomatic tooth or shortly after the initial emergency treatment or during the course of treatment. +ausative factors +omprise mechanical, chemical and, or microbial in'ury to thepulp or periapical tissues resulting in the release of myriad of inflammatory mediators. *ain then occurs due to the direct stimulation of the nerve fibers by these mediators or edema resulting % an increase in the hydrostatic pressure with conse-uent compression of nerve endings. .echanical in'ury .echanical in'ury may occur in form of -overinstrumentation, most common cause of mid treatment flare-ups -inade-uate debridement or incomplete removal of pulp tissue can result in pain -perapical extrusion of debris can lead to periapical inflammation and flare-ups +hemical in'ury +hemical in'ury to the periapical tissues may be caused by %rrigants %ntracanal medicaments /verextended filling materials .icrobial in'ured in'ury %s considered as the most significant factor in the flare up pathogenesis. .icrobial factors may be combined with iatrogenic factors to cause inter-appointment pain. +ontributing factors for flare ups

0sia pasien *atient in the 1-2" years range have the most flare ups and those under the age of 31 have the least. 4ender 5ystemic conditions #ooth type Anxiety *resence of preoperative pain and,or swelling *ulpal,periapical status 6umber of visit 7etreatment cases