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Xiqian L, Ying Z, Mian M. The effect of apical patency on postoperative pain following endodontic therapy: A systematic review and meta-analysis. Eur J Oral Sci 2024; 132:e12986. [PMID: 38632110 DOI: 10.1111/eos.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
This systematic review and meta-analysis aimed to determine whether apical patency increases postoperative pain after endodontic therapy. This study explored the degree and incidence of postoperative pain during root canal therapy, as well as the number of required analgesic doses. We searched PubMed, Scopus, Embase, Web of Science, Cochrane Library, and gray literature from the date of database inception until May 2023. RevMan 5.4 software was used for data analysis. Twelve studies were considered eligible for meta-analysis. The mean pain scores on days 1 (mean difference [MD] = -1.69) and 2 (MD = -0.85) differed significantly between the apical patency and non-patency groups. The odds for pain after 24 h were significantly lower (OR 0.59) in the apical patency group than in the non-patency group. Furthermore, the mean number of required analgesic doses was not significantly different between the two groups. In conclusion, apical patency significantly alleviated postoperative pain (low-quality evidence) and reduced the incidence of pain (moderate evidence). However, high-quality randomized controlled trials are required to validate these findings.
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Affiliation(s)
- Liu Xiqian
- Department of Stomatology, Changzhi Medical College Affiliated Heping Hospital, Changzhi City, Shanxi Province, China
| | - Zhai Ying
- Department of Stomatology, Yangquan Coal Industry Group General Hospital, Yangquan City, Shanxi Province, China
| | - Mao Mian
- Department of Pharmacy, Sichuan Cancer Hospital and Institute, Chengdu, China
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Mamat R, Nik Abdul Ghani NR. The Complexity of the Root Canal Anatomy and Its Influence on Root Canal Debridement in the Apical Region: A Review. Cureus 2023; 15:e49024. [PMID: 38111413 PMCID: PMC10727774 DOI: 10.7759/cureus.49024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
The main goal of root canal treatment is to eliminate the infection in the complex root canal system for the long-term preservation of a functional tooth. Proper debridement of the root canal system, especially in the apical portion, is essential for successful root canal treatment. The complexity of the canal anatomy in the apical region plays a crucial role in reducing the microbial load. Therefore, clinicians must have a thorough knowledge of the anatomy of the root canal system and its variations, especially in the apical portion. Root canal configurations in cross-section have been classified as round, oval, long oval, flattened, or irregularly shaped. Treating oval, long oval, flattened, or irregularly shaped canals is challenging and should be approached differently than a circular canal. Recognizing the root canal shape and apical anatomy determines the different strategies to be used in cleaning, shaping, and obturation to achieve the best result of root canal treatment. The recent development of the instrumentation system improves the treatment outcome for clinicians and patients. This review aimed to discuss the definition, prevalence, and instrumentation for cleaning and shaping in the apical area with the complexity of root canal systems. Therefore, with the aid of this review, we can better understand the variations in the anatomy of the root canal, especially at the apical portion.
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Affiliation(s)
- Rosnani Mamat
- Conservative Dentistry and Endodontics, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Nik Rozainah Nik Abdul Ghani
- Conservative Dentistry and Endodontics, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, MYS
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Cavender MS, Waters C. The Effect of Patency Files on Apical Canal Anatomy Using SEM Imaging. Int J Dent 2023; 2023:7195512. [PMID: 37635899 PMCID: PMC10449587 DOI: 10.1155/2023/7195512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/14/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction There are many reasons to maintain apical patency during routine endodontic treatment. Thousands of canals are treated utilizing a patency file every year all around the world. The effect patency has on the apical anatomy of the root has been controversial for generations. Objective This ex vivo descriptive study was created to show the effect patency files actually have on the apical root canal anatomy using visually detailed SEM images supported by dental radiographs. Materials and Methods Three extracted maxillary anterior teeth that represent the multitude of canals in vivo were instrumented utilizing patency files. Two of the three maxillary anterior teeth were instrumented with hand files, the other maxillary anterior tooth with a .06 taper rotary file. The teeth were then scanned with an electron microscope to view the effect that the instruments had on the apical canal anatomy. A fourth tooth, a maxillary second molar, was shaped with an .06 taper rotary file and cone fitted. This tooth was radiographed with a gutta percha cone fitted to reveal the position of the narrowest constriction after patency was achieved. Results The patency files, both hand files and rotary, were shown not to adversely affect the apical canal anatomy. Additionally, the SEM's revealed a precise demarcation of cementum to dentin which was at the root surface after patency was achieved. Conclusion The patent use of greater tapered rotary files provides a clear demarcation of the CDJ which allows a precise acquisition of the narrowest constriction of the canal with the use of an electronic apex locator for establishing the ideal working length and precision placement of a gutta percha cone.
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Affiliation(s)
- Michael S. Cavender
- Department of Endodontics, School of Dentistry, West Virginia University, 1080A Health Sciences Center North, Morgantown, WV 26506, USA
| | - Christopher Waters
- Department of Dental Research, School of Dentistry, West Virginia University, 106a Health Sciences Addition, PO Box 9448, Morgantown, WV 26506, USA
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Kirkevang LL, El Karim IA, Duncan HF, Nagendrababu V, Kruse C. Outcomes reporting in systematic reviews on non-surgical root canal treatment: A scoping review for the development of a core outcome set. Int Endod J 2022; 55:1128-1164. [PMID: 35969087 DOI: 10.1111/iej.13812] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies related to non-surgical root canal treatment are amongst the most frequently performed clinical studies in endodontics. However, heterogeneity in reporting outcomes and lack of standardization is a significant challenge to evidence synthesis and guideline development. OBJECTIVES The aims of the present scoping review were to (a) identify outcomes reported in systematic reviews evaluating non-surgical root canal treatment; (b) identify how and when the reported outcomes were measured; (c) assess possible selective reporting bias in the included studies. The information obtained in this study should inform the development of a core outcome set (COS) for non-surgical root canal treatment. METHODOLOGY Structured literature searches were performed to identify systematic reviews on non-surgical root canal treatments published in English between January 1990 and December 2020. Two reviewers undertook study selection and data extraction. Outcomes were categorized according to a healthcare taxonomy into five core areas (survival, clinical/physiological changes, life impact, resource use, and adverse events). The outcome measurement tools and length of follow-up were recorded. RESULTS Seventy-five systematic reviews were included, of which 40 included meta-analyses. Most reviews reported on physiological and clinical outcomes, primarily pain and/or radiographic assessment of periapical status, and a variety of measurement tools and scales were used. Few reviews focused on tooth survival, life impact, resources, and adverse events. The heterogeneity amongst the reviews was large on all parameters. Less than 40% of the reviews assessed the risk of selective reporting. DISCUSSION Overall aims of the included reviews were highly heterogenic; thus, outcomes and how they were measured also varied considerably. Patient-centred outcomes and the use of resources were rarely reported on. CONCLUSIONS Most studies reported on physiological and clinical outcomes, in particular pain and/or radiographic healing. Measurement tools, scales, thresholds, and follow-up periods varied greatly within each outcome, making comparison across studies complicated. Less than 40% of the reviews assessed risk of selective reporting; thus, selective bias could not be ruled out. The presented information on reported outcomes, measurement tools and scales, and length of follow-up may guide the planning of future research and inform the development of a COS for non-surgical root canal treatment.
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Affiliation(s)
| | - Ikhlas A El Karim
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Henry Fergus Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Casper Kruse
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Rech LC, Montagner F, Luisi SB, Melo TAFD. How is working length determination taught? A survey to assess what is recommended in undergraduate Schools of Dentistry in Brazil. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:516-522. [PMID: 34816557 DOI: 10.1111/eje.12728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/28/2021] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To analyse what are the methods for working length (WLD) determination taught for undergraduate students in Brazilian Dental Schools and the perception of professors about the use of electronic WL determination in the clinical practice. METHODS An online questionnaire with eighteen closed questions was sent to 209 Schools of Dentistry in Brazil using the Google Forms Platform. The questionnaire was structured to analyse the perception of professors in the department of endodontics about the method of working length determination taught in undergraduate courses in Dentistry. The data collected in the questionnaires were transferred to an Excel® spreadsheet and analysed using absolute and relative frequencies. The non-parametric Mann-Whitney test was used to compare groups. RESULTS Of the 209 schools contacted, 41 (19.61%) returned answers to the questionnaire. According to professors, electronic working length (WL) determination had a shorter length of time to perform it (p < .001), WL measurement accuracy (p < .001) and ease of performance (p < .001). Professors felt safer when maintaining patency when using electronic WL determination (p = .0020). CONCLUSIONS Both radiographic and electronic methods of WL determination are taught in Brazilian Schools of Dentistry. The electronic method was used more frequently, especially in undergraduate clinical courses.
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Affiliation(s)
- Luara Cristina Rech
- Departamento de Odontologia Conservadora, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Francisco Montagner
- Departamento de Odontologia Conservadora, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Simone Bonato Luisi
- Departamento de Odontologia Conservadora, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tiago André Fontoura de Melo
- Departamento de Odontologia Conservadora, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Di Spirito F, Scelza G, Fornara R, Giordano F, Rosa D, Amato A. Post-Operative Endodontic Pain Management: An Overview of Systematic Reviews on Post-Operatively Administered Oral Medications and Integrated Evidence-Based Clinical Recommendations. Healthcare (Basel) 2022; 10:healthcare10050760. [PMID: 35627897 PMCID: PMC9141195 DOI: 10.3390/healthcare10050760] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 01/08/2023] Open
Abstract
Endodontic treatment comprises the overall management of pre-, intra- and post-operative symptoms, including post-operative endodontic pain, considered as a complication susceptible of chronicization. Post-operative pain is very common and highly unpreventable and has a multi-factorial etiology and a potential pathogenic link to the acute inflammation of the periapical area, secondary to localized chemical, mechanical, host and/or microbial damage occurring during endodontic treatment. Considering the multitude of heterogeneous technical and pharmacological approaches proposed to control post-operative endodontic pain, the present study primarily comprised an overview of systematic reviews of systematic reviews of randomized clinical trials, summarizing findings on post-operatively administered oral medications for post-operative endodontic pain control, in order to note the most effective type and dosage of such drugs. Secondarily, a narrative review of the current evidence on technical solutions to be observed during endodontic treatment procedures, to control post-operative pain, was conducted to provide integrated evidence-based clinical recommendations for optimal post-operative endodontic pain management.
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Affiliation(s)
- Federica Di Spirito
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (G.S.); (F.G.); (D.R.); (A.A.)
- Correspondence: or
| | - Giuseppe Scelza
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (G.S.); (F.G.); (D.R.); (A.A.)
| | | | - Francesco Giordano
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (G.S.); (F.G.); (D.R.); (A.A.)
| | - Donato Rosa
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (G.S.); (F.G.); (D.R.); (A.A.)
| | - Alessandra Amato
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (G.S.); (F.G.); (D.R.); (A.A.)
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de Freitas Portela FSM, De Martin AS, Pelegrine RA, Gutmann JL, Kato AS, Bueno CEDS. Effect of Foraminal Enlargement on Postoperative Pain in Necrotic Single-Rooted Teeth: A Randomized Clinical Trial. J Endod 2021; 47:1046-1051. [DOI: 10.1016/j.joen.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
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Shubham S, Nepal M, Mishra R, Dutta K. Influence of maintaining apical patency in post-endodontic pain. BMC Oral Health 2021; 21:284. [PMID: 34078331 PMCID: PMC8173919 DOI: 10.1186/s12903-021-01632-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/12/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The concept of instrumentation beyond the apical foramen by small flexible file to prevent apical blockage is apical patency. However, this procedure might endow postoperative pain, thus to maintain apical patency or not is the matter of dilemma. Hence, the primary objective of this study was to compare postoperative pain between apical patency and non-patency groups and secondary objective was to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain. METHODS Preselected (n = 178) patients based on group of teeth and status of pulp were randomly divided into 2 groups, apical patency and non-patency which was further treated in either single or multiple visits. After exclusion, 160 patients were included. Each group (n = 80) was subdivided in single visit (n = 40) and multiple visits (n = 40), including vital (n = 20) and non-vital teeth (n = 20) and single-rooted (n = 10) and multiple-rooted teeth (n = 10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using Numerical Rating Scale (NRS-11). Statistical analysis was done using Mann-Whitney U test, Spearman correlation and Multiple linear regression analysis. RESULTS The primary outcome of this study showed statistically significant difference (p < 0.05) in postoperative pain scores between patency and non-patency groups with higher pain scores in patency group on 1st, 2nd and 7th day follow up. The secondary outcome showed postoperative pain in patency-maintained group was influenced by status of the pulp and preoperative pain only. Vital teeth of patency-maintained group treated in multiple visits showed statistically significant (p = 0.02) post-operative pain in day 1 follow up. Pre-operative pain showed positive correlation with postoperative pain with statistically significant difference. CONCLUSIONS Our study concluded that maintenance of apical patency increased postoperative pain. Evaluation of influence of number of visits, status of pulp, group of tooth and preoperative pain revealed status of pulp and preoperative pain as influencing factors for postoperative pain in patency group.
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Affiliation(s)
- Snigdha Shubham
- Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
| | - Manisha Nepal
- Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
| | - Ravish Mishra
- Department of Oral and Maxillofacial Surgery, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
| | - Kishor Dutta
- Department of Orthodontics and Dentofacial Orthopaedics, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
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Amini K, Nouri H, Jahromi M. Comparison of full rotation and reciprocating movements in regaining apical patency during endodontic retreatment. Dent Res J (Isfahan) 2021. [DOI: 10.4103/1735-3327.328753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abdelsalam N, Hashem N. Impact of Apical Patency on Accuracy of Electronic Apex Locators: In Vitro Study. J Endod 2020; 46:509-514. [DOI: 10.1016/j.joen.2020.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/18/2022]
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Influence of endodontic procedure on postoperative pain: Evidence from systematic reviews. BALKAN JOURNAL OF DENTAL MEDICINE 2019. [DOI: 10.2478/bjdm-2019-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pain control, during and after root canal treatment is one of the important issues in endodontic practice. Occurrence of pain after intervention often presents considerable distress to both patient and dentist. In many studies influence of different endodontic treatment factors on incidence of postoperative pain has been investigated. However, different and inconsistent results between studies and growth in number of published papers each year made professional updating and clinical-decision making challenging. Systematic reviews synthesized and combined data from relevant studies to find the answer to a research question providing the highest level of scientific evidence. Thus, their use may facilitate decision making in clinical practice. The aim of this article was to present results from systematic reviews about the influence of endodontic treatment on postoperative pain.
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