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Signor B, Poli Kopper PM, Aspesi M, Münchow EA, Scarparo RK. Postoperative pain after single-visit root canal treatment or vital pulp therapy: A systematic review and meta-analysis. J Am Dent Assoc 2024; 155:118-137.e1. [PMID: 38325970 DOI: 10.1016/j.adaj.2023.11.008] [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: 07/11/2023] [Revised: 10/06/2023] [Accepted: 11/05/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain. STUDIES REVIEWED The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT. RESULTS The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001). PRACTICAL IMPLICATIONS PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.
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Thyvalikakath T, LaPradd M, Siddiqui Z, Duncan W, Eckert G, Medam J, Rindal D, Jurkovich M, Gilbert G. Root Canal Treatment Survival Analysis in National Dental PBRN Practices. J Dent Res 2022; 101:1328-1334. [PMID: 35549468 PMCID: PMC9516632 DOI: 10.1177/00220345221093936] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Few studies have examined the longevity of endodontically treated teeth in nonacademic clinical settings where most of the population receives its care. This study aimed to quantify the longevity of teeth treated endodontically in general dentistry practices and test the hypothesis that longevity significantly differed by the patient's age, gender, dental insurance, geographic region, and placement of a crown and/or other restoration soon after root canal treatment (RCT). This retrospective study used deidentified data of patients who underwent RCT of permanent teeth through October 2015 in 99 general dentistry practices in the National Dental Practice-Based Research Network (Network). The data set included 46,702 patients and 71,283 RCT permanent teeth. The Kaplan-Meier (product limit) estimator was performed to estimate survival rate after the first RCT performed on a specific tooth. The Cox proportional hazards model was done to account for patient- and tooth-specific covariates. The overall median survival time was 11.1 y; 26% of RCT teeth survived beyond 20 y. Tooth type, presence of dental insurance any time during dental care, placement of crown and/or receiving a filling soon after RCT, and Network region were significant predictors of survival time (P < 0.0001). Gender and age were not statistically significant predictors in univariable analysis, but in multivariable analyses, gender was significant after accounting for other variables. This study of Network practices geographically distributed across the United States observed shorter longevity of endodontically treated permanent teeth than in previous community-based studies. Also, having a crown placed following an RCT was associated with 5.3 y longer median survival time. Teeth that received a filling soon after the RCT before the crown was placed had a median survival time of 20.1 y compared to RCT teeth with only a crown (11.4 y), only a filling (11.2 y), or no filling and no crown (6.5 y).
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Affiliation(s)
- T. Thyvalikakath
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - M. LaPradd
- Current affiliation: Syneos Health, Morrisville, NC, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Z. Siddiqui
- Current affiliation: West Virginia University School of Pharmacy, Morgantown, WV, USA
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, IUPUI, Indianapolis, IN, USA
| | - W.D. Duncan
- Current affiliation: University of Florida College of Dentistry, Gainesville, FL, USA
- Affiliation during study: Biomedical Data Science and Shared Resource, Roswell Park Cancer Center, Buffalo, NY, USA
| | - G. Eckert
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J.K. Medam
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, IUPUI, Indianapolis, IN, USA
- Current affiliation: ELLKAY, Elmwood Park, NJ, USA
| | - D.B. Rindal
- HealthPartners Institute, Minneapolis, Bloomington, MN, USA
| | - M. Jurkovich
- HealthPartners Institute, Minneapolis, Bloomington, MN, USA
| | - G.H. Gilbert
- National Dental Practice-Based Research Network, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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Yu YH, Kushnir L, Kohli M, Karabucak B. Comparing the incidence of postoperative pain after root canal filling with warm vertical obturation with resin-based sealer and sealer-based obturation with calcium silicate-based sealer: a prospective clinical trial. Clin Oral Investig 2021; 25:5033-5042. [PMID: 33555456 DOI: 10.1007/s00784-021-03814-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This prospective clinical study compares postoperative pain after single-visit, non-surgical root canal treatment of teeth with irreversible pulpitis using two different root canal filling techniques. MATERIAL AND METHODS All cases were treated by endodontic residents with a standardized protocol (minimum apical size 35) and filled with one of the two techniques: warm vertical compaction technique (WVT) with gutta percha and epoxy resin-based sealer (AH Plus Jet Root Canal Sealer, Dentsply Maillefer, York, PA, USA) or sealer-based filling technique (SBT) with single cone gutta percha and calcium silicate-based sealer (EndoSequence BC Sealer, Brasseler, Savannah, GA, USA). Surveys were given to participating patients to record pain intensity on a numeric rating scale (NRS, 0-10) at 4, 24, and 48 h postoperatively. Statistical significance was set at 0.05 level. RESULTS One hundred ninety-four surveys were distributed over eighteen months. Ninety-two patients returned the survey (41 WVT and 51 SBT), of which 38% were asymptomatic irreversible pulpitis cases. The NRS values reduced over time for both techniques. No statistical difference was found between the two groups at the three time points assessed (p > 0.05). Postoperative pain was related to age, gender, presence of preoperative pain, and sealer extrusion (p < 0.05), however not related to preoperative periapical symptoms (percussion/palpation), dental arch, root type, and experience of the provider (p > 0.05). CONCLUSIONS The intensity of postoperative pain for the two obturation techniques was equivalent at evaluated time points. CLINICAL RELEVANCE The obturation technique does not influence postoperative pain. After endodontic treatment of symptomatic irreversible pulpitis teeth, the pain subsides in 48 h regardless of the technique. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04462731.
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Affiliation(s)
- Ya-Hsin Yu
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA, 19104, USA.
| | - Larisa Kushnir
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA, 19104, USA
| | - Meetu Kohli
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA, 19104, USA
| | - Bekir Karabucak
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA, 19104, USA
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Jang YE, Kim Y, Kim BS. Influence of Preoperative Mechanical Allodynia on Predicting Postoperative Pain after Root Canal Treatment: A Prospective Clinical Study. J Endod 2021; 47:770-778.e1. [PMID: 33516824 DOI: 10.1016/j.joen.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Odontogenic pain can manifest as pulpal pain, periapical pain (mechanical allodynia), or both. This study aimed to assess the changes in the intensity of mechanical allodynia (MA) and to identify predictors of postoperative pain after root canal treatment (RCT). METHODS In total, 579 consecutive patients who required RCT were enrolled; we included patients with asymptomatic pulpal diagnoses to avoid any effects of preoperative spontaneous pain on postoperative pain and to evaluate MA independently. Using a visual analog scale (VAS), patients separately indicated the intensity of spontaneous pain, tenderness to percussion, and pain on biting; these measurements were performed before treatment (preoperative pain), at the beginning of each visit (postpreparation pain), and daily for 1 week after RCT (postobturation pain). For analytical purposes, patients were subdivided into 2 groups based on the intensity of preoperative MA (none to mild [VAS <4] or moderate to severe [VAS ≥4]) to evaluate changes in MA and predictive factors of moderate to severe postoperative pain. A generalized estimating equation, repeated-measures analysis of variance, and logistic regression analysis were used. RESULTS Although the intensity of MA was significantly higher in the moderate to severe group after the initiation of RCT (P < .05), 93% of them experienced alleviation in MA, and 30% of patients in the none to mild group experienced an increase in MA. After adjusting for clinical variables, moderate to severe preoperative MA and the presence of necrotic pulp were significantly correlated with moderate to severe postoperative pain with an odds ratio of 4.107 and 0.286, respectively. CONCLUSIONS Moderate to severe preoperative MA was a predictive factor of postoperative pain in patients undergoing RCT.
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Affiliation(s)
- Young-Eun Jang
- Department of Conservative Dentistry, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yemi Kim
- Department of Conservative Dentistry, College of Medicine, Ewha Womans University, Seoul, Korea.
| | - Bom Sahn Kim
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Cunha SA, Soares CJ, Rosatto CMP, Vieira JVSM, Pereira RADS, Soares PBF, Leles CR, Moura CCG. Effect of Endodontic Sealer in Young Molars Treated by Undergraduate Students - A Randomized Clinical Trial. Braz Dent J 2020; 31:589-597. [PMID: 33237229 DOI: 10.1590/0103-6440202003258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022] Open
Abstract
The progression of caries in permanent molar teeth of young patients, frequently result in endodontic treatment. This randomized blinded clinical trial assessed the effect of two endodontic sealers (Sealer 26 and AH Plus) on the incidence of pain and apical repair after endodontic treatment of young molar teeth, and secondly identify factors associated with the outcomes. Endodontic treatment was performed by undergraduate students in molar teeth (n=69) of young patients (n=54) at the Endodontic and Restorative Public Extension Clinic Service. Protaper Next was used and the endodontic sealers were allocated which were restored with direct composite resin. Two primary clinical outcomes - apical repair and postoperative pain, were assessed after 12 and 24 months for blinded operators. Description of incidence rates and mixed-model regression using Generalized Estimation Equations (GEE). After 2 years 69 molar teeth of 54 patients were evaluated. No effect of the endodontic sealer was observed irrespective of period of evaluation. Apical repair incidences and asymptomatic teeth were, respectively, 90.5 and 89.3, 96.8 and 90.0% during 1 and 2 years of follow-up. Failed apical repair was associated with unsatisfactory pulpectomy (p=0.003) and periapical conditions (p=0.007) as well as their interaction (p=0.016). None of these independent variables was able to predict the occurrence of pain in both periods. Prognosis of apical repair is dependent on the initial conditions. Endodontic treatment of young molars associated with composite resin restorations performed by undergraduate students have satisfactory results after 2 years and was effective to prevent the risk of permanent teeth loss.
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Affiliation(s)
- Suely Aparecida Cunha
- Biomechanics Research Group, Department of Operative Dentistryand Dental Materials, School of Dentistry, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Carlos José Soares
- Biomechanics Research Group, Department of Operative Dentistryand Dental Materials, School of Dentistry, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Camila Maria Peres Rosatto
- Department of Endodontics, School of Dentistry, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | - Renata Afonso da Silva Pereira
- Biomechanics Research Group, Department of Operative Dentistryand Dental Materials, School of Dentistry, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Priscilla Barbosa Ferreira Soares
- Department of Periodontology and Implantology, School of Dentistry, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Cláudio Rodrigues Leles
- Department of Prevention and Oral Rehabilitation, School of Dentistry, UFG - Universidade Federal de Goiás, Goiânia, GO, Brazil
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Ferreira NDS, Gollo EKF, Boscato N, Arias A, Silva EJNLD. Postoperative pain after root canal filling with different endodontic sealers: a randomized clinical trial. Braz Oral Res 2020; 34:e069. [PMID: 32696911 DOI: 10.1590/1807-3107bor-2020.vol34.0069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/20/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of this randomized clinical trial was to compare the occurrence and intensity of postoperative pain and analgesic intake after root canal treatment, using different root canal sealers. Sixty single-rooted teeth diagnosed with asymptomatic necrosis and apical periodontitis were randomly assigned to 3 experimental groups (n=20), according to the root canal sealer: AH Plus, Endofill or MTA Fillapex. Endodontic treatment was performed in two sessions, and calcium hydroxide was used as the intracanal dressing. Patients were instructed to record pain intensity as none, slight, moderate and severe. Scores from 1 to 4 were attributed to each level of pain after 24 h, 48 h and 7 days. The need for analgesic intake was also recorded. Differences in the incidence of postoperative pain and the need for an analgesic were analyzed using the chi-square test. Differences in pain intensity after treatment were analyzed using the ordinal (linear) chi-square test. No significant differences were detected among the groups in terms of either incidence or intensity of postoperative pain, or need for analgesic intake, at any timepoint (p>0.05). No pain was reported after 7 days. AH Plus, Endofill and MTA Fillapex used for filling root canals resulted in the same rate of postoperative pain and need for analgesic medication.
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Affiliation(s)
- Nadia de Souza Ferreira
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | | | - Noeli Boscato
- Department of Restorative Dentsitry, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Ana Arias
- Conservative Dentistry Department, School of Dentistry, Universidad Complutense de Madrid, Madrid, Spain
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Murillo-Benítez M, Martín-González J, Jiménez-Sánchez MC, Cabanillas-Balsera D, Velasco-Ortega E, Segura-Egea JJ. Association between dental anxiety and intraoperative pain during root canal treatment: a cross-sectional study. Int Endod J 2019; 53:447-454. [PMID: 31691312 DOI: 10.1111/iej.13245] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
AIM To investigate whether dental anxiety influences the intraoperative pain felt by patients during root canal treatment. METHODOLOGY In a cross-sectional design, 180 patients (90 men and 90 women) were included. Pre-operative anxiety levels were assessed using the short-form Dental Anxiety Inventory (S-DAI). Pain during root canal treatment was evaluated using a 10-cm visual analogue scale (VAS) that ranked the level of pain between 'Absence of pain' and 'Unbearable pain'. The minimal sample size was determined using the software of the National Center for Advancing Translational Sciences (NIH, UK). Multivariate logistic regression analysis was used to identify relationships between variables. RESULTS Mean pain level during root canal treatment was 2.2 ± 2.1. The mean anxiety S-DAI score was 27.2 ± 12.5. Fifty percent of men had mild anxiety levels, while in 70% of women anxiety was moderate or high (P = 0.017). Anxiety correlated positively with intraoperative pain (R = 0.406). Multivariate logistic regression analysis revealed that anxiety was significantly associated with intraoperative pain felt by patients (OR = 4.0; 95% C.I. = 1.7-9.3; P = 0.001). CONCLUSIONS Anxious patients were more than twice as likely to feel moderate or intense intraoperative pain during root canal treatment. To know the patient´s degree of anxiety could help the dentist to decide whether to use anxiolytic premedication and/or supplemental local anaesthesia to assure better control of pain during root canal treatment.
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Affiliation(s)
- M Murillo-Benítez
- Department of Stomatology, Division of Endodontics, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - J Martín-González
- Department of Stomatology, Division of Endodontics, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - M C Jiménez-Sánchez
- Department of Stomatology, Division of Endodontics, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - D Cabanillas-Balsera
- Department of Stomatology, Division of Endodontics, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - E Velasco-Ortega
- Department of Stomatology, Division of Endodontics, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - J J Segura-Egea
- Department of Stomatology, Division of Endodontics, School of Dentistry, University of Sevilla, Sevilla, Spain
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Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review. J Taibah Univ Med Sci 2017; 12:376-384. [PMID: 31435267 PMCID: PMC6695063 DOI: 10.1016/j.jtumed.2017.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/19/2017] [Accepted: 03/27/2017] [Indexed: 01/12/2023] Open
Abstract
Postoperative pain after root canal treatment can be reduced by applying recent advances in endodontic techniques and equipment. This systematic review includes current knowledge about pain after nonsurgical root canal treatment, including predictors, related factors, effects of recent advances, and management. A literature search was performed using the PubMed, ScienceDirect, and Cochrane Library databases for articles published between 1990 and 2016. Search keywords included postoperative pain, nonsurgical treatment, single visit, recent advances in endodontics, and management of postoperative pain with endodontic treatment. Only original research studies were included; editorials, reviews, brief notes, conference proceedings, and letters to the editor were excluded. The initial search yielded 4941 articles, which were assessed and filtered using the selection criteria. Sixty-five studies met the inclusion criteria and were included in the review. The findings showed that pain after nonsurgical root canal treatment occurred in 3–69.3% of patients. Microorganisms were identified as the primary contributors to postoperative pain, and there was no significant difference in postoperative pain between single- and multiple-visit treatments. Postoperative pain after root canal treatment ranges from mild to moderate and occurs even after optimally performed procedures. Furthermore, adequate management of postoperative pain is often considered an indicator of clinical excellence. Application of recently developed endodontic techniques and devices will reduce postoperative pain. Furthermore, a flexible, severity-based drug administration plan can be used to control and manage pain after root canal treatment. Application of the current research findings will reduce pain following root canal treatment and improve patient outcomes.
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Iranmanesh F, Parirokh M, Haghdoost AA, Abbott PV. Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review. IRANIAN ENDODONTIC JOURNAL 2017; 12:123-130. [PMID: 28496516 PMCID: PMC5421265 DOI: 10.22037/iej.2017.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/02/2017] [Accepted: 03/04/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Post-operative pain and flare-up may occur in up to 58% of patients following root canal treatment. The aim was to conduct a systematic review and a possible meta-analysis to determine the effect of glucocorticosteroid (GCS) on pain following root canal treatment. METHODS AND MATERIALS Scopus, MEDLINE and CENTRAL databases were searched up to 30th January 2017 with broad key words. In addition, the reference lists in eligible papers and text books were hand-searched. Assessment of the eligibility of papers and data extraction were performed by two independent reviewers. RESULTS Of 9891 articles, 18 were recruited as eligible papers. Most of these papers showed pain reducing effect of GCS on post-endodontic pain. Because of wide heterogeneity among the recruited papers, it was not possible to perform meta-analysis. CONCLUSION Based on the results of this systematic review, there is a vast heterogeneity amongst articles regarding the use of GCS and their effect on post-operative pain after endodontic treatment. Further investigations with similar methods and materials are needed before meta-analysis on the effect of GCS on post-operative pain following root canal treatment can be performed.
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Affiliation(s)
- Foad Iranmanesh
- Department ofEndodontics, Dental School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran;
| | - Masoud Parirokh
- Endodontology Research Center, Dental School, Kerman University of Medical Sciences, Kerman, Iran;
| | - Ali Akbar Haghdoost
- Research Center for Modeling in Health, Kerman University of Medical Sciences, Kerman, Iran;
| | - Paul V. Abbott
- Dental School, University of Western Australia, Perth, Australia
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