Effect of Rotary and Reciprocating Instrumentation Motions on Postoperative Pain Incidence in Non-Surgical Endodontic Treatments: A Systematic Review and Meta-Analysis

Can instrumentation kinematics affect postoperative pain and substance P levels? A randomized controlled trial

BACKGROUND

This study aimed to assess the influence of continuous rotation and reciprocation kinematics on postoperative pain (POP) levels and substance P (SP) levels in patients diagnosed with irreversible pulpitis and symptomatic apical periodontitis (SAP).

MATERIALS AND SUBJECTS

A total of twenty patients were randomly assigned into two groups: Continuous Rotation Group (CRG) (n = 10), subjected to mechanical preparation with the EdgeEndox7 rotary system (Albuquerque, NM, USA), and Reciprocation Group (RG) (n = 10), treated with the EdgeOne Fire reciprocating system (Albuquerque, NM, USA). Apical fluid (AF) samples were collected, and SP levels were quantified through radioimmunoassay. POP was assessed using the Numerical Rating Scale (NRS) at various time intervals (preoperatively, 6 h, 12 h, 24 h, 48 h, and 72 h). Data were statistically analyzed utilizing the independent t-test, Mann-Whitney U test, Friedman's test, and Nemenyi post hoc test.

RESULTS

There was a significant increase in SP levels in the reciprocating group compared to the continuous rotation group (P ≤ 0.05). Additionally, patients in the reciprocating group reported significantly higher POP levels (P ≤ 0.05) at all measured intervals (6 h, 12 h, 24 h, and 48 h), with both groups exhibiting similar pain level reductions at the 72-hour mark.

CONCLUSION

Our findings suggest that continuous rotation kinematics in root canal preparation leads to a considerable reduction in SP expression and POP.

TRIAL REGISTRATION

The study protocol was retrospectively registered on the www.

CLINICALTRIALS

gov database (NCT06081335) at (13/10/2023) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASU-RecIM012135).

Evaluation of postoperative pain with new heat-treated rotary and reciprocating nickel-titanium files: A randomized controlled clinical trial

Introduction

A special heat-treated endodontic file (TruNatomy) was recently introduced with the claim of superior flexibility to enhance dentin preservation. The aim of the present study was to assess postoperative pain in single-visit root canal treatment with this newly introduced file, comparing it with other contemporary reciprocating and rotary file systems.

Materials and Methods

One hundred seventy patients with acute irreversible pulpitis in maxillary premolars were randomly assigned to four experimental file systems: TruNatomy, HyFlex EDM, EdgeFile, and ProTaper Gold. Pre- and postoperative pain scores were assessed with 10-point visual analog scale. Data were statistically analyzed using Kruskal-Wallis test.

Results

TruNatomy file system had significantly the highest postoperative pain incidence (53.8%), while the EdgeFile system had significantly the least postoperative pain incidence (24%) and 24-h pain score.

Conclusion

The present study demonstrated that the reciprocating multiple-file system, EdgeFile, had significantly reduced postoperative pain incidence compared to other heat-treated rotary nickel-titanium file systems.

What is the best effective postoperative medication in reducing pain after non-surgical root canal treatment?

Data sources Medline, Embase, CENTRAL, Cumulative Index to Nursing and Allied Health Literature and Scopus databases were searched (until July 31 2019). They searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov databases for completed and ongoing trials, as well as ProQuest, Google Scholar (first 100 hits) and the OpenGrey database for those unpublished. In addition, abstracts of annual meetings from the American Association of Endodontists, the International Federation of Endodontic Associations and the European Society of Endodontics were searched. A manual search of references in related papers and textbooks was carried out. Any missing information was filled in by contacting the authors.Study selection All randomised clinical trials (RCT) of nonsurgical endodontic therapy with pharmaceutical treatments provided postoperatively to alleviate pain on adult subjects were eligible. Two reviewers selected the studies and extracted the data and the results were examined by a third reviewer. Any differences were settled with the help of a fourth reviewer.Data extraction and synthesis Two authors independently evaluated and retrieved data from chosen trials found through searches. Another reviewer looked at the trial selection and data extraction. They also assessed the risk of bias in each of the research they chose.The mean and standard deviation of a 0-100 (mm) visual analogue pain scale were extracted or derived from study text, graphs and tables The postoperative medications were compared using network meta-analysis in a Bayesian model. Mean differences (MDs) and 95% credible intervals (CrIs) of post-operative pain were estimated at 6-8 hours and 12, 24 and 48 hours. Two authors utilised the CINeMA web application to assess the confidence in the main results by accounting for six domains: within- and across-study bias; indirectness; imprecision; heterogeneity; and incoherence. Each domain was assigned no concerns, major concerns, or minor concerns. Each result would be assigned a confidence level of high, moderate, low, or very low. To establish an agreement, a third reviewer was consulted.Results From the initial search of 969 records, 11 RCTs matched the inclusion criteria. Five studies were rated as having a low risk of bias, five as having a moderate risk and one as having a high risk. Moderate and major heterogeneity and some inconsistencies were detected, though not statistically significant.Oral medications were classified into placebo, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, acetaminophen, NSAIDs + acetaminophen, corticosteroids, NSAIDs + benzodiazepines and NSAIDs + opioids groups.With moderate confidence, NSAIDs + acetaminophen were shown to be more efficacious than placebo at 6-8 hours following nonsurgical root canal therapy (MD = 22; 95% CrI = [-38, -7.2]). With very low confidence, NSAIDs had a greater effect than placebo after 12 and 24 hours (MD = -28; 95% CrI = [-49, -7] and MD = -15; 95% CrI = [-27, -2.3], respectively). After 6 12 and 24 hours, other medications were no more effective than placebo in pain reduction. After 48 hours, no treatment was more effective than placebo. Subgroup analysis found that other medications, such as corticosteroids and acetaminophen, were no more beneficial than placebo for patients who could not use NSAIDs. Six trials provided safety data and concluded that the therapies were safe and posed no significant risks.Conclusions Very low to moderate-quality evidence suggests that postoperative administration of NSAIDs and acetaminophen, or NSAIDs alone, reduced discomfort after non-surgical root canal therapy in patients with irreversible pulpitis or pulpal necrosis. Trials have shown, however, that using these drugs does not result in major complications. We cannot, however, be confident that they are risk-free.

Post-Operative Endodontic Pain Management: An Overview of Systematic Reviews on Post-Operatively Administered Oral Medications and Integrated Evidence-Based Clinical Recommendations

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.