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Elmsmari F, Shujaie H, Alzaabi R, González JA, Aljafarawi T, Olivieri JG, Jurado CA, Afrashtehfar KI. Lasers efficacy in pain management after primary and secondary endodontic treatment: a systematic review and meta-analysis of randomized clinical trials. Sci Rep 2024; 14:26028. [PMID: 39472604 PMCID: PMC11522329 DOI: 10.1038/s41598-024-74998-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 10/01/2024] [Indexed: 11/02/2024] Open
Abstract
Postoperative pain is a common concern following root canal treatments (RCT), impacting both patients and oral health practitioners. This systematic review and meta-analysis aimed to evaluate the effectiveness of laser treatment modalities in reducing postoperative pain compared to conventional methods after primary and secondary RCT in permanent mature teeth. A search of three electronic databases (PubMed, ScienceDirect, and The Cochrane Library) was conducted, using a broad range of keywords and terms. Gray literature and manual searches were conducted to complement the search. The inclusion criteria included randomized clinical trials based on the objective of the secondary study. A minimum sample size of 10 participants per group and a clearly defined criterion for postoperative pain assessment were required. The characteristics of the included studies were presented as tables. The Cochrane collaboration tool RoB 2.0 was used to assess the risk of bias within each study. Two reviewers extracted the data and assessed the studies independently, and discrepancies were resolved through consultation with a third reviewer. A random-effects model was employed for meta-analysis to estimate the overall effect measure. Heterogeneity was evaluated using Cochran's Q test and the I2 index. Publication bias was explored via Funnel plots and Egger's test. Subgroup analyses and meta-regression were conducted to assess variations among laser methods and examine the influence of independent factors. The significance threshold for all analyses was set at 5% (α = 0.05). Intraoral laser therapy demonstrated no significant advantage over conventional treatments but consistently outperformed placebo, particularly from 4 to 72 h post-treatment. Low-level laser therapy provided slight pain reduction in the first 8 h, though its effectiveness diminished in retreatment scenarios. Photodynamic therapy and laser disinfection showed marginal benefits, especially shortly after treatment, with reduced efficacy in longer-term or retreatment contexts. Further research is needed to explore different applications of laser modalities and assess distinct prognostic factors in more detail.
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Affiliation(s)
- Firas Elmsmari
- Evidence-Based Practice Unit, Clinical Sciences Department, College of Dentistry, Ajman University, P.O. Box 346, Ajman City, UAE.
- Center of Medical and Bio-allied Health Sciences Research, Ajman University, PO Box 346, Ajman, UAE.
- Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), 08195, Barcelona, Spain.
| | - Hafsa Shujaie
- Evidence-Based Practice Unit, Clinical Sciences Department, College of Dentistry, Ajman University, P.O. Box 346, Ajman City, UAE
| | - Roaya Alzaabi
- Evidence-Based Practice Unit, Clinical Sciences Department, College of Dentistry, Ajman University, P.O. Box 346, Ajman City, UAE
| | - José A González
- Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), 08195, Barcelona, Spain
| | - Tareq Aljafarawi
- Evidence-Based Practice Unit, Clinical Sciences Department, College of Dentistry, Ajman University, P.O. Box 346, Ajman City, UAE
- Center of Medical and Bio-allied Health Sciences Research, Ajman University, PO Box 346, Ajman, UAE
| | - Juan G Olivieri
- Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), 08195, Barcelona, Spain
| | - Carlos A Jurado
- Division of Operative Dentistry, Department of General Dentistry, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, 38103, USA
- Department of Prosthodontics, University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, 52242, USA
| | - Kelvin I Afrashtehfar
- Evidence-Based Practice Unit, Clinical Sciences Department, College of Dentistry, Ajman University, P.O. Box 346, Ajman City, UAE.
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3010, Bern, Switzerland.
- Consultant private practice limited to pre-prosthetic surgery, implant, esthetic,and reconstructive dentistry, Abu Dhabi, UAE.
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Nunes LP, Nunes GP, Ferrisse TM, Strazzi-Sahyon HB, Dezan-Júnior E, Cintra LTA, Sivieri-Araujo G. A systematic review and meta-analysis on the effects of phototherapy on postoperative pain in conventional endodontic reintervention. Clin Oral Investig 2024; 28:232. [PMID: 38556608 DOI: 10.1007/s00784-024-05623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES This systematic review and meta-analysis (SRM) aimed to evaluate the efficacy of laser phototherapy (LPT) on the reduction in postoperative pain (PP) of endodontic origin after conventional/non-surgical reintervention of root canals. METHODS This SRM was registered with PROSPERO (CRD42021243500) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Meta-analysis was conducted using R software with the "META" package, the mean difference (MD) measure of effect was calculated, and the fixed effect model was applied with a 95% confidence interval (CI). The Cochrane collaboration scale was used to assess the risk of bias and the GRADE tool to assess the quality of evidence. RESULTS Initially, 1028 articles were found, and five articles were included. Most studies were classified as "low" risk of bias. Of the five clinical studies, four showed a significant decrease in PP after endodontic reintervention in the LPT groups compared to the control group, especially in the first four days after the intervention. In symptomatic teeth with multiple roots, LPT led to less PP at 24 h (MD -0.52 [-1.03; -0.02] p = .04). However, no significant difference between the groups was found at 48 and 72 h (p > .05). The certainty of the evidence was classified as low. CONCLUSION Despite the limitations of this SRM, LPT was shown to be a promising alternative for reducing and controlling PP in conventional endodontic reintervention. CLINICAL SIGNIFICANCE The use of LPT in endodontic reintervention may be a safe and promising alternative to clinically efficacious agent for use in the management of PP in this procedure.
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Affiliation(s)
- Larissa Pereira Nunes
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio, Araçatuba, SP, Brazil
| | - Gabriel Pereira Nunes
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio, Araçatuba, SP, Brazil.
| | - Túlio Morandin Ferrisse
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araraquara, SP, Brazil
| | - Henrico Badaoui Strazzi-Sahyon
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil
| | - Eloi Dezan-Júnior
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio, Araçatuba, SP, Brazil
| | - Luciano Tavares Angelo Cintra
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio, Araçatuba, SP, Brazil
| | - Gustavo Sivieri-Araujo
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio, Araçatuba, SP, Brazil
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Abbara MT, Akil S, Hamadah O, Achour H, Mahayni G, Alsayed Tolibah Y. Can diode laser 810 nm decrease post endodontic pain in patients with asymptomatic necrotic maxillary incisors? A four-arm randomized controlled trial. BDJ Open 2024; 10:23. [PMID: 38485988 PMCID: PMC10940693 DOI: 10.1038/s41405-024-00203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 03/18/2024] Open
Abstract
AIM To find the best method for applying the diode laser 810 nm to relieve post-endodontic pain on necrotic maxillary incisors with periapical lesions within a single-visit treatment. METHODS Eighty patients with a necrotic incisor, diagnosed with asymptomatic apical periodontitis, received standardized cleaning and shaping procedures, then divided randomly with a 1:1:1:1 allocation ratio into four groups: Group 1: control group with no laser application, Group 2: applying the diode laser as an irrigation activation system (IAS), Group 3: applying the diode laser from the buccal and palatal mucosa, Group 4: applying the diode laser as an IAS and from buccal and palatal mucosa. The postoperative pain was assessed using the visual analog scale (VAS) 1, 3, 7, and 14 days after the treatment. The mean values of the VAS score were statistically analyzed used Kruskal-Walis and Mann-Whitney U tests. The level of significance was set at a = 0.05. RESULTS During 14 days after treatment, there was a statistically significant difference between mean values of VAS scores in the four groups (P value < 0.05); Group 1 scored the highest score, whereas Group 4 showed the lowest one. Moreover, Group 4 showed favorable outcomes compared with Group 2 and Group 3 during the first three days after treatment. CONCLUSION Diode laser reduced postoperative pain after necrotic teeth with large-sized apical lesion treatment, whereas using diode laser either as an IAS or LLLT reduced the postoperative pain compared with the control group. Moreover, the usage of a diode laser in both previous techniques represents the best protocol for postoperative pain relief during 14 days of treatment. CLINICAL RELEVANCE The clinical significance of this study is to investigate the best method to reduce postoperative pain using diode lasers 810 nm; where the results of this study indicated that the more diode laser exposer in LLLT and IAS, the less postoperative pain after endodontic procedures.
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Affiliation(s)
- Mohammad Tamer Abbara
- DDs, MSc,Ph.D student at the department of Endodontics, Faculty of Dentistry, Damascus University, P.O. Box 3062, Damascus, Syria
| | - Samar Akil
- DDS,MSc,Ph.D Associate Professor at the department of Endodontics, Faculty of Dentistry, Damascus University, P.O. Box 3062, Damascus, Syria
| | - Omar Hamadah
- DDS,MSc,Ph.D Associate Professor at the department of Oral Medicine, Faculty of Dentistry, Damascus University, P.O. Box 3062, Damascus, Syria
| | - Hassan Achour
- DDS,MSc,Ph.D Associate Professor at the department of Endodontics, Faculty of Dentistry, Damascus University, P.O. Box 3062, Damascus, Syria
| | - Ghina Mahayni
- DDs, Faculty of Dentistry, Al-Sham Private University, P.O. Box 3062, Damascus, Syria
| | - Yasser Alsayed Tolibah
- DDs, MSc,Ph.D student at the department of Pediatric Dentistry, Faculty of Dentistry, Damascus, University, P.O. Box 3062, Damascus, Syria.
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Almohaimede A, Al-Madi E. Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11750. [PMID: 34831517 PMCID: PMC8621421 DOI: 10.3390/ijerph182211750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022]
Abstract
This research aimed to assess the potency of intracanal cold therapy in diminishing postoperative endodontic pain. PubMed, Scopus, the Cochrane Library, EMBASE, the Web of Science, grey literature, and endodontic journals were used to identify randomized controlled clinical trials evaluating postoperative pain after a final irrigation with a cold irrigant (as an experimental group) and a room temperature irrigant (as a control group). The risk of bias was rated according to the Cochrane Collaboration's tool and the Grading Recommendation Assessment, Development, and Evaluation (GRADE) system was used to estimate the evidence quality. For the meta-analysis, a random effects model was utilized. The qualitative analysis contained 16 studies and the quantitative analysis contained 9 studies. The experimental groups showed a reduction in postoperative pain at 6 h (mean difference (MD) = -1.11; p = 0.0004; I2 = 72%; low quality evidence), 24 h (MD = -1.08; p = 0.003; I2 = 92%; low quality evidence), 48 h (MD = -0.38; p = 0.04; I2 = 81%; low quality evidence), and 72 h (MD = -0.69; p = 0.04; I2 = 90%; low quality evidence). A higher quality of evidence from more clinical trials is needed.
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Affiliation(s)
- Amal Almohaimede
- Department of Restorative Dental Sciences, Endodontic Division, College of Dentistry, King Saud University, Riyadh 11451, Saudi Arabia;
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Effect of intracanal cryotherapy application on postoperative endodontic pain: a systematic review and metaanalysis. Clin Oral Investig 2020; 25:23-35. [PMID: 33222053 DOI: 10.1007/s00784-020-03693-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the influence of intracanal cryotherapy application on postoperative pain after endodontic treatment. MATERIALS AND METHODS A systematic review (SR) was conducted in seven databases. Articles that were published up to 04 February 2020 were included and randomized clinical trials that used a cold saline solution for final irrigation to manage postoperative endodontic pain were compared with those that used a saline solution at room temperature. Metaanalysis was performed to assess postoperative pain after 6, 24, 48, and 72 h using a random effects model, a confidence interval of 95%, and heterogeneity tested by the I2 index. The certainty of evidence was rated using GRADE. RESULTS Qualitative and quantitative analysis included eight and six studies, respectively. Individuals treated with cryotherapy presented lower means of postendodontic pain than the controls, 6 and 24 h after endodontic treatment (MD - 1.30 [- 2.32, - 0.28] p = 0.01 and SMD - 0.68 [ - 1.21, - 0.16] p = 0.01, respectively, with very low certainty of evidence). After 48 and 72 h, both groups demonstrated similar means of postendodontic pain (MD - 0.06 [- 0.18, 0.07] p = 0.38 and SMD - 0.54 [- 1.18, - 0.11] p = 0.10, with high and low certainty of evidence, respectively). CONCLUSIONS Based on the limited quality evidence, intracanal cryotherapy application reduced postoperative endodontic pain after 6 and 24 h. New clinical trials are needed to support the result of this review. CLINICAL SIGNIFICANCE This SR provides information about the use of intracanal cryotherapy in clinical practice, guides clinicians to make evidence-based decisions and suggests recommendations for further high-quality studies.
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Effect of calcium hydroxide mixed with lidocaine hydrochloride on postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis: a preliminary randomized controlled prospective clinical trial. Clin Oral Investig 2020; 25:203-210. [PMID: 32462277 DOI: 10.1007/s00784-020-03354-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the effect of calcium hydroxide mixed with lidocaine HCl on postoperative spontaneous pain. MATERIALS AND METHODS Sixty patients having irreversible pulpitis and symptomatic apical periodontitis with a preoperative spontaneous pain and percussion pain which was more than 50 on a visual analogue scale (100 mm VAS) were included in this study. After the preparation of the root canals, the patients were randomly distributed into two groups according to the calcium hydroxide vehicle, control group (mixed with saline) and calcium hydroxide mixed with lidocaine HCl (n = 30). Postoperative spontaneous pain scores were recorded by a VAS every day for a week. Data were analysed using one-way analysis of variance, chi-squared test and Mann-Whitney U tests (p = 0.05). RESULTS The calcium hydroxide mixed with lidocaine HCl group resulted in significantly less pain compared with the calcium hydroxide mixed with saline group during days 1 to 4 (p < 0.05). There were no significant differences between the groups in terms of postoperative percussion pain levels (p > 0.05). CONCLUSION Within the limitations of this study, it can be concluded that the calcium hydroxide mixed with lidocaine HCl can be beneficial in reducing postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis. CLINICAL RELEVANCE The calcium hydroxide mixed with lidocaine HCl can be beneficial in reducing postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis. CLINICAL REGISTRATION NUMBER TCTR20181121003.
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Emara RS, Abou El Nasr HM, El Boghdadi RM. Evaluation of postoperative pain intensity following occlusal reduction in teeth associated with symptomatic irreversible pulpitis and symptomatic apical periodontitis: a randomized clinical study. Int Endod J 2018; 52:288-296. [DOI: 10.1111/iej.13012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/28/2018] [Indexed: 01/17/2023]
Affiliation(s)
- R. S. Emara
- Department of Endodontics Faculty of Oral and Dental Medicine Cairo University Cairo Egypt
| | - H. M. Abou El Nasr
- Department of Endodontics Faculty of Oral and Dental Medicine Cairo University Cairo Egypt
| | - R. M. El Boghdadi
- Department of Endodontics Faculty of Oral and Dental Medicine Cairo University Cairo Egypt
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