24 August 2022

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Pain symptomatology after endodontic treatment: how to reduce it?

Massimo Gagliani

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A certain pain symptomatology is found, after a root canal treatment, with a frequency that varies between 3% and 58% of the cases.

It is above all a complication both for the dentist and, above all, for the patients, as they often undergo temporary alterations in the quality of life. The genesis of postoperative pain is multifactorial and the process of root canal instrumentation is the cause of the current process responsible for postoperative pain. During the preparation the canal can cause the extrusion of dental debris in the periapical tissues, soaked or not with bacteria, main agents of inflammatory reactions accompanied by pain. 

Materials and Methods 
In a systematic review published in Oral Disease of March 2018, all the articles traced through the major databases such as PubMed, EMBASE, Cochrane Library and Web of Science which deal with the issue of endodontic post-treatment pain were selected, reviewed and analyzed. The data were treated with meta-analytical systems. Two reviewers are selected by examining all relevant titles and abstracts selected based on a "search strategy". A third reviewer was involved in the event of a dispute. Two reviewers extracted the data independently using a standardized form. The risk of bias in the included studies was independently assessed by the two reviewers by referring to the guidelines described in the Cochrane Manual for systematic reviews (Higgins & Green, 2011 and 2013).

Results
Seventeen articles were included in the final review. There were numerous variables taken into consideration and the final results showed that, in patients receiving endodontic treatments with rotating instruments, a significantly lower incidence of postoperative pain was found (RR, 0.32, P = 0.0005) and a reduced intensity of pain compared to those in which the treatment had been carried out with manual instrumentation. Moreover, a similar difference was noted in patients in whom treatment was performed with rotating NiTi alloy instruments compared to the one in which the patients had been treated with NiTi alloy systems with reciprocating movement (RR, 0.73; P <0, 0001).

On the basis of this review the authors propose the execution of controlled clinical trials the authors should follow the CONSORT guidelines, which provide a clear guide to the design and communication of controlled trials. To confirm the data of this meta-analysis, however, more high-quality studies and standardized procedures to reduce bias are needed.

Conclusions
The use of rotary instruments in NiTi alloy has helped to reduce the incidence and intensity of postoperative pain compared to the use of manual files in patients who underwent root canal treatment in a single session. Furthermore, the use of these systems has reduced the incidence of postoperative pain even compared to that found with recently introduced reciprocating systems.

Clinical implications
The real effectiveness of NiTi rotary alloy instruments seems to be proven also by this analysis, as these instruments are operated with a rotating movement, more effective than the manual ones in steel in reducing post-operative pain problems.

(Photocredit: Dr. Simona Chirico)

For additional informations:  Pain after root canal treatment with different instruments: A systematic review and meta-analysis