Pain After Single-Visit Toot Canal Treatment With Different Instrumentation Systems:A Systemetic Review And Meta-Analysis

Background: Postoperative pain is a common complication after single-visit root canal treatment,which severely affects patients quality of life.The instrumentation used for root canal preparation has been demonstrated to be an important factor that affects the incidence and intensity of postoperative pain.Many recently published studies have compared the pain after single-visit root canal treatment with different instruments.However,consensus has not been reached,which is detrimental to clinical postoperative pain control.Therefore,it is necessary to carry out a comprehensive systematic review of the literatures on this topic,so as to provide a better basis for clinical decision-making.Objective: The aims of this systematic review were to compare the incidence and intensity of postoperative pain after single-visit root canal treatment using manual,rotary,and reciprocating instrumentation systems.Methods: Systematic literature searches were performed in PubMed,EMBASE,Cochrane Library and Web of Science.Identify the investigations that evaluated the effects of different instrumentation systems on postoperative pain after single-visit root canal treatment according to the established inclusion criteria and exclusion criteria.Meta-analyses and subgroup analyses were conducted using Review Manager 5.3,and sensitivity analyses were conducted using Stata 12.0.Additionally,the studies not originally included in the meta-analysis were qualitatively analyzed.Results: We included seventeen trials in this study.Pooled results showed that patients treated with rotary instrumentation systems experienced a significantly lower incidence of postoperative pain(RR=0.32,p=0.0005)and reduced pain intensity than did patients treated with manual instrumentations.In addition,patients treated with multiple rotary-file systems experienced a significantly lower incidence of postoperative pain than did those treated with reciprocating systems(RR=0.73,p<0.0001).Conclusions: The use of rotary instrumentation systems contributed to a lower incidence and intensity of postoperative pain than did the use of manual instrumentations in patients who received single-visit root canal treatment.In addition,the use of multiple rotary-file systems contributed to a lower incidence of postoperative pain than did the use of reciprocating systems.