Postoperative pain in primary root canal treatments after Er: YAG laser-activated irrigation: a systematic review and meta-analysis

Abstract

This systematic review aimed to compare postoperative pain in endodontic treatments using PIPS Er: YAG laser-activated irrigation (LAI) versus conventional needle irrigation. An electronic search was conducted to identify randomized clinical trials (RCT) investigating postoperative pain in patients who underwent root canal treatments in permanent teeth using PIPS Er: YAG laser-activated irrigation or conventional needle irrigation. Two reviewers performed study selection, data extraction, risk of bias assessment (RoB 2.0 tool), and the certainty of evidence (GRADE). The meta-analyses were conducted using Review Manager software (p ≤ 0.05). The mean difference (MD) was chosen as the effect measure, and a random-effect model was employed, along with a 95% confidence interval (CI). The search identified 2864 records, and after selecting, three RCTs were included in the quantitative analysis. The meta-analysis showed a difference in postoperative pain according to the evaluation time. The subgroup meta-analysis revealed that the PIPS Er:YAG showed a significant reduction in the postoperative pain in the 48 hours (MD = -0.78; 95% CI [-1.39, -0.17]; p = 0.01; I² = 69%) compared to the control group. However, no statiscally significant results were found when assessing postoperative pain after 1, 3 and 7 days (95% CI; p > 0.05). The PIPS Er: YAG laser-activated irrigation reduced postoperative pain at 2 days following primary endodontic treatment. However, the certainty of the evidence is low and further RCTs are needed to confirm these results and avoid bias and confounding factors. Registration: PROSPERO registration number: CRD42023432499.

Keywords: Endodontics; Irrigation; Laser disinfection; Post-endodontic pain; Systematic review.