Postoperative Pain After Root Canal Preparation With Different Instruments in Primary Teeth: A Systematic Review and Meta-Analysis

Abstract

Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of different instrumentation systems in reducing postoperative pain following root canal preparation in primary teeth.

Material and methods: The present study was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD42020135904). The review aimed to determine whether there is a difference in postoperative pain incidence using various instrumentation systems (manual and mechanical) for root canal preparation of primary teeth during pulpectomy. An extensive database search was performed using specific MeSH terms to include clinical studies up to November 2024. Based on eligibility criteria, the selected articles were subjected to quality assessment and the risk of bias was conducted using the Cochrane Risk of Bias (RoB 2) tool. In addition, meta-analyses were conducted on homogeneous studies.

Results: A total of 11 studies were included for qualitative assessments, and 7 studies underwent quantitative analysis. The results review indicated that mechanical instrumentation systems yielded better overall pain reduction compared to manual systems. The meta-analysis further demonstrated statistically significant pain reduction at 6 (p < 0.01, 95% CI: 1.46) and 12 h (p < 0.01, 95% CI: 2.15). However, no notable pain reduction or significance were observed at other time points (p = 0.41, 95% CI: 1.66; p = 0.23, 95% CI: 1.67; p = 0.61, 95% CI: 1.25). The overall risk of bias was low for the included studies.

Conclusion: Rotary NiTi instrumentation systems were superior in reducing Postoperative pain incidence in primary teeth undergoing pulpectomy.

Clinical relevance: Mechanical instrumentation is not only advantageous in decreasing overall treatment time, but also in reducing pain incidence after pulpectomy, which nowadays represents an important and widely used procedure to preserve primary teeth.

Keywords: endodontic treatment; mechanical instrumentation; pain; primary teeth; pulpectomy; root canal preparation.

Figure 1

PRISMA flow chart describing the search strategy.

Figure 2

Risk of Bias Graph obtained by revised Cochrane risk‐of‐bias tool for randomized trials (RoB 2).

Figure 3

Risk of Bias Summary obtained by revised Cochrane risk‐of‐bias tool for randomized trials (RoB 2).

Figure 4

Forest plot of overall postoperative pain incidence between manual and mechanical instrumentation systems after pulpectomy procedures of primary teeth. Pain occurrence was statistically higher in the case of manual instrumentation.

Figure 5

Forest plot of overall postoperative pain incidence at 6 h between manual and mechanical instrumentation systems after pulpectomy procedures of primary teeth. Pain occurrence was statistically higher in the case of manual instrumentation.

Figure 6

Forest plot of overall postoperative pain incidence at 12 h between manual and mechanical instrumentation systems after pulpectomy procedures of primary teeth. Pain occurrence was statistically higher in the case of manual instrumentation.

Figure 7

Forest plot of overall postoperative pain incidence at 24 h between manual and mechanical instrumentation systems after pulpectomy procedures of primary teeth. There was no statistically significant difference between manual and mechanical instrumentation.

Figure 8

Forest plot of overall postoperative pain incidence at 48 h between manual and mechanical instrumentation systems after pulpectomy procedures of primary teeth. There was no statistically significant difference between manual and mechanical instrumentation.

Figure 9

Forest plot of overall postoperative pain incidence at 72 h between manual and mechanical instrumentation systems after pulpectomy procedures of primary teeth. There was no statistically significant difference between manual and mechanical instrumentation.