The Incidence and Intensity of Postendodontic Pain and Flareup in Single and Multiple Visit Root Canal Treatments: A Systematic Review and Meta-Analysis

Satish Vishwanathaiah,Alessandro Mazzoni,Shankargouda Patil,A Thirumal Raj,Hitesh Chohan,Sanjeev B Khanagar,Shilpa Bhandi,Archana A Gupta,Deepak Mehta,Luca Testarelli,Prabhadevi C Maganur

doi:10.3390/app11083358

Abstract

To assess the incidence and intensity of postendodontic pain and flareup in single and multiple visit root canal treatment (RCT) and determine if the difference between the two is significant, a search of PubMed, Medline, Embase, Cochrane, Scopus and Web of science was conducted. The grey literature was searched using Google Scholar and Saudi digital library. Randomised controlled trials evaluating the incidence and intensity of postendodontic pain and flareup published in English from 1 January 2000 to 15 April 2020 were searched. The PRISMA protocol was followed to select the articles. A random effects model was used for the meta-analysis of the data in the included studies. Twenty-one articles were included in the review. Three compared both the incidence and the intensity, while the rest compared either one of the parameters. Most studies used both hand-driven and rotary instruments and irrigated with sodium hypochlorite. Twelve studies used an intracanal medicament. Although individual studies showed discordant treatment outcomes, the meta-analysis did not reveal any significant difference in the incidence or the intensity of the postendodontic flareup between the single and multiple visit RCT groups. Single or a multiple visit root canal treatment is not an independent determinant for the risk of postendodontic pain or a flareup.

Highlights

Endodontic therapy or root canal treatment (RCT) aims to eradicate bacteria from an infected root canal [1]
Severe pain and flareup after root canal treatment reflect the clinical expression of complex physiological changes occurring at a cellular stage [37]
Taking into account the limitations of this study, the meta-analysis showed that there was no significant difference in the incidence, or the intensity of the pain as measured between single visit RCT and multiple visit RCT

Summary

Introduction

Endodontic therapy or root canal treatment (RCT) aims to eradicate bacteria from an infected root canal [1]. It is generally performed over multiple visits, which is considered a safer procedure than a single visit [2]. One or single visit RCT involves cleaning and shaping, and obturation of the root canal in one appointment; whereas multiple visit RCT provides a gap after placement of an intracanal medicament followed by obturation. Patient needs and expectations have made one/single visit treatment more popular as it is brief and economical [5]. With recent advances in endodontic technology, single-visit endodontics is favoured [6,7]. The existing literature is unclear if either of the options offers an advantage over the other [2,3,5,6]

Methods

Results

Discussion

Conclusion