Does achieving apical patency increase postoperative pain during endodontics?

Area of Science:

• Endodontics
• Dental Surgery
• Pain Management

Background:

• Root canal treatment aims to eliminate intraradicular infection and prevent reinfection.
• Apical patency, the maintenance of a clear apical foramen, is a debated procedural step in endodontics.
• The impact of apical patency on postoperative pain remains incompletely understood.

Purpose of the Study:

• To systematically review and meta-analyze the effect of apical patency on postoperative pain and analgesic use following root canal treatment.
• To evaluate the influence of apical patency on patient-reported outcomes in endodontic procedures.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (PubMed, Scopus, Embase, Web of Science, Cochrane Library) and gray literature up to May 2023.
• Twelve randomized controlled trials (RCTs) involving patients without systemic diseases undergoing root canal treatment were included.
• Data were analyzed using RevMan 5.4 software, employing appropriate statistical tests for dichotomous and continuous data, with fixed- or random-effects modeling.

Main Results:

• Apical patency was associated with significantly reduced postoperative pain at 24 hours, 1 day, and 2 days post-procedure (P < 0.05).
• No significant difference in analgesic use was observed between groups maintaining or not maintaining apical patency (P = 0.42).
• Study quality varied, with high heterogeneity and imprecision noted, particularly in pain measurements and analgesic use.

Conclusions:

• Apical patency demonstrates a significant benefit in reducing early postoperative pain after root canal treatment.
• The findings, while promising, should be interpreted with caution due to considerable heterogeneity and variable evidence quality.
• Integrating patient-reported outcomes like pain reduction with traditional success measures supports the clinical rationale for maintaining apical patency.