Effect of Foraminal Enlargement on Postoperative Pain in Primary Endodontic Treatment: A Systematic Review and...

This systematic review and meta-analysis investigated the effect of foraminal enlargement (FE) on postoperative pain following primary endodontic treatment.

A comprehensive electronic search was conducted across 4 major databases: PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. Randomized clinical trials comparing the effect of FE with no foraminal enlargement (NFE) on postoperative pain were included. The risk of bias in included studies was assessed using the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. A meta-analysis was planned to quantitatively evaluate the effect of FE on pain within the first week post-treatment.

Eight randomized clinical trials involving a total of 802 participants met the inclusion criteria. Risk of bias assessment revealed that two studies had an overall high risk, four had some concerns, and 2 had a low risk of bias. The meta-analysis demonstrated that postoperative pain was significantly higher in the FE group compared to the NFE group at the following time points: 12 hours (standardized mean difference [SMD] = 0.79, 95% confidence interval [CI] = 0.30-1.28, P = .002, I² = 28%), 24 hours (SMD = 0.74, 95% CI = 0.12-1.36, P = .02, I² = 89%), and 48 hours (SMD = 2.90, 95% CI = 0.23-5.57, P = .03, I² = 98%).

This meta-analysis suggests that postoperative pain is significantly higher within the first 48 hours following FE compared to NFE. Pain intensity was generally mild to moderate in both groups and decreased over time. Further research is required to ascertain the effect of FE on endodontic treatment outcomes and whether its clinical application provides tangible benefits to patients.