TruNatomy versus protaper gold for postoperative pain in pulpitis: a systematic review and meta-analysis of...

Root canal treatment aims to eliminate organisms within the canal system through the removal of pulp tissue, infected dentin, and necrotic materials. However, experiencing pain or swelling after root canal operations can be a significant concern. Minimally invasive (MI) techniques, such as the TruNatomy rotary file system, are intended to preserve tooth structure. However, conventional systems, such as ProTaper Gold rotary file system, aim for complete debridement. In this meta-analysis, we aim to assess the efficacy of the TruNatomy and ProTaper Gold in reducing postoperative pain. In November 2025, we conducted a systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) comparing TruNatomy to ProTaper Gold in adult patients with pulpitis. For the meta-analysis, we used R 4.5.0 with R Studio 2024.12.1 + 563. Using a random-effects model, we evaluated dichotomous data using risk ratios (RRs) and 95% confidence intervals (95% CI); whereas continuous data were analyzed using standardized mean difference (SMD) and 95% CI. Visual inspection of the forest plot was used to determine statistical heterogeneity between trials, in addition to I-squared (I2) and chi-squared (Chi2) statistics. Our analysis included four RCTs comprising 381 patients. Pooled analysis showed no statistically significant difference between TruNatomy and ProTaper Gold in pain intensity at 24 h (SMD = 0.03, 95% CI -0.17; 0.23), 48 h (SMD = 0.13, 95% CI -0.16; 0.42), or 72 h (SMD = -0.59, 95% CI -1.33; 0.14). There was no significant difference between the two groups in analgesic intake (RR = 1.2, 95% CI 0.70; 2.06). Also, the presence of postoperative pain at 24 and 48 h was similar in both groups. The results showed low statistical heterogeneity for most outcomes; however, the results should be interpreted with consideration of the clinical variability between the included studies. According to our data, the TruNatomy showed no superiority over ProTaper Gold rotary file systems in managing postoperative pain following root canal therapy. The choice of either approach may be based on other criteria, such as dentin preservation or operator preference. Thus, future large-scale clinical trials should validate these findings.