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Incidence of Postoperative Pain After Single-Visit Root Canal Treatment vs Vital Pulp Therapy
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain.
STUDIES REVIEWED
The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT.
RESULTS
The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001).
PRACTICAL IMPLICATIONS
PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.
Additional Info
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Postoperative pain after single-visit root canal treatment or vital pulp therapy: A systematic review and meta-analysis
J Am Dent Assoc 2024 Feb 01;155(2)118-137.e1, B Signor, PM Poli Kopper, M Aspesi, EA Münchow, RK ScarparoFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Vital pulp therapy (VPT) preserves the radicular pulp and, occasionally, a portion of the coronal pulp. VPT is an important alternative to root canal treatment (RCT) annd can be utilized in carious, iatrogenic, or traumatic pulp exposures. Understanding the biological basis for VPT may allow a more conservative approach to preserving the natural dentition. Histological and radiographic evidence suggests that the removal of inflamed tissues and the placement of a biocompatible material allows tissue healing. Maintenance of healthy pulp tissues has many benefits, including the conservation of defense and proprioceptive functions. Recent clinical trials found the success rates of VPT to be similar to those of RCT. Despite these benefits, however, dentists may fail to consider this treatment modality in practice for a variety of reasons, including insufficient exposure to VPT during training, uncertainty regarding technical execution, or the fear of an increased risk of postoperative pain.
To address the latter concern, Signor and colleagues performed a systematic review and meta-analysis to assess the differences in postoperative pain between VPT and single-visit RCT. The authors searched PubMed, Cochrane Library, Embase, and Latin America and the Caribbean Literature on Health Sciences databases for randomized clinical trials with a quantitative pain assessment at various time intervals following the treatment. The systematic review included 57 studies, but only 3 studies were included in the meta-analysis owing to heterogeneous methodologies. The study concluded that full pulpotomy resulted in a lower incidence of mild and moderate postoperative pain and a higher incidence of no pain than RCT. Both full pulpotomy and RCT resulted in a low incidence of severe postoperative pain. Analgesic intake postoperatively is typically limited to a short period and is often unnecessary. Study limitations include the subjective nature of pain and the limited number of studies suitable for meta-analysis. More robust clinical trials are needed to enhance the level of evidence on this topic.