Prevalence of Postoperative Pain After Endodontic Treatment Using Low and High Concentrations of Sodium Hypochlorite: a Systematic Review and Meta-analysis

Overview

Journal Clin Oral Investig

Specialty Dentistry

Date 2023 Jul 19

PMID 37466716

Authors

Rayssa Sabino-Silva

Ihan Vitor Cardoso

Filipe Colombo Vitali

Ana Maria Hecke Alves

Beatriz Dulcineia Mendes Souza

Eduardo Antunes Bortoluzzi

Lucas da Fonseca Roberti Garcia

Cleonice da Silveira Teixeira

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine the prevalence of postoperative pain after endodontic treatment using low (LC) and high (HC) concentrations of sodium hypochlorite (NaOCl).

Materials And Methods: Six databases and the grey literature were searched to identify randomized clinical trials that evaluated postoperative pain after endodontic treatment using NaOCl. NaOCl concentrations were dichotomized into 'LC' (0.5% to 3%) and 'HC' (≥ 5%) and a proportion meta-analysis was applied to determine the postoperative pain prevalence: overall and according to pain intensity and postoperative time. The prevalence of patients using pain control medication was also determined. A significance level of 5% and a random effect model were applied for data analysis. Between-study heterogeneity was assessed by I index. Risk of bias (RoB) was assessed using the Cochrane Risk-of-Bias 2.0 tool. The certainty of evidence was assessed using the GRADE approach.

Results: Ten studies were included in the review and eight in the meta-analysis. The overall prevalence of postoperative pain was 45% in LC and 39% in HC. The prevalence of pain in LC and HC after 24 h was 25% and 40%, respectively. After 48 h, the prevalence decreased to 10% in LC and 25% in HC. 'Absent pain' was the most prevalent score. The prevalence of patients who used medication was 9% in LC and 15% in HC. Three studies were classified as 'high RoB', five as 'low RoB', and two as 'some concerns'. The certainty of evidence was very low.

Conclusions: The overall prevalence of postoperative pain after endodontic treatment using LC and HC of NaOCl was 45% and 39%, respectively.

Clinical Relevance: Postoperative pain is common after endodontic treatment using NaOCl, but tends to decrease over time.

Citing Articles

Postoperative pain in primary root canal treatments after Er: YAG laser-activated irrigation: a systematic review and meta-analysis.

Schmidt L, Ferreira L, Junior F, Fernandes Montagner A, de Oliveira da Rosa W, de Araujo L Lasers Med Sci. 2025; 40(1):37.

PMID: 39849275 DOI: 10.1007/s10103-024-04271-0.

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