ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Apical patency technique does not increase post endodontic pain
Clinical Question In patients undergoing root canal treatment, does use of apical patency(AP) technique, as compared to treatment with no apical patency(NAP), have an effect on post treatment pain?
Clinical Bottom Line In patients undergoing non-surgical root canal treatment, use of apical patency technique does not increase post treatment pain. In addition, it might even lead to further reduction in pain after 5 days when compared to non-patency technique.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 30170845Abdulrab/ 20184 randomized clinical trials with 781 patientsMeta-Analysis
Key resultsIn this meta-analysis, data from 4 clinical trials were pooled to assess the effect of AP technique on post treatment pain (standardized mean differences=MD) at different time intervals. AP technique did not increase post endodontic pain at 1 day (p>.05; 95 % CI, -2.75 to 0.97). However, after 5 days there was statistically significant less postoperative pain in the AP group compared with the NAP group (p Ë‚ .01; MD = 0.52; 95% CI, 0.60 to 0.44). The authors conclude that apical patency technique, in comparison to no apical patency technique, did not lead to increase in post- operative pain and there was no significant difference in the use of analgesics between the two groups.
Evidence Search (apical[All Fields] AND patency[All Fields]) AND ("pain"[MeSH Terms] OR "pain"[All Fields])
Comments on
The Evidence
Validity: The article by Abdulrab et al followed the PRISMA guidelines to conduct a meta-analysis of randomized clinical trials. To conduct a comprehensive study, an extensive and detailed literature search was done. Two reviewers independently screened the data and assessed the trials for quality and risk of bias using Cochrane Collaboration’s Risk of Bias Assessment Tool. The studies included in this meta-analysis had teeth with varying pulp status, irrigation techniques and tooth type (anterior vs posterior), which can act as confounding variables. Apart from the significant heterogeneity amongst the studies included in the meta-analysis, another drawback of this study is that pain was evaluated using different scales, which added to difficulty in pooling the data. Further, well-designed multi center randomized clinical trials are warranted to establish the relation between use of apical patency and its effect on post endodontic pain.
Applicability The prevalence of post-endodontic pain at 24 hours has been reported at 40% (J Endod. 2011;37(4):429-38). Post endodontic pain is most often ascribed to release of inflammatory mediators. Although it can be hypothesized that maintaining apical patency might extrude debris and induce periapical inflammation, leading to increased post-operative pain but this meta-analysis proves otherwise. This conclusion should be interpreted with caution as the analysis had only a limited number of studies with most of them having high risk of bias. There are also many potential confounding variables (e.g. age, gender, tooth location, pulp status and instrumentation technique), which could affect the outcome measure and a subset analysis was not performed to study the same. This heterogeneity further limits the external validity and makes the generalization of the results to a diverse patient population questionable. Apical patency technique has advantages of keeping a root canal free of blocks, ledges and helps in apical delivery of root canal irrigant. Keeping in mind the abovementioned advantages and the finding that it does not increase post endodontic pain, apical patency technique during root canal instrumentation might be utilized to ensure proper root canal disinfection and maintain original canal anatomy.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords pain, patency , root canal treatment, apical foramen
ID# 3358
Date of submission: 11/14/2018spacer
E-mail ather@livemail.uthscsa.edu
Author Amber Ather BDS, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Dr. Nikita Ruparel MS, PhD
Faculty mentor/Co-author e-mail Ruparel@uthscsa.edu
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