Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA.
J Endod. 2010 Feb;36(2):224-30. doi: 10.1016/j.joen.2009.11.007.
Little is known about the frequency of persistent pain after endodontic procedures even though pain is a core patient-oriented outcome. We estimated the frequency of persistent pain, regardless of etiology, after endodontic treatment.
Persistent tooth pain was defined as pain present > or = 6 months after endodontic treatment. Endodontic procedures included in the review were pulpectomy, nonsurgical root canal treatment, surgical root canal treatment, and retreatment. Four databases were searched electronically complemented by hand searching. Two independent reviewers determined eligibility, abstracted data, and assessed study quality. A summary estimate of persistent all-cause tooth pain frequency was established by using a random-effects meta-analysis. Using subgroup analyses, we explored the influence of treatment approach (surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate, follow-up duration, initial treatment versus retreatment, and quality of reporting (Strengthening the Reporting of Observational Studies in Epidemiology rankings) on the pain frequency estimate.
Of 770 articles retrieved and reviewed, 26 met inclusion criteria. A total of 5,777 teeth were enrolled, and 2,996 had follow-up information regarding pain status. We identified 168 teeth with pain and derived a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause tooth pain. High and statistically significant heterogeneity among studies (I2 = 80%) was present. In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%). Quality of study reporting was identified as the most influential reason for study heterogeneity.
The frequency of all-cause persistent tooth pain after endodontic procedures was estimated to be 5.3%, with higher report quality studies suggesting >7%.
尽管疼痛是患者导向的核心结局之一，但对于根管治疗后持续性疼痛的发生频率知之甚少。我们评估了根管治疗后无论病因如何发生持续性疼痛的频率。
持续性牙齿疼痛定义为根管治疗后疼痛持续存在≥6 个月。本综述纳入的根管治疗操作包括牙髓切除术、非手术根管治疗、手术根管治疗和再治疗。通过电子方式在四个数据库中进行搜索，并辅以手工搜索。两位独立的审查员确定纳入标准、提取数据并评估研究质量。使用随机效应荟萃分析建立持续性全因牙齿疼痛频率的汇总估计值。通过亚组分析，我们探讨了治疗方法（手术/非手术）、纵向研究设计（前瞻性/回顾性）、随访率、随访时间、初始治疗与再治疗、报告质量（观察性研究的流行病学报告质量强化标准）对疼痛频率估计值的影响。
在检索和审查的 770 篇文章中，有 26 篇符合纳入标准。共有 5777 颗牙齿纳入研究，其中 2996 颗牙齿有关于疼痛状况的随访信息。我们发现 168 颗牙齿有疼痛，并得出持续性全因牙齿疼痛的频率为 5.3%（95%置信区间，3.5%-7.2%，p<0.001）。研究之间存在高度且具有统计学意义的异质性（I2=80%）。在亚组分析中，前瞻性研究的疼痛频率（7.6%）高于回顾性研究（0.9%）。研究报告质量被确定为研究异质性的最主要原因。
根管治疗后全因持续性牙齿疼痛的频率估计为 5.3%，报告质量较高的研究提示疼痛频率>7%。
