Department of Dentistry, Military Hospital, Isparta, Turkey.
Department of Endodontics, Ege University, Izmir, Turkey.
J Endod. 2018 Aug;44(8):1228-1236. doi: 10.1016/j.joen.2018.05.002. Epub 2018 Jun 20.
The concept of maintaining apical patency (AP) is a controversial issue in endodontics. The primary objectives of this systematic review of randomized controlled trials (RCTs) were to determine the influence of maintaining AP during instrumentation on postoperative pain severity and the prevalence of flare-ups. A second objective was to assess the effect of maintaining AP on the use of analgesics.
RCTs and controlled clinical trials were searched for in MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library. Four reviewers independently screened all identified articles for eligibility. The included studies were assessed for bias using the Cochrane Risk of Bias Tool. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of the body of evidence. Because of the considerable heterogeneity of the studies, a meta-analysis was not possible. Therefore, the results were analyzed narratively.
Five RCTs that included a total of 848 patients were found eligible and included in the review. An assessment of the risk of bias in the included studies provided results that classified the studies as showing a low risk (n = 1), high risk (n = 1), or unclear risk (n = 3) of bias. The available evidence indicated that maintaining AP (1) did not increase postoperative pain in teeth with nonvital pulp, (2) did not increase postoperative pain in teeth with vital pulp, and (3) did not cause (0%) flare-ups. The available evidence also indicated that maintaining AP did not increase analgesic use. The available evidence indicated that maintaining AP did not increase postoperative pain when a single-visit or 2-visit root canal treatment approach was used.
In light of the current evidence, maintaining AP does not increase postoperative pain in teeth with vital/nonvital pulp when compared with nonapical patency (low to moderate quality evidence). Furthermore, maintaining AP did not cause flare-ups (low evidence) and did not increase analgesic use (moderate evidence).
在牙髓学中，保持根尖通畅（AP）的概念是一个有争议的问题。本系统评价随机对照试验（RCT）的主要目的是确定在器械预备过程中保持 AP 对术后疼痛严重程度和爆发性疼痛发生率的影响。第二个目标是评估保持 AP 对使用镇痛药的影响。
在 MEDLINE（Ovid）、Embase（Ovid）和 Cochrane 图书馆中搜索 RCT 和对照临床试验。四名评审员独立筛选所有符合条件的文章。使用 Cochrane 偏倚风险工具评估纳入研究的偏倚。使用推荐评估、制定和评估方法对证据体的质量进行评级。由于研究之间存在很大的异质性，因此无法进行 meta 分析。因此，结果以叙述性方式进行分析。
共发现 5 项 RCT，共纳入 848 名患者，符合纳入标准并纳入综述。对纳入研究的偏倚风险评估结果表明，这些研究被归类为低风险（n=1）、高风险（n=1）或不确定风险（n=3）。现有证据表明，保持 AP（1）不会增加无活力牙髓牙齿的术后疼痛，（2）不会增加活力牙髓牙齿的术后疼痛，（3）不会引起（0%）爆发性疼痛。现有证据还表明，保持 AP 不会增加镇痛药的使用。现有证据表明，与非根尖通畅（低到中等质量证据）相比，保持 AP 不会增加单次或两次就诊根管治疗方法后牙齿的术后疼痛。
根据现有证据，与非根尖通畅相比，保持 AP 不会增加有活力/无活力牙髓牙齿的术后疼痛（低到中等质量证据）。此外，保持 AP 不会引起爆发性疼痛（低证据），也不会增加镇痛药的使用（中等证据）。
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