Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India.
Boston University Goldman School Of Dental Medicine , Boston, USA.
Int Dent J. 2024 Apr;74(2):335-342. doi: 10.1016/j.identj.2023.10.012. Epub 2023 Nov 18.
Root canal re-treatment (RCR) cases are considered some of the most challenging cases in the field of endodontics, as they are mostly associated with various iatrogenic errors such as ledge formation, incomplete biomechanical preparation, file separation, and incomplete obturation. These iatrogenic errors lead to defective niches within root canals that may act as reservoirs for various viable microorganisms. Such residual microbial niches may cause postoperative pain even after thorough debridement and reshaping the canals, ultimately leading to a poor prognosis for the tooth. Nowadays, prevention of postoperative pain in re-treatment cases and prognosis are effectively managed by photobiomodulation therapy (PBMT).
Relevant studies in the English language published before November 2022 were identified using electronic databases like PubMed, SCOPUS, and EBSCO to conduct bibliographic research. This systematic review is based on 3 studies that were found eligible as per the inclusion and exclusion criteria. This systematic review is in accordance with PRISMA guidelines.
The systematic review indicated a positive impact by significantly decreasing postoperative pain in RCR cases when treated with PBMT. The variation was statistically significant at 24 hours (P = .0002), 48 hours (P = .03), and 72 hours (P = .02). The mean difference at 24 hours was 0.65 (95% CI, 0.32-0.99), at 48 hours was 0.46 (95% CI, 0.05-0.87), and at 72 hours was 0.40 (95% CI, 0.07-0.74). There was no statistical heterogenicity at 24 hours (P > .05), but a medium heterogenicity was observed at 48 hours and 72 hours.
PBMT or low-level laser therapy has shown superior results as compared to the conventional pharmacologic approach in postoperative pain management in RCR cases.
根管再治疗（RCR）病例被认为是牙髓病学领域最具挑战性的病例之一，因为它们主要与各种医源性错误有关，如肩形成、不完全的生物力学预备、器械分离和不完全的封闭。这些医源性错误导致根管内的缺陷龛位，这些龛位可能成为各种存活微生物的储库。即使在彻底清创和重塑根管后，这些残留的微生物龛位仍可能导致术后疼痛，最终导致牙齿预后不良。如今，通过光生物调节疗法（PBMT）可以有效预防再治疗病例的术后疼痛和预后。
使用电子数据库，如 PubMed、SCOPUS 和 EBSCO 等，检索 2022 年 11 月前发表的英文相关研究，进行文献研究。本系统评价基于符合纳入和排除标准的 3 项研究。本系统评价符合 PRISMA 指南。
系统评价表明，PBMT 治疗 RCR 病例时，显著降低了术后疼痛，差异具有统计学意义，在 24 小时（P =.0002）、48 小时（P =.03）和 72 小时（P =.02）时。24 小时的平均差异为 0.65（95%CI，0.32-0.99），48 小时为 0.46（95%CI，0.05-0.87），72 小时为 0.40（95%CI，0.07-0.74）。24 小时时无统计学异质性（P >.05），但在 48 小时和 72 小时时观察到中等异质性。
与传统药物治疗相比，PBMT 或低水平激光治疗在 RCR 病例的术后疼痛管理中显示出更好的效果。
