Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
J Endod. 2024 Sep;50(9):1233-1244. doi: 10.1016/j.joen.2024.06.005. Epub 2024 Jun 15.
This study systematically reviewed literature regarding the effect of different concentrations of sodium hypochlorite (NaOCl) used during root canal treatment (RCT) on postendodontic pain (PEP) and rescue analgesia.
Following registration with PROSPERO (CRD42023388916), a search was conducted using PubMed, Scopus, Web of Science, and Embase databases. Randomized controlled trials of patients receiving RCT which assessed PEP at different time intervals were included. Following data extraction and Cochrane risk of bias assessment 2, meta-analyses were performed to evaluate PEP during the first 48 hours along with rescue analgesic intake. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
Five randomized controlled trials with 674 patients were included. One study exhibited a low risk of bias, while 4 raised some concerns. Patients treated with low concentrations of NaOCl (≤3%) were significantly less likely to report PEP at 24 hours (OR = 2.32; [95% CI, 1.63-3.31]; P < .05) and 48 hours (OR = 2.49; [95% CI, 1.73-3.59]; P < .05) as compared with high concentrations of NaOCl (≥5%). Furthermore, with low concentrations of NaOCl, significantly lesser moderate-severe PEP was reported at 24 hours (OR = 2.32; [95% CI, 1.47-3.62]; P < .05) and 48 hours (OR = 2.35; [95% CI, 1.32-4.16]; P < .05) and lesser analgesia was needed (OR = 2.43; [95% CI, 1.48-4.00]; P < .05).
While PEP can be influenced by several factors, low certainty evidence suggests that when NaOCl is used as an irrigant during RCT, PEP may be less likely with lower concentrations of NaOCl. Moderate certainty evidence indicates that lesser analgesia may be required with lower concentrations of NaOCl. These results should be cautiously interpreted.
本研究系统地综述了有关根管治疗（RCT）中使用不同浓度次氯酸钠（NaOCl）对根管治疗后疼痛（PEP）和救急镇痛的影响的文献。
在 PROSPERO（CRD42023388916）注册后，使用 PubMed、Scopus、Web of Science 和 Embase 数据库进行检索。纳入了评估不同时间间隔 PEP 的 RCT 患者的随机对照试验。在提取数据和 Cochrane 偏倚风险评估 2 后，进行荟萃分析以评估前 48 小时内的 PEP 以及救急镇痛药的摄入情况。使用推荐评估、制定与评估分级法评估证据的确定性。
纳入了 5 项 RCT，共 674 名患者。1 项研究存在低偏倚风险，而 4 项研究存在一些问题。使用低浓度 NaOCl（≤3%）的患者在 24 小时（OR = 2.32；95% CI，1.63-3.31；P <.05）和 48 小时（OR = 2.49；95% CI，1.73-3.59；P <.05）时报告 PEP 的可能性显著降低与高浓度 NaOCl（≥5%）相比。此外，使用低浓度 NaOCl 时，24 小时（OR = 2.32；95% CI，1.47-3.62；P <.05）和 48 小时（OR = 2.35；95% CI，1.32-4.16；P <.05）报告的中度至重度 PEP 明显较少，且需要的镇痛剂较少（OR = 2.43；95% CI，1.48-4.00；P <.05）。
尽管 PEP 可能受到多种因素的影响，但低确定性证据表明，当 NaOCl 用作 RCT 冲洗液时，低浓度的 NaOCl 可能会降低 PEP 的发生。中等确定性证据表明，低浓度的 NaOCl 可能需要较少的镇痛剂。这些结果应谨慎解释。
