Impact of instrumentation kinematics on post endodontic pain-an umbrella review with stratification of evidence and sensitivity analysis.

BACKGROUND

Our umbrella review examines the impact of instrumentation kinematics on postoperative pain in endodontic treatment by synthesizing current evidence from systematic reviews and meta-analyses.

METHODS

We performed an extensive search across six major electronic databases up to March 2025, focusing on English-language literature comparing rotary and reciprocating instrumentation systems. Quality assessment was rigorously conducted using the AMSTAR 2 tool, and a comprehensive risk of bias evaluation was carried out using the ROBIS tool.

RESULTS

Our analysis incorporated eight systematic reviews, seven of which provided meta-analytic data, thus ensuring a robust consolidation of findings. The results reveal that rotary instrumentation generally produces lower overall post-operative pain levels compared to reciprocating systems. However, the influence of instrumentation type appears to be time-dependent, with evidence suggesting that reciprocating systems may offer advantages in the immediate post-operative phase by reducing mild pain within 24 h. The review underscores the multifactorial nature of post-operative pain, where clinical outcomes are influenced not only by instrumentation kinematics but also by patient-specific factors, operator experience, and procedural variables.

CONCLUSION

The insights provided by our review contribute to the current understanding of endodontic pain management and encourage further research utilizing standardized methodologies and extended follow-up periods to elucidate long-term outcomes. These findings have significant implications for clinical practice and the development of patient-centered treatment protocols in endodontics.