Teja Kavalipurapu Venkata, Vasundhara Kaligotla Apoorva, Spagnuolo Gianrico, Cernera Mariangela, Armogida Niccolò Giuseppe, Iaculli Flavia, Rengo Carlo
Department of Conservative Dentistry & Endodontics, Mamata Institute of Dental Sciences, Hyderabad, Telangana, India.
Department of Prosthodontics, Saveetha Dental College and Hospitals - Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
Clin Exp Dent Res. 2025 Aug;11(4):e70180. doi: 10.1002/cre2.70180.
This systematic review and meta-analysis aimed to evaluate the effectiveness of different instrumentation systems in reducing postoperative pain following root canal preparation in primary teeth.
The present study was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD42020135904). The review aimed to determine whether there is a difference in postoperative pain incidence using various instrumentation systems (manual and mechanical) for root canal preparation of primary teeth during pulpectomy. An extensive database search was performed using specific MeSH terms to include clinical studies up to November 2024. Based on eligibility criteria, the selected articles were subjected to quality assessment and the risk of bias was conducted using the Cochrane Risk of Bias (RoB 2) tool. In addition, meta-analyses were conducted on homogeneous studies.
A total of 11 studies were included for qualitative assessments, and 7 studies underwent quantitative analysis. The results review indicated that mechanical instrumentation systems yielded better overall pain reduction compared to manual systems. The meta-analysis further demonstrated statistically significant pain reduction at 6 (p < 0.01, 95% CI: 1.46) and 12 h (p < 0.01, 95% CI: 2.15). However, no notable pain reduction or significance were observed at other time points (p = 0.41, 95% CI: 1.66; p = 0.23, 95% CI: 1.67; p = 0.61, 95% CI: 1.25). The overall risk of bias was low for the included studies.
Rotary NiTi instrumentation systems were superior in reducing Postoperative pain incidence in primary teeth undergoing pulpectomy.
Mechanical instrumentation is not only advantageous in decreasing overall treatment time, but also in reducing pain incidence after pulpectomy, which nowadays represents an important and widely used procedure to preserve primary teeth.
本系统评价和荟萃分析旨在评估不同器械系统在降低乳牙根管预备术后疼痛方面的有效性。
本研究按照PRISMA指南进行，并在PROSPERO（CRD42020135904）上注册。该评价旨在确定在乳牙牙髓摘除术中使用各种器械系统（手动和机械）进行根管预备后，术后疼痛发生率是否存在差异。使用特定的医学主题词进行广泛的数据库检索，以纳入截至2024年11月的临床研究。根据纳入标准，对所选文章进行质量评估，并使用Cochrane偏倚风险（RoB 2）工具进行偏倚风险评估。此外，对同类研究进行荟萃分析。
共纳入11项研究进行定性评估，7项研究进行定量分析。结果综述表明，与手动系统相比，机械器械系统在总体疼痛减轻方面效果更好。荟萃分析进一步表明，在6小时（p < 0.01，95%可信区间：1.46）和12小时（p < 0.01，95%可信区间：2.15）时疼痛减轻具有统计学意义。然而，在其他时间点未观察到明显的疼痛减轻或显著性（p = 0.41，95%可信区间：1.66；p = 0.23，95%可信区间：1.67；p = 0.61，95%可信区间：1.25）。纳入研究的总体偏倚风险较低。
旋转镍钛器械系统在降低接受牙髓摘除术的乳牙术后疼痛发生率方面更具优势。
机械器械不仅有利于缩短总体治疗时间，还能降低牙髓摘除术后的疼痛发生率，而牙髓摘除术目前是保存乳牙的一项重要且广泛应用的操作。
