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Post-endodontic pain with different engine-driven endodontic instruments in multi-visit root canal therapy: A systematic review and meta-analysis

Aim: Post-endodontic pain during root canal treatment (RCT) is inevitable. Previous meta-analysis reported a lesser post-endodontic pain in using continuous rotation instruments compared with using reciprocating instruments in a single-visit root canal therapy. No evidence has been elucidated to prove the same in multi-visit root canal therapy. The aim of this systematic review was to compare the intensity of post-instrumentation pain on using continuous and reciprocating motion engine-driven systems in multi-visit root endodontic treatment. Materials and Methods: An extensive literature search in PubMed, Cochrane Library, and Google Scholar was performed to identify investigations that evaluated the effect of continuous and reciprocating instrument systems on post-operative pain. The certainty of evidence was assessed using GRADEpro (GRADEpro GDT software, https://gradepro.org). We included two trials in this review, and their risk of bias was found to be low. A fixed-effects model was used to pool the mean post-operative pain as this was found by less heterogeneity. Results: Pooled results showed no difference in the mean post-instrumentation pain measured using a visual analog scale between continuous and reciprocating instrument systems with a mean difference of −0.13 (P = 0.48; I2 = 26%). Also pooled relative risk showed no difference in the risk for post-endodontic pain between continuous and reciprocating instrument systems with a relative risk of 0.53 (P = 0.08; I2 = 34%). Conclusion: The use of both continuous and reciprocating instruments had lower intensity of post-operative pain in patients who received multi-visit RCT with no significant difference between them. Further clinical trials with high quality are needed to understand the effect of continuous and reciprocal engine-driven instrumentation systems in multi-visit RCT.