Enhancing Postoperative Endodontic Pain Management: a Systematic Review

Objectives: Pain post-endodontic treatment is unpredictable and multifactorial, affecting individuals across ages and genders. Given various technical and pharmacological strategies, this study systematically reviews the current literature to identify the most effective pain control method post-treatment.
Methods: We conducted a literature search on PubMed, the National Institutes of Health, and EMBASE to identify studies published between 2000 and 2023. Initially, we found 784 titles and abstracts, and after careful review, we excluded 642 articles. Among the remaining 142 articles, we excluded 123 more based on our criteria. Two independent investigators assessed the full texts of the remaining articles to ensure accuracy, resolving discrepancies through discussion using Covidence. In the end, we included 19 articles in this review.
Results: Recent studies indicate that two-visit endodontic treatment with intracanal medication is more effective in reducing postoperative pain (PP) and flare-ups. However, some studies suggest that one-visit treatment may result in lower PP or no significant difference. PP tends to be higher in mandibular teeth compared to maxillary ones. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective for postoperative pain management after non-surgical root canal treatment, though corticosteroids show superior relief for 6 to 24 hours. Rotary instrumentation is preferred, with the step-back technique potentially causing more PP than step-down or crown-down methods. Conversely, the modified step-back technique may yield less pain than rotational and reciprocal techniques, especially within 48 hours.
Conclusions: The current evidence on postoperative endodontic pain management offers evidence-based recommendations for improved outcomes. However, it is essential to consider the operator's expertise and the need for further data validation. Larger randomized controlled studies are necessary to confirm these findings.