Meta-Analysis Assessing Persistent Pain Following Root Canal Therapies: IADR/CADR 86th General Session

The incidence of persistent pain following root canal therapies is not well known, even thought 16.4 million are performed yearly in the USA. Objectives: Determine the incidence of ‘all cause' pain ³6 months following endodontic procedures, via meta-analysis of published literature, and describe the quality of the reported research. Methods: MEDLINE database search, from 1950 to November 2007, using PubMed keywords associated with pain and endodontic procedures. Citations were screened by 2 reviewers following training with acceptable inter-rater reliability. Criteria for article selection were: 1) endodontic procedures including pulpectomy, pulpotomy and apical surgery but not root desensitization, pulp capping or concomitant extraction; 2) procedure performed on human secondary teeth, with a tooth as unit of observation; 3) ‘all-cause' pain defined as any pain report including those provoked by percussion, palpation or biting; and 4) follow up duration of ³6 months. Quality of reported research was determined by means of applying a modified version of the STROBE criteria. Consensus between reviewers was required for all end-points. Random effects meta-analysis was used to derive a pooled estimate of the incidence. Results: The search identified 463 articles and abstract screening eliminated 285 articles. Inter-rater reliability was good (k=0.79). Full article review of the remaining 187 articles resulted in 18 meeting the selection criteria; 5 with ‘fair' quality and 13 with ‘marginal' quality. Notable publications did not meet the criteria, while 2 foreign language articles fitted and were included after translation. The overall incidence of ‘all-cause' persistent pain was determined to be 6-9% (95%CI=4-8% and 95% CI=6-12%). Study quality did not influence estimates in a meta-regression (P=0.77 or P=0.78). Conclusions: The ‘all-cause' incidence of pain following root canal therapies was 6-9% based on available literature that was not of high quality. Further research of better quality is needed. Supported by NCRR K12-RR023247 (DR Nixdorf)