Restor Dent Endod.  2023 Feb;48(1):e5. 10.5395/rde.2023.48.e5.

Effect of endodontic sealer on postoperative pain: a network metaanalysis

• Monteiro CMC
• Martins ACR
• Reis A
• Geus JLd

• KMID: 2548173
• DOI: http://doi.org/10.5395/rde.2023.48.e5

Abstract

This systematic review and network meta-analysis aimed to answer the following focused research question: “Does the type of endodontic sealer affect the postoperative pain in patients who received endodontic treatment?” Different databases and grey literature were surveyed. Only one randomized controlled trial were included. The risk of bias in the studies was evaluated by using the Cochrane Collaboration’s tool. A random-effects metaanalysis was conducted to compare the risk and intensity of postoperative pain. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Out of 11,601 studies, 15 remained for qualitative analyses and 12 for meta-analysis. Seven studies were classified at high risk of bias, and 8 studies raised some concerns. No significant differences between the endodontic materials were observed in the direct comparisons, both in risk and in intensity of postoperative pain (pairwise comparisons with 2 studies: I² = 0%; p > 0.05 and 8 studies: I² = 23%; p > 0.05, respectively). The certainty of the evidence was graded as low or moderate. There was no difference in the risk and intensity of postoperative pain after filling with different endodontic sealers. Further systematic reviews should be conducted.

Keyword

Meta-analysis; Pain postoperative; Root canal filling materials; Root canal obturation; Systematic review

Figure

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  Figure 1 Flow diagram of study identification.

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  Figure 2 Summary of the risk of bias assessment according to the RoB 2.0 (Cochrane Collaboration tool).

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  Figure 3 Network plot presenting the trial data contributing evidence comparing different endodontic sealers. (A) Risk of postoperative pain: 7 trials, 4 groups, 701 participants. (B) Intensity of postoperative pain: 12 trials, 5 groups, 1,319 participants. The size of the nodes represents how many times the exercise appears in any comparison about that treatment and the width of the edges represents the total sample size in the comparisons it connects.ER, epoxy resin; CS, calcium silicate; CH, calcium hydroxide; ZOE, zinc-oxide eugenol.

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  Figure 4 Traditional pairwise meta-analysis for all possible pairs for the risk of postoperative pain.RR, risk ratio; CI, confidence interval.

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  Figure 5 Global assessment for loop inconsistency for risk of postoperative pain. This plot represents each data points’ contribution to the residual deviance for the NMA with consistency (horizontal axis) and the UME inconsistency models (vertical axis) along with the line of equality. The points on the equality line mean there is no improvement in model fit when using the inconsistency model, suggesting no evidence of inconsistency. Points above the equality line represent minor residual deviance for the consistency model, indicating a better fit in the NMA consistency model. Points below the equality line mean they have a better fit in the UME inconsistency model.NMA, network meta-analysis; UME, unrelated mean effect.

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  Figure 6 Traditional pairwise meta-analysis for all possible pairs for the intensity of postoperative pain.SD, standard deviation; MD, mean difference; CI, confidence interval.

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  Figure 7 Node splitting method and the global assessment for loop inconsistency for postoperative pain intensity. This plot represents each data points’ contribution to the residual deviance for the NMA with consistency (horizontal axis) and the UME inconsistency models (vertical axis) along with the line of equality. The points on the equality line mean there is no improvement in model fit when using the inconsistency model, suggesting no evidence of inconsistency. Points above the equality line represent minor residual deviance for the consistency model, indicating a better fit in the NMA consistency model. Points below the equality line mean they have a better fit in the UME inconsistency model.NMA, network meta-analysis; UME, unrelated mean effect.

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