Sodium hypochlorite concentration and post-endodontic pain - unveiling the optimal balance: a systematic review and meta-analysis

Prasad, Niharika, Bajaj, Parul Dasson, Shenoy, Ramya, Dutta, Arindam ORCID: https://orcid.org/0000-0003-4488-0831 and Thomas, Manuel S. 2024. Sodium hypochlorite concentration and post-endodontic pain - unveiling the optimal balance: a systematic review and meta-analysis. Journal of Endodontics 50 (9) , pp. 1233-1244. 10.1016/j.joen.2024.06.005 Item availability restricted.

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Abstract

Introduction This study systematically reviewed literature regarding the effect of different concentrations of sodium hypochlorite (NaOCl) used during root canal treatment (RCT) on post-endodontic pain (PEP) and rescue analgesia. Methods Following registration with PROSPERO (CRD42023388916), a search was conducted using PubMed, Scopus, Web of Science, and Embase databases. Randomized controlled trials (RaCTs) of patients receiving RCT which assessed PEP at different time intervals were included. Following data extraction and Cochrane risk of bias assessment 2, meta-analyses were performed to evaluate PEP during the first 48h along with rescue analgesic intake. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach. Results Five RaCTs with 674 patients were included. One study exhibited a low risk of bias, while four raised some concerns. Patients treated with low concentrations of NaOCl (≤3%) were significantly less likely to report PEP at 24h (OR=2.32; [95%CI, 1.63-3.31]; P<0.05) and 48h (OR=2.49; [95% CI,1.73-3.59]; P<0.05) as compared with high concentrations of NaOCl (≥5%). Furthermore, with low concentrations of NaOCl, significantly lesser moderate-severe PEP was reported at 24h (OR=2.32; [95%CI, 1.47-3.62]; P<0.05) and 48h (OR=2.35; [95%CI, 1.32-4.16]; P<0.05) and lesser analgesia was needed (OR=2.43; [95%CI, 1.48-4.00]; P<0.05). Conclusions While PEP can be influenced by several factors, low certainty evidence suggests that when NaOCl is used as an irrigant during RCT, PEP may be less likely with lower concentrations of NaOCl. Moderate certainty evidence indicates that lesser analgesia may be required with lower concentrations of NaOCl. These results should be cautiously interpreted.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Dentistry
Publisher:	Elsevier
ISSN:	0099-2399
Date of First Compliant Deposit:	18 June 2024
Date of Acceptance:	8 June 2024
Last Modified:	11 Nov 2024 14:45
URI:	https://orca.cardiff.ac.uk/id/eprint/169881

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