Influence of glide path kinematics during endodontic treatment on the occurrence and intensity of intraoperative and postoperative pain: a systematic review of randomized clinical trials

Abstract

Background Preliminary canal enlargement (glide path preparation) may play a significant role in the development of pain. The aim of this systematic review of randomized clinical trials was to assess the influence of glide path kinematics during endodontic treatment on the occurrence and intensity of intraoperative and postoperative pain. Methods A search was performed in June 2019 in six electronic databases (PubMed, Scopus, LILACS, SciELO, Embase and Web of Science) and two grey literature databases (OpenGrey and OpenThesis). The bibliographic references of the eligible articles were also hand-searched. The included clinical studies assessed the occurrence and intensity of intraoperative and/or postoperative pain after root canal preparation without glide path preparation (WGP) or with glide path preparation using manual (M-GP), continuous rotary (CR-GP), or reciprocating (R-GP) instruments. The primary outcome was the occurrence and intensity of intraoperative and postoperative pain, while analgesic consumption was the secondary outcome. The full texts of the eligible studies were analyzed by two reviewers who performed calibration exercises to verify the risk of bias and quality of the individual studies using the Joanna Briggs Institute Critical Appraisal tool. Results From 1283 identified articles, only six studies were included in the qualitative analysis of the results, with a total sample of 884 patients/teeth. Three studies presented a high risk of bias, while three studies presented a moderate risk. Two studies reported that CR-GP causes lower pain levels than M-GP and WGP, and three studies showed no differences between CR-GP and R-GP. Regarding analgesic consumption, two studies found no differences among glide path kinematics, and one study reported lower consumption for CR-GP than for M-GP. Because of the limited number of studies and methodological differences, no statistical analyses were performed for the glide path kinematics comparisons. Conclusions Compelling evidence indicating a significantly different occurrence and intensity of pain among glide path kinematics is lacking. The systematic review protocol was registered in the PROSPERO database [CRD42020139989].

Analysis of a glide path creation necessity at the initial stages of endodontic treatment

“…[8]. That is, we can say that at present, most rotary systems need, or for them, to one degree or another, it is recommended to establish a glide path to the apical foramen before direct use of automatic instrumentation in order to eliminate blocking elements of the individual anatomy of the canals and preserve their macroanatomical characteristics, the occurrence of iatrogenic complications such as canal transportation, aberrations, perforations, fractures of nickel-titanium instruments and the formation of "dentin plugs" [1,3,7].…”

“…1/2021 Обзоры / Reviews in the first 48 hours and to 11% 7 days after treatment. Numerous factors contribute to potentiation / elimination of postoperative pain, in particular, it depends on the patient's reactivity, the group of the tooth being restored, the number of patient visits for treatment, the type of chemical used for irrigation or relief of inflammation, as well as the method of obturation, which makes the clinical study of postoperative pain quite difficult [1,8].…”

“…The clinical symptoms and severity of post-endodontic pain is in direct proportion to the concentration and amount of sodium hypochlorite excreted from the root apex. Standardization of irrigation protocols, such as control of needle penetration depth, can eliminate the effect of intraoperative variables on pain scores [1,29].…”

“…All instrumentation methods are associated with the extrusion of in-canal content, and its amount varies depending on the kinematics and design of the tool used [7,8,13,22]. According to the authors, the use of the "glide path" method (mainly rotary instruments) at the initial stages of root canal preparation can reduce the amount of substances extruded behind the apex, which, in turn, reduces the response from the periapical tissues, reducing postoperative sensitivity and pain, since there is no massive release of chemical mediators of inflammation, such as neuropeptides, metabolites of arachidonic acid, cytokines, lysosomal enzymes, platelet activating factor, fibrinolytic peptides, vasoactive amines, kinins and others [1].…”

“…One of the pre-enlargement strategies for canal preparation, which has become a widely discussed issue in endodontics, is the creation of a "glide path". This condition is defined as the presence of even and smooth walls of the root canal from the orifice to physiological constriction, which ensures further predictable behavior of the instruments [1][2][3][4][5][6][7][8][20][21][22][23][24][25]. The glide path can be created with both manual and rotary instruments.…”