Influência das técnicas de instrumentação manual, rotatória e reciprocante na dor pós-operatória endodôntica: revisão sistemática da literatura.

Abstract

This systematic review aimed to evaluate the influence of hand, rotary and reciprocating instrumentation techniques on postoperative pain in patients submitted to endodontic treatment in permanent teeth. Articles were selected for this review according to the following inclusion criteria: randomized clinical trials with patients undergoing endodontic treatment in permanent teeth, comparing instrumentation techniques with different kinematics (hand stainless steel files vs. engine-driven nickeltitanium files or rotary vs. reciprocating engine-driven nickel-titanium files) and their effect on postoperative pain. Data on analgesic intake was also recorded. The electronic search was undertaken in MEDLINE, ISI Web of Science and Scopus databases, in addition to hand searches. Risk of bias was evaluated for each study and GRADE framework was applied for quality of evidence assessment. Twelve studies and 1659 patients aged between 14 and 73 years old were included in this review. Five studies compared hand vs. engine-driven (rotary and/or reciprocating) instrumentation techniques. Most results showed higher postoperative pain levels for hand preparation. Seven studies and one dataset from one of the five previous studies were included in the comparison of rotary vs. reciprocating techniques, with contrasting results. Most studies showed higher postoperative pain levels for reciprocating instrumentation. Data on analgesic intake revealed controversial findings. GRADE showed low quality of evidence. In conclusion, hand instrumentation technique induced higher postoperative pain levels when compared to engine-driven techniques. Reciprocating instruments drift to higher postoperative pain levels than rotary techniques. However, given the low quality of evidence and conflicting findings, results should be considered with caution.