Assessment of apical patency maintenance and its influence on post-endodontic pain of root canal treated teeth: A systematic review and meta-analysis

Purpose: The purpose of this study was to determine the effect of apical patency versus non-apical patency filing on post-endodontic pain in root canal treated teeth in permanent dentition.
Methods: A search was conducted in Medline, Google Scholar, Scopus, Web of science, and Cochrane databases for randomized controlled trials and clinical trials comparing post-endodontic pain with apical patency and without apical patency maintenance with a follow-up period of 12 h, 24 h, 2 days, and 7 days. Certainty of evidence was determined using the grading of recommendations, assessment, development, and evaluations assessment tool. A random-effect model was used to assess the mean differences between the two used techniques.
Results: Five studies met the inclusion criteria. A total of 372 patients with apical filling versus 372 with no apical filling were available for analysis at end of 24 and 48 h. Apical patency maintenance was associated with lesser post-endodontic pain with a statistically significant difference at 12 h (MD = −1.49; p = 0.003) and 2 days (MD = −0.85; p = 0.04). Certainty of evidence for this association was moderate.
Conclusion: This meta-analysis presents evidence for reduced post-endodontic pain in permanent dentition when the apical patency technique is used for recapitulation. Clinical trials are further recommended so that research evidence may again be substantiated in the future.