Impact of instrumentation kinematics on post endodontic pain-an umbrella review with stratification of evidence and sensitivity analysis

Background: Our umbrella review examines the impact of instrumentation kinematics on postoperative pain in endodontic treatment by synthesizing current evidence from systematic reviews and meta-analyses. Methods: We performed an extensive search across six major electronic databases up to March 2025...

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Main Authors: Dax Abraham, Aakansha Puri, Alpa Gupta, Karina Singal, Adinath Walmik Talekar, Praharsha Anabathula
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:Journal of Oral Biology and Craniofacial Research
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Online Access:http://www.sciencedirect.com/science/article/pii/S2212426825001216
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author Dax Abraham
Aakansha Puri
Alpa Gupta
Karina Singal
Adinath Walmik Talekar
Praharsha Anabathula
author_facet Dax Abraham
Aakansha Puri
Alpa Gupta
Karina Singal
Adinath Walmik Talekar
Praharsha Anabathula
author_sort Dax Abraham
collection DOAJ
description Background: Our umbrella review examines the impact of instrumentation kinematics on postoperative pain in endodontic treatment by synthesizing current evidence from systematic reviews and meta-analyses. Methods: We performed an extensive search across six major electronic databases up to March 2025, focusing on English-language literature comparing rotary and reciprocating instrumentation systems. Quality assessment was rigorously conducted using the AMSTAR 2 tool, and a comprehensive risk of bias evaluation was carried out using the ROBIS tool. Results: Our analysis incorporated eight systematic reviews, seven of which provided meta-analytic data, thus ensuring a robust consolidation of findings. The results reveal that rotary instrumentation generally produces lower overall post-operative pain levels compared to reciprocating systems. However, the influence of instrumentation type appears to be time-dependent, with evidence suggesting that reciprocating systems may offer advantages in the immediate post-operative phase by reducing mild pain within 24 h. The review underscores the multifactorial nature of post-operative pain, where clinical outcomes are influenced not only by instrumentation kinematics but also by patient-specific factors, operator experience, and procedural variables. Conclusion: The insights provided by our review contribute to the current understanding of endodontic pain management and encourage further research utilizing standardized methodologies and extended follow-up periods to elucidate long-term outcomes. These findings have significant implications for clinical practice and the development of patient-centered treatment protocols in endodontics.
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publishDate 2025-07-01
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spelling doaj-art-19bbe0f5dc6746efa93bc5ad8b6b4e302025-08-20T03:59:30ZengElsevierJournal of Oral Biology and Craniofacial Research2212-42682025-07-0115488889810.1016/j.jobcr.2025.06.008Impact of instrumentation kinematics on post endodontic pain-an umbrella review with stratification of evidence and sensitivity analysisDax Abraham0Aakansha Puri1Alpa Gupta2Karina Singal3Adinath Walmik Talekar4Praharsha Anabathula5Corresponding author. Room no. QS 21, Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Sec 43, Delhi Surjakund Road, Faridabad, 121001, Haryana, India.; Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, IndiaDepartment of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, IndiaDepartment of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, IndiaDepartment of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, IndiaDepartment of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, IndiaDepartment of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, IndiaBackground: Our umbrella review examines the impact of instrumentation kinematics on postoperative pain in endodontic treatment by synthesizing current evidence from systematic reviews and meta-analyses. Methods: We performed an extensive search across six major electronic databases up to March 2025, focusing on English-language literature comparing rotary and reciprocating instrumentation systems. Quality assessment was rigorously conducted using the AMSTAR 2 tool, and a comprehensive risk of bias evaluation was carried out using the ROBIS tool. Results: Our analysis incorporated eight systematic reviews, seven of which provided meta-analytic data, thus ensuring a robust consolidation of findings. The results reveal that rotary instrumentation generally produces lower overall post-operative pain levels compared to reciprocating systems. However, the influence of instrumentation type appears to be time-dependent, with evidence suggesting that reciprocating systems may offer advantages in the immediate post-operative phase by reducing mild pain within 24 h. The review underscores the multifactorial nature of post-operative pain, where clinical outcomes are influenced not only by instrumentation kinematics but also by patient-specific factors, operator experience, and procedural variables. Conclusion: The insights provided by our review contribute to the current understanding of endodontic pain management and encourage further research utilizing standardized methodologies and extended follow-up periods to elucidate long-term outcomes. These findings have significant implications for clinical practice and the development of patient-centered treatment protocols in endodontics.http://www.sciencedirect.com/science/article/pii/S2212426825001216Root canal therapyEndodonticsPostoperative painRotary instrumentationReciprocating instrumentationSystematic review
spellingShingle Dax Abraham
Aakansha Puri
Alpa Gupta
Karina Singal
Adinath Walmik Talekar
Praharsha Anabathula
Impact of instrumentation kinematics on post endodontic pain-an umbrella review with stratification of evidence and sensitivity analysis
Journal of Oral Biology and Craniofacial Research
Root canal therapy
Endodontics
Postoperative pain
Rotary instrumentation
Reciprocating instrumentation
Systematic review
title Impact of instrumentation kinematics on post endodontic pain-an umbrella review with stratification of evidence and sensitivity analysis
title_full Impact of instrumentation kinematics on post endodontic pain-an umbrella review with stratification of evidence and sensitivity analysis
title_fullStr Impact of instrumentation kinematics on post endodontic pain-an umbrella review with stratification of evidence and sensitivity analysis
title_full_unstemmed Impact of instrumentation kinematics on post endodontic pain-an umbrella review with stratification of evidence and sensitivity analysis
title_short Impact of instrumentation kinematics on post endodontic pain-an umbrella review with stratification of evidence and sensitivity analysis
title_sort impact of instrumentation kinematics on post endodontic pain an umbrella review with stratification of evidence and sensitivity analysis
topic Root canal therapy
Endodontics
Postoperative pain
Rotary instrumentation
Reciprocating instrumentation
Systematic review
url http://www.sciencedirect.com/science/article/pii/S2212426825001216
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