A systematic review of the impact of apical patency on postoperative pain

Abstract

Background and aims: Apical patency (AP), a technique in endodontics, involves keeping a small opening in the apical foramen during root canal instrumentation. However, there has been a debate about its effect on postoperative pain. To clarify this issue, this systematic review aimed to study the literature and determine the impact of AP on postoperative pain after endodontic procedures. Methods: A systematic search was conducted across multiple databases, including PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library, up to November 2, 2023. Studies on the relationship between AP and postoperative pain in endodontic treatments were included in this research. Relevant articles were independently screened, and data were extracted based on our study aims. Results: Eleven randomized controlled trial studies met the inclusion criteria. The findings indicated that among the included studies, six demonstrated no differences between the AP and non-AP (NAP) groups in terms of postoperative pain scores. In addition, four studies reported a decrease in operative pain in the AP group compared to the NAP group, and only one study showed that AP increases postoperative pain. However, conflicting evidence was observed in a subset of studies; there were no significant differences between the AP and NAP groups in terms of the postoperative pain scores. Conclusion: Compared with NAP, AP does not intensify the postoperative pain in teeth with vital and necrotic pulp.