Publicación:

Dolor Postendodoncia en Una o Multiples citas: Umbrella Review

Resumen

Postendodontic pain after endodontic procedures is an undesirable event for both patients and specialists. It affects the patient's quality of life and the success of their relationship with the specialist, which can impact confidence in the procedure and treatment satisfaction.However, the perception of pain is relatively common even if the treatment was carried out with the highest quality standards; being a recurring constant. In this reasoning, it is necessary to incorporate prediction criteria, in order to warn the patient and consolidate pain control strategies. For this, there are factors that are reported to have significant effects on post-obturation pain, among which are: type of tooth or location, the presence and severity of preoperative pain; pulp state; presence and size of the periapical lesion; number of root canals present; intracanal irrigant, medications; obturation; presence of pain between appointments and number of treatment visits. These factors have been implemented as an outcome measure to justify a difference from single or multi-appointment root canal treatment.After the completion of the procedure, either in one or several appointments, the treated teeth may experience pain for the patient. Despite technological advances with rotary systems, whether continuous or reciprocating, it is likely that extrusion of debris inherent to the treatment will occur; which translates as pain. This causes the pain experienced to be associated with manual or rotary instrumentation. Following instrumentation, another factor that can affect pain is irrigation, this procedure being a means of transporting drugs, infected debris, and bacteria to the periapical tissue .Indeed, the persistence of pain may be unavoidable, since in the treatment of a single appointment or multiple appointments there may be a resistant biofilm that cannot be eliminated, generating an inflammatory reaction and pain after treatment. In the most detrimental setting, inflammatory reactions may evidence persistent pathology. Factors such as instrumentation, irrigation, passage of drugs or infected debris into periapical tissues, damage to vital neural or pulp tissue, or central sensitization have been shown to cause post-endodontic pain with a variation of approximately 3% and 58%. Taking into account that it is complex to classify pain precisely, since there is a subjective and particular perception that starts from the threshold or the psychological perception towards the consultation;there is a need to respond to the controversy about the influence of discomfort after endodontic treatment between one and several appointments. In this sense, the Umbrella Review methodology provides the optimal tools and protocols to examine the academic reviews on the subject, in order to consolidate specific variables that allow a clearer appreciation of the viability of endodontic treatment in one and several appointments. With evolution of new techniques, instruments, materials and a better understanding of the anatomy of the root canal, endodontics has had considerable development.Thus, in light of scientific and technological advances, it is necessary to reconsider the debate regarding the number of sessions that must be taken to perform an endodontic treatment and its influence on post-endodontic pain. Based on the previous contextualization, it is feasible to perform a root canal in a single visit, being a common practice today and revealing advantages such as: reduction in appointments, reduction in filtration, immediate preparation of the canal for the solution of aesthetic problems, reduction of procedure costs, reduction of risks due to the use of anesthesia, the use of a single isolation and a considerable rate of reduction of pain derived from the treatment. On the other hand, the endodontic treatment in multiple visits shows different care protocols, finding that in the first appointment the complete instrumentation is carried out and in the second appointment the obturation continues.Based on the aforementioned, this study arises with the need to determine the incidence of post-endodontic pain in the endodontic treatment of one or several appointments, taking into account, in turn, the role played by factors such as the type of Instrumentation, Irrigation and Medication in the clinical manifestation of pain and in the perception of pain by patients.