Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Effect of rotary and reciprocating instrumentation kinematics on postoperative pain following endodontic retreatment: a systematic review

  • Pratibha Singh (Community Health Center) ;
  • Akash Bhatnagar (Teerthanker Mahaveer Dental College and Research Centre, Teerthanker Mahaveer University) ;
  • Sharique Alam (Conservative Dentistry and Endodontics, Dr Z.A Dental College, Faculty of Medicine, Aligarh Muslim University) ;
  • Kanupriya Rathore (All India Institute of Medical Sciences)
  • Received : 2026.03.17
  • Accepted : 2026.04.27
  • Published : 2026.06.01
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Abstract

This review aimed to systematically evaluate whether rotary or reciprocating nickel-titanium instrumentation systems influence postoperative pain after nonsurgical endodontic retreatment. This systematic review was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261325110). A comprehensive electronic search was conducted in the PubMed, Scopus, Web of Science, and Embase databases. Randomized clinical trials comparing rotary and reciprocating systems for nonsurgical endodontic retreatment and reporting postoperative pain outcomes were included. Risk of bias was assessed using the Modified Cochrane RoB-2 tool. Due to clinical and methodological heterogeneity, a qualitative synthesis was performed. A total of 194 records were identified through a database search, and five randomized clinical trials fulfilled the inclusion criteria. Most studies reported no statistically significant differences in the incidence or intensity of postoperative pain between the rotary and reciprocating retreatment systems at 24, 48, and 72 h. However, one randomized clinical trial reported significantly higher early postoperative pain associated with the reciprocating system than with the rotary system during the initial postoperative period, whereas no significant difference was observed at longer follow-up intervals. Furthermore, no statistically significant differences were observed between the rotary and reciprocating kinematics regarding analgesic intake following the retreatment procedures. Based on available randomized evidence, rotary and reciprocating instrumentation systems appear to produce comparable postoperative pain following nonsurgical endodontic retreatment. Postoperative discomfort is generally mild, decreases over time, and does not demonstrate a consistent dependence on instrumentation kinematics.

Keywords

References

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