Restor Dent Endod.  2020 Aug;45(3):e26. 10.5395/rde.2020.45.e26.

Calcium hydroxide intracanal medication effects on pain and flare-up: a systematic review and meta-analysis

• Ibrahim AM
• Zakhary SY
• Wanees Amin SA

• KMID: 2512017
• DOI: http://doi.org/10.5395/rde.2020.45.e26

Abstract

Objectives
This study aimed to systematically review the pain and flare-up effects of calcium hydroxide (CH) as intracanal medication (ICM) in non-vital mature teeth.
Materials and Methods
Electronic-databases searching for published and grey literature and manual searching were conducted. Only randomized clinical trials (RCTs) were included comparing CH to other ICMs in non-vital mature teeth. The risk of bias was assessed using the RoB 2.0 Cochrane tool. The main outcomes were pain and flare-up. Qualitative and quantitative analysis, wherever applicable, was performed. The certainty of evidence (CoE) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results
Sixteen articles were included in 6 comparisons at different time points for different outcomes. CH reduced pain risk than no ICM within the 1–14-days interval (p < 0.05) and than triple-antibiotic paste within the first day (p < 0.05) and was similar to corticosteroid/ antibiotics combination (p > 0.05). Chlorhexidine (CHX) or CH/CHX, however, reduced pain levels than CH alone (p < 0.05). CH showed higher flare-up risk than CHX (p < 0.05). CoE, however, ranged from very low to moderate.
Conclusion
Most comparisons for different outcomes are based on very few studies, mostly low-powered, with an overall low CoE. Thus, the available evidence is considered insufficient to either support or refute CH effectiveness or to recommend one ICM over another.Therefore, further well-designed, larger RCTs are required.

Keyword

Calcium hydroxide; Intracanal medication; Meta-analysis; Non-vital pulp; Systematic review

Figure

• 

  Figure 1 PRISMA flowchart.RCT, randomized clinical trial.

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  Figure 2 Calcium hydroxide (CH) versus no intracanal medication (ICM) comparison. Forest plots showing postoperative pain incidence within (A) the > 1-day-till-3-days interval, and (B) the > 3-day-till-14-days interval; and postoperative pain intensity within (C) the ≤ 1-day interval, (D) the > 1-day-till-3-days interval, and (E) the > 3-day-till-14-days interval.CI, confidence interval; SD, standard deviation.

• 

  Figure 3 Calcium hydroxide (CH) versus chlorhexidine (CHX) comparison. Forest plots showing postoperative pain incidence within (A) the > 1-day-till-3-days interval, with (B) its sensitivity analysis using the random-effect model, then within (C) the > 3-day-till-14-days interval. (D) Flare-up incidence forest plot.CI, confidence interval.

• 

  Figure 4 Calcium hydroxide (CH) versus corticosteroid/antibiotic combination (CS/AB) comparison. Forest plots showing postoperative pain incidence within (A) the ≤ 1-day interval, and (B) the > 1-day-till-3-days interval; and postoperative pain intensity within (C) the ≤ 1-day interval, with (D) its sensitivity analysis using the random-effect model, then within (E) the > 1-day-till-3-days interval with (F) its sensitivity analysis using the random-effect model.

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