The top risk factors for endodontic flare-up: a Monte Carlo simulation

Abstract

Objectives The aim of this study was to analyze the strength of risk factors related to endodontic flare-ups and rank them in order of their importance Materials and methods A systematic literature search of PubMed, Cochrane Central Register of Controlled Trials, Scopus, and ISI Web of Knowledge, and grey literature was conducted up to November 2019. One hundred ninety-eight publications were identified. Twelve records fulfilled the eligibility criteria, and eight significant risk factors for flare-up, namely, "Periapical lesion," "multiple-visit treatment," "preoperative pain," "necrotic teeth," "female gender," "retreatment," "percussion pain," and "analgesics," were selected to construct the simulation model. The final data pool was established by the integration of data of common risk factors in the included articles. Monte Carlo method was used to analyze of combined numerical data, for simulation of the risk factor impacts. Ten thousand iterations were generated in the simulation model. Results The results of the simulation revealed that the risk estimates of the factors had varying ranges of influence and probability on the flare-up risk. "Periapical lesion" was found to be the most sensitive risk factor, following by "preoperative pain" which was ranked the second place. The third-ranked risk factor was "multiple-visit treatment." The least sensitive risk factors for endodontic flare-up were "retreatment," "female gender," "necrotic teeth," and "analgesics." Conclusions The present study provides better comprehension on the importance of risk factors for flare-up based on their risk estimates. Clinical relevance A Monte Carlo simulation was adopted to identify the most influential risk factors for endodontic flare-up with a ranking, which can be used to provide meaningful predictions and further insights into clinicians' perception of flare-up risk.

The effect of two rotary and two reciprocating NiTi systems on postoperative pain after root canal retreatment on single‐rooted incisor teeth: A randomized controlled trial

“…A low incidence of postoperative pain was detected in this study, consistent with several studies (Alves, 2010; Aksoy et al, 2020; Tsesis et al, 2008). This finding can be attributed to the fact that advanced endodontic devices and systems that are used during routine endodontic procedures provide more appropriate chemo‐mechanical disinfection and reduce iatrogenic and procedural errors.…”

“…The more resistant infection present in cases of root canal retreatment may be a contributing factor for postoperative complications (Mattscheck et al, 2001; Siqueira Jr, 2003). Moreover, the presence of a periapical lesion is an important factor for the development of postoperative pain and flare‐up (Alves, 2010; Aksoy et al, 2020).…”

Effect of the Irrigation Agitation Technique on Postoperative Pain in Teeth With Symptomatic Irreversible Pulpitis

“…The aims of cleaning the root canal system are to reduce levels of microbes (primarily gram-negative anaerobes Enterococcus faecalis), dissolve pulp tissue, disrupt biofilm, and remove the smear layer and debris [22]. Failure to clean the canals sufficiently can lead to a poor prognosis and incomplete treatment which can cause postoperative pain and flare-ups [24,25]. NI alone is not the most effective method of cleaning the canal due to the complexities of the root canal systems [22].…”

Comparing the Frequency of Flare-Ups in Single vs Multiple Visit Non-Surgical Root Canal Therapy in Multi-Rooted Non Vital Teeth

“…The multiple-visit endodontic treatment was the third most important risk factor for the incidence of flare-up. 16,17 Flare-ups are complex events involving mechanical, chemical, and microbiological components and are related to age, tooth type, irrigation procedures, frequency of visits, and intra-canal medicaments. 18 A large study conducted in Srinagar Govt.…”