{"title":"与牙髓病发作相关的因素：一项系统回顾和荟萃分析。","authors":"Jun Ohshima, Masayoshi Morita, Yuzo Kawanishi, Shotaro Abe, Nobutake Tanaka, Tsuyoshi Shimaoka, Hazuki Maezono, Yoshifumi Kinomoto, Mikako Hayashi","doi":"10.1111/iej.70164","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Endodontic flare-ups, characterized by severe postoperative pain and/or swelling requiring unscheduled intervention, remain a clinically significant concern in root canal therapy. Identifying the factors associated with flare-ups is important for anticipating and managing patient outcomes.</p><p><strong>Objectives: </strong>This systematic review and meta-analysis aimed to identify and synthesize clinical risk factors associated with endodontic flare-ups following root canal treatment.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus from database inception to September 2025. Eligible studies included observational or interventional studies evaluating the association between potential risk factors and flare-up occurrence. Risk of bias was assessed using ROBINS-I for non-randomized studies and the Cochrane RoB 2 tool for randomized controlled trials. Certainty of evidence was evaluated using the GRADE approach.</p><p><strong>Results: </strong>A total of 15 eligible studies involving 24 320 cases met the inclusion criteria. The overall incidence of severe flare-ups was 2.83%. Significant risk factors included female sex, mandibular tooth location, non-vital pulp status, preoperative spontaneous pain, periapical lesions, multiple-visit treatment, re-treatment, and preoperative percussion pain. Among these, preoperative spontaneous pain (relative risk = 5.83) and percussion pain (relative risk = 3.45) demonstrated the strongest associations. By contrast, age, tooth type, number of root canals, instrumentation technique, and preoperative analgesic use were not significantly associated with flare-up incidence.</p><p><strong>Conclusion: </strong>Several clinical factors appear to be associated with an increased risk of endodontic flare-ups. Although the overall certainty of evidence is low, these findings may assist clinicians in identifying higher-risk cases and counselling patients regarding potential postoperative outcomes. Further well-designed prospective studies are needed to strengthen the evidence base.</p><p><strong>Trail registration: </strong>PROSPERO Systematic review registration number: CRD420251025451.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1000,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors Associated With Endodontic Flare-Ups: A Systematic Review and Meta-Analysis.\",\"authors\":\"Jun Ohshima, Masayoshi Morita, Yuzo Kawanishi, Shotaro Abe, Nobutake Tanaka, Tsuyoshi Shimaoka, Hazuki Maezono, Yoshifumi Kinomoto, Mikako Hayashi\",\"doi\":\"10.1111/iej.70164\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Endodontic flare-ups, characterized by severe postoperative pain and/or swelling requiring unscheduled intervention, remain a clinically significant concern in root canal therapy. Identifying the factors associated with flare-ups is important for anticipating and managing patient outcomes.</p><p><strong>Objectives: </strong>This systematic review and meta-analysis aimed to identify and synthesize clinical risk factors associated with endodontic flare-ups following root canal treatment.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus from database inception to September 2025. Eligible studies included observational or interventional studies evaluating the association between potential risk factors and flare-up occurrence. Risk of bias was assessed using ROBINS-I for non-randomized studies and the Cochrane RoB 2 tool for randomized controlled trials. Certainty of evidence was evaluated using the GRADE approach.</p><p><strong>Results: </strong>A total of 15 eligible studies involving 24 320 cases met the inclusion criteria. The overall incidence of severe flare-ups was 2.83%. Significant risk factors included female sex, mandibular tooth location, non-vital pulp status, preoperative spontaneous pain, periapical lesions, multiple-visit treatment, re-treatment, and preoperative percussion pain. Among these, preoperative spontaneous pain (relative risk = 5.83) and percussion pain (relative risk = 3.45) demonstrated the strongest associations. By contrast, age, tooth type, number of root canals, instrumentation technique, and preoperative analgesic use were not significantly associated with flare-up incidence.</p><p><strong>Conclusion: </strong>Several clinical factors appear to be associated with an increased risk of endodontic flare-ups. Although the overall certainty of evidence is low, these findings may assist clinicians in identifying higher-risk cases and counselling patients regarding potential postoperative outcomes. 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引用次数: 0
摘要
背景：以术后严重疼痛和/或肿胀为特征的根管突发事件，需要进行计划外干预，仍然是根管治疗中临床关注的重要问题。确定与发作相关的因素对于预测和管理患者的预后非常重要。目的：本系统综述和荟萃分析旨在识别和综合与根管治疗后牙根管发作相关的临床危险因素。方法：综合检索PubMed、Web of Science、Scopus数据库自建库至2025年9月的文献。符合条件的研究包括观察性或干预性研究，评估潜在危险因素与突发事件之间的关系。非随机研究采用ROBINS-I评估偏倚风险，随机对照试验采用Cochrane rob2工具评估偏倚风险。使用GRADE方法评估证据的确定性。结果：共纳入15项研究，24320例患者符合纳入标准。严重发作的总发生率为2.83%。显著危险因素包括女性、下颌牙位置、非重要牙髓状态、术前自发疼痛、根尖周病变、多次就诊、再次治疗和术前叩击痛。其中，术前自发性疼痛（相对风险= 5.83）和叩击痛（相对风险= 3.45）的相关性最强。相比之下，年龄、牙齿类型、根管数量、器械技术和术前止痛药使用与急性发作发生率无显著相关。结论：几个临床因素似乎与牙髓病发作的风险增加有关。尽管证据的总体确定性较低，但这些发现可能有助于临床医生识别高风险病例，并就潜在的术后结局向患者提供咨询。需要进一步精心设计的前瞻性研究来加强证据基础。试验注册：PROSPERO系统评价注册号：CRD420251025451。
Factors Associated With Endodontic Flare-Ups: A Systematic Review and Meta-Analysis.
Background: Endodontic flare-ups, characterized by severe postoperative pain and/or swelling requiring unscheduled intervention, remain a clinically significant concern in root canal therapy. Identifying the factors associated with flare-ups is important for anticipating and managing patient outcomes.
Objectives: This systematic review and meta-analysis aimed to identify and synthesize clinical risk factors associated with endodontic flare-ups following root canal treatment.
Methods: A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus from database inception to September 2025. Eligible studies included observational or interventional studies evaluating the association between potential risk factors and flare-up occurrence. Risk of bias was assessed using ROBINS-I for non-randomized studies and the Cochrane RoB 2 tool for randomized controlled trials. Certainty of evidence was evaluated using the GRADE approach.
Results: A total of 15 eligible studies involving 24 320 cases met the inclusion criteria. The overall incidence of severe flare-ups was 2.83%. Significant risk factors included female sex, mandibular tooth location, non-vital pulp status, preoperative spontaneous pain, periapical lesions, multiple-visit treatment, re-treatment, and preoperative percussion pain. Among these, preoperative spontaneous pain (relative risk = 5.83) and percussion pain (relative risk = 3.45) demonstrated the strongest associations. By contrast, age, tooth type, number of root canals, instrumentation technique, and preoperative analgesic use were not significantly associated with flare-up incidence.
Conclusion: Several clinical factors appear to be associated with an increased risk of endodontic flare-ups. Although the overall certainty of evidence is low, these findings may assist clinicians in identifying higher-risk cases and counselling patients regarding potential postoperative outcomes. Further well-designed prospective studies are needed to strengthen the evidence base.
期刊介绍：
The International Endodontic Journal is published monthly and strives to publish original articles of the highest quality to disseminate scientific and clinical knowledge; all manuscripts are subjected to peer review. Original scientific articles are published in the areas of biomedical science, applied materials science, bioengineering, epidemiology and social science relevant to endodontic disease and its management, and to the restoration of root-treated teeth. In addition, review articles, reports of clinical cases, book reviews, summaries and abstracts of scientific meetings and news items are accepted.
The International Endodontic Journal is essential reading for general dental practitioners, specialist endodontists, research, scientists and dental teachers.
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