Emergency Clinical Treatment Protocols for Alleviating Pain in Patients with Symptomatic Irreversible Pulpitis of Permanent Teeth: Systematic Review and Meta-analysis

Introduction: Symptomatic Irreversible Pulpitis (SIP) is a frequent cause of dental emergencies, often presenting with severe and persistent pain. Multiple emergency treatment options have been suggested, but the relative effectiveness of these approaches remains uncertain. Aim: To evaluate the effectiveness of various emergency clinical treatment protocols in reducing pain among patients with SIP in permanent teeth. Materials and Methods: A comprehensive literature search was conducted using Medical Subject Headings (MeSH) terms and Boolean operators across databases including PubMed, Medline, ClinicalKey, ProQuest, and EBSCOhost. Grey literature sources were also searched for English-language articles published up to August 31, 2023. Following PRISMA guidelines, 19 Randomised Controlled Trials (RCTs) were selected based on inclusion and exclusion criteria, and the review was registered with the International Prospective Register of Systematic Reviews (PROSPERO). Results: Preoperatively, pharmacological strategies such as Non steroidal Anti-inflammatory Drugs (NSAIDs) and Novafen enhanced anaesthesia effectiveness and reduced baseline pain. Intraoperatively, pulpotomy–often with Calcium-enriched Mixture (CEM) or Mineral Trioxide Aggregate (MTA)–consistently relieved pain and was favoured for its simplicity. Occlusal reduction showed mixed results, with some studies reporting benefit. Adjuncts like cryotherapy, laser, and acupuncture demonstrated variable but promising outcomes. meta-analysis indicated that occlusal reduction significantly decreases pain at 12 hours (SMD=-0.32), and cryotherapy irrigation during root canal treatment leads to reduced postoperative discomfort (SMD-1.10), with Calcium Hydroxide {Ca(OH)2} pulpotomy showing substantial pain reduction (SMD-3.27). Conclusion: This review underscores the efficacy of diverse preoperative, intraoperative and postoperative strategies, in managing endodontic pain in permanent teeth, with pulpectomy and full pulpotomy offering the most consistent pain reduction. Incorporating these evidence-based interventions into clinical practice can enhance patient outcomes and optimise pain management in endodontic emergencies.