Preliminary canal enlargement (glide path preparation) may play a significant role in the development of\npain. The aim of this systematic review of randomized clinical trials was to assess the influence of glide path kinematics\nduring endodontic treatment on the occurrence and intensity of intraoperative and postoperative pain.\nMethods: A search was performed in June 2019 in six electronic databases (PubMed, Scopus, LILACS, SciELO, Embase\nand Web of Science) and two grey literature databases (OpenGrey and OpenThesis). The bibliographic references of\nthe eligible articles were also hand-searched. The included clinical studies assessed the occurrence and intensity of\nintraoperative and/or postoperative pain after root canal preparation without glide path preparation (WGP) or with\nglide path preparation using manual (M-GP), continuous rotary (CR-GP), or reciprocating (R-GP) instruments. The\nprimary outcome was the occurrence and intensity of intraoperative and postoperative pain, while analgesic\nconsumption was the secondary outcome. The full texts of the eligible studies were analyzed by two reviewers who\nperformed calibration exercises to verify the risk of bias and quality of the individual studies using the Joanna Briggs\nInstitute Critical Appraisal tool.\nResults: From 1283 identified articles, only six studies were included in the qualitative analysis of the results, with a\ntotal sample of 884 patients/teeth. Three studies presented a high risk of bias, while three studies presented a\nmoderate risk. Two studies reported that CR-GP causes lower pain levels than M-GP and WGP, and three studies\nshowed no differences between CR-GP and R-GP. Regarding analgesic consumption, two studies found no differences\namong glide path kinematics, and one study reported lower consumption for CR-GP than for M-GP. Because of the\nlimited number of studies and methodological differences, no statistical analyses were performed for the glide path\nkinematics comparisons.\nCompelling evidence indicating a significantly different occurrence and intensity of pain among glide\npath kinematics is lacking.\nThe systematic review protocol was registered in the PROSPERO database [CRD42020139989].
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