Abstract
BACKGROUND: Our umbrella review examines the impact of instrumentation kinematics on postoperative pain in endodontic treatment by synthesizing current evidence from systematic reviews and meta-analyses. METHODS: We performed an extensive search across six major electronic databases up to March 2025, focusing on English-language literature comparing rotary and reciprocating instrumentation systems. Quality assessment was rigorously conducted using the AMSTAR 2 tool, and a comprehensive risk of bias evaluation was carried out using the ROBIS tool. RESULTS: Our analysis incorporated eight systematic reviews, seven of which provided meta-analytic data, thus ensuring a robust consolidation of findings. The results reveal that rotary instrumentation generally produces lower overall post-operative pain levels compared to reciprocating systems. However, the influence of instrumentation type appears to be time-dependent, with evidence suggesting that reciprocating systems may offer advantages in the immediate post-operative phase by reducing mild pain within 24 h. The review underscores the multifactorial nature of post-operative pain, where clinical outcomes are influenced not only by instrumentation kinematics but also by patient-specific factors, operator experience, and procedural variables. CONCLUSION: The insights provided by our review contribute to the current understanding of endodontic pain management and encourage further research utilizing standardized methodologies and extended follow-up periods to elucidate long-term outcomes. These findings have significant implications for clinical practice and the development of patient-centered treatment protocols in endodontics.