Abstract
Objectives
The apical third is crucial for endodontic success, and while foraminal enlargement (FE) may enhance canal debridement, its effect on postoperative pain remains uncertain. This review aimed to determine whether FE during single-visit nonsurgical root canal treatment (NSRCT) of asymptomatic necrotic permanent teeth leads to increased postoperative pain compared with non-FE.Methods
This systematic review followed PRISMA 2020 and was registered in PROSPERO (CRD420250652786). MEDLINE, Web of Science, Embase, and Cochrane Central were searched to May 20, 2025, for randomized controlled trials (RCTs) comparing single-visit NSRCT with and without FE. Risk of bias was evaluated with RoB 2, and meta-analysis was conducted using a random-effects model.Results
Six RCTs involving 426 teeth were included. The overall pooled analysis demonstrated significantly greater postoperative pain in the FE group (standardized mean difference, 1.02; 95% confidence interval, 0.24-1.80; p = 0.01). The certainty of the evidence was low, primarily because of considerable inconsistency. Subgroup analyses showed statistically significant differences at 12 and 72 hours. Overall heterogeneity was substantial (I² = 92.3%) but decreased after exclusion of two influential studies without changing the direction of the pooled effect.Conclusions
FE is associated with a significant, though transient, increase in postoperative pain during the first week following NSRCT.