The XP-endo Shaper and Its Impact on Posttreatment Discomfort: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: This systematic review and meta-analysis assess the impact of the XP-endo Shaper (XPS) on postoperative pain following root canal treatment and compare its efficacy with other endodontic systems. METHODS: A comprehensive literature search was conducted in MEDLINE, Web of Science, Embase, and the Cochrane Library from January 2000-August 2024. Randomized controlled trials using XPS and reporting postoperative pain were included. Pain levels were measured using the Visual Analog Scale at multiple postoperative time points. Data were pooled and analyzed using a random effects model, revealing significant heterogeneity. RESULTS: Six randomized controlled trials involving 731 patients met the inclusion criteria. The pooled analysis revealed that XPS significantly reduced pain scores at the 6, 12, and 24-hour time points (standardized mean difference [SMD] -1.30, 95% confidence interval [CI] [-2.36, -0.24], P = .016; SMD -3.00, 95% CI [-3.54, -2.46], P < .001; SMD -0.91, 95% CI [-1.53, -0.28], P = .005, respectively) compared to other systems, including WaveOne Gold and HyFlex EDM. Pain scores beyond 48 hours were comparable between XPS and other file systems. CONCLUSIONS: XPS shows substantial short-term efficacy in reducing postoperative pain following root canal treatments, likely due to its flexible design and reduced debris extrusion. The findings suggest that XPS can potentially improve patient comfort, though long-term pain outcomes remain similar to other systems.