Ranking of interproximal reduction techniques by intrapulpal temperature changes: a systematic review and network meta-analysis
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Abstract
Objective: Interproximal reduction generates friction and subsequent heat that may lead to pulpal necrosis. This systematic review and network meta-analysis aimed to evaluate and rank the mean intrapulpal temperature increase (°C) associated with various interproximal reduction systems and cooling conditions to identify thermally safe protocols for clinical practice.
Materials and methods: A comprehensive search of PubMed, Scopus, Embase, WorldCat, and Google Scholar was conducted through January 31, 2026. Experimental and clinical studies evaluating the mean intrapulpal temperature increase (°C) during interproximal reduction in human permanent teeth were included. Internal validity was assessed using the QUIN and RoB 2 tools. A Bayesian network meta-analysis using a random-effects model was performed to calculate mean differences and 95% credible intervals. The thermal safety of 11 protocols was ranked using surface under the cumulative ranking curve (SUCRA) probabilities.
Results: Eight studies involving 712 interproximal measurement units, comparing 11 protocols, were included in the systematic review. Rotary tungsten carbide with coolant demonstrated the highest probability of minimizing temperature rise (SUCRA = 91.56%), followed by rotary low speed with coolant (SUCRA = 87.30%). However, differences among these highly ranked protocols and the control (hand without coolant) were not statistically significant. Conversely, non-cooled mechanical techniques were consistently ranked lower, with rotary tungsten carbide without coolant posing the highest thermal risk (SUCRA = 0.61%).
Conclusions: Rotary tungsten carbide, rotary low speed, rotary, and disc protocols (all with coolant), alongside hand without coolant, provide comparable thermal safety. Continuous water cooling is critical for motorized interproximal reduction. Motorized techniques without coolant pose significant thermal risks, particularly rotary tungsten carbide without coolant, which generates the highest temperature rise and should be avoided. When a dry working field is clinically necessary, oscillating and hand protocols without coolant serve as favorable alternatives.
Systematic review registration: PROSPERO CRD42022293226
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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