Effect of instrumentation systems on endotoxin reduction from root canal systems: A systematic review of clinical studies and meta‐analysis

Abstract

This systematic review assessed the effect of different root canal instrumentation systems on endotoxin reduction from the root canal system. The literature search was conducted in two electronic databases (PubMed and Scopus) using specific key words. The search strategy followed the PRISMA guidelines. Qualitative synthesis and quantitative synthesis of the data were performed and data interpretation was done based on the guidelines in the Cochrane Handbook. The risk of bias was assessed using Cochrane criteria. The initial search yielded 600 citations, of which three papers met the criteria for inclusion in this review. Studies showed a significant reduction in endotoxin following rotary and reciprocating instrumentation, with no significant differences between them. The meta-analysis showed no statistical significant difference between reciprocation and rotary files (P > 0.05). In conclusion, the instrumentation techniques compared in this review decrease endotoxin content from root canals, with no significant difference between them.

Comparison of two rotary systems in bacteria/lps removal from endodontic infections: randomized clinical trial

“…A systematic review has proved that when irrigating regimens are kept constant, the type of instrument used does not have an influence on endotoxin reduction during root canal treatment. 19 Nevertheless, no statistical difference was observed between both instrument systems. Another difference between the protocols of instrumentation evaluated is the final tip diameter of the last instrument used for each system: while HCM presents size #40/04 (step 6), PTN has size #30/07 (X3), which promotes further widening of the zone suggesting greater cleanliness of this region.…”

“…35 Such a threshold value of the infectious content remains unknown. 19 However, it is expected that in the absence of living gram-negative cells to maintain LPS levels, its action would only be transient and unlikely to impact treatment outcome.…”

“…Previous studies 17,18 have shown that the preparation of root canals with rotary system is capable of achieving a reduction of more than 90% of the bacteria and the endotoxin load (range of 99.41% to 99,93% for bacteria and 95,15% to 98,06% for endotoxin) of infected root canals. Neelakantan et al 19 observed that there is no significant difference between instrumentation techniques in the elimination of endotoxins. However, PTN and HCM were not validated yet with clinical studies evaluating their effectiveness in reducing bacteria and LPS.…”

Preferred reporting items for systematic reviews and meta‐analyses for abstracts: best practice for reporting abstracts of systematic reviews in Endodontology

“… Example 5a : ‘The risk of bias was assessed using Cochrane criteria’ (Neelakantan et al . ). Example 5b : ‘Quality of the included studies was appraised by the revised Cochrane risk of bias tool for randomized trials’ (Pulikkotil et al . ). …”

The impact of Distinctive Root Canal Instrumentation Systems on Endotoxin Lessening from the Root Canal: A Systematic Review and Meta-Analysis

“…The Cone-beam Computed Tomography Analysis has determined the bone destruction and it has been found that pain has a relationship with the number of endotoxins in the root canals [14,15]. Therefore, endotoxin's lessening has been considered one of the vital measures to diminish the total bone destruction [14].…”