Irrigating Solutions and Activation Methods Used in Clinical Endodontics: A Systematic Review

Abstract

BackgroundEx vivo and in vitro studies have demonstrated the effectiveness of some irrigation protocols in reducing the bacterial load in the root canal system. However, standardized protocols have not yet been defined for the real clinical context due to many irrigation procedures available.ObjectiveTo evaluate the clinical endodontic protocols and limitations of irrigating solutions in the disinfection of the root canal system in patients with apical periodontitis.MethodsPubMed, Scopus, Embase, Web of Science, and Cochrane databases were searched for randomized controlled trials (RCT) published until January 2021. Hand searching was also performed. Studies focused on evaluating the effectiveness of irrigating solutions and/or irrigation activation methods in reducing the bacterial load in the root canal system were considered. The Cochrane risk-of-bias tool for randomized trials (RoB2) was used to assess the quality of the studies.ResultsFour hundred and twenty eight published articles were identified. After removing the duplicate studies and analyzing full texts, seven RCTs were selected. Two studies compared pure NaOCl with some combination of NaOCl with HEDP and MTAD. Two studies analyzed the antibacterial efficacy of NaOCl and chlorhexidine (CHX). Three studies compared conventional needle irrigation with different irrigation activation methods (PUI, XP-endo finisher, F-file activator, EndoVac activator). The review attained a satisfactory methodology. The main results of each included study were described.DiscussionActivation methods provide significantly higher biofilm reduction than conventional needle irrigation methods. Combinations of NaOCl with different chelating agents were ineffective in terms of antimicrobial, but it could potentially increase the risk of irrigant extrusion. However, the irrigating protocols were not carefully detailed, especially those regarding the irrigants application time or total volume. The existing literature lacks high-quality studies. The level of evidence is moderate.ConclusionsThe available data is too heterogeneous to compare and identify the superiority of specific valuable irrigation protocols in each clinical context. Application time, volume, and activation methods should be standardized to determine the optimal irrigating procedures to reduce the bacterial load and ensure higher predictability of the endodontic treatment.Systematic Review Registration(https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218555), PROSPERO registration: CRD42020218555.

The Effect of Endodontic Irrigation on the Mineral Content of Root Canal Dentin: A Systematic Review and Meta-Analysis

“…Root canal preparation is one of the most critical parts of successful endodontic treatment, and this step is essential in two aspects, including cleaning and shaping the root canal and cleaning tissue debris and root canal irrigation to remove and debride the root canal and disinfect the root canal system ( 1 , 2 ). Various chemical solutions are being introduced and widely used ( 3 , 4 ).…”

“…Generally, it has been shown that because of morphological limitations, a significant percentage of the root canal wall areas (35%-53%) might be untouched during root canal instrumentation ( 2 ). To compensate for this shortcoming, root canal irrigation methods have been introduced to clean, disinfect or remove the smear layer based on the following strategies: irrigation and disinfection of the canal system with a conventional syringe and activating the irrigating solution during the irrigation process ( 2 ). The activation of the irrigants can increase the chemical and physical effects of the solution in the irrigation process due to the greater twitching and dispersion of the solution in the root canal system ( 2 , 14 ).…”

“…To compensate for this shortcoming, root canal irrigation methods have been introduced to clean, disinfect or remove the smear layer based on the following strategies: irrigation and disinfection of the canal system with a conventional syringe and activating the irrigating solution during the irrigation process ( 2 ). The activation of the irrigants can increase the chemical and physical effects of the solution in the irrigation process due to the greater twitching and dispersion of the solution in the root canal system ( 2 , 14 ). The irrigation solution can act by direct mechanical action, creating agitation with files such as F-file or XP-endo Finisher, tools to create subsonic movements such as Endo Activator, or ultrasonic system as a Passive Ultrasonic Irrigation (PUI) method ( 2 , 15 , 16 ).…”

Comparison of Endodontic Pain observed with Sodium Hypochloride, Hydrogen peroxide and Norman Saline based Root canal irrigants

“…It is a lengthy procedure in which the tooth is mechanically and chemically cleaned of bacteria and pulpal remnants, shaped into canals and then sealed into the canal system along with restoration of the coronal portion to prevent future reinfection. 1,2 This is usually done in multiple appointments. At the end of each visit, intracanal medicament with a temporary filling is placed.…”

Comparison of the Antimicrobial Effect of Chlorine Dioxide, Sodium Hypochlorite and Chlorhexidine, on Bacteria Isolated from the Root Canal

“…Most endodontic infections are treated by chemo-mechanical preparation, however, about 35-60% of the root canal walls remain intact [1,2]. Thus, failure of root canal treatment has been predominantly associated with an ineffective elimination of microorganisms in a planktonic state and biofilm, which are present in the entire root canal system [3][4][5]. Moreover, the development of apical periodontitis has also been observed in some apparently well endodontically treated teeth.…”