Effect of Chemical Debridement and Irrigant Activation on Endodontic Treatment Outcomes: An Updated Overview.

Nesreen Tashkandi,Faisal Alghamdi

doi:10.7759/cureus.21525

Abstract

Chemical debridement is considered one of the most important steps during root canal treatment to target unreached areas and provide thorough disinfection of the canals. The efficiency of this step efficiency can be increased using different agitation and irrigation techniques/devices. This comprehensive review aimed to summarize the effect of various irrigant activation and agitation techniques/devices on endodontic treatment outcomes. Using mechanical active irrigation, which enables the activation or agitation of the irrigating solution, is beneficial in root canal treatment by increasing the efficiency of delivering the irrigant up to working length and ensuring isthmus cleanliness. However, considerable variation was noticed between the protocols used in each technique with a lack of well-designed randomized clinical trials to focus on the long-term outcome. Moreover, a low level of evidence was noticed regarding the effectiveness of certain activation techniques over others. Therefore, each study needs to be carefully weighed before using its results and embracing its conclusion. Future studies need to focus more on the antimicrobial effect of each technique and its effect on the healing of apical periodontitis. Also, recent advances, such as multisonic and laser activation, are promising tools that need more clinical investigations to show their efficiency.

Highlights

BackgroundChemical debridement is achieved by effectively cleaning and disinfecting the root canal system using irrigants and appropriate techniques
The bacterial biofilm, viruses, yeasts, archaea, and smear layer formed during instrumentation make the chemical debridement procedure more challenging and form a major obstacle to completely cleaning the root canal system [3]
Many techniques and devices were introduced to the dental market but not all of them were effective. This comprehensive review aims to summarize the effect of various irrigant activation and agitation techniques or devices on endodontic treatment outcomes

Summary

Introduction

Chemical debridement is achieved by effectively cleaning and disinfecting the root canal system using irrigants and appropriate techniques. This is the activation of the irrigant solution inside the root canal using ultrasonic energy between 25-32 Kilohertz (kHz) [35]. The second one is passive ultrasonic irrigation (PUI) that consists of irrigation activation without simultaneous instrumentation This technique transmits energy from the oscillating file to the irrigant inside the root canal to form acoustic streaming and cavitation of the irrigant [38]. Multisonic activation is considered one of the most recent techniques used in chemical debridement It uses the implosion of bubbles created with acoustic waves in various frequencies to improve irrigant flow all over the root canal system and enhances the chemical effect of the irrigant [109]. A recent study showed that GentleWave is not significantly better than ultrasonic activation in regards to debris removal [113]

Conclusions

Disclosures

Findings

Zehnder M