Abstract
Accumulated hard tissue debris (AHTD) in root canal irregularities may negatively impact adequate root canal disinfection. In light of this, the efficacy of passive ultrasonic irrigation (PUI) to reduce AHTD has been largely studied in in vitro studies, which have adopted different analytic methods of varying accuracy to determine the extent of AHTD more correctly. Therefore, the aim of this study was to compare how well PUI and non-activated irrigation (NAI) systems perform in reducing AHTD during final irrigation protocols, based exclusively on studies whose analyses used microCT scanning. A systematic search of the studies published up to April 2020 was performed using MeSH terms and free terms, in the following databases: PubMed, Scopus, Web of Science, BVS (Lilacs and BBO) and Embase. The inclusion criteria consisted of laboratory studies that evaluated the amount of AHTD, and compared PUI with NAI protocols using microCT analysis. The risk of bias in the selected studies was assessed critically by two reviewers. A meta-analysis was performed using the RevMan software program (P<0.05), and included studies providing the standardized mean difference (SMD), using a fixed effect model, and adopting a confidence interval of 95%. In all, 3495 studies were identified, three of which met the inclusion criteria. All three were considered as having a low risk of bias. The meta-analysis comparing the ability of PUI and NAI protocols to remove hard tissue debris showed a higher percentage of AHTD reduction (P<0.01) for PUI, with a confidence interval of 1.41 [0.79, 2.02]. The heterogeneity among the studies was 82% (I2). Considering the limitations of the present study, this systematic review and meta-analysis showed that PUI was more effective than NAI in removing hard tissue debris, based exclusively on studies that used microCT scanning to provide a more precise analysis of the two techniques used. The findings presented in the present study reinforce the concept that PUI can increase residue removal and improve the cleanliness of the root canal in endodontic treatments.
Highlights
The root canal system has a complex anatomy with areas that cannot be touched mechanically by endodontic instruments, such as isthmuses, finsBraz
Instrumentation alone cannot provide the complete removal of debris, even more so in the apical areas, where the use of irrigation protocols is key to achieving satisfactory outcomes for debris removal
Considering the limitations of the Virdee et al.[13] study, and the lack of systematic reviews that evaluated the reduction in accumulated hard tissue debris (AHTD) using microcomputed tomography (microCT) technology, the objective of this study was to compare how well passive ultrasonic irrigation (PUI) and non-activated irrigation (NAI) are able to reduce AHTD using microCT
Summary
The root canal system has a complex anatomy with areas that cannot be touched mechanically by endodontic instruments, such as isthmuses, finsBraz. The accumulated hard tissue debris (AHTD) within root canal irregularities may be inaccessible to conventional syringe-and-needle non-activated irrigation (NAI).[6,8] Additional supplementary methods, such as passive ultrasonic irrigation (PUI) using sodium hypochlorite (NaOCl) and/or ethylenediaminetetraacetic acid (EDTA), have been proposed to drive irrigant solutions into these root canal complexities.[9,10] PUI consists essentially of transmitting energy from an ultrasonically oscillating instrument to the irrigant solutions in the root canal.[11] Recesses in oval-shaped canals.[1,2] Apart from this, the use of endodontic instruments in contact with dentin walls produces dentin debris that accumulates in root canal irregularities and their complexities.[3,4] Residues such as pulpal tissue, infected dentin debris and microbial biofilm may remain inside the root canal system, and may interfere in the overall quality of root canal filling procedures, potentially contributing to endodontic treatment failure.[5,6,7] instrumentation alone cannot provide the complete removal of debris, even more so in the apical areas, where the use of irrigation protocols is key to achieving satisfactory outcomes for debris removal.
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