Ultrasonic versus hand instrumentation for orthograde root canal treatment of permanent teeth

Abstract

Endodontic treatment of root canals or root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis (death) of the dental pulp (nerve). Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment. The objectives of this review were to determine the relative clinical effectiveness of ultrasonic versus hand instrumentation for orthograde root canal treatment of permanent teeth. We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. We searched the reference lists of relevant articles and personal database of trial reports in an attempt to locate additional published and unpublished trials. No language restriction was applied. The last electronic search was conducted in September 2006. Randomised controlled trials involving people over 18 years of age with single and multiple permanent teeth with a completely formed apex and with no evidence of internal resorption, requiring root canal treatment were included. Patients undertaking re-treatment of a tooth were excluded. Screening of eligible studies was conducted in duplicate and independently by two review authors. Results were to be expressed as fixed or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible randomised controlled trials were identified. This review illustrates that there are no published or ongoing randomised controlled clinical trials relevant to this review question and that there is currently insufficient evidence for the effectiveness of ultrasonic instrumentation used alone for orthograde root canal treatment. Future randomised controlled trials might focus more closely on evaluating the effectiveness of hand instrumentation compared with hand instrumentation and adjunctive ultrasonic instrumentation.