Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review

SUSILA, Anand; MINU, Joseph

doi:DOI 10.14744/eej.2019.80774

Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review

Anand SUSILA, (Madha Dental College, Department of Conservative Dentistry Endodontics, Madha Nagar, Kundrathur, Chennai, India)

Joseph MINU (Madha Dental College, Department of Conservative Dentistry Endodontics, Madha Nagar, Kundrathur, Chennai, India)

European Endodontic Journal

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Yıl: 2019 Cilt: 4 Sayı: 3 Sayfa Aralığı: 96 - 110 Metin Dili: İngilizce DOI: DOI 10.14744/eej.2019.80774 İndeks Tarihi: 30-11-2020

Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review

Öz:

Objective: Irrigant activation has been claimed to be beneficial in in vitro and clinical studies. This systematic review aims to investigate the clinical efficiency of mechanically activated irrigants and conventional irrigation. Methods: A literature search (PROSPERO registration number: CRD42018112595) was undertaken in PubMed, Cochrane and hand search. The inclusion criteria were clinical trials, in vivo/ex vivo on adult permanent teeth involving an active irrigation device and a control group of conventional irrigation. The exclusion criteria were studies done in vitro, animals and foreign language. Adult patients requiring endodontic treatment of permanent dentition and irrigant activation during the treatment were chosen as the participants and intervention respectively. Results: After removal of duplicates, 89 articles were obtained, and 72 were excluded as they did not meet the selection criteria. 6 devices (EndoVac, EndoActivator, Ultrasonic, MDA (manual dynamic agitation), CUI (Continuous Ultrasonic Irrigation) and PUI (Passive Ultrasonic Irrigation)) and 6 variables of interest (Post-operative pain, periapical healing, antibacterial efficacy, canal and/or isthmus cleanliness, debridement efficacy and delivery up to working length) were evaluated in the 17 included articles. The risk of bias and quality of the selected articles were moderate. Results showed that mechanical active irrigation reduces post-operative pain. It improved debridement, canal/isthmus cleanliness. It also improved delivery of irrigant up to working length. Bacterial count was more with active irrigation, though not significant. There is no effect on long-term periapical healing. Conclusion: It may be concluded that mechanical active irrigation devices are beneficial in reducing postoperative pain and improving canal and isthmus cleanliness during Endodontics.

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Hargreaves K, Berman L. Cohen’s Pathways of the Pulp. 11th ed. St.Louis, Missouri: Elsevier; 2016.
Parente JM, Loushine RJ, Susin L, Gu L, Looney SW, Weller RN, et al. Root canal debridement using manual dynamic agitation or the EndoVac for f inal irrigation in a closed system and an open system. Int Endod J 2010; 43(11):1001–12.
Tronstad L, Barnett F, Schwartzben L, Frasca P. Effectiveness and safety of a sonic vibratory endodontic instrument. Endod Dent Traumatol 1985; 1(2):69–76.
Ruddle CJ. Microbrush for endodontic use.Available at: https://patentimages.storage.googleapis.com/22/45/de/9b44d0dccd96b4/US6179617. pdf. Accessed Nov 25, 2019.
Weise M, Roggendorf MJ, Ebert J, Petschelt A, Frankenberger R. Four methods for cleaning simulated lateral extensions of curved root canals-a SEM evaluation. Int Endod J 2007; 40(12):979–1007.
Gutarts R, Nusstein J, Reader A, Beck M. In vivo debridement efficacy of ultrasonic irrigation following hand-rotary instrumentation in human mandibular molars. J Endod 2005; 31(3):166–70.
Middha M, Sangwan P, Tewari S, Duhan J. Effect of continuous ultrasonic irrigation on postoperative pain in mandibular molars with nonvital pulps: a randomized clinical trial. Int Endod J 2017; 50(6):522–30.
Rödig T, Bozkurt M, Konietschke F, Hülsmann M. Comparison of the Vibringe system with syringe and passive ultrasonic irrigation in removing debris from simulated root canal irregularities. J Endod 2010; 36(8):1410–3.
De Moor RJ, Blanken J, Meire M, Verdaasdonk R. Laser induced explosive vapor and cavitation resulting in effective irrigation of the root canal. Part 2: evaluation of the efficacy. Lasers Surg Med 2009; 41(7):520–3.
10. Nusstein J. Ultrasonic dental device. Available at: https://patentimages. storage.googleapis.com/a9/59/eb/fe52abbe04f962/WO2004060188A3. pdf. Accessed Nov 25, 2019.
11. Schoeffel GJ. The EndoVac method of endodontic irrigation: safety first. Dent Today 2007; 26(10):92–6.
12. McGill S, Gulabivala K, Mordan N, Ng YL. The efficacy of dynamic irrigation using a commercially available system (RinsEndo) determined by removal of a collagen ‘bio-molecular film’ from an ex vivo model. Int Endod J 2008; 41(7):602–8.
13. Gu LS, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR. Review of contemporary irrigant agitation techniques and devices. J Endod 2009; 35(6):791804.
14. Gondim E Jr, Setzer FC, Dos Carmo CB, Kim S. Postoperative pain after the application of two different irrigation devices in a prospective randomized clinical trial. J Endod 2010; 36(8):1295–301.
15. Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation in endodontics. Br Dent J 2014; 216(6):299–303.
16. Molina B, Glickman G, Vandrangi P, Khakpour M. Evaluation of Root Canal Debridement of Human Molars Using the GentleWave System. J Endod 2015; 41(10):1701–5.
17. Walters MJ, Baumgartner JC, Marshall JG. Efficacy of irrigation with rotary instrumentation. J Endod 2002; 28(12):837–9.
18. Siqueira JF Jr, Alves FR, Almeida BM, de Oliveira JC, Rôças IN. Ability of chemomechanical preparation with either rotary instruments or self-adjusting file to disinfect oval-shaped root canals. J Endod 2010; 36(11):1860–5.
19. Ramamoorthi S, Nivedhitha MS, Divyanand MJ. Comparative evaluation of postoperative pain after using endodontic needle and EndoActivator during root canal irrigation: A randomised controlled trial. Aust Endod J 2015; 41(2):78–87.
20. Liang YH, Jiang LM, Jiang L, Chen XB, Liu YY, Tian FC, et al. Radiographic healing after a root canal treatment performed in single-rooted teeth with and without ultrasonic activation of the irrigant: a randomized controlled trial. J Endod 2013; 39(10):1218–25.
21. Tang Z, Wang H, Jiang S. Clinical study of single-visit root canal treatment with a nickel-titanium (Ni-Ti) rotary instrument combined with different ultrasonic irrigation solutions for elderly patients with chronic apical periodontitis. Biomed Mater Eng 2015; 26 Suppl 1:S311–8.
22. Munoz HR, Camacho-Cuadra K. In vivo efficacy of three different endodontic irrigation systems for irrigant delivery to working length of mesial canals of mandibular molars. J Endod 2012; 38(4):445–8.
23. Haidet J, Reader A, Beck M, Meyers W. An in vivo comparison of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars. J Endod 1989; 15(5):195–9.
24. Archer R, Reader A, Nist R, Beck M, Meyers WJ. An in vivo evaluation of the efficacy of ultrasound after step-back preparation in mandibular molars. J Endod 1992; 18(11):549–52.
25. Carver K, Nusstein J, Reader A, Beck M. In vivo antibacterial efficacy of ultrasound after hand and rotary instrumentation in human mandibular molars. J Endod 2007; 33(9):1038–43.
26. Paiva SS, Siqueira JF Jr, Rôças IN, Carmo FL, Ferreira DC, Curvelo JA, et al. Supplementing the antimicrobial effects of chemomechanical debridement with either passive ultrasonic irrigation or a final rinse with chlorhexidine: a clinical study. J Endod 2012; 38(9):1202–6.
27. Burleson A, Nusstein J, Reader A, Beck M. The in vivo evaluation of hand/ rotary/ultrasound instrumentation in necrotic, human mandibular molars. J Endod 2007; 33(7):782–7.
28. Huffaker SK, Safavi K, Spangberg LS, Kaufman B. Influence of a passive sonic irrigation system on the elimination of bacteria from root canal systems: a clinical study. J Endod 2010; 36(8):1315–8.
29. Siu C, Baumgartner JC. Comparison of the debridement efficacy of the EndoVac irrigation system and conventional needle root canal irrigation in vivo. J Endod 2010; 36(11):1782–5.
30. Pawar R, Alqaied A, Safavi K, Boyko J, Kaufman B. Influence of an apical negative pressure irrigation system on bacterial elimination during endodontic therapy: a prospective randomized clinical study. J Endod 2012; 38(9):1177–81.
31. Topçuoğlu HS, Topçuoğlu G, Arslan H. The Effect of Apical Positive and Negative Pressure Irrigation Methods on Postoperative Pain in Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial. J Endod 2018; 44(8):1210–5.
32. Topçuoğlu HS, Topçuoğlu G, Arslan H. The Effect of Different Irrigation Agitation Techniques on Postoperative Pain in Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial. J Endod 2018; 44(10):1451–6.
33. Martin H, Cunningham WT, Norris JP, Cotton WR. Ultrasonic versus hand f iling of dentin: a quantitative study. Oral Surg Oral Med Oral Pathol 1980; 49(1):79–81.
34. van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J 2007; 40(6):415–26.
35. Llena C, Cuesta C, Forner L, Mozo S, Segura JJ. The effect of passive ultrasonic activation of 2% chlorhexidine or 3% sodium hypochlorite in canal wall cleaning. J Clin Exp Dent 2015; 7(1):e69–73.
36. Sathorn C, Parashos P, Messer H. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review. Int Endod J 2008; 41(2):91–9.
37. van der Sluis LW, Wu MK, Wesselink PR. A comparison between a smooth wire and a K-file in removing artificially placed dentine debris from root canals in resin blocks during ultrasonic irrigation. Int Endod J 2005; 38(9):593–6.
38. Mitchell RP, Baumgartner JC, Sedgley CM. Apical extrusion of sodium hypochlorite using different root canal irrigation systems. J Endod 2011; 37(12):1677–81.
39. Desai P, Himel V. Comparative safety of various intracanal irrigation systems. J Endod 2009; 35(4):545–9.
40. Heilborn C, Reynolds K, Johnson JD, Cohenca N. Cleaning efficacy of an apical negative-pressure irrigation system at different exposure times. Quintessence Int 2010; 41(9):759–67.
41. Alkahtani A, Al Khudhairi TD, Anil S. A comparative study of the debridement efficacy and apical extrusion of dynamic and passive root canal irrigation systems. BMC Oral Health 2014; 14:12.
42. Abarajithan M, Dham S, Velmurugan N, Valerian-Albuquerque D, Ballal S, Senthilkumar H. Comparison of Endovac irrigation system with conventional irrigation for removal of intracanal smear layer: an in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112(3):407–11.
43. Malentacca A, Uccioli U, Zangari D, Lajolo C, Fabiani C. Efficacy and safety of various active irrigation devices when used with either positive or negative pressure: an in vitro study. J Endod 2012; 38(12):16226.
44. Weller RN, Brady JM, Bernier WE. Efficacy of ultrasonic cleaning. J Endod 1980; 6(9):740–3.
45. Weber CD, McClanahan SB, Miller GA, Diener-West M, Johnson JD. The effect of passive ultrasonic activation of 2% chlorhexidine or 5.25% sodium hypochlorite irrigant on residual antimicrobial activity in root canals. J Endod 2003; 29(9):562–4.
46. Rodríguez-Figueroa C, McClanahan SB, Bowles WR. Spectrophotometric determination of irrigant extrusion using passive ultrasonicirrigation, EndoActivator, or syringe irrigation. J Endod 2014; 40(10):1622–6.
47. Ahmad M, Pitt Ford TR, Crum LA. Ultrasonic debridement of root canals: an insight into the mechanisms involved. J Endod 1987; 13(3):93–101.
48. Richman RJ. The use of ultrasonics in root canal therapy and root resection. Med Dent J 1957;12:12– 8.
49. Plotino G, Pameijer CH, Grande NM, Somma F. Ultrasonics in endodontics: a review of the literature. J Endod 2007; 33(2):81–95.
50. Lottanti S, Gautschi H, Sener B, Zehnder M. Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer. Int Endod J 2009; 42(4):335–43.
51. Munley PJ, Goodell GG. Comparison of passive ultrasonic debridement between fluted and nonfluted instruments in root canals. J Endod 2007; 33(5):578–80.
52. Yost RA, Bergeron BE, Kirkpatrick TC, Roberts MD, Roberts HW, Himel VT, et al. Evaluation of 4 Different Irrigating Systems for Apical Extrusion of Sodium Hypochlorite. J Endod 2015; 41(9):1530–4.
53. Verstraeten J, Jacquet W, De Moor RJG, Meire MA. Hard tissue debris removal from the mesial root canal system of mandibular molars with ultrasonically and laser-activated irrigation: a micro-computed tomography study. Lasers Med Sci 2017; 32(9):1965–70.
54. Lambrianidis T, Tosounidou E, Tzoanopoulou M. The effect of maintaining apical patency on periapical extrusion. J Endod 2001; 27(11):696–8.
55. Mitchell RP, Yang SE, Baumgartner JC. Comparison of apical extrusion of NaOCl using the EndoVac or needle irrigation of root canals. J Endod 2010; 36(2):338–41.
56. Myers GL, Montgomery S. A comparison of weights of debris extruded apically by conventional filing and Canal Master techniques. J Endod 1991; 17(6):275–9.

APA	SUSILA A, MINU J (2019). Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review. , 96 - 110. DOI 10.14744/eej.2019.80774
Chicago	SUSILA Anand,MINU Joseph Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review. (2019): 96 - 110. DOI 10.14744/eej.2019.80774
MLA	SUSILA Anand,MINU Joseph Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review. , 2019, ss.96 - 110. DOI 10.14744/eej.2019.80774
AMA	SUSILA A,MINU J Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review. . 2019; 96 - 110. DOI 10.14744/eej.2019.80774
Vancouver	SUSILA A,MINU J Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review. . 2019; 96 - 110. DOI 10.14744/eej.2019.80774
IEEE	SUSILA A,MINU J "Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review." , ss.96 - 110, 2019. DOI 10.14744/eej.2019.80774
ISNAD	SUSILA, Anand - MINU, Joseph. "Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review". (2019), 96-110. https://doi.org/DOI 10.14744/eej.2019.80774

APA	SUSILA A, MINU J (2019). Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review. European Endodontic Journal, 4(3), 96 - 110. DOI 10.14744/eej.2019.80774
Chicago	SUSILA Anand,MINU Joseph Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review. European Endodontic Journal 4, no.3 (2019): 96 - 110. DOI 10.14744/eej.2019.80774
MLA	SUSILA Anand,MINU Joseph Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review. European Endodontic Journal, vol.4, no.3, 2019, ss.96 - 110. DOI 10.14744/eej.2019.80774
AMA	SUSILA A,MINU J Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review. European Endodontic Journal. 2019; 4(3): 96 - 110. DOI 10.14744/eej.2019.80774
Vancouver	SUSILA A,MINU J Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review. European Endodontic Journal. 2019; 4(3): 96 - 110. DOI 10.14744/eej.2019.80774
IEEE	SUSILA A,MINU J "Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review." European Endodontic Journal, 4, ss.96 - 110, 2019. DOI 10.14744/eej.2019.80774
ISNAD	SUSILA, Anand - MINU, Joseph. "Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review". European Endodontic Journal 4/3 (2019), 96-110. https://doi.org/DOI 10.14744/eej.2019.80774