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

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2022 Feb 28

PMID 35223300

Authors

Nesreen Tashkandi

Faisal AlGhamdi

Affiliations

Soon will be listed here.

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.

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References

Bronnec F, Bouillaguet S, Machtou P . Ex vivo assessment of irrigant penetration and renewal during the final irrigation regimen. Int Endod J. 2010; 43(8):663-72. DOI: 10.1111/j.1365-2591.2010.01723.x. View

Gu L, Kim J, Ling J, Choi K, Pashley D, Tay F . Review of contemporary irrigant agitation techniques and devices. J Endod. 2009; 35(6):791-804. DOI: 10.1016/j.joen.2009.03.010. View

Boutsioukis C, Verhaagen B, Versluis M, Kastrinakis E, Wesselink P, van der Sluis L . Evaluation of irrigant flow in the root canal using different needle types by an unsteady computational fluid dynamics model. J Endod. 2010; 36(5):875-9. DOI: 10.1016/j.joen.2009.12.026. View

KEIR D, Senia E, Montgomery S . Effectiveness of a brush in removing postinstrumentation canal debris. J Endod. 1990; 16(7):323-7. DOI: 10.1016/S0099-2399(06)81942-4. View

Ciucchi B, Khettabi M, Holz J . The effectiveness of different endodontic irrigation procedures on the removal of the smear layer: a scanning electron microscopic study. Int Endod J. 1989; 22(1):21-8. DOI: 10.1111/j.1365-2591.1989.tb00501.x. View

Sigurdsson A, Garland R, Le K, Rassoulian S . Healing of Periapical Lesions after Endodontic Treatment with the GentleWave Procedure: A Prospective Multicenter Clinical Study. J Endod. 2018; 44(3):510-517. DOI: 10.1016/j.joen.2017.12.004. View

McGill S, Gulabivala K, Mordan N, Ng Y . 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. DOI: 10.1111/j.1365-2591.2008.01408.x. View

Konstantinidi E, Psimma Z, Chavez de Paz L, Boutsioukis C . Apical negative pressure irrigation versus syringe irrigation: a systematic review of cleaning and disinfection of the root canal system. Int Endod J. 2016; 50(11):1034-1054. DOI: 10.1111/iej.12725. View

Yang Q, Liu M, Zhu L, Peng B . Micro-CT study on the removal of accumulated hard-tissue debris from the root canal system of mandibular molars when using a novel laser-activated irrigation approach. Int Endod J. 2019; 53(4):529-538. DOI: 10.1111/iej.13250. View

10.

Stamos D, Sadeghi E, Haasch G, Gerstein H . An in vitro comparison study to quantitate the debridement ability of hand, sonic, and ultrasonic instrumentation. J Endod. 1987; 13(9):434-40. DOI: 10.1016/S0099-2399(87)80061-4. View

11.

Llena C, Cuesta C, Forner L, Mozo S, Segura J . 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. PMC: 4368021. DOI: 10.4317/jced.52088. View

12.

Sedgley C, Applegate B, Nagel A, Hall D . Real-time imaging and quantification of bioluminescent bacteria in root canals in vitro. J Endod. 2004; 30(12):893-8. DOI: 10.1097/01.don.0000132299.02265.6c. View

13.

Pedulla E, Genovese C, Campagna E, Tempera G, Rapisarda E . Decontamination efficacy of photon-initiated photoacoustic streaming (PIPS) of irrigants using low-energy laser settings: an ex vivo study. Int Endod J. 2012; 45(9):865-70. DOI: 10.1111/j.1365-2591.2012.02044.x. View

14.

Cameron J . The synergistic relationship between ultrasound and sodium hypochlorite: a scanning electron microscope evaluation. J Endod. 1987; 13(11):541-5. DOI: 10.1016/S0099-2399(87)80034-1. View

15.

Susila A, Minu J . Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics - A Systematic Review. Eur Endod J. 2020; 4(3):96-110. PMC: 7006592. DOI: 10.14744/eej.2019.80774. View

16.

Gutmann J, Zehnder M, Levermann V . Historical perspectives on the roots of the apical negative pressure irrigation technique in endodontics. J Hist Dent. 2014; 62(1):32-40. View

17.

Tay F, Gu L, Schoeffel G, Wimmer C, Susin L, Zhang K . Effect of vapor lock on root canal debridement by using a side-vented needle for positive-pressure irrigant delivery. J Endod. 2010; 36(4):745-50. PMC: 2844877. DOI: 10.1016/j.joen.2009.11.022. View

18.

Abou-Rass M, Piccinino M . The effectiveness of four clinical irrigation methods on the removal of root canal debris. Oral Surg Oral Med Oral Pathol. 1982; 54(3):323-8. DOI: 10.1016/0030-4220(82)90103-7. View

19.

Huang T, Gulabivala K, Ng Y . A bio-molecular film ex-vivo model to evaluate the influence of canal dimensions and irrigation variables on the efficacy of irrigation. Int Endod J. 2007; 41(1):60-71. DOI: 10.1111/j.1365-2591.2007.01317.x. View

20.

Adcock J, Sidow S, Looney S, Liu Y, McNally K, Lindsey K . Histologic evaluation of canal and isthmus debridement efficacies of two different irrigant delivery techniques in a closed system. J Endod. 2011; 37(4):544-8. DOI: 10.1016/j.joen.2011.01.006. View