Irrigating Solutions and Activation Methods Used in Clinical Endodontics: A Systematic Review

Riccardo Tonini; Matteo Salvadori; Elisabetta Audino; Salvatore Sauro; Maria Luisa Garo; Stefano Salgarello

doi:10.3389/froh.2022.838043

Irrigating Solutions and Activation Methods Used in Clinical Endodontics: A Systematic Review

Front Oral Health. 2022 Jan 31:3:838043. doi: 10.3389/froh.2022.838043. eCollection 2022.

Authors

Riccardo Tonini¹, Matteo Salvadori¹, Elisabetta Audino¹, Salvatore Sauro^{2

3}, Maria Luisa Garo¹, Stefano Salgarello¹

Affiliations

¹ Department of Medical and Surgery Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy.
² Department of Dentistry, Dental Biomaterials and Minimally Invasive Dentistry, Cardenal Herrera-CEU University, Alfara del Patriarca, Spain.
³ Department of Therapeutic Dentistry, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.

Abstract

Background: Ex vivo and in vitro studies have demonstrated the effectiveness of some irrigation protocols in reducing the bacterial load in the root canal system. However, standardized protocols have not yet been defined for the real clinical context due to many irrigation procedures available.

Objective: To evaluate the clinical endodontic protocols and limitations of irrigating solutions in the disinfection of the root canal system in patients with apical periodontitis.

Methods: PubMed, Scopus, Embase, Web of Science, and Cochrane databases were searched for randomized controlled trials (RCT) published until January 2021. Hand searching was also performed. Studies focused on evaluating the effectiveness of irrigating solutions and/or irrigation activation methods in reducing the bacterial load in the root canal system were considered. The Cochrane risk-of-bias tool for randomized trials (RoB2) was used to assess the quality of the studies.

Results: Four hundred and twenty eight published articles were identified. After removing the duplicate studies and analyzing full texts, seven RCTs were selected. Two studies compared pure NaOCl with some combination of NaOCl with HEDP and MTAD. Two studies analyzed the antibacterial efficacy of NaOCl and chlorhexidine (CHX). Three studies compared conventional needle irrigation with different irrigation activation methods (PUI, XP-endo finisher, F-file activator, EndoVac activator). The review attained a satisfactory methodology. The main results of each included study were described.

Discussion: Activation methods provide significantly higher biofilm reduction than conventional needle irrigation methods. Combinations of NaOCl with different chelating agents were ineffective in terms of antimicrobial, but it could potentially increase the risk of irrigant extrusion. However, the irrigating protocols were not carefully detailed, especially those regarding the irrigants application time or total volume. The existing literature lacks high-quality studies. The level of evidence is moderate.

Conclusions: The available data is too heterogeneous to compare and identify the superiority of specific valuable irrigation protocols in each clinical context. Application time, volume, and activation methods should be standardized to determine the optimal irrigating procedures to reduce the bacterial load and ensure higher predictability of the endodontic treatment.

Systematic review registration: (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218555), PROSPERO registration: CRD42020218555.

Keywords: bacterial load; biofilm; irrigating solutions; periapical periodontitis; root canal agents.

Publication types

Systematic Review