Effectiveness of various irrigant activation techniques on the penetration of sodium hypochlorite into lateral canals of mature permanent teeth: A systematic review and meta-analysis

Ram Surath Kumar; Anil V Ankola; Roopali M Sankeshwari; Mamata Hebbal; Vinuta Hampiholi; Lokesh Kumar S; Apurva Prashant Deshpande; Abhra Roy Choudhury; Atrey J Pai Khot

doi:10.1016/j.sdentj.2022.12.004

Effectiveness of various irrigant activation techniques on the penetration of sodium hypochlorite into lateral canals of mature permanent teeth: A systematic review and meta-analysis

Saudi Dent J. 2023 Jan;35(1):1-23. doi: 10.1016/j.sdentj.2022.12.004. Epub 2022 Dec 16.

Authors

Ram Surath Kumar¹, Anil V Ankola¹, Roopali M Sankeshwari¹, Mamata Hebbal², Vinuta Hampiholi³, Lokesh Kumar S⁴, Apurva Prashant Deshpande¹, Abhra Roy Choudhury¹, Atrey J Pai Khot¹

Affiliations

¹ Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi 590010, India.
² Department of Preventive Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia.
³ Department of Periodontics, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi 590010, India.
⁴ Department of Oral Medicine and Radiology, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi 590010, India.

Abstract

Objective: This review aimed to systematically review the effectiveness of various irrigant activation techniques (IATs) on the penetration of sodium hypochlorite (NaOCl) into the lateral canals of mature permanent teeth.

Methods: Electronic databases including MEDLINE (via PubMed), Scopus, ProQuest, and Cochrane Library were searched to identify laboratory studies evaluating the penetration of NaOCl into lateral canals following the use of apical negative pressure irrigation (ANP), passive ultrasonic irrigation (PUI), sonic irrigation (SI), and/or manual dynamic activation (MDA) techniques. Meta-analysis was performed for individual IATs in comparison with CNI into the lateral canals of both straight and curved root canals. On the basis of the previous literature and parameters, the risk of bias of the selected studies was evaluated with the help of a customized tool.

Results: Of the 983 records screened, 12 studies were selected to include in the systematic review, and 10 studies were selected for the meta-analysis. The total quality assessment across the included studies indicated a high quality (83.3%). Overall, the meta-analysis demonstrated IATs had significant improvement in the penetration of NaOCl into the lateral canals of straight canals (34.3%) over CNI. The subgroup analysis of individual IATs demonstrated PUI (60.9%) to be superior in the penetration into lateral canals of straight canals.

Conclusions: IATs improved the irrigant penetration into lateral canals and therefore their use during routine endodontic practice is recommended. In straight canals, PUI is the most effective IAT followed by ANP, SI, and MDA techniques.

Keywords: Apical negative pressure; Irrigant penetration; Lateral canal; Passive ultrasonic irrigation; Root canal therapy.

Publication types

Review