Comparison of the effectiveness of single- and multiple-sessions disinfection protocols against endotoxins in root canal infections: systematic review and meta-analysis

Abstract

This systematic review (SR) addressed the following common clinical question: What is more effective in reducing or eliminating endotoxin in endodontic infections—single or multiple-session treatments using calcium hydroxide medications? Literature searches of Medline/PubMed, Embase, Cochrane Library, Scielo, Science Direct, Web of Knowledge, Scopus, and Google Scholar databases. Two reviewers independently assessed the eligibility for inclusion, extracted data, and evaluated the quality of the studies using the risk of bias tools. Electronic searches resulted in 358 articles, of which 32 studies were included for full-text assessment, and nine were included in this review. Meta-analysis pooling all the nine studies revealed lower levels of endotoxin for multiple-session treatment (P < 0.001). The sub-group analysis indicated no difference between single-session and 7 days of Ca(OH)2 medication (SMD − 0.32; P = 0.22). However, 14-days (I2 = 80.5%, P < 0.001) and 30-days (I2 = 78.9%, P < 0.01) of Ca(OH)2 medication was more effective than single-session treatment (both, p < 0.001). Overall, Overall, this SR provides evidence to support that multiple-session disinfection protocols with the placement of Ca(OH)2 medications are more effective in reducing the levels of endotoxin from root canal infections compared to single-session when applied for 14 and 30 days.

Comparison of Endodontic Pain observed with Sodium Hypochloride, Hydrogen peroxide and Norman Saline based Root canal irrigants

“…Strong antimicrobial properties and ability to dissolve pulpal remnants, collagen, necrotic and vital organic tissue coin sodium hypochlorite the gold standard in RCT. 7,8 However, sodium hypochlorite is cytotoxic if extruded beyond the apical foramen and causes inflammation, swelling, pain, and ulceration presenting as hypochlorite injury. The taste and smell are unacceptable, and it is caustic to the metallic instruments.…”

Evidências científicas sobre a realização do tratamento endodôntico em sessão única

“…Em sua revisão sistemática, Nascimento et al (2021) realizaram um comparação entre a abordagem em múltipla sessões (com diferença entre 7, 14 e 30 dias entre as sessões) e sessão única, com enfoque na redução dos níveis de endotoxinas do canal radicular, apontando que o uso de medicação intracanal em múltiplas sessões foi superior a sessão única apenas quando feito com diferença de 14 e 30 dias entre as sessões, sem impacto na redução das endotoxinas ao comparar a sessão única e múltiplas sessões espaçadas por apenas 7 dias. Como contraponto, Trinches et al (2018), em um ensaio clínico, apresentaram uma redução eficaz do conteúdo séptico do canal radicular com seu protocolo de abordagem em sessão única, que incluiu a utilização de "Endo PTC" (composto por 10% de peróxido de ureia, 15% Tween 80 e 75% carbowaxveículo), solução Dakin (hipoclorito de sódio Research, Society and Development, v. 10, n. 8, e45210817534, 2021 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v10i8.17534 0,5% tamponado com bicarbonato de sódio), e Tergensol.…”

Comparison of GentleWave system and passive ultrasonic irrigation with minimally invasive and conventional instrumentation against LPS in infected root canals

“…Several disinfection protocols have been tested against LPS in root canal infections over the years 9 – 13 . Previous in vitro and in vivo studies evaluated the ability of different instrumentation techniques using single file or multiple files systems and irrigation protocols to eliminate LPS 9 – 12 .…”

“…Several disinfection protocols have been tested against LPS in root canal infections over the years 9 – 13 . Previous in vitro and in vivo studies evaluated the ability of different instrumentation techniques using single file or multiple files systems and irrigation protocols to eliminate LPS 9 – 12 . Given their limited effectiveness in eradicating LPS from root canals, supplemental treatments with passive ultrasonic irrigation (PUI) and photodynamic therapy (PDT) have been investigated 13 – 15 .…”