Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial

Orozco, Esteban Isaí Flores; Toia, Cássia Cestari; Cavalli, Daiana; Khoury, Rayana Duarte; Cardoso, Flávia Goulart da Rosa; Bresciani, Eduardo; Valera, Márcia Carneiro

doi:10.1590/1678-7757-2019-0100

Cited by 27 publications

(21 citation statements)

References 38 publications

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“…The data collected from the seven included studies are summarized in Table 2 . Three studies compared the effectiveness of irrigation activation systems and that of the conventional irrigation system in reducing the bacterial load [ 37 , 41 , 42 ]. Three studies investigated and compared the efficacy of sodium hypochlorite (NaOCl) alone and that of a combination of NaOCl with dual-rinse HEDP (1-hydroxyethane-1, 1-diphosphonate, or etidronate) [ 40 ], BioPure MTAD (mixture of doxycycline, citric acid, and a detergent) and/or chlorhexidine (CHX) [ 38 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

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

Tonini

Salvadori

Audino

et al. 2022

Front. Oral. Health

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BackgroundEx 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.ObjectiveTo evaluate the clinical endodontic protocols and limitations of irrigating solutions in the disinfection of the root canal system in patients with apical periodontitis.MethodsPubMed, 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.ResultsFour 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.DiscussionActivation 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.ConclusionsThe 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.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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

Tonini

Salvadori

Audino

et al. 2022

Front. Oral. Health

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“…This finding confirmed that mechanical canal preparation followed by PUA could not consistently render the canals free of bacteria. [ 7 22 23 ] Seventeen S2 samples from R-IHAN were free of bacteria. In Yared et al ., all S2 samples from R-IHAN were negative.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo ability of a noninstrumentation technique to disinfect oval-shaped canals

Yared

Ramli

2020

J Conserv Dent

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Context: Oval-shaped canals represent a challenge in endodontics. Infected tissue may remain in their recesses. This concern may be more critical with minimally instrumentation techniques. Aims: The present study evaluated the disinfection ability in oval-shaped canals of a noninstrumentation technique using ultrasonic agitation and intracanal heating of sodium hypochlorite (NaOCl) compared to rotary canal preparation and ultrasonic agitation with and without heating of NaOCl. Settings and Designs: Sixty extracted mandibular incisors were included. The teeth had pulp necrosis and apical periodontitis and oval-shaped canals. They were divided into three groups depending on the treatment protocol: (1) IHAN: intracanal heating and ultrasonic agitation of NaOCl only, (2) R-IHAN: Rotary preparation followed by IHAN, and (3) R-passive ultrasonic agitation (PUA): Rotary preparation and ultrasonic agitation of NaOCl. Methods: Root canal samples were taken before (S1) and after (S2) the endodontic procedures were completed and cultured anaerobically. Statistical Analysis Used: Wilcoxon tests were performed to compare colony-forming units (CFUs) before and after the endodontic procedures for the three groups. The percentage of variation of CFUs was compared among the three groups using Kruskal–Wallis tests, followed by Mann–Whitney U-tests. Results: All S1 samples were positive. All S2 samples showed bacterial growth in R-PUA compared to 17 in R-IHAN. None of the S2 samples in IHAN were positive. Bacteria reduction was significant in each group ( P < 0.001). The percentage of bacteria reduction was highest for IHAN and lowest for R-PUA ( P < 0.001). Conclusions: Intracanal heating and ultrasonic agitation of NaOCl without instrumentation completely eliminated bacteria from infected oval-shaped canals.

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“…29 However, according to the results of a clinical trial by Orozco et al, there was no significant difference between passive ultrasonic irrigation and conventional irrigation in decreasing bacterial counts. 30 Furthermore, the results of a systematic review by Susila and Minu showed that the utilization of mechanical active irrigation devices is advantageous in root canal treatment. They stated that mechanical active irrigation devices are clinically efficient in the conveyance of the irrigant in the root canal, which leads to more cleanliness in root canals.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Antibacterial Effects of Photodynamic Therapy and an Irrigation Activation System on Root Canals Infected With Enterococcus faecalis: An In Vitro Study

et al. 2020

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Introduction: Enterococcus faecalis is a resistant bacterium which is the most abundant species in infected root canals. Photodynamic therapy (PDT) is a method for killing the bacteria with active Oxygen radicals generated in a photosensitizer when exposed to centralized light. Furthermore, as a new method of canal disinfection, a variety of irrigation activation systems have been introduced, one of which is GentleFile (GF) with rotary movements and spiral effects for antibacterial action. This study aimed to compare the effectiveness of the two mentioned methods when used with and without Sodium Hypochlorite in eliminating E. faecalis from infected root canals. Methods: Fifty-eight uniradicular teeth were randomly divided into 4 experimental groups of 14. Two specimens were selected for later scanning electron microscopy in order to screen the procedure steps. In each experimental group, 10 samples were selected to be treated with GF or PDT; 3 of them were selected as positive controls and the other one sample was chosen as a negative control. Experimental groups were as follows: (1) Irrigation activation system, (2) Irrigation activation system + sodium hypochlorite, (3) PDT, and (4) PDT+ sodium hypochlorite. The specimens were then cultured for a bacterial colony count. Results: The decrease in the bacterial count after the treatment with the irrigation activation system was 99.8% (P=0.011) and when the system was used with sodium hypochlorite, it was 100% (P=0.001). The antibacterial effect of PDT was 90.08% (P=0.011) and it was 99.7% when PDT was combined with sodium hypochlorite (P=0.011). Conclusion: All four methods can be administered as complementary methods in root canal disinfection. According to the results of disinfection in the experimental groups of current study it is concluded that integration of new technologies such as activation irrigation system or PDT in Combination with NaOCl ameliorates disinfection of root canal and can provide several advantages in the endodontic outcome.

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Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial

Cited by 27 publications

References 38 publications

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

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

Ex vivo ability of a noninstrumentation technique to disinfect oval-shaped canals

Comparison of Antibacterial Effects of Photodynamic Therapy and an Irrigation Activation System on Root Canals Infected With Enterococcus faecalis: An In Vitro Study

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