Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systematic review and meta‐analysis

Virdee, Satnam Singh; Seymour, David; Farnell, Damian J. J.; Bhamra, Gurcharn; Bhakta, Shashwat

doi:10.1111/iej.12877

Cited by 100 publications

(103 citation statements)

References 68 publications

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“…A recent meta‐analysis on intracanal smear layer and debris removal concluded that irrigant activation techniques such as sonic or ultrasonic activation resulted in greater smear layer and debris removal than conventional manual irrigation across a substantial portion of the canal (Virdee et al . ). However, cleanliness in isthmuses was not evaluated and comparison of findings therefore remains speculative.…”

Section: Discussionmentioning

confidence: 97%

Micro‐CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard‐tissue debris from isthmus‐containing mesial root canal systems of mandibular molars

et al. 2019

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Aim To evaluate the efficacy of sonically and ultrasonically activated irrigation on removal of accumulated hard‐tissue debris (AHTD) in mesial root canal systems of mandibular molars using micro‐computed tomographic (micro‐CT) analysis. Methodology Forty mesial roots of mandibular molars with two independent canals joined apically by an isthmus (Vertucci type II) were selected. The root canals were instrumented using Reciproc R25 instruments, and specimens were scanned at a resolution of 10.5 μm. Subsequently, n = 10 roots were assigned to each of the four final irrigation groups such that the group means and variances were almost identical: sonically activated irrigation with EndoActivator (EA) or EDDY (ED), ultrasonically activated irrigation (UAI) and manual irrigation without activation (MI). The final irrigation procedures were performed using a total of 5 mL 1% NaOCl and 5 mL 15% EDTA per canal over 5 min with activation time of 4 × 20 s. Reconstructed data sets were coregistered, and the mean percentage reduction of AHTD after final irrigation was compared statistically between groups using analysis of variance at a significance level set at 5%. Results A significant reduction of AHTD was achieved after final irrigation in all groups (P < 0.05), ranging from 44.1% to 66.8%. The vol% of debris after irrigation was 3.7 ± 1.9% for EA, 3.3 ± 2.3% for ED, 2.1 ± 1.6% for UAI and 4.4 ± 2.3% for MI, with no significant difference between groups (P > 0.05). Conclusions None of the final irrigation protocols completely removed AHTD from mesial root canal systems in extracted human mandibular molars. Sonically and ultrasonically activated irrigation performed no better compared to manual irrigation.

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Section: Discussionmentioning

confidence: 97%

Micro‐CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard‐tissue debris from isthmus‐containing mesial root canal systems of mandibular molars

et al. 2019

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“…The aforementioned limitations of CNI could, however, be overcome through the use of irrigant activation techniques. Manual dynamic activation (MDA), passive ultrasonic irrigation (PUI) and sonic irrigation (SI) are currently some of the most widely used and studied methods (Gu et al 2009, Virdee et al 2018). MDA involves repeatedly inserting a well‐fitting gutta‐percha (GP) cone to the working length of an instrumented canal to produce hydrodynamic displacing forces within irrigants (McGill et al 2008).…”

Section: Introductionmentioning

confidence: 99%

The influence of irrigant activation, concentration and contact time on sodium hypochlorite penetration into root dentine: an ex vivo experiment

et al. 2020

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Aim To establish whether irrigant activation techniques, namely manual dynamic activation (MDA), passive ultrasonic irrigation (PUI) and sonic irrigation (SI), improve the tubular penetration of sodium hypochlorite (NaOCl) into root dentine when compared with conventional needle irrigation (CNI). Secondly, investigate if increasing NaOCl concentration and/or contact time improves the performance of these techniques. Methodology A total of 83 extracted human maxillary permanent canines were decoronated to 15 mm, and root canals prepared to a size 40, .10 taper. Root dentine was stained with crystal violet for 72 h and embedded in silicone. Eighty specimens were randomly distributed into 16 groups (n = 5) according to the irrigant activation technique, NaOCl concentration (2%; 5.25%) and irrigant contact time (10 min; 20 min). All activation techniques were used for 60 s in the last minute of irrigation. Additionally, three teeth were not exposed to NaOCl to confirm adequate dentine staining had occurred (i.e. negative control). All specimens were subsequently dissected, observed under a light microscope and NaOCl penetration depth (µm) determined by measuring the average width of bleached dentine using ImageJ software. Statistical comparisons were made with paired and unpaired t‐tests, anovas followed by post hoc Tukey’s and Dunnett’s tests, and a general linear model (α < 0.05). Results Overall, NaOCl penetration ranged from 38.8 to 411.0 µm with MDA, PUI and SI consistently resulting in significantly greater tubular infiltration than CNI (P < 0.05). The deepest measurements in the coronal, middle and apical segments were all recorded in the MDA; 5.25%; 20 min group and the least in the CNI; 2%; 10 min group. Increasing either irrigant concentration or contact time resulted in significantly greater NaOCl penetration depths for all techniques and segments of the canal (P < 0.05). However, when irrigant concentration and contact time were increased together, a significant interaction effect between these two independent variables was observed on overall NaOCl penetration (P < 0.05). Conclusions Agitating irrigants with MDA, PUI or SI, as well as using greater irrigant concentrations or contact times, potentiated NaOCl penetration into root dentine. However, longer durations of NaOCl exposure at lower concentrations resulted in similar depths of tubular penetration as those achieved at higher concentrations.

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“…Moreover, accumulation of debris is a potential side effect of root canal instrumentation and may result in an inefficient seal of root canal fillings and, in cases with apical periodontitis, reduces the probability of healing . Therefore, irrigation with antimicrobial and tissue‐dissolving solutions and activation of the irrigant are crucial for thorough disinfection of the entire root canal system .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of different activated irrigation techniques on debris and smear layer removal from curved root canals: a SEM evaluation

et al. 2019

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This study evaluates the effectiveness of different activated irrigation techniques on removal of debris and smear layer from curved root canals. Ninety mandibular molars with a root canal curvature between 20 and 40 degrees were assigned to 4 groups (n = 20): syringe irrigation (SI), passive ultrasonic activation (PUI), sonic activation with EDDY (ED) or EndoActivator (EA) and a control group. Mesiobuccal root canals were prepared to size 40, 0.04 and irrigated with NaOCl (3%) according to the respective technique. Roots were split longitudinally and subjected to scanning electron microscopic analysis. Presence of debris and smear layer was evaluated using 5-grade scoring systems with 2009 and 10009 magnification, respectively. Data were analysed with nonparametric analysis for ordinal longitudinal data (a = 5%). Activation of the irrigant significantly improved smear layer removal (P < 0.05). Regarding debris, only activation with EA and ED was significantly more effective than SI (P < 0.05). No activation technique was able to eliminate debris and smear layer completely from curved root canals.

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Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systematic review and meta‐analysis

Cited by 100 publications

References 68 publications

Micro‐CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard‐tissue debris from isthmus‐containing mesial root canal systems of mandibular molars

Micro‐CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard‐tissue debris from isthmus‐containing mesial root canal systems of mandibular molars

The influence of irrigant activation, concentration and contact time on sodium hypochlorite penetration into root dentine: an ex vivo experiment

Effectiveness of different activated irrigation techniques on debris and smear layer removal from curved root canals: a SEM evaluation

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