Skip to main content Skip to main navigation menu Skip to site footer
Review
Published: 2022-05-15

Research of the major methods and clinical outcomes of irrigation in endodontics: a systematic review

UNORTE - University Center of Northern São Paulo - Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil
UNORTE - University Center of Northern São Paulo - Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil
UNORTE - University Center of Northern São Paulo - Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil
Endodontic irrigation Techniques Root irrigation channel Efficiency Dentin surface

Abstract

Introduction: In the context of endodontic treatment, mainly endodontic irrigation, endodontic therapy promotes the removal of debris from the pulp tissue, seeking cleaning and asepsis against various microorganisms. Objective: Carried out a systematic review of the main methods and clinical outcomes of irrigation in endodontics, presenting information on the effectiveness and biocompatibility on the dentin surface. Methods: The present study followed by a systematic review (PRISMA). The search strategy was performed in the PubMed, Scielo, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. Results and Conclusion: The success of endodontic treatment depends on eradicating microbes (if present) from the root canal system and preventing reinfection. In research comparing the effectiveness of EDTA 17% maleic acid to 7%, and observed a greater effectiveness of maleic acid in removing the smear layer from the apical third of single-adicular human teeth. When compared to maleic acid, 5% of 17% EDTA proved to be equally effective. Irrigation with 70% ethanol showed a significantly higher percentage of clean root canal walls and greater depth of clean dentinal tubules when compared to irrigation with 2.5% sodium hypochlorite and 17% EDTA-T. The volume of irrigants and agitation act to reduce the microhardness of dentin in the root canal. The smallest reduction in hardness was found in the EDTA + NaOCl association, which can be explained by the fact that one substance has the power to neutralize the other. An alternative EDTA (EDTA - T) to the conventional one was studied and showed good results to remove the smear layer and a good antimicrobial action, but showed a greater potential to generate inflammation than conventional 17% EDTA and 10% citric acid. Finally, one study showed that PUI with continuous irrigation and SAF were more effective than EndoVac and the conventional syringe in removing the drug Ca(OH)2 from a standardized artificial groove in the apical part of the root canal.

References

  1. Wright PP, Cooper C, Kahler B, Walsh LJ. Multiple assessment methodologies in determining the antibiofilm actions of sodium hypochlorite mixed with clodronate or etidronate in endodontic irrigation. J Microbiol Methods. 2021 Jan;180:106107. doi: 10.1016/j.mimet.2020.106107. Epub 2020 Nov 21. PMID: 33227309.
  2. Bartols A, Bormann C, Werner L, Schienle M, Walther W, Dörfer CE. A retrospective assessment of different endodontic treatment protocols. PeerJ. 2020 Jan 30;8:e8495. doi: 10.7717/peerj.8495. eCollection 2020.
  3. Hsieh SC, Teng NC, Chu CC, Chu YT, Chen CH, Chang LY, Hsu CY, Huang CS, Hsiao GY, Yang JC. The Antibacterial Efficacy and In Vivo Toxicity of Sodium Hypochlorite and Electrolyzed Oxidizing (EO) Water-Based Endodontic Irrigating Solutions. Materials (Basel). 2020 Jan 7;13(2). pii: E260. doi: 10.3390/ma13020260.
  4. Gambin DJ, Leal LO, Farina AP, Souza MA, Cecchin D. Antimicrobial activity of glycolic acid as a final irrigant solution for root canal preparation. Gen Dent. 2020 Jan-Feb;68(1):41-44.
  5. Brignardello-Petersen R. There may be no differences in periapical healing between passive ultrasonic irrigation and nonactivated irrigation when undergoing endodontic treatment. J Am Dent Assoc. 2020 Feb;151(2):e14. doi: 10.1016/j.adaj.2019.08.019. Epub 2019 Dec 10.
  6. Keine KC, Kuga MC, Coaguila-Llerena H, Palma-Dibb RG, Faria G. Peracetic acid as a single endodontic irrigant: effects on microhardness, roughness and erosion of root canal dentin. Microsc Res Tech. 2019 Dec 13. doi: 10.1002/jemt.23424.
  7. Qing Y, Akita Y, Kawano S, Kawazu S, Yoshida T, Sekine I. Cleaning efficacy and dentin micro-hardness after root canal irrigation with a strong acid electrolytic water. Journal of endodontics, 2006, 32, 1102-6.
  8. Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation in endodontics. Br Dent J. 2014; 216 (6): 299-303.
  9. Dias-Junior LCL, Castro RF, Fernandes AD, Guerreiro MYR, Silva EJNL, Brandão JMDS. Final Endodontic Irrigation with 70% Ethanol Enhanced Calcium Hydroxide Removal from the Apical Third. J Endod. 2021 Jan;47(1):105-111. doi: 10.1016/j.joen.2020.09.017. Epub 2020 Oct 9. PMID: 33045271.
  10. Arul B, Suresh N, Sivarajan R, Natanasabapathy V. Influence of volume of endodontic irrigants used in different irrigation techniques on root canal dentin microhardness. Indian J Dent Res. 2021 Apr-Jun;32(2):230-235. doi: 10.4103/ijdr.IJDR_709_18. PMID: 34810395.
  11. Ferrer-Luque CM, Arias-Moliz MT, González-Rodríguez MP, Baca P. Antimicrobial activity of maleic acid and combinations of cetrimide with chelating agents against Enterococcus faecalis biofilm. J Endod. 2010 Oct;36(10):1673-5.
  12. Ordinola-Zapata R, Bramante CM, Cavenago B, Graeff MS, Gomes de Moraes I, Marciano M, Duarte MA. Antimicrobial effect of endodontic solutions used as final irrigants on a dentine biofilm model. IntEndod J. 2012 Feb;45(2):162-8.
  13. Soares JN, Goldberg F. Endodontia - Técnicas e fundamentos. 2 ed. Artmed: Porto Alegre; 2011.
  14. Sahar-Helft S, Stabholtz A, Moshonov J, Gutkin V, Redenski I, Steinberg D. Effect of Er:YAG laser-activated irrigation solution on Enterococcus Faecalis biofilm in an ex-vivo root canal model. Photomed Laser Surg. 2013 Jul;31(7):334-41.
  15. Zhang K, Kim YK, Cadenaro M et al. (2010) Effects of different exposure times and concentrations of sodium hypochlorite/ethylenediaminetetraacetic acid on the structural integrity of mineralized dentin. Journal of endodontics 36, 105-9.
  16. Kishen A, Sum CP, Mathew S, Lim CT. Influence of irrigation regimens on the adherence of Enterococcus faecalis to root canal dentin. J Endod. 2008 julho; 34 (7): 850-4.
  17. Ates M, Akdeniz BG, Sen BH. The effect of calcium chelating or binding agents on Candida albicans.Oral Surg Oral Med Oral Pathol Oral RadiolEndod. 2005 Nov;100(5):626-30.
  18. Chandrasekhar V, Amulya V, Rani VS, Prakash TJ, Ranjani AS, Gayathri Ch. Evaluation of biocompatibility of a new root canal irrigant Q Mix™ 2 in 1- An in vivo study. J Conserv Dent. 2013 Jan;16(1):36-40.
  19. ZaccaroScelza MF, da Silva Pierro VS, Chagas MA, da Silva LE, Scelza P. Evaluation of inflammatory response of EDTA, EDTA-T, and citric acid in animal model. J Endod. 2010 Mar;36(3):515-9.
  20. Gambarini G, Plotino G, Grande NM, Nocca G, Lupi A, Giardina B, De Luca M, Testarelli L. In vitro evaluation of the cytotoxicity of FotoSan™ light-activated disinfection on human fibroblasts. Med SciMonit. 2011 Feb 25;17(3):MT21-5.

How to Cite

Souza, R. A. de, Castro, F. P. L. de, & Pires, O. J. (2022). Research of the major methods and clinical outcomes of irrigation in endodontics: a systematic review. MedNEXT Journal of Medical and Health Sciences, 3(S3). https://doi.org/10.54448/mdnt22S311