Abstract
Introduction: In endodontic treatment, debridement is crucial for removing microbiota, byproducts, pulp tissue, and organic/inorganic debris. Root canal irrigation complements mechanical instrumentation, ensuring that the root canal system is thoroughly disinfected and the smear layer is removed. This is crucial for eliminating microorganisms, dissolving organic debris, and improving disinfection. Objective: The aim was to conduct a systematic review to describe and compare the various methods of root canal irrigation through clinical studies, with the goal of establishing the optimal cleaning and disinfection treatment protocol. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to August 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 175 articles were found, and 40 articles were evaluated in full, and 30 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 30 studies with a high risk of bias and 25 that did not meet the GRADE and AMSTAR-2 criteria. According to the GRADE instrument, most studies presented homogeneity in their results, with X2=91.2%>50%. It was concluded that irrigation plays a fundamental role in the success of endodontic treatment. Although hypochlorite is the most important irrigating solution, no irrigator can perform all the tasks required by irrigation. A detailed understanding of the mode of action of various solutions is important for optimal irrigation. Within the limitations of this study, the use of the self-adjusting filing system with the combination of EDTA and NaOCl improved the removal of Ca(OH)2. Passive ultrasonic irrigation and self-adjusting filing system were more effective in removing Ca(OH)2 from the lateral grooves in the apical parts of the root canal than EndoVac and conventional syringe irrigation systems.