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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 [Abstract]

Virdee, Satnam, Seymour, David, Farnell, Damian ORCID:, Bhamra, Gurcharn and Bhakta, Shashwat 2017. Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systematic review and meta-analysis [Abstract]. International Endodontic Journal 50 (S1) , pp. 3-56. 10.1111/iej.12813

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Aim To establish whether Irrigant Activation Techniques (IAT) result in greater intracanal smear layer and debris removal than Conventional Needle Irrigation (CNI). Methodology Six electronic databases (PubMed, EMBASE, Cochrane Library, Science Direct, Web of Science and Google Scholar) and supplemental sources were searched by two reviewers from 01.2000 to 11.2016 to identify scanning electron microscopy studies evaluating smear layer and/or debris removal following use of Manual Dynamic Activation (MDA), Passive Ultrasonic Irrigation (PUI), Sonic Irrigation (SI) or Apical Negative Pressure (ANP) IATs in mature permanent teeth. Meta-analyses were performed for each canal segment (coronal, middle, apical and apical 1 mm) in addition to subgroup analyses for individual IATs with respect to CNI. Outcomes are presented as Standardised Mean Differences (SMD) alongside 95%-Confidence Intervals (CI), to allow direct comparisons between studies that used semi-quantitative scoring systems to evaluate intracanal cleanliness. Results From 252 citations, 16 studies were included in the qualitative analysis and 12 in the meta-analysis. Nine studies investigated smear layer, 1 debris and 12 examined both with ANP (n = 10) and PUI (n = 10) being most commonly tested followed by SI (n = 7) and MDA (n = 6). The meta-analysis demonstrated significant improvements in the coronal (SMD: 1.15/CI: 0.72–1.57, SMD: 0.54/CI: 0.29–0.80), middle (SMD: 1.30/CI: 0.59–2.53, SMD: 0.8/CI: 0.58–1.13) and apical thirds (SMD: 1.22/CI: 0.83–1.62, SMD: 1.86/CI: 0.76–2.96) for smear layer and debris removal respectively. In the apical 1 mm, IATs improved cleanliness; however, the differences were insignificant (SMD: 1.15/CI: −0.47–2.77). The most effective IATs in the coronal third were SI (SMD: 1.29/CI: 0.76–3.41) for smear layer and ANP (SMD: 0.62/CI: 0.12–1.12) for debris, and for the middle third were SI again (SMD: 2.21/CI: 1.20–3.22) and PUI (SMD: 1.26/CI: 0.77–1.74). In the apical segment MDA removed the greatest quantity of both smear layer (SMD: 1.50/CI: 0.62–2.37) and debris (SMD: 2.22/CI: 1.19–3.26). Conclusions Within limitations of this study, IATs were found to significantly improve intracanal cleanliness across a substantial portion of the canal. Therefore their use is encouraged during routine root canal treatment. No single technique produced the highest impact across all regions hence a combination of machine and hand assisted IATs is postulated to result in greater efficacy. Based on this review and surrounding literature SI in combination with MDA, the latter being equally effective as ANP at the apex, is likely to lead to the greatest smear layer and debris removal throughout the canal. Further in vivo experiments are required to understand the impact this would have on periapical healing.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Dentistry
Subjects: R Medicine > RK Dentistry
Additional Information: ESE Wladimir Adlivankine Research Prize
Publisher: Wiley-Blackwell
ISSN: 0143-2885
Date of Acceptance: 16 October 2017
Last Modified: 04 Jan 2024 08:34

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