Narrative Review on Methods of Activating Irrigation Liquids for Root Canal Treatment
Source abstract
Abstract
As indicated by standards of modern dentistry, the essence of endodontic treatment is chemo-mechanical disinfection of the root canal system. The vital element of this process is the irrigation of canals with designated solutions as well as activating them. This review article summarizes various techniques of activation of irrigants for endodontic treatment such as manual activation, thermal, pressure, sonic, ultrasonic, and laser techniques in order to compare them. Results were gathered using PubMed, Scopus, Web of Science, and Google Scholar databases by searching keywords: activation, irrigation, irrigation protocols, and sodium hypochlorite.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Endodontics and Root Canal Treatments · Dental Radiography and Imaging · Dental Anxiety and Anesthesia Techniques
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Department of Conservative Dentistry with Endodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wrocław, Poland
Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wrocław, Poland
Affiliation Department of Polymer Engineering and Technology, Faculty of Chemistry, Wrocław University of Science and Technology (WUST), Wyb. Wyspiańskiego 27, 50-370 Wrocław, Poland
Department of Facial Developmental Defects, Wroclaw Medical University, Krakowska 26, 50-425 Wrocław, Poland
Funding
Wroclaw Medical University
References (97)
Show source-provided references
1. Pulp Capping Materials Modulate the Balance between Inflammation and Regeneration10.1016/j.dental.2018.09.008 ↗
2. Dental Caries: A Disease Which Needs Attention10.1007/s12098-017-2381-6 ↗
3. Terminology of Dental Caries and Dental Caries Management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR10.1159/000503309 ↗
4. PROMs following Root Canal Treatment and Surgical Endodontic Treatment10.1016/j.identj.2022.06.015 ↗
5. Efficacy of Several Concentrations of Sodium Hypochlorite for Root Canal Irrigation10.1016/S0099-2399(06)81331-2 ↗
6. Root Canal Irrigants10.1016/j.joen.2005.09.014 ↗
7. Current Trends in Root Canal Irrigation
8. Factors Influencing the Occurrence and Progress of Sodium Hypochlorite Accident: A Narrative and Update Review10.4103/jcd.jcd_422_22 ↗
9. Effect of Liquid and Paste-Type Lubricants on Torque Values during Simulated Rotary Root Canal Instrumentation10.1111/j.1365-2591.2005.00937.x ↗
10. Antibacterial Properties of Root Canal Lubricants: A Comparison with Commonly Used Irrigants10.1111/aej.12075 ↗
11. Impact of Lubricant Parameters on Rotary Instrument Torque and Force10.1016/j.joen.2006.11.007 ↗
12. Experimental Study of Smear Layer and Debris Remaining following the Use of Four Root Canal Preparation Systems Using Scanning Electron Microscopy
13. Root Canal Irrigants: A Review of Their Interactions, Benefits, and Limitations
14. The Smear Layer in Endodontics—A Review10.1111/j.1365-2591.2009.01627.x ↗
15. Smear Layer Removal Using Passive Ultrasonic Irrigation and Different Concentrations of Sodium Hypochlorite10.1016/j.joen.2020.07.020 ↗
16. A Scanning Electron Microscopic Study of Dentinal Erosion by Final Irrigation with EDTA and NaOCl Solutions10.1046/j.1365-2591.2002.00594.x ↗
17. Effect of Manual Dynamic Activation with Citric Acid Solutions in Smear Layer Removal: A Scanning Electron Microscopic Evaluation10.1016/j.jds.2016.01.006 ↗
18. Time-Dependent Effects of Chitosan on Dentin Structures10.1590/S0103-64402012000400008 ↗
19. The Effect of EDTA with and without Ultrasonics on Removal of the Smear Layer10.1016/j.joen.2008.12.007 ↗
20. A Scanning Electron Microscopic Comparison of a High Volume Final Flush with Several Irrigating Solutions: Part 310.1016/S0099-2399(83)80032-6 ↗
21. Efficacy of Various Concentrations of NaOCl and Instrumentation Techniques in Reducing Enterococcus Faecalis within Root Canals and Dentinal Tubules10.1111/j.1365-2591.2005.01038.x ↗
22. Chemomechanical Reduction of the Bacterial Population in the Root Canal after Instrumentation and Irrigation with 1%, 2.5%, and 5.25% Sodium Hypochlorite10.1097/00004770-200006000-00006 ↗
23. Antimicrobial and Toxic Effects of Established and Potential Root Canal Irrigants10.1016/S0099-2399(06)80524-8 ↗
24. Comparison of Antibacterial and Toxic Effects of Various Root Canal Irrigants10.1046/j.1365-2591.2003.00673.x ↗
25. Antimicrobial Susceptibility of Monoculture Biofilms of a Clinical Isolate of Enterococcus Faecalis10.1016/j.joen.2008.09.004 ↗
26. Comparative Evaluation of Endodontic Irrigants against Enterococcus Faecalis Biofilms10.1016/j.joen.2005.09.001 ↗
27. Antimicrobial Efficacy of Chlorhexidine and Sodium Hypochlorite in Root Canal Disinfection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials10.1016/j.joen.2020.05.002 ↗
28. The Effect of Chlorhexidine as an Endodontic Disinfectant10.1016/S1079-2104(03)00168-9 ↗
29. Endodontic Irrigants: Different Methods to Improve Efficacy and Related Problems10.4103/ejd.ejd_56_18 ↗
30. The Effect of Application Time of EDTA and NaOCI on Intracanal Smear Layer Removal: An SEM Analysis10.1111/j.1365-2591.2005.00930.x ↗
31. Present Status and Future Directions—Irrigants and Irrigation Methods10.1111/iej.13739 ↗
32. Experimental Validation of a Computational Fluid Dynamics Model Using Micro-Particle Image Velocimetry of the Irrigation Flow in Confluent Canals10.1111/iej.13827 ↗
33. Effectiveness of Different Disinfection Protocols on the Reduction of Bacteria in Enterococcus Faecalis Biofilm in Teeth with Large Root Canals10.1016/j.joen.2015.12.016 ↗
34. Tissue Dissolution by Sodium Hypochlorite: Effect of Concentration, Temperature, Agitation, and Surfactant10.1016/j.joen.2010.06.021 ↗
35. Irrigant Flow within a Prepared Root Canal Using Various Flow Rates: A Computational Fluid Dynamics Study10.1111/j.1365-2591.2008.01503.x ↗
36. V The Effectiveness of Four Clinical Irrigation Methods on the Removal of Root Canal Debris10.1016/0030-4220(82)90103-7 ↗
37. Measurement of Pressure and Flow Rates during Irrigation of a Root Canal Ex Vivo with Three Endodontic Needles10.1111/j.1365-2591.2007.01244.x ↗
38. Barańska-Gachowska, M. (2021). Endodoncja Wieku Rozwojowego i Dojrzałego, Czelej. [3rd ed.].
39. Effect of Manual Dynamic Activation on Smear Layer Removal Efficacy of Ethylenediaminetetraacetic Acid and SmearClear: An in Vitro Scanning Electron Microscopic Study10.1111/j.1747-4477.2012.00350.x ↗
40. Effectiveness of Different Irrigation Techniques on Smear Layer Removal in Apical Thirds of Mesial Root Canals of Permanent Mandibular First Molar: A Scanning Electron Microscopic Study10.4103/0972-0707.159742 ↗
41. A Bio-Molecular Film Ex-Vivo Model to Evaluate the Influence of Canal Dimensions and Irrigation Variables on the Efficacy of Irrigation10.1111/j.1365-2591.2007.01317.x ↗
42. The Effect of Different Irrigation Agitation Techniques on Postoperative Pain in Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial10.1016/j.joen.2018.06.008 ↗
43. Modern Technologies in Endodontics10.1016/j.gien.2015.12.001 ↗
44. Effect of Alcohol on the Spreading Ability of Sodium Hypochlorite Endodontic Irrigant10.1016/0030-4220(82)90105-0 ↗
45. The Effects of Temperature on Sodium Hypochlorite Short-Term Stability, Pulp Dissolution Capacity, and Antimicrobial Efficacy10.1097/01.don.0000153846.62144.d2 ↗
46. In Vivo Intracanal Temperature Evolution during Endodontic Treatment after the Injection of Room Temperature or Preheated Sodium Hypochlorite10.1016/j.joen.2015.02.011 ↗
47. Sodium Hypochlorite in Endodontics: An Update Review10.1111/j.1875-595X.2008.tb00354.x ↗
48. The Effect of Heating to Intracanal Temperature on the Stability of Sodium Hypochlorite Admixed with Etidronate or EDTA for Continuous Chelation10.1016/j.joen.2018.09.014 ↗
49. Rapid Tissue Dissolution Efficiency of Electrically-Activated Sodium Hypochlorite on Bovine Muscle10.4103/1305-7456.143622 ↗
50. Effect of Intracanal and Extracanal Heating on Pulp Dissolution Property of Continuous Chelation Irrigant10.4103/jcd.jcd_230_21 ↗
51. Intracanal Heating of Sodium Hypochlorite: Scanning Electron Microscope Evaluation of Root Canal Walls10.4103/JCD.JCD_245_18 ↗
52. Dentinal Tubule Penetration and Root Canal Cleanliness following Ultrasonic Activation of Intracanal-Heated Sodium Hypochlorite10.1111/aej.12393 ↗
53. An in Vitro Evaluation of the Degree of Pulp Tissue Dissolution through Different Root Canal Irrigation Protocols10.4103/JCD.JCD_49_18 ↗
54. Ultrasonics in Endodontics: A Review of the Literature10.1016/j.joen.2006.10.008 ↗
55. Cavitation Measurement during Sonic and Ultrasonic Activated Irrigation10.1016/j.joen.2013.09.018 ↗
56. A Comparison of the Cleaning Efficacy of Short-Term Sonic and Ultrasonic Passive Irrigation after Hand Instrumentation in Molar Root Canals10.1097/00004770-200310000-00016 ↗
57. In Vitro Comparison of Passive and Continuous Ultrasonic Irrigation in Simulated Lateral Canals of Extracted Teeth10.1016/j.joen.2011.12.032 ↗
58. Effectiveness of Different Final Irrigant Activation Protocols on Smear Layer Removal in Curved Canals10.1016/j.joen.2010.03.037 ↗
59. Acoustic Hypochlorite Activation in Simulated Curved Canals10.1016/j.joen.2009.07.007 ↗
60. Evaluation of Smear Layer Removal by EDTAC and Sodium Hypochlorite with Ultrasonic Agitation10.1046/j.1365-2591.2002.00488.x ↗
61. The Evaluation of Removal of Calcium Hydroxide Paste from an Artificial Standardized Groove in the Apical Root Canal Using Different Irrigation Methodologies10.1111/j.1365-2591.2006.01182.x ↗
62. The Efficacy of Dynamic Irrigation Using a Commercially Available System (RinsEndo®) Determined by Removal of a Collagen “bio-Molecular Film” from an Ex Vivo Model10.1111/j.1365-2591.2008.01408.x ↗
63. Bactericidal Effect of Er:YAG Laser-Activated Sodium Hypochlorite Irrigation Against Biofilms of Enterococcus Faecalis Isolate from Canal of Root-Filled Teeth with Periapical Lesions10.1089/pho.2017.4293 ↗
64. Bactericidal Efficacy of Three Parameters of Nd:YAP Laser Irradiation against Enterococcus Faecalis Compared with NaOCl Irrigation10.1007/s10103-018-2603-9 ↗
65. Effect of Laser-Activated Irrigation on Biofilms in Artificial Root Canals10.1111/iej.12643 ↗
66. Er:YAG Laser-Induced Cavitation Can Activate Irrigation for the Removal of Intraradicular Biofilm10.1038/s41598-022-08963-x ↗
67. Effect of Laser-Activated Irrigations on Smear Layer Removal from the Root Canal Wall10.1089/pho.2017.4266 ↗
68. Laser Activation of Endodontic Irrigants with Improved Conical Laser Fiber Tips for Removing Smear Layer in the Apical Third of the Root Canal10.1016/j.joen.2008.08.029 ↗
69. Mikołajczyk, M. (2014). Laseroterapia w Endodoncji. Forum Stomatol. Prakt., 30–42. Available online: https://www.praktycznastomatologia.pl/artykul/laseroterapia-w-endodoncji.
70. Effect of Photon-Initiated Photoacoustic Streaming on Removal of Apically Placed Dentinal Debris10.1111/iej.12251 ↗
71. Irrigant Flow during Photon-Induced Photoacoustic Streaming (PIPS) Using Particle Image Velocimetry (PIV)10.1007/s00784-015-1562-9 ↗
72. Evaluation of 4 Different Irrigating Systems for Apical Extrusion of Sodium Hypochlorite10.1016/j.joen.2015.05.007 ↗
73. Laser-Activated Irrigation within Root Canals: Cleaning Efficacy and Flow Visualization10.1111/j.1365-2591.2009.01634.x ↗
74. The Biological and Mechanical Effect of Using Different Irrigation Methods on the Bond Strength of Bioceramic Sealer to Root Dentin Walls
75. Antibacterial and Smear Layer Removal Efficacy of Er:YAG Laser Irradiation by Photon-Induced Photoacoustic Streaming in Primary Molar Root Canals: A Preliminary Study10.1089/pho.2017.4369 ↗
76. Efficacy of Photon-Induced Photoacoustic Streaming in the Reduction of Enterococcus Faecalis within the Root Canal: Different Settings and Different Sodium Hypochlorite Concentrations10.1016/j.joen.2017.05.019 ↗
77. Efficacy of 4 Irrigation Protocols in Killing Bacteria Colonized in Dentinal Tubules Examined by a Novel Confocal Laser Scanning Microscope Analysis10.1016/j.joen.2016.03.009 ↗
78. Comparison of the EndoVac System to Needle Irrigation of Root Canals10.1016/j.joen.2007.01.020 ↗
79. Comparative Efficacy of Different Irrigant Activation Techniques for Irrigant Delivery Up to the Working Length of Mature Permanent Teeth: A Systematic Review and Meta-Analysis
80. Postoperative Pain after the Application of Two Different Irrigation Devices in a Prospective Randomized Clinical Trial10.1016/j.joen.2010.04.012 ↗
81. Root Canal Debridement Using Manual Dynamic Agitation or the EndoVac for Final Irrigation in a Closed System and an Open System10.1111/j.1365-2591.2010.01755.x ↗
82. Comparative Safety of Various Intracanal Irrigation Systems10.1016/j.joen.2009.01.011 ↗
83. Efficacy and Safety of Various Active Irrigation Devices When Used with Either Positive or Negative Pressure: An in Vitro Study10.1016/j.joen.2012.09.009 ↗
84. Penetration Depth of a Dye Marker into Dentine Using a Novel Hydrodynamic System (RinsEndo®)10.1111/j.1365-2591.2007.01264.x ↗
85. Effect of Different Irrigation Methods in the Presence of a Separated Instrument: An in Vitro Study10.1080/00016357.2020.1733076 ↗
86. In Vitro Comparisons of Debris Removal of the EndoActivatorTM System, the F FileTM, Ultrasonic Irrigation, and NaOCl Irrigation Alone after Hand-Rotary Instrumentation in Human Mandibular Molars10.1016/j.joen.2010.03.022 ↗
87. Endodontic Disinfection: Tsunami Irrigation10.4103/1658-5984.149080 ↗
88. Chu, X., Feng, S., Zhou, W., Xu, S., and Zeng, X. (2023). Cleaning Efficacy of EDDY versus Ultrasonically-Activated Irrigation in Root Canals: A Systematic Review and Meta-Analysis. BMC Oral Health, 23.10.1186/s12903-023-02875-6 ↗
89. Canal Cleanliness Using Different Irrigation Activation Systems: A SEM Evaluation10.1007/s00784-017-2070-x ↗
90. Efficacy of EDDY, Ultrasonic Activation, XP-Endo Finisher and Needle Irrigation on the Removal of MTAP from Artificially Created Grooves in Root Canals10.1111/aej.12535 ↗
91. Efficacy of Different Irrigation Technique in Simulated Curved Root Canals10.1007/s10103-021-03263-8 ↗
92. Comparison of Bacterial Reduction in Straight and Curved Canals Using Erbium, Chromium:Yttrium-Scandium-Gallium-Garnet Laser Treatment versus a Traditional Irrigation Technique With Sodium Hypochlorite10.1016/j.joen.2009.11.017 ↗
93. Effectiveness of Different Activated Irrigation Techniques on Debris and Smear Layer Removal from Curved Root Canals: A SEM Evaluation10.1111/aej.12342 ↗
94. Quality Guidelines for Endodontic Treatment: Consensus Report of the European Society of Endodontology10.1111/j.1365-2591.2006.01180.x ↗
95. (2023, May 28). British Endodontic Society A Guide to Good Endodontic Practice. Available online: https://britishendodonticsociety.org.uk/_userfiles/pages/files/a4_bes_guidelines_2022_hyperlinked_final.pdf?fbclid=IwAR2AGaq0xMu2FbqJTy6CDcyX-hQfOqorYZwYQ4FwF2G3YdPANPUTDQS_KqU.
96. Review of Ultrasonic Irrigation in Endodontics: Increasing Action of Irrigating Solutions10.4317/medoral.17621 ↗
97. Effectiveness of Ultrasonically Activated Irrigation on Root Canal Disinfection: A Systematic Review of in Vitro Studies10.1007/s00784-018-2345-x ↗