Manuel J Orozco-Gallego, Eliana L Pineda-Vélez, Wilder J Rojas-Gutiérrez, Martha L Rincón-Rodríguez, Andrés A Agudelo-Suárez
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Eight articles evidenced high methodological quality. Studies showed the effectiveness and efficacy depending on the study design, the findings of primary clinical trials, and factors related to the type of irrigant, concentration, volume, and irrigation systems. Variability between irrigants and protocols was observed. Follow-up periods extend from hours to years, and there were different study samples. SRs and MAs evidenced limitations regarding methodological aspects. Low overlap of the primary studies was found. Quantitative analyses indicated greater efficacy in microbial reduction and apical healing in favor of passive ultrasonic irrigation (PUI; RD -0.15; 95% CI -0.28, -0.01; <i>p</i> = 0.03; I2 = 60%; RD -0.09; 95% CI -0.16, -0.02; <i>p</i> = 0.01; I2 = 0%, respectively). <b>Conclusions:</b> This UR highlights the importance of root canal disinfection, emphasizing sodium hypochlorite (NaOCl) as the primary irrigant. Enhanced activation methods, such as PUI and lasers, improve irrigant efficiency, while alternatives like chlorhexidine (CHX) offer better biocompatibility. Standardized protocols and evidence-based clinical guidelines are needed. PROSPERO register: CRD42023409044.</p>","PeriodicalId":11269,"journal":{"name":"Dentistry Journal","volume":"13 6","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192043/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of Irrigation Protocols in Endodontic Therapy: An Umbrella Review.\",\"authors\":\"Manuel J Orozco-Gallego, Eliana L Pineda-Vélez, Wilder J Rojas-Gutiérrez, Martha L Rincón-Rodríguez, Andrés A Agudelo-Suárez\",\"doi\":\"10.3390/dj13060273\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background:</b> With the inclusion of evidence-based dentistry, numerous systematic reviews (SRs) and meta-analyses (MAs) have been conducted in endodontics with the best available scientific evidence to improve diagnosis and treatment. <b>Objective:</b> To synthesize the scientific evidence on the effectiveness of irrigation protocols in endodontic therapy. <b>Methods:</b> Following the umbrella review methodology (UR), a comprehensive literature search was conducted using scientific and grey literature databases. A quality evaluation and a descriptive analysis of the included SRs and MAs were conducted. Quantitative comparability between MAs was carried out. <b>Results:</b> Four descriptive SRs and nine MAs were included. Eight articles evidenced high methodological quality. Studies showed the effectiveness and efficacy depending on the study design, the findings of primary clinical trials, and factors related to the type of irrigant, concentration, volume, and irrigation systems. Variability between irrigants and protocols was observed. Follow-up periods extend from hours to years, and there were different study samples. SRs and MAs evidenced limitations regarding methodological aspects. Low overlap of the primary studies was found. Quantitative analyses indicated greater efficacy in microbial reduction and apical healing in favor of passive ultrasonic irrigation (PUI; RD -0.15; 95% CI -0.28, -0.01; <i>p</i> = 0.03; I2 = 60%; RD -0.09; 95% CI -0.16, -0.02; <i>p</i> = 0.01; I2 = 0%, respectively). <b>Conclusions:</b> This UR highlights the importance of root canal disinfection, emphasizing sodium hypochlorite (NaOCl) as the primary irrigant. Enhanced activation methods, such as PUI and lasers, improve irrigant efficiency, while alternatives like chlorhexidine (CHX) offer better biocompatibility. Standardized protocols and evidence-based clinical guidelines are needed. 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引用次数: 0
摘要
背景:随着循证牙科的纳入,许多系统评价(SRs)和荟萃分析(MAs)已经在牙髓学中进行了最好的科学证据,以提高诊断和治疗。目的:综合评价灌洗方法在根管治疗中的有效性。方法:采用伞式综述法(UR),利用科学文献数据库和灰色文献数据库进行综合文献检索。对纳入的SRs和MAs进行了质量评价和描述性分析。MAs之间进行了定量比较。结果:包括4个描述性SRs和9个MAs。八篇文章证明了较高的方法质量。研究表明,有效性和疗效取决于研究设计、初步临床试验的结果,以及与冲洗剂类型、浓度、体积和灌溉系统相关的因素。观察了冲洗剂和方案之间的差异。随访时间从数小时到数年不等,而且有不同的研究样本。SRs和MAs证明了方法方面的局限性。初步研究发现重叠程度低。定量分析表明,被动超声冲洗(PUI)在微生物减少和根尖愈合方面效果更好;RD -0.15;95% ci -0.28, -0.01;P = 0.03;I2 = 60%;RD -0.09;95% ci -0.16, -0.02;P = 0.01;I2 = 0%)。结论:本UR强调根管消毒的重要性,强调次氯酸钠(NaOCl)为主要冲洗剂。增强的活化方法,如PUI和激光,提高了灌溉效率,而氯己定(CHX)等替代品提供了更好的生物相容性。需要标准化的方案和基于证据的临床指南。普洛斯彼罗寄存器:CRD42023409044。
Effectiveness of Irrigation Protocols in Endodontic Therapy: An Umbrella Review.
Background: With the inclusion of evidence-based dentistry, numerous systematic reviews (SRs) and meta-analyses (MAs) have been conducted in endodontics with the best available scientific evidence to improve diagnosis and treatment. Objective: To synthesize the scientific evidence on the effectiveness of irrigation protocols in endodontic therapy. Methods: Following the umbrella review methodology (UR), a comprehensive literature search was conducted using scientific and grey literature databases. A quality evaluation and a descriptive analysis of the included SRs and MAs were conducted. Quantitative comparability between MAs was carried out. Results: Four descriptive SRs and nine MAs were included. Eight articles evidenced high methodological quality. Studies showed the effectiveness and efficacy depending on the study design, the findings of primary clinical trials, and factors related to the type of irrigant, concentration, volume, and irrigation systems. Variability between irrigants and protocols was observed. Follow-up periods extend from hours to years, and there were different study samples. SRs and MAs evidenced limitations regarding methodological aspects. Low overlap of the primary studies was found. Quantitative analyses indicated greater efficacy in microbial reduction and apical healing in favor of passive ultrasonic irrigation (PUI; RD -0.15; 95% CI -0.28, -0.01; p = 0.03; I2 = 60%; RD -0.09; 95% CI -0.16, -0.02; p = 0.01; I2 = 0%, respectively). Conclusions: This UR highlights the importance of root canal disinfection, emphasizing sodium hypochlorite (NaOCl) as the primary irrigant. Enhanced activation methods, such as PUI and lasers, improve irrigant efficiency, while alternatives like chlorhexidine (CHX) offer better biocompatibility. Standardized protocols and evidence-based clinical guidelines are needed. PROSPERO register: CRD42023409044.