REVOLUTIONIZING ENDODONTICS: THE IMPORTANCE OF MULTIPLE IRRIGATORS FOR EFFECTIVE DISINFECTION OF THE ROOT CANAL SYSTEM A NARRATIVE REVIEW

Authors

DOI:

https://doi.org/10.47820/recima21.v5i11.5929

Keywords:

Multiple Irrigants, Endodontics, Disinfection.

Abstract

The research entitled “Revolutionizing Endodontics: The Importance of Multiple Irrigants for Effective Disinfection of the Root Canal System” presents a narrative review on the evolution and relevance of irrigants in endodontic treatment. From the use of simple solutions such as water and alcohol, to advanced irrigants such as sodium hypochlorite, EDTA and nanoparticles, the study emphasizes the need for irrigant combinations to improve antimicrobial efficacy and reduce complications associated with periradicular infections. Through a comprehensive review of the literature, gaps in research on the effectiveness of irrigant combinations in removing resistant biofilms are identified. Activation techniques such as ultrasonic irrigation, which optimize the action of irrigants, are also discussed. Among the highlighted findings, it is concluded that the sequential application of irrigants allows maximizing their effectiveness and that the use of ozonized water and sodium thiosulfate may offer promising alternatives. The study highlights the need for a comprehensive approach to endodontic irrigation to achieve optimal clinical outcomes and prevent post-treatment reinfection.

Downloads

Download data is not yet available.

Author Biographies

Irving Pablo Fernandez Calle

Doutorado em Ciências Odontológicas. Mestre em Ortodontia. Mestre em Farmacologia Clínica. Especialidade em Endodontia Clínica. Diploma em Farmacologia Odontológica. Diploma em Farmacologia Geral, Farmacologia e Assistência Farmacêutica. Diploma em Ensino Superior por Competências. Professor, Mestre em Ortodontia, Universidade Técnica de Oruro, Subsede La Paz. Professor e chefe de clínica, Especialidade em endodontia, Universidade Técnica de Oruro, Subsede de La Paz. Universidade Pública de El Alto. Professor, Especialidade em Endodontia, Universidade Nacional “Siglo XX”. 

Edwin Macias Limachi

Odontólogo de Planta Centro de Salud los pinos Municipio de el alto - La Paz. Especialidad Clínica en Odontopediatría. Cursarte Especialidad en Endodoncia Clínica. Diplomado enOdontología del Bebe y Pacientes con Discapacidad. Diplomado en educación superior. Diplomado en residencia Safci. 

Abigail Marisol Vargas Ticona

Maestría en Endodoncia. Diplomado en endodoncia. Diplomado en operatoria dental y estética. Diplomado en educación superior. Diplomado en educación superior por competencias para la docencia en estomatología. Docente Preclínico en Universidad de Aquino Bolivia (UDABOL), La Paz, Bolivia. Docente Posgrado Universidad Pública de El Alto (UPEA), El  Alto, Bolivia. Docente Posgrado Universidad Nacional "Siglo XX”, La Paz, Bolivia.

Jenny Paula Aguilar Avalos

Maestría en Rehabilitación Oral y Estética Dental. Diplomado en Diseño de Sonrisa Diplomado en Endodoncia. Diplomado en Educación superior. Gerente General, Clínica Dental “CLEANDENT”.

Marivel Irene Condori Escobar

Maestría en Salud Pública. Maestría en Ortodoncia. Odontóloga, Centro de Salud Integral, Viacha- La Paz, Bolivia.

Alcides Ramber Maldonado Huaycho

Diplomado en educación superior. Cursante  Maestria en Cirugía Bucal. Odontólogo Clinica Dental Privada.

Jenny Claudia Apaza Cayo

Especialidad en Odontopediatría. Odontóloga, Clínica Privada Salud Dental, El Alto - La Paz, Bolivia.

Miguel Angel Espinoza Vega

Presidente de SCEO UNIOR. Vicepresidente de SCEO UNIOR. Campeón de la SCEO BOL. Cursante de la Especialidad de Endodoncia con mención en microscopia, Universidad Técnica de Oruro, Sub Sede LaPaz.

Jesús Alejandro Marca Zeballos

Presidente de SCEO UNIOR. Cursante de la Especialidad de Endodoncia con mención en microscopia, Universidad Técnica de Oruro, Sub Sede LaPaz. Interno Centro de Salud Huari.

Ivan Iver Apaza Acho

Auxiliar de docencia, Materia de Endodoncia. Cursante de la Especialidad de Endodoncia con mención en microscopia, Universidad Técnica de Oruro, Sub Sede LaPaz. Auxiliar de docencia en la Universidad Nacional “Siglo XX”.

References

ALI, A.; BHOSALE, A.; PAWAR, S.; KAKTI, A.; BICHPURIYA, A.; AGWAN, M. A. Current Trends in Root Canal Irrigation. Cureus, v. 14, n. 5, 2022. https://doi.org/10.7759/CUREUS.24833 DOI: https://doi.org/10.7759/cureus.24833

ALYAHYA, A. A.; REKAB, M. S.; AL-OSTWANI, A. E. O.; ABDO, A.; KAYED, K.. The Effect of a Novel Silver-Citrate Root Canal Irrigation Solution (BioAkt), Ethylenediamine Tetraacetic Acid (EDTA), and Citric Acid on the Microhardness of Root Canal Dentin: A Comparative In Vitro Study. Cureus, 2022. https://doi.org/10.7759/cureus.31255 DOI: https://doi.org/10.7759/cureus.31255

BALSARAF, O.; RAGHAVENDRA, S.; SHAH, D.; SANJYOT, M.; BALSARAF, A. Comparative evaluation of antifungal efficacy of conventional endodontic irrigants and chitosan nanoparticles. Journal of Conservative Dentistry : JCD, v. 26, n. 2, p. 226–229, 2023. https://doi.org/10.4103/JCD.JCD_617_22

BOPPRÉ, L. M.; MENEZES SAVARIS, J.; CATHERINE MAIOLA, E.; PERESSONI VIEIRA-SCHULDT, D.; DA FONSECA ROBERTI GARCIA, L.; DA SILVEIRA TEIXEIRA, C.; ANTUNES BORTOLUZZI, E. Can Heated Distilled Water Effectively Prevent Precipitate Formation between NaOCl and CHX? International Journal of Dentistry, v. 2024, p. 1–6, 2024. https://doi.org/10.1155/2024/6612675 DOI: https://doi.org/10.1155/2024/6612675

BOUTSIOUKIS, C.; ARIAS-MOLIZ, M. T. Present status and future directions - irrigants and irrigation methods. International Endodontic Journal, v. 55, Suppl 3, p. 588–612, 2022. https://doi.org/10.1111/IEJ.13739 DOI: https://doi.org/10.1111/iej.13739

CHAKRAVARTHY, Y.; CHELLAMUTHU, M.; SENTHAMILSELVAN, A.; GANAPATHY, A.; YADHAVAKRISHNAN, M.; ASSMEE, M. A Comparative Evaluation of fibrin density with Chitosan, Papain and 17% EDTA-Normal saline combination as irrigants in teeth with open apices: An ex vivo SEM study. Journal of Conservative Dentistry : JCD, v. 25, n. 2, p. 140–144, 2022. https://doi.org/10.4103/JCD.JCD_553_21 DOI: https://doi.org/10.4103/jcd.jcd_553_21

CHEUNG, A. W. T.; LEE, A. H. C.; CHEUNG, G. S. P. Clinical efficacy of activated irrigation in endodontics: a focused review. Restorative Dentistry & Endodontics, v. 46, n. 1, 2021. https://doi.org/10.5395/RDE.2021.46.E10 DOI: https://doi.org/10.5395/rde.2021.46.e10

DAVE, A. G.; MALLYA, P. L.; BALLAL, N. V.; SHENOY, R. Efecto del ácido etilendiaminetetraacético, el ácido maleico y el ácido fumarico en la resistencia de la fractura de la raíz del tratamiento postendodóntico - Un estudio in vitro. J Conserv Dent Endod, v. 26, n. 4, 2023.

DEWI, A. Smear Layer Removal from Root Canal Dentin and Antimicrobial Effect of Citric Acid-modified Chlorhexidine. European Endodontic Journal, 2020. https://doi.org/10.14744/eej.2020.38258 DOI: https://doi.org/10.14744/eej.2020.38258

DREWS, D. J.; NGUYEN, A. D.; DIEDERICH, A.; GERNHARDT, C. R.. The Interaction of Two Widely Used Endodontic Irrigants, Chlorhexidine and Sodium Hypochlorite, and Its Impact on the Disinfection Protocol during Root Canal Treatment. Antibiotics (Basel), v. 12, n. 3, p. 589, 16 mar. 2023. DOI: https://doi.org/10.3390/antibiotics12030589

ELBAHARY, S.; HAJ-YAHYA, S.; KHAWALID, M.; TSESIS, I.; ROSEN, E.; HABASHI, W.; POKHOJAEV, A.; SARIG, R. Effects of different irrigation protocols on dentin surfaces as revealed through quantitative 3D surface texture analysis. Scientific Reports, v. 10, n. 1, 2020. https://doi.org/10.1038/S41598-020-79003-9 DOI: https://doi.org/10.1038/s41598-020-79003-9

FERNANDEZ CALLE, I. P.; APAZA CAYO, J. C.; BARRIOS MALAGA, C.; FERNÁNDEZ COCA, E.; CONDORI ESCOBAR, M. I.; MACIAS LIMACHI, E.; VARGAS TICONA, A. M. CIENCIA Y ENDODONCIA PARA LA ODONTOLOGÍA ODONTOPEDIATRÍA: UNA REVISIÓN NARRATIVA. RECIMA21 - Revista Científica Multidisciplinar, v. 5, n. 8, p. e585563, 2024. https://doi.org/10.47820/recima21.v5i8.5563 DOI: https://doi.org/10.47820/recima21.v5i8.5563

FORTEA, L.; SANZ-SERRANO, D.; LUZ, L.; BARDINI, G.; MERCADE, M. Update on chelating agents in endodontic treatment: A systematic review. Journal of Clinical and Experimental Dentistry, p. e516–e538, 2024. https://doi.org/10.4317/jced.60989 DOI: https://doi.org/10.4317/jced.60989

GOMES, B. P. F. A.; AVEIRO, E.; KISHEN, A. Irrigants and irrigation activation systems in Endodontics. Brazilian Dental Journal, v. 34, n. 4, p. 1–33, 2023. https://doi.org/10.1590/0103-6440202305577 DOI: https://doi.org/10.1590/0103-6440202305577

GÓMEZ-DELGADO, M.; CAMPS-FONT, O.; LUZ, L., SANZ, D.; MERCADE, M. Update on citric acid use in endodontic treatment: a systematic review. Odontology, v. 111, n. 1, p. 1–19, 2023. https://doi.org/10.1007/s10266-022-00744-2 DOI: https://doi.org/10.1007/s10266-022-00744-2

GOSWAMI, P.; SHARMA, K.; MAITI, N.; YADAV, S.; VERMA, V.; PUTHENKANDATHIL, R. Ozone: An Adjunct in Dental Treatment. Journal of Pharmacy and Bioallied Sciences, v. 16, (Suppl 1), p. S2–S4, 2024. https://doi.org/10.4103/jpbs.jpbs_427_23 DOI: https://doi.org/10.4103/jpbs.jpbs_427_23

GOUTHAM, P. A. J.; KALAISELVAM, R.; GANESH, A.; PAUL, C. B. Antibacterial Efficacy of Irrigants with Varying Osmolarity on E. faecalis Biofilm: An In Vitro Study. The Journal of Contemporary Dental Practice, v. 23, n. 10, p. 998–1003, 2022. https://doi.org/10.5005/JP-JOURNALS-10024-3417 DOI: https://doi.org/10.5005/jp-journals-10024-3417

HARIPRASAD, R.; JOY, B.; KURIAKOSE, F.; SUDHAKAR, A. S.; SOUMYA, T. S.; PATHROSE, S. P. Electrochemical dissolution and retrieval of broken NiTi endodontic files from root canal using chloride based isotonic fluids as electrolytes - An in vitro study. Journal of Pharmacy & Bioallied Sciences, v. 16, (Suppl 2), p. S1539–S1543, 2024. https://doi.org/10.4103/JPBS.JPBS_1225_23 DOI: https://doi.org/10.4103/jpbs.jpbs_1225_23

JOSIC, U.; MAZZITELLI, C.; MARAVIC, T.; FIDLER, A.; BRESCHI, L.; MAZZONI, A. Biofilm in Endodontics: In Vitro Cultivation Possibilities, Sonic-, Ultrasonic- and Laser-Assisted Removal Techniques and Evaluation of the Cleaning Efficacy. Polymers, v. 14, n. 7, 2022. https://doi.org/10.3390/POLYM14071334 DOI: https://doi.org/10.3390/polym14071334

KASHIKAR, R. R.; HINDLEKAR, A.; JADHAV, G. R.; MITTAL, P.; MUKHERJEE, P. Comparative evaluation of four different root canal irrigation techniques for apical extrusion of sodium hypochlorite - An in vitro study. J Conserv Dent Endod ., v. 26, n. 4, 2023.

KUMAR, R. S.; ANKOLA, A. V.; SANKESHWARI, R. M.; HEBBAL, M.; HAMPIHOLI, V.; KUMAR S, L.; DESHPANDE, A. P.; CHOUDHURY, A. R.; PAI KHOT, A. J. Effectiveness of various irrigant activation techniques on the penetration of sodium hypochlorite into lateral canals of mature permanent teeth: A systematic review and meta-analysis. The Saudi Dental Journal, v. 35, n. 1, p. 1–23, 2023. https://doi.org/10.1016/J.SDENTJ.2022.12.004 DOI: https://doi.org/10.1016/j.sdentj.2022.12.004

KUŚKA-KIEŁBRATOWSKA, A.; WIENCH, R.; MERTAS, A.; BOBELA, E.; KIEŁBRATOWSKI, M.; LUKOMSKA-SZYMANSKA, M.; TANASIEWICZ, M.; SKABA, D. Evaluation of the Sensitivity of Selected Candida Strains to Ozonated Water—An In Vitro Study. Medicina, v. 58, n. 12, p. 1731, 2022. https://doi.org/10.3390/medicina58121731 DOI: https://doi.org/10.3390/medicina58121731

MATHEW, T.; BM, S.; GV, P.; JOSE, J. Comparative Evaluation of the Antibacterial Efficacy of Chlorhexidine and 810 nm Diode Laser in the Disinfection of Root Canals Contaminated With Enterococcus faecalis: An In Vitro Study. Cureus, 2022. https://doi.org/10.7759/cureus.28596 DOI: https://doi.org/10.7759/cureus.28596

MEIRE, M.; DE MOOR, R. J. G. Principle and antimicrobial efficacy of laser-activated irrigation: A narrative review. International Endodontic Journal, v. 57, n. 7, p. 841–860, 2024. https://doi.org/10.1111/IEJ.14042 DOI: https://doi.org/10.1111/iej.14042

NUNES, I.; NOVAIS, T.; GARCIA, P.; SILVA, W.; TAVAREZ, R. J.; RIZZI, C. C. CARVALHO, C.; FILHO, E. Antimicrobial action of ozonated water and photodynamic therapy with sonic activation in root canals infected with Enterococcus faecalis. Journal of Clinical and Experimental Dentistry, e486–e491, 2022. https://doi.org/10.4317/jced.57909 DOI: https://doi.org/10.4317/jced.57909

PAWAR, M.; AGWAN, M. A. S.; TOSHNIWAL, N. G.; BISWAS, K.; RAINA, R.; PAWAR, S. Efficacy of Ozone to Eliminate Endopathogenic Microorganism in Rootcanal Biofilm. Journal of Pharmacy and Bioallied Sciences, v. 14, (Suppl 1), S876–S879, 2022. https://doi.org/10.4103/jpbs.jpbs_916_21 DOI: https://doi.org/10.4103/jpbs.jpbs_916_21

RUKSAKIET, K.; HANÁK, L.; FARKAS, N.; HEGYI, P.; SADAENG, W.; CZUMBEL, L. M.; SANG-NGOEN, T.; GARAMI, A.; MIKÓ, A.; VARGA, G.; LOHINAI, Z. Antimicrobial Efficacy of Chlorhexidine and Sodium Hypochlorite in Root Canal Disinfection: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Journal of Endodontics, v. 46, n. 8, p. 1032-1041.e7, 2020. https://doi.org/10.1016/J.JOEN.2020.05.002 DOI: https://doi.org/10.1016/j.joen.2020.05.002

SAHEBI, S.; SOBHNAMAYAN, F.; MOAZAMI, F.; NASERI, M. Assessment of sodium thiosulfate neutralizing effect on micro-hardness of dentin treated with sodium hypochlorite. BMC Oral Health, v. 20, n. 1, p. 326, 2020. https://doi.org/10.1186/s12903-020-01320-2 DOI: https://doi.org/10.1186/s12903-020-01320-2

SHEKHAR, S.; MALLYA, P. L.; BALLAL, V.; SHENOY, R. To evaluate and compare the effect of 17% EDTA, 10% citric acid, 7% maleic acid on the dentinal tubule penetration depth of bio ceramic root canal sealer using confocal laser scanning microscopy: an in vitro study. F1000Research, v. 11, p. 1561, 2023. https://doi.org/10.12688/f1000research.127091.2 DOI: https://doi.org/10.12688/f1000research.127091.2

SURESH, B.; RAVINDRAN, V. Comparative Analysis of Antimicrobial Properties and Physical Properties of Mineral Trioxide Aggregate Mixed With Distilled Water, Chlorhexidine, and Sodium Hypochlorite Solutions: An In Vitro Study. Cureus, 2024. https://doi.org/10.7759/cureus.67563 DOI: https://doi.org/10.7759/cureus.67563

TANVIR, Z.; JABIN, Z.; AGARWAL, N.; ANAND, A.; WAIKHOM, N. Comparative evaluation of antimicrobial efficacy of nanosilver solution, Azadirachta indica, sodium hypochlorite, and normal saline as root canal irrigants in primary teeth. Journal of the Indian Society of Pedodontics and Preventive Dentistry, v. 41, n. 1, p. 76–82, 2023. https://doi.org/10.4103/JISPPD.JISPPD_74_23 DOI: https://doi.org/10.4103/jisppd.jisppd_74_23

TEVES, A.; BLANCO, D.; CASARETTO, M.; TORRES, J.; ALVARADO, D.; JARAMILLO, D. Effectiveness of different disinfection techniques of the root canal in the elimination of a multi-species biofilm. Journal of Clinical and Experimental Dentistry, 2019. https://doi.org/10.4317/jced.56000 DOI: https://doi.org/10.4317/jced.56000

TONINI, R.; SALVADORI, M.; AUDINO, E.; SAURO, S.; GARO, M. L.; SALGARELLO, S. Irrigating Solutions and Activation Methods Used in Clinical Endodontics: A Systematic Review. Frontiers in Oral Health, v. 3, 2022. https://doi.org/10.3389/FROH.2022.838043 DOI: https://doi.org/10.3389/froh.2022.838043

VAN DER SLUIS, L. W. M.; VERSLUIS, M.; WU, M. K.; WESSELINK, P. R. Passive ultrasonic irrigation of the root canal: A review of the literature. International Endodontic Journal, v. 40, n. 6, p. 415–426, 2007. https://doi.org/10.1111/J.1365-2591.2007.01243.X DOI: https://doi.org/10.1111/j.1365-2591.2007.01243.x

WILKOŃSKI, W.; JAMRÓZ-WILKOŃSKA, L.; ZAPOTOCZNY, S.; OPIŁA, J.; GIARDINO, L. Real-time co-site optical microscopy study on the morphological changes of the dentine’s surface after citric acid and sodium hypochlorite: a single-tooth model. BMC Oral Health, v. 21, n. 1, p. 454, 2021. https://doi.org/10.1186/s12903-021-01815-6 DOI: https://doi.org/10.1186/s12903-021-01815-6

ZOU, X.; ZHENG, X.; LIANG, Y.; ZHANG, C.; FAN, B.; LIANG, J.; LING, J.; BIAN, Z.; YU, Q.; HOU, B.; CHEN, Z.; WEI, X.; QIU, L.; CHEN, W.; HE, W.; XU, X.; MENG, L.; ZHANG, C.; CHEN, L.; YUE, L. Expert consensus on irrigation and intracanal medication in root canal therapy. International Journal of Oral Science, v. 16, n. 1, 2024. https://doi.org/10.1038/S41368-024-00280-5 DOI: https://doi.org/10.1038/s41368-024-00280-5

Downloads

Published

14/11/2024

How to Cite

Fernandez Calle, I. P., Macias Limachi , E., Vargas Ticona , A. M., Aguilar Avalos , J. P., Condori Escobar, M. I., Maldonado Huaycho , A. R., … Apaza Acho , I. I. (2024). REVOLUTIONIZING ENDODONTICS: THE IMPORTANCE OF MULTIPLE IRRIGATORS FOR EFFECTIVE DISINFECTION OF THE ROOT CANAL SYSTEM A NARRATIVE REVIEW. RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218, 5(11), e5115929. https://doi.org/10.47820/recima21.v5i11.5929

Issue

Vol. 5 No. 11 (2024): CLICK HERE TO ACCESS THE ARTICLES

Section

ARTIGOS

Categories

License

Copyright (c) 2024 RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Os direitos autorais dos artigos/resenhas/TCCs publicados pertecem à revista RECIMA21, e seguem o padrão Creative Commons (CC BY 4.0), permitindo a cópia ou reprodução, desde que cite a fonte e respeite os direitos dos autores  e contenham menção aos mesmos nos créditos. Toda e qualquer obra publicada na revista, seu conteúdo é de responsabilidade dos autores, cabendo a RECIMA21 apenas ser o veículo de divulgação, seguindo os padrões nacionais e internacionais de publicação.