Abstract
Objectives To evaluate the effectiveness of passive ultrasonic irrigation (PUI) compared with non-activated irrigation (NAI) on periapical healing and root canal disinfection.
Data source A comprehensive search without restrictions was performed in the following systematic electronic databases: PubMed, Scopus, Cochrane, Web of Science, ScienceDirect and OpenGrey. Additional studies were sought through hand-searching in the main endodontic journals.
Data selection We included clinical trials that compared PUI and NAI clinical success and root canal disinfection outcomes. The risk of bias was assessed based on the Cochrane Collaboration common scheme for bias assessment. The power analysis of each study was calculated based on the disinfection rates and sample size, and the evidence was qualified using the GRADE tool.
Data synthesis A total of 346 non-duplicated studies were retrieved in the systematic search. One study that assessed the clinical success rate through periapical radiographic healing evaluation and two studies that evaluated root canal disinfection through bacterial growth were considered eligible. These three studies were classified as low risk of bias. The study evaluating radiographic treatment outcome showed no statistical difference (P >0.05). The studies demonstrated large variability among methodology and, in general, low power and moderate evidence. Inconclusive results were reported regarding root canal disinfection when comparing PUI to NAI strategies.
Conclusions Based on the findings, there was no evidence of effectiveness improvement on periapical healing and bacterial disinfection that supports the use of PUI over the NAI in clinical practice.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Estrela C, Holland R, Estrela C R, Alencar A H, Sousa-Neto M D, Pecora J D. Characterization of successful root canal treatment. Braz Dent J 2014; 25: 3-11.
De-Deus G, Belladonna F G, Silva E J et al. Micro-CT Evaluation of non-instrumented canal areas with different enlargements performed by NiTi systems. Braz Dent J 2015; 26: 624-629.
Paque F, Balmer M, Attin T, Peters O A. Preparation of oval-shaped root canals in mandibular molars using nickel-titanium rotary instruments: a micro-computed tomography study. J Endod 2010; 36: 703-707.
Paque F, Peters O A. Micro-computed tomography evaluation of the preparation of long oval root canals in mandibular molars with the self-adjusting file. J Endod 2011; 37: 517-521.
Versiani M A, Leoni G B, Steier L et al. Micro-computed tomography study of oval-shaped canals prepared with the self-adjusting file, Reciproc, WaveOne, and ProTaper universal systems. J Endod 2013; 39: 1060-1066.
Zuolo M L, Zaia A A, Belladonna F G et al. Micro-CT assessment of the shaping ability of four root canal instrumentation systems in oval-shaped canals. Int Endod J 2018; 51: 564-571.
van der Sluis L W, Versluis M, Wu M K, Wesselink P R. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J 2007; 40: 415-426.
Ahmad M, Pitt Ford T J, Crum L A. Ultrasonic debridement of root canals: acoustic streaming and its possible role. J Endod 1987; 13: 490-499.
Lumley P J, Walmsley A D, Laird W R. Streaming patterns produced around endosonic files. Int Endod J 1991; 24: 290-297.
Roy R A, Ahmad M, Crum L A. Physical mechanisms governing the hydrodynamic response of an oscillating ultrasonic file. Int Endod J 1994; 27: 197-207.
Virdee S S, Seymour D W, Farnell D, Bhamra G, Bhakta S. Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: A systematic review and meta-analysis. Int Endod J 2018; 51: 605-621.
Estevez R, Conde A J, Valencia de Pablo O, de la Torre F, Rossi-Fedele G, Cisneros R. Effect of passive ultrasonic activation on organic tissue dissolution from simulated grooves in root canals using sodium hypochlorite with or without surfactants and EDTA. J Endod 2017; 43: 1161-1165.
Schmidt T F, Teixeira C S, Felippe M C, Felippe W T, Pashley D H, Bortoluzzi E A. Effect of ultrasonic activation of irrigants on smear layer removal. J Endod 2015; 41: 1359-1363.
Duque J A, Duarte M A, Canali L C et al. Comparative effectiveness of new mechanical irrigant agitating devices for debris removal from the canal and isthmus of mesial roots of mandibular molars. J Endod 2017; 43: 326-331.
Carver K, Nusstein J, Reader A, Beck M. In vivo antibacterial efficacy of ultrasound after hand and rotary instrumentation in human mandibular molars. J Endod 2007; 33: 1038-1043.
Chen S, Liu J, Dong G et al. Comparison between ultrasonic irrigation and syringe irrigation in clinical and laboratory studies. J Oral Sci 2016; 58: 373-378.
Rico-Romano C, Zubizarreta-Macho A, Baquero-Artigao M R, Mena-Alvarez J. An analysis in vivo of intracanal bacterial load before and after chemo-mechanical preparation: a comparative analysis of two irrigants and two activation techniques. J Clin Exp Dent 2016; 8: e9-e13.
Rodrigues R C, Antunes H S, Neves M A, Siqueira J F Jr, Rocas I N. Infection control in retreatment cases: in vivo antibacterial effects of 2 instrumentation systems. J Endod 2015; 41: 1600-1605.
Shamseer L, Moher D, Clarke M et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2015; 350: g7647.
Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions. 2018. Available at https://training.cochrane.org/handbook (accessed July 2019).
Sterne J A, Hernan M A, Reeves B C et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919.
Liang Y H, Jiang L M, Jiang L et al. Radiographic healing after a root canal treatment performed in single-rooted teeth with and without ultrasonic activation of the irrigant: a randomized controlled trial. J Endod 2013; 39: 1218-1225.
Herrera D R, Martinho F C, de-JesusSoares A et al. Clinical efficacy of EDTA ultrasonic activation in the reduction of endotoxins and cultivable bacteria. Int Endod J 2017; 50: 933-940.
Nakamura V C, Pinheiro E T, Prado L C et al. Effect of ultrasonic activation on the reduction of bacteria and endotoxins in root canals: a randomized clinical trial. Int Endod J 2018; 51: e12-e22.
Guyatt G, Oxman A D, Akl E A et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64: 383-394.
Alaçam T, Demirtola N, Misirligil A, Ayhan N, Gökay O. In vivo comparison of antimicrobial effectiveness of conventional and ultrasound activated irrigation techniques in root canal therapy. Bull Tokyo Dent Coll 1987; 28: 19-22.
Beus C, Safavi K, Stratton J, Kaufman B. Comparison of the effect of two endodontic irrigation protocols on the elimination of bacteria from root canal system: a prospective, randomized clinical trial. J Endod 2012; 38: 1479-1483.
Urban K, Donnermeyer D, Schafer E, Burklein S. Canal cleanliness using different irrigation activation systems: a SEM evaluation. Clin Oral Investig 2017; 21: 2681-2687.
Siqueira J F Jr, Rocas I N, Ricucci D, Hulsmann M. Causes and management of post-treatment apical periodontitis. Br Dent J 2014; 216: 305-312.
Maia L C, Antonio A G. Systematic reviews in dental research. A guideline. J Clin Paediatr Dent 2012; 37: 117-124.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Silva, E., Rover, G., Belladonna, F. et al. Effectiveness of passive ultrasonic irrigation on periapical healing and root canal disinfection: a systematic review. Br Dent J 227, 228–234 (2019). https://doi.org/10.1038/s41415-019-0532-z
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41415-019-0532-z
This article is cited by
-
Effect of ultrasonically-activated irrigation protocols used for regenerative endodontics on removal of dual species biofilm in a three-dimensionally printed tooth model: in vitro study
BMC Oral Health (2025)
-
Influence of passive ultrasonic irrigation cycles on the penetration depth of sodium hypochlorite into root dentin
Scientific Reports (2025)
-
Cleaning and disinfection of the root canal system provided by four active supplementary irrigation methods
Scientific Reports (2024)
-
Effectiveness of supplementary antimicrobial procedures in disinfecting lateral canals as evaluated by a novel ex vivo analytical approach
Scientific Reports (2024)
-
Impact of passive ultrasonic irrigation on the outcome of non-surgical root canal treatment: a systematic review and meta-analysis of randomized clinical trials
Evidence-Based Dentistry (2024)
