Activated Irrigation vs. Conventional non-activated Irrigation in Endodontics – A Systematic Review

OBJECTIVE: Irrigant activation has been claimed to be beneficial in in vitro and clinical studies. This systematic review aims to investigate the clinical efficiency of mechanically activated irrigants and conventional irrigation. METHODS: A literature search (PROSPERO registration number: CRD42018112595) was undertaken in PubMed, Cochrane and hand search. The inclusion criteria were clinical trials, in vivo/ex vivo on adult permanent teeth involving an active irrigation device and a control group of conventional irrigation. The exclusion criteria were studies done in vitro, animals and foreign language. Adult patients requiring endodontic treatment of permanent dentition and irrigant activation during the treatment were chosen as the participants and intervention respectively. RESULTS: After removal of duplicates, 89 articles were obtained, and 72 were excluded as they did not meet the selection criteria. 6 devices (EndoVac, EndoActivator, Ultrasonic, MDA (manual dynamic agitation), CUI (Continuous Ultrasonic Irrigation) and PUI (Passive Ultrasonic Irrigation)) and 6 variables of interest (Post-operative pain, periapical healing, antibacterial efficacy, canal and/or isthmus cleanliness, debridement efficacy and delivery up to working length) were evaluated in the 17 included articles. The risk of bias and quality of the selected articles were moderate. Results showed that mechanical active irrigation reduces post-operative pain. It improved debridement, canal/isthmus cleanliness. It also improved delivery of irrigant up to working length. Bacterial count was more with active irrigation, though not significant. There is no effect on long-term periapical healing. CONCLUSION: It may be concluded that mechanical active irrigation devices are beneficial in reducing post-operative pain and improving canal and isthmus cleanliness during Endodontics.