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Antimicrobial effectiveness of ultrasonic irrigation in root canal treatment: a systematic review of randomized clinical trials and meta-analysis

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Abstract

Objective

The objective of this systematic review and meta-analysis (SRM) was to answer the question as to whether the use of ultrasonic irrigation (UI) results in better antimicrobial activity in root canal disinfection compared to conventional irrigation (CI).

Methods

A literature search was performed in the main scientific databases, carried out until October 2021. The eligibility criteria were randomized clinical trials (RCTs). Two meta-analyses were conducted using R software with the “META” package. The mean difference (MD) and odds ratio (OR) measure of effect were calculated. The fixed effect model was applied with a 95% confidence interval. The Cochrane collaboration scale was used to assess risk of bias and the GRADE tool to assess the quality of evidence.

Results

A total of 1782 records were screened, and 12 studies meeting the criteria were included in this review. A low risk of bias was observed for most domains, except allocation concealment that was considered unclear. The certainty of evidence was classified as moderate in the OR meta-analyses and low in the MD meta-analyses. Ultrasonic irrigation resulted in a better antimicrobial effect in both meta-analyses, MD 1.42 [1.60; 1.23] p < 0.0001, I2 = 80%; and OR 3.86 [1.98; 7.53] p< 0.0001, I2 = 28.7%.

Conclusion

Within the limitations of this SRM, UI presented better antimicrobial efficacy than CI.

Clinical Relevance

UI should be used by clinicians as it promotes better antimicrobial efficacy in patients undergoing endodontic treatment.

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Acknowledgements

The authors thank the librarian Ana Claúdia Martins Grieger Manzatti for the instructions regarding the search strategy of this review and the researchers.

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

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Authors and Affiliations

  1. Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University – UNESP, 1193 José Bonifácio Street, Araçatuba, SP, 16015-050, Brazil

    Lucas Orbolato Chalub, Gabriel Pereira Nunes, João Eduardo Gomes-Filho, Luciano Tavares Angelo Cintra & Gustavo Sivieri-Araujo

  2. Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University – UNESP, 1193 José Bonifácio Street, Araçatuba, SP, 16015-050, Brazil

    Henrico Badaoui Strazzi-Sahyon & Paulo Henrique dos Santos

  3. Oral Medicine, Department of Diagnosis and Surgery, Araraquara School of Dentistry, São Paulo State University – UNESP, 1680 Humaitá Street, Araraquara, SP, 14801-385, Brazil

    Túlio Morandin Ferrisse

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  1. Lucas Orbolato Chalub
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  8. Gustavo Sivieri-Araujo
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by Lucas Orbolato Chalub, Gabriel Pereira Nunes, Túlio Morandin Ferrisse, Henrico Badaoui Strazzi Sahyon, and Paulo Henrique dos Santos. The first draft of the manuscript was written by Lucas Orbolato Chalub and Gabriel Pereira Nunes. The final draft was written and revised by Lucas Orbolato Chalub, Gabriel Pereira Nunes, Henrico Badaoui Strazzi Sahyon, Túlio Morandin Ferrisse, João Eduardo Gomes-Filho, Luciano Tavares Angelo Cintra, and Gustavo Sivieri Araujo. All authors commented on previous versions of the manuscript, and all authors read and approved the final manuscript.

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Correspondence to Gustavo Sivieri-Araujo.

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Chalub, L.O., Nunes, G.P., Strazzi-Sahyon, H.B. et al. Antimicrobial effectiveness of ultrasonic irrigation in root canal treatment: a systematic review of randomized clinical trials and meta-analysis. Clin Oral Invest 27, 1343–1361 (2023). https://doi.org/10.1007/s00784-023-04897-4

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