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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)Cite this article

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Abstract

Objective

This systematic review aimed to assess the impact of Passive Ultrasonic Irrigation on the periapical healing rate of primary root canal treatment compared to conventional syringe irrigation.

Methods

Registered a priori in the PROSPERO database, this review was conducted by two independent reviewers who performed an electronic search up to December 2023. The search included databases such as MEDLINE (PubMed), Scopus, Web of Science, Embase, LILACS, and the Cochrane Library, as well as grey literature. We included randomized clinical trials (RCTs) that focused on patients undergoing primary root canal treatments. The study compared intervention groups using PUI with control groups that did not use activation techniques. Periapical healing was assessed over follow-up periods of at least six months, utilizing either periapical radiographs or cone-beam computed tomography. To synthesize the findings, a meta-analysis and trial sequence analysis were conducted, employing the Relative Risk as the measure of effect, with a 95% confidence interval. The GRADE approach was utilized to assess the certainty of the evidence.

Results

The meta-analysis incorporated three RCTs, involving 474 patients (501 teeth). The analysis revealed that PUI led to a higher rate of periapical healing compared to CSI (Relative Risk: 1.10; 95% Confidence Interval: 1.01-1.21, I² = 0%), with moderate certainty of evidence.

Conclusions

Despite the limited number of high-quality RCTs, the findings showed a positive impact of PUI on periapical healing rates in primary root canal treatments, in comparison to CSI.

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CRD42021290894.

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Data availability

Data is available upon request from the corresponding author.

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Funding

Funding

This study was partially supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) – Finance code 001.

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Authors and Affiliations

  1. Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil

    Leandro Bueno Gobbo, Walbert de Andrade Vieira, Adriana de-Jesus-Soares, José Flávio Affonso de Almeida & Caio Cezar Randi Ferraz

  2. School of Dentistry, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil

    Lucas Peixoto de Araújo

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  1. Leandro Bueno Gobbo
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Contributions

LBG and LPA conceived the work, performed the search, and wrote the manuscript. TAS and WVA have collected data and performed the statistical analysis. AJS and JFAA are project administrators and have contributed to the accuracy and integrity of the study. CCRF has revised the final version of the manuscript and supervised the whole process. Leandro Bueno Gobbo and Lucas Peixoto de Araújo equally contributed to this work.

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Correspondence to Lucas Peixoto de Araújo.

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Gobbo, L.B., de Araújo, L.P., Vieira, W.d.A. et al. Impact of passive ultrasonic irrigation on the outcome of non-surgical root canal treatment: a systematic review and meta-analysis of randomized clinical trials. Evid Based Dent (2024). https://doi.org/10.1038/s41432-024-01033-3

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