ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Irrigation Devices Used in Endodontics such as EndoVac and EndoActivator Result in More Efficient Removal of the Smear Layer in the Root Canal System
Clinical Question In adults, does the use of an EndoVac and EndoActivator with sodium hypochlorite remove the smear layer more effectively as compared to standard needle syringe irrigation with no activation?
Clinical Bottom Line The EndoVac irrigation system removed the smear layer better than passive ultrasonic irrigation and the EndoActivator. However, all removed the smear layer better than irrigation with needle syringe with no activation.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24139274Mancini/201365 extracted single-rooted human mandibular premolarsLaboratory study
Key resultsThe EndoActivator System was significantly more efficient than PUI and the control groups in removing the smear layer. The EndoVac System removed statistically significantly more smear layer than all other groups. At 5 and 8 mm from the apex, PUI and the EndoVac both performed statistically better than the control groups.
#2) 23595996Andrabi/201445 freshly-extracted human single-rooted mandibular premolars Laboratory study
Key resultsIn the apical-third region, the mean smear scores for teeth in group B (treated with 3% NaOCl and 17% EDTA using ultrasonic activation with a small file) and group C (treated with 3% NaOCl and 17% EDTA using manual activation with master gutta percha point), were significantly less than those of Group A, which received no activation. (P < 0.05).
Evidence Search (((endodontics) AND smear layer) AND sodium hypochlorite) AND ultrasonics
Comments on
The Evidence
Both studies were comparative studies done on extracted teeth. There are few published studies that utilized teeth being treated with root canal therapy in vivo. There are not many meta-analyses or systematic reviews in the literature in regard to this topic. However, the technology in the field of endodontics will continue to grow, and more studies will likely be done in the area of irrigation systems. As of now there is evidence that improved removal of the smear layer in root canal systems is possible with the use of irrigation systems such as the EndoActivator and EndoVac. Both studies used 3% sodium hypochlorite as the irrigation solution; it would be interesting to see if there was increased removal of biofilm and bacteria with an increase from 3% to 6% sodium hypochlorite.
Applicability Effective irrigation and cleaning of the root canal system are important for root canal success. The more effectively irrigation reaches the apical portion of the root canal system, along with adequate cleaning and shaping, the better outcome of root canal therapy. Adding the use of an irrigation system like the EndoActivator can help to increase the practitioner’s ability to more adequately clean the root canal system. Introducing an irrigation system into practice does have a cost, which can be a limiting factor for private practitioners. In addition to cost, EndoVac is a very complicated system to use and would involve a learning curve. Irrigation devices should not be used in patients with open apices.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Smear layer, EndoActivator, EndoVac, irrigation, irrigation devices Pain, Abscess, Dental Abscess
ID# 2957
Date of submission: 10/22/2015spacer
E-mail hendersonlb@livemail.uthscsa.edu
Author Lara Henderson, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Luis C. Yepes, DDS
Faculty mentor/Co-author e-mail Yepes@uthscsa.edu
Basic Science Rationale
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