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Title MTAD Irrigation Has No Significant Clinical Effect on Intracanal Bacterial Counts when Compared to Chemomechanical Endodontic Instrumentation and Sodium Hypochlorite
Clinical Question In patients with apical periodontitis, will the use of MTAD endodontic irrigation as compared to sodium hypochlorite irrigation reduce intracanal bacterial counts?
Clinical Bottom Line MTAD endodontic irrigation has no significant clinical effect on intracanal bacterial counts. This is supported by a randomized controlled clinical trial involving 30 patients that showed a lack of statistically significant effect on bacterial counts following a final rinse with MTAD versus a saline placebo. Further study is needed to establish improved diagnostic accuracy of the current endodontic microbiological techniques. Additional randomized controlled clinical trials are needed to further evaluate the clinical ability of MTAD to reduce intracanal bacterial counts as well as its effect on treatment success.
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) 19840635Malkhassian/200930 patients/teeth, 15 MTAD rinse and 15 saline rinse (control)Randomized Controlled Trial
Key resultsNo significant reduction in bacterial counts noted with MTAD final rinse beyond that achieved by 1.3% NaOCl alone.
Evidence Search ((endodontic irrigant) OR (MTAD)) AND (root canal disinfection)
Comments on
The Evidence
Validity: Malkhassian’s randomized controlled trial (RCT) addressed the in vivo research gap by examining the direct effect of MTAD on the intracanal bacterial counts following instrumentation and disinfection with 1.5% NaOCl. Assignment of patients to the treatment groups was done in a randomized fashion resulting in 15 patients allocated to the control group and 15 in the experimental group. All patients (30) were accounted for prior to the conclusion of the study. This was a double-blinded study. The study group included 15 men and 15 women that had 15 maxillary teeth and 15 mandibular teeth that required endodontic treatment. Teeth with pain, swelling, sinus tract, and percussion sensitivity were included. Confounding factors were minimized by including only patients that were: ASA I or II, 18 years of age or older, able to comply with the protocol, and exhibited good oral hygiene. The teeth that were included had adequate coronal structure, probing depths of less than 4mm, radiographic evidence of apical periodontitis, and negative responses to cold testing. All the patients of the control and experimental groups received the same treatment procedures other than the different rinse intervention. This study therefore has good internal validity due to study design; however, it lacks external validity due to a small sample size. The treatment effect of MTAD showed negligible effects on overall reduction of bacterial counts. The differences between the MTAD and the control group(saline) were not statistically significant.
Applicability The clinical impact of using MTAD irrigation showed insignificant effects on bacterial counts in this study. This finding warrants further study to determine efficacy of MTAD as an adjunct irrigant to potentially improve the success of endodontic treatment. While the evidence presented by this RCT is applicable to a large proportion of the patient population, especially those that are ASA I or II, 18 years of age or older, and able to perform good oral hygiene, the therapeutic effect of the intervention, MTAD, is negligible. Best evidence at this time does not support the notion that addition of MTAD to practitioners’ irrigation regimen would improve patient or provider endodontic outcomes.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords MTAD, endodontics, irrigants, apical periodontitis, disinfection
ID# 3479
Date of submission: 11/23/2021spacer
E-mail pryorp@livemail.uthscsa.edu
Author Paul Pryor, DMD
Co-author(s) Abby Shannon, DDS, MPH
Co-author(s) e-mail shannona@livemail.uthscsa.edu
Faculty mentor/Co-author Nikita Ruparel, DDS, MS, PhD
Faculty mentor/Co-author e-mail ruparel@UTHSCSA.edu
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