Department of Restorative Dentistry, Birmingham Dental Hospital, Birmingham, UK.
Department of Restorative Dentistry, York Hospital, York, UK.
Int Endod J. 2018 Jun;51(6):605-621. doi: 10.1111/iej.12877. Epub 2017 Dec 22.
To establish whether irrigant activation techniques (IATs) result in greater intracanal smear layer and debris removal than conventional needle irrigation (CNI).
Six electronic databases were searched to identify scanning electron microscopy studies evaluating smear layer and/or debris removal following the use of manual dynamic activation (MDA), passive ultrasonic irrigation (PUI), sonic irrigation (SI) or apical negative pressure (ANP) IATs in mature permanent teeth. Meta-analyses were performed for each canal segment (coronal, middle, apical and apical 1 mm) in addition to subgroup analyses for individual IATs with respect to CNI. Outcomes were presented as standardized mean differences (SMD) alongside 95% confidence intervals (95% CI) and chi-squared analysis.
From 252 citations, 16 studies were identified. The meta-analyses demonstrated significant improvements in coronal (SMD: 1.15, 95% CI: 0.72-1.57 / SMD: 0.54, 95% CI: 0.29-0.80), middle (SMD: 1.30, 95% CI: 0.59-2.53 / SMD: 0.8, 95% CI: 0.58-1.13) and apical thirds (SMD: 1.22, 95% CI: 0.83-1.62 / SMD: 1.86, 95% CI: 0.76-2.96) for smear layer and debris removal, respectively. In the apical 1 mm IATs improved cleanliness; however, differences were insignificant (SMD: 1.15, 95% CI: -0.47-2.77). Chi-squared analysis revealed heterogeneity scores of 79.3-92.8% and 0.0-93.5% for smear layer and debris removal, respectively.
IATs improve intracanal cleanliness across a substantial portion of the canal, and therefore, their use is recommended throughout root canal preparation. However, current data is too heterogeneous to compare and identify superiority of an individual technique highlighting the need to standardize experimental protocols and develop a more representative research model to investigate the in vivo impact of IATs on clinical outcomes and periapical healing following root canal treatment.
评估冲洗激活技术（IATs）是否比传统的针头冲洗（CNI）更能有效清除根管内的玷污层和碎屑。
检索了六个电子数据库，以确定在成熟恒牙中使用手动动力激活（MDA）、被动超声冲洗（PUI）、超声冲洗（SI）或根尖负压（ANP）IAT 后，使用扫描电子显微镜评估玷污层和/或碎屑清除效果的研究。对每个根管段（冠部、中部、根尖和根尖 1mm）进行了荟萃分析，此外还对每个 IAT 与 CNI 进行了亚组分析。结果以标准化均数差（SMD）及 95%置信区间（95%CI）和卡方检验表示。
从 252 篇参考文献中，确定了 16 项研究。荟萃分析显示，在冠部（SMD：1.15，95%CI：0.72-1.57/SMD：0.54，95%CI：0.29-0.80）、中部（SMD：1.30，95%CI：0.59-2.53/SMD：0.8，95%CI：0.58-1.13）和根尖三分之一（SMD：1.22，95%CI：0.83-1.62/SMD：1.86，95%CI：0.76-2.96）方面，玷污层和碎屑的清除均有显著改善。在根尖 1mm 处，IATs 提高了清洁度，但差异无统计学意义（SMD：1.15，95%CI：-0.47-2.77）。卡方检验显示，玷污层和碎屑清除的异质性评分分别为 79.3-92.8%和 0.0-93.5%。
IATs 可显著改善根管内的清洁度，因此建议在根管预备的全过程中使用。然而，目前的数据存在很大的异质性，无法比较和确定单一技术的优势，这突出了标准化实验方案和开发更具代表性的研究模型的必要性，以研究 IATs 对根管治疗后临床效果和根尖周愈合的体内影响。
