Susila Anand, Minu Joseph
Department of Conservative Dentistry Endodontics, Madha Dental College, Madha Nagar, Kundrathur, Chennai, India.
Eur Endod J. 2019 Nov 25;4(3):96-110. doi: 10.14744/eej.2019.80774. eCollection 2019.
Irrigant activation has been claimed to be beneficial in in vitro and clinical studies. This systematic review aims to investigate the clinical efficiency of mechanically activated irrigants and conventional irrigation.
A literature search (PROSPERO registration number: CRD42018112595) was undertaken in PubMed, Cochrane and hand search. The inclusion criteria were clinical trials, in vivo/ex vivo on adult permanent teeth involving an active irrigation device and a control group of conventional irrigation. The exclusion criteria were studies done in vitro, animals and foreign language. Adult patients requiring endodontic treatment of permanent dentition and irrigant activation during the treatment were chosen as the participants and intervention respectively.
After removal of duplicates, 89 articles were obtained, and 72 were excluded as they did not meet the selection criteria. 6 devices (EndoVac, EndoActivator, Ultrasonic, MDA (manual dynamic agitation), CUI (Continuous Ultrasonic Irrigation) and PUI (Passive Ultrasonic Irrigation)) and 6 variables of interest (Post-operative pain, periapical healing, antibacterial efficacy, canal and/or isthmus cleanliness, debridement efficacy and delivery up to working length) were evaluated in the 17 included articles. The risk of bias and quality of the selected articles were moderate. Results showed that mechanical active irrigation reduces post-operative pain. It improved debridement, canal/isthmus cleanliness. It also improved delivery of irrigant up to working length. Bacterial count was more with active irrigation, though not significant. There is no effect on long-term periapical healing.
It may be concluded that mechanical active irrigation devices are beneficial in reducing post-operative pain and improving canal and isthmus cleanliness during Endodontics.
在体外和临床研究中，冲洗液激活已被宣称具有益处。本系统评价旨在研究机械激活冲洗液与传统冲洗的临床效果。
在PubMed、Cochrane数据库进行文献检索（PROSPERO注册号：CRD42018112595）并进行手工检索。纳入标准为涉及成人恒牙的体内/体外临床试验，使用主动冲洗装置及传统冲洗对照组。排除标准为体外研究、动物研究及外文研究。分别选取需要对恒牙进行牙髓治疗且治疗过程中使用冲洗液激活的成年患者作为参与者和干预措施。
去除重复文献后，共获得89篇文章，其中72篇因不符合选择标准而被排除。在纳入的17篇文章中，评估了6种装置（EndoVac、EndoActivator、超声、手动动态搅拌（MDA）、连续超声冲洗（CUI）和被动超声冲洗（PUI））以及6个感兴趣的变量（术后疼痛、根尖周愈合情况、抗菌效果、根管和/或峡部清洁度、清创效果及冲洗液到达工作长度的情况）。所选文章的偏倚风险和质量中等。结果表明，机械主动冲洗可减轻术后疼痛，改善清创效果、根管/峡部清洁度，还能提高冲洗液到达工作长度的程度。主动冲洗时细菌计数更多，尽管差异不显著。对长期根尖周愈合无影响。
可以得出结论，在牙髓治疗中，机械主动冲洗装置有助于减轻术后疼痛并改善根管和峡部清洁度。
