Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Street, ElManyal, Cairo, 11553, Egypt.
Odontology. 2022 Jul;110(3):419-433. doi: 10.1007/s10266-021-00671-8. Epub 2021 Nov 3.
This study aimed to systematically review clinical and microbiology-related effects of ultrasonically activated irrigation (UAI) compared to syringe irrigation (SI) during endodontic treatment. Electronic databases searching and manual searching were conducted. Only randomized clinical trials (RCTs) were included comparing UAI to SI. The RoB 2.0 Cochrane tool was used for risk-of-bias (RoB) assessment. The main outcomes were postoperative pain, treatment failure, and microbiology-related outcomes. Qualitative and quantitative analyses, wherever applicable, were performed. Risk ratios (RR) and [standardized] mean differences {[S]MD} were calculated for dichotomous and continuous outcomes, respectively. Certainty of evidence (CoE) was assessed using GRADE tool. Ten RCTs were included. UAI reduced pain incidence within the first 24 h (RR 0.50, 95% CI 0.35-0.71, 308 teeth) and microbial counts (SMD - 0.40, 95% CI [- 0.78, - 0.02], I = 0%, 126 teeth) than SI in non-vital teeth with apical periodontitis (AP). Both groups, however, had similar effects regarding pain intensity, lipopolysaccharide amounts, and the incidence of rescue-analgesic intake, treatment failure, and microbial presence (p > 0.05). CoE ranged from low to very low. Very limited evidence suggests that UAI could reduce postoperative-pain risk within the first 24 h and microbial counts for non-vital teeth with AP compared to SI. Most meta-analyses, however, are based on very few studies, mostly low-powered, with an overall very-low-to-low CoE. Further well-designed, larger RCTs are, thus, required.
本研究旨在系统评价超声冲洗（UAI）与注射器冲洗（SI）在根管治疗中临床和微生物学相关效果。进行了电子数据库搜索和手动搜索。仅纳入比较 UAI 与 SI 的随机临床试验（RCT）。使用 RoB 2.0 Cochrane 工具评估偏倚风险（RoB）。主要结局为术后疼痛、治疗失败和微生物学相关结局。在适用的情况下，进行了定性和定量分析。分别计算二分类和连续结局的风险比（RR）和[标准化]均数差{[S]MD}。使用 GRADE 工具评估证据确定性（CoE）。纳入了 10 项 RCT。与 SI 相比，UAI 可降低非活髓伴有根尖周炎（AP）牙齿在第 1 至 24 小时内的疼痛发生率（RR 0.50，95%CI 0.35-0.71，308 颗牙）和微生物计数（SMD -0.40，95%CI [-0.78，-0.02]，I=0%，126 颗牙）（p<0.05）。然而，两组在疼痛强度、内毒素含量、使用救急镇痛药的发生率、治疗失败率和微生物存在方面均无显著差异（p>0.05）。CoE 范围为低到极低。有限证据表明，与 SI 相比，UAI 可降低非活髓伴有 AP 牙齿在第 1 至 24 小时内的术后疼痛风险和微生物计数。然而，大多数meta 分析主要基于少数研究，且大多研究效力较低，整体 CoE 为低到极低。因此，需要进一步开展设计良好、更大规模的 RCT。
