Orozco-Gallego Manuel J, Pineda-Vélez Eliana L, Rojas-Gutiérrez Wilder J, Rincón-Rodríguez Martha L, Agudelo-Suárez Andrés A
Faculty of Dentistry, University of Antioquia, Medellín 050010, Colombia.
Faculty of Dentistry, CES University, Medellín 050024, Colombia.
Dent J (Basel). 2025 Jun 18;13(6):273. doi: 10.3390/dj13060273.
With the inclusion of evidence-based dentistry, numerous systematic reviews (SRs) and meta-analyses (MAs) have been conducted in endodontics with the best available scientific evidence to improve diagnosis and treatment. To synthesize the scientific evidence on the effectiveness of irrigation protocols in endodontic therapy. Following the umbrella review methodology (UR), a comprehensive literature search was conducted using scientific and grey literature databases. A quality evaluation and a descriptive analysis of the included SRs and MAs were conducted. Quantitative comparability between MAs was carried out. Four descriptive SRs and nine MAs were included. Eight articles evidenced high methodological quality. Studies showed the effectiveness and efficacy depending on the study design, the findings of primary clinical trials, and factors related to the type of irrigant, concentration, volume, and irrigation systems. Variability between irrigants and protocols was observed. Follow-up periods extend from hours to years, and there were different study samples. SRs and MAs evidenced limitations regarding methodological aspects. Low overlap of the primary studies was found. Quantitative analyses indicated greater efficacy in microbial reduction and apical healing in favor of passive ultrasonic irrigation (PUI; RD -0.15; 95% CI -0.28, -0.01; = 0.03; I2 = 60%; RD -0.09; 95% CI -0.16, -0.02; = 0.01; I2 = 0%, respectively). This UR highlights the importance of root canal disinfection, emphasizing sodium hypochlorite (NaOCl) as the primary irrigant. Enhanced activation methods, such as PUI and lasers, improve irrigant efficiency, while alternatives like chlorhexidine (CHX) offer better biocompatibility. Standardized protocols and evidence-based clinical guidelines are needed. PROSPERO register: CRD42023409044.
随着循证牙科的纳入，牙髓病学领域已经进行了大量系统评价（SRs）和荟萃分析（MAs），以利用现有最佳科学证据改善诊断和治疗。为了综合关于牙髓治疗中冲洗方案有效性的科学证据。按照伞状综述方法（UR），使用科学文献数据库和灰色文献数据库进行了全面的文献检索。对纳入的SRs和MAs进行了质量评估和描述性分析。对MAs之间进行了定量可比性分析。纳入了4篇描述性SRs和9篇MAs。8篇文章显示出较高的方法学质量。研究表明，有效性和疗效取决于研究设计、主要临床试验的结果以及与冲洗剂类型、浓度、体积和冲洗系统相关的因素。观察到冲洗剂和方案之间存在差异。随访期从数小时到数年不等，且研究样本不同。SRs和MAs在方法学方面存在局限性。发现原始研究的重叠度较低。定量分析表明，在减少微生物和根尖愈合方面，被动超声冲洗（PUI）更具疗效（RD -0.15；95%CI -0.28，-0.01；P = 0.03；I2 = 60%；RD -0.09；95%CI -0.16，-0.02；P = 0.01；I2 = 0%，分别）。本UR强调了根管消毒的重要性，强调次氯酸钠（NaOCl）作为主要冲洗剂。增强激活方法，如PUI和激光，可提高冲洗剂效率，而洗必泰（CHX）等替代品具有更好的生物相容性。需要标准化方案和循证临床指南。PROSPERO注册号：CRD42023409044。
