International Journal For Multidisciplinary Research

E-ISSN: 2582-2160   •   Impact Factor: 9.24

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Efficacy and Outcomes of Contemporary Endodontic Irrigation Techniques: A Systematic Review

Author(s) Mr. Fahad Khaled Abdulmoshsen, Mr. Abdulaziz R E M F Alkhaldi, Mr. Talal A H M Alharbi, Mr. Nour Ahmad Ibrahim Alanjari, Mr. Maneh M H R M H Alshemeri, Mr. Shaikhah Salem M M Alenezi, Mr. Mohammad S M M J Alenezi, Mr. ALI B H SH Alshammari
Country Kuwait
Abstract The success of endodontic treatment is critically dependent on effective irrigation, which has evolved from simple chemical rinsing to a complex strategy involving solution concentration, type, and advanced activation techniques. This systematic review aims to evaluate the impact of modern endodontic irrigation strategies, including irrigant types, concentrations, and activation methods, on key treatment outcomes such as antimicrobial efficacy, postoperative pain, smear layer removal, and long-term success. A comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for studies published between 2023 and 2025. In vitro, ex vivo, and clinical studies comparing different irrigation protocols and reporting on predefined outcomes were included. Thirty-eight studies were included. Sodium hypochlorite (NaOCl) remains the gold standard for antimicrobial efficacy, but its effectiveness is significantly enhanced by activation techniques like passive ultrasonic irrigation (PUI). Etidronic acid (HEDP) demonstrates superior smear layer removal compared to EDTA, with the added benefit of compatibility with NaOCl. Intracanal cryotherapy (2.5-4°C saline) consistently reduces short-term postoperative pain. Long-term survival is highest with comprehensive protocols combining mechanical preparation, PUI, chelators, and bioceramic sealers. However, minimally invasive preparations may compromise outcomes despite preserving tooth structure. Critical safety findings include the cytotoxic precipitate formed when NaOCl and chlorhexidine are mixed sequentially and the significant reduction in dentin bond strength caused by irrigants, which can be mitigated by pre-endodontic dentin sealing. Promising alternatives like polyhexanide, bromelain-based solutions, and nanoparticles show potential for effective and biocompatible disinfection. The optimal endodontic irrigation strategy is multifaceted. No single irrigant is ideal; instead, success is achieved through an integrated protocol that combines the tissue-dissolving power of NaOCl, the chelating efficacy of HEDP, the enhanced cleanliness of activation techniques like PUI, and the patient comfort benefits of cryotherapy, while carefully managing irrigant interactions and their impact on subsequent restorative procedures.
Keywords Endodontic Irrigation, Sodium Hypochlorite, Smear Layer, Postoperative Pain, Ultrasonic Therapy, Root Canal Therapy
Field Medical / Pharmacy
Published In Volume 7, Issue 5, September-October 2025
Published On 2025-10-19
DOI https://doi.org/10.36948/ijfmr.2025.v07i05.57920
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