Cochrane · intervention · CD008948
Irrigants for non‐surgical root canal treatment in mature permanent teeth
Fedorowicz, Z, Nasser, M, Sequeira‐Byron, P, et al. · Cochrane Database of Systematic Reviews · 2012 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
70
current version
GRADE rated
0
No studies
58
Included studies
11
as reported
No studies 58 · 82.9%Ungraded 12 · 17.1%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Any age involving single or multi-rooted permanent teeth with pulpal or periapical pathology or both which required root canal treatment (single or multiple visit). Only teeth with fully formed roots were considered | A total of 851 participants were investigated and provided 879 teeth. The age of the participants ranged from 14 to 78 years and included both genders |
| Intervention | Any irrigants either against each other or against inactive agent (irrigant) or placebo. Combinations of irrigants were acceptable and if they had been used in conjunction with EDTA (ethylenediaminetetra-acetic acid) or similar chelating agents | Sodium hypochlorite (n=4); Chlorhexidine (n=4); Sodium hypochlorite with hydrogen peroxide (n=1); Sodium hypochlorite with proteolytic enzyme (n=1); Sodium hypochlorite with EDTA (n=1); Sodium hypochlorite with MTAD (n=2); Normal saline (n=3) |
| Comparison | Inactive agent (irrigant)/placebo | Normal saline (n=3); Chlorhexidine (n=4); Sodium hypochlorite (n=4); Hydrogen peroxide (n=1); Proteolytic enzyme (n=1); EDTA (n=1); MTAD (n=1) |
| Outcomes | Proportion of participants with moderate to severe pain in the time period: 72 hours to 14 days following the procedure. Proportion of participants with new or worsening signs symptoms or both of inflammation requiring a revisit at any time point up to 14 days following the procedure. Proportion of participants with moderate to severe pain up to 6 hours following the procedure. The mean change in health-related quality of life or participant-expressed satisfaction with the procedure. Proportion of participants or 'samples' with positive bacterial growth culture following the procedure and until 72 hours at follow-up. Change in periapical radiolucency as assessed by radiography or cone beam computed tomography (CBCT) at any clinically relevant time points and up to 1 year post-endodontic treatment | Proportion of participants with moderate to severe pain 72 hours to 14 days (n=2); Proportion of participants with new or worsening signs symptoms of inflammation (n=2); Proportion of participants with moderate to severe pain up to 6 hours (n=1); Proportion of participants or samples with positive bacterial growth culture (n=7); Change in periapical radiolucency (n=0) |
| Study designs | Randomised controlled trials (RCT) in which the unit of randomisation was an individual participant or tooth. If the unit of analysis was an individual person with more than one treated tooth this study would be considered a cluster RCT | NR |
| Timing | Not reported | Not reported |
Search date: 2012-07. Databases: Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (1950 to 5 July 2012); EMBASE (1980 to 5 July 2012); Latin American and Caribbean Literature on Health Sciences (LILACS)
Questions and results
Current version onlySodium hypochlorite (NaOCl), 2.5% to 5.25% vs Chlorhexidine, 0.2% to 2% (solution or gel)
Population: Patients aged 14 to 78 years with mature permanent teeth (fully formed roots), single or multi-rooted, with pulpal or periapical pathology, undergoing non-surgical root canal treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants with moderate to severe pain up to 6 hours after the procedure | no estimate extracted | 0 studies | No studies |
Mean change in health-related quality of life or participant-expressed satisfaction with the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with new or worsening signs/symptoms of inflammation requiring a revisit, up to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants or samples with positive bacterial growth culture, up to 72 hours after the procedure | RR 0.73 [0.34, 1.56] | 2 studies · 62 participants | Ungraded |
Adverse effects | no estimate extracted | 0 studies | No studies |
Change in periapical radiolucency (radiography or CBCT), up to 1 year after treatment | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain 72 hours to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Sodium hypochlorite 5% (also 2.5%) vs Sodium hypochlorite 1%
Population: Patients aged 14 to 78 years with mature permanent teeth (fully formed roots), single or multi-rooted, with pulpal or periapical pathology, undergoing non-surgical root canal treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in periapical radiolucency (radiography or CBCT), up to 1 year after treatment | no estimate extracted | 0 studies | No studies |
Proportion of participants with new or worsening signs/symptoms of inflammation requiring a revisit, up to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Adverse effects | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain 72 hours to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Mean change in health-related quality of life or participant-expressed satisfaction with the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants or samples with positive bacterial growth culture, up to 72 hours after the procedure | RR 0.22 [0.051, 0.91] | 1 study · 111 participants | Ungraded |
Proportion of participants with moderate to severe pain up to 6 hours after the procedure | no estimate extracted | 0 studies | No studies |
Sodium hypochlorite 5.25% vs Normal saline
Population: Patients aged 14 to 78 years with mature permanent teeth (fully formed roots), single or multi-rooted, with pulpal or periapical pathology, undergoing non-surgical root canal treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants or samples with positive bacterial growth culture, up to 72 hours after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain 72 hours to 14 days after the procedure | RR 0.8 [0.27, 2.5] | 1 study · 178 participants | Ungraded |
Change in periapical radiolucency (radiography or CBCT), up to 1 year after treatment | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain up to 6 hours after the procedure | no estimate extracted | 0 studies | No studies |
Mean change in health-related quality of life or participant-expressed satisfaction with the procedure | no estimate extracted | 0 studies | No studies |
Adverse effects | no estimate extracted | 0 studies | No studies |
Proportion of participants with new or worsening signs/symptoms of inflammation requiring a revisit, up to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Sodium hypochlorite 5% vs Sodium hypochlorite 5% with proteolytic enzyme
Population: Patients aged 14 to 78 years with mature permanent teeth (fully formed roots), single or multi-rooted, with pulpal or periapical pathology, undergoing non-surgical root canal treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in periapical radiolucency (radiography or CBCT), up to 1 year after treatment | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain 72 hours to 14 days after the procedure | None of the participants in either intervention group reported moderate to severe pain persisting after day 2. | 1 study · 166 participants | Ungraded |
Proportion of participants or samples with positive bacterial growth culture, up to 72 hours after the procedure | no estimate extracted | 0 studies | No studies |
Adverse effects | no estimate extracted | 0 studies | No studies |
Proportion of participants with new or worsening signs/symptoms of inflammation requiring a revisit, up to 14 days after the procedure | RR 0.9 [0.6, 1.5] | 1 study · 166 participants | Ungraded |
Proportion of participants with moderate to severe pain up to 6 hours after the procedure | RR 1.5 [0.4, 5.0] | 1 study · 166 participants | Ungraded |
Mean change in health-related quality of life or participant-expressed satisfaction with the procedure | no estimate extracted | 0 studies | No studies |
Sodium hypochlorite 1% with chlorhexidine 2% final rinse vs Sodium hypochlorite 1% with normal saline final rinse
Population: Patients aged 14 to 78 years with mature permanent teeth (fully formed roots), single or multi-rooted, with pulpal or periapical pathology, undergoing non-surgical root canal treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in periapical radiolucency (radiography or CBCT), up to 1 year after treatment | no estimate extracted | 0 studies | No studies |
Adverse effects | no estimate extracted | 0 studies | No studies |
Proportion of participants with new or worsening signs/symptoms of inflammation requiring a revisit, up to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain 72 hours to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain up to 6 hours after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants or samples with positive bacterial growth culture, up to 72 hours after the procedure | RR 0.14 [0.02, 0.99] | 1 study · 24 participants | Ungraded |
Mean change in health-related quality of life or participant-expressed satisfaction with the procedure | no estimate extracted | 0 studies | No studies |
Sodium hypochlorite 1.3% with MTAD final rinse vs Sodium hypochlorite 1.3% with normal saline final rinse
Population: Patients aged 14 to 78 years with mature permanent teeth (fully formed roots), single or multi-rooted, with pulpal or periapical pathology, undergoing non-surgical root canal treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects | no estimate extracted | 0 studies | No studies |
Proportion of participants with new or worsening signs/symptoms of inflammation requiring a revisit, up to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Mean change in health-related quality of life or participant-expressed satisfaction with the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain up to 6 hours after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain 72 hours to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants or samples with positive bacterial growth culture, up to 72 hours after the procedure | Vital bacterial counts decreased after the active intervention (MTAD) but live bacteria were present in all of the samples; no further usable data reported. | 1 study | Ungraded |
Change in periapical radiolucency (radiography or CBCT), up to 1 year after treatment | no estimate extracted | 0 studies | No studies |
Sodium hypochlorite 5.25% with EDTA 17% vs Sodium hypochlorite 1.3% with MTAD
Population: Patients aged 14 to 78 years with mature permanent teeth (fully formed roots), single or multi-rooted, with pulpal or periapical pathology, undergoing non-surgical root canal treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in periapical radiolucency (radiography or CBCT), up to 1 year after treatment | no estimate extracted | 0 studies | No studies |
Adverse effects | no estimate extracted | 0 studies | No studies |
Proportion of participants with new or worsening signs/symptoms of inflammation requiring a revisit, up to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain up to 6 hours after the procedure | no estimate extracted | 0 studies | No studies |
Mean change in health-related quality of life or participant-expressed satisfaction with the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain 72 hours to 14 days after the procedure | Only a graph plot of 'average pain' over the 7-day postoperative period in each group was provided; this could not be transformed into usable data for the review's prespecified outcomes. | 1 study | Ungraded |
Proportion of participants or samples with positive bacterial growth culture, up to 72 hours after the procedure | no estimate extracted | 0 studies | No studies |
Chlorhexidine 0.2% vs Normal saline
Population: Patients aged 14 to 78 years with mature permanent teeth (fully formed roots), single or multi-rooted, with pulpal or periapical pathology, undergoing non-surgical root canal treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants with new or worsening signs/symptoms of inflammation requiring a revisit, up to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain 72 hours to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Change in periapical radiolucency (radiography or CBCT), up to 1 year after treatment | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain up to 6 hours after the procedure | no estimate extracted | 0 studies | No studies |
Adverse effects | no estimate extracted | 0 studies | No studies |
Mean change in health-related quality of life or participant-expressed satisfaction with the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants or samples with positive bacterial growth culture, up to 72 hours after the procedure | Positive bacterial cultures at end of first appointment: 65% of samples (chlorhexidine 0.2%) vs 89% (normal saline); no further data reported. 890 per 1000 (89% positive cultures, normal saline) vs 650 per 1000 (65% positive cultures, chlorhexidine 0.2%) | 1 study | Ungraded |
Sodium hypochlorite 5.25% with hydrogen peroxide 3% vs Normal saline
Population: Patients aged 14 to 78 years with mature permanent teeth (fully formed roots), single or multi-rooted, with pulpal or periapical pathology, undergoing non-surgical root canal treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain up to 6 hours after the procedure | no estimate extracted | 0 studies | No studies |
Mean change in health-related quality of life or participant-expressed satisfaction with the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain 72 hours to 14 days after the procedure | RR 0.65 [0.2, 2.0] | 1 study · 161 participants | Ungraded |
Proportion of participants with new or worsening signs/symptoms of inflammation requiring a revisit, up to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Change in periapical radiolucency (radiography or CBCT), up to 1 year after treatment | no estimate extracted | 0 studies | No studies |
Proportion of participants or samples with positive bacterial growth culture, up to 72 hours after the procedure | no estimate extracted | 0 studies | No studies |
Sodium hypochlorite 5.25% vs Sodium hypochlorite 5.25% with hydrogen peroxide 3%
Population: Patients aged 14 to 78 years with mature permanent teeth (fully formed roots), single or multi-rooted, with pulpal or periapical pathology, undergoing non-surgical root canal treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mean change in health-related quality of life or participant-expressed satisfaction with the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with new or worsening signs/symptoms of inflammation requiring a revisit, up to 14 days after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain up to 6 hours after the procedure | no estimate extracted | 0 studies | No studies |
Adverse effects | no estimate extracted | 0 studies | No studies |
Change in periapical radiolucency (radiography or CBCT), up to 1 year after treatment | no estimate extracted | 0 studies | No studies |
Proportion of participants or samples with positive bacterial growth culture, up to 72 hours after the procedure | no estimate extracted | 0 studies | No studies |
Proportion of participants with moderate to severe pain 72 hours to 14 days after the procedure | RR 1.22 [0.4, 4.2] | 1 study · 167 participants | Ungraded |
Any irrigant, or combinations of irrigants (including used in conjunction with EDTA or similar chelating agents) vs Another irrigant, or an inactive agent (irrigant)/placebo
Population: Any age; single or multi-rooted permanent teeth with pulpal or periapical pathology (or both) requiring root canal treatment (single or multiple visit); root formation completed (fully formed roots) in all treated teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Periapical radiolucency assessed by radiography or cone beam computed tomography (CBCT) Minimum 12 months post-endodontic treatment | no estimate extracted | NR | No studies |
Any unscheduled re-visit or emergency visit | no estimate extracted | NR | No studies |
Change in size of any periapical lesion measured by standardised radiography | no estimate extracted | NR | No studies |
Microbial counts by conventional culture methods or molecular analyses | no estimate extracted | NR | No studies |
Clinical signs of periapical inflammation (swelling, pus formation, pain on biting/percussion/palpation) Minimum 12 months' follow-up | no estimate extracted | NR | No studies |
Quality of life or patient satisfaction measured on a validated scale | no estimate extracted | NR | No studies |
Postoperative pain (time to reduction of pain; intensity; proportion free of pain in follow-up; type, dose and frequency of pain medication) Postoperative / inter-appointment follow-up | no estimate extracted | NR | No studies |
Adverse effects related to any of the active interventions during the treatment phase | no estimate extracted | NR | No studies |