Non-Cochrane · intervention · PM42505758
Effects of Continuous Chelation with Etidronate on Mechanical Properties of the Root Canal Dentin: A Systematic Review with Meta-Analysis.
Sachkova Margarita, Savochkina Daria, Novozhilova Nina, et al. · Dentistry journal · 2026 · PubMed · doi:10.3390/dj14070450
Findings
Population Root canal dentin of permanent human teeth (ex vivo), without previous endodontic treatment
1 finding
| Continuous chelation (sodium hypochlorite and etidronate (HEDP) mixture) | Sequential irrigation (sodium hypochlorite then EDTA) | Root fracture resistance (compressive load to fracture, N) Not applicable (single static load test) · Laboratory (ex vivo) · Overall (bovine-teeth study excluded) | SMD 0.28 [-0.37, 0.92] GRADE not reported 5 studies · 94 participants |
Included primary studies 20
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Ballal 2024 Effect of continuous vs sequential chelation on the mechanical properties of root dentin: An ex vivo study DOI:10.1016/j.jdent.2024.105214 | 2024 | this review only | Root fracture resistance (compressive load to fracture, N) | not extracted yet |
| Bhandari 2026 Optimised clinical protocol for root canal obturation using single cone and hydraulic cement sealer DOI:10.1016/j.dental.2026.02.011 | 2026 | this review only | not stated | not extracted yet |
| Elika 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Gonzalez 2020 Etidronic acid and ethylenediaminetetraacetic acid associated with sodium hypochlorite have limited effect on the compressive fracture… PMID:33911358 | 2020 | this review only | Root fracture resistance (compressive load to fracture, N) | not extracted yet |
| Hazar 2025 Effects of phytic acid and etidronic acid using continuous and sequential chelation on the removal of smear layer, dentin microhardness,… DOI:10.1186/s12903-025-06010-5 | 2025 | this review only | not stated | not extracted yet |
| Kfir 2020 Cleanliness and erosion of root canal walls after irrigation with a new HEDP-based solution vs. traditional sodium hypochlorite followed… DOI:10.1007/s00784-020-03249-w | 2020 | this review only | not stated | not extracted yet |
| Khairy 2026 Comparative evaluation of cetylpyridinium chloride–modified EDTA, sequential, and continuous chelation on smear layer removal and dentin… DOI:10.1016/j.jobcr.2026.101459 | 2026 | this review only | not stated | not extracted yet |
| Lantigua Dominguez 2018 DOI:10.22037/iej.v13i3.19247 | NR | this review only | Root fracture resistance (compressive load to fracture, N) | not extracted yet |
| Lima Nogueira 2018 DOI:10.22037/iej.v13i2.19287 | NR | this review only | not stated | not extracted yet |
| Lottanti 2009 Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer DOI:10.1111/j.1365-2591.2008.01514.x | 2009 | this review only | not stated | not extracted yet |
| Mikheikina 2024 Smear Layer Removing and Pulp Dissolving Ability of Sodium Hypochlorite Mixed with Two Etidronate-Containing Irrigants in Continuous… DOI:10.3390/app14188422 | 2024 | this review only | not stated | not extracted yet |
| Rath 2020 The effects of sequential and continuous chelation on dentin DOI:10.1016/j.dental.2020.10.010 | 2020 | this review only | not stated | not extracted yet |
| Tartari 2013 A New Weak Chelator in Endodontics: Effects of Different Irrigation Regimens with Etidronate on Root Dentin Microhardness DOI:10.1155/2013/743018 | 2013 | this review only | not stated | not extracted yet |
| Tartari 2013 (roughness) Etidronate from Medicine to Endodontics: effects of different irrigation regimes on root dentin roughness DOI:10.1590/1679-775720130201 | 2013 | this review only | not stated | not extracted yet |
| Tartari 2023 Final irrigation protocols can be used to promote stable long-term bond strength of AH Plus to dentin DOI:10.1590/1678-7757-2023-0005 | 2023 | this review only | not stated | not extracted yet |
| Ulusoy 2020 Nanohardness reduction and root dentine erosion after final irrigation with ethylenediaminetetraacetic, etidronic and peracetic acids DOI:10.1111/iej.13372 | 2020 | this review only | not stated | not extracted yet |
| Ulusoy 2021 Effect of final irrigation protocols on the fracture resistance of roots with varying dentine thickness DOI:10.1111/eos.12769 | 2021 | this review only | Root fracture resistance (compressive load to fracture, N) | not extracted yet |
| Wright 2021 Resistance to compressive force in continuous chelation DOI:10.1111/aej.12440 | 2020 | this review only | not stated | not extracted yet |
| Yeter 2024 Effect of different final irrigation solutions on the fracture strength of endodontically treated premolars: An ex vivo study DOI:10.14744/tej.2024.84856 | 2024 | this review only | Root fracture resistance (compressive load to fracture, N) | not extracted yet |
| Zarean 2023 2D and 3D Erosion Landscape Analysis of Endodontic-Treated Teeth Using EDTA and HEDP as Chelating Agents: A High-Resolution Micro-Computed… PMID:38132424 | 2023 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Root canal dentin of permanent human or animal teeth without previous endodontic treatment | Root dentin of extracted human and bovine teeth (n=572 specimens; 20 studies) |
| Intervention | Continuous chelation (sodium hypochlorite and etidronate mixture) | NaOCl + etidronate (7.7% to 18% HEDP) continuous chelation |
| Comparison | Sequential irrigation (sodium hypochlorite and EDTA) | NaOCl then 17% EDTA (12.5% in one study) |
| Outcomes | Dentin mechanical properties: root fracture resistance, erosion, demineralization, collagen damage, microhardness, roughness, chemical composition | Fracture resistance (6 studies), erosion (9), microhardness/nanohardness (5), chemical composition (4), roughness (1), flexural strength (1) |
| Study designs | In vitro, ex vivo studies | Ex vivo studies (n=20) |
| Timing | Not specified | Not specified |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | No | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Partial Yes · NRSI: Partial Yes | NRSI: Partial Yes · RCT: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: Yes | NRSI: Partial Yes · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Low | no |