Biological response to endodontic treatment in one versus two-visit: a systematic review and meta-analysis of animal studies

OBJECTIVES

To perform a systematic review of animal studies that compared the histopathological characteristics between teeth with apical periodontitis after endodontic treatment in one or two visits.

MATERIALS AND METHODS

This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) - CRD42022340849. Studies were collected from PubMed/MEDLINE, LILACS, EMBASE, Livivo, SciELO, Web of Science, Scopus, and Cochrane Library and manual and gray literature searches. Animal studies that evaluated histological characteristics after endodontic treatment of teeth with apical periodontitis in one or two visits were included. Risk of bias analysis of the included studies was performed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. Data synthesis of the included studies with quantitative data was performed, and meta-analysis was conducted with the Comprehensive Meta-Analysis software, using the random effects model and odds ratio (OR).

RESULTS

Eighteen studies met the inclusion criteria (Kappa = 0.891). Meta-analyses indicated values in inflammatory infiltrate intensity with effect size of 5.5% (95% CI: 0.020-0.148; p < 0.001), periodontal ligament thickness: 25.6% (95% CI: 0.134-0.487; p < 0.001), dentin resorption: 13% (95% CI: 0.015-1.141; p = 0.066), cementum resorption: 7.1% (95% CI: 0.015-0.325; p = 0.001), bone resorption: 1.4% (95% CI: 0.002-0.130; p < 0.001), mineralized tissue resorption: 42.8% (95% CI: 0.110-1.671; p = 0.222), biological apical sealing: 13.1% (95% CI: 0.055-0.314; p < 0.001), and presence of microorganisms: 10.3% (95% CI: 0.014-0.747; p = 0.025).

CONCLUSIONS

When considering animal studies, the two-visit endodontic treatment, using calcium hydroxide-based intracanal medication, resulted in better biological repair characteristics.

CLINICAL RELEVANCE

A two-visit endodontic treatment with calcium hydroxide-based intracanal medication yields superior histopathological outcomes.

Effectiveness of a new endodontic irrigation system for removing smear layer and dissolving simulated organic matter

OBJECTIVES

The study aimed to evaluate the potential for the dissolution of organic tissue in areas of simulated complexity and cleaning of root canal walls of the new iVac® endodontic irrigation system.

MATERIAL AND METHODS

Thirty mandibular premolars were evaluated by scanning electron microscopy before and after biomechanical preparation. Then, they were distributed according to the final irrigation protocol into groups with conventional irrigation, ultrasonic agitation with metallic insert (UA), and iVac® system, and new photomicrographs were obtained. For tissue dissolution analysis, glass capillaries filled with catgut were attached to the cervical and apical thirds of twenty-one prototyped upper incisors. They were weighed before and after the previously mentioned irrigation protocols. The data were statistically compared with a significance level of 5%.

RESULTS

The final irrigation provided greater cleaning of the root canal walls in the cervical, middle, and apical thirds of the root canals (P < 0.05), with no statistically significant difference between UA and iVac®, regardless of the analyzed thirds. Both ultrasonic irrigation protocols dissolved a significantly greater volume than the conventional irrigation protocol (P < 0.05), with no difference between the two protocols (P < 0.05).

CONCLUSIONS

The iVac® system showed root canal wall cleaning and tissue dissolution similar to UA with a metallic insert, and both were superior to conventional irrigation.

CLINICAL RELEVANCE

The new irrigation system iVac is more effective than conventional irrigation and has similar root canal wall cleaning and tissue dissolution to UA.