Efficacy of Sonic Versus Ultrasonic Irrigation in Debris Removal from the Root Canal System: A Systematic Review

Abstract

Introduction: The aim of this study was to systematically review the debridement efficacy of ultrasonic irrigation compared with sonic irrigation during the endodontic treatment. Methods: An electronic search was undertaken on Cochrane Library, Medline, ScienceDirect and Scopus for articles published between January 2010 and January 2021 using appropriate Mesh terms and key words. The inclusion criteria were systematic reviews or in vitro controlled trials on permanent mature teeth or models simulating the root canal system involving a sonic or ultrasonic irrigation group and a control group of conventional needle irrigation. Two reviewers independently selected articles to include according to the inclusion criteria, extracted data from the articles and assessed the methodological quality of the included studies. The data items were arranged in tables. Results: From 811 studies, 17 in vitro studies and 3 systematic reviews were included. EndoActivator and EDDY were the most sonic devices used, whereas several ultrasonic devices were tested for passive ultrasonic irrigation. Debris removal was assessed either on root canal walls or isthmuses or both. The risk of bias and quality of the selected studies were qualified as moderate to high according to the JBI (Joanna Briggs Institute) and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) checklists. Overall, the findings confirmed superiority of the two agitation techniques over conventional irrigation and most of the studies showed no significant differences between sonic and ultrasonic irrigation in debris removal, however a moderate level of evidence showed superiority of ultrasonic irrigation. Conclusion: It may be concluded that sonic and ultrasonic activation of the irrigants are beneficial in hard tissue debris removal when compared to conventional needle irrigation, yet, the current data could not find significant differences between the two techniques.