Association between the irrigation-agitation techniques and Periapical Healing of large periapical lesions: a Randomized Controlled Trial

• Published in: Clinical oral investigations Vol. 28; no. 7; p. 376
• Main Authors: Doğan, Mehmet Umutcan, Arıcıoğlu, Banu, Köse, Taha Emre, Çıkman, Ahter Şanal, Öksüzer, Merve Çoban
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 15-06-2024; Springer Nature B.V
• Subjects: Adult; Agitation; Clinical outcomes; Clinical trials; Computed tomography; Cone-Beam Computed Tomography; Dentistry; Endodontics; Female; Humans; Itk protein; Lavage; Lesions; Male; Mandible - diagnostic imaging; Medicine; Middle Aged; Patients; Periapical Diseases - diagnostic imaging; Periapical Diseases - therapy; Radiography; Root Canal Irrigants - therapeutic use; Root Canal Therapy - methods; Root canals; Statistical analysis; Streaming; Teeth; Therapeutic Irrigation - methods; Tomography; Treatment Outcome; Wound Healing; SWEEPS; Irrigation agitation; LAI; PUI; Periapical healing; CBCT
• ISSN: 1436-3771; 1432-6981; 1436-3771
• DOI: 10.1007/s00784-024-05758-4

Objectives
The aim of this study was to evaluate the effects of manual dynamic activation (MDA), passive ultrasonic irrigation (PUI), and laser-activated irrigation (shock wave-enhanced emission photoacoustic streaming (SWEEPS)) on the periapical healing of large periapical lesions following nonsurgical root canal treatment.
Materials and methods
A total of fifty-six systemically healthy patients with a mandibular single-rooted tooth with periapical lesions of endodontic origin and a periapical index score of 3 or higher were included in the study. Before the treatment procedures, lesion volumes were determined volumetrically using cone–beam computed tomography (CBCT). Patients were randomized into treatment (MDA, PUI, SWEEPS) and control groups (
n
 = 14). Root canal treatment and irrigation procedures were performed by a calibrated postgraduate operator and completed at one visit. For routine follow-up, clinical and radiographic evaluations were performed by a blinded evaluator using periapical (PA) radiographs according to Molven’s criteria at 3, 6, and 9 months. At 12 months, lesion volumes were quantified volumetrically using CBCT (ITK-SNAP). The data were statistically analyzed with the Wilcoxon test. The significance level was set at
p
 < 0.05.
Results
In all groups, the mean lesion volume after treatment was significantly smaller than the mean volume before treatment (
p
 = 0.001). Among the 56 teeth, 11 teeth were ‘totally healed’, and 39 teeth were ‘reduced’ on PA radiographs. No ‘enlargement’ was detected in any group. On CBCT, the lesion volume decreased in the following order: LAI-SWEEPS (86.9%) > PUI (85.4%) > MDA (80.4%) > control (74.5%), with no statistically significant difference (
p
 > 0.05).
Conclusions
Despite the limitations of the present study, although a greater percentage of healing was observed in the LAI-SWEEPS and PUI groups, irrigation procedures had no statistically significant effect on the healing of periapical lesions with a single root canal at the 12-month follow-up. On the other hand, the outcome may change in multirooted teeth with curved and complex root canal systems.
Clinical relevance
In the short term and in single-canal teeth, advanced irrigation agitation methods such as laser and ultrasonic did not make a difference in healing other than manual irrigation agitation.