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The effectiveness of using various irrigation solutions for antiseptic treatment of root canals: a network meta-analysis
- Authors: Brazhnikova A.N.1, Klenkina E.D.1, Magaramov I.F.1, Minasyan V.S.1, Sarkisyan D.A.1, Aivazova V.V.1, Kalaycheva V.E.1, Kartoeva A.M.1, Batchaeva A.M.1, Gadjev M.A.1, Zagirov Z.R.1, Magomedova D.N.1, Nalbandyan A.A.1, Balova L.R.1, Dementeva S.O.1, Arustamyan T.A.1
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Affiliations:
- Stavropol State Medical University
- Issue: Vol 80, No 6 (2025)
- Pages: 445-455
- Section: STOMATOLOGY: CURRENT ISSUES
- Published: 17.03.2026
- URL: https://vestnikramn.spr-journal.ru/jour/article/view/18142
- DOI: https://doi.org/10.15690/vramn18142
- ID: 18142
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Abstract
Antiseptic treatment of the root canal system is a key stage of endodontic treatment and largely determines its clinical outcome. There are a number of well-established and alternative variations of irrigation solutions. In this regard, there is a need for choice, which is difficult due to the insufficient amount of information and its fragmentation. The purpose of this systematic review is to evaluate the comparative effectiveness of various irrigation solutions in the antiseptic treatment of root canals. To solve this problem, a meta-analysis was conducted examining various irrigants. The study was searched from PubMed and Web of Science databases with the keywords: “irrigation solutions”, “irrigation efficiency”, “sodium hypochlorite”, “chlorhexidine”, “EDTA”, “root canal disinfection”, “irrigation protocol”, “ultrasonic activation”. All the papers included in the meta-analysis were analyzed for the risk of bias. At each stage of the analysis, an attempt was made to reduce the chance of an operational error to 0. As a result, 4 studies out of 4122 analyzed were included. It was found that the literature search is limited by the lack of elaboration of the topic. When analyzing the data, care must be taken and possible limitations of the study must be taken into account. Solutions based on active chlorine demonstrated the most pronounced antimicrobial activity, while phytopreparations showed significantly more variable results and require additional study. This may be due to the fact that chemical antiseptics have pronounced oxidative and proteolytic effects and are able to penetrate deeply into tissues, whereas plant extracts have a limited spectrum of activity and poorly disrupt the biofilm structure. Regression analysis taking into account the “solution exposure” covariate showed that there was no significant effect of exposure time on the degree of reduction in microbial load.
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About the authors
Anna N. Brazhnikova
Stavropol State Medical University
Author for correspondence.
Email: braznikovaankaf@mail.ru
ORCID iD: 0000-0003-2117-2218
MD, PhD, Assistant Professor
Russian Federation, StavropolEkaterina D. Klenkina
Stavropol State Medical University
Email: klyonkina03@mail.ru
ORCID iD: 0009-0003-8707-9195
Student
Russian Federation, StavropolIlham F. Magaramov
Stavropol State Medical University
Email: imagaramov2003@bk.ru
ORCID iD: 0009-0000-5751-0421
Student
Russian Federation, StavropolVladislav S. Minasyan
Stavropol State Medical University
Email: Minasyan.vlad.03@gmail.com
ORCID iD: 0009-0005-4428-1881
Student
Russian Federation, StavropolDiana A. Sarkisyan
Stavropol State Medical University
Email: di.sarkisyan08@mail.ru
ORCID iD: 0009-0005-7440-7369
Student
Russian Federation, StavropolValeria V. Aivazova
Stavropol State Medical University
Email: Valeriaivazova11@mail.ru
ORCID iD: 0009-0001-9847-783X
Student
Russian Federation, StavropolVioletta E. Kalaycheva
Stavropol State Medical University
Email: violettakalaycheva@mail.ru
ORCID iD: 0009-0008-4048-291X
Student
Russian Federation, StavropolAset M. Kartoeva
Stavropol State Medical University
Email: kartoevaasa44@gmail.com
ORCID iD: 0009-0002-7637-1601
Student
Russian Federation, StavropolAmina M. Batchaeva
Stavropol State Medical University
Email: amina.batchaeva00@mail.ru
ORCID iD: 0009-0007-8674-9977
Student
Russian Federation, StavropolMinabidin A. Gadjev
Stavropol State Medical University
Email: minabidin.43@gmail.com
ORCID iD: 0009-0005-5957-6172
Student
Russian Federation, StavropolZagid R. Zagirov
Stavropol State Medical University
Email: zagid.zagirov05@mail.ru
ORCID iD: 0009-0007-3227-710X
Student
Russian Federation, StavropolDiana N. Magomedova
Stavropol State Medical University
Email: dianka.magomedova.0303@mail.ru
ORCID iD: 0009-0007-5763-7087
Student
Russian Federation, StavropolArsen A. Nalbandyan
Stavropol State Medical University
Email: sintilimon@mail.ru
ORCID iD: 0009-0001-7536-1375
Student
Russian Federation, StavropolLiana R. Balova
Stavropol State Medical University
Email: balova.liana@mail.ru
ORCID iD: 0009-0003-5293-7997
Student
Russian Federation, StavropolSofya O. Dementeva
Stavropol State Medical University
Email: sonehka2003@icloud.com
ORCID iD: 0009-0006-5528-8269
Student
Russian Federation, StavropolTamara A. Arustamyan
Stavropol State Medical University
Email: arystamyan777@gmail.com
ORCID iD: 0009-0005-5405-0884
Student
Russian Federation, StavropolReferences
- Iandolo A. Modern Therapeutic Strategies in Endodontics and Restorative Dentistry. Medicina (Kaunas). 2023;59(2):333. doi: https://doi.org/10.3390/medicina59020333
- Rosenberg PA, Schindler WG, Krell KV, et al. Identify the endodontic treatment modalities. J Endod. 2009;35(12):1675–1694. doi: https://doi.org/10.1016/j.joen.2009.09.027
- Marvaniya J, Agarwal K, Mehta DN, et al. Minimal Invasive Endodontics: A Comprehensive Narrative Review. Cureus. 2022;14(6):e25984. doi: https://doi.org/10.7759/cureus.25984
- Kulinkovych-Levchuk K, Pecci-Lloret MP, Castelo-Baz P, et al. Guided Endodontics: A Literature Review. Int J Environ Res Public Health. 2022;19(21):13900. doi: https://doi.org/10.3390/ijerph192113900
- Boutsioukis C, Arias-Moliz MT. Present status and future directions — irrigants and irrigation methods. Int Endod J. 2022;55(Suppl 3):588–612. doi: https://doi.org/10.1111/iej.13739
- Orozco-Gallego MJ, Pineda-Vélez EL, Rojas-Gutiérrez WJ, et al. Effectiveness of Irrigation Protocols in Endodontic Therapy: An Umbrella Review. Dent J (Basel). 2025;13(6):273. doi: https://doi.org/10.3390/dj13060273
- Gomes BPFA, Aveiro E, Kishen A. Irrigants and irrigation activation systems in Endodontics. Braz Dent J. 2023;34(4):1–33. doi: https://doi.org/10.1590/0103-6440202305577
- Wong J, Manoil D, Näsman P, et al. Microbiological Aspects of Root Canal Infections and Disinfection Strategies: An Update Review on the Current Knowledge and Challenges. Front Oral Health. 2021;2:672887. doi: https://doi.org/10.3389/froh.2021.672887
- Jhajharia K, Parolia A, Shetty KV, et al. Biofilm in endodontics: A review. J Int Soc Prev Community Dent. 2015;5(1):1–12. doi: https://doi.org/10.4103/2231-0762.151956
- Siqueira JF Jr, Rôças IN. Present status and future directions: Microbiology of endodontic infections. Int Endod J. 2022;55(Suppl 3):512–530. doi: https://doi.org/10.1111/iej.13677
- Rossi-Fedele G, Rödig T. Effectiveness of root canal irrigation and dressing for the treatment of apical periodontitis: A systematic review and meta-analysis of clinical trials. Int Endod J. 2023;56(Suppl 3):422–435. doi: https://doi.org/10.1111/iej.13777
- Ali A, Bhosale A, Pawar S, et al. Current Trends in Root Canal Irrigation. Cureus. 2022;14(5):e24833. doi: https://doi.org/10.7759/cureus.24833
- Gomes BPFA, Aveiro E, Kishen A. Irrigants and irrigation activation systems in Endodontics. Braz Dent J. 2023;34(4):1–33. doi: https://doi.org/10.1590/0103-6440202305577
- Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: https://doi.org/10.1136/bmj.n71
- Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Chichester (UK): John Wiley & Sons, 2019.
- Sterne JAC, Savović J, Page MJ, et al. RoB 2: Revised tool for assessing risk of bias in randomized trials. BMJ. 2019;366:l4898. doi: https://doi.org/10.1136/bmj.l4898
- Owen RK, Bradbury N, Xin Y, et al. MetaInsight: An interactive web-based tool for analyzing, interrogating, and visualizing network meta-analyses using R-shiny and netmeta. Res Syn Meth. 2019;10(4):569–581. doi: https://doi.org/10.1002/sim.7369
- Orozco EIF, Toia CC, Cavalli D, et al. Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial. J Appl Oral Sci. 2019;28:e20190100. doi: https://doi.org/10.1590/1678-7757-2019-0100
- Assadian H, Fathollahi S, Pourhajibagher M, et al. Effectiveness of Activated Sodium Hypochlorite Irrigation by Shock Wave-Enhanced Emission Photoacoustic Streaming, Sonic and Ultrasonic Devices in Removing Enterococcus faecalis Biofilm From Root Canal System. J Clin Med. 2024;13(20):6278. doi: https://doi.org/10.3390/jcm13206278
- Palwankar D, Garg A, Tandan M, et al. Antimicrobial efficacy of two commercially available herbal products with and without ultrasonic activation in primary endodontic infections: A randomized clinical trial. J Conserv Dent Endod. 2024;27(3):305–309. doi: https://doi.org/10.4103/JCDE.JCDE_308_23
- Rico-Romano C, Zubizarreta-Macho Á, Baquero-Artigao MR, et al. An analysis in vivo of intracanal bacterial load before and after chemo-mechanical preparation: A comparative analysis of two irrigants and two activation techniques. J Clin Exp Dent. 2016;8(1):e9–e13. doi: https://doi.org/10.4317/jced.52585
- Akbulut MB, Unverdi Eldeniz A. In vitro antimicrobial activity of different electrochemically-activated solutions on enterococcus faecalis. Eur Oral Res. 2019;53(1):44–50. doi: https://doi.org/10.26650/eor.20194564125648
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