Which treatment protocol, among classical methods and/or various laser applications is the most effective in root canal disinfection, in vitro? A systematic review

Abstract

Purpose: The aim of this systematic review was to answer the question " Which treatment protocol, am-ong classical methods and/or various laser applica-tions is the most effective in root canal disinfection, in vitro " . Materials and Methods: A MEDLINE, a Co-chrane and an Embase search (three specified search-es) were conducted to identify randomized controlled trials (RCT) until June 2010, conducted on human teeth and published in English, German or French language, examining the root canal disinfection after the use of lasers with or without mechanical instrumentation. Additionally, hand search was conducted and contact with authors, when needed. Results: The MEDLINE, the Cochrane and the EMBASE search identified 240, 28, and 35 published articles, respectively. Ten articles from the MEDLINE and 5 articles from the Cochrane search (that were also identified in the MEDLINE search) met the inclusion and validity assessment criteria. In E.faecalis elimination, instrumentation of the root canal and diode laser / 665nanometer / 1Watt (diode laser / 665nm / 1W) ir-radiation with the combined effect of Methylene Blue (MB) as photosensitizing agent (logCFU / ml = 1,636) seemed to be the best method. In P.aeruginosa and in A.naeslundii elimination, instrumentation of the root canal followed by irrigation with 5, 25%NaOCl (logCFU / ml = 0) seemed to be the best method. In general, instrumentation of the root canal followed by irrigation with 5, 25%NaOCl (logCFU / ml = 0) and instrumentation of the root canal and Er: YAG laser / 2940 nm / 0,8W irradiation (logCFU / ml = 1,924) seemed to be the best (polymicrobial studies). Conclu-sion: There are treatment protocols with the assistan-ce or not of laser irradiation that can eliminate E.fae-calis, E.coli and S.aureus inside the root canal. How-ever, there is a serious number of S. anginosus, F. nu-cleatum, A. naes-lundii and P.aeruginosa that remain inside the root canal even after laser irradiation. New research is needed in order to set a treatment proto-col effective in the root canal disinfection from all bac-teria that are related to endodontic origin pathology.