Int J Stomatol

Int J Stomatol ›› 2021, Vol. 48 ›› Issue (6): 644-655.doi: 10.7518/gjkq.2021104

• Original Articles • Previous Articles     Next Articles

Systematic review on the effect of photon-initiated photoacoustic streaming in endodontic irrigation

He Rong(),Liu Xuejun(),Zhou Yukun   

  1. Dept. of Special Clinic, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
  • Received:2021-02-04 Revised:2021-07-15 Online:2021-11-01 Published:2021-10-28
  • Contact: Xuejun Liu E-mail:675384051@qq.com;lxj@zzu.edu.cn

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Abstract:

Objective This work aims to evaluate the effect of photon-initiated photoacoustic streaming (PIPS) induced by Er: YAG laser activation on root canal irrigation. Methods Randomized controlled trials (RCTs) on the effect of PIPS in root canal irrigation in China were searched using China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, VIP Chinese Science and Technology Journal Database, PubMed, Embase, Cochrane Library, Web of Science, SCOPUS. All studies were published between January 2010 and July 2020 and were subsequently screened based on the inclusion and exclusion criteria. Item risk assessment and evaluation were conducted following the method of the Cochrane systematic review and PRISMA Guidelines. Results Forty-five eligible studies were included for description classification and systematic review. Results showed that PIPS has a significant effect on sterilizing; removing the smear layer, dentin debris, and calcium hydroxide from root canals; and increasing the depth of dentin tubule penetration. However, some findings failed to reflect the advantages of PIPS. At present, research on PIPS in terms of subjects (differences in length and curvature of isolated canals) remains lacking. The procedures and methods are not standardized, thus leading to differences in the research methods. Studies on root canal micro-fractures, irrigation solution and debris squeezed from apical foramen, standard parameters, comparison of various methods of irrigation, and randomized controlled clinical trials are also lacking. Conclusion Most studies showed that the PIPS of Er: YAG has significant effects on removing the bacteria, smear layer, dentin debris, and calcium hydroxide of root canals and increasing the depth of dentin tubule penetration. However, some results are controversial. This conclusion requires long-term, high-quality, and well-designed RCTs with large sample sizes for further validation.

Key words: Er: YAG laser, photon-initiated photoacoustic streaming, root canal treatment, root canal debridement, bacteria, smear layer, dentin tubule penetration, microcrack

CLC Number: 

  • R781.33

TrendMD: 

Fig 1

Screening flow chart"

Tab 1

Risk Assessment Form"

参考文献 样本量计算 同一操作者进行根管预备 同一操作者进行根管荡洗 牙齿预备荡洗过程标准化 牙齿是否随机分组 对照组和实验组使用的冲洗液是否相同 是否报告了操作者在使用PIPS方面的经验 研究人员是否使用盲法评估实验结果 风险评估
[7] 无 无 无 有 有 有 无 有 中度
[8] 无 有 有 有 有 无 无 无 中度
[9] 无 无 无 有 无 有 无 有 高度
[10] 无 无 无 有 有 无 无 无 高度
[11] 无 无 无 有 有 有 无 无 高度
[12] 无 无 无 有 有 有 无 无 高度
[13] 无 无 无 有 有 有 无 无 高度
[14] 无 无 无 有 有 有 无 无 高度
[15] 无 无 无 无 有 有 无 有 高度
[16] 无 无 无 有 有 有 无 无 高度
[17] 无 无 无 无 有 有 无 无 高度
[18] 无 无 无 有 有 有 无 无 高度
[19] 无 无 无 有 有 有 无 有 中度
[20] 无 无 无 有 有 有 无 无 高度
[21] 无 无 无 有 有 有 无 有 中度
[22] 无 无 无 有 有 有 无 无 高度
[23] 无 无 无 有 有 有 无 无 高度
[24] 无 无 无 无 有 有 无 无 高度
[25] 无 无 无 有 有 有 无 有 中度
[26] 无 无 无 有 有 有 无 无 高度
[27] 无 无 无 有 有 有 无 无 高度
[28] 无 无 无 有 有 有 无 无 高度
[29] 无 无 无 有 有 有 无 有 中度
[30] 无 无 无 有 有 有 无 无 高度
[31] 无 无 无 无 有 有 无 无 高度
[32] 无 无 无 无 有 有 无 无 高度
[33] 无 无 无 无 有 有 无 有 高度
[34] 无 无 无 有 有 有 无 无 高度
[35] 无 无 无 有 有 有 无 有 中度
[36] 无 无 无 有 有 无 无 有 高度
[37] 无 无 无 有 有 有 无 有 中度
[38] 无 无 无 有 有 有 无 无 高度
[39] 无 无 无 有 有 有 无 有 中度
[40] 无 无 无 无 有 有 无 无 高度
[41] 无 无 无 无 有 有 无 无 高度
[42] 无 无 无 有 有 有 无 无 高度
[43] 无 无 无 有 有 有 无 无 高度
[44] 无 有 有 有 有 有 无 无 中度
[45] 无 无 无 有 有 有 无 无 高度
[46] 无 无 无 有 有 有 有 无 中度
[47] 无 无 无 有 有 有 有 无 中度
[48] 无 无 无 有 有 有 无 无 高度
[49] 无 无 无 有 有 有 无 无 高度
[50] 无 无 无 有 有 有 无 无 高度
[51] 无 无 无 有 有 有 无 无 高度

Tab 2

Summary of related literature on sterilization effect of PIPS"

参考文献 研究对象 根管弯曲度 牙齿
类型		 根长/mm 总样本量 PIPS参数设置 PIPS荡洗时间 冲洗液 检测方法 作者结论
[7] PIPS、Nd: YAG、CI 无 单根牙 14 110 35 mJ、15 Hz、
50 μs		 20 s 1% NaClO 扫描电子显微镜 PIPS相比常规冲洗能去除更多的粪肠球菌生物膜
[18] PIPS、CI 直 单根牙 无 50 15 Hz、20 mJ、
50 μs、0.3 W		 1 min、
2 min		 5.25% NaClO 菌落计数、扫描电子显微镜 PIPS能有效去除根管内细菌
[17] PIPS、PUI、CI 无 单根牙 14 70 10 Hz、50 mJ 30 s 6% NaClO 菌落计数、组织学染色 PIPS能有效去除根管内细菌
[10] PIPS、CI 无 单根牙 无 86 10或20 mJ、
15 Hz、50 μs、0.15或0.3 W		 2 min 1%或3%或5% NaClO 菌落计数和扫描电子显微镜 在10或20 mJ的能量下,PIPS均能有效去除细菌
[11] PIPS、CI 无 单根牙 无 68 15 Hz、20 mJ、
50 μs、0.3 W		 90 s 6% NaClO和生理盐水 菌落计数、扫描电子显微镜、激光共聚焦显微镜 PIPS相比于其他组能有效去除细菌
[12] PIPS、SI、CI 无 单根牙 无 90 15 Hz、20 mJ、
50 μs、0.3 W		 60 s 2.5% NaClO、Qmix PCR扩增、菌落计数 PIPS激活冲洗液灭菌作用与对照组无明显差异
[13] PIPS、CI 直 单根牙 无 148 15 Hz、20 mJ、
50 μs、0.3 W		 30 s 5% NaClO 菌落计数 各组间细菌清除率无明显差异
[14] PIPS、CI 无 单根牙 无 26 15 Hz、20 mJ、
50 μs、0.3 W		 60 s 5% NaClO 菌落计数、扫描电子显微镜 PIPS相比于其他组能有效去除细菌
[15] PIPS、CI 无 单根牙 无 48 15 Hz、20 mJ、
50 μs、0.3 W		 60 s 3% NaClO 菌落计数、扫描电子显微镜 PIPS能去除细菌效果和注射器冲洗效果相当
[16] PIPS、Er, Cr: YSGG、Nd: YAG、LD 无 单根牙 无 70 15 Hz、20 mJ、
50 μs、0.3 W		 1 min、3 min 5.25% NaClO 扫描电子显微镜、激光共聚焦显微镜 PIPS能有效去除根管内细菌

Tab 3

Summary of the literature on the role of PIPS in removing the smear layer"

参考文献 研究对象 根管弯曲度 牙齿
类型		 根长/mm 总样本量 PIPS参数设置 PIPS荡洗时间 冲洗液 检测方法 作者结论
[20] PIPS、Er: YAG、Nd: YAG 直 单根牙 无 60 1 W、20 Hz、
50 mJ		 60 s 蒸馏水 扫描电子显微镜 PIPS和其他LAI方法均比常规冲洗去除更多的玷污层
[21] PIPS、Nd:YAG、LD 无 单根牙 11±1 45 15 Hz、20 mJ、50 μs、0.3 W 60 s 5% NaClO 扫描电子显微镜 PIPS体现出良好的玷污层去除效果
[22] PIPS、Er: YAG、Nd: YAG、PUI、SAF、CI 直 单根牙 无 90 45 mJ、20 Hz、
0.9 W、50 µs		 10 s×3次 5% NaClO、
17% EDTA		 扫描电子显微镜 PIPS和其他LAI方法均比常规冲洗去除更多的玷污层
[23] PIPS、Er: YAG、CI 直 单根牙 无 30 20 mJ、15 Hz、
0.3 W、50 μs		 30 s 生理盐水 扫描电子显微镜 PIPS和Preciso工作尖激活生理盐水没有增强玷污层的去除效果
[10] PIPS 无 单根牙 无 86 10/20 mJ、
0.15/0.3 W		 150 s 1%、3%、5% NaClO,17% EDTA 菌落计数和扫描电子显微镜 PIPS激活5% NaClO体现出良好的细菌杀灭和玷污层去除效果
[24] PIPS、Er: YAG 直 单根牙 无 81 0.3、0.6、0.9 W 无 10 g·L-1 NaClO 扫描电子显微镜和根尖染料浸润 0.3 W的模式下能良好地清理玷污层,与其他实验组无明显差异
[25] PIPS、PUI 直 单根牙 16 52 20/30 mJ、15/30 Hz、0.3/0.9 W、50 μs 1 min 1% NaClO 扫描电子显微镜 2种功率的PIPS均能有效去除玷污层,效果无明显差异
[30] PIPS、Nd: YAG、CI 无 单根牙 无 30 40 mJ、20 Hz 5 s×3次 5.25% NaClO、17% EDTA 扫描电子显微镜 PIPS体现出良好的玷污层去除效果
[31] PIPS、Nd: YAG、Er, Cr: YSGG、CI 无 单根牙 无 96 20 mJ、15 Hz、
0.3 W		 80 s 2.5% NaClO、17% EDTA、蒸馏水 扫描电子显微镜 PIPS和其他LAI方法均比常规冲洗去除更多的玷污层
[32] PIPS、Xpulse 无 单根牙 无 18 10/24 mJ、10 Hz 10 s 5.25% NaClO 扫描电子显微镜 24 mJ的PIPS具有良好的玷污层去除效果
[33] PIPS、CI 无 单根牙 无 64 20 mJ、50 Hz、
0.3 W、50 μs		 30 s×2次 20 % EDTA 扫描电子显微镜 PIPS没有提高玷污层去除水平
[34] PIPS、Er: YAG、SI、CI 无 单根牙 16 64 20 mJ、15 Hz、
0.3 W		 20 s×3次 Qmix 扫描电子显微镜 PIPS和SI去除玷污层效果均优于CI
[35] PIPS、ANP、CI 直 单根牙 17 142 20 mJ、15 Hz、
0.3 W、50 μs		 30 s×2次 5% NaClO、17% EDTA 扫描电子显微镜 PIPS、ANP、CI去除玷污层的效果差异无统计学意义
[36] PIPS 无 单根牙 无 80 20 mJ、15 Hz、
0.3 W、50 μs		 30 s 17% EDTA 扫描电子显微镜 PIPS体现出良好的玷污层去除效果

Tab 4

Summary of literature on the effect of PIPS on dentin debris removal"

参考文献 研究对象 根管弯曲度 牙齿类型 根长 总样本量 PIPS参数
设置		 PIPS荡洗时间 冲洗液 检测方法 作者结论
[28] PIPS、Er: YAG、UAI 无 下颌磨牙近中根 无 69 20 mJ、20 Hz、50 μs 20 s×3次 2.5% NaClO micro-CT PIPS与其他组均能有效清除根管内碎屑,但是都未完全去除
[38] PIPS、SNI 无 下颌磨牙近中根 无 16 20 mJ、15 Hz、0.3 W 2 min 6% NaClO、17% EDTA micro-CT PIPS能有效清除根管内碎屑,清除量是SNI的2.6倍
[26] PIPS、Er: YAG、UAI、MAI、CI 无 有根管峡部的磨牙 无 50 20 mJ、20 Hz、50 μs 20 s×3次 2.5% NaClO 显微镜下拍照、碎屑评分 激光组比CI更能有效去除根管内碎屑
[27] PIPS 无 单根牙 无 12 20 mJ、15 Hz、0.3 W 10~30 s 2.5% NaClO micro-CT PIPS可以增强根管内碎屑去除能力

Tab 5

Summary of the literature on the effect of PIPS in removing drugs in the root canal"

参考文献 研究对象 根管弯曲度 牙齿类型 根长 总样本量 PIPS参数设置 PIPS荡洗时间 冲洗液 检测方法 作者结论
[8] PIPS 无 单根牙 无 36 20 mJ、15 Hz、50 μs、0.3 W 60 s 2.5% NaClO micro-CT PIPS能有效去除根管内药物
[19] PIPS、LD、Nd: YAG、Er: YAG、ANP、PUI、CI 直 单根牙 无 80 20 mJ、15 Hz、0.3 W、50 μs 20 s 17% EDTA 纤维桩粘接强度测试 PIPS去除纤维桩效果最佳
[29] PIPS、PUI、CI 无 下颌磨牙winne Ⅱ型根管 无 30 20 mJ、15 Hz 2 min 8.25% NaClO、17% EDTA micro-CT PIPS去除根管内药物作用更好

Tab 6

Summary of related literature on the effect of PIPS on dentinal tubule penetration"

参考文献 研究对象 根管弯曲度 牙齿类型 根长/mm 总样本量 PIPS参数设置 PIPS荡洗时间/s 冲洗液 检测方法 作者结论
[41] PIPS、Er: YAG、PUI、SI、CI 直 单根圆形根管 无 65 30 mJ、30 Hz、
0.9 W		 60 5% NaClO 激光共聚焦显微镜 PIPS能够增加牙本质小管的渗透性
[42] PIPS、PUI、CI 直 单根圆形根管 无 156 30 mJ、30 Hz、
0.9 W		 60 5% NaClO 激光共聚焦显微镜 PIPS和PUI相比于CI均能够增加牙本质小管的渗透性
[35] PIPS、ANP、CI 直 单根牙 17 142 20 mJ、15 Hz、
0.3 W、50 μs		 30 5% NaClO 扫描电子显微镜、激光共聚焦显微镜 PIPS增加牙本质小管渗透性且能去除更多的玷污层
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