Outcomes of Endodontic Therapy Comparing Conventional Sodium Hypochlorite Irrigation with Passive Ultrasonic Irrigation Using Sodium Hypochlorite and Ethylenediaminetetraacetate. A Retrospective Analysis

Moritz Hertel1, Katja Sommer2, Eckehard Kostka2, Sandra Maria Imiolczyk2, Husam Ballout2, Saskia Preissner2, *
1 Charité - Universitätsmedizin Berlin, Department of Oral Medicine, Dental Radiology and Oral Surgery, Assmanshauser Str. 4-6, 14197 Berlin, Germany
2 Charité - Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Assmanshauser Str. 4-6, 14197 Berlin, Germany

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© Hertel et al.; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Assmanshauser Str. 4-6, 14197 Berlin, Germany; Tel: +4930450562675; Fax: +4930450562932; Email:


The aim of the present study was to investigate the clinical outcomes of two different standardized endodontic irrigation protocols. It was assumed that the additional use of ethylenediaminetetraacetate (EDTA) and passive ultrasonic irrigation (PUI) would result in an increased rate of absence of symptoms and remission based on the periapical index (PAI) compared to passive irrigation using only sodium hypochlorite (NaOCl).

Data and radiographs from 199 teeth retrieved from the institutional endodontic database were analyzed retrospectively. In 106 teeth irrigation was performed using only NaOCl (protocol 1). Ninety-three teeth were irrigated using NaOCl and EDTA (protocol 2). Chlorhexidine (CHX) was additionally used in revision treatments in both groups. All irrigants in group 2 were activated by PUI.

Mean follow-up periods were: protocol 1 = 9.2 ± 4.4 and protocol 2 = 6.6 ± 2.5 months (p < 0.0001 (chi-square test). The frequencies of the PAImasterpoint and PAIfollow-up scores did not differ significantly between teeth, which received either protocol 1 or 2 (p = 0.555 and 0.138). Statistical analysis revealed no significant association between treatment success (absence of clinical symptoms and PAIfollow-up = I or PAImasterpoint > PAIfollow-up > I) and the applied protocol (success rates: protocol 1 = 72.6% vs. protocol 2 = 82.8%; p = 0.203). Furthermore, the frequency of extractions did not differ significantly between the two protocols (p = 0.102). No association was found between follow-up time and treatment success (p = 0.888).

The hypothesis was not confirmed. Even though the obtained success rate was higher after supplementing the irrigation protocol with EDTA and PUI, no significance was recorded. Hence, protocol 2 was not superior to protocol 1 regarding therapy success, at least within the limited follow-up period. It may be cautiously concluded that sufficient mechanical debridement combined with passive NaOCl irrigation results in comparably high success rates compared to EDTA and PUI.

Keywords: Disinfection, Endodontic therapy, Passive ultrasonic irrigation, Root canal.