Reevaluating irrigant activation techniques: A call for standardization in clinical practice

Sir, I am writing to stress the pressing need for standardization in activation techniques used on irrigants in endodontic practice. These technicalities and variations of the techniques are going to make a significant difference in the outcome of the treatment, and that is why our field must address these matters. Recent studies have pointed out the numerous techniques applied to activate irrigation liquids in root canal treatments. The review explains how variations in techniques, such as sonic, ultrasonic, and negative pressure irrigation, vary in terms of the quality of debris removal and efficiency of disinfection. Consequently, inconsistencies with clinical decision-making have arisen, which has led to a review of the current clinical practices.[1] For instance, in an in vitro evaluation of various irrigation activation techniques in the context of removing medicaments from internal resorption cavities, it was concluded that certain methods are more effective than others, thus emphasizing the need for adopting a standardized approach to ensure optimal cleaning and disinfection of the root canal system. Such standardization would not only enhance the efficacy of treatments but also enable meaningful comparisons among studies, thereby resulting in a more cohesive body of evidence in our field.[2] In addition, irrigation systems for endodontics emphasize the role played by various irrigants along with activation methods. However, they emphasize that for this, more systematic investigations of these factors are urgently needed and how these different factors interact with each other in treatment outcomes. Just like the call for standardization, without such unification, it is even quite difficult to find what is the most effective method of activation under differing clinical conditions.[3] In addition, the relationship between the volumes of the irrigants applied in the various techniques in relation to root canal dentin microhardness. The conclusion drawn from their findings suggests that the treatment outcome may not only be determined by the activation technique selected but also by the volume of irrigants used, thereby showing that the whole standardization process should entail guidelines in the selection of activation techniques and appropriate volumes of the irrigants to achieve the desired outcome.[4] The lubrication is one of the critical factors in the root canal treatment, as it can affect the performance of the irrigation. Such a consideration indicates that there are multiple aspects to activating an irrigant, all of which have to work in concert: technique, properties of the irrigant, and other procedural aspects.[5] Furthermore, intracanal irrigation techniques may variably influence the removal of paste medicaments. Such a conclusion further complicates the landscape of treatment. It would thus strengthen the necessity for clinicians to have guidelines clearly defining activation techniques for application in particular clinical scenarios.[6] In summary, these studies illustrated that the lack of a standardization in the methods of activation of irrigants by themselves may jeopardize successful treatment and patient outcomes. I appeal to the entire endodontic community and ask them to converge as one to develop guidelines related to different activation methods with volumes of irrigants with procedural considerations. This manner will ensure consistency in all our practices and, subsequently, quality care for the patients. Thank you for taking on this very important issue. I look forward to future discussions on standardizing techniques for irrigation activation in orthodontics. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.