title: Hand and ultrasonic instrumentation for orthograde root canal treatment of permanent teeth.
abstract: Root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment.
  
  
  OBJECTIVE
  The objectives of this systematic review of randomized controlled trials were to determine the relative clinical effectiveness of hand instrumentation versus ultrasonic instrumentation alone or in conjunction with hand instrumentation for orthograde root canal treatment of permanent teeth.
  
  
  METHODS
  The search strategy retrieved 226 references from the Cochrane Oral Health Group Trials Register (7), the Cochrane Central Register of Controlled Trials (CENTRAL) (12), MEDLINE (192), EMBASE (8) and LILACS (7). No language restriction was applied. The last electronic search was conducted on December 13th, 2007. Screening of eligible studies was conducted in duplicate and independently.
  
  
  RESULTS
  Results were to be expressed as fixed-effect or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible randomized controlled trials were identified.
  
  
  CONCLUSIONS
  This review illustrates the current lack of published or ongoing randomized controlled trials and the unavailability of high-level evidence based on clinically relevant outcomes referring to the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment. In the absence of reliable research-based evidence, clinicians should base their decisions on clinical experience, individual circumstances and in conjunction with patients' preferences where appropriate. Future randomized controlled trials might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis on not only clinically relevant, but also patient-centered outcomes.
authors.affiliation: Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, SP, Brazil. pedrazzi@forp.usp.br
authors.forename: Vinícius
authors.initials: V
authors.lastname: Pedrazzi
authors.forename: Jeronimo Manço
authors.initials: JM
authors.lastname: de Oliveira-Neto
authors.forename: Patrick
authors.initials: P
authors.lastname: Sequeira
authors.forename: Zbys
authors.initials: Z
authors.lastname: Fedorowicz
authors.forename: Mona
authors.initials: M
authors.lastname: Nasser
mesh_terms: D003790:Dental Pulp Necrosis / Q000628:therapy; D004867:Equipment Design; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018915:Root Canal Preparation / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation* / Q000379:methods