The surface integrity of gutta-percha cones is a crucial factor in the success of endodontic procedures. Disinfecting solutions play a pivotal role in sterilizing gutta-percha cones, but their influence on gutta-percha surface topography remains a subject of concern. This systematic review aimed to present a qualitative synthesis of available laboratory studies assessing the influence of disinfecting solutions on the surface topography of gutta-percha and offers insights into the implications for clinical practice. The present review followed PRISMA 2020 guidelines. An advanced database search was performed in PubMed, Google Scholar, Embase, Scopus, LILAC, non-indexed citations and reference lists of eligible studies in May 2024. Laboratory studies, in English language, were considered for inclusion. The quality (risk of bias) of the included studies was assessed using parameters for in vitro studies. A total of 28 studies were included in the qualitative synthesis. Based on the included in vitro studies, surface deposits and alterations in the physical properties of gutta-percha cones were observed after the disinfection protocol. A comprehensive review of the available literature indicates that the choice of disinfecting solution, its concentration, and immersion time significantly affect the surface topography of gutta-percha cones.

This study aimed to describe the outcomes of the GentleWave system (GW) (Sonendo) on root canal treatment. Published articles were collected from scientific databases (MEDLINE/PubMed platform, Web of Science, Scopus, Science Direct and Embase). A total of 24 studies were collected from August/2014 to July/2021, 20 in vitro and 4 clinical. GW System was not associated with extrusion of the irrigant, promoted faster organic dissolution than conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI) continuous ultrasonic irrigation (CUI) and EndoVac, reduced more bacterial DNA and biofilm than PUI and CUI, promoted higher penetration of sodium hypochlorite into dentinal tubules than PUI and CUI in vitro, and removed more intracanal medication than CSI and PUI. GW was able to remove pulp tissue and calcifications. Moreover, its ability to remove hard-tissue debris and smear layer was better than that of CSI, and its ability to remove root canal obturation residues was lower or similar to that of PUI, and similar to that of CSI and EndoVac. Regarding root canal obturation of minimally instrumented molar canals, GW was associated with high-quality obturation. Clinically, the success rate of endodontic treatment using GW was 97.3%, and the short-term postoperative pain in the GW group was not different from CSI. Further research, mainly clinical, is needed to establish whether GW has any advantages over other available irrigation methods.

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Apical periodontitis is a biofilm-mediated infection. The biofilm protects bacteria from host defenses and increase their resistance to intracanal disinfecting protocols. Understanding the virulence of these endodontic microbiota within biofilm is essential for the development of novel therapeutic procedures for intracanal disinfection. Both the disruption of biofilms and the killing of their bacteria are necessary to effectively treat apical periodontitis. Accordingly, a review of endodontic biofilm types, antimicrobial resistance mechanisms, and current and future therapeutic procedures for endodontic biofilm is provided.

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