Tradition to innovation: all-in-one irrigators in endodontics - systematic review
DOI:
https://doi.org/10.62741/ahrj.v3iSuppl.%202.184Keywords:
All-in-one, Dual Rinse, HEDP, Triton, QMix, Root canal, Endodontic, Irrigation, IrrigantAbstract
Introduction: Endodontic treatment requires effective irrigation for smear layer removal and intraradicular bacterial reduction. Conventional sodium hypochlorite and ethylenediaminetetraacetic
acid protocols have limitations regarding operative complexity and effects on dentin. Allin-
one irrigants (Triton All-in-One®, Dual Rinse HEDP®, QMix 2in1) aim to simplify protocols
by combining antimicrobial and cleaning actions.
Objectives: This study aimed to evaluate, via systematic review, the efficacy of all-in-one irrigants
versus conventional protocols in smear layer removal and bacterial reduction.
Methodology: The search was conducted in accordance with PRISMA guidelines across the Pub-
Med, Europe PMC, and LILACS databases (2020-2025). Study selection was performed independently
by two reviewers. Inclusion criteria comprised studies (in vitro, ex vivo, or clinical) on
single-rooted human teeth addressing the topic. Animal/primary dentition, curved/artificial canals,
reviews, and studies without a control group were excluded.
Results: 12 studies were included in the qualitative analysis. Laboratory data indicate that allin-
one solutions exhibit smear layer removal and antimicrobial efficacy comparable or superior
to traditional protocols, notably preserving dentin mechanical properties, though variations occurred
based on application time.
Conclusion: Laboratory evidence suggests that all-in-one irrigants are a promising alternative
to traditional protocols; however, current clinical evidence is scarce, and further clinical trials are
mandatory to confirm their in vivo efficacy and safety. Potential simplification of the irrigation
procedure, which may reduce operative time and the risk of accidents during non-surgical endodontic
treatment.
References
Álvarez-Sagües, A., Herce, N., Amador, U., Llinares-Pinel, F., Nistal-Villan, E., Presa, J., Álvarez, L., & Azabal, M. (2021). Efficacy of EDTA and HEDP Chelators in the Removal of Mature Biofilm of Enterococcus faecalis by PUI and XPF File Activation. Dentistry Journal, 9(4), 41. https://doi.org/10.3390/dj9040041
Aoun, C., Rechenberg, D.-K., Karam, M., Mhanna, R., Plotino, G., & Zogheib, C. (2023). Effect of continuous chelation irrigation using DualRinse HEDP + 3% NaOCL with or without high-power sonic activation on debris and smear layer removal. European Endodontic Journal. https://doi.org/10.14744/eej.2022.93064
Ballal, N. V., Narkedamalli, R., Gandhi, P., Arias-Moliz, M. T., Baca, P., Das, S., Varghese, J., Gaonkar, S. L., Rao, B. S. S., Frazier, J., Bergeron, B. E., & Tay, F. R. (2023). Biological and chemical properties of 2-in-1 calcium-chelating and antibacterial root canal irrigants. Journal of Dentistry, 134, 104526. https://doi.org/10.1016/j.jdent.2023.104526
Ballal, N. V., Narkedamalli, R., Shenoy, P. A., Das, S., Balasubramanian, S. K., Varghese, J., Dsouza, H. S., Epps, K., Ravenel, T., & Tay, F. R. (2025). Biological and chemical properties of new multi-functional root canal irrigants. Journal of Dentistry, 153, 105551. https://doi.org/10.1016/j.jdent.2024.105551
Bandoo, C., Suliman, S., Trestrail, E., & Marchan, S. M. (2024). The Effectiveness of Triton Used With XP-3D Adaptive Files and Active Irrigation on Smear Layer Removal During Root Canal Preparation: A Qualitative Scanning Electron Microscopy (SEM) Study. Cureus. https://doi.org/10.7759/cureus.73057
Boutsioukis, C., & Arias‐Moliz, M. T. (2022). Present status and future directions – irrigants and irrigation methods. International Endodontic Journal, 55(S3), 588–612. https://doi.org/10.1111/iej.13739
Campello, A. F., Rodrigues, R. C. V., Alves, F. R. F., Miranda, K. R., Brum, S. C., Mdala, I., Siqueira, J. F., & Rôças, I. N. (2022). Enhancing the Intracanal Antibacterial Effects of Sodium Hypochlorite with Etidronic Acid or Citric Acid. Journal of Endodontics, 48(9), 1161–1168. https://doi.org/10.1016/j.joen.2022.06.006
Castagnola, R., Martini, C., Colangeli, M., Pellicciotta, I., Marigo, L., Grande, N. M., Bugli, F., & Plotino, G. (2023). In Vitro Evaluation of Smear Layer and Debris Removal and Antimicrobial Activity of Different Irrigating Solutions. European Endodontic Journal, 81–88. https://doi.org/10.14744/eej.2023.19042
Chen, Y., Watanabe, S., Myint, P. Y. A., Mochizuki, S., & Okiji, T. (2025). Comparisons of the smear layer removal efficacy of dual-action irrigants and different activation techniques. Journal of Dental Sciences, 20(2), 877–884. https://doi.org/10.1016/j.jds.2024.09.003
Emekli, G. E., Kaptan, R. F., & Tanalp, J. (2025). Evaluation of the effects of traditional irrigation solutions and etidronic acid on the bond strength of endodontic sealers. BMC Oral Health, 25(1), 364. https://doi.org/10.1186/s12903-025-05678-z
Giardino, L., Del Fabbro, M., Morra, M., Pereira, T., Bombarda De Andrade, F., Savadori, P., & Generali, L. (2019). Dual Rinse® HEDP increases the surface tension of NaOCl but may increase its dentin disinfection efficacy. Odontology, 107(4), 521–529. https://doi.org/10.1007/s10266-019-00436-4
Gupta, S., Narkedamalli, R., Shetty, K. P., & Ballal, N. V. (2025). Physical and Chemical Properties of All-in-One Root Canal Irrigants: A Laboratory Study. European Journal of Dentistry, s-0045-1812107. https://doi.org/10.1055/s-0045-1812107
Haapasalo, M., Shen, Y., Qian, W., & Gao, Y. (2010). Irrigation in Endodontics. Dental Clinics of North America, 54(2), 291–312. https://doi.org/10.1016/j.cden.2009.12.001
Haapasalo, M., Shen, Y., Wang, Z., & Gao, Y. (2014). Irrigation in endodontics. British Dental Journal, 216(6), 299–303. https://doi.org/10.1038/sj.bdj.2014.204
Halkai, R., Ishaq, S. S., & Halkai, K. R. (2025a). Comparison of human pulpal dissolution and removal of smear layer by triton and Qmix 2 in 1 solution: An in vitro study. Saudi Endodontic Journal, 15(3), 245–251. https://doi.org/10.4103/sej.sej_12_25
Halkai, R., Ishaq, S. S., & Halkai, K. R. (2025b). Effect of newer irrigating solution Triton on the root dentinal surface roughness and microhardness: An in vitro study. Endodontology. https://doi.org/10.4103/endo.endo_18_25
Halkai, R., Vidyananda, & Halkai, K. R. (2025). Effect of newer all-in-one irrigants on root dentin wettability and surface roughness – An in vitro study. Journal of Conservative Dentistry and Endodontics, 28(8), 790–794. https://doi.org/10.4103/JCDE.JCDE_364_25
Jain, D., Shetty, K. P., Luke, A. M., & Ballal, N. V. (2024). Root canal irrigants effect on the compressive strength and calcium ion release of Biodentine. Heliyon, 10(18), e38267. https://doi.org/10.1016/j.heliyon.2024.e38267
Kamath, S., Narkedamalli, R., Shetty, K. P., & Ballal, N. V. (2025). Effect of Novel All-in-One Root Canal Irrigants on Dislodgement Resistance of Epoxy Resin and Hydraulic Calcium Silicate Sealers: An Ex vivo Study. European Journal of Dentistry, s-0045-1811574. https://doi.org/10.1055/s-0045-1811574
Kamil, A. A., Ali, A. H., Foschi, F., & Mannocci, F. (2025). Effectiveness of Continuous and Sequential Chelation and Different Agitation Techniques on Smear Layer Removal and Microhardness of Root Canal Dentin (An In Vitro Study). Dentistry Journal, 13(5), 221. https://doi.org/10.3390/dj13050221
Kfir, A., Goldenberg, C., Metzger, Z., Hülsmann, M., & Baxter, S. (2020). Cleanliness and erosion of root canal walls after irrigation with a new HEDP-based solution vs. Traditional sodium hypochlorite followed by EDTA. A scanning electron microscope study. Clinical Oral Investigations, 24(10), 3699–3706. https://doi.org/10.1007/s00784-020-03249-w
Kottathil, H., Zehnder, M., Gubler, A., Attin, T., Narkedamalli, R., & Ballal, N. V. (2024). Compatibility of Dual Rinse 1-Hydroxyethane-1,1-Diphosphonic Acid with Sodium Hypochlorite Solutions Containing Proprietary Additives. Journal of Endodontics, 50(10), 1472–1477. https://doi.org/10.1016/j.joen.2024.07.007
Meyappan, N., Mahadevan, M., Manimaran, N. D., Paulaian, B., Gopal, R., & Kumar, N. (2023). Scanning Electron Microscopy Analysis of Smear Layer Removal Ability of Conventional Endodontic Irrigation Regimen, MTAD, and QMixTM Versus a Mixture of Azadirachta indica and Citrus limon: An In Vitro Study. Cureus. https://doi.org/10.7759/cureus.42877
Munoz, H. R., & Camacho-Cuadra, K. (2012). In Vivo Efficacy of Three Different Endodontic Irrigation Systems for Irrigant Delivery to Working Length of Mesial Canals of Mandibular Molars. Journal of Endodontics, 38(4), 445–448. https://doi.org/10.1016/j.joen.2011.12.007
Naenni, N., Thoma, K., & Zehnder, M. (2004). Soft Tissue Dissolution Capacity of Currently Used and Potential Endodontic Irrigants. Journal of Endodontics, 30(11), 785–787. https://doi.org/10.1097/00004770-200411000-00009
Neelakantan, P., Ounsi, H. F., Devaraj, S., Cheung, G. S. P., & Grandini, S. (2018). Effectiveness of irrigation strategies on the removal of the smear layer from root canal dentin. Odontology, 107(2), 142–149. https://doi.org/10.1007/s10266-018-0373-2
Prado, M., Santos Júnior, H. M., Rezende, C. M., Pinto, A. C., Faria, R. B., Simão, R. A., & Gomes, B. P. F. A. (2013). Interactions between Irrigants Commonly Used in Endodontic Practice: A Chemical Analysis. Journal of Endodontics, 39(4), 505–510. https://doi.org/10.1016/j.joen.2012.11.050
Şen, B. H., Wesselink, P. R., & Türkün, M. (1995). The smear layer: A phenomenon in root canal therapy. International Endodontic Journal, 28(3), 141–148. https://doi.org/10.1111/j.1365-2591.1995.tb00289.x
Shahravan, A., Haghdoost, A., Adl, A., Rahimi, H., & Shadifar, F. (2007). Effect of Smear Layer on Sealing Ability of Canal Obturation: A Systematic Review and Meta-analysis. Journal of Endodontics, 33(2), 96–105. https://doi.org/10.1016/j.joen.2006.10.007
Shalavi, S., & Mohammadi, Z. (2021). An Overview on a Promising Root Canal Irrigation Solution: QMix. Iranian Endodontic Journal, 16(2), 71–77. https://doi.org/10.22037/iej.v16i2.27912
Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L. A., & the PRISMA-P Group. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ, 349(jan02 1), g7647–g7647. https://doi.org/10.1136/bmj.g7647
Sheng, X., Yu, J., Liu, H., Wang, Z., Deng, S., & Shen, Y. (2023). Dual effectiveness of a novel all-in-one endodontic irrigating solution in antibiofilm activity and smear layer removal. Frontiers in Bioengineering and Biotechnology, 11, 1254927. https://doi.org/10.3389/fbioe.2023.1254927
Sheth, V. H., Shah, N. P., Jain, R., Bhanushali, N., & Bhatnagar, V. (2024). Development and validation of a risk-of-bias tool for assessing in vitro studies conducted in dentistry: The QUIN. The Journal of Prosthetic Dentistry, 131(6), 1038–1042. https://doi.org/10.1016/j.prosdent.2022.05.019
Silva, P. V., Guedes, D. F. C., Nakadi, F. V., Pécora, J. D., & Cruz‐Filho, A. M. (2012). Chitosan: A new solution for removal of smear layer after root canal instrumentation. International Endodontic Journal, 46(4), 332–338. https://doi.org/10.1111/j.1365-2591.2012.02119.x
Siqueira Junior, J. F., Rôças, I. D. N., Marceliano-Alves, M. F., Pérez, A. R., & Ricucci, D. (2018). Unprepared root canal surface areas: Causes, clinical implications, and therapeutic strategies. Brazilian Oral Research, 32(suppl 1). https://doi.org/10.1590/1807-3107bor-2018.vol32.0065
Stojicic, S., Zivkovic, S., Qian, W., Zhang, H., & Haapasalo, M. (2010). Tissue Dissolution by Sodium Hypochlorite: Effect of Concentration, Temperature, Agitation, and Surfactant. Journal of Endodontics, 36(9), 1558–1562. https://doi.org/10.1016/j.joen.2010.06.021
Swimberghe, R. C. D., Coenye, T., De Moor, R. J. G., & Meire, M. A. (2019). Biofilm model systems for root canal disinfection: A literature review. International Endodontic Journal, 52(5), 604–628. https://doi.org/10.1111/iej.13050
Tawakoli, P. N., Ragnarsson, K. T., Rechenberg, D. K., Mohn, D., & Zehnder, M. (2017). Effect of endodontic irrigants on biofilm matrix polysaccharides. International Endodontic Journal, 50(2), 153–160. https://doi.org/10.1111/iej.12604
Violich, D. R., & Chandler, N. P. (2010). The smear layer in endodontics – a review. International Endodontic Journal, 43(1), 2–15. https://doi.org/10.1111/j.1365-2591.2009.01627.x
Wakas Oraim, H., & Al-Zaka, I. M. (2024). Effectiveness of Triton Irrigation Solution in Smear Layer Removal: An in-vitro Study. European Endodontic Journal, 139–145. https://doi.org/10.14744/eej.2023.58070
Zehnder, M. (2006). Root Canal Irrigants. Journal of Endodontics, 32(5), 389–398. https://doi.org/10.1016/j.joen.2005.09.014
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