Review of contemporary irrigant agitation techniques and devices.

INTRODUCTION Effective irrigant delivery and agitation are prerequisites for successful endodontic treatment. METHODS This article presents an overview of the irrigant agitation methods currently available and their debridement efficacy. RESULTS Technological advances during the last decade have brought to fruition new agitation devices that rely on various mechanisms of irrigant transfer, soft tissue debridement, and, depending on treatment philosophy, removal of smear layers. These devices might be divided into the manual and machine-assisted agitation systems. Overall, they appear to have resulted in improved canal cleanliness when compared with conventional syringe needle irrigation. Despite the plethora of in vitro studies, no well-controlled study is available. This raises imperative concerns on the need for studies that could more effectively evaluate specific irrigation methods by using standardized debris or biofilm models. In addition, no evidence-based study is available to date that attempts to correlate the clinical efficacy of these devices with improved treatment outcomes. Thus, the question of whether these devices are really necessary remains unresolved. There also appears to be the need to refocus from a practice management perspective on how these devices are perceived by clinicians in terms of their practicality and ease of use. CONCLUSIONS Understanding these fundamental issues is crucial for clinical scientists to improve the design and user-friendliness of future generations of irrigant agitation systems and for manufacturers' contentions that these systems play a pivotal role in contemporary endodontics.