Chairside ATP assessment of root canal disinfection: a clinical evaluation of six irrigation protocols

Abstract

Introduction: Success in endodontic therapy depends on meticulous disinfection of the root canal system. A tool to assess disinfection before obturation could help prevent treatment failures. This study introduces the Endocator adenosine triphosphate (ATP) assay, a novel chairside test for evaluating root canal disinfection. This non-randomized single-blinded controlled clinical trial quantifies ATP levels in root canals after different disinfection protocols.

Methodology: A total of 1006 root canals with diverse endodontic diagnoses were treated with six treatment protocols, including Group A: Manual dynamic agitation (MDA) with 3.25% NaOCl, Group B: MDA with 5.25% NaOCl, Group C: Heated 3.25% NaOCl, Group D: Sonic EndoActivator (EA) with 3.25% NaOCl, Group E EA with 5.25% NaOCl, Group F: Ultrasonic (Ultra X) with 5.25% NaOCl. A superiority trial with single blinding was designed. The Endocator was used to assess ATP levels at several points during the root canal.

Results: ATP values decreased significantly across all irrigation protocols with a median decrease from 5643 at baseline to 800 after cleaning and 72.5 after rinsing. Groups with higher NaOCl concentrations exhibited lower final ATP levels, particularly with ultrasonic activation. A small group of patients required one or two additional rounds of NaOCl activation to achieve lower levels of ATP.

Conclusion: A chairside ATP test is a useful tool to quantify organic debris in a root canal, determine what root canals are still contaminated, and guide disinfection strategies. ATP detection provides real-time feedback of contamination levels in a root canal and can help identify cases require additional disinfection.