Triton: All in one irrigation solution in Endodontics

Abstract

Endodontic success hinges on effective irrigation to disinfect canals and remove organic tissue and smear layer. To achieve the same objectives, traditional irrigation employs a series of sequential solutions - sodium hypochlorite (NaOCl) to dissolve organic tissues and disinfect the area, then a chelator such as ethylenediaminetetraacetic acid (EDTA) to remove inorganic smear - since no single irrigant can accomplish all its objectives. This is a multistage procedure, which is chemically complicated and time-consuming because NaOCl and EDTA or chlorhexidine (CHX) can not be mixed without deactivating each other or precipitation. Purpose: This review is a critical evaluation of one novel all-in-one endodontic irrigation solution called Triton, which was created to make the irrigation procedure easier through the combination of a single product containing NaOCl with chelating and surfactants agents. We integrate the latest peer-reviewed articles relating to the Triton composition, effectiveness in disinfection and smear layer removal, safety profile, and clinical implications. Findings: Laboratory experiments show that Triton can have similar or even better antimicrobial efficacy and smear layer elimination than traditional multi-step regimens due to the presence of continuous chelation concept and additional surfactants which increase the penetration of NaOCl and its stability. Its cytotoxicity in vitro is comparable to NaOCl and low than EDTA. Conclusion: Triton is a good all-in-one irrigant with potential to simplify the process of root canal irrigating without affecting the cleaning effect. The existing evidence, however, is mostly in vitro. Its safety and effectiveness in the in vivo setting should be continued to be verified in clinical studies.