Abstract Background: The integration of sonic and ultrasonic technologies into endodontics has revolutionized the field, enhancing canal debridement, irrigant penetration, and precision during treatment. The synergistic use of acoustic energy and fluid dynamics allows improved cleaning efficacy, particularly in complex root canal anatomies where mechanical instrumentation alone is inadequate. This review article deals with the recent advances enabled in ultrasonic technology in the mainstream of endodontics in the last two to three decades in various steps of root canal therapy, such as activation of activation of irrigating solutions; finding calcified canals and removal of attached pulp stones; removal of intracanal obstructions (separated instruments, root canal posts, silver points, and fractured metallic posts); and ultrasonic condensation of gutta percha; in the field of surgical endodontics, it is also used for root-end cavity preparation and placement of root-end obturation material. The review aims to assess the success rates, compare outcomes, explore benefits and drawbacks of ultrasonics in endodontics. Review: Sonic and ultrasonic activation utilize acoustic energy to enhance irrigant effectiveness through cavitation, acoustic microstreaming, and hydrodynamic shear. Ultrasonic systems (25–40 kHz) typically deliver higher energy and more effective cleaning than sonic systems (1–6 kHz), though newer flexible polymer-based sonic systems such as EDDY and EndoActivator have narrowed the gap in clinical efficacy. Applications include irrigant activation, post and instrument retrieval, access refinement, root-end preparation, and restorative finishing. Current research supports the superiority of passive ultrasonic irrigation in smear layer removal and microbial reduction, while emerging multisonic and piezoelectric systems (e.g., GentleWave, PiezoMaster 700) show promising outcomes with minimal dentin loss. This article presents a narrative review synthesizing current literature on sonic and ultrasonic devices in endodontics, focusing on their mechanisms, clinical applications, and emerging technological advances. Conclusion: Sonic and ultrasonic activation are indispensable adjuncts to modern endodontic practice. Future integration of AI-assisted modulation, adaptive frequency control, and digital navigation will further enhance precision and predictability in canal cleaning and disinfection.
International Journal of Medical Science and Advanced Clinical Research (IJMACR) (Fri,) studied this question.