Irrigation is considered an indispensable part of root canal treatment as it fortifies the cleaning and disinfection of areas of the root canal system that have been inadequately influenced by instruments. The aim of this systematic review was to collate published data on the two modes of irrigation i.e., conventional irrigation and apical negative pressure irrigation (ANP) for cleaning and shaping of the canals and to compare their efficacy in debridement and periapical tissue repair. The electronic databases PubMed and Google Scholar were searched in this review using specific inclusion and exclusion criteria. The search was performed in June 2018 and updated in March 2019. Among 1481 studies, five studies satisfied the eligibility criteria and were included in the review to be analysed. These studies compared the effectiveness of ANP method against syringe irrigation in removing debris within the root canal system and their effect in periapical tissue repair, including: different types of irrigation methods, debris removal during cleaning and shaping, and updating studies of their effect in periodontal and periapical repair. The compiled data observed that ANP was more efficient in removing the debris and offered a greater advantage that should lead to wider acceptance among dentists for effective results compared to different irrigation systems. However, more clinical trials with standardized protocol and defined clinical, radiographic, and histopathological outcomes with longer follow-up periods are warranted.