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Root Canal Irrigation

Root canal irrigation is important to remove debris and bacteria from the narrow root canal space. Sodium hypochlorite (NaOCl) is the most commonly used irrigant due to its strong antimicrobial properties and ability to dissolve organic tissue. However, it is toxic in high concentrations. Chlorhexidine (CHX) is also effective against bacteria, including some resistant to NaOCl, and has low toxicity. Ethylenediaminetetraacetic acid (EDTA) is used to remove the inorganic component of the smear layer created during instrumentation, while NaOCl removes the organic component. Proper combination and sequence of irrigants is important for effective cleaning and disinfection of the

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61 views

Root Canal Irrigation

Root canal irrigation is important to remove debris and bacteria from the narrow root canal space. Sodium hypochlorite (NaOCl) is the most commonly used irrigant due to its strong antimicrobial properties and ability to dissolve organic tissue. However, it is toxic in high concentrations. Chlorhexidine (CHX) is also effective against bacteria, including some resistant to NaOCl, and has low toxicity. Ethylenediaminetetraacetic acid (EDTA) is used to remove the inorganic component of the smear layer created during instrumentation, while NaOCl removes the organic component. Proper combination and sequence of irrigants is important for effective cleaning and disinfection of the

Uploaded by

Ishac Abdo
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as RTF, PDF, TXT or read online on Scribd
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Root Canal Irrigation

 Infection in root canal à multibacteria in narrow space (RCS)


 Biochemical preparationà instrumentation only, not affect
 Process of irrigation à removal of dead tissues.

Requirements:
 Different irrigants & every irrigant has a certain situation
 Dissolve organic tissues
 Low toxicity à important in selection of irrigant

 The most important irrigant we use = NaOCl

NaOCl (Sodium Hypochlorite):


 More concentration è more antimicrobial effect.
 Some strains are resistant to NaOCl
 Disadvantage; high toxicity, bad taste & highly irritant
 If it passed beyond apex è emphysema & pain (NaOCl accident) è do passive irrigation (don’t use force)
 Proper isolation is important (to avoid its disadvantages mentioned above)
 Contraindicated in cases of acute infections & Pus drainage, use saline instead
 Contraindicated in cases of open apex, allergy (rare)
 Strong antimicrobial action & dissolution of organic tissues.
 Also used for cleaning & bleaching

 Saline has weak antimicrobial effects.

CHX (chlorhexidine):
 Has antimicrobial effect as NaOCl (& work on some strains that are NaOCl resistant = broad spectrum)
 Substanity = bind to hydroxyapatite (prevent adhesion of bacteria "enterococcus faecalis" & plaque to
surface of teeth) è used in mouth-washes for people liable to form plaque
 Effective in re-ttt cases
 Cationic material
 May cause rupture of the wall of cells (bacteria)
 Lacks dissolution effect
 Low toxicity (not irritant), lubricant, nice taste, no smell.
 Not irritant to tissue ß advantage

H2O2 (Hydrogen Peroxide):


 Effervescence (bubbles) à help in cleaning
 Stops bleeding
 Used in limited way due to its toxicity
 Causes emphysema if extended beyond apex (due to O 2)ß disadvantage
 Use NaOCl in final flush for neutralization ß important

Smear Layer:
 Hybrid layer (organic + inorganic) à blockage of dentinal tubules.
 Coat dentinal tubules due to instrumentation
 smear layer è less bonding of felling material + more leakage
 We remove smear layer by 2 agents: one for organic & other for inorganic (combination of EDTA 1 st &
then NaOCl)
 Should be removed after instrumentation

EDTA:
 Chelating agent
 Has some antimicrobial agent... but weak
 Used to remove the inorganic component of smear layer
 NaOCl to remove the organic component of the smear layer
 Use NaOCl in final flush ß important.

Alcohol:
 For desiccation (‫ …)تنشيف‬but irritant
 Not used anymore...
 Organic dissolvent

Combination of irrigants:
1) H2O2 + NaOCl à foaming (cleaning)
 Contraindication: combination of NaOCl & CHX à perticipates à discoloration(brown color of canal) &
blockage if dentinal tubules
 If they must be used together; wash with water between them.

MTAD:
 T = Tetracycline (antimicrobial)
 A = Acid (dissolution of inorganic)
 D = Detergent (to decrease surface tension à increase cleaning )

Ozonated Water:
 Antimicrobial effect

Method of Irrigation:
Plastic syringe

Advances in root canal irrigation instruments & devices:


 Closed-end syringe
 Vista syringe = warmers
 Irrira C system

LASER in endodontics:
 Every time we insert a file & remove it, we should irrigate the RCS
 Warm irrigant à more effect
 Method:
 Bending of needle for accessibility
 Needle must be free in the canal (not touching the walls) to be effective
 Ultra-sonic irrigation à warm-wave à not efficient in RCS (RCS is narrower than what the machine was
designed for)

Intracanal Medication:
 Done in limited time (between visits) & removed before final obliteration.
 Done to c=kill bacteria inside the canal

Ca(OH)2 :
 Highly alkaline à neutralization of the acidic products
 Make tissues more liable to be dissolved by NaOCl
 In endo, we use non-setting Ca(OH)2
 Used in open apex – barrier – exudates... (initiation of hard tissue formation)

Halides (IKI):
 Combined CaOH
 Disadvantage: discoloration, allergy

Formacresol, CMCP:
 Highly toxic if circulating in blood

Steroids:
 To reduce pain.

Phenolic Compound:
 Not used anymore due to its toxicity (irritant + carcinogenic)

Antibiotics:
 Not used anymore due to its high resistance strain

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