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Group 3.4 Root Canal Irrigant Seminar

The document discusses various irrigating solutions commonly used in root canal procedures including saline, sodium hypochlorite, hydrogen peroxide, chlorhexidine, and ethylene diamine tetraacetic acid. It describes the properties, mechanisms of action, advantages, disadvantages and uses of each solution.

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Janny
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29 views26 pages

Group 3.4 Root Canal Irrigant Seminar

The document discusses various irrigating solutions commonly used in root canal procedures including saline, sodium hypochlorite, hydrogen peroxide, chlorhexidine, and ethylene diamine tetraacetic acid. It describes the properties, mechanisms of action, advantages, disadvantages and uses of each solution.

Uploaded by

Janny
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Root Canal Irrigant

Commonly Used Irrigating


Solutions
Chemically non active solution
• Water
• Saline
• Local anesthetic
Chemically active materials
• Alkalis: Sodium hypochlorite 0.5–5.25%
• Chelating agents: Ethylene diamine tetraacetic (EDTA) acid
• Oxidizing agents: Hydrogen peroxide, carbamide peroxide
• Antibacterial agents: Chlorhexidine, bisdequalinium acetate
• Acids: 30% hydrochloric acid
• Enzymes: Streptokinase, papain, trypsin
• Detergents: Sodium lauryl sulfate
Saline
• Normal saline (0.9%) is an isotonic solution to the
body fluids and is being commonly used as an
irrigating material in endodontic procedures.
Uses
• Gross debridement
• Lubricate the root canals
• Flushing action
• Used as the final rinse for the root canals
In a biological stand point, it is the best irrigant
because it
(a) Produces least apical tissure irritation to damage
(b) Bocompatible to tissues
(c) Produces least amount of cell lysis
Disadvantages
• Does not remove the smear layer. It only flushes
out some of the superficial debris from the root
canal system
• Has poor antibacterial properties
• No disinfecting or dissolution properties
Sodium Hypochlorite (NaOCl)
• It is a clear, straw-colored solution containing about
5% of available chlorine.
• It is the most widely used irrigating solution
Properties
a. Concentration
• If the canal is filled with the solution during the entire
cleaning and shaping procedure, the irrigant will act as a
lubricant, a solvent of pulp tissue, and a potent antimicrobial.
There is no opinion on the concentration of sodium
hypochlorite should be used in root canal therapy.
b. Tissue Dissolution Ability
• The NaOCl completely dissolves an entire pulp in 20 minutes
to 2 hours, whereas the next most effective solution requires
at least 24 hours to accomplish the same result
• The pulp-dissolving ability of this irrigant is useful during the
cleaning and shaping of inaccessible areas such as the
isthmus region and C-shaped canal systems
Mechanism of Action
• NaOCl on ionization produces hypochlorous
acid(HOCl) and hypochlorite ion(OCl-).
• At acidic and neutral pH– chlorine acts as HOCl.
• HOCl is antibacterial.
• Destruction of bacteria takes place in two phases:
- Penetration into the bacterial cell wall
- Chemical combination with the protoplasm of
the bacterial cell and disruption of DNA synthesis
Advantages
• It causes tissue dissolution.
• Remove organic portion of dentin for deeper
penetration of medicaments.
• Removes biofilm.
• It causes dissolution of pulp and necrotic tissue.
• It has antibacterial and bleaching action.
• It causes lubrication of canals.
• Economical.
• Easily available.
Drawbacks
• Cytotoxicity and caustic effects on healthy
periradicular tissues on accidental extrusion during
the irrigating procedure. Such sodium hypochlorite
accidents are the reason for lower concentration 0.5–
1% or 2.5% NaOCl being more commonly preferred by
clinicians.
• It does not remove the inorganic component of the
endodontic smear layer.
• It has an unpleasant taste
• The solution should be kept in a cool place, away from
sunlight.
Hydrogen Peroxide (H2O2)
• Clear and colorless liquid, and quite stable
• Varieties of concentrations ranging from 1% to 30%
• Degrades into water and oxygen
• Active against viruses, bacteria, yeasts, bacterial
spores
Mechanism of action
• Highly unstable and easily decomposed by heat and light
• Rapidly dissociate into water and nascent oxygen, H2O
and [O]
• Liberated [O] has bactericidal effect but effect is
transient and diminishes in presence of organic debris
• Effervescence (bubbling) action occurs when nascent
oxygen in contact with organic tissue, aid in mechanical
debridement by dislodging dentin debris and necrotic
tissue particles and floating them to surface
Uses
• Moller recommended 30% H2O2 as first step of
tooth surface disinfection
• Cleaning the pulp chamber from blood and tissue
remnants
• 3% H2O2 as a canal irrigant due to its effervescent
action in presence of blood products
• Grossman recommended alternate use of H2O2 +
NaOCl irrigating solutions
Advantages of using alternating H2O2 and NaOCl
solution are :
• Effervescent reaction / bubbles mechanically forces
out debris and microorganisms out of canal
• Liberate O2 destroys strictly anaerobic
microorganisms
• Solvent action of NaOCl on soft tissue debris
• Increases the bleaching action on discolored teeth
Disadvantages
• It does not possess tissue dissolving property
• Not a lubricant
• Has limited antimicrobial action
Complications
• When peroxide is used, it must eliminated from
pulp cavity before sealing crown otherwise release
of nascent oxygen in contact with organic tissue
may build up pressure within periapical region and
could force debris and microorganisms into tissues
• Soft tissue emphysema when H2O2 irrigant enforced
beyond apical foramen
Chlorhexidine (CHX)
• Most potent if tested bisbiguanides
• Strong base and most stable in form of salts
(Chlorhexidine gluconate)
• Potent antiseptic
Combination of 0.2% chlorhexidine and 2% sodium
hypochlorite

Chlorhexidine
(Base)
-Increase in ionising
capacity of chlorhexidine

-more alkaline (pH 10)


-making it more
effective

Sodium
Hypochlorite
(Oxidizing agent)
Mechanism of Action
• Chlorhexidine is broadspectrum antimicrobial agent.
• The antibacterial mechanism of chlorhexidine is related
to its cationic bisbiguanide molecular structure.
• The cationic molecule is absorbed to the negatively
charged inner cell membrane and causes leakage of
intracellular components.
• At low concentration, it acts as a bacteriostatic,
whereas at higher concentrations; it causes coagulation
and precipitation of cytoplasm and therefore acts as
bactericidal.
Advantages And Uses
• 2% solution-used as root irrigant in canals.
• More effective on gram-positive bacteria
• 0.2%-used in controlling plaque control

Disadvantages
• Not main irrigant in standard endodontic therapy
• Less effective on gram negative bateria
• Unable to dissolve necrotic tissues remnants
• Does not show effect on biofilms
Ethylene Diamine Tetraacetic
Acid (EDTA)
• Lubricant, chelator and decalcifying agents.
• It is the most effective chelating agent in endodontic
therapy
• Common chelating agent
• Effective on removal of smear layer and pose no effect
on organic tissue. So irrigant with EDTA alone is not ideal
• Also have little or no antimicrobial activity
• Concentration in endodontics is 17%
• Recommended irrigant time is 1 min. Irrigant for longer
period cause excessive removal of dentin.
Mechanism of Action
• inhibits bacterial growth and ultimately destroys
them by starvation because EDTA chelates with the
metallic ions in medium which are needed for
growth of microorganisms.
• SELF LIMITING ACTION. It forms a stable bond with
calcium and dissolve dentin, but when all chelating
ions have reacted, an equilibrium reached which
prevents further dissolution.
Uses
• Dentin dissolving properties
• Enlarge narrow canals
• Reduces time needed for debridement
Indication
• the best use of chelating agents is to aid and simply
preparation for very sclerotic canals after the apex
has already been reached with a fine instrument
Contraindication
• a ledge or blocked canal: if a sharp instrument is
forced or rotated against a wall softened by the
chelate, anew but false canal will forms
• Curved canals once the larger- sized instrument are
being used. These instruments are not as flexible as
the smaller sizes and may produce root perforation.
Disadvantages
• Deactivation of NaOCL by reducing the available
chlorine.

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