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Root canal irrigants /endodontic courses
1. ROOT CANALROOT CANAL
IRRIGANTSIRRIGANTS
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
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3. INTRODUCTIONINTRODUCTION
• An important objective in endodonticAn important objective in endodontic
therapy is the removal of pulpal and dentinaltherapy is the removal of pulpal and dentinal
debris from the root canal system, to accomplishdebris from the root canal system, to accomplish
this it is essential to use an irrigant orthis it is essential to use an irrigant or
combination of irrigants during and aftercombination of irrigants during and after
biomechanical preparation of the canal system.biomechanical preparation of the canal system.
Refers to as chemical preparation, whenRefers to as chemical preparation, when
accomplished simultaneously are often reportedaccomplished simultaneously are often reported
as “chemomechanical preparation”.as “chemomechanical preparation”.
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4. • Goals of irrigation (Ingle):Goals of irrigation (Ingle):
• Levage of debris.Levage of debris.
• Tissue dissolution.Tissue dissolution.
• Antibacterial actionAntibacterial action
• LubricationLubrication
.
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5. • Ideal requirements of irrigating solutionsIdeal requirements of irrigating solutions
(DCNA):(DCNA):
• Antimicrobial property.Antimicrobial property.
• Dissolve necrotic tissue debris.Dissolve necrotic tissue debris.
• Aid in debridement of the root canal system.Aid in debridement of the root canal system.
• Non-toxic to the periapical tissues.Non-toxic to the periapical tissues.
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6. • Role of intracanal irrigants (Weine):Role of intracanal irrigants (Weine):
• Irrigants perform important physical andIrrigants perform important physical and
biologic function during endodontic therapy.biologic function during endodontic therapy.
• Loosens tissue debris – Dentinal shavings andLoosens tissue debris – Dentinal shavings and
microorganisms from the irregular radicularmicroorganisms from the irregular radicular
dentine walls.dentine walls.
• Flushes – The above into the pulp chamberFlushes – The above into the pulp chamber
space where it is easily removed by aspiration orspace where it is easily removed by aspiration or
paper points.paper points.
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7. • Dissolves – Organic tissues that are entrappedDissolves – Organic tissues that are entrapped
in accessory or lateral canals and that isin accessory or lateral canals and that is
inaccessible to hand instruments.inaccessible to hand instruments.
• Antibacterial action – Certain irrigants possessAntibacterial action – Certain irrigants possess
germicidal action, other reduce the number ofgermicidal action, other reduce the number of
microorganisms by eliminating the source ormicroorganisms by eliminating the source or
substrate for survival of these organisms.substrate for survival of these organisms.
Lubricating effect : Facilitates instrumentation ofLubricating effect : Facilitates instrumentation of
the canals.the canals.
Irrigants possess a bleaching action.Irrigants possess a bleaching action.
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8. DESIRABLE PROPERTIES FOR ANDESIRABLE PROPERTIES FOR AN
ENDODONTIC IRRIGANTENDODONTIC IRRIGANT
• The chemical agent selected for endodonticThe chemical agent selected for endodontic
irrigation should poses from major properties :irrigation should poses from major properties :
• Should have antimicrobial activity.Should have antimicrobial activity.
• Dissolve necrotic tissue.Dissolve necrotic tissue.
• Aid in debridement of the canal system.Aid in debridement of the canal system.
• Be nontoxic to the periradicular tissues.Be nontoxic to the periradicular tissues.
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9. • The first three of these properties areThe first three of these properties are
interrelated, tissue dissolution property aids ininterrelated, tissue dissolution property aids in
the debridement by dissolving organic debris,the debridement by dissolving organic debris,
these assist in reducing the microbial flora bythese assist in reducing the microbial flora by
removing necrotic debris and thereby reducingremoving necrotic debris and thereby reducing
the substrate that promotes the growth ofthe substrate that promotes the growth of
microorganisms.microorganisms.
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10. • HISTORY OF IRRIGATING SOLUTIONSHISTORY OF IRRIGATING SOLUTIONS
• Prior to 1940, water was the most commonlyPrior to 1940, water was the most commonly
used endodontic irrigant, it provided lubricatingused endodontic irrigant, it provided lubricating
effect making instrumentation of the canal walleffect making instrumentation of the canal wall
easier.easier.
• The number and types of irrigants that haveThe number and types of irrigants that have
been recommended later on include acid,been recommended later on include acid,
chelating agents, proteolytic enzymes, alkalinechelating agents, proteolytic enzymes, alkaline
solutions and other clinical agents such assolutions and other clinical agents such as
oxidizing agents and normal saline solutions.oxidizing agents and normal saline solutions.
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11. • ACIDS AND CHELATING AGENTSACIDS AND CHELATING AGENTS
• Acids and chelating agents were used because ofAcids and chelating agents were used because of
their ability to soften dentin, makingtheir ability to soften dentin, making
enlargement of the canal system easier. Acidsenlargement of the canal system easier. Acids
such as 30% hydrochloric acid and 50%such as 30% hydrochloric acid and 50%
phosphoric acid were used as late as 1940s withphosphoric acid were used as late as 1940s with
little or no understanding of effects onlittle or no understanding of effects on
periradicular tissues.periradicular tissues.
• These caustic acids dissolved inorganic structureThese caustic acids dissolved inorganic structure
of dentin with the remaining organic matrixof dentin with the remaining organic matrix
offering less resistance to instrumentation.offering less resistance to instrumentation.
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12. • Chelating agentsChelating agents - came into increasing use in- came into increasing use in
the 1970s. They softened the dentin better thenthe 1970s. They softened the dentin better then
acids and also far more biologically acceptable toacids and also far more biologically acceptable to
the soft tissues. They combine with andthe soft tissues. They combine with and
inactivate calcium ions. This decalcificationinactivate calcium ions. This decalcification
effect results in less resistance toeffect results in less resistance to
instrumentation.instrumentation.
Chelating agentsChelating agents areare
• EDTAEDTA,, REDTA (EDTA buffered with sodiumREDTA (EDTA buffered with sodium
hydroxide in an aqueous vehicle). RC-hydroxide in an aqueous vehicle). RC-
Preparation (EDTA and urea peroxide) andPreparation (EDTA and urea peroxide) and
citric acid.citric acid.
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13. • Proteolytic EnzymesProteolytic Enzymes
• Were utilized in 1930s and 1940s for their tissueWere utilized in 1930s and 1940s for their tissue
solvency effect. They possessed very little tissuesolvency effect. They possessed very little tissue
solvency property within root canal systems.solvency property within root canal systems.
• Enzymes used in the therapy are : Streptokinase,Enzymes used in the therapy are : Streptokinase,
streptodornase, papain, enzymol and purifiedstreptodornase, papain, enzymol and purified
trypsin.trypsin.
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14. • Alkaline SolutionsAlkaline Solutions
• Used solutions are, sodium dioxide, sodiumUsed solutions are, sodium dioxide, sodium
hypochlorite, potassium hydroxide, urea andhypochlorite, potassium hydroxide, urea and
sodium hypochlorite. Sodium hypochlorite hassodium hypochlorite. Sodium hypochlorite has
been proved clinically acceptable and is the mostbeen proved clinically acceptable and is the most
commonly used irrigant in endodontics.commonly used irrigant in endodontics.
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15. • Oxidizing AgentsOxidizing Agents
• In 1943, Grossman introduced the concept ofIn 1943, Grossman introduced the concept of
using an oxidizing agent as an irrigant inusing an oxidizing agent as an irrigant in
conjunction with sodium hypochlorite. Heconjunction with sodium hypochlorite. He
recommended that solution of 3% hydrogenrecommended that solution of 3% hydrogen
peroxide be alternated with a solution of 5.25%peroxide be alternated with a solution of 5.25%
sodium hypochlorite, so that the foaming actionsodium hypochlorite, so that the foaming action
resulting from the chemical reaction would helpresulting from the chemical reaction would help
to remove debris from the canal system.to remove debris from the canal system.
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16. • Recently another oxidizing agent, gly-oxide hasRecently another oxidizing agent, gly-oxide has
been recommended, particularly for narrow,been recommended, particularly for narrow,
curved canals contains carbamide peroxide in ancurved canals contains carbamide peroxide in an
anhydrous glycerol base is highly viscous,anhydrous glycerol base is highly viscous,
glycerol base provides very good lubrication, hasglycerol base provides very good lubrication, has
little antibacterial activity not a tissue solvent.little antibacterial activity not a tissue solvent.
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17. • Sodium HypochloriteSodium Hypochlorite
• Used as an endodontic irrigant for well overUsed as an endodontic irrigant for well over
four decades. It is reducing agent, is a cleanfour decades. It is reducing agent, is a clean
straw colored solution containing about 5% ofstraw colored solution containing about 5% of
available chlorine.available chlorine.
• This irrigant when used during cleaning andThis irrigant when used during cleaning and
shaping act as a lubricant, solvent of the pulpshaping act as a lubricant, solvent of the pulp
tissue, antiseptic and bleach.tissue, antiseptic and bleach.
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18. • The amount of dilution and its use inThe amount of dilution and its use in
combination with other irrigants such ascombination with other irrigants such as
glyoxide, RC-Prep, or hydrogen peroxide stillglyoxide, RC-Prep, or hydrogen peroxide still
remain controversial.remain controversial.
• Trepagnier has reported either 5.25% or 2.6%Trepagnier has reported either 5.25% or 2.6%
sodium hypochlorite has the same effects for asodium hypochlorite has the same effects for a
period of 5 minutes when used in root canalperiod of 5 minutes when used in root canal
system.system.
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19. • Cunningham has shown 5.26% and 2.6% NaOclCunningham has shown 5.26% and 2.6% NaOcl
were equally effective at 37°C (bodywere equally effective at 37°C (body
temperature) warming the solution increase itstemperature) warming the solution increase its
antibacterial effect.antibacterial effect.
• Rosefield demonstrated 5.25% sodiumRosefield demonstrated 5.25% sodium
hypochlorite dissolves vital tissue and dissolveshypochlorite dissolves vital tissue and dissolves
necrotic tissue better than in any othernecrotic tissue better than in any other
concentration.concentration.
• Antimicrobial property is due to the destructionAntimicrobial property is due to the destruction
of bacterial by penetration into the bacterial cellof bacterial by penetration into the bacterial cell
and chemical combination with the protoplasmand chemical combination with the protoplasm
of the bacterial cell.of the bacterial cell.
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20. • Hand and associates have shown that sodiumHand and associates have shown that sodium
hypochlorite retain its antimicrobial activity inhypochlorite retain its antimicrobial activity in
the presence of organic matter such as bloodthe presence of organic matter such as blood
and serum albumin.and serum albumin.
• Alternate irrigation with sodium hypochloriteAlternate irrigation with sodium hypochlorite
and hydrogen peroxide (3%) produces energeticand hydrogen peroxide (3%) produces energetic
effervescence that mechanically forces debriseffervescence that mechanically forces debris
and microorganisms out of the canal. Release ofand microorganisms out of the canal. Release of
nascent oxygen causes the forming effect.nascent oxygen causes the forming effect.
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21. • Combination seems to reduce the tissue solvingCombination seems to reduce the tissue solving
property advantage is mechanically bubbles andproperty advantage is mechanically bubbles and
pushes the debris.pushes the debris.
• The solvent action of the sodium hypochlorite.The solvent action of the sodium hypochlorite.
• The disinfectant and, bleaching action by bothThe disinfectant and, bleaching action by both
solution.solution.
• Sodium hypochlorite should be used lastSodium hypochlorite should be used last
because hydrogen peroxide can react with pulpbecause hydrogen peroxide can react with pulp
debris and blood to form gas, trapped gas in thedebris and blood to form gas, trapped gas in the
tooth causes continuous pain.tooth causes continuous pain.
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22. • OTHER IRRIGANTSOTHER IRRIGANTS
• 9-amine acridine reviewed by Schmitz enjoys9-amine acridine reviewed by Schmitz enjoys
regional popularity because of its low toxicityregional popularity because of its low toxicity
and antimicrobial action and has a purportedand antimicrobial action and has a purported
“osteogenic potential”, has no wide spread use“osteogenic potential”, has no wide spread use
because its not a tissue solvent or chelator.because its not a tissue solvent or chelator.
• Chloriamine – T has little ability to dissolveChloriamine – T has little ability to dissolve
necrotic tissue.necrotic tissue.
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23. • Kaufman reported bis-dequalinium acetateKaufman reported bis-dequalinium acetate
(BDA) as disinfectant and chemotherapeutic(BDA) as disinfectant and chemotherapeutic
agent. He cites its low toxicity, lubricationagent. He cites its low toxicity, lubrication
action, disinfecting ability, and low surfaceaction, disinfecting ability, and low surface
tension, as well as its chelating properties andtension, as well as its chelating properties and
low incidence of post-treatment pain. It islow incidence of post-treatment pain. It is
marked as solvidont.marked as solvidont.
• BDA is recommended as an excellent substituteBDA is recommended as an excellent substitute
for sodium hypochlorite in those who arefor sodium hypochlorite in those who are
allergic to sodium hypochlorite.allergic to sodium hypochlorite.
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24. • Chlorhexidine gluconateChlorhexidine gluconate (0.2%). Recently,(0.2%). Recently,
Loma Linda group reported it to be moreLoma Linda group reported it to be more
effective as an antimicrobial agent.effective as an antimicrobial agent.
Action of chlorhexidine : action is theAction of chlorhexidine : action is the
result of absorption of chlorhexidine onto theresult of absorption of chlorhexidine onto the
cell wall of the microbes thereby altering thecell wall of the microbes thereby altering the
cells osmotic equilibrium; resulting in leakage ofcells osmotic equilibrium; resulting in leakage of
intracellular components.intracellular components.
• Broad spectrum, antimicrobial, substantivity andBroad spectrum, antimicrobial, substantivity and
relative absence of toxicity.relative absence of toxicity.
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25. • 2% glutaraldehyde2% glutaraldehyde - Wemes and co-workers- Wemes and co-workers
1982 used 2% glutaraldehyde as an endodontic1982 used 2% glutaraldehyde as an endodontic
irrigant. It causes irreversible fixation of tissues,irrigant. It causes irreversible fixation of tissues,
they observed smooth layer of dentin materialthey observed smooth layer of dentin material
resulted in closure of apical and lateral canalsresulted in closure of apical and lateral canals
and the dentinal tubules and showedand the dentinal tubules and showed
considerable antibacterial effect.considerable antibacterial effect.
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26. • ULTRASONIC IRRIGATIONULTRASONIC IRRIGATION
• The use of ultrasonic irrigation to better cleanseThe use of ultrasonic irrigation to better cleanse
root canals, of their fillings debris and bacteriaroot canals, of their fillings debris and bacteria
has been well reported by Martin andhas been well reported by Martin and
Cunningham.Cunningham.
• The oscillating movement of the file createsThe oscillating movement of the file creates
ultrasonic wave of sodium hypochlorite irrigantultrasonic wave of sodium hypochlorite irrigant
solution which is delivered along the side of thesolution which is delivered along the side of the
file and the vibration produces heat thatfile and the vibration produces heat that
increases the chemical effectiveness.increases the chemical effectiveness.
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27. • It also produces cavitation, that is the growthIt also produces cavitation, that is the growth
and collapse of bubbles, with a resulting increaseand collapse of bubbles, with a resulting increase
in the mechanical cleansing activity of thein the mechanical cleansing activity of the
solution, this increases in thermal andsolution, this increases in thermal and
mechanical activity of the solution, helps inmechanical activity of the solution, helps in
removal of debris and tissue from the isthmusremoval of debris and tissue from the isthmus
and removal of smear layer are more efficientand removal of smear layer are more efficient
bactericidal action also increases.bactericidal action also increases.
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28. • Sonic system uses water as an irrigant andSonic system uses water as an irrigant and
doesn’t usually require diamond files for thedoesn’t usually require diamond files for the
flare of the preparation.flare of the preparation.
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29. • TechniqueTechnique
• The instrument required is a disposable plastic orThe instrument required is a disposable plastic or
glass syringe with an endodontic notched needle.glass syringe with an endodontic notched needle.
The needle should be bent to an angle to reach theThe needle should be bent to an angle to reach the
canals of posterior as well as anterior teeth. Thecanals of posterior as well as anterior teeth. The
needle is inserted into the canal part way and shouldneedle is inserted into the canal part way and should
not bind the canal sufficient room between thenot bind the canal sufficient room between the
needle and canal allows for the return flow andneedle and canal allows for the return flow and
avoids forcing of solution into the periapical time.avoids forcing of solution into the periapical time.
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30. • When it is not binding, the solution should beWhen it is not binding, the solution should be
ejected with little or no pressure, on the plungerejected with little or no pressure, on the plunger
during the shaping and cleaning of the canal careduring the shaping and cleaning of the canal care
should be taken that canals are always full ofshould be taken that canals are always full of
fresh solution.fresh solution.
• A perforated irrigating needle deliver irrigantA perforated irrigating needle deliver irrigant
360° in the canal, and large volumes of the360° in the canal, and large volumes of the
irrigant solution physically remove more materialirrigant solution physically remove more material
it has been claimed.it has been claimed.
• Disadvantage is that it is delicate and bends outDisadvantage is that it is delicate and bends out
of shape easily.of shape easily.
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31. • CONCLUSIONCONCLUSION
• Irrigants in endodontic therapy is a must and areIrrigants in endodontic therapy is a must and are
many, it is for the clinician to select particularmany, it is for the clinician to select particular
irrigant, depending on the clinical observation,irrigant, depending on the clinical observation,
sterility canal configuration, the knowledge ofsterility canal configuration, the knowledge of
the microbial flora, and their isolations andthe microbial flora, and their isolations and
maintaining negative field in the canal improvesmaintaining negative field in the canal improves
the success of root canal.the success of root canal.
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32. ReferencesReferences
1 Endodontics 51 Endodontics 5thth
EditionEdition
J.I.Ingle, Leif.k.BaklandJ.I.Ingle, Leif.k.Bakland
2002 Elsevier.2002 Elsevier.
22 Pathway of pulp 8Pathway of pulp 8thth
Edition.Edition.
S.Cohen & R.C. BurnsS.Cohen & R.C. Burns
2002 by Mosby2002 by Mosby
4 Endodontic Therapy. 64 Endodontic Therapy. 6thth
Edition.Edition.
Franklin.S.WeineFranklin.S.Weine
2004 by Mosby2004 by Mosby
5 DCNA5 DCNA
vol.28,No.4,1984vol.28,No.4,1984
John.W.HarrisonJohn.W.Harrison
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