Root canal irrigants

1. Root Canal Irrigants
Irrigants perform important physical and .
biological roles during endodontic therapy.
When there is wet environment during
canal preparation the dentin debrises are
floated to the chamber. Where they be
.remove by paper points or others
Many liquids would provide these aids, but .
in addition the irrigants that are typically
used have the function of being necrotic
. tissue solvents
Ass.Prof.Dr.Mohamed ALsakkaf 1

2. Because reamers and files much too small to .
fit into accessory canals, it is the solvents
action that removes the tissue remaining
and also the subsequently filling material
.may be packed or pushed into these areas
The commonly used irrigants are capable of .
causing inflammation of periapical tissue.
Therefore instrumentation must be
confined within the canal to limit the
forcing of irrigants through the apical
. foramen
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3. 3

4. Requirements of Ideal Irrigants
It must have broadspectrum antimicrobial . 1
. effect
.It must aid in the root canal debridement . 2
.Ability to dissolve necrotic tissue or debris . 3
.Low toxicity level. 4
.Act as a good lubricant. 5
Low surface tension to flow easily into the . 6
. inaccessible areas
.Remove the smear layer. 7 4

5. Factors Effecting The Irrigants
action
.Concentration. 1
.Contact. 2
.Presence of organic tissue. 3
.Quantity. 4
.Temperature. 5 5

6. :Remember
The smear layer is a micro – crystalline layer
of cutting debris covering the canal walls
after the preparation and its removal may
aid in better adaptation of the obturating
.materials to the canal walls
:It consist of
.A. Organic layer ----- removed by irrigants
B. Inorganic layer --- removed by chealating
. agent
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7. Types of Irrigants
).Sodium hypochloride (NaOCL)(PH 12 – 13 . 1
.The most popular irrigant.
:It provides.
.a. Gross debridement
.b. Dissolution of tissue
.c. Lubricant
.d. Antibacterial
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8. Warming NaOCL increases its tissue solvent .
. effect
.It is provided in bottles of 5.2% .
It, is clear, pale, green – yellow liquid, with .
. strong odor of chlorine
Solution should always be performed .
passively especially in cases with larger
apical diameters, and needles with very
small diameter, also the syringes should
.never be locked in the canal
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9. Hydrogen Peroxide (H2O2) 3%. 2
.It is odorless, clear liquid.
Its effervescence action capable for .
removing loose debris from inside the
.canal
Release of nascent oxygen (O3) works .
. against anaerobic bacteria
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10. Combining 5.25% NaOCL + 3% H2O2.
proved to be better than saline alone at 1 –
.3mm level of the canal
If Hydrogen Peroxide is used, final irrigant .
should be NaOCL because, it may cause
:either
Tissue emphysema if it passes to the .1
. periapical tissue
.Post – Operative Pain. 2
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11. (Chlorhexidine Gluconate (0.2% - 2%. 3
It has antibacterial effect (long standing effect .
by binding to hydroxyapatite and in
combination with Ca(OH(2 effective against
(. anaerobes
.Does not have tissue solvent action .
.Low toxicity compared to NaOCL.
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12. Organic acid as citric acid 10 – 25% in .4
combination with NaOCL removes smear
. layer
MTAD. 5
M ----- Mixture of
T ----- Tetracycline
(A ----- Acid (citric acid
D ----- Detergent
Recommendation: 1.3 – 2.5% NaOCL is the
.irrigant of choice during the preparation 12

13. Method of Irrigation
.Plastic syringe of acceptable needle gauge .
.File Iso 30 = 30
.File Iso 40 = 27
.File Iso 50 = 25
.File Iso 60 = 23
.File Iso 80 = 21
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14. Bending the needle and it must lie passively .
in the canal as forceful irrigation can push
. the irrigant into the periapical tissue
.Volume of irrigation about 2ml each time .
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15. The Ultrasonic Irrigation: Considered the
most effective method of irrigation where
:vibration motion of files inside the canal
Move irrigant in Vortex motion cleaning .1
. the area which cannot be reached by files
The motion causes worming of the irrigant, . 2
. increasing its action
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16. Combination of Irrigants
.H2O2 NaOCL ---- Foaming action. 1
EDTA + NaOCL ---- Removes Smear .2
. Layer
EDTA + Urea Peroxide + NaOCL increase . 3
bubbling action, debridement and removal
. of smear layer
MTAD + NaOCL: For disinfection and .4
. smear layer removal
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17. Chealating Agents
Chelate: react with calcium, so their action is .
to react with calcium ions and substitute it
by sodium ions which can bind to dentin to
. give soluble salt
It used to enlarge narrow curved and .
. calcified canals
Aids in the removal of Smear Layer .
(. (inorganic part
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18. Types of Chealating Agents
a. Ethylene Diamine Tetra Acetic Acid
(EDTA( are the active ingredients in all
. types
.It used for cleaning and widening the canal .
.Used in concentration of 17%.
.Optimal working time 15 minutes.
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19. :b. EDTA C
EDTA Cetavlon which increases anti –
.bacterial activity
Combination of EDTA + Urea peroxide, .
. provides both chelation and irrigation
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20. Intra Canal Medicaments
They are medicaments used in root canal .
. between appointments
I. The popular intra canal medicaments were
: designed and proposed for the following
Anti – microbial activity in the pulp and .1
. periapex
Neutralization of canal remnant to render . 2
. them inert
Control or prevention of post – treatment . 3
. pain 20

21. II. The use of traditional medicaments is
: decreased, because
a. Intra canal bacterial population can be
eliminated by careful instrumentation
. and irrigation
.b. Lack of evidence of medicament usefulness
.c. Toxicity
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22. .III. Limitation and Contraindications
:Intracanal environment. 1
The therapeutic action of the medicaments .
depends on the direct contact with the
.microbe or tissue
Their effect is probably limited to surface .
action only and does not reach the area,
. where the bacteria are hidden
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23. :Duration. 2
Most agents should remain chemically active .
for the period of time between appointments,
.in order to be effective
.Phenolics loose their activity within 24 hrs .
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24. :Toxicity .3
a. Any chemical that kills bacteria, will also
(. kill host cells (Phenol, aldehyde
b. An adverse side effect is also: Allergenicity.
As the medicaments may act as a hapten
and alter the tissue to become foreign
substances, producing an immune
response. May be responsible for their
localized adverse effect on the pulp and /
.or periapical tissue 24

25. :Distribution .4
The pulp is not isolated from the rest of the .
body, as the pulp has a ready accessibility
to the periapical tissue and even to the
.systemic circulation
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26. :Taste and Smell. 5
Phenolics in particular have a pungent odour
and foul taste. The patient will report a
disagreeable medicinal taste, which many
.find objectionable
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27. Recently Used Intra Canal
Medicaments
:Calcium hydroxide. 1
. a. The most popular intra canal medicament
b. It gas antimicrobial action (due to its
(. alkaline PH
.c. Increase organic tissue solvent of NaOCL
d. Alkaline neutralizes the acidity of
. inflammation
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28. Application of Calcium
Hydroxide
Antimicrobial Action (germs coming in contact 
(with the paste are easily destroyed by the high pH
Bone-regenerating effects (stimulates the 
osteoblastic activity and hard tissue deposition ).
.Used in case of root resorption and inmature teeth
Aid the dissolution of organic material 
remaining in the root canal after
.preparation
.Very good biocompatibility 

29. Placement of Medicaments
Syringe Delivery
Spiral Fillers
Hand File
Thin aqueous suspension of Ca(OH)2 used as dressing29

30. :Available as
.Powder. 1
.Paste. 2
.Active Point. 3
.Injectable. 4
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31. :Antibiotics. 2
It was tried as intra canal medication, but
fear of developing bacterial resistance
.which leads, to decrease its use
:Steroids. 3
It was tried due to its anti inflammatory
.effect, to avoid post operative pain
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32. (.Combination (steroids and antibiotics .4
.a. Steroids ------ An inflammatory effect
.b. Antibiotics ------ Controlling infection
Used mainly in case of acute pulpitis with
.apical periodontitis
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33. Iodine Potassium Iodide
Is it an iodoform/calcium hydroxide paste
that has been shown to reduce the presence
of all bacteria but especially Enterococcus
Faecalisi, a hardy bacterium commonly
.associated with failing root treatments
May be useful as an irrigant and intracanal .
. dressing in retreatment cases
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