Dr Sucheta Singh PG 3rd yr Dept of Pedodontics & Preventive Dentistry Rajasthan Dental College & Hospital

2. Presented by : Dr. Sucheta
Narwat
2nd yr PG

3. CONTENTS
• Introduction
• Root Canal Bacterium
• History
• Ideal Requirement for an Irrigant
• Classification
• Different Irrigating Solutions -Newer
Irrigating Solutions, Herbal
• Conclusion

4. INTRODUCTION
• Microorganisms, either remaining in the root canal
space after treatment or re-colonizing the filled
canal system.
• Primary endodontic treatment goal- optimize root
canal disinfection and to prevent re-infection by
cleaning the root canal system thoroughly and
making it free of microbiota and debris, as they
have definite role in the initiation and perpetuation
of pulpal and periapical diseases (Kandaswamy
and V enkateshbabu, 2010).
MAIN CAUSE OF ENDODONTIC FAILURE

5. This process mainly revolves around the
chemomechanical preparation wherein
chemically active solutions are used along
with mechanical instrumentation of the root
canal infections.
Several studies have demonstrated that a large proportion of
areas of the main root canal wall remains untouched during
instrumentation (Peters et al., 2002).
Therefore the use of irrigant solutions is an
essential complement to mechanical preparation
aiding in the removal of pulp remnants and in
the elimination of residual bacteria from the
unreachable areas of the complex root canal
system (Kandaswamy and Venkateshbabu,
2010).

6. Medicine heals
doubts as well
as diseases.
-Karl
Marx

7. Root Canal
Bacterium
Primary root canal infections are polymicrobial, typically
dominated by obligatory anaerobic bacteria. (G.
Sundqvist)
Most
frequently
Isolated
Gram-negative
anaerobic rods,
Gram-positive
anaerobic cocci
Gram-positive
anaerobic and
facultative
rods
Lactobacillus
species, and
Gram-positive
facultative
Streptococcus
species
OBLIGATE
ANAEROBES

8. Facultative bacteria such
as nonmutans
Streptococci,
Enterococci, and
Lactobacilli, once
established, are more
likely to survive
chemomechanical
instrumentation and root
canal medication.
In particular
Enterococcus faecalis
has gained attention in
the endodontic
literature, as it can
frequently be isolated
from root canals in
cases of failed root
canal treatments
In addition, yeasts may also be found in root canals
associated with therapy-resistant apical periodontitis.
(T.M.T. Waltimo, 1997)

9.  The first listed literature about the need for frequent irrigation of the root
canal was advocated by Taft (1859) . He recommended the use of a
‘deodorising agent’ like chloride of sodium.
 Schreir (1893) introduced potassium and sodium metals into canals for
removal of necrotic pulp.
 20-5-% aqueous solution of sulphuric acid applied on a cotton pledget
and sealed into the root canal for 24-48 hours was introduced by
Callahan (1894) .
 A saturated solution of bicarbonate soda was then introduced into the
root canals thereby producing an effervescent action and forcing debris
to the surface.
 In the late 20th century, studies conducted by Grossman and Meiman in
1941 led to introduction of the combined use of double strength sodium
hypochlorite and hydrogen peroxide to wash out fragments of pulp
HISTORY

11. .
Antimicrobial
properties
Debride-
ment
Dissolve
necrotic
tissue
Low toxicity
Good
lubricant
Low surface
tension
Sterilize
Smear layer
Inactivate
endotoxin
Ideal Requirements for an Irrigant
M. Zehnder, “Root canal irrigants,” Journal of Endodontics,vol. 32, no. 5, pp. 389–398, 2006.
Availability Ease of use Cost Convenience

12. Sterlization is the killing of
all microorganisms in a
material or on the surface
of an object.
Disinfection means
reducing the number of
viable microorganisms
present.

13. Functions of Irrigants
Physical &
Biologic
Functions
1.
2. Instruments do not work properly in dry canals. Their
efficiency increases by use in wet canals. Less likely to
break.

14. Dissolve
necrotic
tissue
3.
Removes debris Germicidal Bleaching action Lubricating agents

15. Factors that Modify Activity of
Intracanal Irrigating Solutions
CONCEN-
TRATION
CONTACT

16. Quantity of
irrigant
Needle
Gauge
Surface
tension
Temperature

17. Frequency
Canal
diameter
Age of
irrigant

18. CLASSIFICATION
OF IRRIGANTS

20. Endodontic
Irrigants
Chemical
agents
Tisssue
dissolving
Antibacterial
agents
Chelating
agents
Natural
agents
Antibacterial
agents
Root canal irrigants.Deivanayagam Kandaswamy, Nagendrababu Venkateshbabu (2010)

21. 0.9% solution
Gross debridement
Lubrication of root
canals
Flushing action
Can be used as final
rinse
No adr
No disinfecting and
dissolution properties
Cannot clear microbial flora
from inacessible areas
Do not remove smear layer
BIOCOMPATIBLE IN NATURE
SALINE

22. Sodium Hypochlorite
Easily
miscible with
water & gets
decomposed
by light
• Chlorine is one of the most widely
distributed elements on earth. It is not
found in a free state in nature, but exists
in combination with sodium, potassium,
calcium, and magnesium.
Natural Occurrence
Clear, pale, green-
yellow liquid with
strong odor of chlorine

23. Historical Review
• Potassium hypochlorite was the first chemically produced aqueous chlorine
solution, invented in France by Berthollet (1748-1822).
• Starting in the late 18th century, this solution was industrially produced by Percy
in Javel near Paris, hence the name “Eau de Javel”.
• First, hypochlorite solutions were used as bleaching agents.
• Subsequently, sodium hypochlorite was recommended by Labarraque(1777-
1850) to prevent childbed fever and other infectious diseases.
• Based on the controlled laboratory studies by Koch and Pasteur, hypochlorite
then gained wide acceptance as a disinfectant by the end of the 19th century.
• In World War I, the chemist Henry Drysdale Dakin and the surgeon Alexis Carrel
extended the use of a buffered 0.5% sodium hypochlorite solution to the irrigation
of infected wounds, based on Dakin’s meticulous studies on the efficacy of different
solutions on infected necrotic tissue.

24. Beside their wide-spectrum, nonspecific killing efficacy on all
microbes, hypochlorite preparations are sporicidal, virucidal,
and show far greater tissue dissolving effects on necrotic
than on vital tissues.
Walker
(1936)
• Other chlorine-releasing compounds have been
advocated in endodontics, such as chloramine-T and
sodium dichloroisocyanurate.
• These, however, have never gained wide acceptance
in endodontics, and appear to be less effective than
hypochlorite at comparable concentration.

25. Mechanism of Action
ANTI-
MICROBIAL
ORGANIC
TISSUE
DISSOLVING
NaOCl has organic tissue
dissolving properties
which will help in
degrading fatty acids and
transforming them into
fatty acid salts (soap) and
glycerol (alcohol) which
will help to reduce the
surface tension of the

26. NaOCl buffers the amino acids forming water and
salt.
Formation of hydroxyl ions takes place which leads
to the reduction of pH.

27. • Hypochlorous acid combines
with protein amino groups to
form chloramines. This reaction
between chlorine and the amino
group (NH) leads to the
formation of chloramines that
interfere with the cell
metabolism.
• Antimicrobial action of chlorine
occurs by inhibiting bacterial
enzymes and leading to an
oxidation of SH groups
(sulphydryl groups) of bacterial
enzymes
Kandaswamy and Venkateshbabu: Root canal Irrigants ; Journal of
Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4

28. Increasing the efficacy of NaOCl
Time
pH
Temperature
Greater contact
time – More
effectiveness
• The antibacterial
properties and
tissue-dissolving
properties of
5.25% NaOCl
decrease when it
is diluted.

29. Specialized
irrigating
syringes
Ultrasonic

30. Precautions to be Taken While Using
Sodium Hypochlorite Solution
If extruded
periapically
Excruti-
ating
pain
Peri-
apical
bleedin
g
swelling
• As spread of infection is
related to tissue
destruction, medication
like antibiotics, analgesics,
antihistamine should be
prescribed accordingly.
• Reassure the patient.
Thus, irrigation with NaOCL
should always be performed
passively especially in cases
with larger apical diameters &
needles with small diameter.

31. 1.Tissue Dissolution
2. Antibacterial &
bleaching action
3. Lubrication of Canals
4. Economical
5. Easily available
1. Ability to wet dentin is
less
2. Irritant
3. Caustic nature
4. Bleach clothes if spilt
5. Bad odor & taste
6. Irritation to eyes
7. Corrosive to instruments
ADVANTAGES
DISADVANTAGES

32. Complications of Accidental Spillage
Damage to
clothing
•Most common
•Irreparable bleaching
Eye damage
•Mild burns with sodium hypochlorite can react
with the lipid in the corneal epithelial cells;
thereby forming a soap bubble that penetrates
the corneal stroma and enters into the anterior
chamber leading to tissue necrosis.
•ENDOPTHALMITIS
Damage to
oral mucosa
•Reacts with the proteins
and fats of oral mucosa
which might lead to
secondary infections

33. Complications arising from hypochlorite extrusion
beyond the root apex
Chemical burns &
tissue necrosis
• When sodium hypochlorite is extruded beyond the root canal
into the peri-radicular tissues, the effect is one of a chemical
burn leading to a localised or extensive tissue necrosis.
• Given the widespread use of hypochlorite, this complication is
fortunately very rare indeed.
• A severe acute inflammatory reaction of the tissues develops.
• This leads to rapid tissue swelling both intra orally within the
surrounding mucosa and extra orally within the skin and
subcutaneous tissues.
• The swelling may be oedematous, haemorrhagic or both, and
may extend beyond the region that might be expected with an
acute infection of the affected tooth.

34. Prevention of sodium hypochlorite extrusion
A good proper straight line access cavity design with adequate coronal
preparation.
Preoperative Periapical radiographs to access the root canal anatomy.
Use of specialized needles like leur lock needles. Determine proper working
length and carefully adjust the rubber stopper.
Do not wedge the needle tip in the canal, has to be placed loose inside.
Avoid using excessive digital pressure especially with the thumb.
Constant in and out movements of the irrigating needle into the canal.
Flow back of the solution as it is expressed into the canal, should be
observed.

35. Management
 Immediate irrigation of canal with normal saline to dilute the sodium hypochlorite.
 Let the bleeding response continue to flush the irritant out.
 Advice ice pack compression for 24 hours (15 minutes interval) to minimize the swelling.
 Recommend warm, moist compress after 24 hours (15 minutes interval) .
 Prescribe analgesics.
 Prophylactic antibiotic coverage for 10 days to prevent secondary infection. Steroid therapy for 2-3
days to control inflammatory reaction.
 Reassure the patient and provide with both verbal and written homecare instructions.
 Monitor the patient periodically.
Risks and Management of Sodium Hypochlorite in Endodontics;
Shibu Thomas Mathew (2015)

36. Blechman and
Cohen 1951
Urea denatures the protein by destroying
bonds of the secondary structure resulting
in loss of functional activity of protein.
It has the property of chemically debriding
the wound by softening the underlying
substrate of fibrin.
White,
odorless.
Crystalline
powder

37. Excellent
vehicle for
antimicrobials
Low
toxicity
Open
apex

38. Clear,
odorless
liquid
3% Solution
as irrigating
agent

39.  It is highly unstable and easily decomposed by heat and
light.
 It rapidly dissociates into water and nascent oxygen.
 On coming in contact with tissue enzymes catalase and
peroxidase , the liberated [O] produces bactericidal effect
but this effect is transient and diminishes in presence of
organic debris.
 It causes oxidation of bacterial sulfhydryl group of enzymes
and thus interferes with bacterial metabolism
 The rapid release of nascent oxygen on contact with
organic tissue results in bubbling action which is thought to
aid in mechanical debridement by dislodging particles of
nacrotic tissue and dentinal debris and floating them to the
surface.
Mechanism of Action

40. USE
Bubbling
action
Solvent
action
Disinfecting

41. White
crystalline
powder,
slight odor
Urea peroxide Urea + H2O2
USE (Glyoxide)
1. Inc. stability of solution – shelf
life.
2. Good lubricant.
3. Can be used along with EDTA.

42. CHLORHEXIDINE
 Developed in late 1940’s
 Most potent of tested bisbiguanides
 Strong base & most stable in form of salts
(Chlorhexidine gluconate)
 Potent antiseptic
Mechanism of action

44. Combination of .2% chlorhexidine
and 2% sodium hypochlorite
• CHX - base
• NaOCL –
oxidising agent
Gluconic acid
• Increase in
ionizing capacity
of CHX
• Combination
• > alkaline
> effective

45. Advantages & Uses

46. Not main irrigant
Unable to
dissolve
necrotic tissue
remnants
Less effective
on gram
negative

47. Chelating
Agents

48. What is Smear Layer???
o Whenever dentine is cut using hand or
rotary instruments, the mineralized tissues
are not shredded or cleaved but shattered
to produce considerable quantities of
debris.
o Much of this, made up of very small
particles of mineralized collagen matrix, is
spread over the surface to form what is
called the smear layer.
-Eick JD et al (1970)

50. EDTA Nygaard
Ostby
(cleaning
& shaping)
• Relatively non toxic & slightly
irritating.
• Effect on dentine depends on –
• Serper & Calt in their study
observed that EDTA was more
effective at neutral pH.

51. Functions • Lubrication
• Emulsification
• Holding debris in
suspension
• Smear layer removal

52. Mechanism of Action
 Inhibits bacterial growth & ultimately destroys them by starvation because EDTA
chelates with the metallic ions in medium which are needed for growth of
microorganisms.
 SELF LIMITING ACTION. Forms a stable bond with calcium & dissolve dentin, but when
all chelating ions have reacted, an equilibrium reached which prevents further
dissolution.
• Dentin dissolving properties
• Enlarge narrow canals
• Easy manipulation of instruments
• Reduces time needed for
debridement
Uses

53. RC Prep = EDTA + UREA PEROXIDE + POLYETHYLENE GLYCOL
R-EDTA
EDTA-T
EDTA-C
• Liquid or paste form
• Paste type – STEWART –
combination of urea peroxide
with glycerol

54. The use of 10% citric acid as final
irrigation has shown good results in
smear layer removal and proven to be
more biocompatible than 17% EDTA-T
and 17% EDTA
Should NEVER be mixed with NaOCl

55. • Contains 0.5% NaOCL along
with amino acids.
• Thus it was hypothesized
that this agent can also be
effective in removal of
smear layer in root canal
when used as an irrigant.
DEGRADE THE
DENATURED COLLAGEN
Ramachandra JA et al. Root Canal Irrigants in Primary Teeth. World J
Dent 2015;6(3):229-234

56. Parul Singhal et al. Carisolv as an endodontic irrigant in deciduous teeth: An SEM
study; Indian Journal of Dental Research (2012)
They evaluated the efficacy of
Carisolv TM , 1% sodium
hypochlorite (NaOCl) gel, and 1%
NaOCl solution as root canal
irrigants in deciduous anterior teeth
• Carisolv TM cleans deciduous root canals better than
NaOCl gel (1%) and can be used as an adjunct to root
canal preparation.

57. Ultrasonic irrigation
Continuous flow
of irrigant

58. MECHANISM OF ACTION

59. Ultrasonic
Irrigation

60. ADVANTAGES DISADVANTAGES
 Better than conventional
ones
 Removes smear layer
 Dislodgement of debris
• Unpredictable
preparation
• Excessive cutting

62. Electrochemically activated solution

63. Solovyeva AM, Dummer PMH. Cleaning effectiveness of root canal irrigation with
electrochemically activated anolyte and catholyte solutions: a pilot study.
International Endodontic Journal, 33, 494–504, 2000.
Evaluate the potential of electrochemically
activated (ECA) anolyte and catholyte solutions
to clean root canals during conventional root
canal preparation
 Irrigation with electrochemically activated solutions cleaned root
canal walls and may be an alternative to NaOCl in conventional
root canal treatment.
 Further investigation of ECA solutions for root canal irrigation is
warranted.

64. Ozonated Water Irrigation
• Ozone is a chemical compound consisting of three oxygen atoms (O
3
–
triatomic oxygen), a higher energetic form than normal atmospheric
oxygen (O
2
).
• Very powerful bactericide that can kill micro- organisms
effectively.
• It is an unstable gas, capable of oxidizing any biological
entity.
• It was reported that ozone at low concentration, 0.1 ppm,
is sufficient to inactivate bacterial cells including their
spores. (W. T. Broadwater 1973)
Ozone
generator
Nagayoshi et al. found that killing ability of ozonated water and 2.5% of sodium
hypochlorite was almost comparable when the specimen was irrigated with sonication
.

65. Huth KC, Quirling M, Maier S, Kamereck K, AlKhayer M, Paschos E, Welsch U,
Miethke T, Brand K, Hickel R. Effectiveness of ozone against endodontopathogenic
microor- ganisms in a root canal biofilm model. International Endodontic Journal, 42,
3–13, 2009.
Assessed the antimicrobial efficacy of aqueous and gaseous
ozone as an alternative antiseptic against endodontic
pathogens in suspension and a biofilm model
High-concentrated gaseous and aqueous ozone was dose-, strain-
and time-dependently effective against the tested microorganisms
in suspension and the biofilm test model.

66. Ruddle’s Solution
5%
NaOCL
17% EDTA
Hypaque
RUDDLE’S
SOLUTION
water soluble, radiopaque, contrast
solution which can be utilized to
visualize root canal system anatomy,
monitor the remaining wall thickness
during preparation procedures, detect
pathological defects and manage
iatrogenic mishaps.

67. Clinically, the Ruddle Solution is passively injected into the root canal
system once sufficient access has been made.
NaOCL portion of the composition will digest the pulp and eliminate the
bacteria and related irritants which are harbored within the root canal system.
The solvent action of this solution progressively clears out the contents of the
root canal system thus enabling the iodine portion of the composition to flow
into the vacated space.
Mechanism of Action
So, Ruddle’s solution can be helpful for improving diagnostic
accuracy, t/t planning, management of procedural accidents, but
further studies are needed to prove it as effective as irrigating
solution.

68. Photo Activated Disinfection (PAD)
• PS is activated at specific
wavelength and produces
free oxygen, which causes the
rupture of the bacterial cell
wall on which the PS is
associated with, determining
a bactericidal action. (Burns,
1993)
Photosensitizing molecules (photosensitizer - PS) are able to
bind to the membrane of the bacteria.
 Clinically, after the root canal preparation,
PS is introduced into the canal until working
length with an endodontic needle and is left
in situ for 60 s.
 The specific endodontic tip is then inserted
into the root canal up to the depth that can
be reached and the light irradiation is
performed for 30 s in each canal.
MECHANISM
Williams
(2006)

69. DETERGENT
ACID
TETRACYCLINE
MTAD
Surface Tension Comparison of Four Common
Root Canal Irrigants and Two New Irrigants
Containing Antibiotic
Luciano Giardino, MD, DDS, Emanuele Ambu,
MD, DDS, Carlo Becce, MD, DDS,Lia Rimondini,
MD, DDS, and Marco Morra
MTAD exhibited superior antimicrobial efficacy
compared with 2.5% NaOCL, 17% EDTA and 2%
CHX and also shown to eliminate bacteria in
human RC’s that had been infected by whole
saliva.

71. Plant derived material or
preparation which contains
raw or processed ingredients
from one or more plants with
therapeutic values. (WHO)
• Owing to the potential side effects, safety concerns and ineffectiveness of
conventional allopathic formulations, consumption of preparations from medicinal
plants has increased over the last few decades. (M.S. Sadr Lahijani et al. 2010)
• Herbal or natural products have been used in dental and medical practice for
thousands of years and have become even more popular today due to their high
antimicrobial activity, biocompatibility, anti-inflammatory and anti-oxidant
properties. (Dilsah Cogulu et al. 2006)
Herbal Usage In Endodontics- A Review ; Madhu Pujar, Saleem Makandar
IJCD • JANUARY,2011•2(1)

72. Morinda
Citrifolia
(NONI)
Triphala
and Green
Tea phenols
Propolis Miswak
Turmeric

73. TRIPHALA & GTP’S
• Triphala is one of the well known
Indian Ayurvedic herbal
formulation consisting of dried
and powdered fruits of three
medicinal plants namely
Terminalia Bellerica, Terminalia
Chebula and Emblica Officinalis.
• Contains fruits rich in citric
acid, which may aid in
removal of the smear layer.
• The polyphenols found in Green
tea are more commonly known as
flavanols or catechins.
• Green tea polyphenols have significant
antioxidant, anticariogenic, an anti-
inflammatory, thermogenic, probiotic
and antimicrobial properties. (Pulok et
al 2006)

74. J.Prabhakar, M.Senthikumar, M.S.Priya et.al. Evaluation of Antimicrobial Efficacy of Herbal
Alternatives (Triphala and Green Tea Polyphenols), MTAD, and 5% Sodium Hypochlorite
against Enterococcus faecalis Biofilm Formed on Tooth Substrate: An In Vitro Study. J Endod
2010;36:83-86.
 5% sodium hypochlorite showed maximum antibacterial
activity against 3- and 6-week E. faecalis biofilm formed on
tooth substrate. Triphala and MTAD showed complete
eradication in 3-week biofilm. Triphala, GTPs, and MTAD
showed statistically signifi
 cant antibacterial activity against 6-week bio- film. The use of
herbal alternatives as a root canal irrigant might prove to be
advantageous considering the several undesirable
characteristics of NaOCl.
 Further research is needed to conclusively recommend
herbal solutions as a root canal irrigant.

75. Morinda Citrifolia (NONI)
 Antibacterial
 Anti-inflammatory
 Antiviral
 Antitumor
 Antihelmenthic
 Analgesic
 Hypotensive
 Anti-inflammatory
 Immune enhancing effects
first juice to be identified as a possible alternative
to the use of NaOCl as an intracanal irrigant.

76. Propolis
Resinous beehive product, a
potent antimicrobial,
antioxidant & anti
inflammatory agent. (Nara A
et al. 2010)

77. Propolis and commonly used intracanal irrigants: comparative evaluation of
antimicrobial potential. Jolly M et al; 2013
To evaluate, in
vivo, the
antimicrobial
and
inflammatory/irri
tant potential of
Propolis against
mixed
endodontic
aerobic and
anaerobic
bacteria
 Eradicate E.faecalis and Candida
albicans

78. Miswak
 Derived from the plant Salvadora perscia mainly used as a chewing stick,
which is used for cleansing the teeth. (Al- Obaida MI et a;. 2010)
 Wolinsky & Sote, by isolation of the active ingredient from S. perscia, found
that the liminonoid had a great antimicrobial activity by inhibiting the growth
of various Gram–postive & Gram–negative microorganisms by interfering
extrapolysaccharides and glycosidase enzymes.
Antimicrobial activity of root canal irrigants in primary teeth – Shingare et al.
(2011)

79. Various Delivery Systems for Irrigation
Needle with
notched tip
Needle with bevel

80. MONOJET
NEEDLE
Pro Rinse ( Max 1 probe)
Endo
brushes

81. Irrigation Activation/ Agitation
• Root canal poses several irregularities
such as isthmuses and ramifications that
can not be cleaned with regular
irrigation.
• Moreover, studies have shown that 30%
of root canal system is not irrigated with
regular irrigation.
• For the above reasons, activation of
irrigation is a necessity.

82. Manual
agitation
Sonic &
ultrasonic
activation
Negative
apical
pressure
Safety
irrigator
Laser
activation
system
Different techniques of activation

83. MANUAL AGITATION
The recognition of the difficulty of apical
canal irrigation has led to various
innovative techniques to facilitate the
penetration of solutions in the canal.
One of these includes the use of apically
fitting gutta-percha cones in an up-and-
down motion at the working length.
 Recommended No. of strokes, 100 stroke
per minute.
CHEAPEST
METHOD

84. SONIC AGITATION
• It is based on sonic
vibration of a plastic
tip in the root canal.
• Does not deliver new
irrigant to the canal but
it facilitates the
penetration and
renewal of the irrigant
in the canal.
ENDOACTIVATOR

85. ULTRASONIC
AGITATION
Ultrasonics, together with an irrigant, contributed
to a better cleaning of the root-canal system than
irrigation and hand-instrumentation alone.
Cavitation and acoustic streaming of the irrigant
contribute to the biologic- chemical activity for
maximum effectiveness. (Roy RA et al,1994)

86. NEGATIVE APICAL
PRESSURE
Based on a negative-pressure approach whereby the
irrigant placed in the pulp chamber is sucked down the
root canal and back up again through a thin needle
with a special design.
• Compared with traditional needle irrigation and some other systems, the
EndoVac system lowers the risks associated with irrigation close to the
apical foramen considerably. (Hauser V et al; 2007)
• Advantage of the reversed flow of irrigants may be good apical cleaning at the
1-mm level

87. SAFETY IRRIGATOR
An irrigation/ vaccuation system that apically delivers the irrigant under
positive pressure through a thin needle with a lateral opening, and
evacuates the solution through a large needle at the root canal orifice.

88. Comparative Safety of Various
Intracanal Irrigation Systems
Pranav Desai, BDS, DDS, and Van
Himel, DDS
 This study showed that the EndoVac did not extrude irrigant
after deep in- tracanal delivery and suctioning the irrigant from
the chamber to full working length.
 EndoActivator had a minimal, although statistically
insignificant, amount of irrigant extruded out of the apex when
delivering irrigant into the pulp chamber and placing the tip
into the canal and initiating the sonic energy of the Endo
Activator.
 Manual, Ultrasonic, and Rins endo groups had significantly
greater amount of extrusion compared with EndoVac and

89. NaOCL
NO irrigant
till date 100%
effective
Endodontic success
– elimination of
microorganisms &
SL
Choice of
irrigant
Future research on irrigants
needs to focus on finding a
single irrigant that has tissue
dissolving capacity, smear layer
removal property, and
antibacterial efficacy.

90. References
• Sushma Jaju & Prashant P Jaju Newer Root Canal Irrigants in Horizon: A
Review, International Journal of Dentistry, october 2011
• Soumya Abraham et al; Endodontic Irrigants: A Comprehensive Review
/J. Pharm. Sci. & Res. Vol. 7(1), 2015, 5-9
• Kandaswamy and Venkateshbabu: Root canal Irrigants ; Journal of
Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4
• Kaur R, Singh R, Sethi K, Garg S, Miglani S. Irrigating Solutions in
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