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