Endodontic Irrigants

Irrigation has been performed in conjunction with endodontic

therapy for many years. One of the primary reasons for irrigating
the root canal system is to ensure cleaning of the canals prior
to obturation. This cleanling involves both:
elimination of microorganisms and removal of organic
matter

Desiared functions of irrigating
solutions

_ Washing action (helps remove debris)
_ Reduce instrument friction during preparation (lubricant)
_ Facilitate dentin removal (lubricant)
_ Dissolve inorganic tissue (dentin)
_ Penetrate to canal periphery
_ Dissolve organic matter (dentin collagen, pulp tissue, biofilm)
_ Kill bacteria and yeasts (also in biofilm)
_ Do not irritate or damage vital periapical tissue, no caustic or
cytotoxic effeActs
Do not weaken tooth structure


Benefits of irrigation during endodontic
work
Making a wet environment during preparation ..the dentin shaving
floating to the chamber
Files and reamers are less likely to break when the canal is wet
The irrigant that are typically used have the function of necrotic
tissue solvent
The irrigants loosen depris, pulp tissue , and M,O from irregular
dentin walls
Most irrigants are germicidal
Also have ableaching action to lightens teeth discolored by trauma
post operative darkness

Useful irrigants

Sodium hypochlorite(naocl)
Most widely used.
the pH of sodium hypochlorite is near 12.
During the treatment of a root canal,
the increase in pH likely creates
a microenvironment that is not
particularly hospitable to bacteria in the
root canal system.
. It is potently antimicrobial and dissolves organic material.
It also affects -- but doesn't remove -- the smear layer. Removal
of the smear layer enhances obturation and decreases apical
leakage.
NaOCl may also cause pain and injure periapical tissues when it
extrudes through the apex.

EDTA and CA

Complete cleaning of the root-canal system
requires the use of irrigants that dissolve
organic and inorganic material.
As hypochlorite is active only against the
former, other substances must be used to
complete the removal of the smear layer
and dentin debris.
EDTA and CA effectively dissolve
inorganic material, including hydroxyapatite.
. EDTA is most commonly used as
a 17% neutralized solution (disodium EDTA, pH 7), but a few
reports have indicated that solutions with lower concentrations (eg,
10%, 5%, and even 1%) remove the smear layer equally well after
NaOCl irrigation
Cross section of root dentin covered by the smear layer created by
instrumentation.
Notice smear plugs in dentin canals


Chlorhexidine Digluconate

Chlorhexidine digluconate (CHX) is widely used in disinfection in
dentistry because of its good antimicrobial activity. It has
aconsiderable popularity in endodontics as an irrigating solution
and as an intracanal medicament. CHX does not possess some of
the undesired characteristics of sodium hypochlorite (ie, bad
smell and strong irritation to periapical tissues). However, CHX
has no tissue-dissolving capability and therefore it cannot
replace sodium hypochlorite
. One of the reasons for the popularity of CHX is its substantivity (ie,
continued antimicrobial effect), because CHX binds to hard tissue
and remains antimicrobial.

Other Irrigating Solutions

Other irrigating solutions used in endodontics have included
sterile water,
physiologic saline,
hydrogen peroxide,
urea peroxide,
and iodine compounds.
All of these except iodine compounds lack antibacterial activity
when used alone, and they do not dissolve tissue either. Therefore there
is no good reason for their use in canal irrigation in routine cases. In
addition, water and saline solutions bear the risk of contamination if
used from containers that have been opened more than once.
Iodine potassium iodide (eg, 2% and 4%, respectively) has
considerable antimicrobial activity but no tissue dissolving capability and
it could be used at the end of the chemomechanical preparation like
CHX.
Interactions Between Irrigating Solutions

Hypochlorite and EDTA are the 2 most commonly
used irrigating solutions. As they have different
characteristics and tasks, it has been tempting to use
them as a mixture.
However, EDTA (and CA) instantaneously reduces the
amount of chlorine when mixed with sodium
hypochlorite, resulting in the loss of NaOCl activity.
Thus, these solutions should not be mixed.

CHX & Naocl
CHX has no tissue-dissolving activity and there have
been efforts to combine CHX with hypochlorite for added
benefits from the 2 solutions. However, CHX and NaOCl
are not soluble in each other; a brownish-orange precipitate
is formed when they are mixed .



CHX and EDTA
Mixing CHX and EDTA immediately produces a white
precipitate * it seems that the ability of EDTA to
remove the smear layer is reduced.


IRRIGATION DEVICES AND TECHNIQUES

Conventional
Syringes
Needles
EndoActivator
It is based on sonic vibration (up to 10,000
cpm) of a plastic tip in the root canal
EndoVac
, the EndoVac system is 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
Syringes

Plastic syringes of different sizes (120 mL) are most commonly used
for irrigation.Although large-volume syringes potentially allow some
time-savings, they are more difficult to control for pressure and
accidents may happen. Therefore, to maximize safety and control, use
of 1- to 5-mL syringes is recommended instead of the larger ones.



**Because of the chemical reactions between many irrigants,
separate syringes should be used for each solution

Needles
Although 25-gauge needles were commonplace for endodontic
irrigation, they were first replaced by 27-G needles, now 30-G
and even 31-G needles are taking over for routine use in
irrigation.

Flexi-Glide Utility Tips

Vista Dental's Flexi-Glide Utility Tips are disposable tips
that are ideal for irrigation, application, and micro-
aspiration. Constructed of polyimide tubing, Flexi-Glide's
flexible, crimp-resistant tip facilitates access and provides
maximum reach during canal procedures.


EndoActivator

is a new type of irrigation facilitator. It is based on sonic vibration (up
to 10,000 cpm) of a plastic tip in the root canal.
The system has 3 different sizes of tips that are easily attached
(snap-on) to the handpiece that creates the sonic vibrations
the use of EndoActivator
facilitates irrigant penetration and mechanical cleansing compared with
needle irrigation, with no increase in the risk of irrigant extrusion
through the apex.


MULTIPLE BENEFITS

SAFE
Strong, flexible medical grade polymer tips
Single patient use
Uncoated & non cutting tips
EFFECTIVE
Create fluid hydrodynamics
Improves debridement and the disruption of the smear layer
and biofilm
SIMPLE
Very simple clinical technique
Intuitive device
Ideal in practice when portability is required

EndoVac

the EndoVac system is 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

advantages
1-the EndoVac system lowers the risks associated with irrigation
close to the apical foramen considerably.
2-Another advantage of the reversed flow of irrigants may be good
apical cleaning at the 1-mm level and a strong antibacterial effect
when hypochlorite is used

THANK YOU