IRRIGATION OF THE
ROOT CANAL
SYSTEM
BA-118102 MAJOR MD.RAFIUR RAHMAN,ADC
GRADING TRAINEE IN CONSERVATIVE
DENTISTRY & ENDODNTICS
MILITARY DENTAL CENTER,
DHAKA CANTONMENT
Successful endodontic treatment depends
on combination of proper instrumentation,
irrigation and three dimensional obturation
of the root canal system. One of the most
neglected phases of endodontic treatment
is the removal of minute fragments of
organic debris and dentinal shavings from
the root canal. It is truly said that
Instruments shape, irrigants clean.
Thorough debridement and cleaning are as
necessary in endodontic treatment as in
surgery.
OBJECTIVE:
To apprise you briefly about purposes and different types of
irrigants used in endodontics.
SCOPES:
Purposes of Irrigation
Properties of an ideal irrigants
Method of irrigation
Commonly used irrigants in
endodontics
Newer irrigating solutions
Open forum
PURPOSES OF
IRRIGATION:
Reduction of intraradicular micro-organism
Neutralization of endotoxins
Dissolution & removal of vital or necrotic pulp tissue
Lubrications of canal walls & instruments
Removal of dentin particles
Removal of smear layer
Prevention of packing infected hard & soft tissues apically
into the root canal & periapical area
Removing the debris from fins, isthmuses, anastomoses
and lateral canals where instrumentation can’t reach
PROPERTIES OF AN IDEAL
IRRIGANTS:
A broad antimicrobial action
Organic & Inorganic tissue solvent
Nontoxic
Lubricating action
Low surface tension
Biocompatibility
Have adequate shelf life
METHODS OF
IRRIGATION:
Slow and passive introduction of a 27 or 30-gauge
needle with blunt tip and a 30-degree bend into the
canal.
Needle should not be wedged & should allow
backflow.
In large canals, the tip of the needle should be
introduced until resistance is felt, then withdraw the
needle 2-3mm away from the point and irrigate the
canal passively.
In small canals, solutions should be deposited into the
pulp chamber. Then file will carry the solution into the
canal.
METHODS OF
IRRIGATION(CONTD.):
Irrigants must never be forcibly inserted into the apical tissues.
Various delivery needles for irrigation are as follows:
CLASSIFICATION OF IRRIGANTS:
Normal saline:
Sodium hypochlorite:
Most widely used irrigation solution
Clear, pale, green yellow liquid with strong
odour of chlorine
Concentration varying from 0.5-7%
Introduced by chemist Henry Drysdale Dakin
during world war I
Introduced in endodontics by Coolidge in
1919
Unbuffered at pH 11 at conc. 0.5-5%
Buffered with bicarbonate at pH 9 as 0.5% or
1% solution
Sodium hypochlorite(contd.):
Sodium hypochlorite(contd.):
Hazards of Sodium hypochlorite:
Emphysema may develop
within 10-20 minutes
Oedema & paraesthesia due
to its tissue dissolving
capacity
Ecchymosis may develop
which is associated with
severe pain, profuse
interstitial bleeding &
haemorrhage under the skin
Sodium hypochlorite(contd.):
Hydrogen peroxide:
Clear, odourless liquid
a concentration between 3-5% is preferred
Hydrogen peroxide(contd.):
It can be used alone or alternatively
with NaOCl.
Active against bacteria, yeast, viruses
& even in bacterial spores.
More effective against gram-positive
then gram-negative bacteria.
Catalase or superoxide dismutase
produced by several bacteria can
provide them partial protection against
H2O2.
Chlorhexidine:
Concentration of
0.2-2% are
considered as
toxicologically safe.
Chlorhexidine Di
gluconate(CHX) is
used in 2%
concentration as
irrigating solution.
Chlorhexidine(Contd.):
Advantages:-
Wide anti microbial spectrum
Prolong antimicrobial activity
As a final flush in retreatment cases
Limitations:
May cause anaphylactic reaction
Antimicrobial effect is strongly reduced
by the presence of dentin, inflammatory
exudates, serum albumin, heat-killed
cells of Enterococcus faecalis &
Candida albicans
edta:
17% EDTA(disodium
salt, pH 7) is used as
irrigation solution.
Lubricating,
chelating,
decalcifying agent.
Little antimicrobial
effect.
Edta(c0ntd.):
Liquid type:-
REDTA
EDTAT
EDTAC
Largal Ultra
Paste type:-
Calcinase slide
RC prep
Glyde file
File-Eze
Newer irrigating solutions:
Electrochemically activated
solution:-
Nontoxic to biological tissues
Less or no allergic reaction
Effective with wide range of
microbial spectra
Ruddle’s solution:
Uses:-
Visualization of missed canal,
perforation.
Diagnosis of internal
resorption, its size & site.
Visualization of blockage,
perforation, ledge.
Helps in management of
iatrogenic errors.
Mtad:
Introduced by Torabinejad in
2000 as a final rinse for
disinfection of root canal
system.
Able to safely remove the
smear layer.
Effective against
Enterococcus faecalis.
Biocompatible
Prolong antibacterial effect
Q-mix:
Colourless & odourless solution which
consists of 17% EDTA & 2% chlorhexidine .
To be used as a final rinse, continuous
irrigation for 60-90s.
Functions:-
Kills 99.99% planktonic bacteria.
Penetrates biofilm.
Advantages:
Less demineralization of dentin as
compared to EDTA.
Does not cause erosion of dentin like
NaOCl
Conclusion:
The use of irrigating solution is an important part of endodontic
treatment. Through the years, different irrigating solutions have
been recommended. An optimal irrigant should have all or most
of the positive requirements, but none of the negative
requirements. However, none of the currently available irrigating
solutions has all the properties needed. A combined use of
separate irrigants is the clinical protocol recommended to
ensure successful outcome of endodontic treatment.
