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Endodontic irrigants pres
This document discusses endodontic irrigants and irrigation techniques. It describes the desired functions of irrigating solutions such as washing away debris, lubricating instruments, dissolving tissues, and killing bacteria. Sodium hypochlorite is the most commonly used irrigant due to its ability to dissolve organic material and kill bacteria, though it does not remove the smear layer. EDTA is often used along with sodium hypochlorite to remove the smear layer. Chlorhexidine has antimicrobial properties but does not dissolve tissues. Various irrigation devices and techniques are also discussed such as syringes, needles, sonic activation with EndoActivator, and negative pressure irrigation with EndoVac. Interactions
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Introduction to endodontic irrigants used for cleaning root canal systems during therapy.
Irrigation functions include washing action, reducing friction, dissolving tissue, and killing bacteria.
Irrigation creates a wet environment aiding canal preparation, improves file performance, and has germicidal properties.
Sodium hypochlorite is widely used for its antimicrobial properties and ability to dissolve organic material.
EDTA and CA are used alongside hypochlorite for complete cleaning of the root canal, specifically for inorganic material.
A cross-section showing smear layer created by instrumentation, which can impede canal cleaning.
Chlorhexidine is popular for its antimicrobial properties but lacks tissue-dissolving capabilities unlike sodium hypochlorite.
Mixing of different irrigants like hypochlorite with EDTA or CHX can deactivate their effects or create precipitates.
Various irrigation tools including syringes and needles, with the recommendation to use separate syringes for different solutions.
Flexi-Glide tips are specialized tools for irrigation, designed for flexibility and maximum reach in canal procedures.
The EndoActivator enhances irrigant penetration and cleaning through sonic vibrations without increasing risk of extrusion.
EndoVac employs a negative-pressure approach for effective irrigation and cleaning, reducing risks associated with apical foramen.
Thank you note concluding the presentation.
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Endodontic irrigants pres
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- 2. • Irrigation hasbeen 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
- 3. Desiared functions ofirrigating 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
- 4. Benefits of irrigationduring 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
- 5. 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.
- 6. 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
- 7. Cross section ofroot dentin covered by the smear layer created by instrumentation. Notice smear plugs in dentin canals
- 8. Chlorhexidine Digluconate • Chlorhexidinedigluconate (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
- 9. • . Oneof 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.
- 10. Interactions Between IrrigatingSolutions • 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.
- 11. 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 .
- 12. 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.
- 13. IRRIGATION DEVICES ANDTECHNIQUES • Syringes Conventional • Needles • It is based on sonic vibration (up to 10,000 EndoActivator cpm) of a plastic tip in the root canal • , 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 EndoVac back up again through a thin needle with a special design
- 14. Syringes Plastic syringes ofdifferent sizes (1–20 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.
- 15. • **Because ofthe 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.
- 16. 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. •
- 17. EndoActivator • is anew 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. •
- 18. 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
- 19. EndoVac the EndoVac systemis 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
- 20. advantages • 1-the EndoVacsystem 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
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