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8/9/2019 IRRIGATION 2 BDS 3.ppt

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Irrigation in Endodontic

10/9/200610/9/2006


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IntroductionIntroduction

Micro-organisms either remaining in rootcanal space after treatment orrecolonizing the root filled canal sytem arethe main cause of endodontic failure

rimary endodontic goal-to optimize rootcanal disinfection and pre!entrecolonization


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The use of irrigating solutions is an important part of effective chemomechanical preparation.

Antibacterial agent.

Tissue solvent.

Flush debris.

Lubricant.

Eliminate the smear layer.

Various Irrigation Solution in Endodontic


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Ideal root canal irrigantsIdeal root canal irrigants


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NaOCl


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NaOCl NaOCl Antibacterial agent

Dissolves vital and non-vital(necrotic) tissue.

Lubricant during instrumentation

as uni!ue capacity to dissolve organic components ofsmear layer

"a#$l has been critici%ed for&npleasant taste'elative to icity

nability to remove smear layer


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Bactericidal of NaOCl NaOCl

#$l e erts its effects by o idi%ing sulphydrylgroups *ithin bacterial en%yme systems+thereby disrupting the metabolism of themicroorganism + resulting in the ,illing of the

bacterial cells .


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Concentration

$ompared the biological effects of mild and strong "a#$l solutions and demonstrated greater cytoto icityand caustic effects on healthy tissue *ith . / "a#$lthan *ith 0. / and 1/ solutions.

Either . / or . / sodium hypochlorite has thesame effect *hen used in the root canal space for a

period of minutes.Trepagnier et al. (1977)

Pashley et al. (1985)


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"arming 2#$% naocl to &' degrees-"arming 2#$% naocl to &' degrees-

leads to same effect as $#2$%leads to same effect as $#2$%

(lass )armer *yringe )armer


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Commented that The effectiveness of lowconcentrations of NaOCl may be improved by usinglarger volumes of irrigant or by the presence of

replenished irrigant in the canals for longer periodsof time.

Concentration of NaOCl

Baumgartner & Cuenin (1992)


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Is NaOCl NaOCl equally effective in dissolving vital,non-vital, or fixed tissue ???

Demonstrated that . / sodium hypochloritedissolves vital tissue. ( Rosenfeld et al. 1978 )

As a necrotic tissue solvent+ . / sodiumhypochlorite *as found to be significantly better than

.2/+ 1/+ or 0. /. (Hand et al.1978)

3/ sodium hypochlorite *as found to be optimal fordissolving tissue fi ed *ith parachlorophenol orformaldehyde (Th SD.1979)


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NaOCl & Ca(OH)2

4retreatment of tissue *ith calcium hydro ide canenhance the tissue-dissolving effect of sodiumhypochlorite.

Hasselgren et al.(1988)

$ombination of calcium hydro ide and sodium

hypochlorite *as more effective on the dissolution ofsoft tissue on the root canal *all than using eithermedicament alone.

Wadachi et al.(1998)


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NaOCl & EDTA

$ombining .0/ sodium hypochlorite *ith EDTAenhance considerably the bactericidal effect.

Bystr!m & "un#$%ist (1985


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NaOCl & CHX

The alternate use of sodium hypochlorite andchlorhe idine gluconate irrigants resulted in a greater

reduction of microbial flora (56.2/) *hen compared*ith the individual use of sodium hypochlorite( 7.6/) or chlorhe idine gluconate (80/) alone.

uru%illa an# amath (1998)


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NaOCl & CHX

The time re!uired to eliminate E. faecalis depended onthe concentration and type of irrigant used.

$hlorhe idine in the li!uid form at all concentrations

tested (0. /+ 1/ and /) and "a#$l ( . /) *ere themost effective irrigants. o*ever+ the time re!uired by0. / chlorhe idine li!uid and / chlorhe idine gel to

promote negative cultures *as only 30 s and 1 min+respectively.

Gomes et al.( !!1)


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Temperature

igher temperatures potentiate the antimicrobial andtissue-dissolving effects of "a#$l.

ncreasing the temperature of hypochlorite irrigant to38 0 $+ significantly increased its tissue dissolvingability

Cunningham &Bale' ian (198 )


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Chlorhexidine (CHX)


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Chlorhexidine C!"#

t possesses a broad-spectrum antimicrobial action anda relative absence of to icity.

$ 9 lac,s the tissue-dissolving ability.

t penetrates the cell *all and attac,s the bacterialcytoplasmic or inner membrane or the yeast plasmamembrane.

$oncentrations bet*een 0. / and /.ts activity is p dependent and is greatly reduced in

the presence of organic matter.


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In Vitro-the anti$acterial effect of C!"

In vitro , $ 9 is superior to "a#$l in ,illing of E. faecalis and Staphylococcus aureus .

Gomes et al. ( !!1)"ncag et al. ( !!#)

$ianna et al. ( !!%)

$ 9 effectively ,illed C. albicans

&ar' oll * +ttramadal + (1989) Hiom e al. (199 )

Hamers et al. (199,) Waltimo et al. (1999)


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A potential *ea,ness of $ 9 in the root canal may beits susceptibility to the presence of organic matter.

(R-ssell +D * Da /0 199#)

n an in vitro study+ the effect of $ 9 is sho*ed to bereduced+ although not prevented+ by the presence ofdentine. Haapasalo et al. ( !!!)

$ 9 *as strongly inhibited by dentine matri (theorganic component of dentine).

ortenier et al. ( !! )

C*+


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H 2 O

2


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! % O % t is a clear+ colorless li!uid.

&sed in a variety of concentrations+ 1/ - 30/.

H 2 O 2 is active against viruses+ bacteria+ and yeasts.

t produces hydro yl free radicals (:# )+ *hich attac,several cell components such as proteins and D"A.

n endodontics+ H 2 O 2 has long been used because of its

antimicrobial and cleansing properties.t has been particularly popular in cleaning the pulp

chamber from blood and tissue remnants+ but it hasalso been used in canal irrigation.


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In Vivo-the anti$acterial effect of ! % O %

;acteria counts *ere greatly reduced *hen 10/ H 2 O 2 *as used as part of the irrigating protocol.+ but the

protocol used could not predictably produce sterile root

canals in mon,ey teeth. ,!ller et al. (2 -)


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! % O %

Although H 2 O 2 has long been used in disinfection andcanal irrigation in endodontics+ the available literature

does not support its use over that of other irrigatingsolutions.


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&'()


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MTAD

A mi ture of t etracycline isomer+ acid+ and d etergent. (do ycycline+ citric acid+ and the detergent T*een-50)

t has antibacterial activity.t has lo* p .1


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MTAD

The tissue-solubili%ing action of


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MTAD & NaOCl The effect of various concentrations of "a#$l as an

irrigant before irrigation *ith


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'he anti$acterial effect of MTAD

n vitro study+ the antibacterial effects of


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BDA


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BDA Bis-dequalinium acetate (;DA)

Lo* to icity Lubrication action Disinfecting ability

Lo* surface tension $helating properties. Lo* incidence of post-treatment pain.

;is-de!ualinium acetate is recommended as an e cellentsubstitute for sodium hypochlorite in those patients *hoare allergic to the latter.

aufman 1981


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S*ear +ayer e*oval +emo!al of the smear layer is an important

step to facilitate disinfection of the root canal "rganic +cid 2rrigants3

$itric acid (1/ - 0/ ). 4olyacrylic acid (e.g. Durelon and Fu>u li!uids).

Solutions

$arbamide pero ide.

Amino!uinaldinium diacetate (i.e.+ ?alvi%ol).

Chelating Agents

EDTA


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S*ear +ayer e*oval


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'emoval of the smear layer by EDTA (or citric acid)improves the antibacterial effect of locally useddisinfecting agents in deeper layers of dentine.

rsta%i' & *aa asalo (199 )


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Chelating (gents Chelating (gents


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Chelating (gents

EDTA ( ethylene- diamine tetra- aceticacid) EDTA$ ( ethylene- diamine tetra- aceticacid @centrimide) File-E%e

'$ 4rep


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EDTA


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EDTA

EDTA (18/+ disodium salt+ p 8)

EDTA has little if any antibacterial activity.

t effectively removes smear layer by chelating theinorganic component of the dentine.

Aid in mechanical canal shaping.


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EDTA

The ultrastructure on canal *alls after EDTA andcombined EDTA @ "a#$l irrigation *as evaluated byscanning electron microscopy.


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The optimal *or,ing time of EDTA is 1 minutes+after *hich time no more chelating action can bee pected.

EDTA solutions should replaces in the canal each 1minutes.

3ol#/erg an# " iel/erg (1982)


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RC-Prep


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RC-Prep

'$-4rep is composed of EDTA and urea pero ide in a base of $arbo*a .

t is not *ater soluble.

"a#$l @ '$-4rep

nteraction of the urea pero ide in '$-4rep *ith sodium

hypochlorite+ producing a bubbling action thought toloosen and help float out dentinal debris.

Summary of various irrigation techniques


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Summary of various irrigation techniques


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,ndo!ac irrigation,ndo!ac irrigation


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etailed picture of endo!ac needleetailed picture of endo!ac needle


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ltrasonic Irrigation ltrasonic Irrigation


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Irrigation )ithout dripIrrigation )ithout drip


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ltrasonic Irrigation ltrasonic Irrigation The enhancement of the flushing action of an irrigantsolution by using ultrasound is *ell documented.

(4-nningham * /artin 198 5 4-nningham et al. 198 5Stoc' 19915 6-mle et al. 199#5 6ee et al.

!!%)The ultrasound device allo* the endodontic irrigant to

pass along the ultrasonic files. The irrigant is activated by the ultrasonic energy imparted from the energi%edinstruments producing acoustic streaming and eddies.

(+hmad et al. 19875 rell * 0ohnson 19885 Stoc'1991)


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Ultrasonic IrrigationUltrasonic Irrigation

Mechanical . chemical# * can reach difficult anatomy irrigant

!i ration and cleaning of the canal space#

* creates oth ca!itation and acousticstreaming#

nti acterial effects 3shear stress4#

5here is a synergistic effect et)eensodium hypochlorite 3 a78l4 and *#3 a78l lo!es heat4

BUC


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BUC


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Acoustic streaming around a file in free water (left) and a schematicdrawing (right).


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ltrasonic !i ration can also e effecti!e)hen touching the shan of a hand file

inserted inside the canal# 5he hand file )illtransmit !i rations to the irrigant inside thecanal ut a greater ris for touching

dentinal )alls e:ists# 5he use of a smooth )ire during ultrasonicirrigation in !itro )as as effecti!e as a ;-

file in de ris remo!al and )ith , 5 itenhances the cleanliness of the canal#


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Re resentative S!" hotomicrogra hs.(#mm from the a e$) S ecimens with ( + )smear score % and de&ris score %' ( &) smear score and de&ris score ' and ( 4 )smear score # and de&ris score #

* !+,A- ultrasonic Ultrasonic followed &ya/Cl 0*

0* a/Cl for min.followed &y 0* a/Cl


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Irrigation &y ! +/AC,I1A,/RIrrigation &y ! +/AC,I1A,/R


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'y.es of endodntic needles

;eveled needleect endodontic needle. 4ro'inse probes.


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ect endodontic needles to be the most efficientdelivery system in *hich longer needles of a blunted+open-end system *ere inserted to the full length ofthe canal.

The point is that a larger volume of solution can bedelivered by this method. o*ever+ the closer theneedle tip is placed to the ape + the greater the

potential for damage to the periradicular tissues.

,oser an# *euer (1982)


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n order to be effective+ the needle delivering thesolution must come in close pro imity to the materialto be removed.

?mall diameter needles *ere found to be moreeffective in reaching ade!uate depth but *ere more

prone to problems of possible brea,age and difficultyin e pressing the irrigant from the narro* needles.

+ o- Rass / (198 )


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Met o! o" #$e


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&ethod of se

t is strongly recommended that the needle lie passively in the canal and not engage the *alls.

The solution must be introduced slo*ly.

The irrigating needle should be bent to allo* easierdelivery of the solution and to prevent deep

penetration of the needle.

$are must be ta,en *ith irrigants li,e sodiumhypochlorite to prevent accidents.


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irrigation 2 bds 3.ppt

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