Irrigation of RCT

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.):
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
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.

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IRRIGATION OF THE

BA-118102 MAJOR MD.RAFIUR RAHMAN,ADC

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