Irrigation in

RCT

Thilanka Umesh Sugathadasa(D/10/64)

1 RCT

Definition

Medicaments left in the canal to

exerts there effect over short period

of time.

Ideal Requirements

1. Should have broad spectrum

antimicrobial property.

2. Aid in the debridement of the

root canal system.

3. Low toxicity level., Low cost.

4. Ease of using.

5. Ease of storage. Availability

6. Ability to dissolve necrotic

tissue or debris.

7. Good lubricants.

8. Inactivate endotoxin.

9. Prevent or dissolve smear

layer.

Functions of the irrigants.

1. Remove dentinal shavings by

physical flushing.

2. Increase the efficiency of

instrumentation.

3. Dissolve necrotic tissues.

4. Remove debris from lateral &

accessary canals.

5. Bleaching action.

6. Opening of dentinal tubules by

removal of the smear layer.

7. Lubricating agents further

increase the efficiency.[good

wettability].

Factors that modify activity of

the intracanal irrigating

solutions.

Some modification factors such as

host resistance, bacterial virulence,

microbial susceptibility, is beyond

our control.

Factors which can be controlled

1. Concentration - Tissue

dissolving ability of the sodium

hypochlorite is greater at the

concentration of 5.2% other

than the 2.5%/0.5%. But

higher concentrations are more

cytotoxic.

2. Contact - The agent should

contact with the substrate

otherwise the action will not be

activated. So the canal should

be mechanically enlarged.

3. Surface tension of the irrigants

– Lower surface tension is

having better wettability.

4. Temperature(Irrigants) - with

temperature increase in a

range increase efficiency of

irrigants.

5. Presence of organic tissues – So

organic tissues should be

removed mechanically or

chemomechanically by

simultaneous use of irrigants &

2 RCT

the instruments. Otherwise

form a coagulated barrier.

6. Quantity of irrigants use –

Increase ability of debride.

7. Frequency of irrigation – more

irrigation cause better

debridement of tissues.

8. Canal diameter – Wider the

canal debridement become

effective.

9. Agitation

Main choices of irrigation

solutions

Sodium Hypochlorite (NaOCl)

Presence of 5% free chlorine In

sodium hypochlorite is responsible for

the breakdown of protein in to the

amino group. The pH of the commonly

used sodium Hypochlorite is 12, at

which the OCl- form exist. So due to it’s

high alkaline value necrotic tissues

dissolve.

Increase efficacy

Contact time.

Heat

Volume of NaOCl (syringe type)

Ultrasonic activation.

Precautions to be taken

5.25% NaOCl can cause serious

damages If inject periapically.

It causes excruciating pain.

Perapical bleeding & swelling

Tissue destruction

Analgesics, Antibiotics,

Antihistamines should prescribe

accordingly.

Advantages

1. Easily available

2. Economical

3. Tissue dissolution easily occurs.

4. Causes lubrication of canals.

5. It’s having antibacterial effect

6. Bleaching action present.

Disadvantages

1. It is having bad odor & the taste.

2. It’s corrosive to the instruments.

3. It can bleach the clothes if split

4. Vapors of the NaOCl can irritate

to the eye.

5. Because of it’s high surface

tension. Wettability of the

solution has decreased.

6. Irritant to the tissues if it

extruded periapically.

7. If comes contact it can lead to

inflammation.(if contacts with

3 RCT

the larynx causes difficulty of

speaking).

Decrease efficacy of NaOCl

Storage time

Chemical agents like EDTA.

Normal saline

Advantages

1. Biocompatible in nature.

2. No adverse reaction even if

extruded periapically (Because

osmotic pressure of the normal

saline is same as that of the

blood)

Disadvantages

1. No tissue dissolution &

disinfection properties.

2. Cannot very effectively clear

areas such as accessory

canals.

3. No bleaching action.

4. No antimicrobial property.

5. Do not remove the smear

layer.

Chlorhexidine

Most stable form is Chlorhexidine

gluconate. Potent antiseptic. 2% use as

a irrigant. Then 0.2% use as a mouth

wash. Here the cationic molecules

present in the chlorhexidine adsorb

with the negatively charged inner cell

membrane of the microbes & causes

leakage of intracellular components.

Additionally it causes the effect of

substantivity. Both 2% & 0.2%

chlorhexidine can cause residual

antimicrobial activity for 72 hours.

Advantages

1. Use as a plaque controller in

lower conc & higher conc as

irrigant.

2. More effective on gram +ve

bacteria than gram –ve

bacteria.

4 RCT

Disadvantages

1. It’s not considered as a main

irrigant in standard

endodontic therapy.

2. Unable to dissolve the

necrotic tissue remnants.

3. Less effective on gram –ves.

Smear plugs can be seen in

dentinal tubules

Other Agents

H2O2

Urea Peroxide

Chelating Agents

After canal instrumented an organic

layer remains which covers the

dentinal tubules. Even though the

NaOCl is the ideal irrigation solution.

But it does not possess chelating

properties. So chelating agents are

EDTA

Citric Acid

Polyacrylic Acid

EDTA

Functions

Lubrication

Emulsification

Holding debris in suspension

Smear layer removal

MOA

It inhibit the growth of bacteria

& ultimately destroy them by

starvation. Because EDTA chelate

with the metallic ions in medium

which are needed for

microorganisms.

EDTA has self-limiting action. It

form stable bond with calcium &

dissolve dentin

5 RCT

Different forms of EDTA

R-EDTA : combine with

cetrimide. It helps better

cleaning of canals.

EDTAT : combine with the

taxapon. Here decreasing the

surface tension.

EDTA-C: Enhance the cleaning

efficacy.

Can be applied in liquid or paste

form, A viscous suspension of cheater

promote the emulsification of organic

debris & facilitate the negotiation of

canal.

Smear layer has removed (NaOCl & EDTA)

Ultrasonic irrigation

Better than the conventional method.

Advantages

1. Clean bitterly

2. Remove smear layer

efficiently

3. It dislodges the debris from

canal better due to acoustic

effect

Disadvantages

1. Unpredictable

2. Excessive cutting of canal wall

& may damage to the finished

preparation.

Method of Irrigation

The solution must be

introduced slowly & passively

in to the root canal.

Needle should not be wedge in

to the canal & should allow

adequate back flow.

Blunted needles 25/27 guage is

preferred.

In case of small canals, Deposit

the solution in pulp chamber &

then file carry solutions in to

the canals

Canal size & shape are crucial

for irrigation of the canals.For

effective cleaning of the apical

area, the canals must be

enlarge to size 30 or larger size.

Irrigants should not forcibly

inserted.

Tip of the needle should be

introduced until resistence if

felt. Then withdraw needle 2-3

6 RCT

mm away from that point &

irrigate passively.

Plastic syringe for irrigation (Guage-25/27-

Standard/30/31)

Irrigating systems

Strpko irrigator 27 guage needle with notched

tip Needle with bevel Pro rinse probe Ultrasonic hand piece

Vibringe irrigator which create vibrations

during irrigation

30o angle bent giving efficient

irrigation.

Ideal properties of the

Irrigation needle

Needle should be blunt

It should allow back flow.

It should be flexible.

Longer in length

Easily available

Cost-effective

Flexible Needles

7 RCT

Different type of needle designs.

Placing rubber stoppers to prevent the

extrusion of irrigant beyond apex.

Bending of the irrigation needle.

8 RCT

A B C

Giving greater control of irrigant

delivery.

A- Beveled needle- Irrigant forced

apically. There is a risk of become

extrusion if the needle become

lodge in the canal

B- Mono jet tip- Irrigants can pass

sideways.

C- Safe ended tip- Irrigant can pass

side ways

Ultrasonic Irrigation devise.

9 RCT