Root Canal Irrigation And

Medicaments

Root Canal Irrigants

. Irrigants perform important physical and
biological roles during endodontic therapy.
When there is wet environment during
canal preparation the dentin debrises are
floated to the chamber. Where they be
remove by paper points or others.
. Many liquids would provide these aids, but
in addition the irrigants that are typically
used have the function of being necrotic
tissue solvents.
2

. Because reamers and files much too small to

fit into accessory canals, it is the solvents
action that removes the tissue remaining
and also the subsequently filling material
may be packed or pushed into these areas.
. The commonly used irrigants are capable of
causing inflammation of periapical tissue.
Therefore instrumentation must be
confined within the canal to limit the
forcing of irrigants through the apical
foramen.
3

Requirements of Ideal Irrigants

1. It must have broadspectrum antimicrobial
effect.
2. It must aid in the root canal debridement.
3. Ability to dissolve necrotic tissue or debris.
4. Low toxicity level.
5. Act as a good lubricant.
6. Low surface tension to flow easily into the
inaccessible areas.
7. Remove the smear layer.

Factors Effecting The Irrigants action

1. Concentration.
2. Contact.
3. Presence of organic tissue.

4. Quantity.
5. Temperature.

Remember:
The smear layer is a micro crystalline layer
of cutting debris covering the canal walls
after the preparation and its removal may
aid in better adaptation of the obturating
materials to the canal walls.
It consist of:
A. Organic layer ----- removed by irrigants.
B. Inorganic layer --- removed by chealating
agent.
7

Types of Irrigants
1. Sodium hypochloride (NaOCL)(PH 12 13).
. The most popular irrigant.
. It provides:
a. Gross debridement.
b. Dissolution of tissue.
c. Lubricant.
d. Antibacterial.
8

. Warming NaOCL increases its tissue solvent

effect.
. It is provided in bottles of 5.2%.
. It, is clear, pale, green yellow liquid, with
strong odor of chlorine.
. Solution should always be performed
passively especially in cases with larger
apical diameters, and needles with very
small diameter, also the syringes should
never be locked in the canal.
9

2. Hydrogen Peroxide (H2O2) 3%

. It is odorless, clear liquid.
. Its effervescence action capable for removing
loose debris from inside the canal.
. Release of nascent oxygen (O3) works
against anaerobic bacteria.
10

. Combining 5.25% NaOCL + 3% H2O2 proved

to be better than saline alone at 1 3mm
level of the canal.
. If Hydrogen Peroxide is used, final irrigant
should be NaOCL because, it may cause
either:
1. Tissue emphysema if it passes to the
periapical tissue.
2. Post Operative Pain.
11

3. Chlorhexidine Gluconate (0.2% - 2%)

. It has antibacterial effect (long standing effect
by binding to hydroxyapatite and in
combination with Ca(OH)2 effective against
anaerobes).
. Does not have tissue solvent action.
. Low toxicity compared to NaOCL.
12

4. Organic acid as citric acid 10 25% in

combination with NaOCL removes smear
layer.
5. MTAD
M ----- Mixture of
T ----- Tetracycline
A ----- Acid (citric acid)
D ----- Detergent
Recommendation: 1.3 2.5% NaOCL is the
irrigant of choice during the preparation.

13

Method of Irrigation
. Plastic syringe of acceptable needle gauge.
30 = 30 File Iso.
27 = 40 File Iso.
25 = 50 File Iso.
23 = 60 File Iso.
21 = 80 File Iso.
14

. Bending the needle and it must lie passively

in the canal as forceful irrigation can push
the irrigant into the periapical tissue.

. Volume of irrigation about 2ml each time.

15

The Ultrasonic Irrigation: Considered the

most effective method of irrigation where
vibration motion of files inside the canal:
1. Move irrigant in Vortex motion cleaning
the area which cannot be reached by files.
2. The motion causes worming of the irrigant,
increasing its action.

16

Combination of Irrigants
1. H2O2 NaOCL ---- Foaming action.
2. EDTA + NaOCL ---- Removes Smear
Layer.
3. EDTA + Urea Peroxide + NaOCL increase
bubbling action, debridement and removal
of smear layer.
4. MTAD + NaOCL: For disinfection and
smear layer removal.
17

Intra Canal Medicaments

. They are medicaments used in root canal
between appointments.
I. The popular intra canal medicaments were
designed and proposed for the following:
1. Anti microbial activity in the pulp and
periapex.
2. Neutralization of canal remnant to render
them inert.
3. Control or prevention of post treatment
pain.

18

II. The use of traditional medicaments is

decreased, because:
a. Intra canal bacterial population can be
eliminated by careful instrumentation
and irrigation.
b. Lack of evidence of medicament usefulness.
c. Toxicity.
19

III. Limitation and Contraindications.

1. Intracanal environment:
. The therapeutic action of the medicaments
depends on the direct contact with the
microbe or tissue.

. Their effect is probably limited to surface

action only and does not reach the area,
where the bacteria are hidden.
20

2. Duration:
. Most agents should remain chemically active
for the period of time between appointments,
in order to be effective.
. Phenolics loose their activity within 24 hrs.

21

3. Toxicity:
a. Any chemical that kills bacteria, will also
kill host cells (Phenol, aldehyde).
b. An adverse side effect is also: Allergenicity.
As the medicaments may act as a hapten
and alter the tissue to become foreign
substances, producing an immune
response. May be responsible for their
localized adverse effect on the pulp and /
or periapical tissue.

22

4. Distribution:
. The pulp is not isolated from the rest of the
body, as the pulp has a ready accessibility
to the periapical tissue and even to the
systemic circulation.

23

5. Taste and Smell:

Phenolics in particular have a pungent odour
and foul taste. The patient will report a
disagreeable medicinal taste, which many
find objectionable.

24

Recently Used Intra Canal

Medicaments
1. Calcium hydroxide:
a. The most popular intra canal medicament.
b. It gas antimicrobial action (due to its
alkaline PH).
c. Increase organic tissue solvent of NaOCL.
d. Alkaline neutralizes the acidity of
inflammation.

25

Application of Calcium Hydroxide

Antimicrobial Action (germs coming in contact with the
paste are easily destroyed by the high pH)
Bone-regenerating effects (stimulates the osteoblastic
activity and hard tissue deposition ). Used in case of root
resorption and inmature teeth.
Aid the dissolution of organic material remaining in the
root canal after preparation.
Very good biocompatibility.

Placement of Medicaments
Syringe Delivery

Spiral Fillers
Hand File
Thin aqueous suspension of Ca(OH)2 used as dressing 27

Available as:
1. Powder.
2. Paste.
3. Active Point.
4. Injectable.
28

2. Antibiotics:
It was tried as intra canal medication, but fear
of developing bacterial resistance which
leads, to decrease its use.
3. Steroids:
It was tried due to its anti inflammatory
effect, to avoid post operative pain.

29

4. Combination (steroids and antibiotics).

a. Steroids ------ An inflammatory effect.
b. Antibiotics ------ Controlling infection.
Used mainly in case of acute pulpitis with
apical periodontitis.

30

Iodine Potassium Iodide

Is it an iodoform/calcium hydroxide paste that
has been shown to reduce the presence of all
bacteria but especially Enterococcus
Faecalisi, a hardy bacterium commonly
associated with failing root treatments.
. May be useful as an irrigant and intracanal
dressing in retreatment cases.

31