This document discusses irrigation and disinfection of the root canal system. It covers the objectives of irrigation including flushing out debris, lubricating canals, dissolving tissues, and preventing/removing smear layers. Five factors that influence irrigation are discussed: time, frequency, type of irrigant, agitation, and volume. Common irrigants like sodium hypochlorite, chlorhexidine, and EDTA are described in detail along with their properties, concentrations, and interactions. Various irrigation delivery systems and agitation devices are also presented, including manual agitation, sonic/ultrasonic, negative pressure techniques, lasers and more.

1. www.arefai.edublogs.org
AshrafRefaiSamir BDS MSc DD HMD
Associate Professor of
Endodontics
Al-Azhar University
ashraf_refai@hotmail.com
endoash
www.arefai.edublogs.org
www.idclinics.com
+201001434323
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2. Associate Professor of Endodontics Al-Azhar University)
Disinfection & Irrigation of the
Root Canal System
Dr. Ashraf Refai (BDS MSC DD HMD)

3. Why isn’t Mechanical
Shaping Enough to
do the job?

4. The Nature of the Endodontic Problem?
Mechanical VS Bacteriological

5. The Nature of the Endodontic Problem?
Geometric VS Anatomical

6. Root Canal
Complexities

7. 2010

8. www.rootcanalanatomy.blogspot.com
Micro CT Evaluation Pre & Post Instrumentation

9. www.rootcanalanatomy.blogspot.com
Micro CT Evaluation Pre & Post Instrumentation

10. So we need to
irrigate and disinfect
the canals…

11. Objectives of Irrigation
Biological
Chemical
Mechanical

12. ✤ Flush out debris
✤ Lubricate the canals
✤ Dissolve organic & inorganic tissue
✤ Prevent the formation of smear or remove it once
formed
Mechanical & Chemical Objectives
of Irrigation

13. Biologic Objectives of Irrigation
✤ Antibacterial against anaerobic and facultative
bacterial
✤ Neutralize endotoxins

14. Irrigation is a Factor of 5Things
5 Factors
Time
Frequency
Type
Agitation
Volume

15. Hydrodynamics of Irrigation
✤ Penetration of the needle
✤ Diameter of the root canal
✤ Inner and Outer diameter of the needle
✤ Irrigation Pressure
✤ Type and orientation of the bevel

16. Irrigation Needles
✤ Needle Sizes
✤ 23 gauge (.64 mm)
✤ 27 gauge (.42 mm)
✤ 30 gauge (.32 mm)
✤ Needle Type
✤ Side vented
✤ Double side vented
✤ Half tube
✤ Multi vented

21. Type of Irritants (Main Stream)
✤ Sodium Hypochlorite (NaOCL)
✤ Chlorohexidine (CHX)
✤ Ethylenediamine Tetra-Acetic Acid (EDTA)
✤ 1-hydroxyethylidene-1, 1-bisphosphonate (HBPT)
✤ MTAD & Tetraclean
✤ QMIX
✤ Iodine Potassium Iodide

22. Ideal Properties
of an Irrigant
✤ Effective Germicide & Fungicide
✤ Non-irritant
✤ Remain stable in solution
✤ Prolonged antibacterial action
✤ Be active in presence of blood and tissue
✤ Have low surface tension
✤ Not to interfere with healing of periapcal
tissues
✤ Should not interfere with obturating
materials
✤ Non staining
✤ Capable of inactivation in in a culture
medium
✤ Should not induce a cell mediated
response
✤ Should completely remove smear layer
and disinfect dentin
✤ Non-carcinogenic, non-antigenic and
non-toxic
✤ Should not negatively affect exposed
dentin
✤ Inexpensive
✤ Easy application

23. 2012

24. Sodium Hypochlorite
✤ First used as disinfectant for wounds in 1789
(Dakin’s Solution)
✤ Mode of action:
✤ Saponification: Organic and fat solvent
turns them into fatty acid salts
✤ Neutralisation: Amino acids are
neutralised into water and salts. (-OH
ions reduce pH)
✤ Hypochlorous acid formation:
Dissolution of Chlorine in water forms
this weak acid that breaks down amino
acids

25. Sodium Hypochlorite
✤ Mode of action:
✤ Solvent: Released chlorine
combines with amino acids
toe form Chloramine with
inhibits cell metabolism also
chlorine inhibits cell enzymes
✤ pH reaction: Sodium
hypochlorite is a strong base
pH > 11, interferes with cell
membrane integrity.

26. Sodium Hypochlorite
Concentration, Volume &
Temperature:
0.6% to 6%
Controversy Exists

27. Sodium Hypochlorite
Time
5% can take from 20 mins to 2
hours to dissolve pulp tissue
(Grossman 1941)
Controversy Exists

28. Sodium Hypochlorite
It is Toxic
Fear of
Hypochlorite
Accident
It Happens!

29. Chlorohexidine 2%
✤ Developed in the UK as antiseptic cream
✤ Chemical Structure
✤ pH 5.5 to 7
✤ Of the polybiguanide group
✤ Mode of action
✤ The molecule is cationic and binds to
negatively charged bacteria.
✤ It binds to the cell wall of bacteria
and renders it permeable.

30. Chlorohexidine 2%
✤ Substantivity:
✤ Because of its cationic nature it is
absorbed into to tooth structure and
remain active after the irrigation
session.
✤ Research ranges from 5 minutes to 1
week to initiate the substantivity effect.
✤ Less Toxic than NaOCL
✤ When combined with NaOCL forms
parachloroaniline (Brown precipitate)
which is very toxic.

31. Chlorohexidine 2%
✤ Some researchers have
claimed combining both
CaOH and CHX improves
substantivity and the
antibacterial effect of both
✤ It can be used and as
irrigant and as an
intracanal medicament

32. Chlorohexidine 2%
Combination Reactions
Brown Precipitate & White Precipitate
NaOCL
+
CHX
EDTA
+
CHX

33. EDTA 17%
✤ First developed in 1935 and was
introduced into endodontics in 1957
(Nygaard-Ostby)
✤ It is a polyaminocarboxylic acid
✤ Combines with metal ions like Ca
and Fe
✤ It is used to remove the mineralised
part of the smear layer
✤ Once all the available ions combine
with Ca the dissolution stops (Self
limiting)

34. EDTA 17%
✤ Uses in Endodontics:
✤ Used to remove smear layer in
combination with proteolytic
agent like NaOCL
✤ May also detach biofilm adhering
to dentin
✤ Has been suggested for use to
clean tortuous and narrow canals
✤ When combined with NaOCl it
negates the tissue solving
capacity.

35. Before
After

36. MTAD (Mixture ofTetracycline
Isomer, an Acid and a Detergent
✤ Based on the idea of
combination of surfactant
with irrigants to improve
wetting of surface
✤ 3% Doxycline, 4.25% citric
acid and 0.5% polysorbate
80 (Tween 80)

37. MTAD (Mixture ofTetracycline
Isomer, an Acid and a Detergent
✤ Actions & Characteristics
✤ Strong antibacterial agent (Very
effective against E. Fecalis
✤ Smear layer removal similar to EDTA
✤ Used as a final rinse and has a better
effect if NaOCl is used prior to the final
rinse
✤ Tetraclean is similar to MTAD with
different concentration of Doxyciline and
a different detergent (Polypropylene
glycol)

38. QMIX
✤ Was developed in 2011
✤ A combination of CHX-Analog,
Triclosan and EDTA
✤ Actions & Characteristics
✤ Good antibacterial agent
✤ Removes smear layer
✤ Initially designed to be used
as a final rinse

39. QMIX
✤ Was developed in 2011
✤ A combination of CHX-Analog,
Triclosan and EDTA
✤ Actions & Characteristics
✤ Good antibacterial agent
✤ Removes smear layer
✤ Initially designed to be used as a
final rinse
✤ It is very promising

40. Iodine Potassium Iodide
✤ It is a halogen
✤ Used in concentration 2% to 5%
✤ Has low toxicity
✤ Effective antibacterial agent
✤ Used in combination with CHX
✤ Some patients are allergic to iodine

41. Delivery Systems & Agitation
Devices

42. Delivery System & Agitation
Devices
✤ Manual Agitation
✤ Sonic Agitation (Endoactivator)
1500 Hz to 6000 Hz
✤ Passive Ultrasonic Irrigation (PUI)
✤ Negative Apical Pressure
Techniques
✤ EndoVac
✤ RinsEndo
✤ Safety Irrigator
✤ Gentle wave system
✤ Laser Activated Irrigation
✤ Potoactivated Disinfection
✤ Antibacterial Nanoparticles
✤ Superoxidized Water
✤ Xp EndoFinisher

43. PUI: Passive
Ultrasonic
Irrigation
Acoustic
Micro-Streaming

46. A File Not for Preparation…

50. Runaway Now…