{"id":884,"date":"2018-04-17T02:10:35","date_gmt":"2018-04-17T02:10:35","guid":{"rendered":"https:\/\/endostlaurent.com\/?p=884\/"},"modified":"2018-09-19T16:10:59","modified_gmt":"2018-09-19T16:10:59","slug":"irrigation-in-endodontics","status":"publish","type":"post","link":"https:\/\/endostlaurent.com\/en\/2018\/04\/17\/irrigation-in-endodontics\/","title":{"rendered":"Irrigation in Endodontics"},"content":{"rendered":"

The goal of endodontic therapy is to prevent the invasion of microbes or to eliminate them\u00a0once they\u00a0invade and establish colonies inside the root canal system. This is\u00a0known as\u00a0Microbial Control.\u00a0\u00a0<\/span><\/p>\n

In order to achieve a decent level of microbial\u00a0control, practitioners\u00a0have always relied on the three pillars\u00a0of Endodontics: Instrumentation, Irrigation and Obturation. While no pillar is more important than the other,\u00a0it is their synergistic effect that helps\u00a0us achieve proper microbial control and thus leads\u00a0to endodontic success.\u00a0\u00a0<\/span><\/p>\n

Irrigation is the process of washing out the root canal system with specific solutions with the aim of decreasing the microbial load.\u00a0The idea of using irrigation during a root canal treatment first appeared in 1859 by Taft. Various\u00a0solutions and techniques have\u00a0evolved over the past 50 years all aiming at enhancing irrigation and thus producing a cleaner canal.\u00a0<\/span><\/p>\n

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The most widely used irrigation solution is Sodium Hypochlorite,\u00a0NaOCl, also known as bleach.\u00a0NaOCl\u00a0offers\u00a0dual action:\u00a0\u00a0<\/span><\/p>\n

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  1. It can dissolve organic matter\u00a0\u00a0<\/span><\/li>\n
  2. It can\u00a0neutralize and kill bacteria and their toxins\u00a0<\/span><\/li>\n<\/ol>\n

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    NaOCl\u00a0is available as a commercial solution with concentrations ranging from 3% to 6%.\u00a0In the endodontic field,\u00a0concentrations as low as 0.5% and as high as 6% have been reported to be employed in a clinical setting.\u00a03 points are important to remember:\u00a0<\/span><\/p>\n

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    1. Increasing concentrations will not lead to superior bacterial reduction rather it will enhance the dissolution of the organic matter present in the root canal. Such organic matter can be pulpal debris and necrotized tissues.\u00a0\u00a0<\/span><\/li>\n
    2. It is the regular exchange and replenishment of the root canal with fresh\u00a0NaOCl\u00a0solution that will reduce bacteria.\u00a0\u00a0<\/span><\/li>\n
    3. Heating\u00a0\u00a0NaOCl\u00a0before\u00a0its\u00a0delivery\u00a0to the root canal has been\u00a0said\u00a0to\u00a0increase\u00a0its\u00a0potency.\u00a0However\u00a0such\u00a0claims are\u00a0based\u00a0on in-vitro\u00a0studies\u00a0and\u00a0it\u00a0is\u00a0now\u00a0well\u00a0known\u00a0that\u00a0dentin\u00a0acts\u00a0as a buffer and cools down\u00a0NaOCl,\u00a0making\u00a0it\u00a0obsolete\u00a0to\u00a0be\u00a0heated.\u00a0<\/span><\/li>\n<\/ol>\n

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      Other\u00a0solutions\u00a0that\u00a0are\u00a0also\u00a0used\u00a0during\u00a0a root canal\u00a0treatment\u00a0are\u00a0Ethylenediaminetetraacetic acid<\/a>\u00a0(EDTA) and Chlorhexidine.\u00a0\u00a0<\/span><\/p>\n

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      EDTA\u2019s\u00a0main action consists in removing inorganic debris of the smear layer created while instrumenting the root canal system. EDTA is a demineralizing agent that will chelate the Calcium ions. Removing the smear layer is an important step in reaching microbial control because it can act as a substrate for microbes and can clog the dentinal tubules,\u00a0hence limiting the diffusion of other anti-bacterial substances and medicaments such as Calcium Hydroxide.\u00a0Just like\u00a0NaOCl, EDTA comes in various concentrations ranging from 10% to 17%. Research shows that higher concentrations yield cleaner canals void of smear layer. EDTA is usually used\u00a0at the end of a root canal treatment after flushing the canals with\u00a0NaOCl. It is important to mention that EDTA has no significant antibacterial properties.\u00a0<\/span><\/p>\n

      \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\"\"\u00a0<\/span><\/p>\n

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      Chlorhexidine is an aqueous solution that is used at the end of a root canal treatment, more specifically in necrotic and abscessed cases. Chlorhexidine, commonly abbreviated CHX, takes\u00a0the disinfection to another level due to its broad antibacterial spectrum and its\u00a0substantivity. In fact, CHX is able to kill\u00a0Enterococcus faecalis,\u00a0<\/i>a bacterial species that can resist\u00a0NaOCl\u00a0and\u00a0thought to cause root canal failure. CHX\u2019s action is also long lasting\u00a0thanks to its capacity to interact and bind to the root canal dentin. Despite its superior disinfection capacity CHX does not dissolve tissue, making\u00a0NaOCl\u00a0indispendable\u00a0for every day root canal procedures. CHX, just like EDTA and\u00a0NaOCl, is available in various concentrations,\u00a0with 2% being the most widely used. EDTA, Isopropyl alcohol (rubbing alcohol) or saline water should\u00a0be used in between\u00a0NaOCl\u00a0and CHX\u00a0to avoid the 2 solutions being mixed together as they can create a toxic substance inside the root canal.\u00a0<\/span><\/p>\n

      \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\"\"\u00a0<\/span><\/p>\n

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      Suggested readings:\u00a0<\/span><\/p>\n