6.
Should be non irritating to periapical tissue
Should be an effective germicide and fungicide
Should be stable in solution
Should have prolonged antimicrobial effect
Should be active in presences of blood, serum proteins
derivatives of Tissue.
7.
Should have low surface tension
Should not interfere with repair of periapical tissues
Should not stain tooth structure .
Should not induce a cell mediated immune response
9. SODIUM HYPOCHLORITE
[ NaOCl ]
Commonly used household bleach [ Clorox ]
Most common and popular irrigant in endodontics
Advantages:
Mechanical flushing of debris from the canal
Tissue dissolving capacity → Vital + Non vital [necrotic]
Antimicrobial action
Lubrication
Inexpensive
Easily available
11. Recommended concentration 0.2% → 5.25%
Commonly used 2.5% - less toxic and retains the
tissue dissolving capacity and antimicrobial property.
Decrease in concentration ↔ increase in volume
Effectiveness can be improved by heating the solution
NaOCl can act only when in contact with tissues
hence shaping with instruments is necessary
12.
13. Sodium hypochlorite accident
Extrusion of the irrigant beyond the apical foramen causes
extensive tissue damage.
Preventive measures:
The needle of the irrigating syringe should be placed loosely
within the canal
The irrigant should not be pushed with force.
The needle should not be introduced to the apex
Side vented irrigating needle is used.
The needle is agitated or moved up and down loosely to
agitate the liquid
15. Limitations
Toxic
Not active against E. faecalis
Ineffective at low concentrations.
Not substantive
Corrodes
Unpleasant odor.
Ineffective in smear layer removal.
16. CHLORHEXIDINE
It is a Bisguanide
It has a broad spectrum of anti microbial action
Effective on a wide range of bacterial strains
E. faecalis
Less toxicity
NaOCl + CHX → increased effectiveness
17. Anti microbial action :
Adsorption to the surface of bacteria [due to cationic-anionic
electrostatic attraction]
Increase the membrane permeablility
Results in micro leakage of intracellular components leading
to cell death
CHX
18. SUBSTANTIVITY:
The chlorhexidine molecule gets attached to the dentin
of the root canal and release chlorhexidine slowly as the
concentration of
environment
D
e
n
t
i
n
CHX decreases in the surrounding
19.
Normally used in concentrations between 0.12 and 2.0%
Extremely low level of tissue toxicity
Allergic reaction to CHX are rare
21. SODIUM HYPOCHLORITE +CHLORHEXIDINE
It is seen that when a combination 2.5% NaOCl & 0.2 % CHX is
used in root canal could gain
1) an additive antimicrobial action
2) a tissue dissolving property that is better than that
obtained with
use of CHX alone
3) a solution less toxic then NaOCl
22. OTHER IRRIGATING SOLUTIONS
HYDROGEN PER OXIDE
[ H2O2 ]
It is an oxidizing agent .
It is almost used in conjunction with NaOCl
It acts by two mechanisms
1. The reaction with NaOCl produces effervescence
which mechanically pushes the debris out of the
canal
2. The nascent oxygen released acts as a powerful
antimicrobial agent especially for the anaerobic
organisms
23. Advantages:
It produces less damage to the periapical tissues
It is a good anti anaerobic agent
The nascent oxygen produced tends to penetrate deeper into the tubules. Hence
very effective on bacteria residing deeper in the dentinal tubules.
When used along with CHX, hydrogen peroxide dislodges the smear layer
allowing the CHX to be more effective
A side effect which is beneficial is that it causes bleaching
24. Other agents:
•
SAVLON : Combination of 0.3% cetrimide and
0.03% CHx
•
OXIDATIVE POTENTIAL WATER
• SALVIZOL : root canal chelating irrigant
•
BDA (bis-dequalinium acetate): recommended as an
excellent substitute for sodium hypochlorite in those patients who
are allergic to the latter.
•
ELECTRO CHEMICALLY ACTIVATED WATER
27. Ultrasonics [passive ultrasonic irrigation]
Most of the dentine debris is inorganic
matter that cannot be dissolved by
NaOCl. Therefore, removal of dentine
debris relies mostly on the flushing
action of irrigant.
The ultrasound device allow the
endodontic irrigant to pass along the
ultrasonic files. The irrigant is activated
by the ultrasonic energy imparted from
the energized instruments producing
acoustic streaming and cavitation
28. LUBRICANTS:
Facilitate the file movement during the cleaning and shaping
Help in the initial canal negotiation especially in narrow
canals
They reduce the torsional force on the instruments – reduce
the fracture potential
31. SMEAR LAYER:
Cleaning and shaping → layer of
organic pulpal material
+
inorganic dentin debris
The layer may contain microorganisms
The smear layer may be 1 to 5 μ
Smear layer removal ?????????
32. Removal of the smear layer is the better option
Enhance the irrigants to penetrate the dentinal tubules
Enhance the penetration and adhesion of sealers
33. DECALCIFYING / CHELATING AGENTS
Agents that dissolve or dissolute the inorganic portions of the
root dentine [ calcified portions]
Ethylene di-amine tetra acetic acid [ EDTA]
Helps in the removal of the smear layer
Irrigation with 17% EDTA followed by the final rinse with
NaOCl is recommended
34. Chelators remove the inorganic portion of the debris leaving
behind the organic portions which can be dissolved or
removed with NaOCl
Effect of EDTA is dependant on the time of contact with the
debris and the concentration
Recommended time for the removal of the smear layer is 1 min
EDTA supplied as a
•
liquid
•
paste
35. MTAD [ BIOPURE MTAD]
MTAD was developed by Mohmand Torabinajed et al
MTAD contains mixture of :
•
tetracycline isomer doxy cycline
•
acid- citric acid
•
a detergent - Tween 80
Antimicrobial activity of MTAD
MTAD has superior antimicrobial activity than 5.25% sodium
hypochlorite. The efficiency of MTAD in disinfecting surface of
the roots is a result of the presence of doxycycline.
36. Generally used as a final rinse to remove the smear layer
Effectiveness is enhanced when the canal is irrigated with
low concentration of NaOCl before the use of MTAD.
1.3% recommended concentration
Superior than NaOCl in antimicrobial action
Doxycycline has the ability to bind the tubules and
gradually released over time
Effective in killing E.faecalis
Biocompatible
Does not alter the properties of dentin
Enhances the bond strength
39. MAIN PURPOSE FOR INTRACANAL MEDICAMENT
To reduce interappointment pain
To decrease the bacterial count and regrowth
To render the canal contents inert
41. Phenols and Aldehydes :
Non specific in action
Destroy both
HOST TISSUES + MICRO-ORGANISMS
Toxic
Aldehydes fix the tissues
May reach the periapical tissues → systemic circulation
EUGENOL:
Part of root canal sealers, temporary filling
Antiseptic & anodyne effect
Effect is dose related
•
Low dose (anti-inflammatory activity): inhibits-Pg synthesis, nerve activity,WBC
chemotaxis
•
High dose (cytotoxic effect)- induces cell death, inhibits cell respiration
42. Calcium hydroxide
Ca(OH)2 widely used as an IM
pH 12 to 13
Antimicrobial activity is due to the high alkalinity
May aid in dissolving the tissue remnants, bacteria
and their by-products.
Recommended as an IM in root canals with necrotic
tissue and infected tissue
Little benefit with vital pulp
43. Can be placed in the canals as
Dry powder
Paste
: calcium hydroxide mixed with
→ water
→ local anesthetic solution
→ glycerin
→ chlorhexidine
Proprietary paste supplied in syringes
44. The material is carried into the canal with the help of
lentulo spiral
using a file
injecting
45. Corticosteroids
Anti-inflammatory agents
Proposed to decrease Post operative pain and suppress
inflammation
Can be used in patients with acute apical periodontitis
Hydrocortisone + antibiotics
Chlorhexidine
2% chlorhexidine gel
When mixed with calcium hydroxide the antimicrobial
effect is greater
Disadvantage :
does not remove the smear layer
46. COMBINATION
Corticosteroid + antibiotic
Use of corticosteroid: reduces pain in inflamed tissue
and gives instant
relief
Use of antibiotic: prevents overgrowth of bacteria
when the inflammation
subsides
Eg. Corti-sporin,Tetra-Cortil
47. Ledermix paste :
Combination of a corticosteroid and
antibiotic
Corticosteroid → Triamcinolone
acetonide
Antibiotic →
Demeclocycline calcium
48.
Frequency of placement:
Disinfectant dressing should be preferably
renewed in a week and not longer than 2 weeks
Medicaments used for apexification are used for
3-6 months