irrigation techniques

1. Irrigation techniques
By
Ahmed Mostafa Hussein
Assistant lecturer, Dental Biomaterials Department
Faculty of Dentistry, Mansoura University
2015
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2. Introduction
 In practice, current endodontic treatment uses two irrigants,
sodium hypochlorite (NaOCl), alone or in combination with
EDTA or chlorhexidine.
 All the instrumentation systems as well as current advancements
in the instruments like nickel-titanium instruments and rotary
can only clean the central body of the canal. Rest of the canal
structures are untouched after completion of the preparation.
 “Perhaps the most important factor is the delivery system and
not the irrigating solution per se.”(Walton and Torabinejad)
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3.  Due to the safety factors, capacity of high volume irrigant
delivery and ease of application the newer irrigation devices may
change the insight of conventional endodontic treatment.
 Irrigation techniques might be divided into manual and machine-
assisted techniques.
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4. 4

5. A. Manual irrigation techniques
1. Syringe irrigation with needles
 Still widely accepted by both general practitioners and
endodontists.
 Either passively or with agitation. The agitation is achieved by
moving the needle up and down the canal space.
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6.  Needle: (length, bending, tip design)
 27 gauge needles are most commonly used.
 They should be bent to allow for easier access & entry into the
orifice.
 Fitting of needle with syringe should be:
Luer lock fit: include a screw-in lock for:
a) easy removal b) secure attachment
c) prevent accidental separation of needles from syringe.
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7. 7
Luer lock syringe

8.  Needle tip design:
1) Open-end tips increase the apical pressure.
2) Closed-end tips are side-vented:
* Improve the hydrodynamic activation of an irrigant.
* Reduce the chance of apical extrusion.
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9. 9
A-C: Open-ended needles; (A) flat, (B) beveled & (C) notched.
D-F: Closed-ended needles; (D) side-vented, (E) double side-
vented & (F) muti-vented.

10.  Syringe: (material, size, design, number)
Syringe material: syringes can be made of glass or plastic.
Plastic syringes of different sizes (1–20 mL) are most
commonly used for irrigation.
Syringe size: large-volume syringes are time-saving, but they are
more difficult to control for pressure and accidents may happen.
* To maximize safety and control, using 1–5 mL syringes is
recommended instead of the larger ones
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11. Syringe design: all syringes must have a Luer-Lok design.
Number of syringes: separate syringes should be used for each
irrigant to avoid chemical reactions between irrigants.
 Advantages of Syringe irrigation: easy to manipulate and good
control over needle depth & volume of irrigant.
 Disadvantages: * Relatively weak flushing action.
* In case of open apex: positive pressure could extrude the
solution to the periapex.
* Depth of irrigation: limited; 1 mm beyond the needle tip.
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12. Precaution:
 Compressed air must not be used for drying the root canal
because tissue emphysema may result if air penetrates the
periapical tissue.
 Drying should be done with absorbent points.
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Max-I-Probe needleMonoject needles
Luer-lockLuer-lock
Closed-end & side-portOpen-end
Rounded tip & safe-endNotched
Safer irrigationHigher risk of apical extrusion of irrigant
Thinner & more flexible
Can be used with curved canals
Can be used for endodontic &
periodontal irrigation
Can be used subgingivally

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Monoject: notched Max-I-Probe: side-port

15. NaviTip needle:
 Safe rounded end.
 Rigid in the majority of the shank to prevent bending.
 The last few millimeters are flexible to facilitate navigation
‫إبحار‬even through curved canals.
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16. 2. Brushes (NaviTip FX & Endobrush)
NaviTip FX:
 A 30-gauge irrigation needle covered with a brush.
 Improved cleanliness of the coronal third only when compared
to brushless NaviTip needle.
 NaviTip FX brush bristles may dislodge inside the canal
irregularities. It is very difficult to identify radiographically,
because it is radiolucent.
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17. 17
NaviTip FX

18. Endobrush:
 Consists of nylon bristles set in twisted wires with an attached
handle.
 Could not be used to full working length, because of its size,
which might lead to apical packing of debris.
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19. 3. Manual-dynamic irrigation
 It is often difficult for the irrigant to reach the apical portion of
the canal because of the vapor lock effect.
 Gently moving well-fitting gutta-percha master cone up and
down in short 2 to 3 mm strokes (manual-dynamic irrigation)
within an instrumented canal:
* can produce an effective hydrodynamic effect
* can force the irrigant to the untouched canal surfaces.
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20.  The laborious ‫شاق‬ nature of this hand-activated procedure still
hinders its application in routine clinical practice.
 Therefore, there are a number of automated devices designed for
agitation of root canal irrigants.
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21. B. Machine-assisted irrigation techniques
1) Rotary brushes (Ruddle brush and Canalbrush)
Ruddle brush:
 Microbrush attached to a rotary handpiece.
 Has multiple bristles extending radially from a central wire core.
 Rotates at about 300 rpm.
 Displacing debris in a coronal direction.
 Has not been commercially available since the patent was
approved in 2001.
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22. 22
Ruddle brush

23. Canalbrush:
 Highly flexible microbrush.
 Molded entirely from polypropylene.
 Might be used manually with a rotary action.
 More effective when attached to contra-angle handpiece running
at 600 rpm.
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24. 2) Sonic irrigation
(Rispisonic file, Endoactivator, Vibringe)
 Sonic irrigation is different from ultrasonic irrigation in:
* Lower frequency (1–6 kHz).
[Hertz (Hz) = cycles per second]
* Smaller shear stresses.
* Higher amplitude.
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25. Rispisonic file:
 The most aggressive sonic file
 Aggressive shaping.
 Because they are barbed, these files might damage the finished
canal preparation during agitation.
 Material: stainless steel.
 Can be autoclaved.
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26. Endoactivator:
 Handpiece: Cordless, portable, battery operated.
 Polymer tips: Disposable (single use), smooth non-cutting,
radiolucent, strong & flexible.
 Agitate irrigant solutions.
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27. Vibringe:
 Manual Syringe/needle irrigation + sonic vibration in one step.
 Handpiece: * Cordless.
* Fits in a special disposable 10 ml Luer-Lock syringe.
 Battery: Rechargeable.
 Less effective than passive ultrasonic irrigation.
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28. 3) Ultrasonic irrigation
Introduction:
 Ultrasonic is an adjective referring to ultrasound.
 Ultrasonic: means producing vibrations or sound waves with
a frequency greater than the upper limit of human
hearing (greater than 20 kHz).
 Methods for producing ultrasound: (2 types of ultrasonic units)
* Magnetostrictive.
* Piezoelectric: suitable for endodontic treatment.
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PiezoelectricMagnetostrictive
electrical charge is applied
change in crystal size
vibrations
Electromagnetic energy
mechanical energy
vibrations
Less heat generationMore heat generation, so
cooling is required
Vibration of the tip is linear
(back & front)
Vibration of the tip is elliptical
(eight figure)
Frequency: 40 kHz (cycle per second)Frequency: 24 kHz (cycle per second)
Ideal for endodontic treatment.

30.  Ultrasonic irrigation produces higher frequencies (25- 30 kHz) &
low amplitudes than sonic irrigation.
 Ultrasonic irrigation is better than sonic irrigation at removing
dentin debris.
 Ultrasonic irrigation is more effective in wide canals.
 Ultrasonic handpieces pass sound waves to an endodontic file
and cause it to vibrate at ~25,000 vibration/s.
 The best moment for ultrasonic activation of the irrigant is after
shaping the root canal.
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31.  Ultrasonics can effectively clean debris from the root canal, but
cannot effectively get through the apical vapor lock, because
acoustic microstreaming is only possible in fluids, not in gases.
 Free oscillation of the instrument will cause more ultrasonic
effects in the irrigant solution than an oscillation forced against
canal walls.
 Ultrasonic irrigation creates a higher speed of irrigant in the
canal during irrigation, thereby eliminating more debris.
 It causes acoustic streaming and cavitation of the irrigant.
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32. Acoustic microstreaming and cavitation:
 Acoustic stream can be defined as a rapid movement of the fluid
in a circular or vortex ‫دوامة‬ shape around the vibrating file.
 Cavitation is defined as the creation of steam bubbles or
expansion, contraction and/or distortion of pre-existing bubbles in
a liquid.
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33.  Types of ultrasonic irrigation:
a) Simultaneous combination of ultrasonic irrigation &
instrumentation (UI).
Note: simultaneous = happening at the same time.
* This type has been almost discarded in the clinical practice,
because it is difficult to control the cutting of dentin.
b) Ultrasonic irrigation without simultaneous instrumentation.
* It is called passive ultrasonic irrigation (PUI).
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34.  Passive ultrasonic irrigation (PUI): agitating the irrigant solution
previously placed inside the canal.
 An ultrasonic tip is activated in the canal up to working length
and is moved passively in an up-and-down motion to ensure that
it does not bind with the root canal walls.
 During PUI, energy is transmitted from a file or smooth
oscillating wire to the irrigant by means of ultrasonic waves.
 Ultrasonic file can move freely in the canal, avoiding
perforations.
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35.  Acoustic streaming produces sufficient shear forces to dislodge
debris in instrumented canals.
 Passive Ultrasonic irrigation (PUI) is more effective than
Vibringe, UI & syringe irrigation in removing debris.
 The term passive here relates to non cutting action.
 A canal size of at least 30-40 file is required to maintain free
oscillation.
 Ultrasonic Irrigation can be used as an intermittent irrigation or
a continuous ultrasonic irrigation.
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36. Intermittent flushed ultrasonic irrigation:
 The irrigant is delivered to the root canal by a syringe needle.
 The irrigant is then activated with the use of an ultrasonically
oscillating instrument.
Continuous ultrasonic irrigation system:
 During ultrasonic activation, a 25-gauge irrigation needle is
used instead of an endosonic file.
 The needle is simultaneously activated by the ultrasonic
handpiece & maintains a continuous flow of fresh irrigant.
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37. 4) Pressure alternation devices
(negative-pressure irrigation)
Examples:
 RinsEndo
 EndoVac
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38. RinsEndo:
 Irrigates the canal by using pressure-suction technology.
 It is composed of a handpiece, a cannula with a 7 mm exit
aperture, and a syringe carrying irrigant.
 The irrigant is automatically drawn from the attached syringe
and aspirated.
 The pressure-suction cycles change approximately 100 times per
minute.
 Periapical extrusion of irrigant has been reported.
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RinsEndo
RinsEndo

40. EndoVac:
 An apical negative pressure irrigation system.
 Composed of three basic components:
* Master Delivery Tip (MDT)
* Macrocannula
* Microcannula
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41. 41
EndoVac

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MDT Microcannula

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EndoVac

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45.  A constant flow of fresh irrigant is being delivered by negative
pressure to working length.
 Negative irrigation is better than positive pressure irrigation,
because it prevents apical extrution of irrigant, provides better
cleansing and has no vapor lock effect.
 EndoVac works on negative pressure, which draws irrigation
apically through suction.
 The irrigant is delivered into the pulp chamber by the master
delivery tip and is driven by negative pressure into the root
canals with the aid of the macrocannula and microcannula.
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46.  The manufacturer’s instructions must be followed for correct
use of the Master Delivery Tip and to avoid creation of positive
pressure in the pulp canal.
 The flow of irrigant from the MDT should always be directed
into an axial wall or the wall of pulp chamber and never directly
into an orifice.
 The EndoVac system requires a minimum canal shape:
* No. 35 instrument with a 4% taper
* or with a non-tapered system like LightSpeed, a size #45
at full working length.
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47. Advantages of EndoVac:
 Overcomes the apical vapor lock (air entrapment).
 The unique capability to deliver irrigants up to the working length
(apical third) without the risk of apical extrution.
 Better debridement of apical third.
 A constant flow of fresh irrigant.
 Negative irrigation is better than positive pressure irrigation,
because it prevents apical extrution of irrigant, provides better
cleansing and has no vapor lock effect.
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48. Apical vapor lock:
 Definition: Air entrapment at the apical third by advancing the
irrigant apically. It resists displacement during instrumentation
and final irrigation.
 NaOCl reacts with organic material in the root canal and quickly
forms micro air bubbles at the apical third that coalesce into
an apical vapor lock with subsequent instrumentation.
 Acoustic microstreaming and cavitation are limited to liquids and
have no effect inside the vapour lock. Acoustic microstreaming or
cavitation is only possible in liquids, not in gases.
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49. Problems of apical vapor lock:
 Prevents the flow of irrigant into the apical region.
 Prevents adequate debridement of the canal system.
How to overcome the vapor lock?
 Manual-dynamic irrigation: Hand-activated (moving up &
down) well-fitting gutta-percha master cone that is introduced to
working length after instrumentation.
 Apical negative pressure irrigation, such as EndoVac.
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50. 5) Continuous irrigation during rotary instrumentation
Quantec-E:
 It uses a pump console, 2 irrigation reservoirs and tubing
 It provides continuous irrigation during rotary instrumentation.
 Increased volume of irrigant.
 Cleaner canal walls in the coronal third only (compared with
syringe irrigation with needles).
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51. VATEA system (Self adjusting file)
 Self Adjusting file (SAF), rotary system.
 It adjusts to the anatomy of the root canal.
 It has a hollow thin walled cylinder composed of a thin nickel-
titanium lattice.
 Provides continuous irrigation during instrumentation.
 In oval canals, the SAF was found superior to rotary Ni-Ti files
used with needle irrigation (NaOCl).
 SAF is designed to prepare root canals that do not have a round
cross section.
 It has an abrasive surface.
 Up & down movement (vibration) during rotation.
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52. 52
Self adjusting file (SAF)

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