IRRIGATING SOLUTIONS- DR JAYAKANTH

1. ROOT CANAL IRRIGANTS
Dr.JAYAKANTH.K

3. Jan 2020 Qstn paper

4. CONTENTS :-
Introduction
History
Functions
Ideal Requirements
Classification
Chemically Non-Active Irrigants
Chemically Active Irrigants
Recent Advancements in irrigating solutions
Parameters for evaluation of efficacy of irrigants
Technique of endodontic irrigation
Delivery Systems
Irrigation protocol
Conclusion

5. INTRODUCTION
“ Root canal instruments shape the canals ;
Whereas root canal irrigants clean the canals “
- cleaning and shaping

7. FUNCTIONS :-
1. Lavage of debris
2. Tissue dissolution
3. Lubrication
4. Chelation
5. Antibacterial action
6. Bleaching action
7. Possess a certain amount of radio-opacity

8. IDEAL REQUIREMENTS
OF IRRIGANTS
• Low toxicity
• Should be biocompatible
• Low surface tension
• Low neutralizability
• Easy availability
• Cost effective
• Convenient for usage
• Good shelf life
• Easy storage

9. For university exam purpose
1. Introduced by
2. Its concentration
-available concentrations
3.Mechanism of action
4.Properties
• concentration
p H of irrigant
tissue dissolving properties
methods to increase efficacy
5.Advantages
6.Drawbacks
7.Any interactions

10. CLASSIFICATION
• According to Stock:-
1) Chemically inactive solutions such as water, saline or LA
2) Chemically active solutions which includes
- Alkalis
- Acids
- Chelators
- Oxidizers
- Antibacterial agents
- Detergents
- Enzymes

11. • According to Walton:-
1) Irrigants
2)Dentin softeners –Chelators
- De-calcifiers
3) Lubricants
4) Dessicants

12. CHEMICALLY INACTIVE
SOLUTIONS
NATURE
• - help in flushing out debris
• - Non toxic
• -Easily available
• -Economical
EXAMPLES
• WATER
• SALINE
• LOCAL ANAESTHETIC
SOLUTIONS

14. CHEMICALLY INACTIVE
SOLUTIONS
NATURE
• - help in flushing out debris
• - Non toxic
• -Easily available
• -Economical
EXAMPLES
• WATER
• SALINE
• LOCAL ANAESTHETIC
SOLUTIONS

15. CHEMICALLY ACTIVE SOLUTIONS :-
Sodium hypochlorite(NaOCl)
Introduced by Physician Henry Drysdale Dakin during World War I, to treat
wounds.
Advantages:-
- Tissue dissolution (due to its high alkalinity) Ph-
- Lubrication
- Antimicrobial and bleaching action
- Economical and easily available
- 0.5-5.25% concentration

16. Mechanism of action of NaOCl:-
- The removal of organic tissue by NaOCl is by the release of
hypochlorous acid which reacts with insoluble proteins to form
soluble polypeptides,aminoacids and other byproducts
- At body temperature, reactive chlorine in aqueous solution
exists in two forms-hypochlorite (OCl–) and hypochlorous
acid (HOCl).
- It can dissolve the entire pulp in 20 minutes to 2 hours.
- 5.25% NaOCl penetrates into the dentinal tubules & dissolves
the contents of the tubules adjacent to the main canal

17. • Destruction of bacteria occurs in 2 phases
• 1. penetration in to the bacterial cell wall
• 2. chemical combination with the
protoplasm of bacterial cell & disruption of
DNA synthesis

18. - NaOCl is more effective in removing both
inorganic & organic debris.
- Flushing with 10ml NaOCl removed any
remaining organic tissue thus leaving patent
dentinal tubules on the surface of the canal
walls.
- Ph of NaOCl is 11-11.5
- Its concentration ranges from 0.5-5.25%
- Usually 2.5-3 % concentration is used

19. Methods to enhance the activity of Naocl
- The rate and effectiveness of solution can be enhanced by :-
- Heating it to 60°C
- Using a larger volume of irrigant
-Giving it ample time to work
- Antimicrobial action of NaOCl takes place via 2 modes :-
i) The chlorine ion
ii) Its alkalinity - Ph of NaOCl is 11-11.5
- Factors affecting its antimicrobial properties :-
i) Diluting 5.25% NaOCl inhibits its antimicrobial property significantly
ii) Bactericidal effectiveness of 5.25% NaOCl decreases over time
- Storage shelf-life of 3 months for undiluted preparations (Martin)
- Maintains a remarkable degree of antimicrobial activity in the presence of
organic matter like blood & serum albumin

20. Naocl
Disadvantages:-
-Causes mild to severe cellular damage and toxicity if extruded
beyond apex
-Has high surface tension which decreases its dentin wetting
capacity
-Caustic & can cause inflammation of gingival tissue
-Has an unpleasant taste,odour and its vapours can irritate the
eyes
-Tends to corrode equipment
-Can bleach clothes if spilt
-May cause pharyngeal edema & esophageal burns if
swallowed(Seltzer)

21. University question
• Toxicity of NaOCl to Periapical Tissues
• Qstn – Describe sodium hypochlorite
accident and its management ??

22. Toxicity of NaOCl to Periapical Tissues
• Its inadvertent injection beyond the root canal system causes –
- Severe pain
- Edema
- Profuse haemorrhage both interstitially
& through the tooth
- Upper airway obstruction
• This may be followed for several days by –
- Increasing edema
-Ecchymosis
- Tissue necrosis
- Parasthesia
- Secondary infection(rarely)
• Majority of cases show complete resolution within a couple of
weeks.
• In some cases there may be long-term parasthesia or scarring

24. TREATMENT FOR HYPOCHLORITE
ACCIDENT
• Reassurance-Remain calm and assist the patient in remaining calm
• Recline the chair to decrease pressure from the head
a) For immediate pain relief – nerve block and local anaesthesia
b) Wet,cold,compress- continually applied to the face-for relief of pain &
burning sensation and minimize swelling(for upto 6 hours)
c)Analgesics – after emergency treatment
d) To control inflammation-corticosteroids immediately i.v. for 3 days
e) To prevent infection –antibiotics (1 wk)
f) Heat packs & warm mouth rinse to improve circulation to the area
• Advise the patient about the anticipated swelling & Ecchymosis
• Give the patient both verbal & written instructions
• Reassure the patient that he will regain his normal appearance within a
short period.

25. - The rate and effectiveness of solution can be enhanced by :-
- Heating it to 60°C
- Using a larger volume
-Giving it ample time to work
- Antimicrobial action of NaOCl takes place via 2 modes :-
i) The chlorine ion
ii) Its alkalinity - Ph of NaOCl is 11-11.5
- Factors affecting its antimicrobial properties :-
i) Diluting 5.25% NaOCl inhibits its antimicrobial property significantly
ii) Bactericidal effectiveness of 5.25% NaOCl decreases over time
- Storage shelf-life of 3 months for undiluted preparations (Martin)
- Maintains a remarkable degree of antimicrobial activity in the presence of
organic matter like blood & serum albumin

26. Mechanism of action of NaOCl:-
- The removal of organic tissue by NaOCl is by the release of
hypochlorous acid which reacts with insoluble proteins to form
soluble polypeptides,aminoacids and other byproducts
- It can dissolve the entire pulp in 20 minutes to 2 hours.
- 5.25% NaOCl penetrates into the dentinal tubules & dissolves
the contents of the tubules adjacent to the main canal
- A final flushing of 17% EDTA followed by 10ml of 5.25%
NaOCl is more effective in removing both inorganic & organic
debris.
- Flushing with 10ml NaOCl removed any remaining organic
tissue thus leaving patent dentinal tubules on the surface of the
canal walls.
- Ph of NaOCl is 11-11.5
- Its concentration ranges from 0.5-5.25%

27. Physiologic Saline
(normal saline)
0.9% conc
• -one of the good irrigant to use as it
causes :-
a) Least apical tissue irritation or
damage
b) Biocompatible
c) Least amount of cell lysis
- Irrigation followed by ultrasonic
& sonic instrumentation have been
reported to be almost as effective as
0.5-2.5% NaOCl irrigation in
reducing the number of bacteria in
infected root canals
- DISADVANTAGES :-
i) Does not remove the smear layer
ii) Merely flushes out some of the
superficial debri from the canal system
iii) Has poor antibacterial properties

28. Hydrogen peroxide(H2O2) (oxidising
agent)
- Oxidizing agent used in a concentration of 3%
- Active against bacteria, yeasts & viruses due to
production of free radicals which attack several
cell components such as proteins & DNA
- Combining CHX& H2O2 at low concentrations
found significantly greater antimicrobial activity
against E.faecalis than the tested medicaments
alone.
- Almost always used in conjunction with NaOCl
(Grossman)
- Mechanism of action
• . It rapidly dissociates into H2O + [O] (water and
nascent oxygen).
• On coming in contact with tissue enzymes catalase and
peroxidase, the liberated [O] produces bactericidal
effect but this effect is transient and diminishes in
presence of organic debris.

29. A transient but energetic effervescence,
which can mechanically force debris out of the
canal
Resultant nascent oxygen production as a by
product of their interaction is toxic to the
anaerobes
Permeability of dentinal tubules is increased
allowing deeper penetration of intracanal
medicament
Certain amount of bleaching occurs

30. - Another school of thought –
air bubbles produced by interaction of H2O2 and NaOCl
prevent adequate contact between irrigant and debris
Effectiveness of NaOCl diminished
H2O2 if left un-neutralized can produce gas bubbles, which
can cause continuous pain.
- Weine strongly recommends its usage because of its low
toxicity
- Useful in canals left open for drainage as the effervescence can
help dislodge food particles/debris
- DISADVANTAGES –
- Does not possess tissue dissolution properties
- Is not effective as a lubricant

31. • UREA PEROXIDE (Oxidizing agent )
- Oxidizing agent that reacts chemically, liberating great
amounts of nascent oxygen
- Bactericidal action
- Effervescence removes pulp tissue remnants & dentin
particles
- Endo-PTC – 10% Urea Peroxide, 15% Tween 80
- Detergent & haemostatic properties
- Non allergenic
- Not irritating to periapical tissues
- Used in small curved canals
- Property of lubrication without dentin demineralization
prevents root perforation
- Effective even in presence of blood
- Disadvantage – less effective in removing smear layer

32. Glyoxide ( oxidizing agent )
- An oxidizing agent which is a combination of 10% urea
peroxide(carbamide peroxide) and anhydrous glycerol
- Proposed by Stewart in 1961 as an effective adjunct to
instrumentation for cleaning the root canal
- Germicidal action is greater than H2O2
- Excellent lubricant
- According to Walton, there is decreased chances of strip
formation/perforation while instrumenting curved canals with
glyoxide
- Less toxic to periapical tissues than NaOCl
- Greater solvent action than 3% H2O2
- Used in narrow & curved canals

33. • DISADVANTAGE
• It dissociates more slowly than hydrogen
peroxide (H2O2).
• So, its effervescence is prolonged but not as
pronounced

34. Chlorhexidene(CHX) –
- A bis-biguanide having 4 chlorophenyl rings and 2 biguanide
chains connected by a central hexamethylene bridge.
- 2% concentration is used as root canal irrigant
- At an acidic Ph (5.5-7), , CHX becomes dicationic i.e
possesses 2 +ve charges.
- Dicationic property makes it a highly interactive molecule-it
binds to the bacteria via 1 +ve charge and gets adsorbed on to
the tooth with the other.
- CHX is available in three forms:-
i) digluconate
ii) acetate
iii) Hydrochloride salt

35. Mechanism of action
• 2% Chlorhexidine digluconate is capable of
electrostatically binding to negatively charged
bacterial surfaces.
•
• The antimicrobial activity of CHX against gram-
positive bacteria and yeasts is attributed to its
ability to permeate the microbial cell wall and
cause coagulation of the cytoplasmic
components.

36. ADVANTAGES :-
- Less toxic compared to few other irrigants
- Broad spectrum antimicrobial action, effective even against bacteria such
as
E Faecalis & F. nucleatum associated with endodontic failures
- Bacteriostatic at a concentration of 0.12-2%,causing increased cell
permeability and leakage of important intracellular components
- Bactericidal at a concentration above 2% causing precipitation of bacterial
cytoplasm and ultimately cell death.
- Effective combinations of CHX and calcium hydroxide are available to
counteract obligate anaerobes
- Effective antifungal agent (C.Albicans)

37. - Absorption & Substantivity
- Binds to dentine & enamel & is gradually released over time
- Substantivity- sustained action within the root canals
- Antimicrobial effects outlasts the duration of irrigation(12
weeks)
- Low to almost nil toxic potential
- Widely used in infected canals, acute apical periodontitis &
retreatment cases.
- Biocompatible
- Substantivity property-imparts to its potential
of preventing bacterial colonization of root
canal walls for prolonged periods of time

38. DISADVANTAGES :-
- Lacks tissue dissolving ability -Ineffectiveness at dissolving
pulpal tissue
- Unable to remove the smear layer or neutralise
lipopolysaccharides
- Less effective against gram-ve bacteria(which predominate in
primary endodontic infection)
- Susceptible to the presence of organic material
- Antimicrobial effect of CHX is strongly reduced by the
presence of inflammatory exudates, serum albumin, dentin
matrix & heat killed cells of E.faecalis and C.Albicans
- May cause anaphylactic reactions and even anaphylactic shock
- May cause hypersensitivity reactions like contact dermatitis &
photosensitivity.
- Application of CHX to mucous membrane & intact skin can
cause allergic reactions

39. PRECAUTIONS:-
- Avoid direct contact between NaOCl and CHX as red CHX
crystals precipitate immediately
Precipitation of chlorhexidine when mixed with NaOCl

40. CHELATING AGENTS
Chelating agent is defined as a chemical which
combines with a metal to form chelate.
-Act on calcified tissues
-Act by substituting the Ca+2 ions in the dentin with Na ion,
forming soluble salts which facilitate canal enlargement.
-removes smearlayer

41. PROBLEMS
MISHAPS :-
Formation of false canal if used in blocked canals
Canal straightening, apical transportation and perforations
increased in curved canals on using larger & stiffer
instruments.
Damage to periapical bone on seepage.
Neutralize with NaOCl.
Residual EDTA present in dentinal tubules contributes to
ongoing demineralzation causing apical leakage (Cooke)
Reduce bond strength of resin cements to root dentin(Morris)

42. Ethylene Diamine Tetraacetic Acid
(EDTA)
-Commonest chelating agent
- Concentration 17%
-Discovered by Nygaard Ostby in 1957.
- Properties of 17% EDTA :-
Softening dentin
Good cleaning efficacy between 1-5 min. working time
Chelates the inorganic components of the dentine
Removal of smear layer when used alternatively with NaOCl

43. Demineralization of 20-30µ of dentin when used for 5 mins
Antimicrobial action against certain microorganisms
Relative non-toxicity causing only a moderate degree of
irritation.EDTA has a near neutral Ph of 7.3
Helps in bypassing of broken instruments in the canals

44. ADVANTAGES
Has no corrosive effects on the instruments
Ease in instrumentation
Reduces time necessary for debridement &
disinfection
Aids in enlarging narrow/obstructed canals
Highly biocompatible

45. PRECAUTIONS :-
- EDTA remains active within the canal for 5 days.
- At the completion of the appointment the canal must be
irrigated with NaOCl
- Long exposure time may cause excessive peritubular &
intratubular erosion
- If not inactivated the solution may seep into the periapical
tissues and damage the bone
- Extrusion affects immunological regulatory mechanisms
- Avoid prolonged exposure to EDTA as it may weaken root
dentine
- It is possible to overchelate a canal which can lead to
perforation

47. Factors determining efficiency of Chelating agents :-
Root canal length and width
Penetration depth of the material
Hardness of the dentin
Application time
Ph
Concentration

48. DECALCIFIERS
- High toxicity
- Uncontrollable decalcifying action
- Act by removing mineral salts from dentin to aid canal
preparation
- E.g: 30-50% citric acid, 50% HCl, 50% H2SO4, 40%
Polyacrylic acid, 25%Tannic acid

49. ORGANIC ACIDS
Citric acid –
- Demineralizes and removes smear layer effectively
- Acts as a chelating agent on dentin
- Occurs naturally in the body so is more acceptable
biologically than other acids(Jenkin & Dawer 1963)
-concentrations used of 10%,25% and 50% as a root canal
irrigant
- Compared to EDTA, 10% citric acid is more effective in
removing smear layer & in dissolving powdered dentine
- Enlarges the dentinal tubules by demineralizing the
intertubular dentine around the opening of the tubules
- Used in combination with NaOCl to effectively clean the root
canal
DISADVANTAGES –
- may leave precipitated crystals(calcium & phosphate
containing crystals) in the canal wall

50. Opened dentinal tubules of root canal dentine:
the smear layer was removed with citric acid

51. • Tannic acid
-Its use as a cleansing agent for root canal treatment was
suggested by Graham Mount
- Has been used extensively in the treatment of burns( more
than 100 years old)
- Acts as a surface coagulant by precipitating proteins
- 25% solution has been recommended to remove the smear
layer

52. • Iodine- Potassium Iodide
-Traditional root canal disinfectant
- 2% iodine in 4% potassium iodide
- can penetrate into microorganisms & attacks cell molecules
such as proteins, nucleotides & fatty acids , resulting in cell
death.
- kills a wide spectrum of microorganisms found in root canals
-Iodine compounds are bactericidal, fungicidal & virucidal.
- Iodine acts as an oxidizing agent by reacting with sulfhydryl
groups of bacterial enzymes, cleaving disulfide bonds
- Combinations of IKI and CHX may be able to kill calcium
hydroxide-resistant bacteria more efficiently

53. DISADVANTAGE:-
- Iodine causes an allergic reaction in some patients
- Iodine has also the potential to stain dentine
- Substances commonly found in the root canal inhibit the
antimicrobial efficiency of iodine

54. RECENT ADVANCES
• MTAD
- mixture of a tetracycline isomer(doxycycline,3%), an
acid(citric acid ,4.25%) and a detergent(Tween 80,0.5%)
- Antibacterial
- Removes most of the smear layer(low ph -2.15)
- Effective against E.faecalis(Doxycycline)
- Exhibits the property of Adsorption and Substantivity
- Biocompatible
- Causes decreased dentinal erosion compared to EDTA.
-Protocol for clinical use is 20 minutes with 1.3% NaOCl
followed by 5 minutes of MTAD.

55. - Less cytotoxic than most irrigants
- MTAD displayed good tissue dissolving capability only when
NaOCl was used during instrumentation
• Disadvantages :-
- The alternating use of NaOCl and MTAD might potentially
cause iatrogenic tetracycline staining of teeth.
- Incidence of tetracycline-resistant bacteria in root canals
- Seems to adversely influence the physical properties of
dentine or the bonding strength of adhesives to dentine

56. • Carisolv
- agent used for chemo mechanical caries removal
- Antibacterial
- Has collagen dissolving potential(M.G Al Kilani and Dummer)
• Ruddles solution
- Radiopaque agent Hypaque+5%NaOCl+17%EDTA
- used to detect the presence of lateral/accessory canals
-improves diagnostic accuracy, treatment planning &
management of procedural accidents.
- Mechanism of action :-
i) Solvent action of NaOCl,improved penetration due to EDTA
and radiopacity due to hypaque helps to visualize the shape &
microanatomy of canals & dentin thickness
ii) Solvent action of NaOCl clears the contents of root canal
system & thus enables hypaque to flow into every nook &
corner of the canal system such as fracture, missed canals &
defective restorations

57. • Ozonated water
- Powerful antimicrobial agent against bacteria, fungi, protozoa and viruses.
- Ozonated water may prove to be useful to control oral infectious
microorganism
-Advantages :-
i) Its potency
ii) Ease of handling
iii) Lack of mutagenicity
iv) Rapid antimicrobial effects
• Hydroxyethylidene bisphosphonate (HEBP)
- Also called as etidronate
- Decalcifying agent suggested as an alternative to citric acid or EDTA
- Less toxic

58. Factors affecting the efficacy of an irrigant
 Volume of the irrigant used
 Concentration of the irrigant
 Frequency of irrigation
 Temperature of the irrigant
 Length and time of intracanal contact
 Gauge of the irrigating needle
 Depth of penetration
 Diameter of the prepared canals
 Age of the irrigating solution
(grossman-13th edtn)

59. TECHNIQUES OF ENDODONTIC IRRIGATION
• Rubber dam application
• Access gained to root canal system
• Debridement & flushing of root canal with irrigating solution
• Enlarge the canal orifice
• Flare the canals so that needle of irrigating syringe passes
easily into the canal
• Apical preparation should be size 35-40
• Needle is bent at an obtuse angle to allow easy access into root
canals
• Needle is inserted into the canal and slowly advanced apically
without binding with the canal; walls
• Needle is withdrawn approx. 2 mm when resistance is felt
• Irrigating solution is deposited slowly without any pressure

60. Loose fitting needle
providing space for
optimal flow of
irrigant
A well prepared canal
allows better use of
irrigant
A sterile gauge piece is
placed near access
opening to absorb
excess irrigating solution and
to check the debris from root
canal

61. DELIVERY SYSTEMS
• Disposable 5ml/2-5ml,25-28 gauge syringe needles are preferred
• Needle is bent at an obtuse angle at the center to facilitate placement
• Introduce the needle as near as possible to working length to improve the
irrigation efficiency
• Needle is inserted partway into the canal without binding to the walls
• Solution is ejected passively and the needle oscillated to pump the solution
safely within the confines of the canal
• Sufficient space should exist
• between the canal and the needle
• to allow backflow of the solution.

62. • Types of needle tips:
- conventional needle with the beveled tip
- perforated needle allows 360°flow of irrigant
- monojet notched tip needle eliminates pressure & allows a greater
volume
to flow passively
- Pro-rinse blunt-ended, side-vented needle eliminates the problem o
the
‘water canon’ effect of open ended needle.
- Flexible irrigation needles with a safety tip for severely curved can

63. Needle with notched tip
Needle with bevel Monojet endodontic needle

64. Flexible 30-gauge irrigation needles with
safety tips (NaviTips, Ultradent, Munich,
Germany)
Curved root canal enlarged
with rotary nickel-
titanium
Needle with side venting helps to move
the irrigant sideways in whole canal

65. IRRIGANT ACTIVATION/AGITATION
• Irrigant activation/agitation is the process of activating an
irrigant through the introduction of an instrument into the
canal and moving it within the canal with a reciprocating,
oscillating, or rotating action.

66. IRRIGANT AGITATION TECHNIQUES
Manual
i. a. Syringe irrigation with
needles
ii. b. Brushes
iii. c. Manual dynamic
agitation
Machine Assisted
• a. Rotary brushes
• b. Continuous irrigation during
instrumentation
• c. Sonic irrigation
• d. Ultrasonic irrigation –
-Continuous
ultrasonic irrigation
(CUI)
– Passive ultrasonic
irrigation (PUI)
e. Pressure alternation devices –
-EndoVac
–RinsEndo

67. • SYRINGE IRRIGATION WITH NEEDLES
• This technique involves dispensing of an irrigant into the root
canal using irrigation needles/cannulae of varying gauges.
• The advantage of this technique is length control; however, it
results in a weak mechanical flushing action.
• The recommendations for syringe irrigation are as follows:
Gauge: Sizes 27 and 30 are most commonly recommended
• Depth of insertion: 2–3 mm from the working length
• Design: Blunt-ended side-vented needle

68. BRUSHES
• These are adjunctive aids in canal
debridement or agitation of irrigants.
• The bristles help in cleaning the
uninstrumented recesses of the radicular
pulp space.
• Examples include the Endobrush (C&S
Micro-Instruments Ltd, Ontario, Canada) and
NaviTip FX (Ultradent Products Inc, South
Jordan, UT).

69. • MANUAL DYNAMIC AGITATION
• In this technique, a well-fitted greater taper gutta-percha
master cone is moved up and down the instrumented
canal containing the irrigant in short 2- to 3-mm strokes.
• The frequency of the push–pull motion is 100 strokes per
30 seconds.
• This results in a hydrodynamic effect improving irrigant
exchange and replacement.

70. Rotary Brushes
• Consist of microbrushes attached to rotary handpieces,
e.g., CanalBrush (Coltene Whaledent, Germany).

71. CONTINUOUS IRRIGATION DURING
INSTRUMENTATION
• The device contains an irrigant delivery unit attached to the
Quantec-E-Irrigation System
• (SybronEndo, Orange, CA), which provides increased irrigation
depth and duration.

72. SONIC IRRIGATION
• This technique involves sonic waves operating at a frequency of 1–6
kHz which help in irrigant activation,
• e.g., EndoActivator System (Dentsply Tulsa Dental Specialties,
Tulsa, OK).
• It consists of a portable handpiece with three different sizes of
polymer tips operating at 10,000 cycles per minute.

73. ULTRASONIC IRRIGATION
• This modality operates at frequencies of 25–30
kHz setting up transverse vibrations with a
characteristic pattern of nodes and antinodes.

74. A.CONTINUOUS ULTRA SONIC IRRIGATION
(CUI)
• In CUI, an irrigant is simultaneously activated
ultrasonically while it is being delivered continuously via
an irrigation-delivering syringe

75. B.PASSIVE ULTRASONIC IRRIGATION
(PUI)
• It relies on the transmission of
acoustic energy from an
oscillating file or a smooth wire
to an irrigant in the root canal.
• The energy is transmitted by
means of ultrasonic waves and
can induce acoustic streaming
and cavitation of the irrigant.
Ultrasonic irrigation

76. PRESSURE ALTERNATION DEVICES
• 1.ENDO VAC
• 2.RINS ENDO
• ENDOVAC
• The device consists of a macrocannula and a microcannula
connected via a tubing to an irrigating syringe and the high-speed
suction of a dental unit.
• The macrocannula aids in the gross, initial flushing of the coronal
part of the root canal while the microcannula can be positioned at
the working length to facilitate irrigation.

77. MECHANISM OF ACTION
• The EndoVac functions on negative pressure irrigation
technology with the following advantages:
• Irrigation at the working length with minimal irrigant
extrusion
• More debris removal at
1 mm from the working length
• Avoids air entrapment

78. RINS ENDO
• It is based on pressure-suction technology with
65 μL of a rinsing solution oscillating at a
frequency of 1.6 Hz.

79. Endo irrigator
-Uses hydrodynamic activation on the basis of
innovative pressure-suction technology
- 65 micro litres of sodium hypochlorite solution
oscillating at a frequency of 1.6 hertz are aspirated
from an attached syringe by a clock generator in
hand piece & transmitted to root canal via
RinsEndo cannula.

80. COMBINATION OF IRRIGANTS
CONDITION IRRIGANT
Necrotic pulp NaOCl + CHX/H2O2
Vital pulp exposure NaOCl + H2O2
Calcified/Sclerotic canal EDTA + NaOCl
Infected canal-exudate present NaOCl + H2O2
Periapical abscess – to establish
drainage
Hot water/saline…. Later
NaOCl
Open apex/apical perforation H202 + CHX
Curved canals Gloxide + NaOCl
Canals left open for drainage H202 + NaOCl
Retreatment cases CHX + NaOCl
Final rinse-to remove smear EDTA + NaOCl

81. IRRIGATION PROTOCOL
• Size of apical preparation : at least size 35
• After access cavity : flush the canals with NaOCl
• Between instruments:2-5 ml of NaOCl per canal
• After shaping : 5-10 ml of NaOCl per canal
• After shaping : irrigation with 5 ml of EDTA per canal for 1
minute(or with citric acid)
• Final rinse with 2 ml NaOCl per canal
• Optional : final irrigation with chlorhexidine
• Optional : rinse with alcohol before obturation

82. • Photo Activated Disinfection(PAD)
- It is a breakthrough in the fight against pathogenic bacteria
- It is a fast, effective and minimally invasive disinfection
system which is considered to kill more than 99.99% bacteria
in the endodontic biofilm
- Mechanism of PAD :-
A low powered laser light is transmitted through the
disposable fibro-optic tip to activate the PAD antibacterial
solution
Within 1-3 minutes, the PAD system eliminates more than
99.99% bacteria found in root canals

83. ADVANTAGES :-
1) Most effective antimicrobial agent. Can effectively kill
gram-negative,gram-positive,aerobic and anaerobic bacteria.
2) Overcomes the problems of antibiotic resistance
3) Can kill bacteria present in complex bio-film such as
subgingival plaque which is typically resistant to action of
anti microbial agents
4) PAD does not pose any thermal risk due to low power of
PAD laser
5) Does not cause any sensitization
6) Neither the PAD solution nor its products are toxic to
patients

84. CONCLUSION