DONE BY DR.MARWA AHMED
The use of irrigating solutions in combination with canal
instrumentation, loosen debris, pulp tissue and micro-organisms
from the irregular dentin walls so that they can be removed from
Irrigation is defined as “to wash out a body cavity or
wound with water or a medicated fluid”
Objectives of irrigation
Mechanical & Chemical functions
Smear layer removal
Requirements of Ideal Irrigants
1. It must have broad spectrum antimicrobial effect.
2. It must aid in the root canal debridement.
3. Ability to dissolve necrotic tissue or debris.
4. Low toxicity level.
5. Act as a good lubricant.
6. Low surface tension to flow
easily into the inaccessible areas.
7. Remove the smear layer.
Factors Effecting The Irrigants action
3. Presence of organic tissue.
The smear layer
The smear layer is a micro – crystalline layer of cutting debris covering
the canal walls after the preparation and its removal may aid in
better adaptation of the obturating materials to the canal walls.
It consist of:
A. Organic layer ----- removed by irrigants.
B. Inorganic layer --- removed by chealating agent.
Cross section of root dentin covered
by the smear layer created by
Notice smear plugs in dentin canals
Commonly used irrigating agents
used in endodontics
CHEMICALLY INACTIVE SOLUTIONS
1.Normal saline .
2.Local anaesthetic solution .
CHEMICALLY ACTIVE SOLUTIONS
1.Main solutions: A. Sodium hypochlorite (NAOCL)
B. Chlorhexidine (CHX)
2. Decalcifying solutions: A. Ethylene diamine tetra acetic acid(EDTA).
B. Citric acid.
C. Hydroxy ethylidene-bisphosphonate(HEBP)
D. Qmix (químico MECÁNICA MIX)
E. Mixture of tetracycline Acid detergent(MTAD).
3.Other irrigating agents : A. Hydrogen peroxide.
B. Iodine based compounds.
4. Recent advances in irrigation: A. Carisolv.
B. Ruddles solution.
C. Bioactive materials like bio(active) glass
A. Sodium hypochlorite (NaOCl) 0.5-5.25%
the ideal concentration 2.5%
Current irrigant of choice
Effective antimicrobial agent
Excellent organic tissue solvent
Effective fairly quickly
Toxic (hypochlorite accident)
Corrodes, unpleasant odor
Removes only the organic part
of the smear layer
Safety (Sodium hypochlorite accidents)
Toxic effects of NaOCl on vital
tissues include hemolysis,
epithelial ulceration, and necrosis
Several mishaps during root
canal irrigation can range from
damage to the patient’s clothing,
splashing the irrigant into the
patient’s or operator’s eye,
injection through the apical
Treatment protocol for sodium
Early recognition of extrusion,
Immediate canal irrigation with normal saline,
Encouragement of bleeding,
Pain control with local anesthetics and analgesics and warm
compresses and frequent warm mouth rinses for stimulation of the
local systemic circulation,
Reassurance of the patient, and
Monitoring of improvement.
Plastic bib to protect patient’s clothing
Rubber dam isolation
side-exit Luer-Lock needles
Irrigation needle a minimum of 2
mm short of the working length
Avoidance of binding of the needle
into the root canal
Avoidance of excessive pressure during irrigation
b.CHLORHEXIDINE (CHX) (0.2% - 2%)
1. It has antibacterial effect (long standing
effect by binding to hydroxyapatite and in
combination with Ca(OH)2 effective against
2. Low toxicity compared to NaOCL.
1. main solutions
1.Does not have tissue solvent action.
4.Toxic (in case of swallowing).
So to over come these disadvantages it shouldn’t use alone
but in combination with other irrigation solutions.
NaOCl + CHX
2.5% NaOCL + 0.2 % CHX
property that is better
than that obtained with
use of CHX alone
less toxic then NaOcl
Immediate formation of an orange-
brown precipitate (para-chloroaniline)
NaOCl+CHX precipitate tends to
occlude the dentinal tubules
Precipitate could be prevented by using
absolute alcohol or minimized by using
saline and distilled water as intermediate
A. Ethylene Diamine Tetra Acetic Acid ( EDTA)
Remove the inorganic part of the smear layer
Contribute to the elimination of bacteria in the root canal
Combination products have wide-spectrum antimicrobial activity.
EDTA may have antifungal activity
. It used for cleaning and widening the canal.
. Used in concentration of 17%.
. Optimal working time 15 minutes.
1.Demineralize dentin (20–50 um).
2. Does not have tissue solvent action.
So to over come these disadvantages it
shouldn’t use alone but in combination with
other irrigation solutions.
EDTA 17% + NaOCl 2.5%
EDTA causes NaOCl to lose its tissue dissolving capacity,
and virtually no free chlorine is available
EDTA 17% + CHX 0.2%
Immediate formation of a white, foggy
Precipitate involves the chemical degradation
REDTA EDTA + Sodium hydroxide + cetyl trimethylammonium bromide + water
RC prep EDTA + urea peroxide
EDTAC EDTA + Cetavlon
EGTA ethylene glycol bis (β aminoethyl ether)-N,N,N,N- tetra acetic acid
B. CITRIC ACID 10%
can also be used for irrigation of the
root canal and for removal of smear layer
used in various concentrations, ranging
from 1% to 50%, with a 10% solution
being the most common
10% citric acid has been shown to remove the smear layer more effectively
from apical root end cavities than ultrasound
10% citric acid was more effective than 1% citric acid, which was more
effective than EDTA in demineralizing dentin
C. Hydroxy ethylidene-bisphosphonat(HEBP) 9%-18%
also called etidronic acid
Chelator that can be used in combination with sodium
hypochlorite (NaOCl) without affecting its proteolytic or
HEBP is a weak decalcifying agent and hence cannot be used as a mere
. Does not have tissue solvent action.
So to over come these disadvantages it shouldn’t use alone but in combination
with other irrigation solutions.
NaOCl 5% + HEBP 18% :
better tissue dissolution capacity
reduces dentin debris accumulation
NaOCl 5% + HEBP 18%
D. QMiX(QUÍMICO MECÁNICA MIX)
Q mix is an irrigation solution used as a
final rinse. It is a combination of CHX with
EDTA and a surfactant solution to improve
penetration in dentinal tubules.
Low surface tension is one of the ideal characteristics
of an irrigant
Superior Antibacterial efficacy.
Superior smear layer removal
Ready to use, fast working
Less demineralization OF DENTEN compare to EDTA
6% NaOCl and QMiX were the most effective disinfecting solutions against the
young biofilm, whereas against the 3-week-old biofilm, 6% NaOCl was the most
effective followed by QMiX
E. MTAD ( mixture of tetracyclin , acid and detergent).
MTAD is a mixture of doxycycline
(150MG/5ML), citric acid, and a
IS A MIXTURE OF CITRIC ACID DOXYCYCLINE 50MG/5ML
AND POLYPROPYLENE GLYCOL AS DETERGENT
Smear layer removal
BOTH MTAD & TETRACLEAN performed better than EDTA in cleaning dentinal
tubules of debris and removing the smear layer in the apical third of root canals AND
ALSO BOTH created less erosion than EDTA in the coronal and middle thirds of the root
1.3% NaOCl followed by 5 min MTAD was more effective in the disinfection of canals
than a protocol of 5.25% NaOCl followed by 1 min 17% EDTA and then 5 min 5.25%
NaOCl as a final rinse
A . HYDROGEN PEROXIDE
an oxidizing agent used in conc. of 3-5%
. It is odorless, clear liquid.
. Its effervescence action capable for removing loose debris
from inside the canal.
. Release of nascent oxygen (O2) works against anaerobic
3.Other irrigating agents
1. Tissue emphysema if it passes to the periapical tissue.
2. Post – Operative Pain
Note:it should not use alone or as final irrigant
1. NaOCl 5.25% + H2O2 3%
produce foaming action flush the debris out of root
significantly increase dentinal permeability
deactivationof bacterial endotoxins
In combination antibacterial effect of both solutions was less than
that of individual solutions and it used to decrease tissue dissolving action
Combination with other irrigant
NaOCl 5.25% + H2O2 3%
2. CHX 2% + H2O2 3%
CHX +H2O2 when combined do not counter act one
another at specific concentration
H2O2 Smear layer removal
greater antibacterial effect at deeper layers
kills most of the bacteria in the area
adjacent to the lumen
allow penetration of
CHX into the dentinal
CHX 2% + H2O2 3%
B. IODINE BASED COMPOUNDS
Aqueous iodine solutions are rather
development of iodophors (‘iodine
Antimicrobial action of iodine is rapid, even at low concentrations, Iodine penetrates
into microorganisms and attacks key groups of cell molecules, such as proteins,
nucleotides, and fatty acids, resulting in cell death
Allergic reactions to iodine and the staining of dentin.
Toxic in case of swallowing .
In endodontics, iodine potassium
iodide (IPI) in 10% concentration is
3.Other irrigating agents
10% solution of carbamide peroxide in glycerol
provides lubrication without softening dentin.
antimicrobial activity more than 3% H2O2.
produces transient energetic effervescence with NaOCl .
useful in narrow and curved canals.
does not remove smear layer.
3.Other irrigating agents
4.RECENT ADVANCES IN IRRIGATION
0.2% CHX and 0.2% citrimide
better penetration of CHX into the dentinal tubules and better antimicrobial efficacy
potential as on irrigant as it is antibacterial and has collagen dissolving potential
C. Ruddles solution
Radiopaque agent Hypaque + NaOCl + EDTA
used to detect the presence of lateral / accessory canals
D. Bioactive materials like bio(active) glass
Antimicrobial activity against a range of microbes
naturally occurring polysaccharide chitosan
at 0.2% concentration as chelating agent
without the negative effects of high
easily and locally available, cheap,
biocompatible, biodegradable, has
the property of bioadhesion and has