irrigation and intracanal medicaments

1. Irrigation and Intracanal
Medicaments

2. Ideal Requirements for an Irrigant
• 1. Broad spectrum antimicrobial properties.
• 2. Aid in debridement of the root canal system.
• 3. Ability to dissolve necrotic tissue or debris.
• 4. Low toxicity level.
• 5. Good lubricant.
• 6. Low surface tension to flow into inaccessible area.
• 7. Ability to sterilize the canal.
• 8. Prevent/dissolve smear layer.
• 9. Inactivate endotoxin.

3. Functions of irrigants
• 1. Remove dentinal shavings by physical flushing.
• 2. Increase the efficiency of instruments.
• 3. Dissolve necrotic tissue.
• 4. Remove debris from lateral and accessory canals.
• 5. Germicidal as well as antibacterial properties.
• 6. Bleaching action.
• 7. Irrigants with lubricating agent further increase the
efficiency.
• 8. Opening of dentinal tubules by removal of smear layer.

4. Factors modifying the activity of
irrigating solutions
• 1. Concentration: Tissue dissolving capability of NaOCl is higher
at 5.2 percent.
• 2. Contact: To effective, irrigant must come in contact with the
substrate.
• 3. Presence of organic tissue: Organic tissues must be removed
for effective irrigation.
• 4. Quantity of the irrigant used: Increase in quantity increases the
effectiveness.
• 5. Gauze of irrigating needle: 27 or 28 gauze is preferred for better
penetration in the canal.
• 6. Surface tension of irrigant: Lower the surface tension, better
is wettability.

5. • 7. Temperature of irrigant: Warming the NaOCl increases its
efficacy.
• 8. Frequency of irrigation: More is frequency, better are the
results.
• 9. Level of observation.
• 10. Canal diameter: Wider the canal, better is action of
irrigant
• 11. Age of irrigant: Freshly prepared solutions are more
efficient then older ones.

6. Commonly used irrigating solutions
• Chemically non-active solution
• Water
• Saline
• Local anesthetic
• Chemically active materials:
• Alkalis: Sodium hypochlorite 0.5-5.25 percent
• Chelating agents: Ethylene diamine tetra acetic acid (EDTA)
• Oxidizing agents: Hydrogen peroxide, carbamide peroxide
• Antibacterial agents: Chlorhexidine, Bisdequalinium acetate
• Acids: 30 percent hydrochloric acid
• Enzymes: Streptokinase, papain, trypsin
• Detergents: Sodium lauryl sulfate

7. Sodium Hypochlorite
• Mechanism of Action
• reactive chlorine in aqueous solution exists in two forms-
hypochlorite (OCl–) and hypochlorous acid (HOCl).
• State of available chlorine depends on pH of solution, i.e. above
pH of 7.6, it is mainly hypochlorite form and below this pH, it is
hypochlorous acid.
• Presence of 5 percent of free chlorine in sodium hypochlorite is
responsible for breakdown of proteins into amino groups
• The pH of commonly used sodium hypochlorite is 12, at
which the OCl form exits. Hypochlorite dissolves necrotic
tissue because of its high alkaline nature (pH 12)

9. Advantages of Sodium Hypochlorite
1. It causes tissue dissolution.
2. It has antibacterial and bleaching action.
3. It causes lubrication of canals.
4. Economical.
5. Easily available

10. Disadvantages
1. Because of high surface tension, its ability to wet dentin is less.
2. Irritant to tissues, if extruded periapically, it can result in severe
cellular damage.
3. If comes in contact, it cause inflammation of gingiva because of its
caustic nature.
4. It can bleach the clothes if spilt.
5. It has bad odor and taste.
6. Vapors of sodium hypochlorite can irritate the eyes.
7. It can be corrosive to instruments.

11. HYDROGEN PEROXIDE
• 3 percent solution
• It rapidly dissociates into H2O + [O] (water and
nascent oxygent).
• 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.

12. CHLORHEXIDINE
• optimal antimicrobial action between pH 5.5-7.0
• 2% in concentration
• At low concentration, it acts as a bacteriostatic, whereas at higher
concentrations; it causes coagulation and precipitation of cytoplasm
and therefore acts as bactericidal.

13. Advantages and Uses
1. A 2 percent solution is used as root irrigant in
canals.
2. A 0.2 percent solution can be used in controlling
plaque activity.
3. It is more effective on gram-positive bacteria
than gram negative bacteria.

14. Disadvantages
• 1. It is not considered as the main irrigant in
standard endodontic therapy.
• 2. It is unable to dissolve necrotic tissue
remnants.
• 3. It is less effective on gram-negative than on
gram-positive bacteria.

15. CHELATING AGENTS
• EDTA and other chelating agents like citric
acid, polyacrylic acids are used for this
purpose

16. Functions of EDTA
• Lubrication
• Emulsification
• Holding debris in suspension
• Smear layer removal

17. Uses of EDTA
• It has dentin dissolving properties
• It helps in enlarging narrow canals
• Makes easier manipulation of instruments
• Reduces time needed for debridement

18. INTRACANAL MEDICAMENTS
• Destroy the remaining bacteria and also limits
the growth of new arrivals.
• Useful in treatment of apical periodontitis for
example in cases of inflammation caused due
to over instrumentation

19. Eugenol

20. Uses of Eugenol
1. Used as an intracanal medicament.
2. Used as a root canal sealers.
3. Part of temporary sealing agents.

21. Phenol
• it has strong inflammatory potential, so, at present,
it is rarely used as an intracanal medicament.
• Liquefied phenol (Carbolic acid) consists of 9 parts of
phenol and 1 part of water.
• Uses
a. It is used for disinfection before periapical surgery.
b. It is also used for cauterizing tissue tags that resist
removal with broaches or files.

22. Camphorated Monoparachlorophenol
(CMCP)
• It is probably the most commonly used medicament in
endodontics presently, even though its use has
decreased considerably in the past few years
• Composition
2 parts of para-chlorophenol
+
3 parts gum camphor
↓
Camphorated monochlorophenol (CMCP)
• Uses
Used as a dressing of choice for infected teeth.

23. Formocresol
• Formocresol contains formaldehyde as its main
ingredient and is still widely used medicament for
pulpotomy procedures in primary teeth.
• its toxic and mutagenic properties are of concern
• Uses
Used as dressing for pulpotomy to fix the
retained pulpal tissue

24. • Composition of formocresol
Formaldehyde — 19 percent
Cresol — 35 percent
Water and glycerine — 46 percent

25. Calcium Hydroxide
• Indications of Calcium Hydroxide
• In weeping canals
• In treatment of phoenix abscess
• In resorption cases
• For apexification
• During pulpotomy
• For non surgical treatment of periapical lesion
• In cases of direct and indirect pulp capping
• As sealer for obturation
• To decrease postoperative pain after over
instrumentation

26. • Functions of Ca(OH)2
1. Inhibits root resorption
2. Stimulates periapical healing
3. Encourage mineralization