This document discusses endodontic materials used for root canal therapy, including irrigants and intracanal medicaments. It describes the objectives of root canal therapy as removing infected pulp, cleaning and shaping the root canal system, and filling to prevent reinfection. Sodium hypochlorite and EDTA are identified as the best irrigants to use in alternating fashion, with chlorhexidine used as a final rinse. Calcium hydroxide and antibiotics are discussed as common intracanal medicaments used between appointments. Precise irrigation techniques and use of materials with good antimicrobial efficacy and biocompatibility are emphasized to improve treatment outcomes.

1. Endodontic Materials:
Endodontic Materials:
Root canal irrigants
Root canal irrigants
and medicaments
and medicaments

2. The main objectives of root canal therapy are:
The main objectives of root canal therapy are:
• Removal of the pathologic pulp.
Removal of the pathologic pulp.
• Cleaning and shaping of the root canal system.
Cleaning and shaping of the root canal system.
• Three dimensional obturation to prevent reinfection.
Three dimensional obturation to prevent reinfection.

5. There is no definitive evidence in the literature to
show that mechanical instrumentation alone will
predictably result in bacteria-free root canal
systems.
Irrigation is an essential part of root canal
debridement because it allows for cleaning beyond
what might be achieved by root canal
instrumentation alone.

6. Disinfection of the root canal system is one of the
primary aims of root canal treatment. This can be
achieved through the use of various antimicrobial
agents in the form of irrigants (only used for
relatively short periods of time) and
medicaments (days or several weeks).

7. Irrigants
Irrigants
Ideal properties:
Ideal properties:
Lubricant
Lubricant
Antimicrobial
Antimicrobial
Dissolve organic debris
Dissolve organic debris
Flushing
Flushing
Biocompatible
Biocompatible
Cheap
Cheap

8. Functions of irrigants
Functions of irrigants
 Irrigants are used to clean the root canal and are
Irrigants are used to clean the root canal and are
used in association with the shaping instruments.
used in association with the shaping instruments.
 Functions of irrigants include:
Functions of irrigants include:
1.
1. Lubrication of instruments used to shape the canal.
Lubrication of instruments used to shape the canal.
2.
2. Flushing out of gross debris.
Flushing out of gross debris.
3.
3. Dissolution of organic and inorganic tissue.
Dissolution of organic and inorganic tissue.
4.
4. Antimicrobial effect.
Antimicrobial effect.

9. Phenol based agents, Aldehydes and Halidyes
Phenol based agents, Aldehydes and Halidyes
Phenol, parachlorophenol(PCP), camphorated mono
Phenol, parachlorophenol(PCP), camphorated mono
PCP, cresol, creosote, formacresol and chlorine.
PCP, cresol, creosote, formacresol and chlorine.
Antibacterial agents.
Antibacterial agents.
Highly toxic agents.
Highly toxic agents.
Possible mutagenic and carcinogenic effect.
Possible mutagenic and carcinogenic effect.

10. Classification of irrigants
Classification of irrigants
Chemically inactive irrigants
Chemically inactive irrigants
Water
Water
Saline
Saline
Local anaesthetic solution
Local anaesthetic solution
Chemically active irrigants
Chemically active irrigants
Sodium hypochlorite (NaOCl).
Sodium hypochlorite (NaOCl).
Oxidizing agents as Hydrogen peroxide (H
Oxidizing agents as Hydrogen peroxide (H2
2O
O2
2)
)
Chelating agents as EDTA.
Chelating agents as EDTA.

11. Sodium hypochlorite
Sodium hypochlorite
0.5-5.25 %
0.5-5.25 %
Antibacterial and antifungal.
Antibacterial and antifungal.
Excellent tissue dissolving ability.
Excellent tissue dissolving ability.
Heat may enhance efficiency.
Heat may enhance efficiency.
Has deteriorative effects on mechanical properties of
Has deteriorative effects on mechanical properties of
dentine.
dentine.
Apical reaction
Apical reaction
Rubber dam
Rubber dam

12. Hydrogen peroxide
Hydrogen peroxide
3% +/- NaOCl
3% +/- NaOCl
Production of O2 eliminate anaerobes
Production of O2 eliminate anaerobes
Bubbles may prevent adequate contact of irrigant
Bubbles may prevent adequate contact of irrigant
with debris
with debris
Limited shelf life
Limited shelf life

13. Chlorhexidine
Chlorhexidine
Hibisrcub
Hibisrcub
Usually effective in 2% concentration.
Usually effective in 2% concentration.
Antibacterial and antifungal.
Antibacterial and antifungal.
Substantivity up to 12 weeks.
Substantivity up to 12 weeks.
Flushing
Flushing
Lubricant
Lubricant
Does not dissolve organic debris.
Does not dissolve organic debris.
Should be used as a final rinse.
Should be used as a final rinse.

14. Chelating agent
Chelating agent
Ethylene Diamine Tetracetic Acid “EDTA” (File-eze,
Ethylene Diamine Tetracetic Acid “EDTA” (File-eze,
RC Prep)
RC Prep)
Remove smear layer allowing
Remove smear layer allowing
cleaning of tubules
cleaning of tubules
Soften dentine
Soften dentine
Not antibacterial
Not antibacterial
File-eze is water soluble unlike RC Prep which
File-eze is water soluble unlike RC Prep which
contains carbowax and is difficult to remove
contains carbowax and is difficult to remove

15. • Introduced by Torabinejad et al. in 2003 .
• Mixture of 3% doxycycline, 4.25% citric acid
and a detergent (0.5% Polysorbate 80).
•MTAD is able to remove the smear layer
and is effective against E. faecalis.
•Shows substantivity up to 4 weeks.
BioPure (MTAD)
BioPure (MTAD)

16. Irrigants
Irrigants
Sterile water
Sterile water
Local anaesthetic
Local anaesthetic
Saline (0.9%)
Saline (0.9%)
They only provide lubrication and gross debris removal
They only provide lubrication and gross debris removal
functions.
functions.

17. Best Irrigation protocol is the alternating use
of NaOCl with EDTA or BioPure. CHX can be
used as a final rinse.
Irrigants have to be used in large volumes
and to be confined to root canal space. Never
to be delivered with excessive force.

18. Irrigation Delivery and Agitation techniques:
A-Manual Techniques:
1.Syringe irrigation with needles: passively or with
agitation. Irrigant delivered distally or laterally.
2.Brushes: for irrigant agitation and debridement
of root canal wall.
3.Manual-dynamic irrigation: well-fitted gutta
percha cone.

19. B-Machine-assisted Techniques:
1.Rotary brushes.
2.Continuous irrigation during rotary instrumentation.
3.Sonic irrigation.
4.Ultrasonic irrigation.

20. Intracanal medicaments
Intracanal medicaments
If root canal treatment can’t be finished in a single visit,
If root canal treatment can’t be finished in a single visit,
root canals are dressed with medicaments.
root canals are dressed with medicaments.
A medicament is an antimicrobial agent that is placed
A medicament is an antimicrobial agent that is placed
inside the root canal between treatment appointments in
inside the root canal between treatment appointments in
an attempt to destroy remaining microorganisms and
an attempt to destroy remaining microorganisms and
prevent reinfection.
prevent reinfection.

21. Functions of intracanal medicaments:
Functions of intracanal medicaments:
Primary function: antimicrobial activity
Primary function: antimicrobial activity
 Antisepsis
Antisepsis
 Disinfection
Disinfection
Secondary functions
Secondary functions
 Hard-tissue formation
Hard-tissue formation
 Pain control
Pain control
 Exudation control
Exudation control
 Resorption control
Resorption control

22. Intracanal medicament
Intracanal medicament
Ideal properties
Ideal properties
 Antibacterial
Antibacterial
 Penetrates dentinal tubules
Penetrates dentinal tubules
 Control exudation or bleeding
Control exudation or bleeding
 Biocompatibile.
Biocompatibile.
 Eliminates pain
Eliminates pain
 Induce calcific barrier
Induce calcific barrier
 No effect on temporary
No effect on temporary
 Radio-opaque
Radio-opaque
 Does not stain tooth
Does not stain tooth

23. The clinical effectiveness of these agents
must be evaluated in the light of the
complexity of root canal anatomy and
polymicrobial nature of root canal
infections.

24. The antimicrobial efficacy of intracanal
medicaments on bacterial biofilms still need to be
confirmed.
Root canal preparation, with careful disinfection and
use of intracanal substances that provide good
antimicrobial efficacy, tissue dissolution capacity,
and acceptable biocompatibility, will definitely
improve the prognosis of the treatment of apical
periodontitis.

25. Calcium hydroxide
Calcium hydroxide
 Hypocal
Hypocal
 Antibacterial (pH>12)
Antibacterial (pH>12)
 Denatures protein
Denatures protein
 Synergestic with NaOCL
Synergestic with NaOCL
 Cytotoxic-local necrosis,
Cytotoxic-local necrosis,
calcific barrier
calcific barrier
 Cheap
Cheap
 Dries weeping canals
Dries weeping canals
 Forms a calcific barrier
Forms a calcific barrier

26. Antibiotics
Antibiotics
Tetracyclines have been used to remove the
smear layer from instrumented root canal walls,
for irrigation of retrograde cavities during
periapical surgical procedures , and as an
intracanal medicament.
Combination of drugs required to be effective
Resistant strains becoming more difficult to treat
Allergies.

27. Steroids
Steroids
Triamicinolone, prednisolone
Pain relief but no evidence of more effective than
Ca(OH)2
?use in root resorption by inhibiting odontoclasts
?depresses the host inflammatory response
Not antibacterial but can be mixed with Ca(OH)2
Ledermix= triamicinolone+ tetracycline

28. CHX
CHX
Owing to the greater activity against Gram-positive than
Gram-negative organisms, application of CHX as
intracanal medicament is preferred in retreatment case
compared with initial endodontic infections.