This document discusses root canal irrigants, including their history, functions, classifications, examples of different types of irrigants, and details on specific irrigants like sodium hypochlorite and EDTA. The key points are:
1. Root canal irrigants clean and disinfect the root canal system. Sodium hypochlorite and EDTA are commonly used irrigants.
2. Sodium hypochlorite dissolves organic tissue through the release of hypochlorous acid and has antimicrobial properties. EDTA is a chelating agent that removes the smear layer and demineralizes dentin.
3. Irrigants are classified as chemically active
1) The document discusses various intracanal medicaments that have been used in endodontics, including phenolics, aldehydes, halides, calcium hydroxide, and antibiotics.
2) It provides classifications of intracanal medicaments according to Grossman and the Dental Council of North America.
3) Common intracanal medicaments discussed in detail include calcium hydroxide, chlorhexidine, iodine potassium iodide, corticosteroid-antibiotic combinations, and Ledermix. Their compositions, applications, and limitations are described.
This document discusses root canal sealers, including their definition, requirements, functions, and classifications. It describes various common sealers such as zinc oxide eugenol sealers like Kerr Pulp Canal Sealer, Procosol, and Grossman Sealer. It also discusses non-eugenol sealers, medicated sealers, and calcium hydroxide based sealers. The document provides details on the composition, properties, advantages, disadvantages and uses of different sealers.
This document discusses ideal requirements, functions, and commonly used irrigating solutions and intracanal medicaments in endodontic treatment. Sodium hypochlorite and EDTA are the most commonly used irrigants due to their ability to dissolve tissue and remove smear layer. Chlorhexidine and hydrogen peroxide are also discussed. Intracanal medicaments mentioned include eugenol, phenol, camphorated monochlorophenol, formocresol, and calcium hydroxide which are used to disinfect canals and promote healing.
The document discusses various intracanal medicaments used in endodontic treatment. It describes the functions and ideal properties of intracanal medicaments. Some commonly used medicaments discussed include calcium hydroxide, chlorhexidine, camphorated para-chlorophenol, and corticosteroid-antibiotic combinations. The document also compares different medicaments and provides details on their compositions, mechanisms of action, advantages and disadvantages.
This document provides information on root canal obturation materials. It defines obturation as the three dimensional filling of the entire root canal system as close to the cementodentinal junction as possible. The objectives and ideal requirements of root canal filling materials are described. Materials are classified and various materials used for filling root canals are discussed, including gutta percha, resilon, silver points, and various cements. The properties, advantages, and disadvantages of gutta percha are summarized. Recent advances in materials like medicated gutta percha and resilon are also outlined.
The document discusses various root canal obturation techniques and materials. It describes the monoblock concept of creating a continuous solid layer from the dentin wall to the core filling material. Resilon and Epiphany sealer are introduced as alternatives to gutta-percha that form a monoblock unit due to adhesion. Other techniques discussed include EndoREZ points coated with resin, ActivGP which uses glass ionomer to coat gutta-percha, and Smartseal which uses hydrophilic polymer points that expand to fill voids. Mineral trioxide aggregate is also summarized due to its biocompatibility and uses including pulp capping and root repair.
This document discusses root canal sealers, including their ideal requirements, functions, classifications, compositions, and examples. It provides details on various types of sealers such as zinc oxide-eugenol based sealers (Kerr's Sealer, Grossman's Sealer), chloropercha, nogenol, and calcium hydroxide based sealers. The ideal properties of a sealer include providing a good seal, adhesion, radiopacity, biocompatibility, and dimensional stability.
1) The document discusses various intracanal medicaments that have been used in endodontics, including phenolics, aldehydes, halides, calcium hydroxide, and antibiotics.
2) It provides classifications of intracanal medicaments according to Grossman and the Dental Council of North America.
3) Common intracanal medicaments discussed in detail include calcium hydroxide, chlorhexidine, iodine potassium iodide, corticosteroid-antibiotic combinations, and Ledermix. Their compositions, applications, and limitations are described.
This document discusses root canal sealers, including their definition, requirements, functions, and classifications. It describes various common sealers such as zinc oxide eugenol sealers like Kerr Pulp Canal Sealer, Procosol, and Grossman Sealer. It also discusses non-eugenol sealers, medicated sealers, and calcium hydroxide based sealers. The document provides details on the composition, properties, advantages, disadvantages and uses of different sealers.
This document discusses ideal requirements, functions, and commonly used irrigating solutions and intracanal medicaments in endodontic treatment. Sodium hypochlorite and EDTA are the most commonly used irrigants due to their ability to dissolve tissue and remove smear layer. Chlorhexidine and hydrogen peroxide are also discussed. Intracanal medicaments mentioned include eugenol, phenol, camphorated monochlorophenol, formocresol, and calcium hydroxide which are used to disinfect canals and promote healing.
The document discusses various intracanal medicaments used in endodontic treatment. It describes the functions and ideal properties of intracanal medicaments. Some commonly used medicaments discussed include calcium hydroxide, chlorhexidine, camphorated para-chlorophenol, and corticosteroid-antibiotic combinations. The document also compares different medicaments and provides details on their compositions, mechanisms of action, advantages and disadvantages.
This document provides information on root canal obturation materials. It defines obturation as the three dimensional filling of the entire root canal system as close to the cementodentinal junction as possible. The objectives and ideal requirements of root canal filling materials are described. Materials are classified and various materials used for filling root canals are discussed, including gutta percha, resilon, silver points, and various cements. The properties, advantages, and disadvantages of gutta percha are summarized. Recent advances in materials like medicated gutta percha and resilon are also outlined.
The document discusses various root canal obturation techniques and materials. It describes the monoblock concept of creating a continuous solid layer from the dentin wall to the core filling material. Resilon and Epiphany sealer are introduced as alternatives to gutta-percha that form a monoblock unit due to adhesion. Other techniques discussed include EndoREZ points coated with resin, ActivGP which uses glass ionomer to coat gutta-percha, and Smartseal which uses hydrophilic polymer points that expand to fill voids. Mineral trioxide aggregate is also summarized due to its biocompatibility and uses including pulp capping and root repair.
This document discusses root canal sealers, including their ideal requirements, functions, classifications, compositions, and examples. It provides details on various types of sealers such as zinc oxide-eugenol based sealers (Kerr's Sealer, Grossman's Sealer), chloropercha, nogenol, and calcium hydroxide based sealers. The ideal properties of a sealer include providing a good seal, adhesion, radiopacity, biocompatibility, and dimensional stability.
This is a presentation which describes in details, the shaping aspect of root canal in root canal therapy. This gives the newer files systems being used
The document discusses endodontic irrigating solutions. It describes the objectives and requirements of ideal irrigants, including having broad-spectrum antimicrobial effects, aiding in debridement, dissolving tissue, low toxicity, and lubricating properties. Commonly used irrigants are discussed, such as sodium hypochlorite, chlorhexidine, EDTA, citric acid, and mixtures. Recent advances including cetrexidine, carisolv, and bioactive materials are also mentioned.
Local Anesthesia in Oral and Maxillofacial SurgerySapna Vadera
Local anaesthesia is a loss of sensation in a circumscribed area without loss of consciousness. The document discusses the history of local anaesthesia from ancient times to modern developments. It also covers the desirable properties, mechanisms of action, classifications, pharmacology and clinical aspects of local anaesthetics. The summary provides a high-level overview of the key topics covered in the document relating to the definition, history, properties and mechanisms of local anaesthetics.
This document discusses four techniques for performing a frenectomy: 1) Simple excision technique which involves making an elliptical incision and placing sutures at the maximal depth of the vestibule. 2) Z-plasty technique which involves making a small elliptical excision and rotating flaps into desired position. 3) Localized vestibuloplasty with secondary epithelialization which involves making a wide V-type incision and suturing mucosal margins to periosteum. 4) Laser-assisted frenectomy which uses supraperiosteal ablation and allows healing through secondary epithelialization. It also discusses lingual frenectomy techniques such as bilateral lingual blocks, hemostat placement, and
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
A quick and concise recap of Endodontic Instruments.
This presentation resolves the basic doubts within terminologies and provides visual conceptualization of the same.
This document discusses articulators, which are mechanical devices used to simulate jaw movement. It begins by defining articulators and describing basic mandibular movements. It then discusses the basic components and classifications of articulators, including classifications based on adjustability and the location of condylar elements. Common articulators are described, including the Hanau articulator and mean value articulator. The relationship between the maxilla and mandible is transferred from patient to articulator using records like the facebow transfer and centric jaw relation record.
a very beautifully compiled seminar on endodontic irrigants, do comment if any suggestions regarding anything more to be added, as it is a very huge topic and everyday expanding
Root canal sealers are used with obturating materials to seal the root canal system. They serve functions like filling irregularities, sealing lateral canals, and assisting with microbial control. Ideal sealers provide an excellent seal, adhere well to canal walls and filling material, are radiopaque, and more. Common types include zinc oxide-eugenol, calcium hydroxide, and resin-based sealers. Resin sealers like AH Plus and AH 26 offer advantages like good adhesion, antibacterial properties, and biocompatibility but must be mixed properly to avoid adverse reactions. Proper application of sealers within the canal is important to avoid irritation.
This document discusses root canal irrigation and intracanal medicaments. It outlines the objectives and characteristics of an ideal irrigation system, including removing debris, being bactericidal, and dissolving tissue. EDTA and sodium hypochlorite are described as common irrigation solutions used to remove the smear layer. Factors influencing irrigation efficacy and methods of irrigant delivery are covered. Potential complications of sodium hypochlorite accidents and their treatment are summarized. Finally, the document briefly discusses root canal medication and categories of intracanal medicaments.
This document discusses curved and dilacerated root canals. It defines these terms and lists their causes, prevalence, locations, and methods of detection. Curved and dilacerated canals present challenges for instrumentation like ledges, perforations, and blocked canals. The document describes types of curves and dilacerations based on morphology and location. It outlines techniques for managing these canals, including precurving files, using smaller files, modifying file edges, and crown-down instrumentation. Managing restoring forces and active cutting lengths helps navigate curves safely and minimize iatrogenic damage.
Endodontic sealers a summary and a quick review Rami Al-Saedi
a slideshow presentation lectured and presented in Al-Sadr Specialized dental center in the continuing dental learning weekly lectures.
Rusafa medical institute- Baghdad- Iraq
lecturer: Dr. Rami Ahmed Jumaah (BDS)
Supervisor: Dr. Iman J. Ahmed (BDS: MSc)
Recent advances in endodontics include improved methods for diagnosis using tools like pulse oximetry and laser Doppler flowmetry. Cone beam CT and newer apex locators provide more accurate determination of working length. Advances in instrumentation include nickel-titanium rotary files and self-adjusting files. New irrigants and devices improve cleaning and disinfection of the root canal. Regenerative endodontic procedures aim to regenerate damaged tissues through stem cell therapy and tissue engineering.
The double cord technique involves placing a small diameter cord in the gingival sulcus first, leaving it in place, and then packing a larger diameter cord over the first cord to provide additional retraction and hemostasis for making impressions of multiple prepared teeth or when the gingival tissues are compromised. The small inner cord provides retraction while the outer cord provides additional hemostasis and tissue displacement needed for accurate impressions.
This document discusses chemical plaque control agents. It begins by defining terms like antimicrobial agents, antiplaque agents, and antigingivitis agents. It describes ideal properties of antiplaque agents such as eliminating pathogens selectively and exhibiting substantivity. The document then examines various approaches to chemical plaque control like using antiadhesive, antimicrobial, plaque removal, and antipathogenic agents. Specific agents discussed in detail include chlorhexidine, povidone-iodine, triclosan, and delmopinol. The modes of action, effectiveness, and potential side effects of different agents are summarized.
This document discusses speeds used in operative dentistry. It defines speed as revolutions per minute and classifies speeds as low (<12,000 rpm), medium (12,000-200,000 rpm), or high (>200,000 rpm). Lower speeds provide better tactile sense but slower cutting, while higher speeds cut faster but with less tactile control and increased risk of overheating. Different handpieces and burrs are suited to low, medium, and high speeds. The appropriate speed depends on the procedure and balancing factors like cutting rate, torque, tactile feedback, and heat production.
This document discusses various irrigating solutions used during root canal treatment. It begins with a brief history of irrigants, from water and proteolytic enzymes to chelating agents and sodium hypochlorite. The ideal properties of irrigants are listed as well as the goals and role of irrigation. Various classes of irrigants are classified and described in detail, including acids, chelating agents, oxidizing agents, and others. Individual irrigants such as sodium hypochlorite, hydrogen peroxide, and citric acid are also discussed in regards to their properties, actions, and effectiveness at tissue dissolution, antibacterial activity, and smear layer removal.
This document provides an overview of irrigation in endodontics. It discusses the properties of ideal irrigating solutions, the functions of irrigation, classifications of irrigants, and commonly used irrigating solutions such as sodium hypochlorite, EDTA, and chlorhexidine. It also covers irrigation techniques, factors that influence irrigant activity, and the effects of irrigants on dentin composition, bonding to dentin, and penetration into dentinal tubules. Adverse effects of sodium hypochlorite are also summarized.
This is a presentation which describes in details, the shaping aspect of root canal in root canal therapy. This gives the newer files systems being used
The document discusses endodontic irrigating solutions. It describes the objectives and requirements of ideal irrigants, including having broad-spectrum antimicrobial effects, aiding in debridement, dissolving tissue, low toxicity, and lubricating properties. Commonly used irrigants are discussed, such as sodium hypochlorite, chlorhexidine, EDTA, citric acid, and mixtures. Recent advances including cetrexidine, carisolv, and bioactive materials are also mentioned.
Local Anesthesia in Oral and Maxillofacial SurgerySapna Vadera
Local anaesthesia is a loss of sensation in a circumscribed area without loss of consciousness. The document discusses the history of local anaesthesia from ancient times to modern developments. It also covers the desirable properties, mechanisms of action, classifications, pharmacology and clinical aspects of local anaesthetics. The summary provides a high-level overview of the key topics covered in the document relating to the definition, history, properties and mechanisms of local anaesthetics.
This document discusses four techniques for performing a frenectomy: 1) Simple excision technique which involves making an elliptical incision and placing sutures at the maximal depth of the vestibule. 2) Z-plasty technique which involves making a small elliptical excision and rotating flaps into desired position. 3) Localized vestibuloplasty with secondary epithelialization which involves making a wide V-type incision and suturing mucosal margins to periosteum. 4) Laser-assisted frenectomy which uses supraperiosteal ablation and allows healing through secondary epithelialization. It also discusses lingual frenectomy techniques such as bilateral lingual blocks, hemostat placement, and
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
A quick and concise recap of Endodontic Instruments.
This presentation resolves the basic doubts within terminologies and provides visual conceptualization of the same.
This document discusses articulators, which are mechanical devices used to simulate jaw movement. It begins by defining articulators and describing basic mandibular movements. It then discusses the basic components and classifications of articulators, including classifications based on adjustability and the location of condylar elements. Common articulators are described, including the Hanau articulator and mean value articulator. The relationship between the maxilla and mandible is transferred from patient to articulator using records like the facebow transfer and centric jaw relation record.
a very beautifully compiled seminar on endodontic irrigants, do comment if any suggestions regarding anything more to be added, as it is a very huge topic and everyday expanding
Root canal sealers are used with obturating materials to seal the root canal system. They serve functions like filling irregularities, sealing lateral canals, and assisting with microbial control. Ideal sealers provide an excellent seal, adhere well to canal walls and filling material, are radiopaque, and more. Common types include zinc oxide-eugenol, calcium hydroxide, and resin-based sealers. Resin sealers like AH Plus and AH 26 offer advantages like good adhesion, antibacterial properties, and biocompatibility but must be mixed properly to avoid adverse reactions. Proper application of sealers within the canal is important to avoid irritation.
This document discusses root canal irrigation and intracanal medicaments. It outlines the objectives and characteristics of an ideal irrigation system, including removing debris, being bactericidal, and dissolving tissue. EDTA and sodium hypochlorite are described as common irrigation solutions used to remove the smear layer. Factors influencing irrigation efficacy and methods of irrigant delivery are covered. Potential complications of sodium hypochlorite accidents and their treatment are summarized. Finally, the document briefly discusses root canal medication and categories of intracanal medicaments.
This document discusses curved and dilacerated root canals. It defines these terms and lists their causes, prevalence, locations, and methods of detection. Curved and dilacerated canals present challenges for instrumentation like ledges, perforations, and blocked canals. The document describes types of curves and dilacerations based on morphology and location. It outlines techniques for managing these canals, including precurving files, using smaller files, modifying file edges, and crown-down instrumentation. Managing restoring forces and active cutting lengths helps navigate curves safely and minimize iatrogenic damage.
Endodontic sealers a summary and a quick review Rami Al-Saedi
a slideshow presentation lectured and presented in Al-Sadr Specialized dental center in the continuing dental learning weekly lectures.
Rusafa medical institute- Baghdad- Iraq
lecturer: Dr. Rami Ahmed Jumaah (BDS)
Supervisor: Dr. Iman J. Ahmed (BDS: MSc)
Recent advances in endodontics include improved methods for diagnosis using tools like pulse oximetry and laser Doppler flowmetry. Cone beam CT and newer apex locators provide more accurate determination of working length. Advances in instrumentation include nickel-titanium rotary files and self-adjusting files. New irrigants and devices improve cleaning and disinfection of the root canal. Regenerative endodontic procedures aim to regenerate damaged tissues through stem cell therapy and tissue engineering.
The double cord technique involves placing a small diameter cord in the gingival sulcus first, leaving it in place, and then packing a larger diameter cord over the first cord to provide additional retraction and hemostasis for making impressions of multiple prepared teeth or when the gingival tissues are compromised. The small inner cord provides retraction while the outer cord provides additional hemostasis and tissue displacement needed for accurate impressions.
This document discusses chemical plaque control agents. It begins by defining terms like antimicrobial agents, antiplaque agents, and antigingivitis agents. It describes ideal properties of antiplaque agents such as eliminating pathogens selectively and exhibiting substantivity. The document then examines various approaches to chemical plaque control like using antiadhesive, antimicrobial, plaque removal, and antipathogenic agents. Specific agents discussed in detail include chlorhexidine, povidone-iodine, triclosan, and delmopinol. The modes of action, effectiveness, and potential side effects of different agents are summarized.
This document discusses speeds used in operative dentistry. It defines speed as revolutions per minute and classifies speeds as low (<12,000 rpm), medium (12,000-200,000 rpm), or high (>200,000 rpm). Lower speeds provide better tactile sense but slower cutting, while higher speeds cut faster but with less tactile control and increased risk of overheating. Different handpieces and burrs are suited to low, medium, and high speeds. The appropriate speed depends on the procedure and balancing factors like cutting rate, torque, tactile feedback, and heat production.
This document discusses various irrigating solutions used during root canal treatment. It begins with a brief history of irrigants, from water and proteolytic enzymes to chelating agents and sodium hypochlorite. The ideal properties of irrigants are listed as well as the goals and role of irrigation. Various classes of irrigants are classified and described in detail, including acids, chelating agents, oxidizing agents, and others. Individual irrigants such as sodium hypochlorite, hydrogen peroxide, and citric acid are also discussed in regards to their properties, actions, and effectiveness at tissue dissolution, antibacterial activity, and smear layer removal.
This document provides an overview of irrigation in endodontics. It discusses the properties of ideal irrigating solutions, the functions of irrigation, classifications of irrigants, and commonly used irrigating solutions such as sodium hypochlorite, EDTA, and chlorhexidine. It also covers irrigation techniques, factors that influence irrigant activity, and the effects of irrigants on dentin composition, bonding to dentin, and penetration into dentinal tubules. Adverse effects of sodium hypochlorite are also summarized.
This document discusses root canal irrigants and their importance in endodontic treatment. It begins by explaining that eliminating irritants from the root canal is essential for treatment success. The ideal properties of an irrigant are described, including antimicrobial activity, tissue dissolution, and smear layer removal. Commonly used irrigants like sodium hypochlorite, EDTA, and chlorhexidine are then discussed in detail. Their mechanisms of action, advantages, and limitations are provided. The document emphasizes that a combination of irrigants must be used to fully disinfect the root canal system and produce the best treatment outcomes.
This document provides an overview of root canal disinfection and irrigation. It discusses the ideal requirements of irrigants including antimicrobial activity, flushing ability, non-toxicity, tissue dissolving ability, and smear layer removal. It categorizes common irrigants such as sodium hypochlorite, EDTA, and chlorhexidine and describes their mechanisms of action and limitations. Guidelines for irrigation techniques including manual, sonic, and laser-activated methods are also outlined.
This document discusses irrigation techniques and solutions used in endodontics. It states that irrigation is necessary to clean areas that instruments cannot reach, like fins and anastomoses. The ideal irrigant has antimicrobial properties, tissues dissolving ability, lubrication, and can remove the smear layer while being non-toxic. Commonly used irrigants include sodium hypochlorite, chlorhexidine, hydrogen peroxide, EDTA, and MTAD. Proper irrigation requires needles inserted to the full working length and solutions delivered slowly and passively.
Sodium hypochlorite is the most widely used endodontic irrigant and contains about 5% available chlorine. It has antimicrobial properties through ionization and acts by penetrating and disrupting bacterial cell walls and DNA synthesis. Concentrations of 0.5-6% are used, with 5.2% being most effective and 2.5-3% commonly employed due to lower toxicity. EDTA is a chelating agent that softens dentin, removes inorganic components of the smear layer, and has no deleterious effects on tissues when used as a 17% final rinse followed by sodium hypochlorite. Chlorhexidine digluconate is a less toxic irrigating
1) Successful endodontic therapy requires thorough cleaning and disinfection of the root canal system to eliminate bacteria.
2) No single irrigant can achieve all the desired properties of dissolving tissue, disinfecting, and removing smear layer. The sequential use of sodium hypochlorite, EDTA, and chlorhexidine helps achieve through cleaning.
3) Proper irrigation technique, including using small-gauge needles, up and down motion, and replenishing irrigants, is important for disinfecting inaccessible areas of the complex root canal anatomy.
The document discusses irrigants and intracanal medicaments used in endodontic therapy. The goals of endodontic treatment include eliminating infection, preventing reinfection through cleaning, shaping, obturation and coronal restoration. Sodium hypochlorite and chlorhexidine are commonly used irrigants that have antimicrobial properties. Chelating agents like EDTA are used to remove the smear layer formed during instrumentation. Calcium hydroxide is a widely used intracanal medicament due to its high alkalinity and antimicrobial effects. Combination medications containing corticosteroids and antibiotics can also be used to reduce pain and prevent bacterial overgrowth.
A simple presentation to guide a dentist to choose best irrigant for the case. types of irrigants, their properties, advantages and disadvantages and tips has been discussed through this presentation.
This document discusses root canal irrigants. It begins by outlining the objectives and functions of irrigants, which include removing tissue, microorganisms, and debris from the root canal. It describes the ideal requirements for an irrigant and commonly used irrigating solutions such as sodium hypochlorite, hydrogen peroxide, chlorhexidine, and chelating agents like EDTA. The mechanisms of action, advantages, and disadvantages of different irrigants are provided. Factors that influence irrigant activity and how to increase the efficacy and safely use sodium hypochlorite are also summarized.
Root Canal Irrigants or Endodontic irrigants surabhisoumya1
This presentation is all about the various irrigants and the irrigation systems used currently in dental practice ( in cleaning and shaping of Root canal systems)
This document discusses endodontic irrigants. It provides a brief history of irrigants, noting key developments like the introduction of sodium hypochlorite and EDTA. The objectives of irrigation are outlined as mechanical, chemical, and biological. An ideal irrigant is described as having properties like tissue dissolving ability and low toxicity. Common irrigants discussed include saline, sodium hypochlorite, hydrogen peroxide, chlorhexidine, and chelating agents. Challenges of irrigation involve incomplete removal of debris and smear layer, as well as disinfecting uninstrumented areas and biofilms.
This document discusses endodontic irrigants and irrigation techniques. It describes the desired functions of irrigating solutions such as washing away debris, lubricating instruments, dissolving tissues, and killing bacteria. Sodium hypochlorite is the most commonly used irrigant due to its ability to dissolve organic material and kill bacteria, though it does not remove the smear layer. EDTA is often used along with sodium hypochlorite to remove the smear layer. Chlorhexidine has antimicrobial properties but does not dissolve tissues. Various irrigation devices and techniques are also discussed such as syringes, needles, sonic activation with EndoActivator, and negative pressure irrigation with EndoVac. Interactions
1. Sodium hypochlorite (NaOCl) is the most commonly used endodontic irrigant due to its ability to dissolve organic tissue and its strong antibacterial properties.
2. While effective, NaOCl can cause severe damage if extruded beyond the root apex due to its caustic nature. Care must be taken during passive irrigation to prevent accidental extrusion.
3. A hypochlorite accident manifests as severe pain, swelling, and bleeding and may require treatment with antibiotics, analgesics, and anti-inflammatories to prevent spread of infection from tissue damage.
Irrigation and Intracanal.pdf مواد شستوشو دهندهabibook49
This document discusses irrigation and intracanal medicaments used in endodontic treatment. It outlines the ideal requirements for irrigants including being antimicrobial, aiding in debridement, and dissolving tissue. Commonly used irrigants described are sodium hypochlorite, hydrogen peroxide, chlorhexidine, and EDTA. Sodium hypochlorite has antimicrobial properties but can damage tissues if extruded. Hydrogen peroxide aids in mechanical debridement. Intracanal medicaments are used as dressings and include eugenol, formocresol, calcium hydroxide, and corticosteroid-antibiotic combinations. Placement of intracanal medicaments involves drying canals and placing
The document discusses current concepts of endodontic irrigation. It notes that complete mechanical cleaning of the complex root canal system is impossible, so irrigation is necessary to eradicate present infections and prevent future reinfection for successful treatment. Sodium hypochlorite is the most commonly used irrigant but has disadvantages like toxicity. Chelating agents like EDTA and citric acid are used to remove the smear layer. Chlorhexidine has antimicrobial properties and can remain active in tissue but does not remove debris. No single solution is ideal, so combining solutions in the proper sequence maximizes effectiveness.
Materials for disinfecting the pulp spaceParth Thakkar
The document discusses materials used for irrigating and disinfecting the root canal system during endodontic treatment. It describes the functions and properties of various irrigants including sodium hypochlorite, hydrogen peroxide, EDTA, and others. It also outlines techniques for delivering irrigants into the canal such as Grossman's technique which involves flooding the pulp chamber and replenishing the irrigant as instrumentation occurs. Proper needle size, angle, and placement are emphasized to allow irrigants to reach the full extent of the canal system.
Efficiency of different concentration of sodium hypochlorite duringDrshruti Sood
1. The document discusses sodium hypochlorite (NaOCl) as a root canal irrigant, reviewing its history, mechanisms of action, ideal requirements, and studies on its effectiveness.
2. Several studies found that higher concentrations of NaOCl were more effective at dissolving organic tissue in root canals and inhibiting bacteria. Concentrations of 2.5-5.25% NaOCl showed the best results.
3. NaOCl works through saponification, amino acid neutralization, and chloramination reactions to degrade organic tissues and kill bacteria. It is effective due to its alkaline pH, antimicrobial action, and tissue dissolving properties.
The thyroid gland is the largest endocrine gland located in the neck. It produces thyroid hormones such as T4 and T3 that regulate metabolism. The thyroid follicles contain colloid made of thyroglobulin, which iodine is attached to in order to produce the hormones. The hormones are then released into circulation and have widespread effects increasing the basal metabolic rate and promoting growth and development. Thyroid hormone production is regulated by TSH from the pituitary gland in a negative feedback loop. Disorders can result from too much or too little thyroid hormone production and affect many body systems.
The document provides an overview of the anatomy and physiology of the visual system. It discusses the major parts of the eye including the sclera, cornea, iris, retina, rods and cones. It describes how light is focused on the retina through the lens system and how visual signals are transmitted via the optic nerve and pathways to the visual cortex. It also covers topics like color vision, accommodation, dark adaptation and various eye movements.
This document summarizes the transport and exchange of respiratory gases in the body. It discusses the diffusion of oxygen and carbon dioxide across membranes, factors that affect diffusion, and the roles of hemoglobin and bicarbonate ions in transporting oxygen and carbon dioxide in the blood and tissues. The oxygen-hemoglobin dissociation curve and factors that can shift it are also described.
Spermatogenesis is the process by which male germ cells develop into mature sperm cells. It begins at puberty and continues throughout a man's life. The process occurs in the testes and epididymis. In the testes, spermatogonia undergo mitosis and meiosis to form haploid spermatids. Spermatids then undergo spermiogenesis to form mature sperm, acquiring motility and other structures. Hormones like FSH, LH and testosterone regulate spermatogenesis, which produces several hundred million sperm daily.
Alveolar bone forms the sockets that hold teeth in place and is a component of the periodontium. It develops during tooth formation and is resorbed when teeth are lost. Alveolar bone consists of alveolar bone proper that lines tooth sockets and supporting alveolar bone made of cortical plates and spongy bone. It undergoes remodeling to accommodate tooth movement and is sensitive to pressure and functional demands, making it important for orthodontics and adapting to tooth loss.
Dentin is the hard tissue that forms the bulk of the tooth beneath enamel. It consists of a bone-like matrix with dentinal tubules that contain odontoblast processes and nerves. Dentin is less mineralized than enamel but provides strength and protects the pulp. The three main theories of dentin hypersensitivity are direct neural stimulation, transduction, and the most accepted hydrodynamic theory, which proposes that fluid movement in the dentinal tubules causes mechanical stimulation of intratubular nerves when exposed dentin is subjected to stimuli.
This document summarizes the specialized mucosa and papillae found on the dorsal surface of the tongue. It describes the four main types of papillae - filliform, fungiform, circumvallate, and foliate papillae. It details their locations, histological features, and functions. The document also discusses taste buds and their role in gustation. Finally, it covers the clinical significance of some variations in tongue morphology and the differences seen in other species.
The document provides information on the structure and functions of the dental pulp. It begins with definitions and general anatomy, describing the pulp as a soft connective tissue enclosed within dentin. It then discusses the zones and structural features of the pulp in more detail. This includes the odontoblastic zone containing odontoblasts and nerve endings, the cell-free zone with capillaries and nerves, and the cell-rich zone with fibroblasts and blood vessels. Key cell types like odontoblasts, fibroblasts, and immune cells are also described. The functions of the pulp in dentin formation, nutrition, and defense are highlighted.
This document discusses the various sequelae that can result from pulpitis, including both acute and chronic forms of pulpitis, apical periodontitis, periapical abscess, osteomyelitis, and periapical cysts. It provides details on the etiology, clinical features, and treatment for each condition. Pulpitis can lead to further inflammation of the surrounding tissues like the apical periodontium and bone. Without proper treatment, pulpitis risks developing into more serious conditions such as apical abscesses or osteomyelitis that require surgical intervention.
This document provides an overview of forensic odontology and the role of dental evidence in various contexts. It discusses personal identification using dental records, identification in mass disasters, extracting dental DNA for identification, analyzing bite marks, and the duties of forensic odontologists, such as documenting evidence, comparing records, and testifying as expert witnesses. The key applications of forensic odontology include identifying unknown remains, assisting in mass disasters, and analyzing bite marks and other dental evidence in legal cases.
1. Amelogenesis involves the life cycle of ameloblasts from the pre-secretory to post-secretory phases as they form enamel.
2. In the secretory phase, ameloblasts deposit enamel matrix proteins and undergo partial mineralization, developing Tome's process which is responsible for enamel rod and interrod formation.
3. Enamel maturation then occurs, fully mineralizing the enamel from the dentin-enamel junction outward in a gradual process modulated by alternating ameloblast types.
The document discusses the periodontal ligament. It describes the periodontal ligament as the connective tissue that surrounds the root and connects it to the alveolar bone. It is made up of principal fibers, cells, ground substance, blood vessels and nerves. The principal fibers are organized into groups like the alveolar crest fibers, horizontal fibers, oblique fibers, and apical fibers that provide support and resist various forces on the teeth. The periodontal ligament also contains cells like fibroblasts, cementoblasts and osteoblasts that allow for remodeling of the tissues. It carries out functions like shock absorption and sensation in addition to attachment of teeth to bone.
Odontogenic tumors arise from tooth-forming tissues and can be divided into three categories: tumors of odontogenic epithelium without mesenchyme, tumors with both epithelium and mesenchyme, and tumors of mesenchyme alone. Ameloblastoma is the most common odontogenic tumor, representing 1% of jaw tumors. It typically presents as a multilocular radiolucency in the mandible and is classified as solid/multicystic, unicystic, or peripheral. Histologically it demonstrates islands of epithelial cells resembling dental lamina. Treatment involves wide local excision due to its persistence and recurrence.
Dental caries is caused by acids produced by bacteria in the mouth that metabolize sugars. It is a chemoparasitic process involving tooth demineralization in two stages. Key factors are the "cariogenic" bacteria Streptococcus mutans and Lactobacillus, along with frequent sugar consumption. Early theories attributed caries to worms, humoral imbalances, or chemical/parasitic causes. Current understanding involves the interplay of host tooth/plaque, carbohydrate substrates, and cariogenic microbes. Nursing bottle caries occurs when babies sleep with bottles containing sugars.
This document discusses ethics in research. It defines research ethics as applying ethical standards to all stages of research, from planning to evaluation. Key principles discussed include honesty, objectivity, integrity, care for participants, openness, respect for intellectual property, confidentiality, non-discrimination, and social responsibility. The document also covers issues like authorship, plagiarism, peer review, research with animals and humans, and addressing misconduct. Overall, it emphasizes that ethical research promotes values like trust, accountability and protecting participants.
This document discusses dental ethics and ethical principles that dental professionals should follow. It notes that dentistry, as a profession, is bound by an ethical code of conduct that seeks to determine what actions professionals should and should not take. The document outlines basic ethical principles like autonomy, justice, and confidentiality. It also provides examples of ethical and unethical behaviors. Additionally, it discusses professional codes of ethics, reasons for having codes, and how to resolve ethical dilemmas.
The document discusses stainless steel crowns, including their definition as prefabricated crown forms adapted to individual teeth and cemented. It covers the history, classifications, indications and contraindications for stainless steel crowns in both primary and permanent teeth. The clinical procedure section describes tooth preparation, crown selection and adaptation, and cementation."
This document defines and classifies oral habits such as thumb sucking and tongue thrusting. It discusses the etiology, diagnosis, and treatment of these habits. Specifically, it notes that oral habits can lead to dentofacial deformities if they persist for long periods. Diagnosis involves examining the patient's swallowing pattern and looking for signs like an open bite. Treatment may involve counseling, reminder appliances to interrupt the habit, or myofunctional exercises to train correct tongue and swallowing posture. The goal is to intercept oral habits before they cause dental or skeletal issues.
This document discusses space management and space maintainers. It begins by defining space management and explaining that premature loss of primary teeth is a common cause of malocclusion. It then discusses the objectives and indications of space maintenance, as well as causes of space loss. The document provides details on different types of space maintainers, including removable, fixed, band and loop, and lingual arch space maintainers. It discusses factors to consider for space maintenance such as the amount of space closure, eruption timing of permanent successors, and oral musculature. Overall, the document provides a comprehensive overview of space management and different approaches to space maintenance.
This document provides information on managing medically compromised patients in dentistry. It discusses various conditions including heart diseases, leukemia, diabetes mellitus, and cystic fibrosis. For each condition, it describes clinical manifestations, oral manifestations, and important considerations for dental treatment. Key points discussed include the need for medical consultations, antibiotic prophylaxis if needed, and modifying treatment for patients with low platelet counts or susceptibility to infections.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
5. INTRODUCTION
“ Root canal instruments shape the canals ;
Whereas root canal irrigants clean the canals “
- cleaning and shaping
6.
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
13.
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
23.
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
46.
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
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
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