This document provides an overview of various irrigation techniques and devices used in endodontics. It begins with an introduction to the importance of irrigation in root canal treatment and discusses some of the limitations of conventional needle irrigation. The document then classifies irrigation methods into manual and machine-assisted techniques. Under manual techniques, it describes brushes, dynamic irrigation using gutta percha, and various needle designs. Machine-assisted techniques discussed include continuous irrigation devices, rotary brushes, sonic devices like the EndoActivator, and ultrasonic irrigation. The document provides details on the mechanism and effectiveness of different agitation systems based on supporting literature.
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
Electronic apex locator by dr.imran m.shaikhImran Shaikh
. Knowledge of apical anatomy, prudent use of radiographs and the correct use of an electronic apex locator will assist practitioners to achieve predictable results.
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you. ask me for the books details.
14th publication - Dr Rahul VC Tiwari - Department of oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Takkellapadu,Guntur, Andhra Pradesh - 522509. JAMDSR JOURNALS
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
Electronic apex locator by dr.imran m.shaikhImran Shaikh
. Knowledge of apical anatomy, prudent use of radiographs and the correct use of an electronic apex locator will assist practitioners to achieve predictable results.
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you. ask me for the books details.
14th publication - Dr Rahul VC Tiwari - Department of oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Takkellapadu,Guntur, Andhra Pradesh - 522509. JAMDSR JOURNALS
Sonic and ultrasonic instruments in periodontology.pptxSanaMansuri18
Sonic and Ultrasonic Instruments in periodontology.
HISTORY
ADVANTAGES
DISADVANTAGES
TYPES OF POWER SCALERS
COMPARISON OF POWERED AND HAND INSTRUMENTS
TYPES OF INSERT TIPS
TIPS WEAR AND CARE
MAINTENANCE U/S
MECHANISM OF ACTION
INDICATION
CONTRAINDICATION
ASSOCIATED HAZARDS
CONCLUSION
US , magnification, illumination in endo.pptxpriyamittal66
Ultrasonics is integral part of dentistry. This seminar gives complete details about ultrasonics in endodontics along with magnification and illumination. There are various types of US tips. In this article, all tips detais can be seen. Along with Ultrasonic, sonic system is also explained with pictures. Microscope is demand of today's scenario, so we have highlighted the role of microscope in slides. optic fibre system to visualize inside the canal has been explained in the presentation. Mechanism of action, applications of Ultrasonics, role in irrigation has been explained. Retreival of instrument by US tips, removal of post with clinical cases, MTA placement, Surgerical procedure, Endodontic diagnosis has been explained in presentation.
This presentation of mine is a brief overview of root canal dressing materials and medicaments for undergraduate and postgraduate students . It also includes active irrigation techniques and their uses etc
Study of the Effect of Length and Inclination of Tube settler on the Effluent...AM Publications
Installation of new treatment plants to meet the increased demand is beyond the reach of most of the local bodies
and government as well. Hence ways and means are to be explored to augment water treatment capacity and to improve the
performance of existing water treatment plants. Tube settler systems are inexpensive solution for drinking water and
wastewater plants to increase treatment capacity of clarifier, improve effluent water quality, and decrease operating costs.
Tube settlers use multiple tubular channels sloped at an angle of about 45o to 60o and adjacent to each other, which
combine to form an increased effective settling area. This is combining to form an increased effective settling area.
Current study focuses on the study made to understand the effect of length and inclination of tube settler on the effluent
quality through the pilot plant study. The circular tubes of 45mm diameter were used with inclination of 45o and 60o.
Length of tube was varied as 60cm, 50cm and 40 cm
A Modified Partial Platform Technique to Retrieve Instrument Fragments from C...Nadeem Aashiq
A Modified Partial Platform Technique to Retrieve Instrument Fragments from Curved and Narrow Canals: A Report of 2 Cases
Narasimhan B, Vinothkumar TS, Praveen R, Setzer FC, Nagendrababu V. A (J Endod 2021;47:1657–1663
VARIOUS ROOT CANAL IRRIGANTS IN ENDODONTICSREVATHY M NAIR
History of irrigants
Benefits of irrigation in root canal treatment
Properties of an ideal irrigant
Classification of root canal irrigants
In detail about various root canal irrigants like sodium hypochlorite, chlorhexidine, EDTA, MTAD, HEBP, Tetraclean, hydrogen peroxide, QMIX, peracetic acid, citric acid, maleic acid
newer root canal irrigants include Electrochemically activated water, ozonated water, Herbal irrigants, nanoparticles, Nanobubble technology
Disinfection protocols
Challenges in irrigation of root canal
The second phase of a root canal treatment.
This presentation covers the most basic techniques of root canal shaping.
provides the reader with a concise overview of the big picture.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Root canal disinfection in primary molar during pulpectomy procedure using s1...Pioon Laser
The outcome of root canal treatment is based on efficient disinfection of the root canal system and prevention of reinfection. Pulpectomy is defined as a root canal procedure for pulp tissue that is irreversibly infected or necrotic due to caries or trauma in primary teeth.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
3. INTRODUCTION
• Removal of vital and necrotic remnants of pulp
tissues, microorganisms, and microbial toxins
from the root canal system is essential for
endodontic success.
• Although this might be achieved through
chemo-mechanical debridement, it is impossible
to shape and clean the root canal completely.
Siqueira JF Jr, Roˆ c¸as IN. Clinical implications and microbiology of bacterial
persistence after treatment procedures. J Endod 2008;34:1291–301
4. • Even with the use of rotary instrumentation, the nickel-titanium instruments
currently available only act on the central body of the canal, leaving canal
fins, isthmi, and cul-de-sacs untouched after completion of the preparation.
Wong R. Conventional endodontic failure and retreatment. Dent Clin North Am 2004;48:265–89.
5. Therefore, irrigation is an essential part of root canal
debridement because it allows for cleaning beyond what
might be achieved by root canal instrumentation alone.
Basmadjian-Charles CL, Farge P, Bourgeois DM, Lebrun T. Factors influencing the long-term results of endodontic treatment: a review of the
literature. Int Dent J 2002; 52:81–6.
6. • There is no one unique irrigant that meets the ideal requirement of root canal
irrigants.
• In our contemporary endodontic practice, dual irrigants such as sodium
hypochlorite (NaOCl) with ethylenediaminetetraacetic acid (EDTA) or
chlorhexidine (CHX) are often used as initial and final rinses to complement the
shortcomings that are associated with the use of a single irrigant.
Walton RE. Histologic evaluation of different methods of enlarging the pulp canal space. J Endod 1976;2:304–11
7. • More importantly, these irrigants must be brought into direct contact with the
entire canal wall surfaces for effective action particularly for the apical portions of
small root canals.
• To accomplish these objectives, there must be an effective delivery system of
irrigation devices so that the irrigant reaches the working length.
• Throughout the history of endodontics, endeavors have continuously been made
to develop more effective irrigant delivery and agitation systems for root canal
irrigation.
Haga CS. Microscopic measurements of root canal preparations following instrumentation. J Br Endod Soc 1968;2:41–6.
8. • Today’s irrigation armamentarium presents a diverse variety of tools and
techniques that can assist the practitioner in reducing bacteria and debris
within the canal system.
• However, currently there is no universally accepted standard irrigation
technique.
Gutierrez JH, Garcia J. Microscopic and macroscopic investigation on results of mechanical preparation of root
canals. Oral Surg Oral Med Oral Pathol 1968; 25:108–16.
13. • Manual irrigation system using needles is still
widely accepted by both general practitioners
and endodontists.
• In this technique the dispensing of an irrigant
into a canal through needles/cannulas of variable
gauges, either passively or with agitation.
• The agitation might be achieved by moving the
needle up and down the canal space.
SYRINGEIRRIGATIONWITHNEEDLES/CANNULAS
Kahn FH, Rosenberg PA, Gliksberg J. An in vitro evaluation of the irrigating characteristics of ultrasonic and subsonic handpieces and irrigating needles and probes. J Endod 1995;21:277–80
14. • Irrigation tip gauge and tip design can have a significant impact on the
irrigation flow pattern, flow velocity, depth of penetration, and
pressure on the walls and apex of the canal.
• 27 gauge needle is the preferred needle tip size for routine endodontic
procedures.
• Several studies have shown that the irrigant has only a limited effect
beyond the tip of the needle because of the dead-water zone or
sometimes air bubbles in the apical root canal, which prevent apical
penetration of the solution.
van der Sluis LW, Gambarini G, Wu MK, Wesselink PR. The influence of volume, type of irrigant and flushing method on removing artificially placed dentine debris
from the apical root canal during passive ultrasonic irrigation. Int Endod J 2006;39: 472–6.
15. Factors that have been shown to improve the efficacy of syringe
needle irrigation include
Closer Proximity Of The Irrigation Needle To The Apex
Larger Irrigation Volume
Smaller-gauge Irrigation Needles
Slow Irrigant Delivery In Combination With Continuous Hand
Movement Will Minimize Naocl Accidents.
Goldman M, Kronman JH, Goldman LB, Clausen H, Grady J. New method of irrigation during endodontic treatment. J Endod 1976;2:257–60.
16. (A) Flat(B) Beveled (C)
Notched
Open-ended tips express irrigant out at the
end toward the apex and consequently
increase the apical pressure within the
canal
Needle tip design
Open Ended
Open Ended Closed Ended
Falk KW, Sedgley CM. The influence of preparation size on the mechanical efficacy of root canal irrigation in
vitro. J Endod 2005;31:742–5
17. (D) side vented (E) double side vented ( (F)
multivented
Close Ended
Create more
pressure on
the walls
Allows the
irrigant to
reflux
Causes more
debris to be
displaced
coronally
Reduce the
chance of
apical
extrusion.
18. MAX-I- PROBE
• Max-I-probe is a modified design of regular manual irrigation
needles with a well-rounded, close tip and side-port dispersal.
• The dispersal of the irrigating solution through the side-port in
the cannula creates a unique upward turbulent motion,
which thoroughly irrigates the root canal preparation
but prevents solution and debris from being expressed through
the
19. • Micheal s et al 2000, evaluated the effectiveness of 3 kinds of EDTA salts and
NaOCl delivered alternately by using a Monoject syringe with a 27-gauge
needle reported that the debridement properties of the solutions were
adequate in the coronal two thirds of the canals but were less effective in the
apical third.
• Even after EDTA and NaOCl irrigation was performed with a specially
developed side-vented, closed-end needle that was placed within 1mmof the
working length, abundant smear layer remained in the apical region of the
20. • Nevertheless, the mechanical flushing action created by conventional
hand-held syringe needle irrigation is relatively weak.
• After conventional syringe needle irrigation, inaccessible canal extensions
and irregularities are likely to harbor debris and bacteria, thereby making
thorough canal debridement difficult.
21. • Brushes are adjuncts that have been
designed for debridement of the canal walls
or agitation of root canal irrigant.
• Recently, a 30-gauge irrigation needle
covered with a brush (NaviTip FX;
Ultradent Products Inc, South Jordan, UT)
was introduced commercially.
BRUSHES
22. Solaiman et al 2006, reported improved cleanliness of the coronal third of
instrumented root canal walls irrigated and agitated with the NaviTip FX needle
over the brushless type of NaviTip needle. Nevertheless, the differences in the
apical and middle thirds were not statistically significant.
The results might have been improved if the brush-covered needle was
mechanically activated in an active scrubbing action during the irrigation process
to increase the efficiency of the brush.
23. • Friction created between the brush bristles and the canal irregularities might
result in the dislodgement of the radiolucent bristles in the canals that are not
easily recognized by clinicians, even with the use of a surgical microscope.
• It could not be used to full working length because of its size, which might
lead to packing of debris into the apical section of the canal after brushing.
Disadvantage
Keir DM, Senia ES, Montgomery S. Effectiveness of a brush in removing postinstrumentation canal debris. J Endod 1990;16:323–7.
24. • Research has shown that gently moving a well-fitting
gutta-percha master cone up and down in short 2- to
3-mm strokes (manual dynamic irrigation) within an
instrumented canal
• Can produce an effective hydrodynamic effect and
significantly improve the displacement and exchange
of any given reagent.
Manual Dynamic Irrigation
Pesse AV, Warrier GR, Dhir VK. An experimental study of the gas entrapment process in closed-end microchannels. Int J Heat Mass Transfer 2005;48:5150–65. Review Article 802 Gu
25. Studies by McGill et al and Huang et al (2008) demonstrated that manual-
dynamic irrigation was significantly more effective than an automated-
dynamic irrigation system (RinsEndo; Du¨ rr Dental Co, Bietigheim-
Bissingen, Germany) and static irrigation. Several factors have contributed
to the positive results of manual-dynamic irrigation:
(1) The push-pull motion of a well fitting gutta-percha point in the
canal might generate higher intracanal pressure changes during
pushing movements, leading to more effective delivery of irrigant
to the ’’untouched’’ canal surfaces.
26. 2) The frequency of push-pull motion of the gutta-percha point (3.3
Hz, 100 strokes per 30 seconds) is higher than the frequency (1.6 Hz)
of positive-negative hydrodynamic pressure generated by
RinsEndo, possibly generating more turbulence in the canal.
3) The push-pull motion of the gutta-percha point probably acts by
physically displacing, folding, and cutting of fluid under ‘‘viscously-
dominated flow’’ in the root canal system. The latter probably allows
better mixing of the fresh unreacted solution with the spent, reacted
irrigant.
27. Advantage
• Simplicity and cost-effectiveness
Disadvantage-
The laborious nature of this hand-activated procedure still hinders its
application in routine clinical practice.
• .
31. • A rotary handpiece–attached microbrush has been used by Ruddle to
facilitate debris and smear layer removal from instrumented root canals.
• The brush includes a shaft and a tapered brush section. The latter has
multiple bristles extending radially from a central wire core.
• During the debridement phase, the micro brush rotates at about 300 rpm,
causing the bristles to deform into the irregularities of the preparation. This
helps to displace residual debris out of the canal in a coronal direction
ROTARY BRUSHES
32. Canal Brush (Coltene Whaledent, Langenau,
Germany)
• This highly flexible micro brush is molded entirely from
polypropylene and might be used manually with a rotary
action.
• It is more efficacious when attached to a contra-angle
handpiece running at 600 rpm
• A recent report by Weise et al 2007 , showed that the use of
the small and flexible Canal Brush with an irrigant removed
Weise M, Roggendorf MJ, Ebert J, Petschelt A, Frankenberger R. Four methods for cleaning simulated lateral extensions of curved root canals: a
SEM evaluation. Int Endod J 2007;40:991–2.
33. • Self-contained fluid delivery unit that is attached to the
Quantec-E Endo System.
• It contains
- Pump Console,
- 2 Irrigation Reservoirs,
- Tubing To Provide Continuous Irrigation
During
Rotary Instrumentation
Continuous Irrigation During Rotary Instrumentation
34. • Ideally, continuous irrigant agitation during active rotary instrumentation would
generate an
- Increased volume of irrigant
- Increase irrigant contact time,
- Facilitate greater depth of irrigant penetration inside the root canal.
This results in more effective canal debridement compared with syringe needle
irrigation.
35. .147.151
• These speculations, however, were not supported by the work of Setlock et al.
• Compared with needle irrigation, Quantec-E irrigation did result in cleaner canal
walls and more complete debris and smear layer removal in the coronal third of
the canal walls.
However, these advantages were not observed in the middle and apical thirds of
the root
canal.
• This is also confirmed by Walters et al, who found that there was no significant
difference between standard syringe needle irrigation and irrigation with the
Quantec-E pump.
Setlock J, Fayad MI, BeGole E, Bruzick M. Evaluation of canal cleanliness and smear layer removal after the use of the Quantec-E irrigation system and syringe:
a comparative scanning electron microscope study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:614–7.
37. Sonic Irrigation System
Tronstad et al(1985) - First to report the use of a sonic instrument for
endodontics
Rispisonic
file
Vibringe
system
ENDO
ACTIVATOR
38. • Conventionally, sonic irrigation is performed by using a
Rispisonic file attached to a MM 1500 sonic handpiece
(Medidenta International, Inc, Woodside, NY) after canal
shaping.
• These files have a nonuniform taper that increases with file size.
• Because they are barbed, these files might inadvertently engage
the canal wall and damage the finished canal preparation during
agitation.
Rispisonic file
39. • Irrigation device that combines manual delivery
and sonic activation of the solution.
• The Vibringe is a cordless handpiece that fits in a
special disposable 10-mL Luer-Lock syringe that is
compatible with every irrigation needle.
• The Vibringe allows delivery and sonic activation
of the irrigating solution in one step.. The irrigant
is sonically activated, as is the needle that attaches
VIBRINGE SYSTEM
40. Rodig et al 2010 compared the efficiency of a sonic device (Vibringe), syringe
irrigation, and passive ultrasonic irrigation in the removal of debris from
simulated root canal irregularities and concluded that Ultrasonic irrigation
removed debris significantly better from the artificial canal irregularities than
the Vibringe System and syringe irrigation ( P < .0001). The Vibringe System
demonstrated significantly better results than syringe irrigation in the apical
part of the root canal ( P = .011).
41. The EndoActivator System (Dentsply Tulsa Dental Specialties, Tulsa, OK) is a
more recently introduced sonically driven canal irrigation system .
It consists - Portable handpiece and
- 3 types of disposable polymer tips of different sizes.
ENDOACTIVATOR
42. Endoactivator Tips
• Snap-on/snap-off design
• Color-coded yellow, red, and blue to approximately correspond to file
sizes 20/02, 25/04, and 30/06, respectively.
• Made from a noncutting, medical-grade polymer, are strong and flexible,
and are 22 mm long with orientational depth gauge rings positioned at 18,
19, and 20 mm.
• Tips are disposable, single-use devices that should not be autoclaved..
43.
44. In a well-shaped and fluid-filled canal, the
hydrodynamic phenomenon results when a
vibrating tip generates fluid activation and
intracanal waves
Random waves fracture, resulting in the
formation of bubbles that oscillate within any
given reagent
These bubbles expand, become unstable due to
heat and pressure, then collapse and implode
Each implosion generates up to 30,000
shockwaves that serve to powerfully penetrate,
break up potential biofilms, and wipe surfaces
clean
45. In general, the higher the frequency Lower the amplitude.
when ultrasonic energy is used for 3D disinfection, high frequency sinusoidal
waves are produced with low amplitude, meaning less useful energy.
On the contrary, sonic technology produces a high tip amplitude about 60 times
greater than ultrasonic technology
Advantages of sonic system
46. Sonic System
Noncutting
Sonic technology drives highly flexible,
noncutting, polymer tips that
absolutely maintain the anatomical
integrity of the final preparation.
Ultrasonic system
All ultrasonically driven instruments are
manufactured from metal alloys.
Of greatest concern, vibrating any metal
tip, even precurved, around a canal
curvature invites ledges, apical
transportations, lateral perforations, or
broken instruments
47. Mancini et al 2016 reported that EndoActivator System (Dentsply
Tulsa Dental Specialties, Tulsa, OK) was significantly more
efficient than PUI and the control groups in removing the smear
layer at 3, 5, and 8 mm from the apex.
JOE — Volume 39, Number 11, November 2013
49. • Richman in 1957 introduced ultrasound to endodontics as a means of canal
debridement.
• Martin et al in 1980, designed first ultrasonic unit commercially available for
endodontic
use.
• Weller et al was the first to describe Passive Ultrasonic Irrigation
Types of ultrasonic irrigation
Combination of
simultaneous
ultrasonic
instrumentation
and irrigation (UI).
Passive Ultrasonic
Irrigation (PUI),
Operates Without
Simultaneous
Instrumentation
History
50. Several studies have failed to demonstrate the superiority of UI as a primary
cleaning and shaping technique.
These results might be attributed to
1) The constraint of vibratory motion and cleaning efficacy of an ultrasonic file
within the nonflared root canal space (In addition, it is difficult to control the
cutting of dentin during UI and hence the shape of the prepared root canal.)
2) Strip perforations as well as highly irregular-shaped canals were frequently
produced
Therefore, UI is not generally perceived as an alternative to conventional hand
Ultrasonic Irrigation
(UI)
51. Passive Ultrasonic Irrigation
• The term PUI was first used by Weller et al. in
1980 to describe irrigation without simultaneous
instrumentation.
• This non-cutting technology reduces the potential
for creating aberrant shapes in the root canal
system.
52. •Energy is transmitted
from an oscillating file or a
smooth wire to the irrigant
in the root canal by means
of ultrasonic waves.
These waves induces
acoustic streaming and
cavitation of the irrigant
This produces a
disagglomeration of
bacteria biofilms in the root
canal by the action of the
acoustic current
Gives rise to planktonic
bacteria that are more
susceptible to the
bactericidal activity of
NaOCl
Cavitation may also
produce a temporary
weakening of the cell
membrane making bacteria
more permeable to NaOCl
Mechanis
m of
Action
53.
54. • Recently, Nusstein in US patented a a needle-holding
adapter to an ultrasonic handpiece .
• During ultrasonic activation, a 25-gauge irrigation needle is
used instead of an endosonic file.
• The unique feature of this needle-holding adapter is that the
needle is simultaneously activated by the ultrasonic
handpiece, while an irrigant is delivered from an intravenous
tubing connected via a Luer-lock to an irrigation-delivering
syringe.
Continuous Ultrasonic Irrigation
55. Intermittent Flush Ultrasonic Irrigation
• In intermittent flushed ultrasonic irrigation, the irrigant is delivered to the root
canal by a syringe needle.
• The irrigant is then activated with the use of an ultrasonically oscillating
instrument. The root canal is then flushed with fresh irrigant to remove the
dislodged or dissolved remnants from the canal walls.
• The amount of irrigant flowing through the apical region of the canal can be
controlled because both the depth of syringe penetration and the volume of
irrigant administered are known. This is not possible with the use of the
56. Mozo et al 2014, compared the ability to eliminate debris and open
dentinal tubules of different ultrasound irrigation procedures and
concluded that Passive ultrasonic activation of the irrigation with
Irrisafe tips was the most effective procedure for eliminating the debris
and opening up dentinal tubules, especially in the apical third.
J Clin Exp Dent. 2014 Feb; 6(1): e47–e52.
58. ENDO VAC SYSTEM RINSE ENDO SYSTEM
Pressure Alternating Devices
59. • Three different components of EndoVac system:
- The Master Delivery Tip (MDT)
- The Macro Cannula And
- The Micro Cannula .
• They are used separately (or together) in 4 discrete
phases of root canal preparation and final irrigation:
access opening, canal preparation, macro irrigation,
and micro irrigation.
ENDOVAC SYSTEM
60. Principle Of Endovac System
The process begins immediately after all canals are located
and working lengths are confirmed.
Accordingly, the MDT is used with orifice expansion
instruments to apply and evacuate large quantities of
NaOCl
After completion of all rotary preparations, a micro-
hurricane of NaOCl is created inside the root canal by
using the macro cannula which creates a pressure-washing
effect along the walls of the root canal system.
This micro-hurricane lasts for 20 seconds while at least 15 to
20 mL of irrigation solution are added via the MDT and
continues the macro evacuation process in coronal two
third of root canal.
Significant microscopic debris still remains in the apical one
third that must be removed via the micro cannula.
61. The micro cannula is placed at full working length, and
irrigant cascading down the walls,
The last of the organic debris begins its hydrolysis,
releasing ammonia and carbon dioxide gas.
This serves to “insulate” the residual tissue from further
contact with the NaOCl solution.
In order to eliminate/evacuate these micro-bubbles, it is
necessary for the clinician to lift the micro cannula
coronally 2 mm every 6 seconds, then return it to the full
working length for 6 more seconds
This is done for a total of 30 seconds during the final
micro evacuation phase.
62.
63. Venumbaka et al 2018, evaluated and compared the apical extrusion of
irrigant and depth of irrigant penetration into dentine using the
EndoVac irrigating system and manual irrigation system in primary
molar teeth and he concluded that the EndoVac irrigation system
demonstrated better efficacy compared to manual irrigation system
with less apical extrusion and better depth of irrigant penetration into
dentine.
The Journal of Clinical Pediatric Dentistry, 2018, 42(5):355-360
64. Rinse Endo System
The RinsEndo system irrigates the canal by using pressure-suction technology
developed by Durr Dental Co.
Its components are - Handpiece,
- Cannula with a 7 mm exit aperture,
- Syringe carrying irrigant.
The handpiece is powered by a dental air compressor and has an irrigation
speed of 6.2 ml/min.
Hauser V, Braun A, Frentzen M. Penetration depth of a dye marker into dentine using
a novel hydrodynamic system (RinsEndo). Int Endod J 2007;40:644–52.
65. During the suction phase, the used solution and air are extracted from the root
canal and automatically merged with fresh rinsing solution. The pressure-suction
cycles change approximately 100 times per minute.
With this system, 65 mL of a rinsing solution oscillating at a frequency of 1.6 Hz is
drawn from an attached syringe and transported to the root canal via an adapted
cannula
66. McGill et al , evaluated the effectiveness of RinseEndo system in a split
tooth model. They found to be less effective in removing the stained
collagen from root canal walls when compared with manual-dynamic
irrigation by hand agitation of the instrumented canals with well-fitting
gutta-percha points.
69. Safety Irrigator
It is an irrigation/evacuation system that apically
delivers the irrigant under positive pressure
through a thin neede containing lateral opening and
evacuates the solution through large needle at root
canal orifice.
It features a large coronal evacuation tube, enabling
the user to safely irrigate and evacuate
simultaneously. It fits any standard leur lock
70. • This negative pressure device comes with fully assembled and fitted
with side vented irrigation needle for added safety.
• This system was tested in vitro to evaluate the removal of dentin debris
from artificially made grooves in standardized root canals and showed
that there was no significant difference among the manual dynamic
activation, the safety irrigator and apical negative pressure irrigation.
71. The VATEA system is an irrigation device which is
an integral part of Self Adjusting file rotary system
(SAF).
The VATEA system is a self-contained, fluid
delivery unit intended to be attached to dental
handpieces to deliver irrigation during endodontic
procedures.
VATEA SYSTEM:-
72. During the endodontic treatment, irrigation
solution is pumped from the VATEA's 400 ml
reservoir.
The irrigant is delivered via a disposable silicone
tube to the endodontic file.
The operator can adjust the flow rate from 1-10
ml/min by using the -/+ push buttons located on
the control panel.
The flow of irrigant is toggled using a foot pedal.
74. The first use of laser in endodontics was reported by Weichman and Johnson in 1971.
Laser energy may be used to activate irrigant solutions in different ways
At bulk flow level
Laser Activated
Irrigation
At Molecular Level
Photo Activated
Disinfection
Laser activated irrigation (LAI) is based on the creation of specific cavitation
phenomena and acoustic streaming in intracanal fluids as a result of
photothermal and photomechanical effects
75. Carbon dioxide (CO2),
9600 and 10 600 nm
Potassium titanyl
phosphate (KTP), 532 nm;
Diode, 635 to 980 nm;
Neodimium:yttrium
aluminium garnet
(Nd:YAG), 1064 nm;
Erbium, chromium: yttrium
scandium galium garnet
(Er,Cr:YSGG), 2780 nm
Erbium: yttrium
aluminium garnet
(Er:YAG), 2940 nm;
The laser wavelengths described for cleaning and disinfecting the root canal system
are:
76. Most commonly used laser for endodontic disinfection.
Antimicrobial effect of the Nd:YAG is based on thermal heating of the bacterial
environment and local heating inside bacteria (through chromophores inside
bacteria sensitive to the laser light)
The advantage of this laser is its significant bactericidal effect up to 1 mm into
the dentine.
Moritz et al. found 99.16% reduction of bacterial numbers (Enterococcus
faecalis and Escherichia coli) in inoculated root canals after Nd:YAG irradiation.
Nd:YAG laser
77. Since Nd:YAG laser irradiation is well absorbed in melanin and dark pigmented
tissues and poorly in water, it is not as effective against nonpigmented bacteria and
bacterial biofilms and therefore higher energy densities are required to induce a
lethal thermal effect.
At present, safety parameters for the Nd:YAG laser are 15 Hz, 100 mJ, and 1.5 W,
four times for 5 to 10 seconds, with an interval of 20 s .
Antibacterial effect of Nd:YAG laser has never been shown to be superior to
conventional NaOCl irrigation . Bergman et al. concluded that Nd:YAG laser
irradiation is not an alternative but a possible adjunct to existing protocols for root
Drawbacks
78. • Diode lasers emit radiation within the visible (mostly 660 nm) and
infrared (810 to 980 nm) range of the electromagnetic spectrum.
• Due to the higher absorption coefficient in water (0.68 cm-1), diode
lasers have lower penetration depth into the dentine (up to 750 µm)
compared to Nd:YAG laser .
• In a study by Bago et al. the effect of a diode laser (985 nm, 2 W, 3x20 s)
against E. faecalis biofilm was similar to the use of 2.5% NaOCl for 60 s.
DIODE
LASERS
79. Erbium lasers are commonly used for the
agitation of intracanal water-based fluids.
The strong absorption of the Erbium
laser energy (at low settings of 50-75
mJ) in water and NaOCl
causes vaporization and formation of large
elliptical vapour bubbles
cause a volumetric expansion of up to 1,600
times the original volume of an irrigant with
high intracanal pressure which drives the
fluid out of the canal.
The bubbles implode after 100 to 200
microseconds, creating pressure which
sucks fluid back into the canal: inducing
secondary cavitation effect
Er:YAG and Er,Cr:YSGG
lasers
80. De Moor et al. and De Groot et al. showed a higher efficiency of LAI with
Er,Cr:YSGG and Er:YAG (75 mJ, 20 Hz, 1.5 W, 4 x 5 s) and 2.5% NaOCl in
the removal of dentine debris from the apical part of the root canal
compared to conventional irrigation or Passive ultrasonic irrigation
J Endod. 2010 Sep;36(9):1580-3.
81. If the Er:YAG laser is used at low settings (20 mJ, 15 Hz) and ultra-short laser
pulses (50 µs), intracanal cavitations and shockwaves are created as a result of
photoacoustic and photomechanical effects. This phenomenon is called photon
induced photoacoustic streaming (PIPS).
Compared to the LAI, where intracanal conical side-firing fibre tips are
positioned 5 mm from the apex, PIPS uses a tapered 600 µm wide side-firing
stripped tip which is kept at the entrance of the root canal and used with
82. When using lasers inside the root canal, several limitations
have to be taken into consideration.
Firstly, the laser light is emitted in a straight line from the tip of an
optical plain-ended fibre or a laser guide with a divergence angle of
only 18 to 20 degrees.
Moreover, the root canal preparation as well as retreatment
procedures with laser and plain fibres is dangerous in curved root
canals because of the risk of creating ledges and perforations
Another limitation is the safe use of lasers in the root canal, especially
thermal damage of periradicular tissues through the open apical
foramen may occur when using the erbium lasers at ablative settings
83. Photoactivated Disinfection
• It is a laser induced photochemical disinfection or sterilization of hard and soft tissues
which is based on the activation of a nontoxic photosensitizer by low laser energy.
• As a result of the interaction between the phothosensitizer and the laser light,
singlet oxygen (1O2) is formed out of molecular oxygen (3O2)
which causes damage to the bacterial membrane and to its DNA
84. • Various combinations of light sources (diode laser at 630nm, 660nm and
670nm; Helium: Neon laser) & Dyes (methylene blue, tolonium chloride)
have been investigated and are commercially available.
In an in vivo study of Garcez at al. 2010, a combination of
polyethylenimine chlorine and a diode laser (40 mW, 4 min,
energy: 9.6 J), was used successfully for the eradication of multi-
drug resistant microorganisms.
J Endod. 2010 Sep;36(9):1463-6.
85. Souza et al. 2010 investigate the antibacterial effects of photodynamic
therapy (PDT) with methylene blue (MB) or toluidine blue (TB) (both
at 15 μg/mL) as a supplement to instrumentation/irrigation of root
canals experimentally contaminated with Enterococcus faecalis and did
not find a significant additional effect of the aPDT compared to
chemomechanical instrumentation with either methylene blue or
toluidine blue and 660 nm diode laser (40 mW).
86. Limitation
• Discoloration of teeth due to penetration of dye in
dentinal tubules.
• Limited diffusion of the photosensitizer into intracanal
irregularities, dentinal tubules and into the biofilm with
restricted production of reactive oxygen species (ROS)
will interfere with the efficacy of a PDT in root canal
disinfection
87. Gentle Wave System
• The GentleWave® System (Sonendo, Inc., Laguna
Hills, CA), is an innovative and unrivaled method
designed to create “ultraclean” canals in order to
overcome current limitations and challenges.
• The GentleWave™ System is capable of removing all
tissue, smear layer, biofilm, and bacteria from the
tubules to a very deep level that is not typically seen
in traditional endodontic treatment.
•
88. Features and Benefits :-
1. Haapasalo et al.152 (2014) demonstrated that the tissue dissolution efficacy of
the GentleWave® System is at least eight times greater than that of conventional
irrigation systems, ultrasonic irrigation, and EndoVac
2. The GentleWave System results in negative pressure and zero extrusion at the
apex.
3. To use the GentleWave System, the teeth have to be only minimally
instrumented e.g.: siz e 15/04.
89. • The resulting fluid dynamics, multisonic sound waves, and sono-
chemistry, enable the treatment fluids to penetrate and reach complex
areas such as apical-thirds, isthmi, lateral fins, dentinal tubules, and
other anastomoses.
• This cleaning system composes of a portable treatment unit with a
single-use sterile handpiece. Irrigant solutions of NaOCl, distilled
water and EDTA are included in this cleaning system.
4. Recent clinical study shows that only 3% of the patients experience
moderate post-treatment pain, and 97% of successful healing in the
teeth treated with the GentleWave System at 12months
90. The EC system is composed of a 25/.04 ABS plastic instrument designed to
mechanically activate the irrigant and combines reciprocating motion with
an ‘‘aircraft wing’’ design.
The system cleans by agitation of the irrigation solution and also by
mechanical drag of adhered debris.
Because a mechanical movement is involved, the agitation action occurs
along the whole length of the instrument unimpeded by contact of the
instrument with canal walls.
EASY CLEAN
SYSTEM
91. Kato et al 2016, compared the efficacy of passive ultrasonic irrigation
(PUI) versus a new activation system using reciprocating motion
(EasyClean [EC] and they concluded that activating the irrigant with
a reciprocating system (EC) promoted more effective debris removal
from the more apical regions of the root canal when compared with
PUI
J Endod 2017 Feb;43(2):326-331.
93. • Effective irrigant delivery and agitation are prerequisites for successful
endodontic treatment.
• Technological advances during the last decade have brought to fruition
new agitation devices that rely on various mechanisms of irrigant transfer,
soft tissue debridement, and, removal of smear layers.
• Overall, they appeared to have resulted in improved canal cleanliness
when compared with conventional syringe needle irrigation.
94. • In addition, from a practical point of view, no evidence based study is available
to date that attempts to correlate the clinical efficacy of these devices with
improved treatment outcomes.
• Thus, the question of whether these devices are really necessary remains
unresolved.
• There is a need to determine from a practice management perspective how these
devices are perceived in terms of their practicality and ease of use..
95. 1. Li-sha Gu. Review of Contemporary Irrigant Agitation Techniques and Devices. JOE — Volume 35, Number 6, June 2009,791.
2. L. W. M. van der Sluis. The influence of volume, type of irrigant and flushing method on removing artificially placed dentine
debris from the apical root canal during passive ultrasonic irrigation. International Endodontic Journal, 39, 472–476, 2006.
3. V. Hauser. Penetration depth of a dye marker into dentine using a novel hydrodynamic system (RinsEndo). International
Endodontic Journal, 40, 644–652, 2007.
4. M.K.Wu. A primary observation on the preparation and obturation of oval canals. International Endodontic Journal, 34, 137-
141, 2001.
5. Michael S. O’Connell. A Comparative Study of Smear Layer Removal Using Different Salts of EDTA. JOURNAL OF
ENDODONTICS VOL. 26, NO. 12, DECEMBER 2000.
6. Melvin Goldman. New method of irrigation during root canal treatment. JOE, Vol.2, No.3, Sept 1976.
7. Solaiman M. Al-Hadlaq. Efficacy of a New Brush-Covered Irrigation Needle in Removing Root Canal Debris: A Scanning
Electron Microscopic Study. JOE — Volume 32, Number 12, December 2006, 1181.
REFERENCES
96. 8) Jarbas Gonçalves Passarinho-Neto. In vitro evaluation of endodontic debris removal as obtained by
rotary instrumentation coupled with ultrasonic irrigation. Aust Endod J 2006; 32: 123–128.
9) S.-J. Lee. The efficacy of ultrasonic irrigation to remove artificially placed dentine debris from different sized simulated
plastic root canals. International Endodontic Journal, 37, 607–612, 2004.
10) M. Hülsmann & W. Hahn. Complications during root canal irrigation – literature review and case reports. International
Endodontic Journal,33, 186–193, 2000.
11) Y. Fukumoto. An ex vivo evaluation of a new root canal irrigation technique with intracanal aspiration. International
Endodontic Journal, 39, 93–99, 2006.
12) Benjamin A. Nielsen. Comparison of the EndoVac System to Needle Irrigation of Root Canals. JOE — Volume 33,
Number 5, May 2007..10
13) ENDODONTIC DISINFECTION The Sonic Advantage by Clifford J. Ruddle, DDS.
14) Passive ultrasonic irrigation of the root canal: a review of the literature L. W. M. van der Sluis1 , M. Versluis2 , M. K. Wu1
& P. R. Wesselink1
97. 15)Ronald A. Sabins. A Comparison of the Cleaning Efficacy of Short-Term Sonic and
Ultrasonic Passive Irrigation after Hand Instrumentation in Molar Root Canals. JOURNAL OF
ENDODONTICS VOL. 29, NO. 10, OCTOBER 2003.
16) S.-J. Lee. The effectiveness of syringe irrigation and ultrasonics to remove debris from simulated
irregularities within prepared root canal walls. International Endodontic Journal, 37, 672–678, 2004.
17) Rubin Gutarts. In Vivo Debridement Efficacy of Ultrasonic Irrigation Following Hand-Rotary
Instrumentation in Human Mandibular Molars. JOE—Volume 31, Number 3, March 2005.
Editor's Notes
2-because of the intricate nature of root canal anatomy.