Irrigation and Intracanal.pdf مواد شست‌وشو دهنده

1. IRRIGATION AND INTRACANAL
MEDICAMENTS
BY: DR SHABNAM SABERI

2. OUT LINE
• Ideal Requirements for an Irrigant
• Functions of Irrigants
• Factors that Modify Activity of Irrigating
Solutions
• Commonly used Irrigating Solutions
• Normal Saline
• Sodium Hypochlorite
• Hydrogen Peroxide
• Chlorhexidine
• Chelating Agents
• Method of Irrigation
• Intracanal Medicaments
• Classification of Intracanal Medicaments
• Characteristics of Intracanal Medicaments
• Placement of Intracanal Medicament

3. • Successful endodontic treatment depends on combination of proper instrumentation,
irrigation and three dimensional obturation.
• “Instruments shape, irrigants clean.”
• Irrigation is the only way to clean those areas of root canal wall that are not touched by
mechanical instrumentation.

4. OBJECTIVE OF USING AN IRRIGANT
• is chemical dissolution/disruption,
• mechanical detachment,
• removal of pulp tissue, dentin debris and smear layer, microorganisms and their products
out of the root canal system.
• Bleaching action of irrigants lighten the teeth

5. IDEAL REQUIREMENTS FOR AN IRRIGANT
• broad-spectrum antimicrobial
• Aid in the debridement
• dissolve necrotic tissue or debris
• low toxicity
• good lubricant
• low surface tension
• sterilize the root canal (or at least disinfect
them)
• prevent formation of smear layer during
instrumentation or dissolve the latter once
• inactivate endotoxin
• Be fungicidal
• Not weaken the tooth structure
• Be easily available
• Be cost-effective
• Be easy to use
• Have adequate shelf life

9. NORMAL SALINE
• 0.9% , is commonly used in endodontics for gross debridement and lubrication of root
canals because it acts by flushing action.
• an adjunct to chemical irrigant
• as final rinse for root canals

10. CONT…
NORMAL SALINE
ADVANTAGES
• Biocompatible
• No adverse reaction even if extruded
periapically
DISADVANTAGES
• Does not possess dissolution and
disinfecting properties
• Too mild to thoroughly clean the canals
• Cannot clear microbial flora from
inaccessible areas like accessory canal
• Does not possess antimicrobial activity
• Does not remove smear layer

11. SODIUM HYPOCHLORITE
• NaOCl is a clear, pale, green yellow liquid with strong odor of chlorine.
• known as Dakin’s solution 0.5% (during world war I)
• wide spectrum, it is sporicidal, has tissue dissolving properties
• Availability
• Unbuffered at pH 11 at conc. 0.5% to 5%
• Buffered with bicarbonate at pH 9.0 as 0.5% or 1% solution

14. PRECAUTIONSTO BETAKEN WHILE USING SODIUM
HYPOCHLORITE SOLUTION
• sodium hypochlorite is nontoxic during intracanal use but 5.25% NaOCl can cause
serious damage to tissue if injected periapically
• it causes excruciating pain, periapical bleeding and swelling.
• As potential for spread of infection is related to tissue destruction, medication like
antibiotics, analgesics, antihistamine should be prescribed.
• reassurance to the patient is the prime consideration.
• passive irrigation especially in cases with large apical openings.

16. ADVANTAGES
• •• Causes tissue dissolution
• •• Remove organic portion of dentin for deeper penetration of medicament
• •• Removes biofilm
• •• Causes dissolution of pulp and necrotic tissue
• •• Shows antibacterial and bleaching action
• •• Causes lubrication of canals
• •• Economical
• •• Easily available

17. DISADVANTAGES
• •• Because of high surface tension, its ability to
wet dentin is less
• •• Irritant to tissues, if extruded periapically, it
can cause tissue damage
• •• If comes in contact, it cause inflammation of
gingiva because of its caustic nature
• •• It can bleach the clothes, if spillage occurs
• •• It can be corrosive to instruments
• •• It has bad odor and taste
• ••Vapors of sodium hypochlorite can irritate
the eyes
• •• It is unable to remove inorganic
components of smear layer
• •• Long time of contact with dentin has
determined effect on flexural strength of
dentin
• •• Exudate and microbial biomass inactivates
NaOCl. So, continuous
• irrigation and time are important when
irrigation is done with NaOCl

18. HYDROGEN PEROXIDE
• It is a clear, odorless liquid and mainly 3% solution of hydrogen peroxide is used as an
irrigating agent.
• It is highly unstable and easily decomposed by heat and light.
• It rapidly dissociates into H2O + [O]
• Rapid release of [O] on contact with organic tissue results in
effervescence or bubbling action which is thought to aid in mechanical debridement

19. USES
• It is used as an irrigating solution either alone or alternatively with sodium hypochlorite.
• The advantage of using alternating solutions of 3% H2O2 and 5.2% NaOCl are:
1. Effervescent reaction by hydrogen peroxide bubbles pushes debris mechanically out of
root canal
2. Solvent action of sodium hypochlorite on organic debris
3. Disinfecting and bleaching action by both solutions

21. CHLORHEXIDINE
• (CHX) is most stable in the form of its salts, that is, chlorhexidine gluconate.
• It shows optimal antimicrobial action between pH 5.5 and 7.0. For canal irrigation,
• it is used in 2% concentration
• At low concentration, it acts as a bacteriostatic
• At high concentration acts as bactericidal
• Chlorhexidine has the property of substantivity (residual effect).
• It can show residual antimicrobial activity for 72 h
or even up to 7 days if used as an endodontic irrigant

23. DISADVANTAGES
• It is unable to dissolve necrotic tissue remnants
• It is less effective on Gram-negative than on Gram-positive bacteria
• Does not show effect on biofilms

26. EDTA
• Ethylenediaminetetraacetic acid (EDTA) is the most commonly used chelating agent.
aid in preparation of narrow and tortuous canals
to soften the canal dentin,
Increase dentin permeability and remove smear layer.

29. METHOD OF IRRIGATION
• Solution should be introduced slowly and passively into the canal
• Needle should never be wedged into the canal and should allow an adequate backflow
• Blunted needle of 26 gauge or 27 gauge are preferred
• In case of small canals, deposit the solution in pulp chamber.
• For effective cleaning, the needle delivering the solution should be in close proximity to the
debris to be removed
• In case of large canals, tip of needle should be introduced until resistance is felt, then
withdraw the needle 2–3 mm away from that point and irrigate the canal passively.

31. INTRACANAL MEDICAMENTS
• drugs are still being used as intratreatment dressings, although an ever increasing number
of endodontists use them only for symptomatic cases.

32. DESIRABLE PROPERTIES OF AN INTRACANAL
MEDICAMENTS
• Be effective germicide and fungicide
• Be nonirritating to pulpal tissue
• Remain stable in the solution
• Have prolonged antimicrobial action
• Remain active in presence of blood, pus, etc.
• Have low surface tension
• Not interfere with repair of periapical tissue
• Non-staining to tooth
• Be capable of inactivation in the culture media
• Not induce immune response

34. EUGENOL

35. FORMOCRESOL
• Formocresol contains formaldehyde as its main ingredient and is still widely used
medicament for pulpotomy
• procedures in primary teeth but its toxic and mutagenic properties are of concern.
• Composition of formocresol
 Formaldehyde—19%
 Cresol—35%
 Water and glycerine—46%
• Uses: Used as dressing for pulpotomy to fix the retained pulpal tissue.

36. CALCIUM HYDROXIDE

37. PBSC PASTE

38. CORTICOSTEROID–ANTIBIOTIC
COMBINATIONS
• Ledermix / 1960.
• It contains an antibiotic demeclocycline—HCl (3.2%)
• and a corticosteroid, triamcinolone acetonide (1%).
• Corticosteroid constituent reduces the periapical inflammation
• and gives almost instant relief of pain.
• Antibiotic constituents prevent the overgrowth of microorganisms
when the inflammation subsides

39. PLACEMENT OF INTRACANAL
MEDICAMENT
• Copiously irrigate the canal to remove debris present if any
• Place the master apical file in the canal
• Dry the canal using absorbent paper points
• Place the intracanal medicament on a sterile cotton pellet
• and place it in the pulp chamber
• Over this, another sterile cotton pellet is placed, which is finally sealed with a temporary
restorative material

41. LIMITATIONS OF INTRACANAL
MEDICAMENTS
• For an intracanal, medicament to be effective, it should remain active during the time of
interappointment, which does not happen in every case
• Clinical effectiveness of sustained release delivery systems is unknown
• Therapeutic action of medicament depends upon its direct contact with tissues, but it can
be prevented due to presence of organic tissue/matter