3BDS: Endodontics 12

what are the ideal properties of a root canal irrigant

• Eliminate or minimise microorganisms
• Inactivate endotoxin
• Dissolve necrotic pulp tissue remnants
• Lubricate the root canal instruments
• Remove the smear layer and biofilm (+be antimicrobial)
• Be systemically non-toxic
• Be non-caustic to perio

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what are the commonly used root canal irrigants?

 Antimicrobial: sodium hypochlorite, 2% chlorhexidine (but this has no effect on removing necrotic pulp tissue)
 Removal of smear layer (citric acids, 17% ethyldiaminetetraacetic acid EDTA)

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what can sodium hypochlorite dissolve, what concentrations are available

capable of dissolving necrotic tissue.
1%-5.25%

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why is the volume of sodium hypochlorite, frequency and depth of penetration of irrigating needle important

In order to maximise antimicrobial effect of this

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what are the disadvantages of sodium hypochlorite

• Unpleasant taste
• High toxicity (to vital tissues)
• Inability to remove smear layer when used alone (needs to be used in conjunction with other irrigants in order to work)

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what are the complication os using these irritants during RCT

 Damage to clothing: use plastic bibs and ensure needle correctly attached to syringe
 Damage to eyes: always wear safety glasses, eye should be washed with large amounts of tap water/saline and patient referred to ophthalmologist)

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When can irrigation of sodium hypochlorite beyond root apex happen?

- Wide apical foramina and short root: To prevent this bend the needle 3mm short of WL so it’ll never come close to the periapical tissues
- Very narrow root canal and the needle gets jammed in it and you forcefully extrude the irrigant which has no place

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what are the symptoms if irrigation of sodium hypochlorite takes place?

Extreme pain, burning sensation
Haematoma and ecchymosis
Swelling
Profuse haemorrhage from the root canal
2nd infection and tissue necrosis
Paraesthesia

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what should the treatment of sodium hypochlorite irrigation focus on

- Treatment should focus on the principles of minimising swelling, controlling pain and preventing secondary infection and reviewing the patient until the symptoms have resolved

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what is the treatment of sodium hypochlorite irrigation

Analgesics
External compression with cold packs, replaced with warm compresses for several days
Antibiotics may needed to prevent the possibility of secondary infection
In serious cases a referral to oral surgery may be required for surgical interventio

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what is the endodontic smear layer?
how it formed? what does it contain? what does it prevent? what does it protect?

 Cleaning and shaping produces a layer that covers instrumented walls
 Contains inorganic and organic substances, microorganisms, necrotic materials
 Protects microbes in the dentinal tubules from the effects of disinfectants
 Prevents complete ada

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what can be used to remove smear layer?

EDTA, citric acid

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what syringe do we use for irrigation?

3mL luer lock syringe
27 gauge irrigating needle with side vent

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what is the irrigation sequence?

- Irrigate with 3mL sodium hypochlorite after every rotary file
Recapitulate with size 10 flexofile and irrigate
- Once preparation is completed:
Irrigate with a full syringe of sodium hypochlorite
Then irrigate with a full syringe of citric acid
Then

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3BDS: Endodontics 12

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