Studies comparing the antimicrobial efficacy these approaches to irrigation, with a 3 per cent sodium hypochlorite solution found all to be inferior to varying degrees 11 –13. Sterilox), laser photo activated disinfection and ozone gas filtration of the root canal system. The presence of the flocculate may lead to blockage of narrow anatomy and subsequently hinder adequate penetration of hypochlorite.Īlternative concepts for antimicrobial irrigation include electrochemically-activated water (eg. This flocculate contains para-chloroaniline (PCA), which is known to be carcinogenic, although the level of exposure in such cases is likely to be low. Like sodium hypochlorite, chlorhexidine lacks the ability to dissolve the smear layer 4.Ĭhlorhexidine should not be used in conjunction with sodium hypochlorite due to the formation of a precipitate or flocculate. The major advantages chlorhexidine has over sodium hypochlorite are lower toxicity, less objectionable smell and taste and substantivity, meaning it persists on the walls of the canals. This is likely to be due to its inability to dissolve pulpal remnants 10. While several in-vitro studies have shown anti-microbial efficacy to be similar to sodium hypochlorite, some in-vivo studies have demonstrated chlorhexidine to be inferior, with more culture reversals from negative to positive between visits. As a root canal irrigant, it is generally presented in 2 per cent concentration. ChlorhexidineĬhlorhexidine is a bisguanide, generally used in the form of chlorhexidine digluconate. Its action on organic tissue enables it to disrupt and kill biofilms adherent to the root canal walls.Ĭoncentrations in use in endodontics range from 0.5 to 5.25 per cent. Sodium hypochlorite (NaOCl) is recommended as the main endodontic irrigant due its ability to dissolve organic tissue and its broad anti-microbial spectrum 9. The role of decalcifying agents such as EDTA incudes chelation of the mineral content of this “smear layer” and the opening of access to the lateral anatomy 9. Mechanical instrumentation has been shown to result in the burnishing of organic material and dentine debris against the canal wall and into depressions and lateral anatomy 8. Irrigants in contemporary use can be classified as antimicrobial or decalcifying 4 (see table). Irrigation with such chemically inert media has been shown to be incapable of adequately reducing the viable microorganisms in infected root canal systems 5. Saline and local anaesthetic have each been employed, but these provide only a flushing and lubricating function. In practice, no single irrigant achieves all of these aims and a combination regime is recommended. Irrigant activation may be enabled either by manual or machine-assisted means The functions of endodontic irrigation include: Fins, lateral anatomy and communicating canals render the goal of mechanical removal of all infected tissue impossible therefore, after gross debridement of the vital and non-vital tissue from the canal, the main goal of mechanical preparation is to enable chemical disinfection of the root canal 7. Mechanical cleaning of the root canal system with hand or rotary instruments has been shown to engage only a proportion of the root canal wall – 35 to 53 per cent of the canal wall surface may remain untouched following preparation 6. To this end, our primary treatment modality is chemo-mechanical debridement of the root canal 5. The aim of root canal treatment is the prevention or treatment of apical periodontitis by the elimination of micro-organisms from the root canal system and the prevention of subsequent recontamination 4. Figure 2 - A well-fitting GP cone can be used in a rapid pumping motion for manual dynamic irrigationĪpical periodontitis has been established to be a microbial-induced disease 1 –3.
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