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IN IRRIGATING
SOLUTIONS AND
IRRIGATING DEVICES
INTRODUCTION
The pulp chamber and root canals of
untreated nonvital teeth are filled with
a gelatinous mass of necrotic pulp
remnants and tissue fluid.
HISTORY
Prior to 1940s Water was the most
commonly used irrigant as it was:
Readily available.
Inexpensive.
Provided a lubricating
during instrumentation.
effect
IMPORTANCE OF
IRRIGATION
Irrigation serves as a
Physical flush to remove debris
As well as serving as a bactericidal
agent,
Tissue solvent, and
Lubricant.
Furthermore, some irrigants are
effective in eliminating the smear
layer.
Goals of irrigation;
According to INGLE-
1. Lavage of debris.
2. Tissue dissolution.
3. Antibacterial action.
4. Lubrication.
1. Antimicrobial property.
2. Dissolve necrotic tissue debris.
4. Non-toxic
tissues
to
the
periapical
5. Lubricating
effect
:
instrumentation of the canals.
Facilitates
REMOVAL OF SMEAR
LAYER
It
has
been
described
by
scanning electron microscopy
(SEM)as
an
amorphous
substance with an irregular
surface.
The
syringe
application
of
irrigants, which is used most
frequently, can be replaced by
treatment of the root canal by
ultrasound.
In endodontics,the ultrasound
technique utilizes the mechanical
and
cavitation
effect
and
acoustic streaming of ultrasound
to
remove
the
surface
component of the smear layer.
CLASSIFICATION OF
IRRIGATING SOLUTIONS
I.
ACIDS
ORGANIC
Citric acid
Maleic acid
Tannic acid
Phosphoric acid
Tublicid
Lactic acid
INORGANIC
H2SO4 50%
HCl 30%
CHELATING AGENTS
EDTA
EDTAC
RC-Prep
- Streptokinase.
- Enzymol.
- Streptodornase.
- Purified trypsin.
- Papain
III.
- 3% hydrogen peroxide.
- Urea peroxide.
- Glyoxide.
IV.
OXIDIZING AGENTS
ALKALINE SOLUTIONS
Sodium dioxide.
Urea.
Sodium hydroxide.
Potassium hydroxide.
Chloramine-T.
V. OTHERS
Glutaraldehyde.
2% potentiated acid.
COMMONLY USED
IRRIGATING SOLUTIONS
SODIUM HYPOCHLORITE
Manufactured:
Antibacterial:
Vapor action.
2.
Chemical
protoplasm of
destroys it.
combination
with
the bacterial cell
the
that
for
effective
instrumentation.
2. Bleaching action on discolored
teeth.
3.
Increased
permeability
of
dentinal
tubules
for
easier
penetration
of
an
intra-canal
medicaments.
HYDROGEN PEROXIDE
For
years
3%
H 2O 2
was
recommended as a canal irrigant
because
Disinfecting properties.
in
Actions:
1) Effervesent action:
CHELATING AGENTS
GLYDE FILE :
Clinical recommendation;
1)Root canal preparation can be carried out
with the aid of chelator paste.This may be
introduced into the root canal with the
preparation instrument. The canals first
should have been flooded with NaOCl to
dissolve vital or necrotic tissue.
2)A chelator in paste form serves as a
lubricant for files and may reduce the risk
of instrument fracture in the canal.
3) Preferably NaOCl solution should be used
during preparation because of its
antibacterial and tissue dissolving
property
ADVANCEMENT IN
IRRIGATING SOLUTIONS
Chlorhexidine gluconate
It is a cationic chlorophenyl
bisguanide with bacteriostatic and
bacteriocidal action.
The cation of the chlorhexidine as
antiplaque agent was suggested by
schroeder in 1969.
The most common preparation is
with digluconate salt ,because of
higher water solubility.
Antibacterial action
Properties of CHX;
It possesses a broad-spectrum
antimicrobial action, substantivity,
and a relative absence of toxicity.
However, chlorhexidine gluconate is
not known to possess a tissuedissolving property.
The results from the individual trial of
chlorhexidine gluconate and sodium
hypochlorite indicate that they are
equally effective antibacterial agents.
An Effective Method of
Inactivating
Chlorhexidine;
An effective inactivating agent is required
for chlorhexidine that would facilitate
removal of all residual antimicrobial effect,
which may cause false negative results
during microbiologic culturing.
The combination of 3% Tween 80 and 0.3%
L-a- lecithin was found to be the most
effective inactivating agent, allowing full
recovery of the test organisms in the
presence of chlorhexidine
OXIDATIVE POTENTIAL
WATER
NISIN
Nisin is a naturally occurring antimicrobial
peptide
Produced
by
strains
of
Lactococcus lactis, nisin is an antibiotic
peptide, and is a class I bacteriocin
(Klaenhammer 1993). Nisin is safe to
humans and is used extensively as a
food preservative in over 40 countries
(Delves-Broughton 1990), mainly in
preservation of meat and dairy products
ELECTRO-CHEMICALLY ACTIVATING
WATER
BIS-DEQUALINIUM ACETATE
(BDA)
Kaufman reported the success of several
cases using BDA as a disinfectant and
chemotherapeutic agent
He cited its low toxicity, lubrication
action, disinfecting ability, and low
surface tension, as well as its chelating
properties and low incidence of posttreatment pain
Marketed
as
Solvidont
(Dentsply/DeTrey, Switzerland), the
University of Malaysia reported a
remarkable decrease in postoperative
pain and swelling when BDA was used.
Metranidazole
Active
against
bacteroides,
porphyromonas
fusibacterium,
clostridium
and
peptococci
and
peptostreptococci.
DOXYCYCLINE
HYDROCHLORIDE
Advantages:
Ruddle solution
This
contains
5%
NaOCl,
hypaque, and 17% EDTA.
Hypaque
is
an
aqueous
solution of 2 iodine salts
diatrizoate
meglumine
and
sodium iodine. It is water
soluble with pH of 6.7-7.7.
( tensioactive agent )
MTAD
It is a mixture of a tetracycline
isomer (doxycycline), an acid
[citric acid)], and a detergent
(Tween 80 )
OZONE
Ozone is a pale blue gas which is made up of
three atoms of oxygen with a cyclic structure
3O2 + 68,400cal--------2O3
Waterlase Laser
IRRIGATING DEVICES
ProRinse.
Monoject endodontic
needles
Moser
and
Heuer
reported
Monoject
endodontic needles to
be the most efficient
delivery system in
which longer needles
of a blunted,open-end
system were inserted
to the full length of
the canal.
Closed-end
needle
eliminates
possibilities of puncture of the apical
foramen or a water cannon effect
from open-end needles. [Courtesy of
Dentsply/Tulsa Dental.]
Endo Irrigator II
The Endo
Irrigator II has 3
reservoirs. The
gun on the right
has four buttons.
Three activate
the solutions and
one is for suction.
The device has a
built in heater.
Max-i-Probe
These are designed to produces
upward flushing motion for
complete canal irrigation .
Side port dispersal prevents
solution and debris from being
expressed through the apex
Closed, rounded end reduces risk
of apex damage.
Ultrasonic irrigation
JOURNAL REVIEW
CONCLUSIONS:
The use of distilled and deionized water
and Er:YAG laser showed the greater
increase of dentine permeability.
The use of 1% NaClO with Nd:YAG laser,
distilled, and deionized water with
Nd:YAG laser and the use of water
increased dentine permeability less
than the other groups.
The use of 1% NaClO with and without
Er:YAG laser application were positioned
intermediately among the treatments.
CONCLUSION
Many
new
materials
and
methods have recently been
introduced to improve root
canal debridement and to
achieve root canal sterilization.
Some of the new treatment
modalities have been marketed
to dentists, with the claim that
it is possible to sterilize an
infected root canal system,