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CONTENTS
Introduction Interactions
History Recent developments
Objective and functions . Irrigation protocol in different
Mode of action clinical situations
Conclusion
Classification of irrigants
Introduction of each irrigants
History
Mechanism of action
Advantage of irrigation
Disadvantages of irrigation
Irrigation is a key part of successful root canal treatment as it
fulfils several important mechanical, chemical and (micro)
biological functions. Irrigation is also the only way to impact those
areas of the root canal wall that are not touched by mechanical
instrumentation.
Substances that have been used to rinse and chemically clean root
canals have different purposes, such as dissolution of soft and hard
tissues, antimicrobial effect against bacteria or other
microorganisms in the root canal, and inactivation of bacterial
lipopolysaccharides.
Several factors are important for efficient root canal irrigation. One
critical factor is the volume of irrigant. In a study evaluating the
effect of different amounts of fluids, the volume of irrigant was
found to affect the cleanliness of the root canal. NaOCl and EDTA
administered in larger volumes produced significantly cleaner root
canal surfaces than smaller volumes.
Primary endodontic treatment goal- optimize root
canal disinfection and to prevent re-infection by
cleaning the root canal system thoroughly and
making it free of microbiota and debris, as they
have definite role in the initiation and
perpetuation of pulpal and periapical diseases
(Kandaswamy and Venkateshbabu, 2010).
2.HISTORY
Potassium hypochlorite was the first chemically
produced aqueous chlorine solution, invented in
France by Berthollet (1748-1822).
Age of irrigan
Many irrigating solutions have been studied
extensively to determine which best exhibit these
ideal properties, but the ideal irrigant has not yet
been realized.
CLASSIFICATION OF IRRIGANTS (1)
Many different irrigants and combinations of
irrigants have been used in RCT to achieve these
goals. These include: (2)
1. Sodium hypochlorite;
2. Chlorhexidine;
3. Sterilox (Hypochlorous acid (HClO)
4. EDTA
5. Iodine potassium iodide
6. Hydrogen peroxide
7. Local anaesthetic, saline and/or water;
8. Mixtures of irrigants (QMIXR).
CATEGORIES OF IRRIGANTS: (3)
lubricants,
disinfectants,
Bactericidal irrigants:
Sodium hypochlorite (0.5%, 1%, 1.5%, 2.5%, 5.25%, and 6%
concentrations)
Chlorhexidine (CHX) (2%)
Iodine
Hydrogen peroxide (H 2 O 2 ) (3%).
Chelator solutions
diamine tetra acetic acid (EDTA, 17%)
Citric acid (10-50%)
Mixture of tetracycline, acid and detergent (MTAD, Tween 80)
Tetraclean
Maleic acid.
Herbal irrigants
Others:
activated water (EAW)
Bis-dequalinium acetate (BDA)
Photo-activated disinfection (PAD)
Ozone
Laser.
Sodium hypochlorite
INTRODUCTION
HISTORY
MODE OF ACTION
ADVANTAGES
DISADVANTAGES
INTERACTIONS
1. SODIUM HYDROCHLORITE
3. Chloramination reaction
The chloramination reaction between chlorine and the amino
group (NH) forms chloramines that interfere in cell
metabolism. Chlorine (a strong oxidant) has an antimicrobial
action, inhibiting bacterial enzymes and leading to an
irreversible oxidation of SH groups (sulphydryl group) of
essential bacterial enzymes.
Thus, the saponification, amino acid
neutralization, and chloramination reactions that
occur in the presence of microorganisms and
organic tissue lead to the antimicrobial effect and
tissue dissolution process.
CONCENTRATIONS
NaOCl is used in concentrations between 0.5 and 6%.
secondary infection;
reversible anesthesia; and paresthesia.
Current treatment protocol for sodium hypochlorite
accident are suggest:
early recognition of extrusion,
Also, Garrett et al. studied the effect of citric acid on diseased root
surfaces.
EDTA (ethylenediamine tetra-acetic acid), 10% citric acid, EDTA-T
(EDTA plus 1.25% sodium lauryl ether sulfate), EGTA (ethylene
glycol-bis-(b-amino-ethyl ether) N,N,N9,N9-tetra-acetic acid) and
MTDA (mixture of a tetracycline isomer, a detergent, and an acid)
are considered effective decalcifying agents used for endodontic
treatment for smear layer removal.
Both 10% citric acid and EDTA-T provide a large number of open
dentinal tubules after a 4-min irrigation, with no statistical
difference between them. It has also been reported that irrigation
with 10% citric acid for 3 min showed a similar pattern of Ca++
extraction compared to EDTA-T used for a much longer time
interval (15 min).
Both 10% citric acid and EDTA-T provide a large
number of open dentinal tubules after a 4-min
irrigation, with no statistical difference between
them. It has also been reported that irrigation with
10% citric acid for 3 min showed a similar
pattern of Ca++ extraction compared to EDTA-T
used for a much longer time interval (15 min).
NEWER IRRIGATING SOLUTION
1. MTAD
2. Tetraclean
3. Q MIX Other irrigating solutions:
4. HEBP 1. Hydrogen peroxide.
5. Green tea and Triphala
6. Silver diamine fluoride
2. Iodine potassium iodide
7. Electrochemically activated solutions
8. Photon-activated disinfection
MTAD
Torabinejad et al. developed a irrigant with combined
chelating and antibacterial properties.
.
This combination is advantageous in that the solution
keeps the sodium hypochlorite–hypochlorous acid
equilibrium toward NaOCl, which has better tissue
dissolution capacity than hypochlorous acid and is
also less cytotoxic
Depending on the type ECA device that incorporated the FEM elements
the pH of anolyte varies; it may be acidic (anolyte), neutral (anolyte
neutral), or alkaline (anolyte neutral cathodic); acidic anolyte was used
initially but in recent years the neutral and alkaline solutions have been
recommended for clinical application
. Under clean conditions, freshly generated
superoxidized solution was found to be highly
active against all these microorganisms giving a
99.999% or greater reduction in two minutes or
less.
That allowed investigators to treat it as a potent
microbiocidal agent (Selkon et al., 1999; Shetty et
al., 1999). It is nontoxic when being in contact
with vital biological tissues .
Clinical applications of anolyte and catholyte were reported to be
effective (Legchilo et al., 1996).
The early use of EDTA facilitates the flow of the different irrigants
in the lateral canals permitting a chemical preparation of all the
endodontic system. Chlorehexidine can be used for a total
elimination of the bacteria inside the canal.
The same sequence is adopted for external apical resorption but with
an activation of the patency
CONCLUSION
Irrigation has a key role in successful endodontic treatment.