o sealers and placement o root lling material. I a clinician is having diculty with the obturation phase o endodon-tic therapy, their cleaning and shaping technique should be reevaluated prior to consideration o changing obturationtechniques.
Why Obturate Canals?
Microorganisms and their byproducts are the major cause o pulpal and periapical disease.
However, it is dicult toconsistently and totally disinect root canal systems.
Thereore, the goal o three-dimensional obturation is to providean impermeable fuid tight seal within the entire root canal system, to prevent oral and apical microleakage.
Preparation o Dentin Surace (Irrigation)
The purpose o endodontic irrigation is to remove debris created during instrumentation, and to dissolve and/or fushout inorganic and organic remnants o the pulp system, bacteria and bacterial byproducts that are not removed bymechanical instrumentation. With the introduction o obturation materials designed to bond with dentin, irrigationsolutions must be used with consideration o the condition o the dentin surace that is most suitable or bonding. Fig-ure 3 shows the dentin surace beore and ater preparation or bonding. Attempts to eliminate pulp space inectionwith instrumentation only, without the use o antimicrobial agents, have proven to be unsuccessul.
Modern root canaltreatment requires the use o both mechanical and chemical preparation and disinection o the canal system.During cleaning and shaping procedures, a supercial amorphous layer o tissue remnants, organic and inorganicmaterials, and bacteria and their byproducts accumulate on the canal walls. This “smear layer” may interere or preventadhesion o sealers to the canal wall and serve as a substrate or bacterial growth. Evidence tends to support removingthe smear layer prior to obturation.
This removal supports reduction o potential irritants and permits better adapta-tion o sealer to the canal walls. Removal o the smear layer is easily accomplished by irrigating the canal with 17%disodium EDTA or one minute, ollowed by a nal rinse o sodium hypochlorite. Chelators remove the inorganiccomponents and sodium hypochlorite is necessary or removal o the remaining organic components.Adequate irrigation o root canals requires an eective irrigantas well as an ecient delivery system. The characteristics o an ide-al irrigant and irrigation system are listed in Table I.
The irrigatingsystem should be one that does not allow the irrigant to extrudebeyond the apical oramen into the periapical tissues.
Continued on p. 4
Fig. 3a.Dentin surface before andFig. 3b.after preparation for bonding.
Table II list actors that can infuence the ecacy o irrigatingroot canal systems.
Table I: Characteristics o anIdeal Irrigation System
Physical fushing o debrisBiocompatibleBactericidal agentSustained eect
Disinfect and detoxify dentin and tubules of all microbial substances
Tissue solventLubricantSmear layer removalNot aect physical properties odentin
Table II: Factors Inuencing Efcacy o Irrigation
Diameter o the irrigating needleDepth o the irrigating needle engaged in root canalSize o enlarged root canal (radius o tube)Viscosity o the irrigating solution (surace tension)Velocity o the irrigating solution at the tip o the needle(ultrasonics, sonics)Orientation o the bevel o the needleTemperature