DISINFECTION OF ROOT CANAL
Presented By: Amandeep Chopra

CONTENTS
• • • INTRODUCTION DISINFECTANTS MEDICAMENTS

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INTRODUCTION
• The root canal system is complex and includes many accessory anatomical features such as fins, lateral canals and intracanal communication . • These complex root canal system provides voids or potential site where bacterial colonization take place.

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fungi.. • These organism are found in various combination rather than single species. • Most cases gram +ve organism are present and some gram –ve and rarely yeast. AMANDEEP CHOPRA 5 . filamentous bacteria are also found in root canal.INTRODUCTION contd. • Gram +ve cocci chiefly streptococci and staphylococci and resistent group entrococci are found.

INTRODUCTION contd. • Only those best fit for survival in these environment do survive. • The organism reaching the root canal obviously have there origin in the mouth. • Microbial flora of root canal may contain organism that survive on the dead pulp tissue that is saprophytes.. AMANDEEP CHOPRA 6 . all varieties may have equal chance to invade pulp tissue or root canal.

• All these micro organism can invade periapical tissue. • Recently presence of obligate and facultative anaerobic are also found in root canal.INTRODUCTION contd. so disinfection of root canal is important phase of endodontic treatment. AMANDEEP CHOPRA 7 ..

DISINFECTION • Destruction of pathogenic micro organism which include removal of pulp tissue and debris. and clearing of its content by irrigation. cleaning and enlarging of the canal by biochemical means. • Also accomplished by intracanal medication AMANDEEP CHOPRA 8 .

Trauma The tooth under treatment should be disoccluded if necessary. Dead Spaces For maximum effect medicament should be in contact with microorganism in root canal. 3. 2. 4. Accumulation of exudate Exudate should be drained when it accumulates AMANDEEP CHOPRA 9 . it will interfere with disinfection or repair. Devitalized tissue If present in root canal or periapical tissue.FACTOR PREDISPOSING TEETH TO INFECTION 1.

DISINFECTION DISINFECTANTS MEDICAMENTS AMANDEEP CHOPRA 10 .

DIFFERENT TYPE OF ROOT CANAL DISINFECTANT • • • • • • Sodium hypochlorite Iodine solution Chlorhexidine gluconate Ethylene diamine tetra acetic acid. Electro chemically activated water Photo activated disinfection AMANDEEP CHOPRA 11 .

bis–dequalinium acetate RC-Prep MTAD AMANDEEP CHOPRA 12 .Contd… • • • • • • • • Endox Lasers Hydrogen peroxide Carbamide peroxide Salvizol BDA:.

-dissolves necrotic tissue. Candida microorganism.-dissolves necrotic & vital tissue. AMANDEEP CHOPRA 13 . Effective against .The disinfection caused by sodium hypochlorite is initially slow but increases progressively . Higher Conc. Lower Conc. Actinomycetes.SODIUM HYPOCHLORITE • • • • • Introduced by Gutheridge in 1919. It is effective bactericidal agent without being toxic or interfering with healing .Enterococus.

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• The efficacy of Sodium Hypochlorite decrease with lower conc. Penetration into the bacterial cell.5% solution dissolves necrotic but not vital tissue.SODIUM HYPOCHLORITE Contd… The destruction of bacteria takes place in two phases. AMANDEEP CHOPRA 15 . exposure to light. b. and contamination with metallic ions. Chemical combination with protoplasm of the bacterial cell that destroys it • 0. a. • It deteriorates on storage and becomes less active with time. increased temperature.

Used is from 0.1% solution should be effective in removing root canal debris and dissolving organic matter and even at 0.SODIUM HYPOCHLORITE • Contd… Conc. Regular replacement and agitation is required to maximize the effectiveness .25. AMANDEEP CHOPRA 16 .5% solution is very potent at killing enterococci.5% to 5.

60g of 90% ethanol. Iodine. Povidine.5g Potassium Iodide.IODINE SOLUTIONS • Solution of 5% Iodine in Potassium Iodide or Churchill’s solution can be used. 3. Iodine acts as oxidizing agent by reacting with free sulphydryl gp of bacterial enzyme cleaving disulphide bonds • • AMANDEEP CHOPRA 17 . and 20g.5 g. Churchill’s solution consists of 16. Distilled water.Iodine was not as effective as 3% solution of sodium hypochlorite.

Patient may be allergic or sensitive to Iodine .Iodine Solution • • • • Contd… Solution of 10% Povidine –Iodine achieved a 100% bacterial kill in all samples of E. Combination of IKI & CHX may be able to kill Calcium Hydroxide resistant bacteria AMANDEEP CHOPRA 18 . certainly killing the E.faecalis.faecalis as a biofilm exposure for both 2 and 30min. Iodine solution are considered to be potentially useful adjunct to sodium hypochlorite.

biofilm and pellet presentation of E.faecalis. The solution showed potential to reduce bacterial load but was not effective as 3% sodium hypochlorite or 10% Povidine-Iodine. Effective conc commonly used is 0.CHLORHEXIDINE GLUCONATE • • • Relatively broad spectrum of activity and low toxicity.2% CHX was tested against planktonic. It has good substantivity and ability to adhere to hydroxyapatite crystals in dentine • AMANDEEP CHOPRA 19 .2-2% 0.

Chelating agents can used to remove infected smear layer and open dentinal tubules. 20-50µm particularly in the middle or cornal parts.EDTA-Ethylene diamine tetra acetic acid • EDTA is able to demineralize root wall to a depth of aprox. allowing more effected disinfection of root canal system. • AMANDEEP CHOPRA 20 .

50% tannic acid and 40% polyacrylic acid. Other chelating agents include 25% citric acid.EDTA • • it has direct and indirect antimicrobial action Contd… It is available in gel or aqueous form . Of 17% EDTA and buffered to a neutral pH. Strongest effect when used synergically with NaOCl • AMANDEEP CHOPRA 21 . in a conc.

• • AMANDEEP CHOPRA 22 . Sterilization occur as a result of fulguration and the manufacturer claims it is able to eliminate both pulp and bacteria from the entire root canal system Its not able to eliminate pulp tissue from the root canal system without mechanical cleaning Utilized as a supplement to traditional cleaning and shaping.ENDOX • • The endox endodontic system sterilizes the root canal by emitting high frequency electrical impulses.

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• AMANDEEP CHOPRA 24 .Anolyte also termed as super oxidized or oxidative pot.ELECTRO CHEMICALLY ACTIVATED WATER • After electrolysis of an aqueous saline solution an anolyte and catholyte are produced and isolated Anolyte has antimicrobial effect and high oxidation potentional and pH of between 2 and 9. water but now a days neutral or alkaline sol recommended.

ELECTRO CHEMICALLY ACTIVATED WATER Contd… • When anolyte and catholyte are individually used to irrigate infected canals .5% sodium hypochlorite AMANDEEP CHOPRA 25 . the antimicrobial effectiveness was disappointing compare with 0.

b. AMANDEEP CHOPRA 26 . Electrolysed Neutral Water: .It has pH close to 7.ELECTRO CHEMICALLY ACTIVATED WATER Contd… TYPES a. Oxidative potential water: . The solution is bactericidal against a selection of commonly isolated endodontic pathogen.It also removes smear layer and debris.It is highly antimicrobial because of its acidity and high oxidation –reduction potential .

Non. iii.95% hypochlorous acid Effective biocide Non-toxic . Sterilox The main active ingradient that is produce by sterilox generator is . i.ELECTRO CHEMICALLY ACTIVATED WATER Contd… c.05. ii.irritating and Non-mutagenic AMANDEEP CHOPRA 27 . Non-sensitizing.

It’s suitable for oblation of dentin as they don’t create much heat. It emits radiation at a wavelength similar to the absorption peak of water. Erbium lasers:i.LASERS • TYPES 1. ii. AMANDEEP CHOPRA 28 .

ii. It is able to form the root canal shape without local anesthesia. It is an erbium – chromium.Contd… 2.yttrium. AMANDEEP CHOPRA 29 . The water laser i.scandium-gallium-garnet laser that has been claimed to exert hydrokinetic effects as the laser light react with water molecules.

The bacterial cells rupture well exposed to laser light of appropriate wavelength The PAD system uses a red laser –emitting radiation of wavelength 635 nm. Not as effective as 3% sodium hypochlorite • • AMANDEEP CHOPRA 30 .PHOTO ACTIVATED DISINFECTION (PAD) • • This technique uses the photoactive agent Tolonium Chloride The canal is irrigated with solution which selectively binds to the cellular membrane of bacteria in biofilm. It is effective against streptococcus intermedius biofilm in the root canal .

PHOTO ACTIVATED DISINFECTION (PAD) SYSTEM AMANDEEP CHOPRA 31 .

Less damaging to periapical tissues. 2. Used in endodontics with two mode of action . The bubbling of solutions when in contact with tissue and certain chemicals physically foames debris from the canal. Less effective as solvent. 4.HYDROGEN PEROXIDE 1. 5. Libration of oxygen destroys anaerobic microorganism. 3. AMANDEEP CHOPRA 32 .

It is N1-decamethylene bis-4aminoquianaldinum-diacetate 3. Used as root canal irrigant and chelating agent 2.SALVIZOL 1. It gives the product a cleansing potency while being biologically compatible AMANDEEP CHOPRA 33 . broad spectrum of bactericidal activity and ability to chelate calcium 4.

5. 2. 6.BDA 1. chelating properties Low incidence of post operative pain due to removal of smear layer coated with bacteria and contaminants Indicated to patients allergic to sodium hypochlorite 7. 4. It is bis-dequalinum acetate disinfectant and chemotherapeutic agent Low toxicity Lubrication action Low surface tension. AMANDEEP CHOPRA 34 . 3.

acetic acid and detergent It will kill E.25% sodium hypochlorite and 17% EDTA AMANDEEP CHOPRA 35 .faecalis.MTAD • • • It is recently developed irrigating solution that consist of tetracycline . Effective for removing smear layer along the entire length of prepared root canal It is able to remove both organic and inorganic debris but doesn’t appear to have a determentale effect on the physical dynamics of dentine unlike 5.

EDTA and calcium hydroxide It is used for 5 min. as final rinse after hypochlorite and EDTA.• It is less cytotoxic than eugenol. • AMANDEEP CHOPRA 36 . 3% hydrogen peroxide.

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CALCIUM HYDROXIDE • • • • Long duration of action Good spectrum of Antimicrobial activity Safe to use in combination with sodium hypochloride It is slow acting so needs to be present in sufficient quantity and for at least one week AMANDEEP CHOPRA 38 .

Glycerin can be mixed to improve flow but reduces pH. It’s slurry is thixotrophic and with agitation become more fluid. Dispersion into narrow or highly curved canal is difficult . so other carriers like Methylcellulose can used to make removal of medicament more difficult. It can be mixed 7:1 with barium sulfate to make it radio opaque. AMANDEEP CHOPRA 39 .• • • • • In aqueous form it is poorly dissociated but the hydroxyl ions liberated create the high pH that is required for bacterial killing. Material can be used into canal with a lentulo spiral filler or hand instrument.

3. AMANDEEP CHOPRA 40 . Used as intracanal antiseptic agent in conc. Broad spectrum of activity and low toxicity . Effectiveness is short lived and is not suitable for periods of medication longer than 2 days. Powerful oxidizing agents that disrupt bacterial cellular enzyme system and inactivate them. 2. Between 2% and 10% in aqueous solution.IODINE IN POTASSIUM IODIDE 1.

3. It is relatively ineffective . Use as an adjunct in periodontal treatment c.ANTIBIOTICS 1. contained penicillin . AMANDEEP CHOPRA 41 .used in earlier days . 2. Effective against gram-negative anaerobes b. Metronidazole :a. Grossman’s polyantibiotics paste :. Advocated for use as root canal irrigant Tetracycline :-used in periodontal treatment.

Combination of doxycycline and corticosteroids b. No advantage over conventional root canal dressing such as calcium hydroxide for elimination of bacteria AMANDEEP CHOPRA 42 . Range and duration of antimicrobial action may be limited 5 Clindamycin:a. Ledermix :a. Placed in teeth with necrotic pulps undergoing root canal treatment b.4.

4. 3.CORTICO STEROID – ANTIBIOTIC COMBINATIONS 1. 2. No overgrowth of microorganism will occur due to presence of antibiotics. Gives almost instant relief of pain in extreme tenderness to percussion after canal instrumentation. AMANDEEP CHOPRA 43 . Reduces periapical inflammation . Placed into inflammed periapical tissue by a paper point or reamer.

AMANDEEP CHOPRA 44 . Placed into root canal by paper point. 2. Mixed with sterile water. 3. Used when closing teeth that has been opened after an acute periapical abscess.SULFONAMIDE 1.

PHENOLIC COMPOUNDS A. AMANDEEP CHOPRA 45 . v. iii. PHENOL:i. Protoplasm poison Produces necrosis of soft tissues Strong inflammatory potential Used for disinfection before periapical surgery Used for cauterizing tissue tags that resist removal with broaches or files. ii. iv.

AMANDEEP CHOPRA 46 . EUGENOL •Both antiseptic and anodyne •Inhibits intradental nerve impulses •May be allergic too •Used as medicament after partial or complete pulpectomy.B.

iii.C. iv. ii. AMANDEEP CHOPRA 47 . Effective against fungi as well. Wide spectrum of antibacterial activity. Less irritating to periapical tissue than either phenol or eugenol without sacrificing antimicrobial action. CAMPHORATED MONOPARACHLOROPHENOL i. Inexpensive and has long self life.

4. Non specific bactericidal medicament 2.Most effective against aerobic and anaerobic organism 3.D.Used when pulpectomy is performed as emergency treatment to relieve pain in situation where pulp information in confined to pulp chamber. AMANDEEP CHOPRA 48 . FOROMOCRESOL 1. Useful as dressing for pulpectomy to fix the retain pulp tissues.

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