ENDODONTIC IRRIGATING

SOLUTIONS

DONE BY DR.MARWA AHMED

 Introduction
The use of irrigating solutions in combination with canal
instrumentation, loosen debris, pulp tissue and micro-organisms
from the irregular dentin walls so that they can be removed from
the canal.
Irrigation is defined as “to wash out a body cavity or
wound with water or a medicated fluid”

Objectives of irrigation
Mechanical & Chemical functions
 Flushing
 Lubrication
 Dissolution
Smear layer removal
Biological functions
Antimicrobial
 Requirements of Ideal Irrigants

1. It must have broad spectrum antimicrobial effect.

2. It must aid in the root canal debridement.
3. Ability to dissolve necrotic tissue or debris.
4. Low toxicity level.
5. Act as a good lubricant.
6. Low surface tension to flow
easily into the inaccessible areas.
7. Remove the smear layer.

3
 Factors Effecting The Irrigants action
1.Concentration(%).

2. Contact.

3. Presence of organic tissue.

4. Quantity.

5. Temperature.

4
 The smear layer
The smear layer is a micro – crystalline layer of cutting debris covering
the canal walls after the preparation and its removal may aid in
better adaptation of the obturating materials to the canal walls.
It consist of:
A. Organic layer ----- removed by irrigants.
B. Inorganic layer --- removed by chealating agent.

Cross section of root dentin covered

by the smear layer created by
instrumentation.
Notice smear plugs in dentin canals

5
 Commonly used irrigating agents
used in endodontics
 CHEMICALLY INACTIVE SOLUTIONS
1.Normal saline .
2.Local anaesthetic solution .
 CHEMICALLY ACTIVE SOLUTIONS
1.Main solutions: A. Sodium hypochlorite (NAOCL)
B. Chlorhexidine (CHX)
2. Decalcifying solutions: A. Ethylene diamine tetra acetic acid(EDTA).
B. Citric acid.
C. Hydroxy ethylidene-bisphosphonate(HEBP)
D. Qmix (químico MECÁNICA MIX)
E. Mixture of tetracycline Acid detergent(MTAD).
F. Tetraclean.
3.Other irrigating agents : A. Hydrogen peroxide.
B. Iodine based compounds.
4. Recent advances in irrigation: A. Carisolv.
B. Ruddles solution.
C. Bioactive materials like bio(active) glass
D. Chitosan..
E. Cetrexidine
1.main solutions
A. Sodium hypochlorite (NaOCl) 0.5-5.25%
the ideal concentration 2.5%

Advantages
 Current irrigant of choice
 Effective antimicrobial agent
 Excellent organic tissue solvent
 Lubricates
 Effective fairly quickly
Disadvantages
 Toxic (hypochlorite accident)
 Not substantive
 Corrodes, unpleasant odor
 Removes only the organic part
of the smear layer
Safety (Sodium hypochlorite accidents)

 Toxic effects of NaOCl on vital

tissues include hemolysis,
epithelial ulceration, and necrosis

 Several mishaps during root

canal irrigation can range from
damage to the patient’s clothing,
splashing the irrigant into the
patient’s or operator’s eye,
injection through the apical
foramen.
 Treatment protocol for sodium
hypochlorite accident…

 Early recognition of extrusion,

 Immediate canal irrigation with normal saline,
 Encouragement of bleeding,
 Pain control with local anesthetics and analgesics and warm
compresses and frequent warm mouth rinses for stimulation of the
local systemic circulation,
 Reassurance of the patient, and
 Monitoring of improvement.
Preventive measures

 Plastic bib to protect patient’s clothing

 Protective eye-wear
 Rubber dam isolation
 side-exit Luer-Lock needles
 Irrigation needle a minimum of 2
mm short of the working length
 Avoidance of binding of the needle
into the root canal
 Avoidance of excessive pressure during irrigation
 1. main solutions
b.CHLORHEXIDINE (CHX) (0.2% - 2%)

Advantages
1. It has antibacterial effect (long standing
effect by binding to hydroxyapatite and in
combination with Ca(OH)2 effective against
anaerobes).
2. Low toxicity compared to NaOCL.
Disadvantages

1.Does not have tissue solvent action.

2.Discolaration .
3.Bitter taste.
4.Toxic (in case of swallowing).
So to over come these disadvantages it shouldn’t use alone
but in combination with other irrigation solutions.
 NaOCl + CHX

 an additive
antimicrobial action

 Tissue dissolving
property that is better
than that obtained with Immediate formation of an orange-
use of CHX alone brown precipitate (para-chloroaniline)

 less toxic then NaOcl

NaOCl+CHX precipitate tends to
occlude the dentinal tubules

Precipitate could be prevented by using

absolute alcohol or minimized by using
saline and distilled water as intermediate
flushes
2.5% NaOCL + 0.2 % CHX
 2.DECALCIFYING SOLUTIONS
A. Ethylene Diamine Tetra Acetic Acid ( EDTA)

. It used for cleaning and widening the canal.

. Used in concentration of 17%.
. Optimal working time 15 minutes.

Advantages
 Remove the inorganic part of the smear layer
 Contribute to the elimination of bacteria in the root canal
 Combination products have wide-spectrum antimicrobial activity.
 EDTA may have antifungal activity
Low toxicity
So to over come these disadvantages it
shouldn’t use alone but in combination with
Disadvantages
other irrigation solutions.
1.Demineralize dentin (20–50 um).
2. Does not have tissue solvent action.
EDTA 17% + NaOCl 2.5%

EDTA causes NaOCl to lose its tissue dissolving capacity,

and virtually no free chlorine is available

EDTA 17% + CHX 0.2%

Immediate formation of a white, foggy

precipitate

Precipitate involves the chemical degradation

of chlorhexidine

Variations

EDTAC EDTA + Cetavlon

REDTA EDTA + Sodium hydroxide + cetyl trimethylammonium bromide + water

RC prep EDTA + urea peroxide

EGTA ethylene glycol bis (β aminoethyl ether)-N,N,N,N- tetra acetic acid

2.DECALCIFYING SOLUTIONS
B. CITRIC ACID 10%
 can also be used for irrigation of the
root canal and for removal of smear layer
 used in various concentrations, ranging
from 1% to 50%, with a 10% solution
being the most common

10% citric acid has been shown to remove the smear layer more effectively
from apical root end cavities than ultrasound

10% citric acid was more effective than 1% citric acid, which was more
effective than EDTA in demineralizing dentin
 2.DECALCIFYING SOLUTIONS
C. Hydroxy ethylidene-bisphosphonat(HEBP) 9%-18%
also called etidronic acid
 Chelator that can be used in combination with sodium
hypochlorite (NaOCl) without affecting its proteolytic or
antimicrobial properties
Disadvantages
 HEBP is a weak decalcifying agent and hence cannot be used as a mere
final rinse.
. Does not have tissue solvent action.
So to over come these disadvantages it shouldn’t use alone but in combination
with other irrigation solutions.

NaOCl 5% + HEBP 18% :

 better tissue dissolution capacity
 less cytotoxic
 reduces dentin debris accumulation
NaOCl 5% + HEBP 18%
2.DECALCIFYING SOLUTIONS
D. QMiX(QUÍMICO MECÁNICA MIX)
 Q mix is an irrigation solution used as a
final rinse. It is a combination of CHX with
EDTA and a surfactant solution to improve
penetration in dentinal tubules.

advantages
 Low surface tension is one of the ideal characteristics
of an irrigant
Superior Antibacterial efficacy.
Superior smear layer removal
Ready to use, fast working
Less demineralization OF DENTEN compare to EDTA

 6% NaOCl and QMiX were the most effective disinfecting solutions against the
young biofilm, whereas against the 3-week-old biofilm, 6% NaOCl was the most
effective followed by QMiX
 2.DECALCIFYING SOLUTIONS
E. MTAD ( mixture of tetracyclin , acid and detergent).

MTAD is a mixture of doxycycline

(150MG/5ML), citric acid, and a
detergent

F.TETRACLEAN
IS A MIXTURE OF CITRIC ACID DOXYCYCLINE 50MG/5ML
AND POLYPROPYLENE GLYCOL AS DETERGENT

Smear layer removal

BOTH MTAD & TETRACLEAN performed better than EDTA in cleaning dentinal
tubules of debris and removing the smear layer in the apical third of root canals AND
ALSO BOTH created less erosion than EDTA in the coronal and middle thirds of the root
canals.
Antibacterial efficacy
1.3% NaOCl followed by 5 min MTAD was more effective in the disinfection of canals
than a protocol of 5.25% NaOCl followed by 1 min 17% EDTA and then 5 min 5.25%
NaOCl as a final rinse
3.Other irrigating agents
A . HYDROGEN PEROXIDE
an oxidizing agent used in conc. of 3-5%
. It is odorless, clear liquid.
. Its effervescence action capable for removing loose debris
from inside the canal.
. Release of nascent oxygen (O2) works against anaerobic
bacteria.

Disadvantage:
1. Tissue emphysema if it passes to the periapical tissue.
2. Post – Operative Pain

Note:it should not use alone or as final irrigant

 Combination with other irrigant

1. NaOCl 5.25% + H2O2 3%

 produce foaming action flush the debris out of root
canal
 significantly increase dentinal permeability
 deactivationof bacterial endotoxins NaOCl 5.25% + H2O2 3%
 In combination antibacterial effect of both solutions was less than
 that of individual solutions and it used to decrease tissue dissolving action
of NaOCl
2. CHX 2% + H2O2 3%

 CHX +H2O2 when combined do not counter act one

another at specific concentration
H2O2 Smear layer removal
CHX 2% + H2O2 3%

CHX
allow penetration of greater antibacterial effect at deeper layers
CHX into the dentinal kills most of the bacteria in the area
tubules adjacent to the lumen
3.Other irrigating agents
B. IODINE BASED COMPOUNDS
Aqueous iodine solutions are rather
unstable
development of iodophors (‘iodine
carriers’)
In endodontics, iodine potassium
 Povidone–iodine
iodide (IPI) in 10% concentration is
 Poloxamer– iodine
used
Advantages

Antimicrobial action of iodine is rapid, even at low concentrations, Iodine penetrates

into microorganisms and attacks key groups of cell molecules, such as proteins,
nucleotides, and fatty acids, resulting in cell death

Disadvantages
 Allergic reactions to iodine and the staining of dentin.
Expensive.
Toxic in case of swallowing .
3.Other irrigating agents
C. GLY-OXIDE
10% solution of carbamide peroxide in glycerol

Advantages

 provides lubrication without softening dentin.

 antimicrobial activity more than 3% H2O2.
 produces transient energetic effervescence with NaOCl .
 useful in narrow and curved canals.

Disadvantages

 does not remove smear layer.

4.RECENT ADVANCES IN IRRIGATION
A. Cetrexidine
 0.2% CHX and 0.2% citrimide
 better penetration of CHX into the dentinal tubules and better antimicrobial efficacy
B. Carisolv
 potential as on irrigant as it is antibacterial and has collagen dissolving potential
C. Ruddles solution
 Radiopaque agent Hypaque + NaOCl + EDTA
 used to detect the presence of lateral / accessory canals
D. Bioactive materials like bio(active) glass
 Antimicrobial activity against a range of microbes
E. Chitosan Advantages:
 naturally occurring polysaccharide chitosan  easily and locally available, cheap,
at 0.2% concentration as chelating agent biocompatible, biodegradable, has
without the negative effects of high the property of bioadhesion and has
concentration EDTA antimicrobial activity