In E ndodontics

Dr Jeffy Mary

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CO NT ENT S

Introduction
Types of needles
• Prorinse probes
• Max-l-probe
• Stropko NI-TI irrigation needles
• The endo vac system
• Ultra sonic irrigation
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Conclusion
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▪ Although the technique for irrigation is simple, the potential for
serious complications exists.

▪ Regardless of the delivery system,

-the solution must be introduced slowly

- the needle never wedged in the canal

▪ As a rule, the clinician should irrigate copiously, recapitulate and

continue.

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▪ The most common method of delivering irrigant into the canal is
with the aid of a syringe and needle

▪ A 5 ml syringe with a Leur Lok mechanism is the preferred one.

▪ Gauge of the needle

▪ Gauges ranging from standard 22 to finer 30 have been used in

endodontic irrigation.

▪ Since irrigation of the apical third requires the needle to be in

close proximity for adequate effect the canals should be flushed
with a 27-30 gauge preferably.

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▪ It should be bent approximately 30degrees in the center of the
needle to allow easier delivery of the solution and to prevent deep
penetration of the needle or probe.

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 Squeezing the plunger with the thumb
may result in more rapid delivery
Of irrigant and possible extrusion

Using a forefinger to depress the plunger

gives greater control of irrigant delivery

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 Designs of needle
▪ 1. open ended blunt needles
▪ 2. beveled needles
▪ 3.blunt ended side venting needle
▪ 4.notched tip
▪ 5. perforated needle

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 Monoject type-
irrigant passes sideways
and apically

Safe ended tip

Irrigant passes sideways
Bevelled needle
Irrigant passes apically
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 Designs of needle
▪ ProRinse probes

▪ The effectiveness of the ProRinse seemed related to its design.

▪ It has a blunt tip, with the lumen 2 mm from the tip.

▪ Expression of fluid through the lumen creates turbulence around

and beyond the end of the probe.

▪ Also prevents forceful periapical injection of irrigant.

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▪ 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.

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▪ Stropko NI-TI irrigation needles
▪ They are available in short (17 mm) and (25 mm) long sizes and
can be sterilized and reused.
▪ Needle size is 27 gauge, side vented.
▪ Advantages are its good flexibility and their resistance to
clogging.

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▪ MAX-l-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.

▪ Closed-end needle eliminates possibilities of puncture of the

apical foramen

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 THE ENDO VAC SYSTEM
▪ The EndoVac system (Discus Dental) consists of a
delivery/evacuation tip attached to a syringe of irrigant and the
highspeed suction of the dental unit.

▪ A small tube attaches either a macro or micro-cannula to the

suction.

▪ The delivery/evacuation tip places irrigant in the chamber and

siphons off the excess to prevent overflow.

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 THE ENDO VAC SYSTEM

▪ The macro-cannula is plastic with an open end that measures

size 55 with a 0.02 taper.

▪ The micro-cannula is stainless steel and has 12 small, laterally

positioned, offset holes in 4 rows of 3, with a closed end
measuring ISO size 30.

▪ The micro-cannula can be used at working length in a canal

enlarged to ISO size 35 or larger.

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 Scanning electron microscope photograph of
the microcannula

Comparison picture of
the closed-ended open-ended macrocannula
microcannula (ISO size 55).
(ISO size 30)
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 The macrocannula attached to its handle used for
initial flushing of the coronal portion of the canal.

The microcannula attached to its handle.

and is used for irrigation at the apical portion
of the canal to working length.

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The delivery/evacuation tip attached to a syringe.
Irrigant is delivered to the pulp chamber by the metal needle.
Any excess is immediately suctioned off through the plastic tubing
surrounding the metal that is attached to the suction.

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A) The complete EndoVac system including all tubing and vacuum
attachment.
The free end of the large tubing plugs into the high speed
suction of the dental chair.

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 Ultrasonic irrigation
▪ Ultrasonic devices were first introduced in Endodontics by
Richman (1957).

▪ Martin and Cunningham have coined the term endosonics.

▪ In 1976 Martin had designed the first commercial system which

used ultrasonics for preparing root canal.

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 Ultrasonic irrigation
▪ Ultrasonically activated files have the potential to prepare and
debride root canals mechanically.

▪ The files are driven to oscillate at ultrasonic frequencies of 25–30

kHz

▪ The files operate in a transverse vibration, setting up a

characteristic pattern of nodes and anti-nodes along their length
(Walmsley 1987, Walmsley & Williams 1989).

▪ Ultrasonic irrigation has been shown not very effective for

shaping the root canal.

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▪ On the other hand it has been shown that ultrasonically driven
files are effective for the ‘irrigation’ of root canals.

▪ Two types of ultrasonic irrigation have been described in the

literature:
▪ 1. where irrigation is combined with simultaneous ultrasonic
instrumentation (UI)

▪ 2. without simultaneous instrumentation, so called passive

ultrasonic irrigation (PUI).

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▪ Acoustic streaming
▪ Acoustic streaming is the rapid movement of fluid in a circular or
vortex-like motion around a vibrating object. ( file)

▪ The acoustic streaming that occurs in the root canal during

ultrasonic irrigation has been described as acoustic micro-
streaming.

▪ The shear flow caused by acoustic microstreaming produces

shear stresses along the root canal wall, which can remove debris
and bacteria from the wall.

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Acoustic streaming around a file in free water and a schematic
drawing.

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▪ Cavitation

▪ Acoustic cavitation can be defined as the creation of new bubbles

or the expansion, contraction and/or distortion of pre-existing
bubbles (so-called nuclei) in a liquid, the process being coupled to
acoustic energy (Leighton 1994).

▪ These bubbles expand and then rapidly collapse producing a

focus of energy.

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 The ultrasonically energized file
creates current of streaming of
Piezon unit irrigant within the root canal

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 Dentine debris packed in oval shaped
root canal after syringe irrigation

and clean oval canal after 3 min

of PUI

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 SEM micrograph of a size 15 stainless
steel K-file used for ultrasonic
activation of the irrigation

SEM micrograph of a blunt

Ni–Ti-wire used for
ultrasonic activation of the
irrigation

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▪ Application of irrigant during PUI
▪ Two flushing methods can be used during PUI, namely
▪ a continuous flush of irrigant from the ultrasonic handpiece
▪ or an intermittent flush method using syringe delivery
(Cameron 1988).

▪ In the intermittent flush method, the irrigant is injected into the

root canal by a syringe, and replenished several times after each
ultrasonic activation.

▪ Both flushing methods were equally effective in removing dentine

debris from the root canal in an ex vivo model when the
irrigation time was set at 3 min (van der Sluis et al. 2006).

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▪ THE MICROMEGA 1500
▪ is a sonic hand pieces that can be used with endodontic files and
irrigation solutions to debride canals.
▪ Sonic handpieces allows for simultaneous canal flaring,
debridement and irrigation with cavitation effect.

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 ENDOACTIVATOR

The EndoActivator System is a more recently introduced sonically driven canal

irrigation system by Dentsply. It consists of a portable handpiece and 3 types of
disposable polymer tips of different sizes. These tips are claimed to be strong and
flexible and do not break easily. Because they are smooth, they do not cut dentin.
Vibrating the tip, in combination with moving the tip up and down in short vertical
strokes, synergistically produces a powerful hydrodynamic phenomenon. This
might be operated 10,000 cycles per minute (cpm) has been shown to optimize
debridement and promote disruption of the smear layer and biofilm. The
EndoActivator System was reported to be able to effectively clean debris from
lateral canals, remove the smear layer, and dislodge clumps of simulated biofilm
within the curved canals of molar teeth.

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SUMMARY
Various irrigation devices have been developed to give the effective cleaning
and superior debris removal in order to replace the older needle irrigation
method. Many clinical studies have reported the higher efficacy in effective
microbial count. However, there is no high level of evidence that correlates
the clinical efficacy of these devices with better treatment outcomes.
Nevertheless, due to the safety factors, capacity of high volume irrigant
delivery and ease of application the newer irrigation devices may change
the insight of conventional endodontic treatment.

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▪ Many new materials and methods have recently been introduced
to improve root canal debridement and to achieve root canal
sterilization.

▪ However, bearing in mind the complex anatomy of the root canal

system and the ability of microorganisms to survive under
adverse conditions, it might be premature to believe that the
total sterilization of the root canal system could be readily
achieved by any of the systems.

▪ In the age of evidence-based dentistry, it is advisable to wait until

quality independent data are available to support the use of such
new technologies.

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 References
:

1.Endodontics (4th & 5th edition) – John I. Ingle

2.Pathways of pulp (9th edition)- S Cohen and Burns

3.Endodontic Practice (11th Edition) – Louis I. Grossman

4.Endodontic Therapy (4th & 5th edition) – Franklin S. Weine

5.Endodontics in clinical practice (4rd edition) – F.J. Harty

6.Endodontics (3rd edition) – K Gulabivala

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