FINALS ENDO
ENDODONTIC IRRIGATING SOLUTIONS, DISINFECTING DEVICES
AND TECHNIQUES
Dr. April Sherry Mae Guillermo
*side notes
FUNCTIONS OF IRRIGATING SOLUTION
- Reducing friction between the instrument and dentin -
reduce/prevent fracture
- Improving the cutting effectiveness of the files
- Dissolving organic remnants - not all irrigating solutions are
able to do that, only one expected
- Cooling both the file and tooth
- Washing effect and an antimicrobial effect - rinse out dentinal
shavings
- Irrigation is also the only way to have a positive impact on
areas of the root canal wall not touched by mechanical
instrumentation (accessory canals) - *new study: non
mechanical endo
CLASSIFICATION OF IRRIGATING SOLUTIONS
- Antimicrobial solutions
- Chelating solutions aka anticalcifying
- Combinations (antibacterial and chelating solutions combines)
- Solutions with detergent
- Antimicrobial effects: (antiseptic solutions, topical antibiotics)
bacteriostatic solution, and bactericidal solutions
*For vital one sitting appointment - use bactericidal (vs bacteriostatic)
OBJECTIVES OF USING ENDODONTIC IRRIGANTS
Mechanical Objectives
- Rinse out debris and lubricate the canal
Chemical objectives
- Solvent - soften and dissolve organic and inorganic tissues
(not all)
- Prevent the formation of a smear layer during instrumentation
- Dissolve smear layer once it has formed (Not all)
- Antimicrobial agent
*Alin Ang nakaka dissolve ng inorganic? Alin ang nakakdisaolve ng organic?
*best for removing smear layer: those containing EDTA, especially gels
in which the shavings may be suspended, but these are not recommended
when using NiTi
Biological objectives
- Related to their antiseptic and nontoxic properties.
Properties of an ideal irrigating solutions
- Disinfect the root canal system
- Should be a biocompatible bactericidal agent, tissue solvent,
lubricant, and smear layer remover capable of physically
flushing debris
- Penetrate dentin and its tubules
- With sustained effect but without affecting the physical
properties of the dentin
- Non-antigenic, non-toxic, non-carcinogenic
*Because there is no irrigant that has these properties, use at least two that
collectively will have all of these properties
*Chlorhexidine gets absorbed by oral mucosa, also EDTA but it depends on
the concentration
*Sodium hypochlorite does not have a sustained effect - always prepare
a fresh solution
Example:
In pulp extirpation, change the solution once you get to biomech prep
Remember:
Any materials used to achieve all the aims mentioned in root canal will
have the same effect in the periapical tissues - use the material at a
concentration that is high enough to achieve the aims, yet low enough
to avoid periapical irritation
- *Always Consider benefit:risk ratio
 - Irrigating solutions must always be contained within the canal
only - maintain apical construction *never use hypochlorite if
there is an open apex or large apical foramen
- Irrigating solutions must always be confined to the canal
during use to avoid harmful effects to the periapical tissues
- There is not one solution available that will achieve all of the
mentioned aims
- Organic solvents are not as effective as inorganic solvents.
Therefore it is necessary to use 2 solutions to achieve all of
these aims

HClO - hypochlorous acid, odorless

Example of 2 solutions used together (ABBOT endo manual)

- 17% ethylene diamine tetraacetic acid with cetrimide (EDTAC)
and 1% sodium hypochlorite (NaOCl) when used together can
achieve the aims mentioned above

IRRIGATING SOLUTIONS USED IN ENDODONTICS

1. Local anesthetic, saline/distilled water

2. Sodium Hypochlorite
NaOCl – antiseptic solution
Most common irrigating solution used in endodontics
Properties:
- Antimicrobial and proteolytic agent, excellent organic
Mode of Action
tissue solvent, and lubricant with fairly quick effects
1: Saponification reaction
- An oxidizing agent and a hydrolyzing agent
2: Neutralization reaction
- Commercial sodium hypochlorite solutions are
3: Hypochlorous acid formation
strongly alkaline and hypertonic and typically have
4: Solvent action
nominal concentrations of 10-14% available chlorine
5: High pH
Using Sodium Hypochlorite
Allergic reaction
*Inflammatory response similar to allergic reaction
*Chlorhexidine
Toxicity
- most common
- signs and symptoms:
- Severe pain
- Edema of neighboring soft tissue
- Possible extension of edema over the injured
half of face and upper lip
- *One of the most common signs of toxicity: profuse
bleeding in the canal → use antibiotic and analgesic
hypersensitivity
on NaOCl = also
contraindicated
tp chlorhexidine
due to chlorine
content

CONTRAINDI
CATION:
- open apex
 easily soluble, very
stable

- cannot remove
smear layer

Substantivity - due to the cationic nature of CHX molecule -

can be absorbed by an ionic substrate (oral mucosa, tooth
structure) → results in sustained effect
Uptake is reversible - substantive antimicrobial property
- Lower concentrations - single layer stored
- Higher concentrations - multilayer stored on the tooth
3. Chlorhexidine Gluconate (CHX) surface, providing a reservoir
Length of exposure affects length of effect
CHX cannot dissolve organic tissues - NaOCl still considered
primary irrigating solution, **but depends on the stage of the
treatment
CHX may be used every time you change medicament
 EDTA alone cannot remove the smear layer, paired with
NaOCl to effectively remove it

DECALCIFYING AND CHELATING AGENTS

1. idk
2. idk
3. Basta 4 na yung start
4. Citric Acid

5. Ethylenediaminetetraacetic Acid (EDTA) 6. HEBP (Etidronic acid)

colorless, water-soluble

- chelate and remove the

remineralized portion of the prevents
bone
smear layer resorption,
applied with
patients who
has
osteoporosis
- little or no antibacterial effect or Paget's
disease
Combinations and Solutions with Detergents

MTAD - alternative for

EDTA in removing
smear layer

7. BioPure MTAD and Tetraclean

 9. Iodine Potassium

E. fecalis often assoc with therapy-resistant periapical

8. QMIX infections, and combinations of IKI and CHX may be able to
kill Ca(OH)2-resistant bacteria more efficiently
Obvious disadvantage of iodine - possible allergic reaction in
some patients
10. Lubricant

Facilitate manipulation of hand files during cleaning and shaping

Aid in initial canal negotiation
KY jelly - used in ultrasound
Endo lubricants always contain EDTA
Not recommended during night time(??)
When you are to use EDTA in chemo mechanical prep, it will
deactivate the antimicrobial effect of sodium hypochlorite but will also
reduce the chlorine and potential toxicity of it
 13. Super oxidized water

11. Alcohol
14. Ozonated water

12. Hydrogen peroxide

 15. Herbal
- NaOCl + CHX → change of color and precipitate
- Rxn is dependent on concentration of NaOCl
- Higher conc NaOCl, larger precipitate - if 2% CHX is used
- Concern: color change may have clinical relevance, causing
staining of the tooth
- Resulting precipitate may interfere with the seal of the root
canal obturation

Interaction between CHX, NaOCl, and EDTA

 EDTA must still be used after - deactivates itself, must be replaced with
fresh solution subsequently
The continue doing the biomech
EDTA may be used as a final rinse after biomech to remove the smear
layer
However, mas maganda yung pag remove ng smear layer pag finish mo din
ng NaOCl

**
Sodium ferborate as a bleaching agent
Chlorhexidine - what property does it have that is most beneficial to Endo?
Antibacterial property
- When to use? (Instead of NaOCl)
Also note the contraindications
Sodium hypochlorite - harmful upon perforation of root, any instance
EDTA may also be used during biomech to soften dentin – easier
that it may infiltrate periapical/periradicular/PDL area
Use a solution in between NaOCl and CHX to avoid ppt
filing/shaping

*class note:
NaOCl - use during pulp extirpation to dissolve organic tissue
EDTA - soften dentin
We can still irrigate with NaoCl every change of file
DISINFECTION DEVICES AND TECHNIQUES

C. ?
Tests: all must be (-)
Percussion
Palpation
Spont pain
Fistula healed
Reduced radiolucency
Culture test

If ayaw mag negative - apply medicaments (iodine potassium)