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Blok Aesthetic Dentistry 1

Ke d o k t e r a n G i g i
Universitas Jenderal
Soedirman

IRIGASI
SALURAN AKAR

By : drg. Irfan Dwiandhono,


Sp.KG

Referensi
Grossman, L.I., Oliet, S., Rio,
C.E.D. 1995. Ilmu Endodontik Dalam
Praktek. EGC. Jakarta
Ford, T.R.P., Rhodes, J.S., Ford,
H.E. 2002. Endodontics ProblemsSolving Clinical Practice. London.
Martin Dunitz
Burns, C.R., Cohen, S. Pathways of
The Pulp. 6 t h Ed.
Rhodes, J.S. 2006. Advanced
Endodontics Clinicals Retreatment
Surgery. Taylor & Francis. London

SYARAT IDEAL IRIGASI SALURAN


AKAR
1. Mempunyai sifat antimikroba & broad spectrum
2. Mempunyai tegangan permukaan rendah Dapat mengalir
ke daerah yang tidak terjangkau dengan mudah
3. Tidak mutagenic, carcinogenic, atau cytotoxic
4. Mempunyai kemampuan untuk melarutkan jaringan
nekrotik atau debris
5. Tetap aktif dalam penyimpanan
6. Dapat menonaktifkan endotoksin
7. Mencegah formasi smear layer selama instrumentasi, atau
melarutkannya ketika smear layer terbentuk
8. Membantu debridement sistem saluran akar
9. Menjadi pelumas/lubricant yang baik
10. Efektif mendesinfectkan saluran akar

SYARAT LAIN IRIGASI SALURAN


AKAR
1.
2.
3.
4.
5.

Availability
Tidak mahal
Kemudahan penggunaan (convenience)
Adequate shelf life
Kemudahan penyimpanan

FUNGSI IRIGASI SALURAN


AKRAB
Menghilangkan fragmen jaringan pulpa dan
serpihan dentin yang menumpuk
Membuang debris dari saluran akar lateral
atau asesoris
Sebagai Pelumas
Membunuh kuman
Melarutkan Jaringan nekrotik
Bila ditambah larutan kelasi Dapat
menghilangkan smeared layer

FAKTOR YANG MENGUBAH


AKTIVITAS LARUTAN IRIGASI
SALURAN AKAR
Konsentrasi
Kemampuan NaOCl dalam melarutkan jaringan lebih
tinggi pada konsentrasi 5,25%
Kontak
Supaya efektif,cairan irigasi harus kontak dengan
substrat
Keberadaan jaringan organic
Jaringan organik harus dibersihkan supaya cairan irigasi
dapat efektif
Kuantitas cairan irigasi yang digunakan
Semakin tinggi kuantitas cairan irigasi, semakin tinggi
juga efektifi tasnya
Ukuran jarum irigasi
Jarum irigasi 27 atau 28 gauze sering dipakai karena
penetrasi di dalam saluran akar lebih baik

FAKTOR YANG MENGUBAH


AKTIVITAS LARUTAN IRIGASI
SALURAN AKAR
Tegangan permukaan cairan irigasi
Tegangan permukaan rendah penetrasi ke area
sempit untuk debridement yang lebih baik
Temperatur cairan irigasi
Memanaskan NaOCl akan meningkatkan efektifi tasnya
Frekuensi irigasi
Semakin sering irigasi, semakin baik hasilnya
Diameter saluran akar
Saluran akar yang lebar debridement lebih baik
Umur cairan irigasi
Larutan irigasi yang masih fresh lebih efi sien
daripada yang sudah lama

MACAM-MACAM LARUTAN IRIGASI


Sodium Hypochlorite
Iodine Solutions
Chlorhexidine Gluconate
EDTA Ethylene Diamine Tetraacetic Acid
Citric acid
MTAD Mixture of Tetracycline And Disinfectant
EAW Electrochemically Activated Water
PAD Photo Activated Disinfection
Ozone
Endox.

1. Sodium Hypochlorite (NaOCl)


Sodium hypochlorite is a clear, pale, greenyellow liquid with strong odor of chlorine. It
is easily miscible with water and gets
decomposed by light.
First introduced into Endodontics by
Gutheridge in 1919.
Has been used as an irrigant in endodontics
for many years
It is highly bactericidal and very effective at
dissolving necrotic material.
Solutions ranging in strength from 0.5% to
5.25% have been recommended for use in
endodontics

1. Sodium Hypochlorite (NaOCl)


A 1.0% sodium hypochlorite solution should
be effective in removing root canal debris and
dissolving organic matter and even at 0.5%
solution is very potent at killing enterococci
No difference was found experimentally
between a solution of 0.5 and 5.0%, but with
lower concentrations the efficacy decreases
rapidly, requiring copious irrigation to remain
effective.
Commercially available sodium hypochlorite,
such as thin household bleach, would
normally have a concentration of
approximately 4 0.5%.

1. Sodium hypochlorite (NaOCl)


Deteriorates on storage and becomes less active
with time, exposure to light or contamination
with metallic ions.
The solutions are often very alkaline,
hypertonic, and highly irritant, and they may
require dilution with 0.5% sodium bicarbonate
before use as an endodontic irrigant. This will
reduce the pH without affecting the bactericidal
properties.

1. Sodium hypochlorite (NaOCl)


Faktor yang mempengaruhi efektifitas NaOCl :
1. Waktu kontak
Semakin lama NaOCl kontak dengan saluran akar, efektifitas
antimikroba NaOCl semakin lebih baik. Terutama pada jaringan
nekrotik
2. Panas
Memanaskan NaOCl 60-70 o meningkatkan kemampuan
melarutkan jaringan.
Tidak memanaskan NaOCl secara berlebihan karena bisa
memecah konstituen NaOCl dan merusak larutan

1. Sodium hypochlorite (NaOCl)


Faktor yang mempengaruhi efektifitas NaOCl :
3. Syringe irigasi khusus
Menggunakan jarum irigasi diameter kecil
(30 gauge) sehingga cairan irigasi dapat
mendekati apeks dan side venting sehingga
cairan irigasi keluar dan bergerak ke
samping
4. Aktivasi Ultrasonic

1. Sodium hypochlorite (NaOCl)


Keuntungan irigasi dengan menggunakan Sodium Hypochloride :
Gross Debridement
Dissolution of soft tissue
Lubrication
Economical
Antibacterial and bleaching action
Easily available
Kerugian NaOCl :
Because high tension surface, its ability to wet dentin is less
Irritant to tissues, if extruded periapically, it can result in severe cellular
damage
If comes in contact, it cause inflammation of gingiva because of its
caustic nature
It can bleach the clothes if split
It has bad odor and taste
Vapors of sodium hipochlorite can irritate the eyes
It can be corrosive to instruments

1. Sodium hypochlorite (NaOCl)


Increasing the concentration will increase the
rate at which organic material is dissolved, and
may improve its effectiveness as an
antibacterial agent.
Menaikkan suhu NaOCl sampai 60 0 C akan
meningkatkan efektifitas
Konsentrasi yang digunakan :
5,25% : sebagai antiseptik kuat tapi toksik
2,5 % : biasa digunakan sebagai larutan
irigasi
1,25%, 1% atau 0,5%

1. Sodium hypochlorite (NaOCl)


Jika NaOCl keluar sampai jaringan periapikal,
Komplikasi pemakaian NaOCl yang bisa terjadi :
Rasa sakit yang menyiksa
Perdarahan periapikal
Pembengkakan

2. Saline isotonik
The use of saline as the sole irrigant is
not considered appropriate, as normal
solutions are ineffective as antimicrobial
agents and will not dissolve organic
material.
Dalam kemasan larutan infus sebagai
saline steril
It basically acts by flushing action
As final rinse for root canals to remove
any chemical irrigant left after root canal
preparation

2. Saline isotonik
Kelebihan :
Biokompatible
Tidak mengiritasi jaringan pulpa
Tidak menyebabkan inflamasi
Bersifat sebagai pelumas
Kekurangan :
Dapat terkontaminasi
Tidak dapat melarutkan dan tidak memiliki sifat mendesinfektan
Tidak dapat membunuh kuman
Tidak dapat membersihkan microbial flora pada inaccessible area
seperti saluran akar assesoris
Tidak melarutkan smear layer

3. Chlorhexidine gluconate
Can be purchased as a mouthwash in a 0.2%
solution.
It may be effective in concentrations from 0.22.0%, but there is little published clinical evidence.
Chlorhexidine, while antibacterial, will not dissolve
organic material, and is also relatively expensive.
Although the solution showed the potential to
reduce bacterial load, it was not as effective as 3%
sodium hypochlorite or 10%povidone iodine.
it was not considered as a primary irrigant because
of poor tissue-digesting properties.
Has good substantivity and has the ability to
adhere to hydroxyapatite crystals in dentine. It has
been postulated that it could potentially remain
active following root canal treatment

3. Chlorhexidine gluconate
Kelebihan :
A 2% solution is used as root irigant in canals
A 0,2% solution can be used in controlling plaque activity
It is more effective on gram-positive bacteria than gram-negative
bacteria
Kekurangan :
It is not considered as the main irrigant in standard endodontic
therapy
It is unable to dissolve necrotic tissue remnants
It is less effective on gram-negative than on gram-positive bacteria

4. EDTA - Ethylenediaminetetraacetic
acid
Fungsi :
Menghilangkan smear layer
Melunakkan jaringan dentin sehingga membantu preparasi
saluran akar yang kecil
It is not antibacterial, and will not dissolve necrotic tissue or
remove superficial debris; but it is very effective for removing
the smear layer.
It is usually purchased as a 17% solution with a pH of 8.0.

4. EDTA - Ethylenediaminetetraacetic
acid
Tersedia dalam 2 bentuk :
1. Viscous / gel : Digunakan ketika preparasi
saluran akar sebagai pelunak dentin
2. Aques / solution : digunakan untuk
membuang smear layer
.When used in series with sodium hypochlorite
the smear layer can be removed, allowing
penetration of the antibacterial irrigant deeper
into infected dentine tubules.

4. EDTA - Ethylenediaminetetraacetic
acid

4. EDTA - Ethylenediaminetetraacetic
acid
Sodium hypochlorite and saline solutions
are ineffective at reducing smear layer
The use of sodium hypochlorite or EDTA
as a single irrigant will not remove all of
the debris.
The rationale therefore has been to
alternate these solutions in high volume
It is interesting that using the solutions
in the sequence EDTA, sodium
hypochlorite and EDTA has proved to be
more effective at removing smear layer
than sodium hypochlorite, EDTA and
sodium hypochlorite

Iodine solution in Potasium Iodide


Has been recommended as a potential
root canal irrigant because E. faecalis
is sensitive to it.
There have been reports that some
strains of bacteria that are associated
with failed root canal treatment have
survived in the presence of calcium
hydroxide
This solution may be useful as an
irrigant in retreatment cases.
It is used as a 2% solution of iodine in
4% aqueous potassium iodide

Iodine solution in Potasium Iodide


A solution of 10% povidoneiodine
(Betadine, Seton Healthcare, Oldham,
UK) achieved a 100% bacterial kill in all
samples of E. faecalis as a biofilm after
exposure for both 2 and 30 minutes.
Povidoneiodine was not as effective as
a 3% solution of sodium hypochlorite.
Iodine solutions were considered to be a
potentially useful adjunct to sodium
hypochlorite, certainly for the killing of
E. faecalis.
It is not uncommon to come across
patients who are sensitive or allergic to
iodine.

TEKNIK IRIGASI

Alat yang digunakan :


1. Syringe, dengan berbagai bentuk
jarum :

SYRINGE IRIGASI

Commercial endodontic
syringes have a fine bore to
allow delivery of irrigant into
the apical part of the root
canal system.
Gauge 27 needles are
manufactured with a cut away
tip to allow irrigant to pass out
sideways and reduce the risk
of apical extrusion

SYRINGE IRIGASI

Jarum dibengkokkan
dan diberi stopper
Jarum tidak boleh pas
dalam saluran akar
Harus ada ruang
untuk larutan keluar
ke arah koronal
Jarum harus tumpul

Irrigating needle

Ideal properties of irrigating


needle

Needle should be blunt


It should allow back-flow
It should be flexible
Longer in length
Easily available
Cost-effective

DELIVERY OF IRRIGANTS

Root canal irrigants are normally


introduced into the root canal
system using a safe-ended
endodontic syringe.
Care must be taken to ensure that
the needle tip does not bind, as
irrigant may be forced through the
apex.
The tip can be premeasured and
bent to avoid extrusion and the
solution delivered slowly, without
pressure

DELIVERY OF IRRIGANTS

Larutan irigasi dikeluarkan perlahan lahan


Tanpa tekanan dengan gerakkan memompa
Larutan tidak boleh terdorong ke arah apikal
Tiap kali melakukan irigasi harus melimpah
kira kira 2 ml tiap irigasi

Precautions to be taken while irrigation

Avoid wedging the needle into the


canal
Avoid forcing the solution into canal
Avoid placing the needle beyond the
apical area or very near to apical
area
Avoid using larger gauge needle
Avoid using metallic, autoclavable
syringe as they more prone to
breakage

2. Endosonic
Endosonics is a very useful means of
delivering irrigant.
Most portable ultrasonic units can be
fitted with an endosonic attachment that
allows the delivery of irrigant
During ultrasonic vibration of an
endosonic file in the root canal,
streaming of the irrigant is created, and
this may help dislodge material from the
canal system.
It also ensures penetration of irrigant into
lateral canals, where files cannot
penetrate

Endosonic
Ultrasonic streaming
occurs best when a small
file (size 15) is vibrated
freely within the root canal
Binding of the file results
in a decrease in streaming.
The endosonic file should
be moved up and down to
facilitate irrigation and
prevent possible ledging of
the canal wall

Endosonic

Keuntungan :
It cleans the root canal walls better than
conventional ones
It removes the smear layer efficiently
It dislodges the debris from the canal better
due to acoustic effect

Kerugian :
Ultrasonic preparation of the canal is found to
be unpredictable
It can lead to excessive cutting of canal walls
and may damage the finished preparation

Endosonic
A high volume of
irrigant can be
exchanged with the
use of endosonics
Ultrasonic irrigation
will eliminate bacteria
from infected root
canals more effectively
than syringe irrigation
alone

THANK YOU..
CU
TOMMOROW..