IRRIGATION DYNAMICS

P RES E N TE D BY :- A B H I L A S H A G U G L I A N I
P REC EP TO R :- D R.V I D H I
CONTENTS Introduction
Irrigation devices
Syringe irrigation
Brushes
Manual Dynamic agitation
Sonic irrigation
Ultrasonic irrigation
Pressure alteration devices
CONTENTS Irrigation dynamics
Contd..
Flow of the irrigant

Irrigant refreshment –chemical effect

Shear wall stress – mechanical effect

Apical Vapor lock

Negative pressure irrigation

Newer Avenues

references
 INTRODUCTION

The success of endodontic treatment depends on the eradication of microbes (if

present) from these complex root-canal systems and prevention of reinfection.
 The root canal is shaped with hand and rotary instruments under constant irrigation
to remove the inflamed and necrotic tissue, microbes/biofilms, and other debris
from the root-canal space.

 The main goal of instrumentation is to facilitate effective irrigation, disinfection,

and filling.

A FILE SHAPES AND AN IRRIGANT

CLEANS
 Irrigation has a central role in endodontic treatment. It can be summarized as follows:

to to
flush lubricate
out BIOLOGICAL
to EFFECT
dissolve
and
disrupt

Anti-
microbial
MECHANICAL AND
CHEMICAL EFFECT
Gulabivala K, Ng YL, Gilbertson M, Eames I. The fluid
mechanics of root canal irrigation. Physiol Meas.
 Incomplete
disinfection
CHEMICAL ACTIVATION
AGENTS DEVICES of root
canal
system
In endodontic disinfection, the process of delivery is as important as the
antibacterial characteristics of the irrigants

Irrigant flow

Exchange within
Penetrate
root canal system

Produce forces

A better understanding of the fluid dynamics of different modes of irrigation will

contribute to achieving predictable disinfection of the root canal system.
IRRIGATION DEVICES
  The effectiveness and safety of irrigation depends on the means of delivery.

 Throughout the history of endodontics, endeavors have continuously been made to

develop more effective irrigant delivery and agitation systems for root canal irrigation.

 These systems might be divided into 2 broad categories, manual agitation techniques
and machine-assisted agitation devices

Gu LS, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR. Review
of contemporary irrigant agitation techniques and devices. J
Endod. 2009;35(6):791-804.
IRR SUMM
IGA A
TIO RY O
N F
EN DEV VAR
DO I
DO ICES OUS
NT U
ICS SED
IN

Gu LS, Kim JR, Ling J, Choi KK,

Pashley DH, Tay FR. Review of
contemporary irrigant agitation
techniques and devices. J Endod.2009
35(6):791-804.
SYRINGE IRRIGATION

 Plastic syringes of different sizes (1–20 mL)

-commonly used for irrigation

 Size of the syringe – affects amount of tactile

force applied – transmitted to the irrigant in
syringe – build up of pressure

 Positive pressure irrigation

 To maximize safety
and control, use of 1-
to 5-mL syringes is
recommended instead
of the larger ones.

These syringe can

be used to reach
the optimal flow
rates.
Very high pressure inside
syringe - Luer-Lok
threaded fitting design –
avoids accidental
detachment of needle
during irrigation
Needles
 Not only the size of syringe but also the size of needle (gauge) decides the amount of
pressure applied.

 The needles are selected based upon their external diameter and also based upon the
preparation sizes.
Flat Beveled Notched Side-vented Double Multi-vented
Side-vented

OPEN ENDED CLOSED ENDED

NEEDLES NEEDLES
BRUSHES
 Brushes are not directly used for delivering an irrigant into the canal spaces.

 Adjuncts designed for debridement of the canal walls or agitation of root canal irrigant
.
 They might be indirectly involved with the transfer of irrigants within the canal spaces

ENDOBRUSH
 Improved cleanliness of the coronal third of
instrumented root canal walls irrigated and
agitated with the NaviTip FX needle over the
brushless type of NaviTip needle

A 30-gauge irrigation needle covered

with a brush (NaviTip FX; Ultradent
Products Inc, South Jordan, UT) was
introduced commercially.

The differences in the apical and

middle thirds were not statistically
significant.

Al-Hadlaq SM, Al-Turaiki SA, Al-Sulami U, Saad AY. Efficacy of a

new brush-covered irrigation needle in removing root canal debris: a
scanning electron microscopic study. J Endod. 2006;32(12):1181-1184.
Rotary brushes
 A rotary handpiece–attached microbrush has been used by Ruddle to facilitate debris and
smear layer removal from instrumented root canals.

 Rotates at about 300 rpm,- the bristles deform into the irregularities of the preparation helping
to displace residual debris out of the canal in a coronal direction.
 CanalBrush (Coltene Whaledent, Langenau,
Germany) is an endodontic microbrush which is
highly flexible and is molded entirely from
polypropylene

 Used manually with a rotary action - more

efficacious when attached to a contra-angle
handpiece running at 600 rpm
MANUAL DYNAMIC AGITATION USING WELL FITTED GUTTA PERCHA

 An irrigant must be in direct contact with

the canal walls for effective action.

 Gently moving a well-fitting gutta-percha

master cone up and down in short 2- to 3-
mm strokes within an instrumented canal
produce an effective hydrodynamic effect
and significantly improve the
displacement and exchange of any given
reagent
 SONIC IRRIGATION DEVICES
Sonic irrigation operates at a lower frequency (1–6 kHz) and produces smaller shear stresses

This mode of vibration is

When the movement of
the sonic file is
They have 1 node constrained, the sideway
near the attachment oscillation disappears.
of the file and 1 This results in a pure
ntinode at the tip of longitudinal file
he file. oscillation.
efficient for root canal
debridement, because it is
largely unaffected by loading
and exhibits large
displacement amplitudes
 ENDO ACTIVATOR
Electrically driven and works at the much lower
frequencies of 33, 100, and 167 Hz. designed to
use polymer tips of various sizes (ISO size 15,
25, 35) and tapers (0.02, 0.04)

Sonic Air Endo Handpiece

driven by air pressure to produce
vibration frequencies of 1500–
3000 Hz Vibringe
Vibringe consists of a sonically activated
device attached to a syringe, which is
said to create agitation as the irrigant is
delivered
ULTRASONIC IRRIGATION DEVICES

 Produces high frequencies but low

amplitudes.

 These are designed to oscillate at

ultrasonic frequencies of 25–30 kHz,
which are beyond the limit of human
auditory perception (>20 kHz).

 Operate in a transverse vibration,

setting up a characteristic pattern of
nodes and antinodes along their length
 The success of ultrasonic instrumentation is attributed to the interaction of the ultrasonic
energy and the irrigating solution. This interaction is called as the “synergistic system”.

Cavitation
MOA of ultrasonic devices

Acoustic Streaming
Passive Ultrasonic irrigation (PUI)
 The term PUI was first used by Weller et al to describe an irrigation scenario where
there was no instrumentation, planing, or contact of the canal walls with an endodontic
file or instrument

 During PUI, the energy is transmitted from an oscillating file or a smooth wire to the
irrigant in the root canal by means of ultrasonic waves and induces acoustic streaming
and cavitation

IRRISAFE
 INTERMITTENT FLUSH TECHNIQUE,
• the irrigant is injected into the root canal by a syringe and replenished several times
after each ultrasonic activation cycle.
• The amount of irrigant flowing through the apical region of the canal can be
controlled.

 This is not possible with the use of the continuous flush regime.

n t o be
n s ho w
v e b e e t h e r o ot
th od s ha i s f rom
in g m e n d e b r e w as
f lus h d ent i o n tim
r,B o t h o v i ng rri g a t i
w ev e i n re m t h e i
Ho ff ec t i ve e l w h en
ua l l y e o m od
eq e xv i v
n a n
canal i inutes
t a t 3 m
se
Simultaneous Ultrasonic instrumentation & irrigation (UI)

Less effective than PUI because of reduction of acoustic streaming and cavitation.

In UI, the file contacts the root canal wall, so the oscillations are dampened and
becomes too weak to maintain acoustic streaming.

For proper acoustic streaming, the ultrasonic file should move freely in the canal
without making contact with the canal wall.
PRESSURE ALTERATION DEVICES

EndoVac System RinsEndo System

IRRIGATION DYNAMICS
 Fluid dynamics is the study of fluids in motion and the subsequent effects of the fluids
upon the boundaries, either solid surfaces or interfaces with other fluids

 Root canal irrigation can be viewed as the microscale flow of a liquid (irrigant) inside an
irregularly shaped domain of very small dimensions (root canal system).

 Hence, it falls within the scope of fluid dynamics and microfluidics

IRRIGATION DYNAMICS refers to how irrigants

IRRIGATION DYNAMICS refers to how irrigants
flow, penetrate, and readily exchange within the root
flow, penetrate, and readily exchange within the root
canal system as well as the forces they produce.
canal system as well as the forces they produce.
 Keeping Irrigation dynamics in mind, the basic aims of root canal irrigation can be restated
as follows:

FLOW of the irrigant to full extent of root canal system

Frequent refreshment of irrigant –chemical effect

Application of force on root canal wall (wall shear stress)

Restriction of the flow within the constraints of root canal

system
FLOW OF THE IRRIGANT
 TYPE OF FLUID FLOW

Laminar Turbulent

• random , unpredictable, and

• smooth or regular paths of chaotic
particles of the fluid
• Highly unsteady and vary along
• Fluid flows in parallel layers  the three spatial directions.

turbulent eddies
 The type of flow occurring within the root canal depends primarily on the balance
between the inertia (driving) forces and viscous (frictional) forces affecting the irrigant.

 This balance is expressed by the Reynolds number ( Re )

Viscous forces are

dominant over
inertia forces -
LOW Re flow remains
laminar

Inertia forces are

dominant over HIGH Re
viscous forces -
flow becomes
turbulent
In the case of root canal
irrigation, turbulence But the root canal
would greatly assist presents a system with a This is mainly because
irrigant penetration and low Reynolds number – of the flow rate of the
refreshment due to the laminar type of fluid irrigant
far more effective flow
mixing
 FLOW RATE -highly
significant in determining flow
pattern in irrigation dynamics ;
influence the replacement of the
irrigant. irrigant delivered at very low flow
rates (~0.01 mL/s) via 30G
needle, a steady laminar flow is
developed.

At higher flow rates (up to at

least 0.26 mL/s), the flow
becomes unsteady, but
remains laminar

a higher,unrealistic, flow rate

(0.53–0.79 mL/s) - development
of turbulence mostly close to the
tip of the needle
 Overall the highest velocities were
observed within the needle lumen

As the irrigant approached the needle

outlet, it primarily followed the main
flow stream towards the root canal

A jet of irrigant was formed at the needle

outlet, directed towards the apex with a
divergence of approximately 30 degrees
 The type of the needle has also a substantial effect on the basic flow pattern developed in
the root canal during syringe irrigation
a flow rate of 0.01– 0.26 mL sec)1
should be combined with placement of
the irrigation needle to within 1 mm
from working length, in order to
achieve acceptable irrigant exchange
 Assessed and compared the influence of endodontic needle gauges on endodontic irrigation
flow rate

 The clinical flow rates according to the study were 0.27 mLs−1 for 26 gauge, 0.19 mLs−1
for 27 gauge, and 0.09 mLs−1 for 30-gauge needles.

26 gauge and 27-gauge needles

This study revealed inverse
provide higher flow rates, but within
correlation between gauge of
the root canal the external diameter
endodontic needles and
of these impair the depth of
endodontic irrigation flow rate.
penetration
IRRIGANT REFRESHMENT –
CHEMICAL EFFECT
 Tip
design

IRRIGANT Size and

Flow
REFRESH- taper of
rate
MENT canal

Place-
ment
depth of
needle
 EFFE
INSE CT OF N
RTIO EEDL
IRRI N DEPT E
GAN H ON
T FL
OW

Boutsioukis C, Lambrianidis T,
Verhaagen B, Versluis M,
Kastrinakis E, Wesselink P, van
der Sluis LWM. The effect of
needle insertion depth on the
irrigant flow in the root canal:
evaluation using an unsteady
computational fluid dynamics
 EFFE
PREP CT OF A
ARA PICA
IRRI T ION L
GAN SIZ
T FL E ON
OW

Boutsioukis C, Gogos C,
Verhaagen B, Versluis M,
Kastrinakis E, van der
Sluis LWM. The effect of
apical preparation size
on irrigant flow in root
canals evaluated using an
unsteady computational
fluid dynamics model
OPEN ENDED NEEDLE
>Apical enlargement to >Irrigant exchange
size 30 with 0.06 taper occurs 1mm apically to

CLOSE ENDED NEEDLES

leads to effective the tip in root canal of
exchange 2mm apically size 30 with 0.06 taper
>Size 35 with 0.05-0.06 >increase of size of
taper results in taper - minimal
significant irrigant additional effect
refreshment almost
3mm apically to the
needle
 Impact of the size of irrigating needle, the depth of irrigating needle insertion, and the size of
enlarged root canals on the flow distribution of irrigant solution investigated

Stepback instrumentation
to achieve different sizes of
master apical file ranging
from size 25, 30, 35, 40,
45, 50 to size 80

Three sizes of irrigating

syringe needles (gauges 23,
25 and 27) used at three
different depths: 3, 6 and 9
mm from the apical stop
 The flow distribution of root canal
irrigation can be affected adversely by
large diameter irrigating needles, by
greater distances between the needle tip
and the apical stop, and by narrow root
Hsieh, Y. D., Gau, C. H., Kung Wu, S. F., Shen, E. C., Hsu, P. W., & Fu, E.
canals
(2007). Dynamic recording of irrigating fluid distribution in root canals using
thermal image analysis. International Endodontic Journal, 40(1),11–17
 It has been reported that a dead-water or stagnation zone may exist apically to the tip of
closed-ended needles, beyond which no irrigant refreshment takes place

The further the stagnation plane is

from the end of the needle tip –
better the irrigant penetration

Ideally, the stagnation plane

should be coincident with the root
apex

Gulabivala K, Ng YL, Gilbertson M, Eames I.

The fluid mechanics of root canal
irrigation. Physiol Meas. 2010;31(12):R49-
 Showed the existence of a 2.3mm long
cleared zone beyond the needle tip,
beyond which is the ‘dead water’ zone

 The length of the cleared zone was dependent upon

needle design – with a notched or slotted needle
showing almost 3mm of cleared zone beyond the needle
tip
 A side-vented close-ended needle demonstrated poorer
penetration of irrigant
WALL SHEAR STRESS – MECHANICAL
EFFECT
 Frictional forces occurring within a flowing irrigant and between flowing irrigant and root
canal walls tend to resist its motion.

 These forces give rise to wall shear stress - it can detach material from the root canal wall,
- determines the mechanical effect

In order to explain this phenomenon, the

irrigant is considered to consist of
individual layers of infinitely small
thickness, which can slide over each other.
As the irrigant moves, the layers
farther away from the wall tend to
move faster than the ones closer to the
wall and a shear stress is developed
Boutsioukis C, Verhaagen
B, Versluis M, Kastrinakis
E, Wesselink PR, van der
Sluis LW. Evaluation of
irrigant flow in the root
canal using different needle
types by an unsteady
computational fluid
dynamics model. J Endod.
 Shear stress on the canal wall have an influence on the mechanical detachment of
debris, tissue remnants, isolated microbes, and biofilm.

No quantitative data on the minimum shear stress required,

Distribution of shear stress along the canal wall provides an indication of the
debridement efficacy of each needle type

Area of high shear stress was identified in the apical part of the canal, relatively
close to the tip of the needle. In this area, biofilm and debris detachment is most
efficient.

Boutsioukis C, Verhaagen B, Versluis M, Kastrinakis E, Wesselink PR, van der Sluis LW. Evaluation of irrigant flow in the root
canal using different needle types by an unsteady computational fluid dynamics model. J Endod. 2010;36(5):875-879.
 EFFE
INSE CT OF N
RTIO EEDL
IRRIG N DEPT E
ANT H ON
FLOW

Boutsioukis C,
Lambrianidis T, Verhaagen
B, Versluis M, Kastrinakis
E, Wesselink P, van der
Sluis LWM. The effect of
needle insertion depth on
the irrigant flow in the
root canal: evaluation using
an unsteady computational
fluid dynamics model.
Needle insertion depth, root canal size, and taper - no affect on distribution of wall
shear stress to a large extent.

The maximum shear stress decreases as needles move away from WL or with
increasing size or taper - more space is available for the reverse flow of the irrigant, -
irrigant velocity decreases - the area affected by maximum shear stress becomes larger

It could be hypothesized that

overenthusiastic enlargement of the root
canal further than a certain size or taper
may in fact reduce the mechanical
effect of irrigation
APICAL VAPOR LOCK
 Vapor lock effect was first mentioned by Luks in 1974 and later described by Machtou.

Roots surrounded by
periodontium behaves like
a close ended channel

pressure applied by
the syringe in this
close ended channel
Air bubble APICAL
formation in VAPOR
apical end of
root canal LOCK

Entrapment of air
 Caused by one of the Small bubbles
principal properties of This leads to the are produced
sodium hypochlorite - formation of carbon that prevent the
dissolution capacity of the dioxide and ammonia in penetration and
organic component. the root canals, renewal of
irrigants mostly
in apical levels
Methods to eliminate / prevent AVL
ACHIEVE APICAL PATENCY
It can be achieved
with a small size file,
which moves
establishing apical passively through the
patency is leaving the foramen
apical foramen
During accessible, free from
instrumentation, dentin chips, pulp
dentin chips and fragments and other
fragments of apical debris.
pulp tissue get
compacted into the The patency filing technique may
foramen, causing be considered an important step in
apical blockage. preventing AVL

Lalitagauri Mandke, Leena Padhye. Apical vapour lock effect in endodontics – a

review. International Journal of Contemporary Medical Research 2018;5(2):B14-B17.
APICAL SIZE OF ROOT CANAL

The need for adequate enlargement of the root canal to improve

irrigation efficacy was recognized by Grossman .

Larger the apical size of the root canal, lesser is the chance of AVL
formation.

The drawbacks of over- enlargement of the canal viz. reduction in

radicular dentin thickness and subsequent weakening of the root
structure, should be considered before deciding on the apical size
SIZE OF IRRIGATING NEEDLE TIP AND ITS EXTENT IN THE ROOT CANAL

Commercially available needles of size 27G, 30G or 31G

facilitate insertion of the needle tip close to the working
length.

A 27 gauge needle is the most preferred needle tip size for

routine endodontic procedures.

The tip must extend as close to working length as possible,

taking care that there be no periapical extrusion of the irrigant.
IRRIGANT FLOW RATE

 Higher flow rates were correlated to decreased AVL.

 A higher flow rate has also been linked to increased irrigant pressure at the apical
foramen (Verhaagen et al. 2012), with increased risk of irrigant extrusion. So flow rate
should be adjusted according to the irrigation technique used.

exceeding a rate above 4 ml/ min does not

improve apical clearance but increase the risk
of extrusion; therefore 1 ml increments over 15
seconds give maximum exchange and
minimum risk

Verhaagen, B., Boutsioukis, C., Heijnen, G. L., van der Sluis, L. W.

M., & Versluis, M. (2012). Role of the confinement of a root canal on
jet impingement during endodontic irrigation. Experiments in Fluids,
MANUAL DYNAMIC AGITATION

Following instrumentation, the canal is filled with irrigant and the

gutta percha master cone inserted.

It is then ‘pumped’ up and down in rapid 3 mm motions.

This overcome AVL and facilitate irrigant exchange close to the final
working length,at the same time disinfecting the GP cone prior to
cementation.

This technique is the simplest and easiest method of tackling AVL

 during MDA, air entrapment reoccurs
Ultrasonically activated file was effective in
during removal of the K-file; hence, MDA
eliminating the vapor lock but less effective
can result in more debris in the apical
than the EndoActivator, i.e., sonic system
regions of the root canal.
PRESSURE ALTERATION DEVICES

Concomitant irrigant delivery and aspiration via the use of

pressure alternation devices provide a plausible solution to
this problem

Apical negative pressure irrigation with Endovac or

Rinsendo irrigating systems or ACWIS (Activated
continuous warm irrigation and evacuation system) using
Endo Irrigator plus can prevent AVL.

Lalitagauri Mandke, Leena Padhye. Apical vapour lock effect in

endodontics – a review. International Journal of Contemporary
Medical Research 2018;5(2):B14-B17.
NEGATIVE PRESSURE IRRIGATION
 Pressure is defined as force per unit area.

 In the endodontic treatment, when the irrigant is delivered into the root canal, the
pressure is exerted on the walls.

 Negative pressure occurs when the enclosed space has lower pressure than the
surrounding space. It acts like the vacuum cleaner
 Negative pressure irrigation is an alternative method for the delivery of irrigants inside
the root canal that was proposed in order to minimize the risk of irrigant extrusion
through the apical foramen
(Nielsen & Baumgartner 2007, Gutmann et al . 2014)

 Irrigants are delivered by a syringe and

needle inside the pulp chamber and a fine
suction tip placed near WL creates the
necessary negative pressure that drives the
irrigant into the canal
(Nielsen & Baumgartner 2007,
Adorno et al . 2016)
Endovac System
 The EndoVac system uses two steps to remove the debris.

 The first step involves a macrocannula of 0.55-mm diameter placed in the middle third
to eliminate gross debris and pulp remains.

 The second step includes a microcannula of 0.32-mm diameter used for the full
working length to remove the minute debris.

 Therefore, appropriate apical enlargement to a minimum of a size 0.35 file must be

created to ensure that the microcannula tip (0.32 mm) reaches the apical tip.
 The EndoVac creates a negative pressure ranging from approximately −30 to −260mm
Hg throughout the root canal system extending from the coronal access opening and
terminating at the apical extent of the major diameter

 This allows irrigants to be safely and effectively drawn in abundant quantities down
and/or across the canal walls and/or through intracanal irregularities like isthmus areas
and wall fins as they are added coronally and evacuated apically

Negative pressure irrigation system: A review A. Ashik

Ahamed1 , James David Raj
 Goode et al. in 2013 demonstrated that ultrasonic activation could not effectively
clean debris from a multiplaner canal; but the EndoVac produced significantly
better debris removal than PP, manual dynamic, sonic, and ultrasonic activation.

 Cohenca’s research team evaluated different irrigation systems in oval canals:

EndoVac, PP, and self-adjusting file (SAF) system.
• Results again confirmed the advantages of EndoVac, which delivered a full and
constant irrigation at WL, showing significant differences compared to the
other two systems
Chen JE, Nurbakhsh B, Layton G, Bussmann M, Kishen A. Irrigation dynamics associated with
positive pressure, apical negative pressure and passive ultrasonic irrigations: a computational
fluid dynamics analysis. Aust Endod J. 2014;40(2):54-60.
 the passive-ultrasonic
irrigation group showed
The apical
the highest wall shear
negative
stress along with the
open-ended but pressure mode
greatest magnitude of
was localised of irrigation
velocity
to a small generated the
region of the lowest wall
Syringe-based canal wall. shear stress,
irrigation with a
side-vented needle
showed a higher
wall shear stress
NEWER AVENUES
LASER ASSISTED IRRIGATION
 The first use of laser in endodontics was reported by Weichman and Johnson in 1971 who
attempted to seal the apical foramen in vitro with a high power carbon dioxide (CO2) laser

 Lasers can be used in various endodontic procedures such as: pulp capping/pulpotomy,
cleaning and disinfecting the root canal system, obturation, endodontic retreatment, and
apical surgery

Jurič IB, Anić I. The Use of Lasers in Disinfection and Cleanliness

of Root Canals: a Review. Acta Stomatol Croat. 2014;48(1):6-15.
 Laser-activated irrigation (LAI) has been introduced as a powerful method for root canal
irrigation.

 LAI occurs when irrigant is placed in the root canal and we are activating it with Laser

 The heat or the thermal effect of LASER produces transient cavitation in the liquid .

 erbium: yttrium aluminum garnet (Er:YAG), chromium: yttrium scandium gallium garnet
(Er,Cr:YSGG) lasers, have high absorption properties in water, and hence are suitable for
activating irrigation solution in the root canal
 Streaming patterns during LAI was visualized along with examination of effect of tip
position on the irrigation flow and velocity.

On laser irradiation within

coronal chamber, rapid streaming
appeared in the entire root canal
immediately after the advent of
the vapor bubble.
In contrast, when the tip was placed
in the root canal, rapid streaming was
related to the appearance of
secondary cavitation bubbles and
confined to the apical region
PHOTON INDUCED PHOTOACOUSTIC STREAMING
(PIPS)
•PIPS is based on the radial firing stripped tip
with laser impulses at sub-ablative energies which
induce interaction of water molecules with peak
powers of 400W.

•This creates successive shock waves leading to

formation of a powerful streaming of the
antibacterial fluid located inside the canal, with no
temperature rising

Mohammadi Z, Jafarzadeh H, Shalavi S, Palazzi F. Recent Advances

in Root Canal Disinfection: A Review. Iran Endod J. 2017.
 Comparison between fluid movements generated from photon-induced photoacoustic
streaming (PIPS) and passive ultrasonic irrigation (PUI).

Irrigation enhancement beyond

PIPS caused higher average fluid
needle irrigation is relevant to more
speeds when compared to PUI, both
effectively eradicate microorganisms
close and distant from the instrument.
from root canal systems.

PIPS may be an alternative approach

due to its ability to create high
streaming velocities further away from
the activation source compared to
ultrasonic activation
 CONCLUSION
 Despite the significant advances in root canal treatment, there remains a lack of clarity
about the mechanisms of irrigant delivery, replenishment, mixing, flushing and wall
erosion

 This is because Endodontic research is mainly focused on finding the instruments and
clinical procedures that might improve success rates by more effectively reaching the
apical anatomy.

 Integrating the physical processes that are occurring within the root canal system with the
clinical procedures is the need of the hour.

 Only a proper understanding of the dynamics of the irrigating system can help us to
achieve a proper disinfection of the root canal system which is the key factor for success of
RCT.
 REFERENCES
Disinfection of Root Canal Systems :The Treatment of Apical Periodontitis

Endodontic irrigation – Chemical disinfection of the root canal system By Bettina Basrani

Gu LS, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR. Review of contemporary irrigant agitation techniques and devices. J
Endod. 2009;35(6):791-804.

Al-Hadlaq SM, Al-Turaiki SA, Al-Sulami U, Saad AY. Efficacy of a new brush-covered irrigation needle in removing root
canal debris: a scanning electron microscopic study. J Endod. 2006;32(12):1181-1184.

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