Irrigating agents

Goals of irrigation

• Irrigation has a central role in endodontic treatment. During and

after instrumentation, the irrigants facilitate removal of
microorganisms, tissue remnants, and dentin chips from the root
canal through a flushing mechanism

• Irrigants can also help prevent packing of the hard and soft
tissue in the apical root canal and extrusion of in- fected
material into the periapical area. Some irrigating solutions
dissolve either organic or inorganic tissue in the root canal
• In addition, several irrigating solutions have antimicrobial
activity and actively kill bacteria and yeasts when introduced in
direct contact with the microorganisms

• However, several irrigating solutions also have cytotoxic

potential, and they may cause severe pain if they gain access
into the periapical tissues.
An optimal irrigant should have all or most of the positive
characteristics listed in the next slide, but none of the
negative or harmful properties. None of the available
irrigating solutions can be regarded as optimal. Using a
combination of products in the correct irrigation sequence
contributes to a successful treatment outcome
• 􏰀 Washing action (helps remove debris) 􏰀

• Reduce instrument friction during preparation (lubricant) 􏰀

• Facilitate dentin removal (lubricant) 􏰀

• Dissolve inorganic tissue (dentin) 􏰀

• Penetrate to canal periphery 􏰀

• Dissolve organic matter (dentin collagen, pulp tissue, biofilm) 􏰀

• Kill bacteria and yeasts (also in biofilm) 􏰀

• Do not irritate or damage vital periapical tissue, no caustic or cytotoxic effects

􏰀 Do not weaken tooth structure
IRRIGATING SOLUTIONS
• Sodium hypochlorite

• EDTA

• CA

• NaOCl

• Hydrogen peroxide

• Chloerexidine
Sodium hypochlorite
A light yellow liquid with a delicate chlorine odor.
Used in concentrations from 0.5% -5.25%
 ACTIVITY
• It has cleaning properties and whitens hard tooth tissues.

• The preparation in lower concentrations (0.5-2%) is

recommended for rinsing tooth canals with pulpitis.

• The preparation in higher concentrations (5.25%) is used to

rinse root canals with internal resorption.
This agent can damage the skin or mucosa, therefore it should
be used on teeth protected with a rubberdam.
 PROPERTIES

• Removes bacteria pulp residues remaining in the canals.

• Reduce the risk of breakage of the dental instruments, mekes

easier work (wet environment).

• It also helps in removing the granulation tissue.

 CHELATING AGENTS: ETHYLENE
DIAMINE TETRA-ACETIC ACID (EDTA)

• Chelating agent is defined as a chemical which combines with a metal to

form chelate. EDTA is most commonly used chelating agent. It was
introduced in dentistry by Nygaard Ostby for cleaning and shaping of
the canals.

It contains four acetic acid groups attached to ethylenediamine.

EDTA is relatively nontoxic and slightly irritating in weak solutions. The effect of
EDTA on dentin depends on the concentration of EDTA solution and length of
time it is in contact with dentin.
 FUNCTIONS OF EDTA
• Lubrication
• Emulsification
• Holding debris in suspension
• Smear layer removal.

MECHANISM OF ACTION
• It inhibits growth of bacteria and ultimately destroys them by starvation because
EDTA chelates with the metallic ions in medium which are needed for growth of
microorganisms.
• EDTA has self limiting action. It forms a stable bond with calcium and dissolve
dentin, but when all chelating ions have reacted, an equilibrium reached which
prevents further dissolution
• EDTA effectively dissolve inorganic material, including
hydroxyapatite. They have little or no effect on organic
tissue.

• EDTA is used for 2 to 3 minutes at the end of instrumentation and after NaOCl
irrigation. Removal of the smear layer by EDTA improves the antibacterial effect of
locally used disinfecting agents in deeper layers of dentin.
 Uses of EDTA
• It has dentin dissolving
properties
• It helps in enlarging
narrow canals
• Makes easier
manipulation of
instruments
• Reduces time needed for
debridement.
 IRRIGANT
DELIVERY DEVICES
• Irrigants may be delivered into the root
canal using either a needle and syringe, or
an ultrasonic device.

• Different sizes of endodontic irrigating

syringes and needles.

•Needle with side venting helps to move the

irrigant sideways in whole canal. Needle
should never be wedged into the canal and
should allow an adequate back-flow.
 CITRIC
ACID
 Use in various concentrations,
ranging from 1% to 50%, with a
10% solution being the most
common

 Can also be used for irrigation of

the root canal and for removal of
smear layer

 Citric acid has been shown to

remove the smear layer more
effectively from apical root and
cavities than ultrasound
 Why do we use citric acid?
Why is it effective?

• It has good chemical stability, shows anti-microbial effects

against the facultative and obligative anaerobes.

• Use of citric acid was suggested as root canal irrigating

solution because of its properties like the removing capacity
of the inorganic component of smear layer and decalcification
capacity of dentin.

• When compared with phosphoric acid, polyacrylic acid or

lactic acid, it is more effective in smear layer removal.
 1. Citric acid during irrigation should
NEVER be mixed with sodium
hypochlorite (NaOCl)
Is it 2. Otherwise it is considered safe
safe?
Disadvantages and advantages

4. Demage to the
1. Efficiency on 2. Efficiancy on
3. Antibacterial surrounding
organic residues: inorganic residues:
acitivity: YES periodontal tissues:
YES YES
YES

5. Manageability
(bad smell, clothes 7 .Enlargment of
6. Cost: Low
staining and others: dental tubules: Low
RATHER NO
 Hydrogen peroxide( H2O2)
-It is a clear, colorless liquid.
-H2O2 is active against viruses, bacteria,
and yeasts.
-It has been particularly popular in
cleaning the pulp chamber from blood and
tissue remnants, but it has also been used
in canal irrigation.
Hydrogen peroxide( H2O2)
-Anti microbial properties
(broad spctrum antimicrobial agent )

-Tissue solvent. 
-Flush debris. 
-Lubricant. 
-Eliminate the smear layer. 
-Low toxicity level.
 Mechanism of action
-It is highly unstable and easily decomposed by heat and light. 
-It rapidly dissociate into H2O+O (water+nascent oxygen), the
liberated O has bacteriocidal effect.
-The rapid release of O nascent oxygen on contact with organic
tissue results in effervesce (bubbling) action which aid in
mechanical debridement by dislodging dentin debris and
necrotic tissue particles and floating them to the surface.
 Concentration
It is recommended to use in 3% conentration for endodontic irrigation.

Advantages of using alternating 3% H2O2 with Naocl

solution are :
1.Effervescent reaction (bubbles pushes debris mechanichally out of
root canal)
2.Solvent action of sodium hypochrorite on organic debris.
3.Disinfection and bleaching effect by both solutions.