‫بسم هللا الرحمن الرحيم‬

 IRRIGATING
SOLUTIONS AND
INTRACANAL
MEDICAMENTS IN
ENDODONTICS
*outline:

-.Irrigation solution

-.Techniques of irrigation

-.Intra canal medication

.Application of Intra canal medication-

Chemicals used during cleaning :and shaping*

.a – Irrigation materials

.b – intra canal medication

1-IRRIGATION MATERIALS:
*Criteria of ideal irrigating material:
Dissolve necrotic pulp tissue .
Inactive endotoxin .
Prevent formation of smear layer
during instrumentation .
Low toxicity level .
Low surface tension .
Good lubricant .
Be non-caustic to periodontal tissues .
Have a broad antibacterial spectrum
and high efficiency against anaerobic
and facultative microorganisms.
Don't affect sealing ability of obturation
material.
1-IRRIGATION MATERIALS:
: Types of irrigation materials*

Chemical-1
Electrochemical activation.-
2
photo activated Disinfection-3
I. IRRIGATION MATERIALS
*Types of irrigation materials:
 Chemical:
1. Sodium hypochlorite (Naocl): the most commonly
used irrigation solution .
Concentration : 0.5 – 5.25 % .

PH : about 11.

I. IRRIGATION MATERIALS
*Types of irrigation materials:
 Chemical:
1. Sodium hypochlorite (Naocl): the most
commonly used irrigation solution.
 Advantages :
 Excellent antibacterial agent.
 dissolve necrotic and vital pulp.
I. IRRIGATION MATERIALS
*Types of irrigation materials:
 Chemical:
1. Sodium hypochlorite (Naocl): the most
commonly used irrigation solution .
 Disadvantages :
o Inability to remove inorganic material .
o Allergic reactions to the irrigant .
o Damage to the patient clothing .
I. IRRIGATION MATERIALS
Types of irrigation materials
 Chemical:
2-Chlorhexidine gluconate (CHX) :
-Is a braod spectrum antimicrobial agent.
Concentration : 0.2-2 % (Bactericidal).
PH : 5.5-7 .
Chlorohexidine points
I. IRRIGATION MATERIALS:
*Types of irrigation materials:
 Chemical:
2-Chlorhexidine gluconate (CHX) :
Advantages :
Antimicrobial agent
Substantivity: ability to bind with dentin wall
and retain antibacterial activity up to 72h.
Used as irrigation material and an intra canal
medicaments
Has low grade of toxicity.
Disadvantages :
 Inability to dissolve organic and inorganic
material.
.

 Concentrations: 0.2 – 2 % (bactericidal)

PH:5.5-7.
 
I. IRRIGATION MATERIALS
*Types of irrigation materials:
 Chemical:
3-EDTA (Ethylenediaminetetraacetic acid):
Ethylenediaminetetraacetic acid
- ph: 7.3
-widely abbreviated as EDTA
- normally used in a concentration of 17%.
- It removes smear layers in less than 1 minute.
- no antimicrobial action
- Nowadays, to increase their antimicrobial capacity,
antiseptics such as quaternary ammonium compounds
(EDTAC) added to EDTA .
I. IRRIGATION
MATERIALS:
*Types of irrigation materials:
 Chemical:
4- Q-Mix :
-is an irrigation solution used as a final rinse. It
is a combination of CHX with EDTA and a
surfactant solution (urea peroxide) to improve
penetration in dentinal tubules by decreasing
surface tension.
I. IRRIGATION MATERIALS
*Types of irrigation materials:
 Chemical:
5-MTAD :
-Is a mixture of tetracycline isomer
(doxycycline) 3% , an acid (citric acid) 4.25% ,
and a detergent(tween 80) 5 % .A compound has
been developed with combined chelating and
antibacterial properties. It is applied as a 5-
minute final rinse after canal instrumentation
and irrigation with 1.3% NaOCl.
I. IRRIGATION MATERIALS
*Types of irrigation materials:
 Chemical:
5-MTAD :
Advantages
 Antimicrobial effect .
 Removes smear layer .
Concentration : 4.25 of citric acid present.
PH : 1.8 – 2.15 .
I. IRRIGATION
MATERIALS:
*Types of irrigation materials:

6-Tetra clean:
-Mix of
acid (citric) and Ab (Doxycycline) and
Detergent(polypropylene) .
• Decrease surface tension.
I. IRRIGATION
MATERIALS:
*Types of irrigation materials:
 Chemical:
7-Hydrogen peroxide :
is a mild antiseptic solution.
Advantages:
Antimicrobial effect(anaerobes) nascent O2 release
Flushing action.
Disadvantages :
No ability to dissolve both organic and non-organic material.
Decomposition by light.
In adverant injection ( sever pain – emphysema ).
Concentration : 6%.
PH : 6.2.
1-IRRIGATION MATERIALS:
: Types of irrigation materials*

Chemical-1
Electrochemical activation.-
2
photo activated Disinfection-3
I. IRRIGATION
MATERIALS:
*Types of irrigation materials:
 Electrochemical activation solution:

Principle:
• Produce metastable liquid through
electrochemical unipolar action
 I. IRRIGATION
MATERIALS:
*Types of irrigation materials:
 Electrochemical activation solution:
 Equipment:
• Flow electrolytic module (anode) fits axially in
(cathode)
• Produce solution have bactericidal and sporicidal
effect , odourless, nontoxic, oxidizing action
• More effective than NaOCl in smear layer removal-
• e.g.: sterilox (aquatinealpha electrolyte) using
hypochlorous acid.
1-IRRIGATION MATERIALS:
: Types of irrigation materials*

Chemical-1
Electrochemical activation.-
2
photo activated Disinfection-3
I. IRRIGATION
MATERIALS:
*Types of irrigation materials:

 photo activated Disinfection(PDT) or (LAT):

Also called photodynamic therapy

(PDT) or light activated therapy (LAT).
 
I. IRRIGATION
MATERIALS:
*Types of irrigation materials:
 photo activated Disinfection(PDT) or (LAT):
The activation of photosensitizer
molecules( toluidine blue, tolonium chloride,
methylene blue) by a specific wavelength of light(635
nm) produces deleterious chemical entities that kill
bacteria. The strong oxidizer generated during the
process can act on multiple targets in a microbial
cell, incomplete destruction of biofilm.
1-IRRIGATION MATERIALS:
: Types of irrigation materials*

Chemical-1
Electrochemical activation.-
2
photo activated Disinfection-3
 II. Techniques of irrigation
Syringe

Manual Brush
.Irrigation tecq

Manual-dynamic

Rotary brush

Continuous irrigation during rotary instrumentation

Sonic
Continous
Ultrasonic
Machine Intermittent

Endo vac
Pressure alteration
Rinsendo
II. Techniques of irrigation:
Passive Irrigation:
 it is intiated by slowly injection an irrigant into a
canal where, irrigant is passively dispensed through
a flexible canula which is loose in the canal, and
allows the irrigant to reflux and move debris
coronally.
 Smaller gauged canulas chose to achieve
deeper and more effective placement.
:II. Techniques of irrigation
Passive Irrigation:
 Disadvantages :
• is the static reservoir of irrigant that
restricts the potential for any irrigant to
penetrate, circulate, and clean into all
aspects of a root canal system.
• Low depth of penetration
II. Techniques of irrigation
 Active irrigation ;
it is to initiate fluid hydrodynamics which
plays a strategic role in cleaning and
disinfecting into all aspects of the root canal
system. The traditional methods of activation
included:
mechanical – electrochemical – light
activated.
II. Techniques of irrigation
A. manual active irrigation techniques:
1- Syringe irrigation with needles / cannulas:
Technique :
the needle tip is put at coronal third of narrow
canal or the middle third of wide canal and
moving the needle up and down the canal space.
Enlargement of root canal up to size 40 is
mandatory for effective technique.
II. Techniques of irrigation
A. Manual active irrigation techniques:
1- Syringe irrigation with needles / cannulas:
Technique :
• Plastic syringes of different sizes (1–20 mL) large-
volume syringes potentially allow some time-
savings, they are more difficult to control for
pressure and accidents may happen. Therefore, to
maximize safety and control, use of 1- to 5-mL
syringes
• Needles: 27- gauge needles, 30- gauge and even 31-
gauge needles are most commonly used for
irrigation.
II. Techniques of irrigation
:A. manual irrigation techniques
2- Brushes :
Brushes are not directly used for delivering an
irrigant into the canal spaces. They are adjuncts that
have been designed for debridement of the canal
walls or agitation of root canal irrigant such as
Endobrush.
II. Techniques of irrigation
A. manual irrigation techniques
2- Brushes :
Disadvantages:
could not be used to full working length
because of its size
lead to packing of debris into the apical
section of the canal after brushing.
dislodgment of the brush
II. Techniques of irrigation
A. manual active irrigation techniques:
3- Manual dynamic irrigation:
Research has shown that gently moving a
well-fitting gutta-percha master cone up
and down in short 2 mm to 3 mm strokes
within an instrumented canal (30 sec ):
- producing a hydrodynamic effect
- significantirrigant exchange
- increase contact of canal wall
II. Techniques of irrigation
B. Machine – assisted irrigation technique
1- Rotary brushes
A rotary handpiece - attached micro-brush and
use to facilitate debris and smear layer removal
from instrumented root canals, such as Ruddle
brush and canal brush.
The micro-brush rotates at about 300 rpm, and
the disadvantage is causing the bristles to
deform into the irregularities of the
preparation .
II. Techniques of irrigation
B. Machine – assisted active irrigation technique:
2- continuous irrigation during rotary
instrumentation :
• Increase the time of contact.
• Replace the volume.
• Continuous replacement .
A) The Quantec-E irrigation system: it is self
contained fluid delivery unit that is attached to the
Quantec-E Endo system.
B) The self-adjusting file (SAF): it is recently
introduced as an endodontic file.
II. Techniques of irrigation
B. Machine – assisted active irrigation technique:

3- Sonic irrigation:
 It is operating at frequencies of 1-6 kHz and
produce smaller shear stresses such as:
EndoActivator and Rispisonic file.
EndoActivator The system has 3 different sizes
of tips that are easily attached (Snap-On) to the
headpiece that creates the sonic vibrations.
EndoActivator does not deliver new irrigant to
the canal but it facilitates the penetration and
renewal of the irrigant in the canal.
EndoActivator
EndoActivator Tips
II. Techniques of irrigation
B. Machine – assisted active irrigation technique:
4- Ultrasonic irrigation:
 The use of ultrasonic energy for cleaning of the root canal and
to facilitate disinfection has a long history in endodontics.
 It produces high frequencies but low amplitude, oscillating at
frequencies of 25-30 kHz. Ultrasonic can effectively dislodge
from the root canal system.
 There are 2 types :
The first type is combination of simultaneous
ultrasonic instrumentation and irrigation (UI) .
 The second type is passive ultrasonic irrigation (PUI).
II. Techniques of irrigation
B. Machine – assisted irrigation technique
4- Ultrasonic irrigation:
Irrigant application methods during PUI:

Continuous Ultrasonic
Irrigation
Intermittent Flush Ultrasonic
Irrigation
Ultrasonic Irrigation
 Continuous Ultrasonic Irrigation

• Recently, a needle-holding adapter to an

ultrasonic headpiece has been developed by
Nusstein . During ultrasonic activation, a 25-
gauge irrigation needle is used instead of an
endosonic file. This enables ultrasonic
activation to be performed at the maximum
power setting without causing needle
breakage
• continuous flow instead of being
intermittently replenished from the
coronal access opening.
 
 Intermittent Flush Ultrasonic
Irrigation:
 In intermittent flushed ultrasonic
irrigation, the irrigant is delivered to the
root canal by a syringe needle. The irrigant is
then activated with the use of an
ultrasonically oscillating instrument. The
root canal is then flushed with fresh irrigant
to remove the dislodged or dissolved
remnants from the canal walls.
:II. Techniques of irrigation
B. Machine – assisted irrigation technique:
5- pressure alteration device:

EndoVac system

The RinsEndo system

5- pressure alteration device:
EndoVac system
uses suction to PULL irrigant down the
root canal, and then up and back up again
through a thin needle with a special
design. We call this “negative apical
pressure , because EndoVac applies
suction rather than forceful injection to
consistently deliver a perfect.
EndoVac
5- pressure alteration device:

The RinsEndo system

With this system, 65 mL of a rinsing

solution oscillating at a frequency of 1.6
Hz is drawn from an attached syringe and
transported to the root canal via an
adapted cannula. The pressure-suction
cycles change approximately 100 times
per minute.
 iii. INTRA-CANAL
MEDICATIONS:
*Goals of intra-canal medications:
 eliminate of any remaining bacteria after instrumentation.
 reduce inflammation of periapical tissue.
 render canal contents inert and neutral.

*Requirements of intracanal medications:

 should be effective germicide and fungicide &
bactericide.
 should not be irritant to periapical tissue.
 should remain stable in solution.
 should not stain the tooth structure
 iii. INTRA-CANAL
MEDICATIONS:
*Types of intracanal medications:
I – halogens e.G.:K1( iodine potassium
iodine) irrigating solution and short term
dressing( potent antimicrobial).
II – phenols : it is a protoplasm poison and
produces necrosis of soft tissue. However
it has strong inflammatory potential and
it is no longer used
( Paramonochlorophenal , cresal).
III –Calcium hydroxide : it is a broad-spectrum
antimicrobial agent. It's antiseptic action probably
related to its high PH and leaching action on
necrotic pulp tissue , in activation of endotoxins .
IV – Chlorohixedine: it is a broad-spectrum
antimicrobial agent. Studies shows that calcium
hydroxide and CHX combination is more effective.
-Antibiotics - corticosteroids
 
 
Calcium hydroxide applicator
 iii. INTRA-CANAL
MEDICATIONS:
* limitations of intracanal medications:
 The therapeutic action of these medications
depends on the direct contact on the tissue,
but these substances probably don't reach all
the areas where bacteria are presentand
limited to the surface action only.
 Duration : to be effective, these agents should
be remain chemically active during the time
of inter appointments.
 iii. INTRA-CANAL
MEDICATIONS:
*application of intr-acanal medications:

Several different techniques for placing

intracanal medications into root canals have
been proposed.
Amalgam carrier
pluggers
McSpadden-Compactor
Lentulo-spiral
Thank
you