Dyanamics Of Root

Canal Irrigation

Dr. Gaurav Rampuri
 Introduction

Endodontic irrigants are liquid antimicrobials
used to disinfect microbial biofilms within
the root canal.
Irrigation can be defined as washing out a
body cavity or wound with water or a
medicated fluid.

Hargreaves K, Cohen S. Pathways of the pulp 10th edition.

 Aims & Objectives

 The Chemical Effect –
 Chemical disruption or inactivation of biofilms,
 Killing of microorganisms and inactivation of
endotoxin,
 Dissolution of pulp tissue remnants, dentin debris
and of the smear layer by the active chemical
component’s of the irrigant.
 E.g: Sodium hypochlorite.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
 The Mechanical Effect -
 Mechanical disruption, detachment and removal of
microorganisms/biofilms, pulp tissue remnants, and
dentin debris from the root canal system via forces
applied by the flowing irrigant.
 Mechanical effects can be exerted by both chemically
active and inert irrigants (e.g., water, saline)

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
 The chemical effect strongly depends upon
 The concentration of the active component’s of the
irrigant,
 The area of contact, and
 The duration of interaction with the targeted
material.
 
 It is important to realise that even the most
powerful irrigant will be of no use if it cannot
penetrate the apical portion of the root canal,
interact with the root canal wall and exchange
frequently within the root canal system.
 Consequently, irrigation dynamics should be
considered when evaluating the effect of an
irrigant on root canal contents.

Anil Kishen. Irrigation dynamics in root canal therapy. Dental Tribune

International. 2015
 
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.
Fluids are substances that cannot withstand
any attempt to change their shape when at
rest; they include both liquids and gases, as
both have the ability to flow.
Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root
Canal System. 2015
 
 A flow is caused by the action of externally applied
forces, like pressure difference, gravity, or buoyancy.
 Irrigants can reach the sites of interest preferably by
the flow developed during delivery (or during
agitation).
 This way, chemically active particles
(molecules/ions) are transported quickly and
efficiently by the fluid motion, a process termed
Convection.
 
 In addition, while flowing, the irrigant applies forces
on the targeted material, thus exerting the
mechanical effect.
 In areas of the root canal where a flow cannot be
created, irrigant transport may still take place by
Diffusion, the random movement of particles in a
fluid, but this process is markedly slower than
convection, and its rate is further affected by the size
of the particles, temperature, and concentration
gradients.
 Irrigant role and delivery and their relationship
with the mechanics of canal preparation

 Root canal treatment may be divided into three
distinct phases by the dominant role of irrigation.
1. Canal negotiation phase
2. Canal enlargement phase
3. Active canal irrigation phase

Gulabivala K et al. the fluid mechanics of root canal irrigation. Physiol.

Meas. 31 2010. R49-84
 Canal Negotiation Phase

At this stage, the irrigant may
only be delivered predictably as
far as the pulp chamber or
coronal third of canal
depending on the extent of
penetration of the irrigating
needle.
Coronal preflaring or
crowndown approach
 
The irrigant may facilitate such canal
negotiation and equally the act of file
negotiation may help to drag the fluid
interface further apically through surface
tension effects.
 Canal Enlargement Phase

Mechanical shaping or enlargement of the canal
at the expense of the dentine may help free up
tags of pulp tissue and will also generate
dentine debris, which is released into the fluid
reservoir within the canal cavity.
As the metal instruments negotiate and enlarge
the canal space, it progressively becomes easier
to inject the fluids further apically into the canal
system.
 
The primary role of the irrigant at this stage
is to flush out this debris with the frequent
injection of irrigant in between filing and
reaming.
Debris-laden irrigant is only effective in the
coronal part of the canal where the irrigant
needle is able to reach.

Gulabivala K et al. the fluid mechanics of root canal irrigation. Physiol.

Meas. 31 2010. R49-84
 
 The dissolving organic pulp content
mix with the dentine debris and
may lead to the progressive increase
in the viscosity of the irrigant fluid,
to the point where it may begin to
behave as a paste, clinically known
as dentine ‘Mud’ and be pushed by
the piston action of the increasingly
larger files into the un-debrided and
still contaminated apical anatomy.
 
 Apical blockage of the canal.
 Transportation and uncontrolled shaping of
the canal walls.
 
To help flush out debris from the apical part,
the freshly replaced coronal irrigant is mixed
with the still debris-laden fluid in the apical
part by apical transference and mixing using
a small file, a process called ‘Recapitulation’.
Passing the file beyond the canal terminus to
prevent its blockage is called ‘Patency filing’.

Gulabivala K et al. the fluid mechanics of root canal irrigation. Physiol.

Meas. 31 2010. R49-84
 
The frequency of replenishment of the
coronal irrigant, which with progressive
canal preparation allows irrigant delivery
further and further apically, as well as the
frequency of recapitulation, is crucial in the
ability to maintain the apical canal anatomy
patent.
 Active Canal Irrigation Phase.

Once the canal shaping is complete the entire
root canal system (including the
instrumented and un-instrumented surfaces)
should be accessible for final washing by the
irrigant.

Gulabivala K et al. the fluid mechanics of root canal irrigation. Physiol.

Meas. 31 2010. R49-84
 
The irrigant is again delivered by injection
through a needle into the prepared part of the
canal and the process completed by means of
agitation, pumping and mixing to drive the
irrigant into the ‘unshaped’ part of the canal
system.
This final phase of irrigation is relatively poorly
adopted in general dental practice because of
the lack of awareness of its importance.
 
Since the nature of irrigation influences the
flow of irrigant up to the working length
(WL) and interaction of irrigant with the
canal wall, it is mandatory to understand the
irrigation dynamics associated with various
irrigation techniques.
 Syringe Irrigation

 In order to perform irrigation, syringes of variable
capacity ranging from 1 to 20 mL have been
suggested for use.
 
 During syringe irrigation, a clinician applies tactile
force to the syringe plunger.
 This force is transmitted to the irrigant into the
syringe, where pressure is built up.
 The pressure ( P ) developed inside the syringe
barrel is defined as:

P=

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
 A clinician will need to apply different amounts of
force and will feel different levels of difficulty to
push the plunger when syringes of a different size
are used.
 Larger syringes are more difficult to depress and
control.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
While depressing the plunger, the pressure
inside the syringe barrel remains
considerably higher than the ambient
pressure around the tip of the needle (which
is nearly atmospheric).
This pressure difference drives the irrigant
through the needle and into the root canal,
and that is why syringe irrigation is
categorized as a positive - pressure
technique.
 
The irrigant flow rate is proportional to this
difference, but is also affected by the size of
the needle.
So, for the same pressure difference, the flow
rate through a smaller needle will be much
less than through a larger needle.
 
 The flow rate ( Q ) of an irrigant is defined as:

Q=
 The irrigant flow rate is frequently expressed in
mL/s or mL/min.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
A 5-mL syringe has been recommended as a
reasonable compromise between less
frequent refilling and ease of use.
This syringe can be used to reach flow rates
at least up to 0.20– 0.25 mL/s even when
combined with fine irrigation needles.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
Type Of Needle

 
All needles create a Jet at their outlet, but the
exact position and shape of the outlet
determines the orientation and, to some
extent, the intensity of the jet.
In the case of the open-ended needles the jet
is very intense and extends along the root
canal, apically to their tip.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
The jet formed by the
flat and beveled needle
is slightly more intense
and extends further
apically than that of the
notched needle.
 
 Within a certain distance the jet appears to break up
gradually.
 Reverse flow towards the canal orifice occurs near
the canal wall.
 
 When closed-ended needles are
used, the jet is formed near the
apical side of the outlet, and it is
directed apically with a slight
divergence.
 The irrigant mainly follows a
curved path around the tip and
then towards the coronal orifice.
 A series of counter-rotating
vortices are formed apically to the
tip, extending almost to the WL.
 Physical Properties Of Irrigants

 Apart from the equipment (syringe and needle), the
flow of irrigants is also affected by their physical
properties, mainly Density and Viscosity.
 Density ( ρ ) is defined as:
ρ=
 Viscosity describes the resistance of the irrigant to
motion.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
For commonly used endodontic irrigants,
these properties are very similar to those of
distilled water because most irrigants are
sparse aqueous solutions.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
 The concept of the Reynolds number is particularly
important in fluid dynamics analysis as it describes
the ratio of inertial forces to viscous forces.
 Reynolds number (Re) combines four parameters:
fluid density ( ρ ) and viscosity ( μ ), characteristic
velocity scale ( υ ), and characteristic length scale (D).

Re =

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
A fluid flow with a low Reynolds number is
characterized as being Laminar as it is
dominated by viscous forces.
A fluid flow with a high Reynolds number is
characterized as being Turbulent, inertia
forces are dominant over viscous forces.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
 Turbulent flow is random, unpredictable, and
chaotic.
 They are highly unsteady and generally vary along
the three spatial directions.
 Visualizations of turbulent flows reveal rotational
flow structures of various sizes, called turbulent
eddies.
 
 The kinetic energy is continuously transferred from
large eddies to progressively smaller eddies until it is
dissipated and converted into thermal energy.
 In the case of root canal irrigation, turbulence would
greatly assist irrigant penetration and refreshment
due to the far more effective mixing .
 However, the development of turbulence inside root
canals during syringe irrigation has not been verified
experimentally yet.
 
 When the irrigant is delivered at very low flow rates
(~0.01 mL/s) through a 30G needle, a steady laminar
flow is developed within the root canal.
 At higher flow rates (up to at least 0.26 mL/s), the
flow becomes unsteady, but it remains laminar.
 Irrigant Refreshment

Irrigant exchange in the root canal system is a
key prerequisite for achieving optimum
chemical effect, because the chemical efficacy
of the irrigants are known to be rapidly
inactivated by dentine, tissue remnants or
microbes.

Anil Kishen. Irrigation dynamics in root canal therapy. Dental Tribune

International. 2015
 
Enlarging the root canal to place the needle to
a few millimetres from the WL and ensuring
adequate space around the needle for reverse
flow of the irrigant towards the canal orifice
allow effective irrigant refreshment coronal
to the needle tip.

Anil Kishen. Irrigation dynamics in root canal therapy. Dental Tribune

International. 2015
 
Even when an optimal flow rate is attained, it
seems that root canal preparation to apical
size 25, 0.06 taper does not allow adequate
irrigant flow and apical refreshment.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
Apical enlargement to size 30 leads to effective
exchange 2 mm apically to an open ended
needle when combined at least with 0.06 taper,
while size 35 combined with 0.05–0.06 taper
results into significant irrigant refreshment
almost 3 mm apically to the needle.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
In closed-ended needles, irrigant exchange
occurs almost 1 mm apically to their tip in a
root canal of size 30 and at least 0.06 taper,
while further increase of the size or taper has
only a minimal additional effect.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
Khademi et al in his study on MB canals on
mandibular molars reported that, apical
instrumentation up to #30 file with 6%
coronal taper is effective for deeper
penetration of the irrigation needle and
improved irrigant replacement.

Khademi A, Yazdizadeh M, Feizianfard M. Determination of the minimum

instrumentation size for penetration of irrigants to the apical third of root
canal systems. J Endod. 2006;32(5):417-20.
 
Srirekha A, et al. concluded that an apical
preparation size of 30 and 6% preparation
taper in DB canal of mandibular molars allow
adequate irrigation penetration in the apical
third with flat open ended needles
performing better than side vented needles.

Srirekha A, Shrivastava P, Vijay R, Savitha A, Archana S. Effect of Apical

Preparation Size and Taper on Irrigant Penetration in Apical Third of Root
Canal using Two Different Endodontic Needles: An In Vivo Study. J Dent Oral
Biol. 2017; 2(13): 1083.
 
 The effect of curvature on irrigant exchange has been
studied indirectly by Nguy and Sedgley.
 They report that only severe curvatures in the order
of 24–28° hampered the flow of irrigants. If the canal
is enlarged to at least size 30 or 35 and a 30-gauge
flexible needle placed near the WL is used, then
irrigant refreshment can be expected even in severely
curved canals.

Anil Kishen. Irrigation dynamics in root canal therapy. Dental Tribune

International. 2015
 
It has been reported that a Dead-water or
Stagnation zone may exist apically to the tip
of closed-ended needles, where no irrigant
refreshment takes place.
This zone has been observed while irrigating
at a medium flow rate (~0.1 mL/s) through
closed-ended needles positioned 3–5 mm
short of WL.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
To prevent this a patency file should be
repeatedly used after each active shaping
instrument which will help break up the gas
bubbles and moves fresh irrigant into the
apical last millimeters mixing it with the
stagnant solution of the “dead zone”.

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
The frequency of replenishment of the coronal
irrigant with the syringe along with the
progressive shaping of the root canal and the
repeated use of patency files are factors that
allow the delivery of irrigant further and
further apically.
Furthermore, increasing the volume of irrigant
delivered could help to improve refreshment
in such cases.
Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root
Canal System. 2015
 Wall Shear Stress

The frictional stress that occurs between the
flowing irrigant and the canal wall is termed
“Wall shear stress”.
This force is of relevance in root canal
irrigation because it tends to detach microbial
biofilm from the root canal wall.

Anil Kishen. Irrigation dynamics in root canal therapy. Dental Tribune

International. 2015
 
 In open-ended needles, an
area of increased shear
wall stresses develops
apical to the needle tip, in
the region of jet breakup.
 This area is approximately
symmetrical around the
needle and is slightly
smaller for the beveled and
notched needles.
 
 In closed-ended needles,
a higher maximum
shear stress is generated
near their tips, on the
wall facing the needle
outlet.
 
 Consequently, it is necessary to move the needle
inside the root canal, so that the limited area of high
wall shear stress involves as much of the root canal
wall as possible. 
 The maximum shear stress decreases as needles
move away from WL or with increasing size or taper,
because more space is available for the reverse flow
of the irrigant, so the irrigant velocity decreases; at
the same time, the area affected by maximum shear
stress becomes larger.
 
 Thus, overzealous root canal enlargement above a
certain size or taper could diminish the debridement
efficacy of irrigation.
 Apical Vapor Lock

 Air bubbles may be
entrapped in the apical
part of the root canal
during syringe irrigation
and totally block irrigant
penetration in that area ,
a phenomenon termed as
apical vapor lock. (Gu et
al 2009)

Bettina Basrani, Endodontic Irrigation Chemical Disinfection of the Root

Canal System. 2015
 
Removal of an apical vapor lock may be
challenging so additional techniques like
activation or the use of apical negative
pressure (ANP) are considered useful
adjuncts to overcome the problem.
Boutsioukis et al. has shown that the vapor
lock does not exist in all situations and the
insertion of a fine needle close to the working
length is able to prevent or remove it.
 
 But additional agitation of the solution is needed to
break up the gas bubbles if the final goal is to
distribute and exchange irrigants into the intricacies
of the apical anatomy.
 Enhancing Irrigation Dynamics Using
Physical Irrigation Methods

Fluid dynamics studies on apical negative-
pressure irrigation have demonstrated
maximum apical penetration of the irrigant,
without any irrigant extrusion. 

Anil Kishen. Irrigation dynamics in root canal therapy. Dental Tribune

International. 2015
 
In negative-pressure techniques, the irrigant
is delivered passively near the canal orifice
and a suction tip (negative-pressure) placed
deep inside the root canal creates a pressure
difference.
The irrigant then flows from the orifice
towards the apex, where it is evacuated.

Anil Kishen. Irrigation dynamics in root canal therapy. Dental Tribune

International. 2015
 
 The apical negative-pressure irrigation produced the
lowest wall shear stress.
 This decrease in the wall shear stress could be
attributed in part to the reduction in the flow rate
with this irrigation system.
 
Passive ultrasonically assisted irrigation,
when compared with other irrigation
methods, showed the highest wall shear
stress along the root canal wall, with the
highest turbulence intensity travelling
coronal from the ultrasonic tip position.
 
The lateral movement of the irrigant
displayed by this method has important
implications with respect to its ability to
permit better interaction between the irrigant
and the root canal wall, and to potentially
enhance the interaction of irrigants with
intra-canal biofilms.

Anil Kishen. Irrigation dynamics in root canal therapy. Dental Tribune

International. 2015
 Conclusion

 The requirements of adequate irrigant penetration,
irrigant exchange, mechanical effect and minimum
risk of apical extrusion oppose each other and a
subtle equilibrium is required during irrigation.
 An open-ended needle should be placed 2 or 3 mm
short of the WL to ensure adequate irrigant exchange
and high wall shear stress.
 In the case of a closed-ended needle, placement
should be within 1 mm short of the WL, so that
optimum irrigant exchange can be ensured.
 REFERENCE

 Hargreaves K, Cohen S. Pathways of the pulp 10th edition.
 Anil Kishen. Irrigation dynamics in root canal therapy. Dental
Tribune International. 2015
 Gulabivala K et al. the fluid mechanics of root canal irrigation.
Physiol. Meas. 31 2010. R49-84
 Bettina Basrani, Endodontic Irrigation Chemical Disinfection
of the Root Canal System. 2015
 Khademi A, Yazdizadeh M, Feizianfard M. Determination of
the minimum instrumentation size for penetration of irrigants
to the apical third of root canal systems. J Endod.
2006;32(5):417-20.
 
 Srirekha A, Shrivastava P, Vijay R, Savitha A, Archana S.
Effect of Apical Preparation Size and Taper on Irrigant
Penetration in Apical Third of Root Canal using Two Different
Endodontic Needles: An In Vivo Study. J Dent Oral Biol. 2017;
2(13): 1083.