Irrigation And Intracanal Medicaments Notes

Irrigation And Intracanal Medicaments Notes

Irrigation And Intracanal Medicaments

Successful endodontic treatment depends on a combination of proper instrumentation, irrigation, and three-dimensional obturation of the root canal system. Among these, irrigation plays an indispensable role in endodontic treatment.

It is truly said, “Instruments shape, irrigants clean.” Irrigation is the only way to clean those areas of root canal walls that are not touched by mechanical instrumentation. These areas are fis, isthmuses, anastomosis, and large lateral canals.

The objective of using an irrigant is chemical dissolution/disruption, mechanical detachment, removal of the pulp tissue, dentin debris, and smear layer, microorganisms, and their products out of the root canal system.

Read And Learn More: Endodontics Notes

Ideal Requirements For An Irrigant

It should

• Have broad-spectrum antimicrobial properties
• Aid in the debridement of the canal system
• Have the ability to dissolve necrotic tissue or debris
• Have low toxicity level
• Be a good lubricant
• Have low surface tension so that it can easily flow into inaccessible areas
• Be able to effectively sterilize the root canal (or at least disinfect them)
• Be able to prevent the formation of a smear layer during instrumentation or dissolve the latter once it is formed
• Inactivate endotoxin

Other desirable properties of an ideal irrigant are that it should

• Be able to penetrate root canal periphery
• Be able to dissolve pulp tissue, smear layer, and biofilm
• Be bactericidal even for microorganisms in biofilm
• Be fungicidal
• Not weaken the tooth structure
• Be easily available
• Be cost-effctive
• Be easy to use
• Have an adequate shelf life
• In addition to these properties, if endodontic irrigants come in contact with vital tissue, these should be sys- chemically nontoxic, noncaustic to the periodontal tissue, and have little potential to cause an anaphylactic reaction

Functions Of Irrigants

• Irrigants perform physical and biological functions. They remove dentin shavings from canals and thus prevent blockage of canal apex
• The effiency of instruments increases in wet canals and they are less likely to break in lubricated canals
• Irrigants act as a solvent of necrotic tissue, so they loosen debris, pulp tissue, and microorganisms from irregular dentinal walls
• Irrigants help in remove the debris from fis, – miosis, accessory, and lateral canals where instruments cannot reach
• Most irrigants are germicidal and have antibacterial action
• The bleaching action of irrigants lightens the teeth discolored due to trauma or extensive silver restorations

Factors That Modify the Activity Of Irrigating Solutions

Efficy of irrigating solutions depends on the following factors:

Concentration:

Studies have shown that though the tissue-dissolving ability of sodium hypochlorite increases linearly with concentration, it is preferred to use a lower concentration due to its cytotoxic effects.

Contact:

To be effective, the irrigant must contact the substrate (organic tissue or microbes). When canals are sufficiently enlarged, irrigant can be deposited directly in the apical area with a fie irrigating needle to increase its effect.

Presence of Organic Tissue:

The presence of organic tissues decreases the effctiveness of intracanal medicaments. The protein content of organic tissues form a coagulate when reacts with medicament. This coagulant serves as a barrier to prevent further penetration of medicament, thus limiting its effctiveness.

Quantity of Irrigant Used:

The quantity of irrigant used is directly related to its ability to remove the debris from the canal.

The gauge of Irrigating Needle:

27- or 28-gauge needle is preferred as it can go deeper in the canal for better delivery and debridement action.

Surface Tension of Irrigant:

The lower surface tension of an irrigant increases its wettability, hence better penetration in narrow areas for effctive debridement.

Temperature of Irrigant:

As the temperature of the irrigant is increased, its efficacy increases.

Frequency of Irrigation:

Copious irrigation has the following advantages:

• More irrigation causes better debridement of tissues
• Each time a fresh potent irrigant plays an action

Canal Diameter:

The wider the canal, the better is the debridement action of the irrigant.

Age of Irrigant;

Freshly prepared solutions are more efficient, than older ones.

Commonly Used Irrigating Solutions