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Root canal irrigants

Root canal irrigants

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Root canal irrigants

  1. 1. Root Canal IrrigantsIrrigants perform important physical and . biological roles during endodontic therapy. When there is wet environment duringcanal preparation the dentin debrises arefloated to the chamber. Where they be.remove by paper points or othersMany liquids would provide these aids, but . in addition the irrigants that are typicallyused have the function of being necrotic. tissue solvents Ass.Prof.Dr.Mohamed ALsakkaf 1
  2. 2. Because reamers and files much too small to . fit into accessory canals, it is the solventsaction that removes the tissue remainingand also the subsequently filling material.may be packed or pushed into these areasThe commonly used irrigants are capable of . causing inflammation of periapical tissue. Therefore instrumentation must beconfined within the canal to limit theforcing of irrigants through the apical. foramen 2
  3. 3. 3
  4. 4. Requirements of Ideal IrrigantsIt must have broadspectrum antimicrobial . 1. effect.It must aid in the root canal debridement . 2.Ability to dissolve necrotic tissue or debris . 3.Low toxicity level. 4.Act as a good lubricant. 5Low surface tension to flow easily into the . 6. inaccessible areas.Remove the smear layer. 7 4
  5. 5. Factors Effecting The Irrigants action.Concentration. 1.Contact. 2.Presence of organic tissue. 3.Quantity. 4.Temperature. 5 5
  6. 6. :RememberThe smear layer is a micro – crystalline layerof cutting debris covering the canal wallsafter the preparation and its removal mayaid in better adaptation of the obturating.materials to the canal walls:It consist of.A. Organic layer ----- removed by irrigantsB. Inorganic layer --- removed by chealating. agent 6
  7. 7. Types of Irrigants).Sodium hypochloride (NaOCL)(PH 12 – 13 . 1.The most popular irrigant.:It provides..a. Gross debridement.b. Dissolution of tissue.c. Lubricant.d. Antibacterial 7
  8. 8. Warming NaOCL increases its tissue solvent .. effect.It is provided in bottles of 5.2% .It, is clear, pale, green – yellow liquid, with .. strong odor of chlorineSolution should always be performed . passively especially in cases with larger apical diameters, and needles with verysmall diameter, also the syringes should.never be locked in the canal 8
  9. 9. Hydrogen Peroxide (H2O2) 3%. 2.It is odorless, clear liquid.Its effervescence action capable for .removing loose debris from inside the.canalRelease of nascent oxygen (O3) works .. against anaerobic bacteria 9
  10. 10. Combining 5.25% NaOCL + 3% H2O2.proved to be better than saline alone at 1 –.3mm level of the canalIf Hydrogen Peroxide is used, final irrigant . should be NaOCL because, it may cause:eitherTissue emphysema if it passes to the .1. periapical tissue.Post – Operative Pain. 2 10
  11. 11. (Chlorhexidine Gluconate (0.2% - 2%. 3It has antibacterial effect (long standing effect . by binding to hydroxyapatite and in combination with Ca(OH(2 effective against(. anaerobes.Does not have tissue solvent action ..Low toxicity compared to NaOCL. 11
  12. 12. Organic acid as citric acid 10 – 25% in .4 combination with NaOCL removes smear. layerMTAD. 5M ----- Mixture ofT ----- Tetracycline(A ----- Acid (citric acidD ----- DetergentRecommendation: 1.3 – 2.5% NaOCL is the.irrigant of choice during the preparation 12
  13. 13. Method of Irrigation.Plastic syringe of acceptable needle gauge ..File Iso 30 = 30.File Iso 40 = 27.File Iso 50 = 25.File Iso 60 = 23.File Iso 80 = 21 13
  14. 14. Bending the needle and it must lie passively . in the canal as forceful irrigation can push. the irrigant into the periapical tissue.Volume of irrigation about 2ml each time . 14
  15. 15. The Ultrasonic Irrigation: Considered themost effective method of irrigation where:vibration motion of files inside the canalMove irrigant in Vortex motion cleaning .1. the area which cannot be reached by filesThe motion causes worming of the irrigant, . 2. increasing its action 15
  16. 16. Combination of Irrigants.H2O2 NaOCL ---- Foaming action. 1EDTA + NaOCL ---- Removes Smear .2. LayerEDTA + Urea Peroxide + NaOCL increase . 3 bubbling action, debridement and removal. of smear layerMTAD + NaOCL: For disinfection and .4. smear layer removal 16
  17. 17. Chealating AgentsChelate: react with calcium, so their action is . to react with calcium ions and substitute it by sodium ions which can bind to dentin to. give soluble saltIt used to enlarge narrow curved and .. calcified canalsAids in the removal of Smear Layer .(. (inorganic part 17
  18. 18. Types of Chealating Agentsa. Ethylene Diamine Tetra Acetic Acid (EDTA( are the active ingredients in all. types.It used for cleaning and widening the canal ..Used in concentration of 17%..Optimal working time 15 minutes. 18
  19. 19. :b. EDTA CEDTA Cetavlon which increases anti –.bacterial activityCombination of EDTA + Urea peroxide, .. provides both chelation and irrigation 19
  20. 20. Intra Canal MedicamentsThey are medicaments used in root canal .. between appointmentsI. The popular intra canal medicaments were: designed and proposed for the followingAnti – microbial activity in the pulp and .1. periapexNeutralization of canal remnant to render . 2. them inertControl or prevention of post – treatment . 3. pain 20
  21. 21. II. The use of traditional medicaments is: decreased, becausea. Intra canal bacterial population can be eliminated by careful instrumentation. and irrigation.b. Lack of evidence of medicament usefulness.c. Toxicity 21
  22. 22. .III. Limitation and Contraindications:Intracanal environment. 1The therapeutic action of the medicaments . depends on the direct contact with the.microbe or tissueTheir effect is probably limited to surface . action only and does not reach the area,. where the bacteria are hidden 22
  23. 23. :Duration. 2Most agents should remain chemically active . for the period of time between appointments,.in order to be effective.Phenolics loose their activity within 24 hrs . 23
  24. 24. :Toxicity .3a. Any chemical that kills bacteria, will also(. kill host cells (Phenol, aldehydeb. An adverse side effect is also: Allergenicity. As the medicaments may act as a hapten and alter the tissue to become foreign substances, producing an immune response. May be responsible for their localized adverse effect on the pulp and /.or periapical tissue 24
  25. 25. :Distribution .4The pulp is not isolated from the rest of the . body, as the pulp has a ready accessibilityto the periapical tissue and even to the.systemic circulation 25
  26. 26. :Taste and Smell. 5Phenolics in particular have a pungent odourand foul taste. The patient will report adisagreeable medicinal taste, which many.find objectionable 26
  27. 27. Recently Used Intra Canal Medicaments:Calcium hydroxide. 1. a. The most popular intra canal medicamentb. It gas antimicrobial action (due to its(. alkaline PH.c. Increase organic tissue solvent of NaOCLd. Alkaline neutralizes the acidity of. inflammation 27
  28. 28. Application of CalciumHydroxide Antimicrobial Action (germs coming in contact (with the paste are easily destroyed by the high pH Bone-regenerating effects (stimulates the  osteoblastic activity and hard tissue deposition )..Used in case of root resorption and inmature teeth Aid the dissolution of organic material  remaining in the root canal after .preparation .Very good biocompatibility 
  29. 29. Placement of Medicaments Syringe DeliverySpiral Fillers Hand File Thin aqueous suspension of Ca(OH)2 used as dressing29
  30. 30. :Available as.Powder. 1.Paste. 2.Active Point. 3.Injectable. 4 30
  31. 31. :Antibiotics. 2It was tried as intra canal medication, butfear of developing bacterial resistance.which leads, to decrease its use:Steroids. 3It was tried due to its anti inflammatory.effect, to avoid post operative pain 31
  32. 32. (.Combination (steroids and antibiotics .4 .a. Steroids ------ An inflammatory effect .b. Antibiotics ------ Controlling infection Used mainly in case of acute pulpitis with .apical periodontitis 32
  33. 33. Iodine Potassium IodideIs it an iodoform/calcium hydroxide pastethat has been shown to reduce the presenceof all bacteria but especially EnterococcusFaecalisi, a hardy bacterium commonly .associated with failing root treatmentsMay be useful as an irrigant and intracanal .. dressing in retreatment cases 33

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