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Endodontics

Authors: Dr. Mandar Pimprikar

Effective irrigant delivery and agitation techniques are prerequisites for successful endodontic treatment . Removal of vital and necrotic remnants of pulp tissues, microorganisms and microbial toxins from the root canal system is essential for endodontic success . Although this might be achieved through chemo mechanical debridement, it is impossible to shape and clean the root canal completely , because of intricate nature of the root canal anatomy even with the use of rotary instrumentation, the Nickel Titanium instruments currently available only act on the central body of the canal, leaving Canal fins isthmi and cul-de-sacs untouched after completion of the preparation.These areas might Harbor tissue,debris, microbes, and their by products. And result in persistent periradicular inflammation .therefore , irrigation is an essential part of root canal debridement because it allows for cleaning beyond what might be achieved by root canal instrumentation alone .The Endo tell a tale is an attempt to address the issues related to irrigation and disinfection in day to day root canal treatment. Please post your questions on This email address is being protected from spambots. You need JavaScript enabled to view it.

Q.1- Why NaOCl (sodium hypochlorite)is considered as gold standard disinfecting solution?
  1. It has wide range of activity against Gram Positive and Gram Negative bacteria.
  2. It can kill microbes in few seconds on direct contact.
  3. It is the strongest antifungal amongst all irrigating solutions.
  4. It is non-specific proteolytic agent with excellent tissue dissolvation property.
  5. It is the only irrigant to destroy bacterial biofilms effectively.
  6. It is an excellent haemostatic agent; it can improve the prognosis of vital pulp therapy
  7. The ability to prevent culture growth and destroying the biofilms. According to Franklin R Tay study; only 6% NaOCl could prevent culture growth & the biofilms status was absent.
Q. 2- In what concentration is NaOCl advised to use?
  1. Commercially NaOCl is available in 3% and 5% concentration.
  2. Lower the concentration; bigger should be the volume and longer should be the contact time. Higher the concentration; lesser can be the volume and shorter can be the contact time.

Isolation principles should be followed, irrespective of the concentration used.

Q. 3- Is it advisable to use warm sodium hypochlorite and what are the advantages?

Yes, it is advisable to use warm sodium hypochlorite - 40 to 50 °C.

Advantages:

It's all about basic chemistry.

Increasing the temperature or improving the kinetic energy of the solution will increase the rate of pulp dissolution by reducing the contact time; thereby increasing the rate of dissolvation and disinfection.

This is Literature supported that 1% of sodium hypochloride at 45 °C dissolved the pulp tissue as effectively as 5.25% at 20 °C (JoE- September 2005).

Optimizing the concentration, temperature and flow can improve the tissue dissolving efficacy of NaOCl even 50 fold (JoE 2010).

Q. 4- What is the role of CHX (chlorhexidine) as an endodontic irrigant?

CHX is extensively studied as an endodontic irrigant; it can have bacteriostatic and bactericidal actions depending on its concentrations.

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