Root canal irrigation during endodontic treatment

Department of odontology, periodontology and pathology Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Root canal irrigation aims to clean and disinfect root canal system by removing organic tissue, smear layer and microorganisms. The most commonly used irrigants are: NaOCl 0,5-5,25%, EDTA 17%, MTAD, CHX (0.2%, 1%, and 2%), citric acid (10%). Aim of the study. To monitor over the time the effectiveness of endodontic treatment using different irrigants in combination with sonic and ultrasonic activation systems. Materials and methods. The study was based on the treatment of 15 patients with pulpitis and periapical processes who were subjected to endodontic treatment of 9 single rooted teeth and 10 multiple rooted teeth. The irrigation protocol of pulpitis treatment entailed: 2,5%NaOCl; 17%EDTA;5,25%NaOCl; final irrigation: 5,25%NaOCl+ultrasonic activation;17%EDTA+sonic activation; distilled water; drying and filling. In the treatment of patients with periapical processes, the root canals were irrigated as follows: 5,25%NaOCl ;17% EDTA ;2%CHX, temporary filling with calcium hydroxide for 10 days. The second visit entailed removal of the temporary filling, irrigation with 17%EDTA; distilled water; 2%CHX drying and filling, X-ray. Results. The patients were examined at 3, 6 and 12 moths. The study showed that treatment by using different irrigants in combination with sonic and ultrasonic activation had a high rate of success (95-97%). This protocol of irrigation was selected in treatment of pulpitis and periapical lesions due to the properties of each irrigant: NaOCl has bactericidal cytotoxicity, dissolves organic material, it has no effect on the smear layer. EDTA effectively removes the smear layer by chelating the inorganic components of the dentine. It does not have any antibacterial activity and does not dissolve the organic tissues. CHX has a wide antimicrobial spectrum and is effective against Gram-positive and Gram- negative bacteria, especially against E.faecalis. Conclusions. Successful endodontic treatment depends on the correct use of the irrigants, respecting the consecutivity, concentration and application time of each irrigant and also a tridimensional filling of root canal

Procedures and techniques of root canal irrigation in endodontic treatment

Rezumat. Succesul tratamentului endodontic, conform opiniei Dr. Herbert Schilder, considerat ca fiind fondatorul endodonției, depinde de abilitățile operatorului în cea ce privește prelucrarea mecanică și chimică a sistemului de canale radiculare și ulterior, o obturare tridimensional. Endodonțium constă dintr-un spațiu care este ușor accesibil pentru instrumentarul rotativ și manual (canalele principale) și, cum a fost confirmat de numeroase studii clinice și histologice, din spații dificil de accesat sau complet inaccesibile (delte, bucle, istmuri, canale accesorii laterale și tubuli dentinari). În particular canalele accesorii laterale se regăsesc cu o frecvență semnificativă în special în treimea apicală a rădăcinii și în furcațiile molarilor [5,9,11].Summary. Successful endodontic treatment, according to Dr. Herbert Schilder, the founder of endodontics, depends on the abilities of the dentist to perform the mechanical and chemical root canal preparation as well as three-dimensional filling. Endodontium consists of a space that is easily reachable with rotary and manual instruments (main canals) and spaces that are difficult to access or completely inaccessible (deltas, loops, isthmuses, lateral accessory canals and dental tubes), as confirmed by numerous clinical and histological studies. Lateral accessory canals are frequently found, especially in the apical third of the root and in molars furcation