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introduction
• Endodontic treatment consists of three basic phases namely
Recent advances in diagnostic phase, preparatory phase and obturation phase.

irrigation systems • The preparatory phase which is chemomechanical debridement is

most essential for endodontic success.

• The purpose of this phase is to eliminate pulpal tissue,

Dr Krishna Kumar
microbiota, their by-products, organic and inorganic debris by
using instruments and intracanal irrigants.

• For the effectiveness of the irrigation, the endodontic

• It is impossible to shape and clean the root canal completely
irrigants must be brought into direct contact with the entire
because of the intricate nature of the canal configuration.
canal wall surfaces, particularly for the apical portions of small
root canals.
• Even with the use of rotary instrumentation, the nickel titanium
instruments currently available only act on the central body of the
• Throughout the history of the endodontics, various methods
canal, leaving canal fins, isthmi and cul-de-sacs untouched after
have been developed in order to provide effective endodontic
completion of the preparation.
irrigant delivery.

• Therefore irrigation is an essential part of root canal debridement

• These systems might be devided into 2 broad catergories:
because it allows for cleaning beyond what might be achieved by
– Manual agitation techniques
root canal instrumentation alone.
– Machine-assisted agitation devices

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Irrigation agitation techniques and devices • Machine-assisted

• Rotary brushes- Ruddle brush; CanalBrush
• Manual- • Continuous irrigation during rotary instrumentation
Quantec-E
• Syringe irrigation with needles/cannulas -
• Sonic- Rispisonic file; EndoActivator
End-venting; side-venting
• Ultrasonic -Continuous :Nusstien’s needle holding
• Brushes -Endobrush; NaviTip FX
device
• Manual-dynamic agitation -
-Intermittent: Ultrasonic file; smooth wire
Hand-activated well-filling gutta-percha

• Pressure alternation devices -EndoVac; RinsEndo

• Self-adjusting file
• Photoactivation disinfection

Syringe irrigation with needles • The syringe irrigation gives advantage of easy
• Conventional irrigation with syringes has been widely practiced by both control of the depth of the needle penetration
general practitioner and endodontists.
within the canal.
• The technique involves dispensing of irrigant into a canal through needles
either passively or with agitation.
• DISADVANTAGES-
• These needles are designed to dispense an irrigant through their most • Weak mechanical flushing action.
distal ends or closed-ended side-vented channels. • The irrigating solution delivered only 1mm deeper than the
tip of the needle.
• It is crucial that the needle should remain loose in the canal during • Smear layer removal in the apical third not effective.
irrigation so that it allows debris to be displaced coronally and avoid
inadvertent extrusion of the irrigant periapically. • Periapical extrusion of irrigant.

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brushes
• The results might have been improved if the brush-
covered needle was mechanically activated so that it
• They are used as adjuncts for debridement of the canal walls or can perform active scrubbing action against.
agitation of root canal irrigant.

• A 30-gauge irrigation needle covered with a brush (NaviTip FX;
Ultradent Products Inc, South Jordan, UT) was introduced
commercially.
• A study reported improved cleanliness of the coronal third of
instrumented root canal walls irrigated and agitated with the
NaviTip FX needle over the brushless type of NaviTip needle.
•
• But, friction created between the brush bristles and
the canal irregularities might result in the
dislodgement of the radiolucent bristles in the canals
that are not easily recognized by clinicians, even with
the use of a surgical microscope.

• However, the Endobrush could not be used to full working

• Keir et al in early 1990s, performed a study and used Endobrush for
length because of its size, which might lead to packing of
improved canal debridement.
debris into the apical section of the canal after brushing.

• The Endobrush (C&S Microinstruments Ltd, Markham, Ontario, Canada)

is a spiral brush designed for endodontic use that consists of nylon
bristles set in twisted wires with an attached handle and has a relatively
constant diameter along the entire length.

• In that study the bristles of the brush were claimed to extend to the non
instrumented canal walls and into the fins, cul-de-sacs, and isthmi of the
canal system to remove trapped tissue and debris.
ENDOBRUSH

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MANUAL DYNAMIC IRRIGATION • Although manual-dynamic irrigation is simple and cost-

effectiveness, the laborious nature of this hand-activated
• An irrigant must be in direct contact with the canal walls for effective action.
procedure still hinders its application in routine clinical practice.

• However, it is often difficult for the irrigant to reach the apical portion of the
canal because of the so-called vapor lock effect. • Therefore, there are a number of automated devices designed for
agitation of root canal irrigants.
• Research has shown that gently moving a well fitting gutta-percha master
cone up and down in short 2-3 mm strokes (manual dynamic irrigation)
within an instrumented canal can produce an effective hydrodynamic effect
and improve the displacement of any given reagent.

• It has demonstrated that manual dynamic irrigation was significantly more

effective than an automated dynamic irrigation system (RinsEndo Du¨ rr
Dental Co, Bietigheim-Bissingen, Germany) and static irrigation.

MACHINE ASSISTED IRRIGATION

• Commercially available endodontic microbrush is
Canalbrush (Coltene Whaledent, Langenau, Germany).
• ROTARY BRUSHES
• Ruddle used a micro brush attached to rotary handpiece.
• This is highly flexible and is molded entirely from
• The brush includes a shaft and a tapered brush section. The latter has polypropylene.
multiple bristles extending radially from a central wire core.
• It might be used manually with a rotary action. However, it is
• This micro brush rotates at about 300 rpm, causing the bristles to more efficacious when attached to a contra-angle handpiece
deform and go into the irregularities of the preparation & displace running at 600 rpm.
residual debris out of the canal in a coronal direction.

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Continuous Irrigation During Rotary • It uses:

Instrumentation: 1. Pump console.
QUANTEC - E 2. Two irrigation reservoirs.
• Continuous irrigant agitation during active rotary 3. Tubing to provide continuous irrigation during rotary
instrumentation would generate:
instrumentation.
1) Increased volume of irrigant.
2) Increase irrigant contact time.
3) Greater depth of irrigant penetration inside the root • Quantec-E irrigation did result in cleaner canal walls and
canal. more complete debris and smear layer removal in the
coronal third of the canal walls.
• The Quantec-E irrigation system (SybronEndo, Orange,
CA) is attached to the Quantec-E Endo System. • However, these advantages were not observed in the
middle and apical thirds of the root canal.

Sonic Irrigation • When the movement of the sonic file is constrained, the sideway oscillation
disappears. This results in a pure longitudinal file oscillation.
FREQUENCY AND OSCILLATING PATTERN OF SONIC INSTRUMENTS

• This mode of vibration has been shown to be particularly efficient for root
• Tronstad et al were the first to report the use of a sonic instrument for canal debridement.
endodontics in 1985.
• The Rispisonic files have a non uniform taper that increases with file size.
• Because they are barbed, these files might inadvertently engage the canal
• Sonic irrigation is different from ultrasonic irrigation in that wall and damage the finished canal preparation during agitation.
1) It operates at a lower frequency (1–6 kHz)
2) Produces smaller shear stresses .
3) Generates significantly higher amplitude or greater back-and-forth tip
movement.

• Moreover, the oscillating patterns of the sonic devices are different compared
with ultrasonically driven instruments.

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• Endoactivator consists of a portable handpiece and 3

• These tips are claimed to be strong and flexible and do not break easily.
types of disposable polymer tips of different sizes that
are easily attached (snap-on) to the handpiece
• Because they are smooth, they do not cut dentin.

• It does not deliver new irrigant to the canal but it facilitates the
penetration of the irrigant in the canal.

• A recent study have indicated that the use of endoactivator facilitates

irrigant penetration and mechanical cleansing compared with needle
irrigation, with no increase in the risk of irrigant extrusion through the
apex.
ENDOACTIVATOR WITH THE LARGE (BLUE) PLASTIC TIP

ULTRASONICS • UI is shown to be less effective than PUI. This can be explained by a reduction of
• Ultrasonic devices were first introduced in endodontics by Richman. acoustic streaming and cavitation.

• In UI, the file contacts the root canal wall, so the oscillations are dampened and
• Ultrasonic energy produces higher frequencies (25- 30 kHz) than sonic becomes too weak to maintain acoustic streaming.
energy but low amplitudes.
• For proper acoustic streaming, the ultrasonic file should move freely in the canal
• They operate in transverse vibration. without making contact with the canal wall.

• A canal size of at least 30-40 file is required to maintain free oscillation. (Irrigant can
• Two types of ultrasonic irrigation are available for use. also penetrate more easily into apical part).

• The first type is simultaneous ultrasonic instrumentation and irrigation • Disadvantage of UI is difficult to control the cutting of dentin during ultrasonic
(UI), and the second type is referred to as passive ultrasonic irrigation preparation which can result in apical perforation & irregular canal shapes.
(PUI) operating without simultaneous instrumentation.

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• PUI was first described by Weller et al.
• The term passive relates to non cutting action of ultrasonically
activated file.
• The active streaming of the irrigant, increases its potential to
contact a greater surface area of the canal wall.
• Ultrasonics is not able to effectively get through the apical vapor lock
in the apical 3 mm of the canal.
• It has been shown that once a sonic or ultrasonically activated tip
leaves the irrigant and enters the apical vapor lock, acoustic
microstreaming and/or cavitation becomes physically impossible
which is not the case with the apical negative pressure irrigation
technique.
• This is because acoustic microstreaming or cavitation is only possible in
fluids/liquids, not in gases.
• Ultrasonics can help in debridement of anastomoses between double
canals, isthmuses, and fins.
13-12-2016
• After the canal has been shaped to MAF, a small file or a smooth wire
is introduced at the centre of the canal, as far as the apical region.
• Canal is then filled with irrigating solution, and ultrasonically
oscillating file activates the irrigant.
• Using this non cutting methodology, the potential to create aberrant
shapes within root canals are reduced to a minimum.
CONTINUOUS ULTRASONIC
IRRIGATION
• Chlorine, which is responsible for the dissolution of organic
tissues and the antibacterial property of NaOCl, is unstable
and is consumed rapidly during the first phase of tissue
dissolution, probably within 2 minutes.
• Therefore, an improved delivery system that is capable of
continuous replenishment of root canal irrigants is highly
desirable.
• Recently, a needle-holding adapter to an ultrasonic handpiece
has been developed by Nusstein.
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• During ultrasonic activation, a 25-gauge irrigation needle is Intermittent Flush Ultrasonic

used instead of an endosonic file.
• The unique feature of this needle-holding adapter is that the
needle is simultaneously activated by the ultrasonic
handpiece, & at the same time maintains a continuous flow of
fresh irrigant.
Irrigation
• In intermittent flushed ultrasonic irrigation, the irrigant is
delivered to the root canal by a syringe needle.
• The irrigant is then activated with the use of an
ultrasonically oscillating instrument.

• This technique resulted in: • The root canal is then flushed with fresh irrigant to remove
1. Greater reduction in colony forming units. the dissolved remnants from the canal walls.
2. Reduction in time required for irrigation.

PRESSURE ALTERNATING DEVICES • Master delivering tip simultaneously delivers and evacuates the irrigant from
ENDOVAC ANP SYSTEM the pulp chamber.
• In the EndoVac system (Discus Dental, Culver City, CA), has
three components: • The plastic macro cannula has a size 55 open end with a .02 taper and is
attached to a titanium handle.
1. Master delivering tip
2. Macro cannula • It is used to suction irrigant from the chamber to the coronal and middle
3. Micro cannula segments of the canal.

• The ISO size 0.32 stainless steel micro cannula has 4 sets of 3 laser-cut,
laterally positioned, offset holes (total 12 holes) adjacent to its closed end.

• The holes are 100 microns in diameter and spaced 100 microns apart.

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• This is attached to a finger-piece for irrigation of the apical part of the

canal by positioning it at the working length.
• The micro cannula can be used in canals that are enlarged to size
35/.04 or larger.
• The cannula in the canal simultaneously exerts negative pressure
that pulls irrigant from its fresh supply in the chamber, down the
canal to the tip of the cannula, into the cannula, and out through
the suction hose.

• Thus, a constant flow of fresh irrigant is being delivered by negative

• The Master Delivery Tip is connected to a syringe of irrigant. pressure to working length.

• The macro cannula or micro cannula is connected via tubing to the • ADVANTAGE:
high-speed suction of a dental unit.
1. Avoid air entrapment.
2. Avoid undue extrusion.
• During irrigation, the Master Delivery Tip tip delivers irrigant to the
3. Maintains a gentle flow rate.
pulp chamber and siphons off the excess irrigant to prevent overflow.

• Apical negative pressure has been shown to enable irrigants to The RinsEndo System
reach the apical third and help overcome the issue of apical vapor
lock. • RinsEndo irrigates the canal by using pressure-
suction technology.
• In a comparing the Endoactivator, passive ultrasonic, the F file, the • Its components are a handpiece, a cannula with a
manual dynamic max-i-probe, the pressure ultrasonic, and the
endovac, only the endovac was capable of cleaning 100% of the
7 mm exit aperture, and a syringe carrying
isthmus area. irrigant.

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• The handpiece is powered by a dental air SELF ADJUSTING FILE

compressor and has an irrigation speed of 6.2
ml/min & (1.6 Hz amplitude).
• Periapical extrusion of irrigant has been
reported with this device.
• It has a hollow thin walled cylinder composed of a thin nickel-titanium
lattice.
• It is compressible and adjusts to the anatomy of the root canal.
• SAF operates with a continuous flow of irrigant (5ml/min) running
through the instrument.
• The vibrating movement of SAF within the irrigant facilitates its cleaning
and debriding effects.

RINSEENDO HANDPIECE WITH

DISPOSABLE CANNULAS
AND SPLASH PROTECTOR

• Root canals vary greatly in their cross-sectional anatomy, and oval,

flat, and C-shaped canals are commonly found

• SAF is designed to efficiently prepare root canals that do not have a

round cross section because the compressible file adapts its shape to
the canal anatomy.

• It is operated with a modified KaVo handpiece that generates in and

out vibrations with 5000vibrations/min and 0.4mm amplitude.

• A VATEA irrigation unit is used to deliver a constant flow of irrigant.

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Photoactivation disinfection
• Photoactivated disinfection is a new antimicrobial method for root canal
disinfection, based on photodynamic therapy
• Photodynamic therapy is based on the idea that nontoxic photosensitive
agent, called photosensitizer, preferentially localizes in target tissues. The
photosensitizer is then activated by light with susceptible wavelength and
produces singlet oxygen and free radicals, which are cytotoxic for the
target cells
• Phenothiazine dyes – Methylene blue (MB) and Toluidine blue (TBO) are
the most commonly used photosensitizers in dental practices.
• The use of red light producing diode laser is used for activation of the
photosensitizer.

conclusion 1 Paque F, Ganahl D, Peters OA.

• Various irrigation devices have been developed to give the
effective cleaning and superior debris removal in order to
replace the older needle irrigation method.
Effects of root canal preparation on apical geometry assessed by micro-computed tomography.
J Endod 2009; 35: 1056–1059.
2. Peters OA, Scheonenberger K, Laib A.
Effects of four Ni–Ti preparation techniques on root canal geometry assessed by micro
computed tomography. IntEndod J 2001; 34:221–230.

3. Basrani B, Haapasalo M. Update on endodontic irrigating solutions Endodontic topics 2012;

27:74–102.
• The safety factors, capacity of high volume irrigant
4. Kandaswamy D, Venkateshbabu N. Root canal irrigants. J Conserv Dent 2010; 13: 256 264.
delivery and ease of application the newer irrigation
devices may change the insight of conventional endodontic 5. Zehnder M. Root canal irrigants. J Endod 2006; 32: 389–398
treatment.

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6. Grossman LI, Meiman BW.

Solution of pulp tissue by chemical agents. J Am Dent Assoc 1941;28:223–225.

7. Naenni N, Thoma K, Zehnder M.

Soft tissue dissolution capacity of currently used and potential endodontic irrigants. J Endod
2004;30:785–787.

8. Grigoratos D, Knowles J, Ng YL, Gulabivala K.

Effect of exposing dentine to sodium hypochlorite and calcium hydroxide on its flexural strength and
elastic modulus. IntEndod J 2001;34:113–119.

9. Sirtes G, Waltimo T, Schaetzle M, Zehnder M. The effects of temperature on sodium hypochlorite

short-term stability, pulp dissolution capacity, and antimicrobial efficacy. J Endod 2005;31:669-671.

10. Childer H, Yee FS.

Canal debridement and disinfection. In: Cohen S, Burns RC, eds. Pathways of the Pulp.3 edn. St. Louis:
The C.V. Mosby Company 1984; 175.

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