Various Irrigation

Solution in Endodontic
 Various Irrigation Solution in Endodontic

The use of irrigating solutions is an important part of effective

chemomechanical preparation.
Antibacterial agent.

Tissue solvent.
Flush debris.
Lubricant.

Eliminate the smear layer.

NaOCl
NaOCl
Antibacterial agent
Dissolves vital and non-vital tissue.
Lubricant during instrumentation

NaOCl has been criticized for

Unpleasant taste
Relative toxicity
Inability to remove smear layer
 Bactericidal of NaOCl

HOCl exerts its effects by oxidizing sulphydryl groups

within bacterial enzyme systems, thereby disrupting the
metabolism of the microorganism, resulting in the
killing of the bacterial cells.
Unbuffered solution at pH 11 in concentration 0.5
5.25% , and buffered with bicarbonate buffer (pH 9.0)
usually as a 0.5% solution (Dakin's solution).
NaOCl
Buffering had little effect on tissue dissolution.
Dakin's solution was equally effective on necrotic and
fresh tissues.
No differences were recorded for the antibacterial
properties of Dakin's solution and an equivalent
unbuffered hypochlorite solution

Zehnder et al. (2002)

In Vitro Antibacterial Studies

High resistance of E. faecalis and the high susceptibility

of C. albicans to NaOCl.
C.albicans was killed in vitro in 30 s by both 5% and
0.5% NaOCl.
E. faecalis was killed in less than 30 s by the 5.25%
solution, while it took 10 and 30 min for complete killing
of the bacteria by 2.5% and 0.5% solutions.
Radcliffe et al (2004) , Gomes et al.
(2001) Peciuliene et al. (2001)
,Waltimo et al. (1999)
 In Vivo Antibacterial Studies

Although 0.5% NaOCl, with or without (EDTA),

improved the antibacterial efficiency of preparation
compared with saline irrigation, all canals could not be
rendered bacteria free even after several appointments.
No significant difference in antibacterial efficiency in
vivo between 0.5% and 5% NaOCl solutions.

Bystrm & Sundqvist (1983,1985)

 Antibacterial Studies

The in vitro studies performed in

A testtube.
Root canals of extracted teeth.
Prepared dentine blocks infected with a pure culture of
one organism at a time.

The in vivo studies, on the other hand, have focused on

the elimination of microorganisms from the root canal
system in teeth with primary apical periodontitis.
 Antibacterial Studies

Explanation to poorer in vivo performance

Root canal anatomy, in particular, the difficulty in
reaching the most apical region of the canal with large
volumes of fresh irrigant.
Chemical milieu in the canal is quite different from a
simplified test tube environment
 Concentration
Compared the biological effects of mild and strong
NaOCl solutions and demonstrated greater cytotoxicity
and caustic effects on healthy tissue with 5.25% NaOCl
than with 0.5% and 1% solutions.
Pashley et al. (1985)

Either 5.25% or 2.5% sodium hypochlorite has the

same effect when used in the root canal space for a
period of 5 minutes.
Trepagnier et al. (1977)
Concentration

5% NaOCl may be too toxic for routine use. They

found that 0.5% NaOCl solution dissolves necrotic
but not vital tissue and has considerably less toxicity
than a 5% solution.
They suggested that 0.5% NaOCl be used in
endodontic therapy.
Spngberg et al.(1974)
 Concentration of NaOCl

Commented that It seemed probable that there would

be a greater amount of organic residue present
following irrigation of longer, narrower, more
convoluted root canals that impede the delivery of the
irrigant.
Baumgartner &Cuenin (1992)
The ability of an irrigant to be distributed to the
apical portion of a canal is dependent on:
Canal anatomy
Size of instrumentation
Delivery system
 Concentration of NaOCl

Commented that The effectiveness of low

concentrations of NaOCl may be improved by using
larger volumes of irrigant or by the presence of
replenished irrigant in the canals for longer periods of
time.
Baumgartner & Cuenin (1992)
 Concentration of NaOCl

The efficacy of 0.5%, 2.5% and 5.25% sodium

hypochlorite (NaOCl) as intracanal irrigants associated
with hand and rotary instrumentation techniques
against E. faecalis within root canals and dentinal
tubules.
5.25% NaOCl has a greater antibacterial activity
inside the dentinal tubules infected with E. faecalis
than the other concentrations tested.

. Berber et al. (2006)

 Is NaOCl equally effective in dissolving vital,
non-vital, or fixed tissue ???

Demonstrated that 5.25% sodium hypochlorite

dissolves vital tissue. (Rosenfeld et al. 1978 )
As a necrotic tissue solvent, 5.25% sodium
hypochlorite was found to be significantly better than
2.6%, 1%, or 0.5%. (Hand et al.1978)

3% sodium hypochlorite was found to be optimal for

dissolving tissue fixed with parachlorophenol or
formaldehyde (Th SD.1979)
NaOCl & Other Medicaments
NaOCl & Ca(OH)2
Pretreatment of tissue with calcium hydroxide can
enhance the tissue-dissolving effect of sodium
hypochlorite.
Hasselgren et al.(1988)

Combination of calcium hydroxide and sodium

hypochlorite was more effective on the dissolution of
soft tissue on the root canal wall than using either
medicament alone.
Wadachi et al.(1998)
NaOCl & Ca(OH)2
Complete chemomechanical instrumentation combined
with 2.5% sodium hypochlorite irrigation alone
accounted for the removal of most tissue remnants in the
main canal. Prolonged contact with calcium hydroxide
after complete instrumentation was ineffective.
Tissues in inaccessible areas of root canals were not
contacted by calcium hydroxide or sodium hypochlorite
and were poorly dbrided.

Yang et al. 1998

NaOCl & EDTA

Combining 5.0% sodium hypochlorite with EDTA

enhance considerably the bactericidal effect.

Bystrm & Sundqvist (1985)

NaOCl & CHX

The alternate use of sodium hypochlorite and

chlorhexidine gluconate irrigants resulted in a greater
reduction of microbial flora (84.6%) when compared
with the individual use of sodium hypochlorite
(59.4%) or chlorhexidine gluconate (70%) alone.

Kuruvilla and Kamath (1998)

NaOCl & CHX
The time required to eliminate E. faecalis depended on
the concentration and type of irrigant used.

Chlorhexidine in the liquid form at all concentrations

tested (0.2%, 1% and 2%) and NaOCl (5.25%) were the
most effective irrigants. However, the time required by
0.2% chlorhexidine liquid and 2% chlorhexidine gel to
promote negative cultures was only 30 s and 1 min,
respectively.
Gomes et al.(2001)
 Temperature
Higher temperatures potentiate the antimicrobial and
tissue-dissolving effects of NaOCl.
Increasing the temperature of hypochlorite irrigant to
370C, significantly increased its tissue dissolving ability

Cunningham &Balekjian (1980)

Volume

The volume of the irrigant has a greater potential to

significantly reduce bacteria colonies in root canal.
Chlorhexidine (CHX)
Chlorhexidine (CHX)

It possesses a broad-spectrum antimicrobial action and

a relative absence of toxicity.
CHX lacks the tissue-dissolving ability.
It penetrates the cell wall and attacks the bacterial
cytoplasmic or inner membrane or the yeast plasma
membrane.
Concentrations between 0.2% and 2%.
Its activity is pH dependent and is greatly reduced in
the presence of organic matter.
Chlorhexidine (CHX)

In
direct contact with human cells, CHX is cytotoxic; a
comparative study using fluorescence assay on human
PDL cells showed corresponding cytotoxicity with 0.4%
NaOCl and 0.1% CHX.
Chang et al.(2001)
In vivo-the antibacterial effect of CHX
There are no in vivo studies yet available that would
confirm the better activity of CHX against E. faecalis
in the infected root canal.
CHX & H2O2
In Vitro, 3% H2O2 and CHX was superior in its
antibacterial activity (E. faecalis ) compared with other
regimens such as CHX alone and NaOCl.
The combination of the two substances totally killed E.
faecalis in concentrations much lower than each
component alone.
CHX & H2O2

There are No reports of clinical studies where the

combinations of CHX and H2O2 have been used to
disinfect the root canal system.
Cytotoxicity of the medicament combinations should
first be investigated. Interestingly, combinations of CHX
and carbamide peroxide have been shown to be additive
in their cytotoxicity