Irrigants and irrigation activation systems in Endodontics

Abstract

Root canal infections are typically polymicrobial and involve strong bacterial interactions. The goal of endodontic treatment is to remove infected content from the root canal system to allow the healing of a pre-existing periapical lesion or to prevent infection of the periradicular tissues. Instrumentation alone is not capable of touching all of the root canal walls. Therefore, the irrigation process is an essential step in the endodontic treatment. However, due to the complex anatomy of the root canal system, this cleaning is very challenging. Although syringe and needle irrigation associated with the use of chemical substances is still the most used method, it does not guarantee optimal cleaning of the root canals. As a result, not only alternative irrigating substances but also numerous activation systems - which are technologies that aim to optimize the action of irrigating substances, both chemically and physically - have been developed. This work aimed to review the characteristics of both classic and current alternatives of irrigating substances and irrigation activation systems.

The Effect of Different Compositions and Concentrations of Etidronate-Containing Irrigants on the Antibacterial Activity of Sodium Hypochlorite against Enterococcus faecalis and Candida albicans

“…Another issue that is important to discuss is the mechanism that leads to the loss of SH activity. Antimicrobial and proteolytic effects of SH are produced by free available chlorine, which consists of hypochlorite (OCl−) and hypochlorous acid (HOCl) [ 11 , 53 ]. The free available chlorine concentration in SH decreases over time, with exposure to light or heat, and on contact with various substances, including EDTA, which is commonly used with SH during endodontic irrigation [ 53 ].…”

“…Antimicrobial and proteolytic effects of SH are produced by free available chlorine, which consists of hypochlorite (OCl−) and hypochlorous acid (HOCl) [ 11 , 53 ]. The free available chlorine concentration in SH decreases over time, with exposure to light or heat, and on contact with various substances, including EDTA, which is commonly used with SH during endodontic irrigation [ 53 ]. The reaction between these two solutions results in the rapid loss of free available chlorine [ 23 , 54 ], rendering SH ineffective on bacteria and necrotic tissue.…”

The Incidence and Intensity of Postoperative Pain and Flare-up Following the Use of Three Different Intracanal Medicaments In Teeth With Posttreatment Apical Periodontitis: A Randomized Clinical Trial

“…Reducing or eliminating lipopolysaccharides associated with clinical symptoms such as spontaneous pain, percussion, and palpation was presented as a part of its pain-controlling mechanism (39). However, when 2% chlorhexidine is used in irrigation it was reported that 47% lipopolysaccharides was detoxi ed but it is insu cient to fully inactivate them (40). When its gel form was placed as a root canal medicament areup developed in four cases in the chlorhexidine (0.12%) gel group, whereas no are-up was observed in the group with calcium hydroxide/camphorated paramonochlorophenol/glycerin paste (41).…”

The incidence and intensity of postoperative pain and Flare-up following the use of three different intracanal medicaments in teeth with posttreatment apical periodontitis: a randomized clinical trial

“…Reducing or eliminating lipopolysaccharides associated with clinical symptoms such as spontaneous pain, percussion, and palpation was presented as a part of its pain-controlling mechanism [ 19 ]. However, when 2% chlorhexidine is used in irrigation it was reported that 47% lipopolysaccharides were detoxified but it is insufficient to fully inactivate them [ 40 ]. When its gel form was placed as a root canal medicament flare-up developed in four cases in the chlorhexidine (0.12%) gel group, whereas no flare-up was observed in the group with calcium hydroxide/camphorated paramonochlorophenol/glycerin paste [ 41 ].…”