Irrigation in endodontics

[Khaled Balto]

What are the current advances in the field of irrigation?

[Miss.Endo]

As i know...this is a very wide area of research...

sure i can't cover everything... but as a quick answer...

i liked the endovac System...also liked the concept...

I'm sure u have a different point of view Dr.khaled ^_^

[Khaled Balto]

The current concept of irrigation has changed dramatically from the traditional stereotypical syringe irrigation to the dynamic, interactive concepts. These current concepts are all centered around activation of the irrigation solution within the root canal system. Such bio-mechanical interaction could be achived mechanically, by sound energy or other ways.

There are enormous systems that evolve around this concept...one creative one is the EndoVac....So as starter....Miss endo can you tell us about the system and then I can comment on it?

Thanks for your input.

[Miss.Endo]

Actually i've attended a course about this system before a couple of months...
although i can't recall all its features...:o

but ok as a start i'll try to remember nice things...

First the system comprise mainly from a major delivery tip...with macro & micro cannulas...

the tip delivers the irrigation solution...and evacuate any excess as it'll be connected to the evacuation system of the dental chair...
the tip can only flush the pulp chamber...
then the macro cannula is used to move the irrigation into the canal and evacuate the large size debris particles...

then the nice micro cannula is used to get the irrigation solution down to the apical area...and evacuate the trapped air bubbles and small size debris particles from the apical area...without the need to push the irrigation solution with force into the periapical area which may cause damage to the sensitive tissues there...


i had a nice video about this system ...but unfortunately it's not avaliable online anymore...however i managed to find this nice vid too about the system... Enjoy (http://www.youtube.com/watch?v=e3z-TnvjIBM)

[Khaled Balto]

Interesting Miss Endo...thanks for the info....I will be using this device in the next two days and I will let you know how it goes.

To be up to the point in this subject....regular syringe irrigation does not accomplish what we think we are accomplishing. Slaus showed that in a regular needle gauge; the irrigation does not travel beyond 1 mm ahead of the needle tip. Also, if you use smaller needles, the entrapped air prevents the solution from going further. Taking these two points together; we become to conclude that we have to account for the limited flow of irrigation solution and we have to account for the entrapped air.

The variations in the diameter of needles, agitating the solution inside the root canal by mechanical or ultrasonic means, delivering the solution under cycles of evacuation are all parameters that have been taken by the new gadgets.

It seems that thinking of irrigation delivery mechanisms is as important as instrumentation and obturation.

[sorfali]

Thank you Dr.Khaled for raising this question, Their was many attempts to improve this part of the specialty starting from the size and shape of the needle and ending of introducing new gun Rins Endo and Set Flow ,But the idea of irrigation an evacuation is great

[salman]

It is my pleasure Dr. Khalid to participate in this interisting topic.
Current concepts of irrigation are related to the new movement in hydrodynamic disinfection or what is called Tsunami endodontics by Ruddle. There are alot of systems achieving this goal such as EndoActivator, IrriSafe, Sonicare CanalBrush, EndoRinse, EndoVac and others
the idea mainly depends on agitation(activation) of the irrigant within the root canal system either by sonic or ultrasonic energy or irrigation under vaccum. This will allow for cleaning beyond root canal instrumentation as you know that all current instrumentation techniques do not contact all the root canal surfaces.
Worthnoting is the concept of passive Ultrasonic irrigation if using metalic files to agitate the irrigant or active agitation when using brushes or plastic files.
I will forward more details about the issue sooner. You can have further information about the Sonicare CanalBrush irrigation in my article in the international Endodontic Journal; M. I. Salman, M. A. Baumann, M. Hellmich, M. J. Roggendorf, S. Termaat. SEM evaluation of root canal debridement with Sonicare CanalBrush irrigation.Int Endodon J 2010;43(5):363-369. It is part of my doctoral thesis in endodontics from Cologne University, Germany.
Accept my highest considerations
Dr. Mohamed Salman
BDS, M.Sc. PhD, Dr Med Dent

[salman]

Currently used methods of instrumentation produce debris and smear layer that covers the root canal walls and the openings to dentinal tubules (
Heard et al. 1997, Peters and Barbakow 2000). These debris and smear layer must be removed for the following reasons;
1. interfere and prevent adhesion and penetration of sealers into dentinal tubules (White et al. 1984, Gencoglu et al. 1993, Pallares et al. 1995) with consequent increase in apical and coronal microleakage (Gutmann 1993, Leonard et al. 1996)

2. Substrate for remaining viable bacteria (Pashley 1984, Behrend et al. 1996, Brannström 1984)

3. Interfere with the action of irrigants and medicaments (Ørstavik and Haapasalo, 1990)
Another important fact during instrumentation is that approximately 35-40% of the root canal surfaces remains untouched after preparation with an instrument(Peters et al. 2001) furthermore, within oval canals only 40% of the apical root canal wall can be contacted during rotary instrumentation(Wu et al. 2003)
Untouched areas may contain bacteria and necrotic tissues even though the root canal filling appears to be radiographically adequate with consequent root canal treatment failure even in some well treated cases.
Thorough cleaning of the complex root canal system using syringe irrigation alone remains difficult (Wu and Wesselink 1995)
THE SOLUTION
Activation of irrigation as it allows for cleaning beyond root canal instruments
METHODS
MicroBrushes
EndoRinse
EndoVac
Sonics
Ultrasonics
Vibringe
Sonicare/CanalBrush
EndoActivator
:):):)
U r what u think, make ursef matter.

[Khaled Balto]

Dr. Salman....many thanks for the comperhensive info. I learned a lot form it...what is you experience with EndoVac? do you have any pros/cons with the other systems. Are we coming close yet to have a golden standard method for irrigation?

[taher al omari]

Daer All,
This is my first intry to the web site, i hope i will added something,

Regarding the endo vac, i got some experience with it, it comprise a major delivery tip,macro & micro cannulas. the idea is simple to create an negative pressure to suc the irrigant down the canal to the point it could reach, a very recent article advice to use it to irrigate in open apex cases without the need to place tri mixture antibiotic. da Silva et al,Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 May;109(5):779-87.

well, i will post more about the topic within the week

regards

[salman]

It is my pleasure Dr. Khalid. Regarding the Endovac, I've suffered from the clogging problem of the microcanula that have been reported by many users of the system. Another disadvantage of the system is increasing chair time due to changing vaccum hoses during treatment. You may remember in 1980, Pierre Machtou clinically described and scientifically showed the results of pumping a fitted master cone to activate solutions. Although the results were encouraging, Pierre perfectly understood that virtually no clinician would spend five (5) minutes per canal utilizing this method to improve the exchange of an irrigant.
there is a growing body of evidence that shows sonic or ultrasonic activation from 30 to 60 seconds improve the cleanliness of the pepared root canal system so, I prefer using this adjunct after complete shaping the root canals.

By developing all these systems which are realy a paradigm shift in endodontic irrigation, debate is still ongoing regarding a golden standard method to clean the root canal system 3-dimentionaly and that is obviously because many variables affecting this process, for example,
Type and concentration of irrigant.
The volume of the solution used.
Canal diameter.
The viscosity or surface tension of the solution.
The diameter and depth of penetration of the irrigating needle.
The anatomy of the canal.
The method of delivering the irrigant.
Contact time with the tissue.
Temperature of the irrigant.
The effect of combining different types of solutions.

So, we are only talking about one variable here; the method of delivering the irrigant.

[endodontist]

What are the current advances in the field of irrigation?

there are no current things in endodontic irrigation sir
read the classical artiles & you will realize that such passive things, time, depth, conc., amount, etc ....are already present B4 we born
the tools only changed in a better way :eek:

[Khaled Balto]

It sounds that you were born yesterday!!

[Wajih]

Well said Dr. Khaled.

[salman]

After the paradigm shift in endodontics by the innovation of one file endodontics such as Reciproc, wave one and SAF; the future of endodontics will be activation of irrigation and development of new irrigation and intracanal medication materials and protocols to render the complex root canal system sterile and this surely will benifit the regenerative endodontic procedures which is ongoing now massively....... what do you think Dr. Khalid

[Wajih]

As far as SAF is concerned, I would be highly critical and would prefer it to be more of an irrigant carrier then a preparation file. Time will tell, but there are as I am aware of atleast three major developments in modern irrigants, (there maybe more), but again it will have to wait and go trough trials before any significant change in todays regime.