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Syringe Irrigation

syringe Irrigation in endodontic treatment

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Syringe Irrigation

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  1. Endodontic Circuit Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020

  2. Irrigation TechniquesWays in make the irrigants reaching the target areas Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020

  3. Fluid Dynamic

  4. Study of fluid in motion & its subsequent effects on boundaries • Root canal irrigation is microscale ( microfluidics)flow of a liquid (irrigant) inside an irregularly shaped domain of very small dimensions (root canal system). • Two ways for the Irrigants to reach all the pulp:- • Convection ………. flow developed during delivery (or during agitation), In his way, chemically active particles (molecules/ions) are transported quickly and efficiently by the fluid motion, that applies forces on the targeted material ( mechanical effect ). • Diffusion………. The random movement of particles in a fluid • In areas of the root canal where a flow cannot be created, • irrigant transport by diffusion without mechanical effect . Fluid Dynamic

  5. Endodontic irrigation must achieve 4 aims • 1- Efficient. Flow rate ………. To the full extent of the root canal system and subsequently to the • canal orifice, in order to:- • come in close contact with microorganisms/biofilm, • debris, and tissue remnants, carry them outside the canal • d) provide lubrication for the instruments. 2- Chemical Effects ……… Frequent refreshment of the irrigant, in order to retain a high concentration of its active component(s) at the sites of interest and compensate for their rapid consumption (applicable only to chemically active irrigants). 3- Mechanical Effects ………. Application of force on the root canal wall (wall shear stress), in order to detach/disrupt microorganisms/biofilm, debris, and tissue remnants. 4- Safety …………….Restriction of the flow within the root canal system and prevention of irrigant extrusion towards the periapical tissues.

  6. Positive Pressure Techniques Syringe Irrigation Three essential Components for positive pressure irrigation Which syringe size ??? 5 ml Leur Lock Rubber stopper.. WL Close ended with side vented Variable capacities20—1ml P --- pressure developed inside syringe barrel F --- tactile force applied to syringe plunger A --- cross-section area of the syringe plunger Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020 Good Pressure Good Flow Rate

  7. Syringe Irrigation Flow Rate Factors determine the flow rates Internal diameter of the needle • Flow Ratedirectly proportional Pressure differences along the needle • Flow Rateinversely proportional Viscosity of the irrigant Length of the Needle Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020

  8. Syringe Irrigation Flow Rate Factors determine the flow rates Internal diameter of the needle • Flow Ratedirectly proportional Pressure differences along the needle • Flow Rateinversely proportional Viscosity of the irrigant Length of the Needle Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020

  9. Syringe Irrigation Flow Rate Laminate Flow Turbulent Flow Fluid moves in smooth paths or layers Fluid moves in irregular paths or layers • In endodontic lamina flow is recommended because it gives • steady constant flow rate and sufficient volume of irrigant . • In order to achieve lamina flow during canal irrigation ,the flow rate must be;- 0.01 mL/s steady lamina flow rate 0.26 mL/s unsteady lamina flow rate Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020 o.53-0.79 mL/s turbulent flow rate A high pressure can cause extrusion of the irrigant into the periapical tissue (Hulsmann et al. 2009).

  10. Syringe Irrigation Needle Sizes 70 45 M3 pro gold 35/4% Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020

  11. Syringe Irrigation Fluid Dynamics Needle Position during Canal Irrigation Stagnation area Stagnation area 3 mm 3 mm 3 mm 1 mm 1 mm 1 mm Needles kept 5 mm short of WL Dr.Abdalazim Badraldin Sudanese Dental Ce Khartoum-Suda April. 2020 Flat tip Beveled Notched Side vented double Multi vented side vented

  12. Needle Position during Canal Irrigation 30 G close end side vented 23 G 0.69 0.65 0.61 0.57 Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020 0.53 o.39 Stagnation area (dead space) 35/4%

  13. Needle Position during Canal Irrigation 3mm short WL 1mm short WL Not recommended in endodontic clinical practice Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020 Close ended Open ended

  14. Syringe Irrigation Wall Shear • Is the frictional forces occurring between the flowing irrigant and canal walls. • Wall shear determines the mechanical effects, because it detached material from the root canal wall. • In open-ended needles, an area of increased shear stress is developed apically to the needle tip, in the region of jet breakup. • closed-ended needles (side-vented and double-side-vented) lead to almost twice as high maximum shear stress, but limited near their tip, on the wall facing the needle outlet . • The high wall shear stress around the needle tip, • for this reason it is recommended to move the • needle up and down along the canal wall • ( longitudinal movement) and also in a rotation • movement in side vented closed ended needle. Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020

  15. Syringe Irrigation / Needles Jet • High – velocity fluid stream force out of a small – diameter opening • During needle irrigation the jet extends along the root canal, • apically to their tip, within a certain distance, which depends on :- • The shape of the root canal • The insertion depth of the needle • The flow rate, • The jet appears to break up gradually and • reverse flow towards the canal orifice . • In open-ended needles (flat, beveled, • notched), the jet is very intense . • In closed-ended needles are used (side vented, • double-side-vented), the jet is formed near the apical • side of the outlet (the one proximal to the tip for the • double-side-vented needle), and it is directed apically • with a slight divergence. C. Boutsioukis and L.W.M. van der Sluis Endodontic irrigation Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020

  16. Syringe Irrigation Apical size Preparation In Syringe Irrigation , Minimum apical size 30 or 35 is Required More preparation size • More Micro-leakage • More Transportation • Weaken the root • More chance for VRF Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020

  17. Syringe Irrigation Apical size Preparation • Enlargement of canal to 3 sizes larger than the first FABF is adequate • Further enlargement – No additional benefits in treatment. Outcome Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020

  18. Syringe Irrigation Challenges 1- Dentinal tubules Disinfection 2- Apical Deltas Penetration 3- Biofilm removable 4- Isthmuses cleaning Traditional needles irrigation fail to clean these areas, Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan April. 2020 this is why we need to activate the irrigant by creation of Tsunami effect in order to push the irrigant to these areas

  19. Thanks Dr.Abdalazim Badraldin Sudanese Dental Center Khartoum-Sudan Khartoum … Sudan Tuesday 18 Ramadan 1441

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