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Rationale for chemo-mechanical debridement. Dr LM Naidoo BDS, MSc Dent, M Dent Pros (Wits) 28/02/2011. Shilder 1974.

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slide1

Rationale for chemo-mechanical debridement

Dr LM NaidooBDS, MSc Dent, M Dent Pros (Wits)

28/02/2011

shilder 1974
Shilder 1974

“Unlike funnels of simple geometric design, this root canal preparation should occupy not only three planes, but as many planes as are presented by the root canal under treatment…”

Stace Linde 2003

round files in root canals
Round files in root canals

Not All Canals Are Round

Stace Linde 2003

round files in root canals1
Round files in root canals

Grande et al. 2007

objectives of chemo mechanical debridement
Objectives of chemo-mechanical debridement
  • Remove organic material and inorganic debris
  • Disinfect as much of the canal system as possible
  • Allow for ease of cleaning and shaping of the canals in preparation for obturation
shilder 19741
Shilder 1974

“Unlike funnels of simple geometric design, this root canal preparation should occupy not only three planes, but as many planes as are presented by the root canal under treatment…”

Stace Linde 2003

principles of irrigation
Principles of Irrigation
  • Only irrigate under usage of rubber dam
  • Irrigate following the use of each file
  • Canal access endeavours should allow for the irrigation tip to lie at two thirds of the radiographic working length.
principles of irrigation1
Principles of Irrigation
  • The needle tip should not bind to the walls of the canal
  • Allow for adequate time in the canal system for optimal action
  • Always check for leakage around the protected areas.
types of irrigants
Types of Irrigants

Unknown source

contemporary irrigants
Contemporary Irrigants
  • NaOCl (Sodium hypochlorite)
      • Dissolves organic content
      • Bacteriostatic and bactericidal
      • Spectrum of action includes fungi
      • Effective at low concentrations
      • Able to penetrate up to 300 microns into the dentinal tubules
      • Harmful to the periapical tissues if extruded beyond the apex.
contemporary irrigants1
Contemporary Irrigants
  • 2. Sterile water and or Distilled water
      • Weak evidence that it is bacteriostatic
      • Does not adequately dissolve organic contents
      • Less harmful if extruded beyond the apex.
contemporary irrigants2
Contemporary Irrigants
  • 3. Local anaesthetic
      • Weak evidence that it is bacteriostatic
      • Does not dissolve organic contents
      • Penetration into dentinal tubules?
      • Less harmful if extruded beyond the apex.
contemporary irrigants3
Contemporary Irrigants
  • 4. Hydrogen peroxide
      • Bacteriostatic and bactericidal
      • Weak action against fungi
      • Dissolves organic contents?
      • Penetration into dentinal tubules?
      • Toxic if extruded beyond the apex
contemporary irrigants4
Contemporary Irrigants
  • 5. Chlorhexidine
      • Bacteriostatic and bactericidal
      • Very weak action against fungi
      • Dissolves organic contents?
      • Penetration into dentinal tubules?
      • Less toxic to periapical tissues compared with NaOCl
slide16

International Standards

  • American Association of Endodontists (2004)- Not comprehensive with non-surgical endodontics
  • European Society of Endodontology (1994)- Predated Rotary Instrumentation.
  • (2006)- More comprehensive
  • ISO- Standards based on evidence-based research
the optimal irrigant
The optimal irrigant

In terms of antimicrobial and tissue-dissolving properties there is no other current irrigant besides NaOCl which can optimally achieve the objectives of chemo-mechanical debridement

The current available evidence is suggestive that a concentration of >1% NaOCl is not required

naocl edta
NaOCl + EDTA
  • No evidence to support any claims for the
  • antimicrobial action of EDTA
  • Partial inhibition of the action of NaOCl

Grawehr et al. 2003; Zehnder et al. 2005

Stace Linde 2003

naocl chlorhexidine
NaOCl + Chlorhexidine

The combination of 2% NaOCl and 0.2% chlorhexidine digluconate produced better antimicrobial results compared to their separate use. (Kuruvilla and Kamanth 1998)

  • A dense brown substance is the resultant
  • A chemically unstable material produced
  • Marcheson et al. 2007; Cathro 2004