Irrigation techniques are our methods for tackling root canal systems and removing signs of disease. Root canal sterilization works best through disinfection systems to help the inner tissues of the tooth heal and recover from the onset of bacteria. For us, irrigation systems are a primary point of interest because without these systems, removing bacteria from the tooth becomes much more difficult to achieve. These irrigation systems can be modified and changed to produce more favorable outcomes, and it’s our goal as endodontists to explore irrigation systems and find the best solutions to create a new golden standard for cleaning root canals.
Throughout this article, we’ll be exploring the various irrigation systems, how they have been improved, and what techniques are used today to ensure safer and more effective root canal cleanings.
Chemical Agents Used In Endodontic Treatment
One of the main components of endodontic irrigation systems is chemical agents. Chemical agents work to remove bacteria growth within the root canal system and disinfect it to prepare the tooth for further treatments. The ideal irrigation system will work to be nonallergenic, contain antimicrobial activity, has the ability to dissolve endotoxins, and prevents the formation of bacteria. Chemical agents used in irrigation systems are the primary component of these systems, and there are a few agents that are used in today’s systems that help remove root canal bacteria, including:
- NaOCL: Sodium hypochlorite, known as NaOCL, is the gold standard for endodontists because of its advantages due to its ability to dissolve pulp tissue and kill bacteria. It disrupts the biofilms often produced from bacteria and interferes with the bacteria’s cellular process, thus giving it a direct killing effect. However, even while this is the most commonly used chemical agent in endodontic irrigation systems, it also comes with some disadvantages. It’s cytotoxic, meaning if used incorrectly can cause accidents. The agent itself doesn’t stay active long and thus needs to be used frequently to work properly, which can interfere with cleaning techniques used by endodontics, especially for more complex cases.
- EDTA: Ethylenediaminetetraacetic acid, or EDTA, is often combined with NaOCL to bind and remove calcium and demineralized dentin. EDTA can act as a lubricant during the cleaning process and can work to remove the biofilm layer that protects the bacteria, causing it to die off. However, this is a less commonly used agent by itself because, in some cases, EDTA can be insufficient for cleanings when used on its own.
- CHX: Chlorhexidine gluconate, or CHX, is an antiseptic agent that can rupture the cellular wall of the bacteria by interacting with its phospholipids, therefore causing cell death. It has the ability to bind to the dentin and create a prolonged release of antimicrobial activity that can last for months, one of the biggest advantages that NaOCL doesn’t have. However, it doesn’t have the ability to dissolve the necrotic pulp tissue, eliminate signs of biofilm, or remove the smear layers. Because of its disadvantages, it’s often used as a secondary irrigant at the end of a procedure, and it cannot be used together with other agents such as NaOCL because it can affect canal anatomy and prevent obturation.
Although all these agents come with their own advantages and disadvantages, these agents cannot be properly used without their techniques. Endodontists that study techniques often have to know how to use these agents to their desired effect, and by understanding some of the techniques sued, desired effects can be better achieved.
Types of Irrigation Techniques Used Today
Techniques are the core foundation for any successful endodontic practice – for irrigation systems, knowing how to manually clean the root canal systems without the use of devices can be a highly valuable skill, and there are some benefits to using manual techniques over special devices. One of those benefits includes the ability to control canal depth, a better sense of agency during treatment, and it can create fine-tuned cleanings that are professional and reliable. However, conventional syringes and open/closed-ended cannulas can also come with some disadvantages. For some, manual methods only provide less control over the irrigation process and can also create a higher risk of canal failure as a result.
While manual irrigation techniques often provide the staple for treatment, many endodontists also like to experiment with different techniques with advanced systems. At the same time, traditional methods can bring problems like debris clogged in the cannula or insufficient amounts of chemical agents being delivered during irrigation; other irrigation systems attempt to resolve those issues by improving these methods through various means.
Irrigation systems are always being improved upon, and while most improvements rely on techniques overall, some also attempt to remove traditional rotary instruments with other devices. These types of irrigation systems include:
- Passive Ultrasonic Irrigation: PUI is a method of irrigation that activates the chemical agent inside the canal. The irrigant is pushed laterally throughout the canal and creates a micro-streaming effect that touches on canal areas that traditional methods don’t normally. This method is typically used in the presence of lateral canals and is argued to penetrate those layers better than the syringe and cannula methods.
- Intermittent Passive Ultrasonic Irrigation: This technique combines traditional methods with irrigant devices, such as ultrasonic tips to provide activation for the chemical solution. The syringe and cannula are used to deposit the chemical agent, while the attached ultrasonic tip provides the ability to activate chemical agents and easily dissolve organic tissues.
- Continuous Passive Ultrasonic Irrigation: This process uses acoustic microstreaming in a continuous mode rather than an intermittent mode. The ultrasonic tip allows for the solution to be dispensed, giving more control to the endodontist for the amount of agent used during the procedure. However, when provided in a continuous manner instead of an intermittent one, the continuous flow of agent through the ultrasonic tip provides more well-rounded bacteria and tissue dissolution.
Effective cleanings through the activation of chemical agents can help destroy bacteria along the root canal systems, and with advancements in the irrigation systems being explored, future treatments can become more viable for patients and give them better tooth pain relief without the risk of failure.
