The root canal procedure has always relied on mechanical and chemical action for disinfection. Mechanical debris removal is accomplished by stainless steel hand files and NiTi rotary files, and chemical disinfection and lubrication by irrigants. While there are many irrigants on the market would like to highlight a few that we use in our offices.
Sodium hypochlorite ( NAOCL) is still the irrigant of choice in endodontics. Its effectiveness, low cost, and availability make it the go-to irrigant for root canals. There are some drawbacks to using it, including its propensity to damage clothing and carpet when spilled, and awful taste. If extruded through the apex during treatment it is extremely painful and will result in swelling and possible bruising. While these injuries will resolve in about a week, they leave a lasting impression on the poor patient (not to mention the treating dentist)!
One drawback to NaOCL is that it does not remove the smear layer from the canal walls. Noted on SEM scans of instrumented root canals, the smear layer is basically ground tissue, bacteria and their byproducts mushed into a fine gelatinous mass that adheres to the canal walls and prevents sealers and gutta percha from adhering to the canal walls.
The most common ways to remove the smear layer include 17% EDTA, CHX-Plus, MTAD, and Qmix.
17% EDTA is ethylenediamine-tetraacetate. Considered a chelating agent, EDTA helps remove calcium from the walls of the canal and in so doing removes the smear layer adherent to it. It is user friendly, and effective but has no antibacterial properties.
The following Irrigants not only help remove the smear layer but have some secondary disinfection properties.
CHX-Plus is 2% Chlorhexidine Gluconate solution. Normally used for periodontal disinfection, this formulation has surface modifiers and wetting agents which allow it to “get closer” to the canal walls to flush away the smear layer.
MTAD is a mixture of Doxycycline, citric acid, and a detergent. Not only does it remove smear layer and inhibit bacteria, but we have also found it to be a very good lubricant for instrumenting fine canals. MTAD should be in contact with the canal walls for no less than 3 minutes to be effective. MTAD is the only irrigant to have an antibiotic component, and It is important to screen for allergies!
Qmix is an effective smear layer-remover ( EDTA) and a powerful antimicrobial agent (Chlorhexidine) with surfactants and water. The solution is an FDA-cleared endodontic irrigant that is indicated for the cleaning and disinfection of the root canal system in a single step following initial use of standard sodium hypochlorite solution. The solution has been shown to kill bacteria on contact without the use of antibiotics. Studies have shown that it can be effective in 60-90 seconds.
An interesting irrigant getting some attention in recent years is Ozonated water. Ozone has been used to disinfect swimming pools and hot tubs, and now in hospitals. Ozonated water requires a special apparatus to make but is then used like any other irrigant.
With so many Irrigants available it is up to you to find what works best for you. If you have any questions or want to know what we are currently using please call, we are happy to discuss Irrigants, other aspects of root canal treatment.
Steve Shoha DDS
About Professional Endodontics
Professional Endodontics has been exceeding the standard of care in Wayne and Macomb counties for over 50 years. The team specializes in treating issues with the inside of the tooth and goes out of its way to provide a safe easy environment for patients. Each member of the practice is dedicated to providing excellence in patient care and values high-quality relationships with referring dentists and specialists. Each endodontist at Professional Endodontics has been individually chosen as Hour Detroit Magazine’s Best Dentists. Thanks to contemporary advances in endodontics, Professional Endodontics is able to use innovative technology to treat and save teeth that have suffered damage to the soft tissue within the roots of the tooth.
Professional Endodontics offers state-of-the-art facilities in Clarkston, Clinton Township, St. Clair Shores, and Southfield. All locations offer the latest in advanced dental delivery systems, microscopy, and digital radiography.
6803 Dixie Highway
Clarkston, MI 48346
29201 Telegraph Road
Southfield, MI 48034
Henry Ford Hospital Medical Pavilion
16151 19 Mile Rd, Suite 101
Clinton Township, MI 48038
St. Clair Shores
St. Clair Professional Plaza
23829 Little Mack, Suite 300
St. Clair Shores, MI 48080