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A Bacterial Counter-Attack with Root Canal Irrigation
30.06.2020

A Bacterial Counter-Attack with Root Canal Irrigation

The risk of post-treatment disease can be high. Root canal irrigation helps eliminate the risk by removing bacteria, pulp tissue, smear layer and other debris from the root canal system.

No doubt, bacteria are aggressive. Their aggression is often agitated by mechanical instrumentation leaving canal areas untreated – at a rate of 10 to 15% for individual canals.

The result: treatment failure!

How root canal irrigation counters bacterial aggression

Bacteria are not selective when or where they affect treatment outcomes. Their influence increases significantly when present at the time of filling.

And worse…

They appear to be unfazed by irrigating solution or medication.

The procedural counterattack on bacteria must involve the removal of as many microorganisms as possible from the root canal system.

Synergy is vital

Mechanical preparation and irrigation procedures must work together. Their success is influenced by a variety of factors.

  • Fluid properties
  • Irrigant volume and delivery
  • Depth of irrigant placement
  • Overall anatomy of the root canal system

It’s not enough to rely on a conventional needle irrigation for adequate disinfection results. As further explored in this available comprehensive study – a risk is posed by the vapor lock effect for starters.

There are other issues relative to needle use and the specific challenges of reaching the most apical region of the canal with fresh irrigant.

Again, these procedural details are thoroughly discussed in a related clinical treatise.

Supplemental assistance is useful

As noted in the clinical data, the proximity of the needle to the working length the more effective the irrigation. Certain products make this step in the procedure easier and more effective.

Available products can more efficiently follow the anatomy of the prepared root canal. And the further value of such products applies to flux control so that additional debris is not extruded into the periapical tissues.

IrriFlex is such a product created by Produits Dentaires SA, Switzerland. The novel polypropylene needle has a back-to-back side vent design that provides effective and safe root canal irrigation plus…

  • A 30G tip
  • An effortless reach to the working length
  • Bringing a high volume of irrigant to the apex
  • Effectiveness in curved canalRoot canal irrigation IrriFlex from Produits Dentaires

The novel polypropylene needle of IrriFlex has a back-to-back side vent design that provides effective and safe root canal irrigation.

 

Two cases that reveal how IrriFlex effectively meets the challenges associated with root canal irrigation

Case 1: Endodontic retreatment referral on a 62 year old patient

Case: Swelling on the upper left portion of the gum. Radiograph revealed presence of an existing endodontic therapy and periapical radiolucencies.

Procedural detail is available via a more thorough clinical article. The following covers the highlights of the retreatment that involved usage of IrriFlex for root canal irrigation.

  • The pulp chamber was made viewable via the access cavity following removal of the existing composite filling from the crown’s center.
  • Existing root canal filling was removed by specifically designed retreatment instruments followed by removal of remnants from the pulp chamber floor.
  • 5% sodium hypochlorite was used to fill the chamber followed by the shaping of the MB2 canal – not previously shaped and cleaned during the initial treatment.
  • Decontamination was required due to the endodontic lesion and the presence of swelling.
  • Root canal irrigation was delivered by IrriFlex to the apical third of each root capitalizing on the instrument’s flexibility.
  • The irrigant was activated using ultrasonic inserts at the discretion of the clinician.
  • Dried root canals were filled via the warm gutta percha compaction technique.
  • The access cavity was filled with a direct composite restoration and follow-up X-rays confirmed the final results.

 

“The importance of irrigation in challenging cases” by dr Marco Martignoni

 

Case 2: Emergency treatment on a 50 year old patient

Case: Broken tooth while eating and tooth fragment not located. Pulp was exposed as a result of the fracture causing spontaneous and acute pain.

Pre-op x-ray revealed that the tooth had a very thin canal lumen. Endodontic treatment protocols were followed involving a restoration and prosthetic crown.

Procedural detail is available via a more thorough clinical article. The following covers the highlights of the emergency treatment.

  • Ultrasonic tips were used to enlarge the root canal opening following the design of the access cavity.
  • The narrow root canal space was shaped using Ni-Ti rotary instruments.
  • IrriFlex was used for multiple root canal irrigation procedures alongside the ultrasonic activation of sodium hypochlorite to reduce bacterial growth.
  • The irrigant was delivered as close as possible to the apical constriction of the root as a result of using a polypropylene irrigation cannula.
  • Warm gutta percha was delivered once the root canal walls appeared clean and shiny.
  • A composite build-up was completed and followed by a periapical x-ray.

 

Different cases…each uniquely challenging…with one common denominator

Each case was unique along with their specific challenges. Instrument usage and their sequence of usage changed from case to case as well.

One thing did not change…

The priority of root canal irrigation as required by each case.

Bacteria elimination was the key to success for each case that involved endodontic retreatment on failed procedures.

Both cases also used a flexible irrigation cannula. This made treatment easier and more efficient due to the ability to deliver high volumes of irrigant to the areas of need.

IrriFlex was capable for providing the necessary and desired treatment outcomes involving root canal irrigation.

A more comprehensive clinical treatise is available from Produits Dentaires SA. It outlines the clinical applications of these featured case studies on root canal treatment involving root canal irrigation and IrriFlex. Contact Produits Dentaires SA for more information about root canal treatment and related products.

 

The article was based on the paper “The importance of irrigation in challenging cases” by dr Marco Martignoni. The original version with the documentation is available on our e-Learning platform.