A Simple Technique and Related Support for Better Endodontic Disinfection

As you’ve perhaps experienced, not all root canal systems are the same. And their complexities add to the challenge associated with endodontic disinfection.

Canal anatomies can create issues during shaping. Curvatures, oval or flattened canals, and other related conditions make instrumentation challenging.

”Different preparation techniques leave from 10% to 50% of the root canal surface area untouched.” [1]

As we cover the basics here be aware that a thorough clinical treatise is also available. It presents the details associated with effective endodontic disinfection protocols and the solutions that helped achieve desired outcomes.

The root problem associated with endodontic disinfection

Bacteria are persistent following what are referred to as “chemo-mechanical procedures.” Their resistance to treatment further increases their ability to be unaffected by instruments and irrigants.

Even so, some microorganisms reveal resistance to endodontic disinfection although their opposition to debridement procedures (and NaOCI) is unlikely. The core problem with disinfection has to do with the primary canal lumen and the observed irregularities via preparation.

The results:

  • Bacteria and certain tissue can elude disinfection modes
  • Bacteria can spread via canal pathways into the periodontal ligament prompting disease

The available comprehensive clinical data and related diagrams point to the limitations of instruments and the short retention time of irrigants used within the root canal.

Again, the overall clinical point of view attributes related difficulty to the canal’s complex anatomy. Adequate infection control is necessary in the main canal lumen and throughout the entire root canal system.

Shaping and irrigant delivery as a vital duo in endodontic protocol

The shaping process relies heavily on irrigant delivery for effective disinfection. This is especially relevant to those areas that cannot be reached by files.

The irrigant’s effectiveness in decontamination relies on being delivered as close as possible to the apex thus allowing good exchange and activation. This is an important standard of measurement for endodontic treatment and retreatment.

Your irrigation goals:

  • Remove as much bacteria as possible from the root canal area
  • Promote apical healing (pending lesion presence)
  • Prevent reinfection

There are certain clinical markers that make endodontic disinfection a critical process. Among them are the minimal penetration of irrigant solution, how the irrigant interacts within more complex anatomical environments, and the irrigant’s experience with biofilm resistance.

The clinical study has more viewable specifics that demonstrate the effective combination of mechanical preparation and antibacterial irrigants. They’re observed to significantly enhance endodontic disinfection in comparison to saline irrigation.

A simple technique for more effective irrigant exchange and activation

Clinicians most often use a common irrigation protocol. The irrigant is extruded by gripping the syringe using the index and middle fingers under the wings of the syringe and their thumb over the plunger.

A cleaner method has been proven more effective.

  • No special devices are needed
  • Alternates positive and negative irrigation

The push-pull technique provides a simple, clean irrigation.

  • 1-A small amount of irrigant is extruded
  • 2-Thumb placement under the plunger
  • 3-Upward push (using thumb) creates negative pressure
  • 4-Opposing pressure is used to inject irrigant into the canal

The outcome results in the suction of fluids in the canals. This improves the overall fluid dynamics within the root canal system.

Generally, the push-pull technique keeps the needle stationary while moving the plunger. This enables the liquids to better penetrate the canals.

Specifically, during the negative pressure phase the fluids within the canal return to the syringe and are reactivated. Pathogens are eliminated by the irrigant solution and new irrigants can actively contact the entire dentine surface.

Complete diagrams and detailed explanation of this simple technique are available within the related comprehensive clinical description.

endodontic disinfection with IrriFlex

The push-pull technique is used during irrigation with IrriFlex. “Clinical aspects of endodontic disinfection” by dr Francesca Cerutti and dr Riccardo Tonini.


Improved technique support for endodontic disinfection

A polypropylene irrigation needle has been introduced to the market. IrriFlex is an innovation developed by Produits Dentaires SA (Switzerland) aimed at improving the use of the push-pull irrigation technique.

IrriFlex provides…

  • Back to back side vent design that improves fluid dynamics within the canal
  • 30G tip that provides adequate adaptation in curved canals
  • Flexibility (beyond that of steel or Ni-Ti) that follows root anatomy through the working length – without blocking

Irrigant is delivered to the most needed locations in the canal. IrriFlex effortlessly dispenses a large volume of solution and allows operational control of tip depth (due to millimetric notches viewable on the cannula shank).

Overall, fluid dynamics are improved throughout the root canal system when using IrriFlex.

Detailed information and diagrams about IrriFlex and its  alignment with the push-pull technique are available in the related clinical study.

Contact Produits Dentaires SA for more information about root canal treatment, endodontic disinfection, and related products.


[1] “Clinical aspects of endodontic disinfection” by dr Francesca Cerutti and dr Riccardo Tonini



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.


The impact of COVID-19 on dental surgeons

The SARS-CoV-2 (COVID) outbreak has caused significant disruption to dental practice worldwide. Oral health professionals are still facing diverse challenges to providing dental care while protecting patients and themselves from the health threat posed by SARS-CoV-2. Especially since dentistry tops list of most dangerous jobs during pandemic, according to The Alberta Federation of Labour.

A survey recently released by Groupe Stemmer Distribution has investigated how dental surgeons are managing their practices during the ongoing SARS-CoV-2 pandemic in Europe. The results provide an inside look at the current state of the dental industry, which is facing unprecedented challenges.

Situation in Europe

The survey found that 39% of dental offices were fully closed in Europe during the lockdown with as much as 79% in France alone. Those number were slightly lower for Belgium, Spain and Portugal (53%, 46% and 43% respectively). Only 9% of cabinets were closed in Italy. 88% of dental practices which remained open in Europe were accepting emergency cases only. The lockdown was used by dental surgeons to do online courses and webinars: 68% of dentists in Europe and 49% in France declared having participated in various online trainings during this period.

COVID impact on dental offices

Dental practices have begun to reopen across Europe in mid-March as governments began to ease public restrictions. However, over 30% of the European dental surgeons who participated in the survey still do not know when they will be ready to work again. And for those who opened, social distancing is the new cornerstone of appointment scheduling. 97% of the participants declared that they are planning to limit the number of patients in the waiting rooms, 78% want to, if possible, perform several dental procedures during one appointment and 73% plan to introduce COVID testing. And while health precautions vary in different dental markets, one thing is sure. A dental appointment will no longer look like what it was in January.

MTA placement with MAP System

Over 20 years ago, dr. Torabinejad, who was the principle investigator of the dental applications of mineral trioxide aggregate (MTA) provided a clinically focused reference detailing the properties and uses of MTA. Today, it is the preferred material used by endodontists because of its superior properties such as its seal and biocompatibility that significantly improves outcomes of endodontic treatments. Pulp capping, apexification, repair of root perforations and root-end filling are commonly described clinical procedures to seal the pathway of communication between the root canal system and the external surface of the tooth. The application of MTA was first described as being achieved with aid of plastic or metal spatulas. However, this method was proved inefficient.


It was not until the arrival of carrier instruments dedicated to aid in the placement of MTA, that the situation improved. A real game changer in this field was introduced by Produits Dentaires. Its Micro-Apical Placement (MAP) System offers different application points for every clinical situation. The Intro Kit and the Universal Kit are for orthograde obturation and the Surgical Kit for retrograde obturation. New NiTi Memory Shape tips can be manually shaped to any required curvature. After autoclave sterilisation, the needle returns to its initial shape. With the use of the MAP System, proper placement of MTA has become an easy task for every dentist.


Clinical use of MTA

“MTA placement with the Produits Dentaires MAP System” by dr Mauro Armato

Pulp capping

Vital pulp therapy has become more popular in recent years. Calcium hydroxide has been the most common material for pulp capping, but MTA has shown even better results in biocompatibility and outcome. Cases with large carious pulp exposure can be treated successfully with partial pulpotomy and MTA as a capping agent, keeping teeth vital.


In order to prevent extrusion of root canal filling material in immature teeth with open apices, MTA is used as an apical plug. The results of many studies have shown that MTA induced apical hard-tissue formation more often and its use was associated with less inflammation than with other test materials.

Repair of root perforations

Accidental perforation of the pulp chamber or of the root canal significantly changes the prognosis of the tooth. Perforation repair with a biocompatible sealing material such as mineral trioxide aggregate may save compromised teeth.

Apical surgery

MTA is the material with the most favourable outcome as a root-end filling material for apical surgery and has been associated with significantly less inflammation, cementum formation and regeneration of the periradicular tissue.


The article was based on the paper “MTA placement with the Produits Dentaires MAP System” by dr Mauro Armato. The original version with the documentation is available on our e-Learning platform.



Restorative Outcomes You Can Expect from Vital Pulp Therapy

Goal awareness is essential to success in any endeavor. That said, the primary goal of restorative treatment is preserving tooth vitality through vital pulp therapy. Exposed pulp poses a problem when you’re attempting to treat a patient’s permanent tooth. It’s especially challenging when you lack adequate clinical guidance and when the pulp in question is carious.

What is the most suitable treatment?

Two perspectives exist:

  • a pulpectomy
  • knowledge that the survival of endodontically treated teeth ranks lower than vital teeth.

Each perspective has validity. And more extensive (and available) clinical data can clarify those outcomes – along with related therapeutic solutions.[1]

The goal, of course, is protecting the vitality of the dental pulp that has experienced large areas of decay or trauma.

Vital pulp therapy applies restorative materials directly or indirectly on the affected pulp tissue. Regeneration is the goal for tissues impacted by decay or trauma – though current therapies are less likely to stimulate present dentine.

The issue of dentinogenesis

Primary ondontoblasts and dental pulp stem cells can prompt tertiary dentine development. The dentinogenesis will be recognized as reactionary and reparative in this instance.

The process in question has variables that serve to promote reactionary and/or reparative dentinogenesis. And it’s further recognized that extracellular dentine equally involves additional factors during the dentinogenesis process.

These factors and related clinical data are worth exploring to gain further understanding and clarity.

What vital pulp therapy accomplishes for regenerative procedures

Three procedures are classified as vital pulp therapies.

  • Direct pulp capping
  • Indirect pulp capping
  • Pulpotomy

Direct pulp capping

This procedure covers an exposed dental pulp with a protective material.

Indirect pulp capping

The application of a protective material on a thin layer of dentine over the partially exposed dental pulp.


The surgical removal of the coronal pulp portion that’s inflamed within the exposed pulp tissue. This saves the remaining healthy tissue.

Each procedure gives you (as a clinician) an attempt at effective pulp capping. Outcomes include:

  • Appropriate sealing ability
  • Maintaining the vitality of pulp tissues
  • Promoting the formation of a dentinal bridge and other tissues such as neural cells.

These root canal therapy alternatives are for teeth that have immature or mature apices. Pulp exposure with reversible injury and that lack signs of inflammation create a more conservative approach.

Data across several studies indicates that the effectiveness of direct and indirect pulp capping can be affected by the chosen biomaterials and their biological properties.

Beyond dental pulp tissue regeneration here’s what else is working for immature permanent teeth


This procedure enables the immature permanent teeth to continue root end development.


Provides a calcified barrier at the immature root end. The procedure places biocompatible material next to periapical tissue.

Research indicates that the interactions between dental materials and cells achieve best results in terms of biocompatibility and pulp inflammation.

The goal…

”…treating the exposed pulp with an appropriate pulp capping material…promote the dentinogenic potential of the pulpal cells.” [2]

The biocompatibility outcomes and the variety of materials used is rather extensive. Each have their success ratios and measurable data that indicates procedural effectiveness.

An available clinical treatise thoroughly outlines the use of various pulp capping materials. Overall, vital pulp therapy relies on case selection.

Assessment difficulty and the related decision involves whether the pulp’s status is reversible or irreversible. An age based decision is not universally accepted.

Vital pulp therapy is recommended for younger patients. Their pulp tissue has a higher healing capacity compared with older patients.

Again, clinical data is not sufficient to reveal the impact of patient age on treatment outcome. Vital pulp therapy has been shown to successfully treat patients ranging in age from six to 70. Data highlighted the healing potential of pulp tissue following the removal of disease cause.

Vital pulp therapy

Restorative therapy. Pictures come from the clinical article “Calcium hydroxide and MTA in vital pulp therapy” by dr. Francesca Cerutti and dr. Davide Guglielmi available on our e-Learning platform.

A wise material choice for vital pulp therapy

The reduction of bacterial growth and an effective seal within the root canal system is a preferred outcome for regenerative procedures – including vital pulp therapy.

PD™ MTA White promotes compatibility with the dentinal wall. And it creates a perfect seal for healing while reducing the number of retreatment procedures.

Related to the clinical procedure reviewed above, PD™ MTA White is useful as a pulp capping material and for the pulpotomy of primary teeth in children and adolescent patients.

Other notable benefits of PD™ MTA White include:

  • Bismuth oxide free ingredients to eliminate staining and discoloration
  • Optimized particle size for homogeneous and complete wetting during mixing
  • Simplicity of manipulation allowing tailored use for clinical cases
  • Washout resistance and non-resorbability
  • Radiopaqueness
  • Perfect marginal sealing
  • Optimal use via smart individual dose

Count on PD™ MTA White in combination with the MAP System to enhance precise placement and predictable treatment outcomes.

Specific product information and additional supportive clinical data associated with vital pulp therapy and PD™ MTA White is available from Produits Dentaires SA.

This article was based on the paper “Calcium hydroxide and MTA in vital pulp therapy” by dr. Francesca Cerutti and dr. Davide Guglielmi. The original document (in English) is available on our e-Learning platfom.

[1] “Calcium hydroxide and MTA in vital pulp therapy” by dr. Francesca Cerutti and dr. Davide Guglielmi

[2]  “Calcium hydroxide and MTA in vital pulp therapy” by dr. Francesca Cerutti and dr. Davide Guglielmi