|Year : 2021 | Volume
| Issue : 2 | Page : 77-78
Critical review on root canal irrigants used in dentistry
S Sasidharan1, P Rahmath Meeral2
1 Sivam Dental and Maxillofacial Clinic, Chennai, Tamil Nadu, India
2 Best Dental Science College, Madurai, Tamil Nadu, India
|Date of Submission||30-Dec-2021|
|Date of Acceptance||17-Feb-2022|
|Date of Web Publication||26-Mar-2022|
Dr. S Sasidharan
Sivam Dental and Maxillofacial Clinic, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
The purpose of the endodontic treatment is to eliminating the entire pulp including both vital and necrotic tissues along with the microorganisms and its byproducts from root canal system, with the help of chemical and mechanical aids. The present article summarizes a brief note on endodontic irrigant solutions and also its negative impact which should also be considered to lead a discovery of better endodontic treatment systems.
Keywords: Endodontic, irrigant, negative impact
|How to cite this article:|
Sasidharan S, Meeral P R. Critical review on root canal irrigants used in dentistry. Int J Community Dent 2021;9:77-8
| Introduction|| |
Bacteria have long been recognized as the primary etiologic factors in the development of pulp and periapical lesions,,, which are supposed to be eliminated which is commonly done with the help of chemical irrigants and mechanical endodontic files. Irrigant solutions are important because they could influence the mechanical properties of the dental structure,, as well as assist in cleaning the root canal. Some studies have identified a relationship between mechanical defects in dental structures, such as a reduction in the microhardness of root dentin or an increase in the incidence of vertical fracture with auxiliary chemical solutions., Factors such as increased concentrations of irrigant solutions, high capacity to remove smear layer, and time of dentin exposure to solutions are being discussed as possible causes of these faults.,,,,, However, this issue is still controversial, and it is unclear in the literature which mechanical properties could be affected by irrigant solutions. Accordingly, scoping reviews offer an important tool that can provide a map of the range of available evidence. [Table 1] shows the classification of root canal irrigation solutions.
| Negative Impact of Different Endodontic Irrigants|| |
Cavalleri et al. have shown that using sodium hypochlorite (NaOCl) as an irrigating solution in root canals for short-term contact (several minutes, as is the case in clinical practice) does not alter the surface structure of the files through corrosion and does not cause any risk of fracture of nickel-titanium instruments. NaOCl irrigation decreases bond strength between resin cements and dentin because hypochlorite affects the polymerization of the resin sealer.
NaOCl and chlorhexidine (CHX) are not soluble in each other, and a brownish orange precipitate is formed, which is a carcinogenic product, parachloroanaline (PCA). PCA has mutagenic potential. Atomic absorption spectrophotometry has indicated that the precipitate contains iron, which may be the reason for the orange development. This reaction coats the canal surface and significantly occludes the dentinal tubules and affects the seal of the root canal. It would appear prudent to minimize the formation of PCA by washing away the remaining NaOCl with alcohol or ethylene diamine tetracetic acid (EDTA) before using CHX.
NaOCl is caustic if accidentally extruded into periapical tissue or adjacent anatomical structures such as the maxillary sinus. Emphysema develops within 10–20 min if accidentally injected into the periapical tissue. Edema and paresthesia may result due to the tissue-dissolving capability of NaOCl. Because the potential for spread of infection is related to tissue destruction, medications such as antibiotics, analgesics, and antihistamines should be prescribed accordingly.
CHX cannot be advocated as the main irrigant in standard endodontic cases because it is unable to dissolve necrotic tissue remnants and remove biofilm and it is less effective on Gram-negative than Gram-positive bacteria. Direct contact between NaOCl and CHX should be avoided; otherwise, red CHX crystals will precipitate immediately (PCA, which is known to be carcinogenic).
Prolonged exposure to EDTA may weaken root dentin and thereby increase the risk of creating a perforation during mechanical root canal instrumentation. EDTA retains its calcium-complexing ability when mixed with NaOCl, but EDTA causes NaOCl to lose its tissue-dissolving capacity. Therefore, EDTA and NaOCl should be used separately and should never be mixed.
MTAD seems to adversely influence the physical properties of dentin and causes significant reduction in bond strength of both resin-based and calcium hydroxide-based sealers due to precipitate formation. Concerns have been expressed regarding the use of tetracycline (doxycycline) because of possible resistance to the antibiotic and staining of tooth hard tissue, as demonstrated by exposure to light in an in vitro model. However, no report of in vivo staining has been published.
| Conclusion|| |
The most known and used irrigating agents today are NaOCl, CHX, and EDTA. None of these substances is the ideal irrigator; all have advantages and disadvantages, and because of this, it is convenient to use them in combination. The market is always launching new compounds or new alternatives to enhance the effects of existing irrigants. It would therefore be interesting to compare the efficacy of the old and new irrigants on the endodontic microbiota and to see if one method is more effective than another when eradicating the bacterial biofilm, until an ideal protocol is determined.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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