Endodontic irrigation

[denticon]

Hi,
I am an FTD and am new out here! I have a question for all practicing dentists in the USA, I was wondering how you guys irrigate the root canal? I have been using a 2ml syringe and bend it's needle. Sometimes, I am not convinced that this method flushes the root canal thoroughly and the NAOCL goes all the way till the root tip...especially the narrow canals. I feel most of it oozes out....and on an average, how much NAOCL do you use for a molar rct...? Any thoughts... suggestions?
THANKS!!

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[DrTacoElf]

We were taught getting it down to the tip is all about proper taper and not so much about what tip you are using on the irrigation syringe. But that being said we use exactly what you mention.

 

[jh1581]

The research shows that the irrigant (regardless of type) only gets from1 to 3mm past the tip of the irrigating needle, depending on how curved the canal is. Therefore, your irrigating needle needs to penetrate as far down as it possibly can without ever getting closer than 1mm to the apex (to avoid risking extrusion of the NaOCl). There are various sizes and gauges of needles you can use depending on the canal anatomy. You can get the needle to pentrate deeper by performing adequate access to the apical 1/3. This can be achieved by a crown-down technique using rotary instrumentation and then apical enlargement using .02, .04 or .06 tapered files. Either way, the most effective irrigation occurs after the root canal has been instrumented which allows for the greatest penetration of irrigant.

NaOCl is a great irrigant as it dissolves organic and inorganic debris as well as having great antibacterial properties. Another great irrigant I always finish cases with is Chlorhexidine. Make sure you flush the NaOCl out before using the CHX b/c if you dont a black percipitate will form and stick to the canal walls.

My typical protocol for irrigation is AFTER instrumentation is completed is:
5ml of 2.5% NaOCl PER CANAL
2ml of EDTA per canal (to remove the smear layer)
Final 5ml of 2.2% Chlorhexidine per canal (has great antibacterial properties and substantivity)

Keep in mind that throughout the procedure, NaOCl should be flooded in the canals. Contact time is also important.

Hope this helps.

 

[denticon]

Thanks guys, great info.. anybody else!

 

[12YearOldKid]

After I have found the apex I always work my files to length in a canal flooded with hypochlorite.

The surface tension of the liquid won't allow it to be forced into the canal by the syringe. But the file can break up the tension and allow the hypochlorite to be carried as far as the apex. I am very hesitant to insert a needle too deeply into a canal for fear of a bleach accident and I never "force" bleach into a canal. I work with a flooded canal, rinsing frequently to make sure I have clean solution with no debris at all times.

The new rinsendo units look neat, but for me they seem like a solution in need of a problem.

 

[denticon]

ok, how long is the appointment from start driilling for access to end of that visit.. (i.e BMP and intermediary) assuming that you are not using any rotary instrument other than gates glidden...

and what is the time gap between the BMP appointment and the obturation appointment.

Is it common practice to give prophylactic antibiotics (if yes, which one..dosage..?) to prevent post instrumentation flareups? or if tooth is tender on percussion?

views and opinions solicited..
Thanks!