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Dental Tribune United Kingdom Edition

Quality Products & Quality Support A complete range of irrigants for root canal treatment buy now at www.qedendo.co.uk or call 0800 731 9486 Gluco-Chex 2.0% Chlorhexidine digluconate 2% - antibacterial dental preparation for rinsing the root canals. It is more efficient than sodium hypochlorite in destroying such microorganisms as E. faecalis which are often responsible for unsuccessful endodontic treatment. Chlorax 2% or 5.25% (Sodium Hypochlorite) Chlorax dissolves organic matter. It has cleaning properties and has a bleaching effect on tooth and hard tissue. Endo-Solution EDTA Endo-Solution is used during mechanical preparation of the root canals. The preparation supports widening and cleaning of the root canal, removes the smear layer and exposes the dentinal tubules. Citric Acid 40% Citric Acid 40% removes the smear layer from the root canal walls, allowing precise penetration of root canal sealer. Isopropyl Alcohol Reduces the surface tension enabling Sodium Hypochlorite to penetrate the tubules. 62106-irrigation a4.indd 1 07/06/2011 10:28 21ClinicalJune 13-19, 2011United Kingdom Edition N owadays dentists have such a wide range of exciting gadgetry at their disposal to help prepare root canals quickly and easily that sometimes the biological focus of treatment is somehow overlooked. Of course, the latest NiTi systems can certainly help im- prove efficiency in the surgery, but they don’t necessarily help us achieve our ultimate goal - clean root canals. Even if the post-treatment radiograph does reveal a beautiful shape, with- out fully disinfected canals, the treatment will fail. When we look closely at the complex structure of the canal systems in cleared teeth it is immediately evident that it is impossible that our files can even come close to cleaning the intricate shapes. It doesn’t mat- ter which NiTi system we use or how cleverly we can manip- ulate a rigid stainless steel file - we are just deluding ourselves. For this reason, irrigants are the weapon of choice for elimi- nating bacteria that are har- boured in the intricate chan- nels of the root canal systems. The irrigants work in inflamed teeth by dissolving the organic pulp tissue and in infected teeth by killing and removing bacte- ria. This is further enhanced by opening up tubules and re- moving the smear layer using chelating agents. The files are merely making space for our ir- rigants to get in. The importance of a rubber dam cannot be over-estimated. The rubber dam is a brilliant tool to prevent the inhalation of files, protect the airways and maintain a clean, dry area in which to treat the patient. It is also vital for medico-legal rea- sons and moreover ensures that the irrigants stay in the tooth and are not swallowed. If a rub- ber dam is not being used the only thing the tooth is being ir- rigated with is probably saliva. Some studies have shown that the success rate of teeth treated under rubber dam is double those that are poorly isolated. Sodium hypochlorite is the irrigant of choice for disinfect- ing root canals. The solution works by dissolving pulp tissue, killing the bacteria and flushing debris away to prevent canals from becoming blocked dur- ing instrumentation. This, in turn, helps prevent ledging and other procedural errors so that the canals can be thoroughly cleansed. Sodium hypochlo- rite also happens to be a very cheap solution. Also recom- mended is chlorhexidine solu- tions (two per cent): This, like sodium hypochlorite, is strong- ly anti-microbial but cannot dissolve pulpal tissue; it is also expensive. The concentration of bleach that is used varies from country The ultimate goal - clean canals Michael Sultan discusses the challenges of getting root canals clean page 22DTà ‘Even if the post- treatment radio- graph does reveal a beautiful shape, without fully dis- infected canals, the treatment will fail’