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Irrigation & Disinfection

  1. 1. www.arefai.edublogs.org AshrafRefaiSamir BDS MSc DD HMD Associate Professor of Endodontics Al-Azhar University ashraf_refai@hotmail.com endoash www.arefai.edublogs.org
 www.idclinics.com +201001434323 Follow Me Photograph This Slide
  2. 2. Associate Professor of Endodontics Al-Azhar University) Disinfection & Irrigation of the Root Canal System Dr. Ashraf Refai (BDS MSC DD HMD)
  3. 3. Why isn’t Mechanical Shaping Enough to do the job?
  4. 4. The Nature of the Endodontic Problem? Mechanical VS Bacteriological
  5. 5. The Nature of the Endodontic Problem? Geometric VS Anatomical
  6. 6. Root Canal Complexities
  7. 7. 2010
  8. 8. www.rootcanalanatomy.blogspot.com Micro CT Evaluation Pre & Post Instrumentation
  9. 9. www.rootcanalanatomy.blogspot.com Micro CT Evaluation Pre & Post Instrumentation
  10. 10. So we need to irrigate and disinfect the canals…
  11. 11. Objectives of Irrigation Biological Chemical Mechanical
  12. 12. ✤ Flush out debris ✤ Lubricate the canals ✤ Dissolve organic & inorganic tissue ✤ Prevent the formation of smear or remove it once formed Mechanical & Chemical Objectives of Irrigation
  13. 13. Biologic Objectives of Irrigation ✤ Antibacterial against anaerobic and facultative bacterial ✤ Neutralize endotoxins
  14. 14. Irrigation is a Factor of 5Things 5 Factors Time Frequency Type Agitation Volume
  15. 15. Hydrodynamics of Irrigation ✤ Penetration of the needle ✤ Diameter of the root canal ✤ Inner and Outer diameter of the needle ✤ Irrigation Pressure ✤ Type and orientation of the bevel
  16. 16. Irrigation Needles ✤ Needle Sizes ✤ 23 gauge (.64 mm) ✤ 27 gauge (.42 mm) ✤ 30 gauge (.32 mm) ✤ Needle Type ✤ Side vented ✤ Double side vented ✤ Half tube ✤ Multi vented
  17. 17. Type of Irritants (Main Stream) ✤ Sodium Hypochlorite (NaOCL) ✤ Chlorohexidine (CHX) ✤ Ethylenediamine Tetra-Acetic Acid (EDTA) ✤ 1-hydroxyethylidene-1, 1-bisphosphonate (HBPT) ✤ MTAD & Tetraclean ✤ QMIX ✤ Iodine Potassium Iodide
  18. 18. Ideal Properties of an Irrigant ✤ Effective Germicide & Fungicide ✤ Non-irritant ✤ Remain stable in solution ✤ Prolonged antibacterial action ✤ Be active in presence of blood and tissue ✤ Have low surface tension ✤ Not to interfere with healing of periapcal tissues ✤ Should not interfere with obturating materials ✤ Non staining ✤ Capable of inactivation in in a culture medium ✤ Should not induce a cell mediated response ✤ Should completely remove smear layer and disinfect dentin ✤ Non-carcinogenic, non-antigenic and non-toxic ✤ Should not negatively affect exposed dentin ✤ Inexpensive ✤ Easy application
  19. 19. 2012
  20. 20. Sodium Hypochlorite ✤ First used as disinfectant for wounds in 1789 (Dakin’s Solution) ✤ Mode of action: ✤ Saponification: Organic and fat solvent turns them into fatty acid salts ✤ Neutralisation: Amino acids are neutralised into water and salts. (-OH ions reduce pH) ✤ Hypochlorous acid formation: Dissolution of Chlorine in water forms this weak acid that breaks down amino acids
  21. 21. Sodium Hypochlorite ✤ Mode of action: ✤ Solvent: Released chlorine combines with amino acids toe form Chloramine with inhibits cell metabolism also chlorine inhibits cell enzymes ✤ pH reaction: Sodium hypochlorite is a strong base pH > 11, interferes with cell membrane integrity.
  22. 22. Sodium Hypochlorite Concentration, Volume & Temperature: 0.6% to 6% Controversy Exists
  23. 23. Sodium Hypochlorite Time 5% can take from 20 mins to 2 hours to dissolve pulp tissue (Grossman 1941) Controversy Exists
  24. 24. Sodium Hypochlorite It is Toxic Fear of Hypochlorite Accident It Happens!
  25. 25. Chlorohexidine 2% ✤ Developed in the UK as antiseptic cream ✤ Chemical Structure ✤ pH 5.5 to 7 ✤ Of the polybiguanide group ✤ Mode of action ✤ The molecule is cationic and binds to negatively charged bacteria. ✤ It binds to the cell wall of bacteria and renders it permeable.
  26. 26. Chlorohexidine 2% ✤ Substantivity: ✤ Because of its cationic nature it is absorbed into to tooth structure and remain active after the irrigation session. ✤ Research ranges from 5 minutes to 1 week to initiate the substantivity effect. ✤ Less Toxic than NaOCL ✤ When combined with NaOCL forms parachloroaniline (Brown precipitate) which is very toxic.
  27. 27. Chlorohexidine 2% ✤ Some researchers have claimed combining both CaOH and CHX improves substantivity and the antibacterial effect of both ✤ It can be used and as irrigant and as an intracanal medicament
  28. 28. Chlorohexidine 2% Combination Reactions Brown Precipitate & White Precipitate NaOCL + CHX EDTA + CHX
  29. 29. EDTA 17% ✤ First developed in 1935 and was introduced into endodontics in 1957 (Nygaard-Ostby) ✤ It is a polyaminocarboxylic acid ✤ Combines with metal ions like Ca and Fe ✤ It is used to remove the mineralised part of the smear layer ✤ Once all the available ions combine with Ca the dissolution stops (Self limiting)
  30. 30. EDTA 17% ✤ Uses in Endodontics: ✤ Used to remove smear layer in combination with proteolytic agent like NaOCL ✤ May also detach biofilm adhering to dentin ✤ Has been suggested for use to clean tortuous and narrow canals ✤ When combined with NaOCl it negates the tissue solving capacity.
  31. 31. Before After
  32. 32. MTAD (Mixture ofTetracycline Isomer, an Acid and a Detergent ✤ Based on the idea of combination of surfactant with irrigants to improve wetting of surface ✤ 3% Doxycline, 4.25% citric acid and 0.5% polysorbate 80 (Tween 80)
  33. 33. MTAD (Mixture ofTetracycline Isomer, an Acid and a Detergent ✤ Actions & Characteristics ✤ Strong antibacterial agent (Very effective against E. Fecalis ✤ Smear layer removal similar to EDTA ✤ Used as a final rinse and has a better effect if NaOCl is used prior to the final rinse ✤ Tetraclean is similar to MTAD with different concentration of Doxyciline and a different detergent (Polypropylene glycol)
  34. 34. QMIX ✤ Was developed in 2011 ✤ A combination of CHX-Analog, Triclosan and EDTA ✤ Actions & Characteristics ✤ Good antibacterial agent ✤ Removes smear layer ✤ Initially designed to be used as a final rinse
  35. 35. QMIX ✤ Was developed in 2011 ✤ A combination of CHX-Analog, Triclosan and EDTA ✤ Actions & Characteristics ✤ Good antibacterial agent ✤ Removes smear layer ✤ Initially designed to be used as a final rinse ✤ It is very promising
  36. 36. Iodine Potassium Iodide ✤ It is a halogen ✤ Used in concentration 2% to 5% ✤ Has low toxicity ✤ Effective antibacterial agent ✤ Used in combination with CHX ✤ Some patients are allergic to iodine
  37. 37. Delivery Systems & Agitation Devices
  38. 38. Delivery System & Agitation Devices ✤ Manual Agitation ✤ Sonic Agitation (Endoactivator) 1500 Hz to 6000 Hz ✤ Passive Ultrasonic Irrigation (PUI) ✤ Negative Apical Pressure Techniques ✤ EndoVac ✤ RinsEndo ✤ Safety Irrigator ✤ Gentle wave system ✤ Laser Activated Irrigation ✤ Potoactivated Disinfection ✤ Antibacterial Nanoparticles ✤ Superoxidized Water ✤ Xp EndoFinisher
  39. 39. PUI: Passive Ultrasonic Irrigation Acoustic
 Micro-Streaming
  40. 40. A File Not for Preparation…
  41. 41. Runaway Now…

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