Root Canal Treatment: Rooth Canal Rinsing

Watch Dental Video about Root Canal Rinsing

Rinsing out the root canal is an important part of the root treatment.

First the canals are made conical and even by means of special files. This serves principally to produce better results. The aims of root canal rinsing are:

  • Reduction of germs and bacterial toxins in the root canal system
  • Dissolution and removal of the remains of the pulp tissues
  • Supporting the physical preparation and removal of dentine fragments

 

Requirements of rinsing fluids?

  • Disinfective effect
  • Biologically compatible
  • Tissue dissolving effect
  • Simple application for disinfection

The antimicrobial effect of a rinsing fluid increases in relation to the frequency of application, the duration of application, the concentration and the temperature. The rinsing effect is only effective when preparation permits full access of the rinsing cannula in the root tip area. It is therefore recommended to prepare a wide area and to make use of narrow cannulae for rinsing, which, without interference, can be brought to within 4-5mm of the apical preparation end point. Jamming the cannula in the root canal is to be avoided as it may lead to unnecessarily high pressure of the rinsing fluid within the apical tissues and thus to destruction of tissue and possible severe pain. The activation of the rinsing solution by means of ultrasound for example is advantageous. In infected canals an effective long interaction for the dissolution of the biofilm is advised.

Rinsing during root canal treatment

Rinsing during root canal treatment

  • very good antibacterial effect on most of the germs found within tooth and jaw with low toxicity
  • the ability to dissolve necrotic as well as vital tissue
  • the ability to neutralize lipopolysaccharides

Since the NaOCl solution breaks down rapidly at high temperatures it should be warmed just before or during its use. It should be stored in a cool and dark location.

Chlorhexidine gluconate (CHX) in concentrations of between 0.2% and 2% also demonstrates very good antimicrobial effects with good biological compatibility. It doesn’t have a tissue-dissolving effect and doesn’t neutralize endotoxins. Rinsing with CHX should be seen as an additional rinse, its advantages lying in its particular effectiveness against gram-positive bacteria (e.g. enterococci) and fungi which are seen to proliferate in follow-up cases and which may be resistant to NaOCl and/or Ca(OH)2. CHX crystals may sometimes form in the root canal when rinsing with CHX after rinsing with NaOCl, so a rinse with – for example – Aquadest should be performed between the CHX and NaOCl rinses.

Rinsing during a root canal procedure

Rinsing during a root canal procedure

Hydrogen peroxide (H2O2) 3-5% hardly has an antimicrobial effect. Changing to H2O2 from NaOCl does not make much sense since both the antimicrobial and the tissue dissolving effects of the NaOCl will be strongly reduced by the neutralizing actions of the solutions (H2O2 +NaOCl -> H2O+ NaCl + O2).

Nowadays substances containing phenols and formaldehydes are no longer indicated. They are non-specifically toxic, that is to say toxic toward both healthy and unhealthy body tissues. They can cause bone-inflammations, amongst other reasons because of their rapid diffusion in the areas beyond the root canal which will result in a rapid effect within a short time there.

What does a root canal rinsing procedure look like?

  • With the physical preparation of the root canal a smear layer is formed of the canal tissues which have been worked on, namely dentine, pulp and bacteria, which blocks the tubules.
  • Ethylenediaminetetraacetic acid (EDTA) has moderate antibacterial properties and is usually used in a concentration of up to 15% to remove the smear layer.
  • After an application of EDTA a rinse with natrium hypochlorite is recommended.
  • Alcohol doesn’t have sufficient antibacterial properties but can be applied just before the filling of the root canal in order to dry it out.

Click here to see the video: Sodium Hypochlorite

 

This post is also available in: German

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