DISINFECTION OF ROOT CANAL

CONTENTS
INTRODUCTION DISINFECTANTS MEDICAMENTS

INTRODUCTION
The root canal system is complex and includes many accessory anatomical features such as fins, lateral canals and intracanal communication . These complex root canal system provides voids or potential site where bacterial colonization take place.

Most cases gram +ve organism are present and some gram ve and rarely yeast , fungi , filamentous bacteria are also found in root canal . These organism are found in various combination rather than single species. Gram +ve cocci chiefly streptococci and staphylococci and resistent group entrococci are found. Microbial flora of root canal may contain organism that survive on the dead pulp tissue that is saprophytes. The organism reaching the root canal obviously have there origin in the mouth , all varieties of microorganism may have equal chance to invade pulp tissue or root canal. Only those best fit for survival in these environment do survive. Recently presence of obligate and facultative anaerobic are also found in root canal. All these micro organism can invade periapical tissue, so disinfection of root canal is important phase of endodontic treatment.

DISINFECTION
Destruction of pathogenic micro organism which include removal of pulp tissue and debris , cleaning and enlarging of the canal by biochemical means , and clearing of its content by irrigation. Also accomplished by intracanal medication

FACTOR PREDISPOSING TEETH TO INFECTION

Trauma The tooth under treatment should be disoccluded if necessary. Devitalized tissue If present in root canal or periapical tissue , it will interfere with disinfection or repair.

Dead Spaces
For maximum effect medicament should be in contact with microorganism in root canal.

Accumulation of exudate
Exudate should be drained when it accumulates

DISINFECTION
DISINFECTANTS MEDICAMENTS

DIFFERENT TYPE OF ROOT CANAL DISINFECTANT

Sodium hypochlorite Iodine solution Chlorhexidine gluconate Ethylene diamine tetra acetic acid. Electro chemically activated water Photo activated disinfection

Endox Lasers Hydrogen peroxide Carbamide peroxide Salvizol BDA:- bis dequalinium acetate RC-Prep MTAD

SODIUM HYPOCHLORITE
Introduced by Gutheridge in 1919 It is effective bactericidal agent without being toxic or interfering with healing . The disinfection caused by sodium hypochlorite is initially slow but increases progressively . The destruction of bacteria takes place in two phases. Effective against- Enterococus, Actinomycetes, Candida microorganism

a.

Penetration into the bacterial cell.

b. Chemical combination with protoplasm of the bacterial cell that destroys it 0.5% solution dissolves necrotic but not vital tissue. The efficacy of Sodium Hypochlorite decrease with lower conc. It deteriorates on storage and becomes less active with time, increased temperature, exposure to light, and contamination with metallic ions.

Conc. Used is from 0.5% to 5.25. 1% solution should be effective in removing root canal debris and dissolving organic matter and even at 0.5% solution is very potent at killing enterococci. Regular replacement and agitation is required to maximize the effectiveness .

IODINE SOLUTIONS
Solution of 5% Iodine in Potassium Iodide or Churchills solution can be used. Churchills solution consists of 16.5 g. Iodine, 3.5g Potassium Iodide, and 20g. Distilled water, 60g of 90% ethanol. Povidine- Iodine was not as effective as 3% solution of sodium hypochlorite.

Solution of 10% Povidine Iodine achieved a 100% bacterial kill in all samples of E.faecalis as a biofilm exposure for both 2 and 30min. Iodine solution are considered to be potentially useful adjunct to sodium hypochlorite, certainly killing the E.faecalis. Patient may be allergic or sensitive to Iodine .

CHLORHEXIDINE GLUCONATE
Relatively broad spectrum of activity and low toxicity 0.2% CHX was tested against planktonic, biofilm and pellet presentation of E.faecalis. The solution showed potential to reduce bacterial load but was not effective as 3% sodium hypochlorite or 10% Povidine-Iodine. It has good substantivity and ability to adhere to hydroxyapatite crystals in dentine

EDTA-Ethylene diamine tetra acetic acid

EDTA is able to demineralize root wall to a depth of aprox. 20-50m particularly in the middle or cornal parts. Chelating agents can used to remove infected smear layer and open dentinal tubules, allowing more effected disinfection of root canal system.

it has direct and indirect antimicrobial action

It is available in gel or aqueous form , in a conc. Of 17% EDTA and buffered to a neutral pH. Other chelating agents include 25% citric acid, 50% tannic acid and 40% polyacrylic acid

ENDOX
The endox endodontic system sterilizes the root canal by emitting high frequency electrical impulses. Sterilization occur as a result of fulguration and the manufacturer claims it is able to eliminate both pulp and bacteria from the entire root canal system Its not able to eliminate pulp tissue from the root canal system without mechanical cleaning Utilized as a supplement to traditional cleaning and shaping.

ELECTRO CHEMICALLY ACTIVATED WATER

After electrolysis of an aqueous saline solution an anolyte and catholyte are produced and isolated Anolyte has antimicrobial effect and high oxidation potentional and pH of between 2 and 9

TYPES
a. b. Electrolysed Neutral Water: - It has pH close to 7. The solution is bactericidal against a selection of commonly isolated endodontic pathogen. Oxidative potential water: - It is highly antimicrobial because of its acidity and high oxidation reduction potential .It also removed smear layer and debris.

c. i. ii. iii.

Sterilox The main active ingradient that is produce by sterilox generator is .05- 95% hypochlorous acid . Effective biocide Non-toxic , Non-sensitizing, Non- irritating and Non-mutagenic

LASERS
TYPES 1. Erbium lasers:i. It emits radiation at a wavelength similar to the absorption peak of water . ii. Its suitable for oblation of dentin as they

dont create much heat.

2. The water lase

i. It is an erbium chromium- yttrium- scandium-gallium-garnet laser that has been claimed to exert hydrokinetic effects as the laser light react with water molecules It is able to form the root canal shape without local anesthesia .

ii.

PHOTO ACTIVATED DISINFECTION

This technique uses the photoactive agent Tolonium Chloride The canal is irrigated with solution which slectively binds to the cellular membrane of bacteria in biofilm.The bacterial cells rupture well exposed to laser light of appropriate wavelength The PAD system uses a red laser emitting radiation of wavelength 635 nm. It is effective against streptococcus intermedius biofilm in the root canal . Not as effective as 3% sodium hypochlorite

HYDROGEN PEROXIDE
1. 2. Used in endodontics with two mode of action . The bubbling of solutions when in contact with tissue and certain chemicals physically foames debris from the canal 3. Libration of oxygen destroys strictly anaerobic microorganism . 4. Less effective as solvent 5. Less damaging to periapical tissues.

SALVIZOL
1. Used as root canal irrigant and chelating agent 2. It is N1-decamethylene bis-4aminoquianaldinum-diacetate 3. broad spectrum of bactericidal activity and ability to chelate calcium 4. It gives the product a cleansing potency while being biologically compatible

BDA
1. 2. 3. 4. 5. 6. 7. It is bis-dequalinum acetate disinfectant and chemotherapeutic agent Low toxicity Lubrication action Low surface tension , chelating properties Low incidence of post operative pain due to removal of smear layer coated with bacteria and contaminants Indicated to patients allergic to sodium

hypochlorite

MTAD
It is recently developed irrigating solution that consist of tetracycline , acetic acid and detergent It will kill E.faecalis. Effective for removing smear layer along the entire length of prepared root canal It is able to remove both organic and inorganic debris but doesnt appear to have a determentale effect on the physical dynamics of dentine unlike 5.25% sodium hypochlorite and 17% EDTA

CALCIUM HYDROXIDE
Long duration of action Good spectrum of Antimicrobial activity Safe to use in combination with sodium hypochloride It is slow acting so needs to be present in sufficient quantity and for at least one week
In aqueous form it is poorly dissociated but the hydroxyl ions liberated create the high pH that is required for bacterial killing. Dispersion into narrow or highly curved canal is difficult . Its slurry is thixotrophic and with agitation become more fluid. Material can be used into canal with a lentulo spiral filler or hand instrument. It can be mixed 7:1 with barium sulfate to make it radio opaque. Glycerin can be mixed to improve flow but reduces pH. so other carriers like Methylcellulose can used to make removal of medicament more difficult.

IODINE IN POTASSIUM IODIDE

Powerful oxidizing agents that disrupt bacterial cellular enzyme system and inactivate them. Used as intracanal antiseptic agent in conc. Between 2% and 10% in aqueous solution. 3. Broad spectrum of activity and low toxicity . Effectiveness is short lived and is not suitable for periods of medication longer than 2 days .

ANTIBIOTICS
1. Grossmans polyantibiotics paste :- used in earlier days . contained penicillin . It is relatively ineffective .

2.

Metronidazole :a. Effective against gram-negative anaerobes b. Use as an adjunct in periodontal treatment c. Advocated for use as root canal irrigant Tetracycline :-used in periodontal treatment.

3.

4.

Ledermix :a. Combination of doxycycline and corticosteroids b. Range and duration of antimicrobial action may be limited

Clindamycin:a. b. Placed in teeth with necrotic pulps undergoing root canal treatment No advantage over conventional root canal dressing such as calcium hydroxide for elimination of bacteria

CORTICO STEROID ANTIBIOTIC COMBINATIONS

1. Placed into inflammed periapical tissue by a paper point or reamer. 2. Reduces periapical inflammation . 3. Gives almost instant relief of pain in extreme tenderness to percussion after canal instrumentation. 4. No overgrowth of microorganism will occur due to presence of antibiotics.

SULFONAMIDE
1. 2. 3. Mixed with sterile water Placed into root canal by paper point Used when closing teeth that has been opened after an acute periapical abscess

PHENOLIC COMPOUNDS
A. PHENOL:i. Protoplasm poison ii. Produces necrosis of soft tissues iii. Strong inflammatory potential iv. Used for disinfection before periapical surgery

v.

Used for cauterizing tissue tags that resist removal with broaches or files.

B.

EUGENOL i. ii. iii. iv. Both antiseptic and anodyne Inhibits intradental nerve impulses May be allergic too Used as medicament after partial or complete pulpectomy.

C. i. ii. iii. iv. D.

CAMPHORATED MONOPARACHLOROPHENOL Wide spectrum of antibacterial activity Effective against fungi as well Less irritating to periapical tissue than either phenol or eugenol without sacrificing antimicrobial action Inexpensive and has long self life

FOROMOCRESOL Non specific bactericidal medicament Most effective against aerobic and anaerobic organism iii. Useful as dressing for pulpectomy to fix the retain pulp tissues iv. Used when pulpectomy is performed as emergency treatment to relieve pain in situation where pulp information in confined to pulp chamber. i. ii.