DISINFECTION OF

ROOT CANAL

Presented By:

Amandeep Chopra

AMANDEEP CHOPRA 3

CONTENTS

• INTRODUCTION

• DISINFECTANTS

• MEDICAMENTS

AMANDEEP CHOPRA 4

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.

AMANDEEP CHOPRA 5

• 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.

INTRODUCTION contd..

AMANDEEP CHOPRA 6

• 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 may have equal chance to invade pulp tissue or root canal.

• Only those best fit for survival in these environment do survive.

INTRODUCTION contd..

AMANDEEP CHOPRA 7

• 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.

INTRODUCTION contd..

AMANDEEP CHOPRA 8

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

AMANDEEP CHOPRA 9

FACTOR PREDISPOSING TEETH TO INFECTION1. Trauma

The tooth under treatment should be disoccluded if necessary.

2. Devitalized tissueIf present in root canal or periapical tissue, it will interfere with disinfection

or repair.

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

in root canal.

4. Accumulation of exudateExudate should be drained when it accumulates

AMANDEEP CHOPRA 10

DISINFECTION

DISINFECTANTS MEDICAMENTS

AMANDEEP CHOPRA 11

DIFFERENT TYPE OF ROOT CANAL DISINFECTANT

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

AMANDEEP CHOPRA 12

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

Contd…

AMANDEEP CHOPRA 13

SODIUM HYPOCHLORITE• Introduced by Gutheridge in 1919.• Effective against - Enterococus, Actinomycetes, Candida

microorganism.• Lower Conc.-dissolves necrotic tissue.• Higher Conc.-dissolves necrotic & vital tissue.• It is effective bactericidal agent without being toxic or interfering with

healing .The disinfection caused by sodium hypochlorite is initially slow but increases progressively .

AMANDEEP CHOPRA 14

AMANDEEP CHOPRA 15

The destruction of bacteria takes place in two phases.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.

SODIUM HYPOCHLORITE Contd…

AMANDEEP CHOPRA 16

• 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 .

SODIUM HYPOCHLORITE Contd…

AMANDEEP CHOPRA 17

IODINE SOLUTIONS• Solution of 5% Iodine in Potassium Iodide or Churchill’s

solution can be used. Churchill’s 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.

• Iodine acts as oxidizing agent by reacting with free sulphydryl gp of bacterial enzyme cleaving disulphide bonds

AMANDEEP CHOPRA 18

Iodine Solution Contd…

• 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 .• Combination of IKI & CHX may be able to kill Calcium Hydroxide

resistant bacteria

AMANDEEP CHOPRA 19

CHLORHEXIDINE GLUCONATE

• Relatively broad spectrum of activity and low toxicity.• Effective conc commonly used is 0.2-2% • 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

AMANDEEP CHOPRA 20

EDTA-Ethylene diamine tetra acetic acid

• EDTA is able to demineralize root wall to a depth of aprox. 20-50µm 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.

AMANDEEP CHOPRA 21

• 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.

• Strongest effect when used synergically with NaOCl

EDTA Contd…

AMANDEEP CHOPRA 22

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.

AMANDEEP CHOPRA 23

AMANDEEP CHOPRA 24

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.Anolyte also termed as super oxidized or oxidative pot. water but now a days neutral or alkaline sol recommended.

AMANDEEP CHOPRA 25

• When anolyte and catholyte are individually used to irrigate infected canals , the antimicrobial effectiveness was disappointing compare with 0.5% sodium hypochlorite

ELECTRO CHEMICALLY ACTIVATED WATER Contd…

AMANDEEP CHOPRA 26

TYPES

a. Electrolysed Neutral Water: - It has pH close to 7. The solution is bactericidal against a selection of commonly isolated endodontic pathogen.

b. Oxidative potential water: - It is highly antimicrobial because of its acidity and high oxidation –reduction potential .It also removes smear layer and debris.

ELECTRO CHEMICALLY ACTIVATED WATER Contd…

AMANDEEP CHOPRA 27

c. Sterilox i. The main active ingradient that is produce by

sterilox generator is .05- 95% hypochlorous acid ii. Effective biocide iii. Non-toxic , Non-sensitizing, Non- irritating and

Non-mutagenic

ELECTRO CHEMICALLY ACTIVATED WATER Contd…

AMANDEEP CHOPRA 28

LASERS

• TYPES1. Erbium lasers:-

i. It emits radiation at a wavelength similar to the absorption peak of water.

ii. It’s suitable for oblation of dentin as they don’t create much heat.

AMANDEEP CHOPRA 29

2. The water laser

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.

ii. It is able to form the root canal shape without local anesthesia.

Contd…

AMANDEEP CHOPRA 30

PHOTO ACTIVATED DISINFECTION (PAD)• This technique uses the photoactive agent Tolonium Chloride • The canal is irrigated with solution which selectively 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

AMANDEEP CHOPRA 31

PHOTO ACTIVATED DISINFECTION (PAD) SYSTEM

AMANDEEP CHOPRA 32

HYDROGEN PEROXIDE1. Used in endodontics with two mode of action . 2. The bubbling of solutions when in contact with tissue and

certain chemicals physically foames debris from the canal.

3. Libration of oxygen destroys anaerobic microorganism.4. Less effective as solvent.5. Less damaging to periapical tissues.

AMANDEEP CHOPRA 33

SALVIZOL

1. Used as root canal irrigant and chelating agent

2. It is N1-decamethylene bis-4- aminoquianaldinum-diacetate

3. broad spectrum of bactericidal activity and ability to chelate calcium

4. It gives the product a cleansing potency while being biologically compatible

AMANDEEP CHOPRA 34

BDA1. It is bis-dequalinum acetate2. disinfectant and chemotherapeutic agent3. Low toxicity 4. Lubrication action 5. Low surface tension, chelating properties6. Low incidence of post operative pain due to

removal of smear layer coated with bacteria and contaminants

7. Indicated to patients allergic to sodium hypochlorite

AMANDEEP CHOPRA 35

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 doesn’t

appear to have a determentale effect on the physical dynamics of dentine unlike 5.25% sodium hypochlorite and 17% EDTA

AMANDEEP CHOPRA 36

• It is less cytotoxic than eugenol, 3% hydrogen peroxide, EDTA and calcium hydroxide

• It is used for 5 min. as final rinse after hypochlorite and EDTA.

AMANDEEP CHOPRA 37

AMANDEEP CHOPRA 38

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

AMANDEEP CHOPRA 39

• 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 . It’s 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.

AMANDEEP CHOPRA 40

IODINE IN POTASSIUM IODIDE1. Powerful oxidizing agents that disrupt bacterial cellular enzyme

system and inactivate them.

2. 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.

AMANDEEP CHOPRA 41

ANTIBIOTICS1. Grossman’s 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

treatmentc. Advocated for use as root canal irrigant

3. Tetracycline :-used in periodontal treatment.

AMANDEEP CHOPRA 42

4. Ledermix :-a. Combination of doxycycline and

corticosteroids b. Range and duration of antimicrobial

action may be limited

5 Clindamycin:-a. Placed in teeth with necrotic pulps

undergoing root canal treatmentb. No advantage over conventional root

canal dressing such as calcium hydroxide for elimination of bacteria

AMANDEEP CHOPRA 43

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.

AMANDEEP CHOPRA 44

SULFONAMIDE

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

periapical abscess.

AMANDEEP CHOPRA 45

PHENOLIC COMPOUNDSA. PHENOL:-

i. Protoplasm poison ii. Produces necrosis of soft tissuesiii. Strong inflammatory potentialiv. Used for disinfection before

periapical surgeryv. Used for cauterizing tissue tags

that resist removal with broaches or files.

AMANDEEP CHOPRA 46

B. EUGENOL

•Both antiseptic and anodyne

•Inhibits intradental nerve impulses

•May be allergic too

•Used as medicament after partial or complete pulpectomy.

AMANDEEP CHOPRA 47

C. CAMPHORATED MONOPARACHLOROPHENOLi. Wide spectrum of antibacterial activity.

ii. Effective against fungi as well. iii. Less irritating to periapical tissue than either phenol or eugenol without

sacrificing antimicrobial action. iv. Inexpensive and has long self life.

AMANDEEP CHOPRA 48

D. FOROMOCRESOL 1. Non specific bactericidal medicament 2.Most effective against aerobic and anaerobic organism 3. Useful as dressing for pulpectomy to fix the retain pulp tissues.4.Used when pulpectomy is performed as emergency treatment to relieve pain in situation where pulp information in confined to pulp chamber.