IRRIGATION OF ROOT CANAL SYSTEM
There are various irrigants available for irrigation of root
canal system. Irrigation procedure for Multiple visit RCT & Single visit RCT does not have much difference except the
case of non vital teeth, where last irrigation before obturation should be done by Dexamethasone & Normal Saline mixture
to lessen the chances of phoenix reaction. It is needless in case of Single sitting RCT of vital teeth.
Various irrigants available are
1) Na Hypochloride (Warm)
3) Hydrogen Peroxide
4) Chlorhexidine Gluconate
5) Normal Saline & Dexamethasone
The regimen which I will like to recommend
for IRRIGATION is as follows-
1) Open the pulp chamber
2) Extirpate the coronal pulp with spoon
excavator or ultra sonic tip
3) Flood the chamber with EDTA & CARBAMIDE
PEROXIDE GEL for lubrication of canals while exploring
4) EDTA usually act on canal walls causing
chelation n results in loosening of debris. Try to remove those soft tissue debris with Warm NaOCl n collect it on cotton
5) Complete the removal of infected dentin
with routine protocol( assisted with EDTA lubrication).
NOW THIS IS THE STAGE WHERE YOUR IRRIGATION
ACTUALLY GOING TO HELP YOU IN REAL WAY
6) Flood the root canal system with LIQUID
EDTA (I will again like to stress that till this stage we are using EDTA gel for lubrication and hence further we are
using EDTA liquid for IRRIGATION resulting in chelation, smear layer removal, opening of blocked canals etc)
7) After that Irrigate and flood the Root
canal system with warm NaOCl for 10-15mins at least. During which just agitate the solution with hand files or simply
just aspirate and again flood it in system continuously to prevent apical vapor lock. If possible the best way is creating
Negative pressure at apex by using advanced irrigation system commercially available with name ENDOVAC.
8) Now irrigate forcefully with HYDROGEN
TILL THIS STAGE WE WERE DEALING WITH CLEANING
OF DEBRIS TRAPPED IN CANAL IRREGULARITIES WHICH WE CAN'T CLEAN WITH ROUTINE SYSTEM.
9) Again flood the root canal system by
liquid EDTA followed by Warm NaOCl.
10) Now, use the ENDOSONIC irrigation
system in root canal. It will force the NaOCl on Lateral Accessory canals and apical deltas.
11) Again irrigate with Hydrogen Peroxide.
12) Flood root canal system with liquid
EDTA for management of smear layer.
13) Flood root canal system with either CHLORHEXIDINE
GLUCONATE or SODIUM HYPOCHLORITE(NaOCl).
14) Dry the canals with Paper Points
15) If you have doubt of having Phoenix Reaction then you can irrigate the canal with Mixture of Dexamethasone and Normal
16) Dry the canals with paper points.
NOW THE ROOT CANAL SYSTEM IS READY FOR