Method of Bio-Mechanical Preparation of Root canal

Bio Mechanical Preparartion of Root Canal & Irrigation of Root Canal.

Bio mechanical preparation of root canal system mainly consists of 3 elements namely,

1) MECHANICAL REMOVAL OF PULP TISSUE & INFECTED DENTIN

2) IRRIGATION OF ROOT CANAL &

3) INTRA-CANAL MEDICAMENTS.

In case of single visit RCT, third element is of no use. Hence, we have to do with first 2 elements only. Both are equally important & depend on each other for their effectiveness & ultimate success of the procedure. None of them is effective alone. Mechanical removal of infected pulp & dentin helps irrigating solutions to reach & disinfect root canal system in deeper aspects. Vice versa, copious irrigation removes debris & gives clean & clear path for insertion & working of root canal instruments in root canals.

MECHANICAL REMOVAL OF INFECTED PULP & DENTIN

Many dentists consider removal of pulp (& not infected dentin) is only objective of this step. They consider dentin removal unnecessary. This is one of the biggest misconceptions in field of Endodontics. Due to this misconception only, there is big failure rate for single sitting rct cases especially in non vital teeth.

Fact is that, bacteria are present in dentinal tubules, which creates bacterial toxins. These toxins are equally offending agent for periapical pathology. These bacterial colonies are more in non vital teeth cases. Even, clean dentinal shavings can't ensure you 100% that infected dentin is completely removed. Hence, it is important to remove infected dentine so that irrigating solutions penetrates deep in to the tubules & kills bacteria. Thus, ultimately disinfects the root canal system.

Here, I will always like to state firmly that many Endodontists always gives important to Irrigation only??? We always have to keep it in mind Mechanical Instrumentation is also one of the most important part of BMP!!!

It is mandatory to enlarge apex till at least size of 40 with conventional instruments and size of 30 with greater taper instruments (like ProTaper, HeroShaper etc.) whenever canal anatomy permits us to do so.

Also one should try hard to locate accessory canals by pre-curving the files. Even If you succeed in locating and instrumenting the orifice of accessory canal just once during whole procedure then also it helps a lot for irrigating solution to work well.

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)

2) EDTA

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 PEROXIDE.

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 Saline.

16) Dry the canals with paper points.

NOW THE ROOT CANAL SYSTEM IS READY FOR OBTURATION

Intra Canal Medicaments

Intra Canal Medicaments are the medicaments used to place inside the canals to disinfect the root canal system in between the two appointments.

Studies shows that No intra canal medicament other than CALCIUM HYDROXIDE & MINERAL TRIOXIDE AGGREGATE really make any difference!!!

Also, as we are dealing with SINGLE SITTING RCT there is no question of inter-appointment dressing.

It is impossible to give details of each step. So, interested persons can contact us. CLICK HERE FOR CONTACT DETAILS

This site is dedicated to SINGLE SITTING ENDODONTICS, a branch of dentistry related to Root Canal Treatment completed in just one visit & allied matters.