
- •Foreword
- •Preface
- •Acknowledgments
- •Contents
- •Contributors
- •Introduction
- •Resistance to Antimicrobials
- •Bacterial Cells That Persist
- •Markers of Cell Viability
- •Surface Coating
- •Concluding Remarks
- •References
- •A Brief History of the First Studies on Root Canal Anatomy
- •Computational Methods for the Study of Root Canal Anatomy
- •References
- •Introduction
- •Syringes
- •Needles
- •Physical Properties of Irrigants
- •Irrigant Refreshment
- •Wall Shear Stress
- •Apical Vapor Lock
- •Anatomical Challenges
- •Summary: Clinical Tips
- •References
- •Introduction
- •Challenges of Root Canal Irrigation
- •In Vitro: Direct Contact Tests
- •In Vivo Models
- •Sampling Methods
- •Models to Study Cleaning of Isthmus Areas
- •Dentin Canals
- •Lateral Canals
- •Smear Layer
- •New Models to Study Irrigation
- •Measuring Antibacterial Activity
- •Inaccessible Root Canal Areas
- •Particle Image Velocimetry
- •Irrigation Pressure in the Apical Canal
- •Wall Shear Stress/Wall Velocity
- •Needle Design
- •Conclusions
- •References
- •Antiseptic Solutions
- •Sodium Hypochlorite
- •Mode of Action
- •Concentration
- •Volume
- •Time
- •Effect on the Dentin
- •Depth of Penetration
- •Limitations
- •Clinical Recommendation
- •Chlorhexidine Gluconate (CHX) [6]
- •Molecular Structure
- •Mode of Action
- •Substantivity
- •Chlorhexidine as an Endodontic Irrigant
- •Allergic Reactions to Chlorhexidine
- •Limitations
- •Clinical Recommendations
- •Decalcifying Agents
- •Ethylenediaminetetraacetic Acid
- •History
- •Mode of Action
- •Applications in Endodontics
- •Interaction Between CHX and NaOCl
- •Interaction Between CHX and EDTA
- •Interaction Between EDTA and NaOCl
- •Clinical Recommendations
- •HEBP
- •Effect of Temperature
- •NaOCl + Heat
- •EDTA + Heat
- •CHX + Heat
- •Combinations and Solutions with Detergents
- •BioPure MTAD and Tetraclean
- •Mode of Action
- •Smear Layer Removal
- •Clinical Trials
- •Protocol for Use
- •QMiX
- •Protocol
- •Smear Layer Removal
- •Clinical Trials
- •Disinfection Protocol Suggested
- •References
- •Microbial Control: History
- •NaOCl: Cytotoxicity
- •NaOCl: Complications
- •Maxillary Sinus Considerations
- •Intraosseous Injection
- •The Peck Case History
- •Informed Consent
- •Conclusion
- •References
- •Introduction
- •On Apical Transportation
- •Role of the Patency File on Irrigant Penetration into the Apical Third of Root Canals
- •The Use and Effect of the Patency File in Cleaning of the Root Canals in Teeth with Vital Pulps
- •References
- •Static Versus Dynamic Irrigation
- •The Vapor Lock Effect
- •MDA Mode of Use
- •Conclusion
- •References
- •Apical Negative Pressure
- •The EndoVac System
- •Method of Use
- •Debris Removal
- •Microbial Control
- •Smear Layer Removal
- •Apical Vapour Lock
- •Calcium Hydroxide Removal
- •Sodium Hypochlorite Incidents
- •Safety
- •Conclusion
- •References
- •10: Sonic and Ultrasonic Irrigation
- •Introduction
- •Ultrasonic Activation
- •Ultrasonic Energy Generation
- •Debris and Smear Layer Removal
- •Safety
- •Laser-Activated Irrigation (LAI)
- •Sonic Activation
- •Debris and Smear Layer Removal
- •Safety
- •Summary
- •References
- •The Self-Adjusting File (SAF) System
- •The Self-Adjusting File (SAF)
- •The RDT Handpiece Head
- •EndoStation/VATEA Irrigation Pumps
- •Mode of Irrigation by the SAF System
- •Positive Pressure Irrigation
- •Negative Pressure Irrigation
- •No-Pressure Irrigation
- •Mode of Action of EDTA
- •Mode of Cleaning with the SAF System
- •Disinfection of Oval Canals
- •Effect of Cleaning on Obturation
- •The Challenge of Isthmuses
- •The Challenge of Immature Teeth
- •References
- •12: Ozone Application in Endodontics
- •Introduction
- •Applications of Ozone in Medicine
- •Ozone in Dentistry
- •Effects on Dentin Bonding
- •Ozone in Endodontics
- •Antibacterial Activity
- •Antifungal Activity
- •Ozone and Endotoxin
- •Conclusion
- •References
- •Newer Laser Technology
- •PIPS
- •PIPS Protocol
- •References
- •Introduction
- •Conclusion
- •References
- •Introduction
- •History
- •The Rationale for Local Application of Antibiotics
- •Tetracyclines
- •Structure and Mechanisms of Action
- •Properties
- •Applications in Endodontics
- •Substantivity of Tetracyclines
- •MTAD
- •Antimicrobial Activity
- •Substantivity of MTAD
- •Smear Layer Removal and Effect on Dentin
- •Toxicity of MTAD
- •Tetraclean
- •Antibacterial Activity
- •Substantivity of Tetraclean
- •Smear Layer Removal Ability
- •Ledermix Paste
- •Triple Antibiotic Paste
- •Conclusions
- •References
- •16: Intracanal Medication
- •The Infectious Problem
- •Calcium Hydroxide
- •Vehicles for Calcium Hydroxide
- •Mechanisms of Antimicrobial Effects
- •Combination with Biologically Active Vehicles
- •Paste in CPMC
- •Paste in CHX
- •Chlorhexidine Alone for Intracanal Medication
- •Other Intracanal Medicaments
- •Other Indications for Intracanal Medication
- •References
- •Introduction
- •Missing Canals
- •Vertical Root Fracture
- •Infection
- •Removal of Filling Material
- •Carrier-Based Filling Materials
- •Sodium Hypochlorite (NaOCl)
- •Chelants
- •Ethylenediaminetetraacetic Acid (EDTA)
- •Chlorhexidine Digluconate (CHX)
- •Concluding Remarks
- •References
- •Introduction
- •Irrigation Techniques
- •Concluding Remarks
- •References
- •19: Conclusion and Final Remarks
- •Index

Acknowledgments
I would like to start by thanking Springer International Publishing for giving me the wonderful opportunity of editing a textbook on chemical disinfection of the root canal system. I appreciate the trust, patience, and knowledge they demonstrated throughout the whole process. I also want to thank Dean Haas, Faculty of Dentistry, University of Toronto, for granting me the 6-month sabbatical to focus on this project, and I have a deep appreciation to the whole endodontic department of the faculty of dentistry for their motivation and constant support. Special thanks to Warrena Wilkinson for editing some of the chapters and Dr. Calvin Torneck for the thoughtful writing of the preface.
Gratitude goes to the collaborators of this book. It was a great pleasure to invite you to participate in this project, and your motivated and enthusiastic responses were always encouraging. Thanks for your expertise and dedication.
Finally, I want to recognize my family. I have to start by thanking my father, Professor Emeritus Dr. Enrique Basrani, for showing me what a life of an endodontist looks like. He lived in Buenos Aires, Argentina, and divided his time between academics and clinical practice, while he wrote six textbooks in endodontics, finishing his last one on his death bed. He never stopped working. I should say: he never stopped doing what he loved. Now, as I follow in his steps, dividing my own time between academics and clinical practice, and feel him guiding me in spirit in all that I do. Secondly, I want to thank my mother, Clarita, and mother-in-law, Enid Alter for listening and understanding when sometimes I think that life is overpowering. My brother Dr. Damian Basrani and his family always have a special place in my heart. Howard, my beloved and precious husband, thanks for being there for me, always. Without your presence in my life, I would not be able to be the person that I am today. And to my beautiful children, Jonathan and Daniel, for being as enthusiastic as I am in everything they do.
I want to conclude by thanking all my students, from the undergraduate to graduate program and participants in lectures and workshops. You are the ones who make us better teachers, the ones who challenge us, who inspire us to give our best, and the ones who I also dedicate this book to.
xi

Contents
1 |
Microbial Biofilms in Endodontics . . . . . . . . . . . . . . . . . . . . . . . . |
. 1 |
|
Luis E. Chávez de Paz |
|
2 |
Update in Root Canal Anatomy of Permanent |
|
|
Teeth Using Microcomputed Tomography . . . . . . . . . . . . . . . . . . |
15 |
|
Marco A. Versiani, Jesus D. Pécora, |
|
|
and Manoel D. Sousa-Neto |
|
3 |
Syringe Irrigation: Blending Endodontics |
|
|
and Fluid Dynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
45 |
|
Christos Boutsioukis and Lucas W.M. van der Sluis |
|
4 |
Research on Irrigation: Methods and Models . . . . . . . . . . . . . . . |
65 |
|
Ya Shen, Yuan Gao, James Lin, Jingzhi Ma, Zhejun Wang, |
|
|
and Markus Haapasalo |
|
5 |
Update of Endodontic Irrigating Solutions . . . . . . . . . . . . . . . . . |
99 |
|
Bettina Basrani and Gevik Malkhassian |
|
6 |
Complications of Endodontic Irrigation: |
|
|
Dental, Medical, and Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
117 |
|
Gary Glassman |
|
7 |
The Role of the Patency File in Endodontic Therapy . . . . . . . . |
137 |
|
Jorge Vera |
|
8 |
Manual Dynamic Activation (MDA) Technique . . . . . . . . . . . . |
149 |
|
Pierre Machtou |
|
9 |
Apical Negative Pressure: Safety, Efficacy and Efficiency . . . . |
157 |
|
Gary Glassman and Karine Charara |
|
10 |
Sonic and Ultrasonic Irrigation . . . . . . . . . . . . . . . . . . . . . . . . . . |
173 |
|
John M. Nusstein |
|
11 |
Continuous Instrumentation and Irrigation: |
|
|
The Self-Adjusting File (SAF) System . . . . . . . . . . . . . . . . . . . . |
199 |
|
Zvi Metzger and Anda Kfir |
|
12 |
Ozone Application in Endodontics . . . . . . . . . . . . . . . . . . . . . . . |
221 |
|
Zahed Mohammadi and Amir Azarpazhooh |
|
xiii
xiv |
Contents |
|
|
13Irrigation of the Root Canal System by Laser Activation (LAI): PIPS Photon-Induced
|
Photoacoustic Streaming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
227 |
|
David E. Jaramillo |
|
14 |
Photodynamic Therapy for Root Canal Disinfection . . . . . . . . |
237 |
|
Anil Kishen and Annie Shrestha |
|
15 |
Local Applications of Antibiotics and Antibiotic-Based |
|
|
Agents in Endodontics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
253 |
|
Zahed Mohammadi and Paul V. Abbott |
|
16 |
Intracanal Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
267 |
|
José F. Siqueira Jr. and Isabela N. Rôças |
|
17 |
Disinfection in Nonsurgical Retreatment Cases. . . . . . . . . . . . . |
285 |
|
Rodrigo Sanches Cunha and Carlos Eduardo da Silveira Bueno |
|
18 |
Irrigation in Regenerative Endodontic Procedures. . . . . . . . . . |
301 |
|
Anibal R. Diogenes and Nikita B. Ruparel |
|
19 |
Conclusion and Final Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . |
313 |
|
Bettina Basrani |
|
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
315 |