Sonic and Ultrasonic Irrigation |
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John M. Nusstein |
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Abstract
Cleaning and shaping of the root canal with the use of irrigants is a fundamental principle of endodontic therapy. However, current research has shown that needle-delivered irrigation, although effective, is unable to clean and disinfect the root canal system as well as an activated irrigant. This chapter reviews the use of ultrasonic, laser, and sonic-activated irrigation to improve the cleaning and disinfecting of the root canal system. A review of the concepts, systems, and mechanisms will be presented as well as review of the pertinent literature to justify the use of activated endodontic irrigants.
Introduction
The goal of root canal cleaning and shaping is the removal of vital or necrotic tissue, microorganisms, and their by-products and provide space for placing obturating materials. The ultimate goal is the complete removal and disinfection of the root canal space. The question is if that goal is truly achievable utilizing the standard techniques we are currently taught. Almost 100 years ago, Hess [76] showed us the challenges dentists face in cleaning the root canal system (Fig. 10.1). With modern scientiÞc technology, we have been reminded of
J.M. Nusstein, DDS, MS
Division of Endodontics, The Ohio State University
College of Dentistry,
Postle Hall, Room 3058, 305 W. 12th Ave.,
Columbus, OH 43210, USA
e-mail: Nusstein.1@osu.edu
these facts. According to work by Peters [126], one can see on these overlays (Fig. 10.2) that even with our improved NiTi Þle systems, all of the walls of the canals are not touched during cleaning and shaping. HessÕs original Þndings on the complexity of root canal anatomy have been reconÞrmed. As one looks at a cross section of the mesial root of a mandibular Þrst molar (Fig. 10.3), one sees nice round canal preparations at the 1 mm apical level. However, a great deal of tissue is left behind in the isthmus and along the canal wall irregularities. These Þndings are the reason why irrigation has taken on a new importance and why there has been an increase in the research on irrigation. Irrigation works at a level that endodontic Þles cannot reach. Unfortunately the traditional use of needle-only irrigation may not be achieving the results we anticipate.
The ability of an irrigant to dissolve pulp tissue, kill bacteria, and remove smear layer are
© Springer International Publishing Switzerland 2015 |
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B. Basrani (ed.), Endodontic Irrigation: Chemical Disinfection of the Root Canal System, DOI 10.1007/978-3-319-16456-4_10
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Fig. 10.1 Hess [76] intricacies of canal anatomy
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Fig. 10.2 Micro CT scans of canals following rotary Þle instrumentation (red) overlaid preoperative scans (green) [126]
well known and reported in the literature. Some irrigants are better suited for some jobs than others. Research has shown that the preparation
(hand Þles and/or rotary NiTi Þles) of an infected root canal with standard needle irrigation (using sodium hypochlorite Ð NaOCl) and even