DISINFECTION

OF
ROOT CANAL
Presented By:
Amandeep Chopra
CONTENTS

• INTRODUCTION

• DISINFECTANTS

• MEDICAMENTS

AMANDEEP CHOPRA 3
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 4
INTRODUCTION contd..

• 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.

AMANDEEP CHOPRA 5
INTRODUCTION contd..

• 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.

AMANDEEP CHOPRA 6
INTRODUCTION contd..

• 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.

AMANDEEP CHOPRA 7
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 8
FACTOR PREDISPOSING TEETH TO INFECTION
1. Trauma
The tooth under treatment should be disoccluded if necessary.

2. Devitalized tissue
If 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 exudate
Exudate should be drained when it accumulates

AMANDEEP CHOPRA 9
 DISINFECTION

DISINFECTANTS MEDICAMENTS

AMANDEEP CHOPRA 10
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 11
 Contd…

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

AMANDEEP CHOPRA 12
 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 13
AMANDEEP CHOPRA 14
SODIUM HYPOCHLORITE Contd…

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.

AMANDEEP CHOPRA 15
SODIUM HYPOCHLORITE Contd…

• 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 .

AMANDEEP CHOPRA 16
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 17
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 18
 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 19
 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 20
EDTA Contd…

• 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

AMANDEEP CHOPRA 21
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 22
AMANDEEP CHOPRA 23
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 24
 ELECTRO CHEMICALLY ACTIVATED WATER Contd…

• When anolyte and catholyte are individually used to irrigate infected

canals , the antimicrobial effectiveness was disappointing compare
with 0.5% sodium hypochlorite

AMANDEEP CHOPRA 25
ELECTRO CHEMICALLY ACTIVATED WATER Contd…

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.

AMANDEEP CHOPRA 26
ELECTRO CHEMICALLY ACTIVATED WATER Contd…

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

AMANDEEP CHOPRA 27
LASERS
• TYPES
1. 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 28
 Contd…

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.

AMANDEEP CHOPRA 29
 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 30
PHOTO ACTIVATED DISINFECTION (PAD) SYSTEM

AMANDEEP CHOPRA 31
HYDROGEN PEROXIDE
1. 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 32
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 33
BDA
1. It is bis-dequalinum acetate
2. disinfectant and chemotherapeutic agent
3. Low toxicity
4. Lubrication action
5. Low surface tension, chelating properties
6. 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 34
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 35
• 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 36
AMANDEEP CHOPRA 37
 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 38
• 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 39
IODINE IN POTASSIUM IODIDE
1. 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 40
ANTIBIOTICS
1. 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
treatment
c. Advocated for use as root canal irrigant

3. Tetracycline :-used in periodontal treatment.

AMANDEEP CHOPRA 41
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 treatment
b. No advantage over conventional root
canal dressing such as calcium
hydroxide for elimination of bacteria

AMANDEEP CHOPRA 42
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 43
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 44
PHENOLIC COMPOUNDS
A. PHENOL:-
i. Protoplasm poison
ii. Produces necrosis of soft tissues
iii. Strong inflammatory potential
iv. Used for disinfection before
periapical surgery
v. Used for cauterizing tissue tags
that resist removal with
broaches or files.

AMANDEEP CHOPRA 45
B. EUGENOL

•Both antiseptic and anodyne

•Inhibits intradental nerve impulses

•May be allergic too

•Used as medicament after partial or

complete pulpectomy.

AMANDEEP CHOPRA 46
C. CAMPHORATED MONOPARACHLOROPHENOL
i. 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 47
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.

AMANDEEP CHOPRA 48