Over the years, many irrigating agents have been tried in order to achieve tissue dissolution and bacterial decontamination. The ability to deliver irrigants to the root-canal terminus in a safe manner without causing harm to the patient is as important as the efficacy of those irrigants. Root-canal irrigants must not only be effective for dissolution of the organic of the dental pulp, but also effectively eliminate bacterial contamination and remove the smear layer - the organic and inorganic layer that is created on the wall of the root canal during instrumentation. Therefore, a suitable irrigant and irrigant delivery system are essential for efficient irrigation and the success of endodontic treatment. faecalis commonly expresses multidrug resistance, complicating treatment. In addition, Enterococcus faecalis and Actinomyces prevention or treatment of apical periodontitis such as Actinomyces israelii - which are both implicated in endodontic infections and in endodontic failure - penetrate deep into dentinal tubules, making their removal through mechanical instrumentation impossible. The challenge for successful endodontic treatment has always been the removal of vital and necrotic remnants of pulp tissue, debris generated during instrumentation, the dentin smear layer, microorganisms, and micro-toxins from the root-canal system.Įven with the use of rotary instrumentation, the nickel-titanium instruments currently available only act on the central body of the root canal, resulting in a reliance on irrigation to clean beyond what may be achieved by these instruments. Additionally, the root-canal system has a complex anatomy that consists of arborisations, isthmuses and cul-de-sacs that harbor organic tissue and bacterial contaminants (Figs. The presence of microorganisms embedded in a biofilm and growing in the root-canal system is a key factor for the development of periapical lesions. These adherent cells are frequently embedded within a self-produced matrix of extracellular polymeric substance. A biofilm is an aggregate of microorganisms in which cells adhere to each other and/or to a surface. There is evidence that apical periodontitis is a biofilm-induced disease. For these to be achieved, appropriate instrumentation, irrigation, decontamination and root-canal obturation must occur, as well as attainment of a coronal seal. The ultimate goal of endodontic treatment per se is the prevention or treatment of apical periodontitis, such that there is complete healing and an absence of infection, while the overall long-term goal is the placement of a definitive, clinically successful restoration and preservation of the tooth. With the introduction of modern techniques, success rates of up to 98 percent are being achieved. In selecting an irrigant and technique, consideration must be given to their efficacy and safety. Common root-canal irrigants include sodium hypochlorite (NaOCl), chlorhexidine gluconate, alcohol, hydrogen peroxide and ethylenediaminetetraacetic acid (EDTA). Several irrigants and irrigant delivery systems are available, all of which behave differently and have relative advantages and disadvantages. These steps must be followed by complete obturation of the root canals, and placement of a coronal seal, prior to restorative treatment. Success depends on a number of factors, including appropriate instrumentation, successful irrigation and decontamination of the root-canal space to the apices and in areas such as isthmuses. Endodontic treatment is a predictable procedure with high success rates.
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