Inter J Stomatol ›› 2018, Vol. 45 ›› Issue (4): 465-472.doi: 10.7518/gjkq.2018.04.017

• Reviews • Previous Articles     Next Articles

Research progress on root canal irrigation

Huang Lidong, Gong Weiyu, Dong Yanmei.   

  1. Dept. of Conservative Dentistry and Endodontics, School and Hospital of Stomatology, Peking University, Beijing 100081, China
  • Received:2017-11-29 Revised:2018-03-13 Online:2018-07-02 Published:2018-07-02
  • Supported by:
    ; This study was supported by National Natural Science Foundation of China (51372005).

Abstract: Root canal irrigation is an indispensable part of root canal preparation. Effective irrigation depends on the continuous development of irrigants and irrigation techniques. Recently, studies in irrigants and techniques have been carried out to improve the effect of irrigation and disinfection. Microorganisms, smear layer and lipopolysaccharide within root canal can be removed at a larger degree by means of improving the performance of irrigants and combined using different irrigants. And with the aid of supplementary methods and new techniques, irrigants can be better delivered and agitated, which induces higher cleaning efficiency in apical third and enhanced effect of chemical preparation in root canal system. This paper reviewed the research progress on root canal irrigants, irrigation methods and techniques.

Key words: root canal irrigation, root canal treatment, root canal disinfection

CLC Number: 

  • R781.05

[1] Estrela C, Estrela CR, Barbin EL, et al.Mechanism of action of sodium hypochlorite[J]. Braz Dent J, 2002, 13(2): 113-117.
[2] Tulsani SG, Chikkanarasaiah N, Bethur S.An in vivo comparison of antimicrobial efficacy of sodium hy-pochlorite and Biopure MTAD™ against Enteroco-ccus faecalis in primary teeth: a qPCR study[J]. J Clin Pediatr Dent, 2014, 39(1): 30-34.
[3] Siqueira JF Jr, Rôças IN, Favieri A, et al.Chemome-chanical reduction of the bacterial population in the root canal after instrumentation and irrigation with 1%, 2.5%, and 5.25% sodium hypochlorite[J]. J Endod, 2000, 26(6): 331-334.
[4] Mercade M, Duran-Sindreu F, Kuttler S, et al.An-timicrobial efficacy of 4.2% sodium hypochlorite adjusted to pH 12, 7.5, and 6.5 in infected human root canals[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 107(2): 295-298.
[5] Camps J, Pommel L, Aubut V, et al.Shelflife, disso-lving action, and antibacterial activity of a neutra-lized 2.5% sodium hypochlorite solution[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108(2): e66-e73.
[6] Rossi-Fedele G, Guastalli AR, Doğramacı EJ, et al.Influence of pH changes on chlorine-containing en-dodontic irrigating solutions[J]. Int Endod J, 2011, 44(9): 792-799.
[7] Guerreiro-Tanomaru JM, Morgental RD, Flumignan DL, et al.Evaluation of pH, available chlorine con-tent, and antibacterial activity of endodontic irrigants and their combinations against Enterococcus faecalis [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2011, 112(1): 132-135.
[8] Kinoshita N, Unemoto T, Kobayashi H.Proton mo-tive force is not obligatory for growth of Escherichia coli[J]. J Bacteriol, 1984, 160(3): 1074-1077.
[9] Gandi P, Vasireddi SR, Gurram SR, et al.Evaluation of the antibacterial efficacy of omeprazole with so-dium hypochlorite as an endodontic irrigating solu-tion—an in vivo study[J]. J Int Oral Health, 2013, 5(2): 14-20.
[10] Wagner C, Barth VC Jr, de Oliveira SD, et al. Effec-tiveness of the proton pump inhibitor omeprazole associated with calcium hydroxide as intracanal medication: an in vivo study[J]. J Endod, 2011, 37(9): 1253-1257.
[11] Bolfoni MR, Ferla Mdos S, Sposito Oda S, et al.Effect of a surfactant on the antimicrobial activity of sodium hypochlorite solutions[J]. Braz Dent J, 2014, 25(5): 416-419.
[12] Bukiet F, Couderc G, Camps J, et al.Wetting pro-perties and critical micellar concentration of benzal-konium chloride mixed in sodium hypochlorite[J]. J Endod, 2012, 38(11): 1525-1529.
[13] Guastalli AR, Clarkson RM, Rossi-Fedele G.The effect of surfactants on thestability of sodium hy-pochlorite preparations[J]. J Endod, 2015, 41(8): 1344-1348.
[14] Aslantas EE, Buzoglu HD, Altundasar E, et al.Effect of EDTA, sodium hypochlorite, and chlorhexidine gluconate with or without surface modifiers on dentin microhardness[J]. J Endod, 2014, 40(6): 876-879.
[15] Baron A, Lindsey K, Sidow SJ, et al.Effect of a benzalkonium chloride surfactant-sodium hypoch-lorite combination on elimination of Enterococcus faecalis[J]. J Endod, 2016, 42(1): 145-149.
[16] Rico-Romano C, Zubizarreta-Macho Á, Baquero-Artigao MR, et al.An analysis in vivo of intracanal bacterial load before and after chemo-mechanical preparation: a comparative analysis of two irrigants and two activation techniques[J]. J Clin Exp Dent, 2016, 8(1): e9-e13.
[17] Mohammadi Z, Abbott PV.Antimicrobial substan-tivity of root canal irrigants and medicaments: a review[J]. Aust Endod J, 2009, 35(3): 131-139.
[18] Mahendra A, Koul M, Upadhyay V, et al.Compara-tive evaluation of antimicrobial substantivity of dif-ferent concentrations of chlorhexidine as a root canal irrigant: an in vitro study[J]. J Oral Biol Craniofac Res, 2014, 4(3): 181-185.
[19] María Ferrer-Luque C, Teresa Arias-Moliz M, Ruíz-Linares M, et al. Residual activity of cetrimide and chlorhexidine on Enterococcus faecalis-infected root canals[J]. Int J Oral Sci, 2014, 6(1): 46-49.
[20] Mohammadi Z, Asgary S.A comparative study of antifungal activity of endodontic irrigants[J]. Iran Endod J, 2015, 10(2): 144-147.
[21] Ma J, Tong Z, Ling J, et al.The effects of sodium hypochlorite and chlorhexidine irrigants on the anti-bacterial activities of alkaline media against Entero- coccus faecalis[J]. Arch Oral Biol, 2015, 60(7): 1075-1081.
[22] Sinha N, Patil S, Dodwad PK, et al.Evaluation of antimicrobial efficacy of calcium hydroxide paste, chlorhexidine gel, and a combination of both as in-tracanal medicament: an in vivo comparative study[J]. J Conserv Dent, 2013, 16(1): 65-70.
[23] Rossi-Fedele G, Doğramaci EJ, Guastalli AR, et al.Antagonistic interactions between sodium hypochlo-rite, chlorhexidine, EDTA, and citric acid[J]. J Endod, 2012, 38(4): 426-431.
[24] Cintra LT, Watanabe S, Samuel RO, et al.The use of NaOCl in combination with CHX produces cyto-toxic product[J]. Clin Oral Investig, 2014, 18(3): 935-940.
[25] Mirhadi H, Abbaszadegan A, Ranjbar MA, et al.Antibacterial and toxic effect of hydrogen peroxide combined with different concentrations of chlorhe-xidine in comparison with sodium hypochlorite[J]. J Dent (Shiraz), 2015, 16(4): 349-355.
[26] Barrios R, Ferrer-Luque CM, Arias-Moliz MT, et al.Antimicrobial substantivity of alexidine and chlo-rhexidine in dentin[J]. J Endod, 2013, 39(11): 1413-1415.
[27] Soares JA,Roque de Carvalho MA, Cunha Santos SM, et al. Effectiveness of chemomechanical pre-paration with alternating use of sodium hypochlorite and EDTA in eliminating intracanal Enterococcus faecalis biofilm[J]. J Endod, 2010, 36(5): 894-898.
[28] Mai S, Kim YK, Arola DD, et al.Differential aggre-ssiveness of ethylenediamine tetraacetic acid in causing canal wall erosion in the presence of sodium hypoch-lorite[J]. J Dent, 2010, 38(3): 201-206.
[29] Ozdemir HO, Buzoglu HD, Calt S, et al.Chemical and ultramorphologic effects of ethylenediaminetetraacetic acid and sodium hypochlorite in young and old root canal dentin[J]. J Endod, 2012, 38(2): 204-208.
[30] Saghiri MA, Delvarani A, Mehrvarzfar P, et al.A study of the relation between erosion and micro-hardness of root canal dentin[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108(6): e29-e34.
[31] Taneja S, Kumari M, Anand S.Effect of QMix, peracetic acid and ethylenediamine tetraacetic acid on calcium loss and microhardness of root dentine[J]. J Conserv Dent, 2014, 17(2): 155-158.
[32] Kara Tuncer A, Tuncer S, Siso SH.Effect of QMix irrigant on the microhardness of root canal dentine[J]. Aust Dent J, 2015, 60(2): 163-168.
[33] Ulusoy Öİ, Görgül G.Effects of different irrigation solutions on root dentine microhardness, smear layer removal and erosion[J]. Aust Endod J, 2013, 39(2): 66-72.
[34] Lottanti S, Gautschi H, Sener B, et al.Effects of ethylenediamine tetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer[J]. Int Endod J, 2009, 42(4): 335-343.
[35] Zhang R, Chen M, Lu Y, et al.Antibacterial and residual antimicrobial activities against Enterococcus faecalis biofilm: a comparison between EDTA, chl-orhexidine, cetrimide, MTAD and QMix[J]. Sci Rep, 2015, 5: 12944.
[36] Dai L, Khechen K, Khan S, et al.The effect of Q- Mix, an experimental antibacterial root canal irrigant, on removal of canal wall smear layer and debris[J]. J Endod, 2011, 37(1): 80-84.
[37] Uzunoglu E, Yilmaz Z, Erdogan O, et al.Final irri-gation regimens affect fracture resistance values of root-filled teeth[J]. J Endod, 2016, 42(3): 493-495.
[38] Gründling GL, Melo TA, Montagner F, et al.QMix® irrigant reduces lipopolysacharide (LPS) levels in an in vitro model[J]. J Appl Oral Sci, 2015, 23(4): 431-435.
[39] Magalhães PO, Lopes AM, Mazzola PG, et al.Me-thods of endotoxin removal from biological prepara-tions: a review[J]. J Pharm Pharm Sci, 2007, 10(3): 388-404.
[40] Arslan H, Uygun AD, Keskin A, et al.Evaluation of orange-brown precipitate formed in root canals after irrigation with chlorhexidine and QMix and spe-ctroscopic analysis of precipitates produced by a mixture of chlorhexidine/NaOCl and QMix/NaOCl[J]. Int Endod J, 2015, 48(12): 1199-1203.
[41] Chandrasekhar V, Amulya V, Rani VS, et al.Evaluation of biocompatibility of a new root canal irrigant Q Mix™ 2 in 1—An in vivo study[J]. J Conserv Dent, 2013, 16(1): 36-40.
[42] Gupta J, Nikhil V, Jha P.Corelation between ma-chines assisted endodontic irrigant agitation and apical extrusion of debris and irrigant: a laboratory study[J]. Sci World J, 2014, 2014: 346184.
[43] Kungwani ML, Prasad KP, Khiyani TS.Comparison of the cleaning efficacy of EndoVac with conven-tional irrigation needles in debris removal from root canal. An in-vivo study[J]. J Conserv Dent, 2014, 17(4): 374-378.
[44] Dua A, Dua D.Comparative evaluation of efficacy of EndoVac irrigation system to Max-Ⅰ probe in removing smear layer in apical 1 mm and 3 mm of root canal: an in vitro scanning electron microscope study[J]. Dent Res J (Isfahan), 2015, 12(1): 38-43.
[45] Siu C, Baumgartner JC.Comparison of the debride-ment efficacy of the EndoVac irrigation system and conventional needle root canal irrigation in vivo[J]. J Endod, 2010, 36(11): 1782-1785.
[46] Cachovan G, Schiffner U, Altenhof S, et al.Com-parative antibacterial efficacies of hydrodynamic and ultrasonic irrigation systems in vitro[J]. J Endod, 2013, 39(9): 1171-1175.
[47] Cohenca N, Silva LA, Silva RA, et al.Microbiolo-gical evaluation of different irrigation protocols on root canal disinfection in teeth with apical periodon-titis: an in vivo study[J]. Braz Dent J, 2013, 24(5): 467-473.
[48] Ahuja P, Nandini S, Ballal S, et al.Effectiveness of four differentfinal irrigation activation techniques on smear layer removal in curved root canals: a scanning electron microscopy study[J]. J Dent (Tehran), 2014, 11(1): 1-9.
[49] AkyuzEkim SN, Erdemir A. Comparison of different irrigation activation techniques on smear layer re-moval: an in vitro study[J]. Microsc Res Tech, 2015, 78(3): 230-239.
[50] Munoz HR, Camacho-Cuadra K. In vivo efficacy of three different endodontic irrigation systems for irri-gant delivery to working length of mesial canals of mandibular molars[J]. J Endod, 2012, 38(4): 445-448.
[51] Spoorthy E, Velmurugan N, Ballal S, et al.Comparison of irrigant penetration up to working length and into simulated lateral canals using various irrigating te-chniques[J]. Int Endod J, 2013, 46(9): 815-822.
[52] Al-Nahlawi T, Hatab TA, Alrazak MA, et al.Effect of intracanal cryotherapy and negative irrigation technique on postendodontic pain[J]. J Contemp Dent Pract, 2016, 17(12): 990-996.
[53] Cohenca N, Romualdo PC, da Silva LA,et al. Tissue response to root canal irrigation systems in dogs’ teeth with apical periodontitis[J]. Clin Oral Investig, 2015, 19(5): 1147-1156.
[54] Matsuoka E, Jayawardena JA, Matsumoto K.Mor-phological study of the Er, Cr:YSGG laser for root canal preparation in mandibular incisors with curved root canals[J]. Photomed Laser Surg, 2005, 23(5): 480-484.
[55] George R, Walsh LJ.Apical extrusion of root canal irrigants when using Er:YAG and Er, Cr:YSGG lasers with optical fibers: an in vitro dye study[J]. J Endod, 2008, 34(6): 706-708.
[56] Al Shahrani M, DiVito E, Hughes CV, et al. Ehanced removal of Enterococcus faecalis biofilms in the root canal using sodium hypochlorite plus photon-induced photoacoustic streaming: an in vitro study[J]. Photomed Laser Surg, 2014, 32(5): 260-266.
[57] Ordinola-Zapata R, Bramante CM, Aprecio RM, et al.Biofilm removal by 6% sodium hypochlorite ac-tivated by different irrigation techniques[J]. Int Endod J, 2014, 47(7): 659-666.
[58] Wang Z, Shen Y, Haapasalo M.Effectiveness of endodontic disinfecting solutions against young and old Enterococcus faecalis biofilms in dentin canals[J]. J Endod, 2012, 38(10): 1376-1379.
[59] Balić M, Lucić R, Mehadžić K, et al.The efficacy of photon-initiated photoacoustic streaming and sonic-activated irrigation combined with QMiX solution or sodium hypochlorite against intracanal E. faecalis biofilm[J]. Lasers Med Sci, 2016, 31(2): 335-342.
[60] Tennert C, Drews AM, Walther V, et al.Ultrasonic activation and chemical modification of photosensi-tizers enhances the effects of photodynamic therapy against Enterococcus faecalis root-canal isolates[J]. Photodiagnosis Photodyn Ther, 2015, 12(2): 244-251.
[61] Bumb SS, Bhaskar DJ, Agali CR, et al. Assessment of photodynamic therapy (PDT) in disinfection of deeper dentinal tubules in a root canal system: an in vitro study[J]. J Clin Diagn Res, 2014, 8(11): ZC67-ZC71.
[62] Wang Y, Xiao S, Ma D, et al.Minimizing concen-tration of sodium hypochlorite in root canal irrigation by combination of ultrasonic irrigation with photody-namic treatment[J]. Photochem Photobiol, 2015, 91(4): 937-941.
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[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[7] . [J]. Foreign Med Sci: Stomatol, 2005, 32(06): 458 -460 .
[8] . [J]. Foreign Med Sci: Stomatol, 2005, 32(06): 452 -454 .
[9] . [J]. Inter J Stomatol, 2008, 35(S1): .
[10] . [J]. Inter J Stomatol, 2008, 35(S1): .