Irrigation in Endodontics: “Slow and Steady wins the Race, Clean and Tidy wins the Chase”

Abstract

and prevention of recontamination of the root canal after treatment are the essential elements for successful outcomes. Although many advances have been made in different aspects of endodontics within the past few years to preserve natural dentition, the main objective of this field remains elimination of microorganisms from the root canal systems and prevention of recontamination after treatment.1 In 1910, Hunter introduced the concept of “oral sepsis” and stated that this condition would lead to a wide array of systemic diseases, such as gastritis, anemia, ulcers, colitis, and nephritis. It was to give the fledgling field of endodontics the direction it needed to direct treatment and scientific investigation aimed at more definitive treatment. The thought that treatment of the pulpal chamber and root canal systems was viable had been challenged by a multitude of factors during the first half of the 20th century. The work of Hess and others had shown the root canal system to be a maze of interconnecting lateral canals, ramifications, fins, and isthmus.2 It is this complexity that led L Grossman to remark, “One may well ask at this point if root canal work is justified in view of the complexity of the canals, since by no method can all the minute ramifications be filled.” This underlying conclusion had even gained popularity in the early 1900s due to the broad acceptance of the theory of “focal infection.” It is only with progressive understanding of the biological systems involved in endodontic pathology that we have been able to overcome these barriers to treatment. By identifying bacteria as the underlying cause of periapical periodontitis and clearly showing the therapeutic benefit of removing these bacteria and their by-products, the field of endodontics has developed and continues to improve the standards of treatment.3 The importance of using an antimicrobial irrigant to reduce the bacteria load during root canal treatment, regardless of the irrigant or instrumentation technique, has been reported.4 Bystrom and Sundqvist5 evaluated the antibacterial effectiveness of mechanical instrumentation and irrigation. They found considerable reduction in bacterial counts after instrumentation and irrigation with saline, yet all the teeth had a positive culture after the first appointment. When they used sodium hypochlorite (NaOCl) separately or combined with ethylene diamine 1Professor, 2Professor and Head, 3-5Postgraduate Student 1-5Department of Conservative Dentistry and Endodontics, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India