To find out the choice of root canal irrigant by general dental practitioners
A questionnaire consisting of 20 questions were randomly distributed to 500 dental practitioners in Tamilnadu. The results were then analyzed and tabulated.
It was found in the study that mostly dental practitioners prefer normal saline combined with sodium hypochlorite as primary irrigant.
Saline is the primary choice of irrigant in root canal procedures. It is necessary for the dental practitioners to update the knowledge of recent root canal irrigants with their uses.
Development of new materials, devices and techniques, quality of treatment in endodontics has led to increased endodontic success rate. Although many modern techniques that use NiTi files, more than 35% of the root canal’s surface are left uninstrumented after non-surgical root canal treatment. For removing the debris and addressing these uninstrumented surfaces, it becomes mandatory to copiously irrigate the root canal [1,2].
One of the most important steps in root canal system is irrigation and one of the most critical one during endodontic treatment. The main etiological cause of endodontic failure is the residuals of necrotic or vital tissue within the root canal space. Therefore, the irrigation protocol plays a key role in disinfection of root canal space [3].
The most popular irrigant seems to be Sodium hypochlorite since it has a broad antibacterial spectrum and some ability to inactivate endotoxins. Therefore, Sodium hypochlorite remains the irrrigant of choice worldwide in spite of its high toxicity, inability to completely remove the smear layer and very unpleasant taste to patients. However, antibacterial trait of 2% Chlorhexidine has made it one of the commonly used endodontic irrigants [3-10].
There exists a controversy regarding whether it is advantageous to remove the smear layer that is formed during root canal instrumentation. Current methods to remove smear layer might involve the use of a chelating agent during irrigation or as a final rinse in combination with other irrigants [11].
Different adjuncts have been developed in an effort to improve the delivery and effectiveness of irrigants. Both sonic and ultrasonic agitation of the irrigant has been studied for their ability to improve canal cleanliness. In spite of the progress that academic teaching and endodontic societies have made so far in this field of growing interest, there is a lack of relevant information regarding the attitude of general dental practitioners towards irrigation protocol [12].
So, the aim of the survey was to reveal the choice of root canal irrigant used by general dental practitioners.
A survey was conducted with appropriate questionnaire which was designed of 20 questions. That questionnaire comprised of the following items: commonly used irrigant, volume of irrigant used, removal of smear layer, irrigant used for periapical lesion, irrigant used for treating vital pulp, irrigant used for treating necrotic pulp, irrigant used for retreatment procedures, gauge of needle, depth of penetration of needle, tip design of needle, volume of syringe used for irrigation, most effective irrigant.
For the purpose of this study a 500 questionnaire were randomly distributed to the dental practitioners in Tamilnadu. The sample was personally collected from them. Results were then analyzed and tabulated.
a. 21-30 b.11-20 c. 5-10 d. ≥5
a. Single rooted b. Multi rooted c. Re-treatment cases
a. 0-5 teeth b. 6-10 c. 11-15 d. 16-20 e. 21 or above
a. Sodium hypochlorite b. Chlorhexidine c. Saline
d. EDTA e. MTAD f. sterile water
a. Sodium hypochlorite b. Chlorhexidine c. Saline
d. EDTA e. MTAD f. Sterile water
a. 0.5ml b. 2.5ml c. 5-10ml d.≥10ml
a. Antibacterial capacity b. Biocompatibility c. Tissue discoloration d. Substantivity e. Expense
a. yes b. no
a. Yes b. No
a. Sodium hypochlorite b. Chlorhexidine c. Saline
d. Sterile water e. Water
a. Sodium hypochlorite b. Chlorhexidine c. Saline
d. Sterile water e. Water
a . Sodium hypochlorite b. Chlorhexidine c. Saline
d. Sterile water
a. Sodium hypochlorite b. Chlorhexidine c. Saline
d. Sterile water e. Other f. Do not perform retreatment
a. Ultrasonic activation b. Sonic c. Negative pressure d. Endovac e. Other f. None
a. 26 b. 27 c. 30 d. 31
a. 6mm from apical foramen b. 2mm c. 3mm d. 4mm
a. Brush covered needle (Navitip fx) c. Single bevel needle
b. Side vented needle (RC twents) d. Other
a.1ml b. 2.5ml c. 5ml d. 10ml
a. ≤30sec b. 30-1min c. 1-2min d. ≥2min
For how many years are you practicing endodontic therapy?
Do you regularly treat?
On the average, how many root canal therapies do you perform per week?
Which all irrigants do you use?
Which irrigants do you commonly use?
How much volume of irrigant do you employ per canal?
Rank the reason for your primary irrigant selection from most important to least important.
Do you routinely aim to remove smear layer?
Does your choice of irrigants differ based on the pulpal or periapical diagnosis?
Which of the following irrigants could you primarily utilize when treating a tooth with vital pulp?
Which of the following irrigants could you primarily utilize when treating a tooth with necrotic pulp?
Which of the following irrigants could you primarily utilize when treating a tooth with radiographic evidence of periapical lesion?
Which of the following irrigants could you primarily utilize when doing retreatment?
Which, if any adjuncts to irrigation do you utilize?
What is the routine gauge of the needle employed by you, during syringe irrigation?
How much depth of penetration of needle do you prepare for irrigation?
Which tip design of the needle do you use?
What is the volume of syringe do you use for irrigation?
What is the duration of irrigation do you prepare per canal?
In your opinion which irrigant do you feel effective?
a. Sodium hypochlorite b. Chlorhexidine c. Saline
d. EDTA e. MTAD f. Sterile water g. Citric acid h. Other
Table 1: Commonly used irrigant
|
|
|
| Sodium hypochlorite | 23 |
| Chlorhexidine | 29 |
| Saline and Hypochlorite combination | 40 |
| MTAD | 4 |
| EDTA | 4 |
Graph 1 : Commonly used irrigant
Table 2: Removal of smear layer
|
|
|
| Yes | 79 |
| No | 21 |
Table 3: Irrigant for necrotic pulp
|
|
|
| Sodium hypochlorite | 24 |
| Normal saline | 15 |
| Chlorhexidine | 27 |
| Saline and Hypochlorite combination | 34 |
Graph 2: Irrigant for necrotic pulp
Table 4: Irrigant for periapical lesion
|
|
|
| Sodium hypochlorite | 25 |
| Chlorhexidine | 33 |
| Normal saline | 9 |
| Saline and Hypochlorite combination | 33 |
Table 5: Irrigant for retreatment
|
|
|
| Sodium hypochlorite | 28 |
| Chlorhexidine | 32 |
| Saline and Hypochlorite combination | 30 |
| Other | 5 |
| Do not perform | 5 |
Table 6: Tip design of needle
|
|
|
| Single bevel needle | 65 |
| Side vented needle | 18 |
| Brush covered needle | 12 |
| Other | 5 |
The purpose of this study is to know the choice of root canal irrigant by the dental practitioners in Tamil nadu. In the present study, it was found that majority of respondents (40%) use normal saline in combination with sodium hypochlorite as their primary irrigant. In the International studies, it was found that Sodium hypochlorite was used as their primary irrigant. It shows that usually the developed countries tend to use Sodium hypochlorite and the developing countries rely mainly on saline. The probable reason for such a finding could be the ease of availability of normal saline, its cost effectiveness as opposed to other effective irrigants and established fact that normal saline is least harmful to the oral hard and soft tissues [4-10].
79% of the respondents in this study aim to remove smear layer. Many dental practitioners fail to use chelating agent for removal of this smear layer because of lack of knowledge of irrigants. The ideal irrigant of choice for necrotic pulp is Sodium hypochlorite [12]. But in this study the dental practitioners commonly use combination rather than sodium hypochlorite alone.
The irrigant of choice for periapical lesion is Chlorhexidine due to its high antibacterial action and substantivity. For retreatment, Chlorhexidine is widely used due to its effectiveness against E. fecalis. Root canal failures are mainly due to the presence of E.fecalis and chlorhexidine is the suitable one for this.4 Many practioners do not perform retreatment because it is more complicated procedure.
The findings of this study are
That most dental practioners are using saline as primary irrigant. It shows there is a high need to update the knowledge on effective irrigants than normal saline.
Sodium hypochlorite should be used for effective treatment. Mostly dental practioners do not use it because of inexperience and fear of sodium hypochlorite accidents.
Smear layer should be removed using chelating agents.
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