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Bacteria are the major cause of pulpal and periapical diseases. Complexity of the root canal system, invasion of the dentinal tubules by microorganisms, formation of smear layer during instrumentation and presence of dentin as a tissue are the major obstacles for complete elimination of bacteria during cleaning and shaping of root canal systems.
The bacterial population of infected root canals can be significantly reduced by using saline irrigation; however, irrigants that have antibacterial effects have clearly superior effectiveness in bacterial elimination when compared with saline solution. The irrigants that are currently used during cleaning and shaping include NaOCl, CHX, EDTA and MTAD. None of these irrigants has all of the characteristics of an ideal irrigant. Sonic and ultrasonic vibrations alone or in combination with antibacterial irrigants as well as application of negative pressure have been used to increase the efficacy of these irrigants. Intracanal medicaments have been used to disinfect root canals between appointments and reduce inter appointment pain. The major intracanal medications currently used in endodontics include Ca(OH)2 and CH. The search for an ideal material and/or technique to completely clean infected root canals continues.
Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment.
The main aim of the endodontic therapy is to disinfect the entire root canal system, which requires elimination of microorganisms and microbial components and prevention of its re-infection during and after treatment. This goal is pursued by chemo-mechanical debridement, where the mechanical systems are associated with the irrigating solutions.
This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy.
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