Novel Approaches to Disinfection in Endodontics

The success of root canal treatment relies on effectively eradicating or lowering bacterial burden below a threshold that would allow healing of the periradicular tissues. In this regard, mechanical preparation focuses on shaping the root canal, creating a smooth and tapered preparation that facilitates the delivery of irrigants throughout the canal. Sodium hypochlorite is recommended as the primary irrigant because of its extensive antibacterial properties and ability to dissolve organic substances like pulp remnants, bacterial biofilms, and their by-products. Chelating agents work together with sodium hypochlorite by eliminating the inorganic components of the smear layer from canal walls. The physical effect of root canal irrigants complements disinfection by flushing out bacteria, debris and necrotic tissue, especially from areas of the root canal system that remain untouched by mechanical instruments.

Traditional approaches, such as irrigation with syringes and needles, often fall short in reaching and thoroughly disinfecting the complex anatomy of the root canal system. Novel approaches to disinfection have emerged to address these limitations. Advanced irrigation techniques, such as negative apical pressure systems and sonic/ultrasonic agitation, improve the flow of irrigants in inaccessible root canal areas. Intracanal medicaments, lasers and photodynamic therapy offer innovative approaches for sustained antimicrobial effects. Nanoparticles have shown potent antibacterial effects against microorganisms commonly found in endodontic infections. Nano-technology has also been employed to improve the delivery of substances, using nanoparticles as carriers for antibiotics, antimicrobial agents, and regenerative materials.

The irrigating concepts presented in this collection are aimed at guiding clinicians in obtaining a clean root canal system by assessing solutions undertaken during the irrigation protocol on their volume, concentration, sequence, and kinematic alongside its possible side effects on dentin.

The impact of different irrigants and technological advances in equipment and materials have made on:

- Dissolution of pulp tissue remnants and biofilms;
- Antimicrobial effectiveness;
- Improving the cleaning of untouched areas of root canal system;
- Prevention of smear layer formation;
- Removal of dentin debris and smear layer;
- Inactivation of endotoxins;
- Extrusion and cytotoxicity to the periapical tissues;
- Side effect on the dentin substrate.

Keywords: Activation, delivery, irrigant, sodium hypochlorite, syringe, ultrasonic, root canal disinfection, irrigant flow rate, needle, pressure, nanotechnology, nanomaterials

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