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Endodontics lecture- Irrigants and intracanal medicaments. — Transcript

by Dr Teeth · 1,818 words · 292 segments · language en · Watch on YouTube

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0:03irance and
0:07inal endodontic
0:10treat cleaning shaping are the initial
0:13steps which we are we have to take to
0:17shaping
0:19instruments CLE instruments cannot be
0:22helpful okay basically people s shaping
0:25and cleaning all those can be done by
0:27instrument but actually cleaning needs
0:28irance okay
0:35microbial
0:41infection seven requirements
0:45an mechanical flushing non-toxic
0:49biocompatible dissolves the necrotic and
0:51vital PP tissue lubricant removes the SP
0:54layer and low surface tension irant
1:00the most important one sodium
1:01hypochloride the Eda the chlorexidine D
1:04gluconate and the Mt
1:07a sodium hypochloride that is NCL it is
1:12a reducing agent clear straw color
1:15solution containing 5% available
1:18chlorine okay so
1:20na it ionizes and produces hypochlorous
1:24acid and hypochloride ion and these two
1:27what they do they provide antimicrobial
1:30activity sodium hypochloride
1:33concentration basically generally
1:36concentration
1:38range5 to 5.2% solution however
1:432.5%
1:46because
1:49toxity
1:532. but what happens is when you reduce
1:56the concentration the effectiveness also
1:58lessens so how how will you compensate
2:00for
2:07it and passive
2:18ulty 2
2:25minutes next most
2:28effective so this is the most effective
2:31irrigant in dissolving the
2:35pulp okay to uh
2:38Na work it works in two phases so it
2:42causes the destruction of bacteria by
2:44two phases first is the penetration in
2:46through the bacterial wall bacterial
2:48cell wall and second is the chemical
2:51combination with the protoplasm Okay so
3:02it will cause disruption of the DNA
3:04synthesis okay so this uh sodium hypoc
3:08chloride had certain drawbacks first of
3:11all it has cyto toxicity problem and
3:13that is the reason we are using 2.5%
3:16concentration or lesser concentration
3:18okay even though 5.2 was more effective
3:21and it does not remove the inorganic
3:23components of failure it is unpleasant
3:25taste and it requires cool place okay so
3:28you have to keep it in cool place so it
3:30is also kind of drawback for
3:34it
3:37Ed it is ethylene diamine Tetra acetic
3:41acid and uh it is a chating agent and
3:44was given by nigar it is nontoxic
3:47irritating in Weak solution okay so it
3:49is a chating agent sodium hypoc chloride
3:51reducing agent Ed chating agent or
3:54non-toxic irritating weak solution so it
3:57is non-toxic sodium hypochloride toxic
4:00okay High concentration so what it does
4:02it is highly stable chilate okay so it
4:06forms highly stable chilate in
4:08combination with heavy metals okay so
4:10the function is function it forms
4:12calcium
4:20solution will become
4:22more it will be easier to instrument
4:26therefore this Eda it is helpful in
4:29cleaning and shaping to okay so more
4:32exposure more demoralization okay and
4:35the second thing is that it removes the
4:43SM first of all
4:52[Music]
5:01how do you use it in the clinics it is
5:03177% Ed for 1 minute followed by final
5:07rinse with na
5:10okay chlorohexidine
5:13dluc 2% and it is a broad spectrum
5:18antimicrobial and mainly it works on
5:22analis uh it is the most common pathogen
5:25in the root canals okay and it also it
5:28has the property of subst anity Chlor
5:31digluconate has a property of
5:32substantivity means sustained
5:34availability it gets absorbed and it
5:37will be released in between durations
5:40and it is less toxic but the main thing
5:42is that it does not do removal of this m
5:45therefore you have to use it with
5:47conjugation with irant you cannot use it
5:49alone you have to use it with
5:53Igan and how does it work it also
5:56penetrates the cell membrane and it
5:57causes coagulation of the Cy plas
6:00content we had studied uh before in Eda
6:04that it
6:06[Music]
6:07causes sorry in uh sodium hypochloride
6:11uh that it disrupts the DNA synthesis
6:14and here we have studied that it just
6:17coagulates the coplas so um the first
6:22one was sodium hypochloride it was a
6:24reducing agent then we studied that uh
6:27um second one which is the DTA it was a
6:30chating agent and then we studied that
6:33the chlorexidine digluconate it is a
6:36antimicrobial agent
6:39okay the next one is Mt a it is a
6:42mixture of tetracycline isomer uh citric
6:46acid and a detergent so it is a mixture
6:48of tetracyclin isomo citric acid and a
6:51detergent which is 280 so this tety
6:54isomer provides antibacterial effect so
6:57Mt ad it is used to final rinse this Mo
7:02to remove this smer it is used as a
7:04final rinse to remove the smer and the
7:07regime is 1.3 na CL irrigation is done
7:12and then you use the mt8
7:14okay now the
7:18factors affecting the efficacy of
7:20irrigant first is the adequate
7:23irrigation is next three then frequent
7:25irrigation is done the diameter of canal
7:27and exchange of pollution temperature of
7:29a
7:31seal and then the passive ultrasonic
7:35irrigation so more the diameter less uh
7:39better will be the irrigation and
7:42temperature the no na temperature
7:44increase okay now certain irrigation
7:48guidelines are
7:50there irrigation guidelines uh in that
7:54uh the one thing and the only one thing
7:56you need for irrigation is a lure lock
7:59syring
8:00and that has to be disposable obviously
8:03and what uh what is the you know cor
8:07what is special about the syringe is
8:09that it has side winds so there is no
8:12ayal Force so it will produce force in
8:15this direction no pical force will be
8:17there so there will be no cage in the
8:20per radicular area okay so um there
8:24should be room between the needle and
8:25the root canal so when you insert the
8:27needle there should be some room some
8:29space between the needle and the root
8:31canal so that the irrig irrigating
8:34solution you it can you know uh get back
8:37towards the coronal aspect it should not
8:40come here downwards okay and you have to
8:42insert the needle passively to not apply
8:44much force and the needle should not
8:47bind if it is binding that means the
8:49space in between is not present so when
8:51you inject in such situation it will
8:54definitely go in this direction and it
8:56will cause infection and further
8:58damage so you have to inject with little
9:01or no pressure and there should be
9:03return of return flow of solution okay
9:06so the solution will return towards the
9:09coronal aspect and you have to use a gge
9:11to soak the solution and after
9:14irrigation dry it and you you can suck
9:18the remaining irrigation solution back
9:19with the plunger okay you have to dry it
9:21and you have to suck the remaining
9:22solution and then the final drying it is
9:25done with absorbent paper the final
9:27drawing is done with absorbent paper and
9:29the clinical significance is sodium hyp
9:31chloride accident uh which occurs when
9:33you accidentally give a lot of pressure
9:36in the pical area and uh you inject the
9:39solution downwards so the hypop oride is
9:41toxic so it causes toxicity and necross
9:44the area okay next we'll study about the
9:47inra canal
9:50medicaments so why do we need intra
9:53Canal medicaments we have done cleaning
9:56shaping and now we have done the
9:58irrigation also and now why do we need
10:00intal medic so they are used in cases
10:03when the poly microbal nature demands
10:06the use for example you have weeping
10:08canals or the canal is very infected so
10:10in that cases you need intra Canal
10:13medicament so there are certain ideal
10:15requirements of ininal medicaments first
10:17of all it should be antimicrobial non
10:20iritating and it should remain stable it
10:22should have prolong effect and it should
10:24be active in the presence of blood
10:26seramin proteins and it should have low
10:28surface tension should not interfere
10:29with the repair and it should not cause
10:32training of the to and no cell mediat
10:35immune response to be there so
10:37indications of the usage as I already
10:40said it is used in weaping canals
10:42remaining microbes uh removed and in
10:45when the root canal contains U
10:49inert I mean to render the root canal
10:52contains inert and neutralize the tissue
10:54TI RIS and as a barrier against the okay
10:58so uh
11:00history and present so what materials
11:02were used in history and what materials
11:04are used now so in history Grossman
11:07stated the use of
11:09PBS C that is P for pencin B for Basin s
11:13for streptomycin and C is by which is a
11:16vehicle here and he also used pbsn which
11:20is neomy and it is an antifungal agent
11:23but both of these they have only
11:25bacterio static effect therefore they're
11:27not recommended now also formal Crystal
11:30was used but uh it's now used also by
11:34the pedodontist but uh not in endodontic
11:37okay and eugenol it is a peric tissue
11:40toxin so these two are also not
11:43recommended now so what do we recommend
11:45now these are calcium hydroxide and
11:48chlorexidine digluconate calcium
11:50hydroxide and chlorexidine
11:54digluconate so calcium hydroxide it was
11:57introduced by Herman and the pH of
11:59calcium hydroxide is 12.5 and it is
12:03because of this pH that it has a bactery
12:06cidal effect
12:11okay and uh uh it has two properties
12:15antimicrobial and heart tissue repair
12:18information so how it works it works by
12:21releasing uh hydroxy ions which has
12:24antimicrobial property so this hydroxy
12:27ions they are highly oxidizing free
12:30radicals and they will cause a damage to
12:33the membrane to the cell membrane and to
12:38will cause protein denaturation and will
12:40damage the bacterial DNA okay so what it
12:43does it does three things damage the
12:45membrane protein denaturation and
12:47damages the bacterial DNA and the
12:49vehicle used is aqu aquar visus or o
12:53vehicles and we not use water soluble
12:56Vehicles because you have to change the
12:58dressing again and again again so
13:01examples of Aquas vehicles are Glycerine
13:03poly ethylene glycol so um these would
13:08need multiple
13:10dressing multiple
13:13dressing while these can go long without
13:17U changing the dressing
13:21okay so we often combine uh cmcp with
13:25the 0.12% chlorohexidine to get the
13:28synergist antimicrobial effect now the
13:31next one is Chlor hexagen digluconate
13:33and it is effective against eales and
13:36canid alicin so it is used both as an
13:39irrigant and as inra Canal medicament
13:42okay so for the medicament you need 2%
13:44uh it is available as 2% CH G and a
13:49mixture of CHX and calcium hydroxide now
13:52we come to temporary filling materials
13:54these are Cav and irm and um generally
13:57when we do temporary filling the
13:59dressing has to be renewed within a week
14:01okay so because what happens is um these
14:06dressings they become diluted with the
14:10per radical oxidate and they decomposed
14:12by interaction with the microorganism so
14:15we need to change it so the temporary
14:17filling material they should be uh
14:19impervious to the fluids they should
14:21provide hermetical seal and uh no
14:24pressure in the dressing and they should
14:26Harden with within minutes and and uh
14:29should be able to wear uh the
14:32masticatory forces and they should be
14:36easy to manipulate

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