Enhanced endodontic irrigation solutions
by Dennis Brave, DDS & Kenneth Koch, DMD
Never forget the adage, "instruments shape,
irrigants clean." Every root-canal system has spaces that can't be cleaned
mechanically. The only way we can clean webs, fins, and anastomoses is
through the effective use of an irrigation agent. View the preparation as
a way to increase the efficacy of your irrigation agent. The
irrigation agents we recommend are sodium hypochlorite (5.25 percent) and EDTA (17 percent).
Irrigation has received much attention in the past few years.
Multiple companies have introduced various products to the market place.
As previously mentioned in our March column, Real World Endo will now
certify those outstanding products that meet our criteria for
recommendation. As an example of a Real World certified product, we would
like to introduce a SmearClear®, a new, enhanced irrigation solution by
Sybron Endo.
Sybron Endo has taken liquid, 17 percent EDTA and combined it with
multiple surfactants. Surfactants reduce surface tension and enhance the
ability of a cleaning solution such as EDTA to work more effectively in
the root canal system. This increased cleaning ability is why common
detergents take advantage of surfactants. Surfactants can make a good
product better. The result of using SmearClear is the effective removal of
the smear layer and the cleanest dentinal tubules (SEM's) we've ever seen.
SmearClear exceeds the current standard for smear layer removal and clean
tubules. The dentinal tubules are so clean after using this solution that
they are a bondodontist's dream. Let's look at the guidelines for the use
of this exciting new product.
SmearClear comes in a kit that includes side-vented needles. These are an
added plus for any irrigation method because they reduce the potential for
extrusion of the irrigants past the apex. Perform the root canal as usual.
After completion of the preparation, suction out all the sodium
hypochlorite and slowly deliver the SmearClear into the tooth. If desired,
you can take a side-vented needle half way down the canals, being careful
not to bind the needle. The .06 fully tapered preparation will help the
hydraulics in this situation. Fill the chamber with SmearClear so that it
covers all the orifices. Let the SmearClear sit in the tooth for 60
seconds. Then suction out the solution and do a final rinse with sodium
hypochlorite. Proceed to evacuate the bleach, thoroughly dry the canal
with a matching paper point, and obturate. We think you'll be thrilled
with the results from this enhanced irrigation technique.
This product removes the smear layer and cleans the tubules so efficiently
that we hope the manufacturer comes out with a gel version. When you see
the SEM's of the tubules, you will realize that
SmearClear could be a wonderful complement to the cementation of fiber
posts.
As we progress through 2003, our goal is to help make endodontics easier
and, most importantly, better for all practitioners. As always, we strive
to make endodontics simpler and less complicated. We will not only
continue to offer tips, but also will attempt to debunk some of the myths
associated with modern endodontics. Material science is coming to the
forefront and we hope to guide you in the proper direction. As we progress
on this journey to better endodontics, we will continue to give you "Just
The Facts, Nothing But The Facts."
Dr. Dennis Brave is a diplomate of the American Board of Endodontics and
was the senior managing partner of a group specialty practice for 27
years. Dr. Kenneth Koch is the founder and past director of the new
program in postdoctoral endodontics at the Harvard School of Dental
Medicine. Drs. Koch and Brave together are Real World Endo, an endodontic
education company. They can be reached at (866) RWE-ENDO, or visit their
Web site at www.RealWorldEndo.com.
This article was originally printed in Dental Economics April, 2003
Author(s) : Kenneth Koch Dennis Brave |
|