Endodontic Irrigation Chemical Disinfection of the Root Canal System 1st Edition by Bettina Basrani ISBN 3319164554 9783319164557

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ISBN 10:       3319164554
ISBN 13: 978-3319164557
Author:         Bettina Basrani

This book reviews the available information on bacterial disinfection in endodontics, with emphasis on the chemical treatment of root canals based on current understanding of the process of irrigation. It describes recent advances in knowledge of the chemistry associated with irrigants and delivery systems, which is of vital importance given that chemical intervention is now considered one of the most important measures in eliminating planktonic microbes and biofilms from the infected tooth. Recommendations are made regarding concentrations, exposure times and optimal sequences. Possible complications related to the use of the different solutions are highlighted, with guidance on response. In addition, clinical protocols are suggested on the basis of both clinical experience and the results of past and ongoing research. Throughout, a practical, clinically oriented approach is adopted that will assist the practitioner in ensuring successful endodontic treatment.

Endodontic Irrigation: Chemical Disinfection of the Root Canal System 1st Table of contents:

1: Microbial Biofilms in Endodontics

• Introduction
• Formation of Microbial Biofilms
• Biofilms Developed in Root Canals
• Resistance to Antimicrobials
  • Physical Barrier to the Penetration of Antimicrobials in Biofilms
  • State of Nutrient Deprivation and Dormancy
  • Formation of Phenotypically Different Subpopulations
  • Bacterial Cells That Persist
• Methods to Study Bacteria in Biofilms
  • SEM and LSM
  • rRNA Fluorescence In Situ Hybridization (FISH)
  • Markers of Cell Viability
  • In Vivo Models for Biofilm Testing
• Antibiofilm Strategies
  • Surface Coating
• Concluding Remarks
• References

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2: Update in Root Canal Anatomy of Permanent Teeth Using Microcomputed Tomography

• A Brief History of the First Studies on Root Canal Anatomy
• Computational Methods for the Study of Root Canal Anatomy
• The Micro-CT Technology in Endodontics
• Evaluation of Root Canal Anatomy Using Micro-CT
• The Influence of Root Canal Anatomy on Irrigation Procedures
• References

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3: Syringe Irrigation: Blending Endodontics and Fluid Dynamics

• Introduction
• Redefining the Aims
• Syringes
• Needles
• Physical Properties of Irrigants
• Irrigant Flow During Syringe Irrigation
• Irrigant Refreshment
• Wall Shear Stress
• Apical Vapor Lock
• Anatomical Challenges
• Summary: Clinical Tips
• References

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4: Research on Irrigation: Methods and Models

• Introduction
• Challenges of Root Canal Irrigation
• Models Employing Teeth and Dentin Blocks
  • In Vitro: Direct Contact Tests
  • In Vitro/Ex Vivo: Use of Extracted Teeth
  • In Vivo Models
• Sampling Methods
• Uninstrumented Parts of the Root Canal System
  • Models to Study Cleaning of Isthmus Areas
  • Dentin Canals
  • Lateral Canals
  • Smear Layer
• New Models to Study Irrigation
  • Measuring Antibacterial Activity
  • Biofilm Substrate, the Surface to Attach to
  • Mono- and Multi-species Biofilms
  • Physiological Status of the Biofilm Bacteria
  • Biofilms: Static Versus Dynamic
  • Inaccessible Root Canal Areas
• Improved Models to Study Biofilms in Dentin Canals
  • Dissolution of Organic Matter in the Root Canal
  • Mathematical Virtual Simulation Models
  • Particle Image Velocimetry
  • Irrigation Pressure in the Apical Canal
  • Wall Shear Stress/Wall Velocity
  • Needle Design
• Conclusions
• References

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5: Update of Endodontic Irrigating Solutions

• Antiseptic Solutions
  • Sodium Hypochlorite
    • Mode of Action
    • Concentration
    • Volume
    • Time
    • Effect on the Dentin
    • Depth of Penetration
    • Effect on Biofilms
    • Limitations
    • Clinical Recommendation
  • Chlorhexidine Gluconate (CHX)
    • Molecular Structure
    • Mode of Action
    • Substantivity
    • Chlorhexidine as an Endodontic Irrigant
    • Allergic Reactions to Chlorhexidine
    • Limitations
    • Clinical Recommendations
  • Decalcifying Agents
    • Ethylenediaminetetraacetic Acid
      • History
      • Mode of Action
      • Applications in Endodontics
    • Interaction Between CHX and NaOCl
    • Interaction Between CHX and EDTA
    • Interaction Between EDTA and NaOCl
    • Clinical Recommendations
  • HEBP
    • Effect of Temperature
    • NaOCl + Heat
    • EDTA + Heat
    • CHX + Heat
  • Combinations and Solutions with Detergents
    • BioPure MTAD and Tetraclean
    • Mode of Action
    • Smear Layer Removal
    • Antibacterial Efficacy
    • Clinical Trials
    • Protocol for Use
    • QMiX
      • Protocol
      • Smear Layer Removal
      • Antibacterial Efficacy and Effect on Biofilms
      • Clinical Trials
      • Disinfection Protocol Suggested
• References

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6: Complications of Endodontic Irrigation: Dental, Medical, and Legal

• Microbial Control: History
• Microbial Control: Biofilm and NaOCl
• NaOCl: Cytotoxicity
• NaOCl: Complications
  • NaOCl: Reviewing the Extrusion Incident
  • Maxillary Sinus Considerations
  • Maxillary Sinus: NaOCl Incident – Case Reports
  • Maxillary Sinus: NaOCl Incidents – Treatment and Prevention
• Pathognomonic Appearance of NaOCl Extrusion: A Problem
  • A New Theory
  • Intraosseous Injection
  • Multivaried Factors
  • Periapical Pressure Gradient
• Preventing the NaOCl Endodontic Incident
• Treatment of the NaOCl Extrusion Incident
• Informed Consent
• Conclusion
• References

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7: The Role of the Patency File in Endodontic Therapy

• Introduction
• Role of the Patency File in Shaping, Irrigating, and Cleaning the Root Canal System
• On Apical Transportation
• On Extrusion of Irrigants and Debris Through the Apical Foramen
• Role of the Patency File on Irrigant Penetration into the Apical Third of Root Canals
• Effect in Vital and Necrotic Teeth
• Influence on Postoperative Pain and Flare-Ups
• Prognosis
• References

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8: Manual Dynamic Activation (MDA) Technique

• Static Versus Dynamic Irrigation
• The Vapor Lock Effect
• Manual Dynamic Activation Technique
• MDA Mode of Use
• Conclusion
• References

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9: Apical Negative Pressure: Safety, Efficacy, and Efficiency

• The Challenge of Endodontic Debridement
• Manual and Machine-Assisted Irrigation Techniques
• Continuous and Intermittent Flushing Techniques
• Apical Negative Pressure
  • The EndoVac System
  • Method of Use
  • Debris Removal
  • Microbial Control
  • Smear Layer Removal
  • Apical Vapour Lock
  • Calcium Hydroxide Removal
  • Sodium Hypochlorite Incidents
• Safety
• Conclusion
• References

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10: Sonic and Ultrasonic Irrigation

• Introduction
• Ultrasonic Activation
  • Ultrasonic Energy Generation
  • Passive Ultrasonic Irrigation (PUI)
  • Debris and Smear Layer Removal
  • Bacteria/Biofilm Removal
  • Safety
• Continuous Ultrasonic Irrigation (CUI)
• Laser-Activated Irrigation (LAI)
• Sonic Activation
• Summary
• References

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11: Continuous Instrumentation and Irrigation: The Self-Adjusting File (SAF) System

• The Role of Irrigants in Endodontic Treatment
• The Self-Adjusting File (SAF) System
  • The SAF
  • The RDT Handpiece Head
  • EndoStation/VATEA Irrigation Pumps
  • Minimally Invasive Shaping and Cleaning
  • Mode of Irrigation by the SAF System
  • Cleaning Efficacy of the SAF System
• Disinfection of Oval Canals
• Effect on Obturation
• Challenge of Isthmuses and Immature Teeth
• References

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12: Ozone Application in Endodontics

• Introduction
• Applications of Ozone in Medicine and Dentistry
• Effects on Dentin Bonding
• Antibacterial Activity
• Antifungal Activity
• Ozone and Endotoxin
• Conclusion
• References

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13: Irrigation of the Root Canal System by Laser Activation (LAI): PIPS Photon-Induced Photoacoustics

• Newer Laser Technology
• PIPS
• PIPS Protocol
• References

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14: Photodynamic Therapy for Root Canal Disinfection

• Introduction
• Mechanism of Photodynamic Inactivation of Microbial Cells
• Antimicrobial PDT in Root Canal Disinfection
• Conclusion
• References

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15: Local Applications of Antibiotics and Antibiotic-Based Agents in Endodontics

• Introduction
• Tetracyclines
  • Mechanisms of Action
  • Applications in Endodontics
  • Substantivity of Tetracyclines
• MTAD and Tetraclean
  • Antimicrobial Activity
  • Substantivity and Smear Layer Removal
  • Toxicity and Clinical Recommendations
• Ledermix Paste, Triple Antibiotic Paste
  • Combination and Clinical Application
• References

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16: Intracanal Medication

• The Infectious Problem
• Calcium Hydroxide
  • Antimicrobial Effectiveness
  • Mechanisms of Action
• Combination with Biologically Active Vehicles
• Other Intracanal Medicaments
• Indications and References

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17: Disinfection in Nonsurgical Retreatment Cases

• Introduction
• Challenges in Retreatment
  • Missing Canals and Vertical Root Fractures
  • Infection and Success Rate
• Disinfection Protocol
  • Sodium Hypochlorite (NaOCl)
  • Chelants and Chlorhexidine
• Concluding Remarks
• References

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18: Irrigation in Regenerative Endodontic Procedures

• Introduction
• Chemical Debridement and Regenerative Procedures
• Irrigation Techniques
• Overview of Regenerative Protocol
• Concluding Remarks
• References

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19: Conclusion and Final Remarks

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