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Disinfection of the root canal system: what should the protocol be? Stephen J Bonsor Dental Update 2024 48:10, 707-709.
Authors
Stephen JBonsor
BDS(Hons) MSc FHEA FDS RCPS(Glasg) FDFTEd FCGDent GDP
The Dental Practice, 21 Rubislaw Terrace, Aberdeen; Hon Senior Clinical Lecturer, Institute of Dentistry, University of Aberdeen; Online Tutor/Clinical Lecturer, University of Edinburgh, UK.
The presence of micro-organisms within the root canal system is the critical aetiological factor in peri-radicular periodontitis. During root canal treatment (RCT) it is imperative that this infection and other organic debris are removed from the root canal system. This is challenging because complex tooth anatomy, the presence of a biofilm and the smear layer complicate the process. There are a number of irrigant chemicals and adjunctive systems available in contemporary endodontic practice that are used to disinfect the root canal system during root canal preparation. This article reviews the available evidence concerning these disinfection methods and concludes by presenting a clinical protocol supported by the literature.
CPD/Clinical Relevance: A clinical protocol, supported by the literature, is presented for effective decontamination of the root canal system during root canal therapy.
Article
In order to retain a tooth that has experienced irreversible pulpitis or peri-radicular periodontitis, the root canal system needs to be decontaminated. This is achieved by removing all the pulpal tissue and micro-organisms, cleaning and shaping the root canals before obturating the root canal space. Conventional technique involves the use of endodontic files and the introduction of chemicals (irrigants) into the root canal system during canal preparation to achieve disinfection. Intra-canal medications may be placed in the root canals with the same aim if the procedure is to be performed over more than one visit; however, these medicaments are outwith the scope of the present article and hence are not discussed. More recently, other systems and armamentaria have been introduced with the objective of enhancing and improving the efficiency of micro-organism removal during root canal preparation. It is incumbent that clinicians keep abreast of new techniques and technologies and, where possible, practise evidence-based dentistry. The aim of the present article is to review the current literature concerning the disinfection of the root canal space during root canal treatment (RCT) and provide the clinician with a protocol that they may follow, reassured that this is current best practice.
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