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Endodontic ‘solutions’ part 1: a literature review on the use of endodontic lubricants, irrigants and medicaments M-L Good IA El Karim DL Hussey Dental Update 2024 39:4, 707-709.
Consultant, Department of Restorative Dentistry, The Royal Hospitals, Belfast Health and Social Care Trust, Grosvenor Road, Belfast, BT12 6BP, Northern Ireland
Professor of Restorative Dentistry and Consultant, Department of Restorative Dentistry, Queen's University, Grosvenor Road, Belfast, BT12 6BP, Northern Ireland, UK
Endodontic lubricants, irrigants and medicaments help prepare and disinfect root canal systems (RCS) but primary and secondary cases involve different microbes and therefore it is unlikely that one protocol will be effective for both case types. Each individual ‘solution’ or sequence of ‘solutions’ could play a significant role in each case type, but there are no detailed published guidelines in existence. To help inform clinical practice it was decided to undertake a literature review followed by a UK and Republic of Ireland wide audit on current endodontic ‘solution’ usage within dental schools. The literature review was undertaken under the following headings: pre-op oral rinse; file lubricants; root canal irrigants and intracanal medicaments and provides an evidence base for protocol development for both primary and retreatment cases. The audit project and the protocols developed from the findings of both the literature review and audit will be presented in Part 2.
Clinical Relevance: As our clinical practice should reflect evidence-based dentistry, it is important to be aware of the current literature on endodontic lubricant, irrigant and medicament use.
Article
The aim of endodontic treatment is to disinfect the root canal system and prevent re-infection. In a study by Peters et al1 examining root canal instrumentation, they found that half of the canal wall surface remained untouched by endodontic instruments. Therefore, in order to achieve the treatment aims, cleaning and shaping are essential. There are many endodontic ‘solutions’ available which can be categorized as lubricants, irrigants and intracanal medicaments. Their purpose is to prepare and disinfect the root canal system (RCS) adequately to enable the host response to favour healing of the periapical tissues.
Apical periodontitis is an inflammatory disorder of periradicular tissues caused by persistent microbial infection within the root canal system.2 The infection can be described as primary where the tooth has not yet been root-treated, or secondary where a previous endodontic treatment has failed.
The microbes involved in root canal infections are cocci, rods, filaments, spirochaetes, fungi and viruses.3,4 These microbes are organized into protective adhesive biofilms5 which, in addition to the anatomical complexity of the root canal system, make root canal disinfection challenging if not impossible.6 Primary infections are polymicrobial, mainly involving gram negative anaerobic bacteria containing 10–30 species per canal plus fungi.3 Secondary cases, however, tend to involve fewer microbial species (1–5 per canal), such as Enterococcus faecalis and Candida albicans. Enterococcus faecalis is the most common isolate in 22–77% of retreatment cases7–9 and they can survive in harsh environments, including highly alkaline pH, such as when calcium hydroxide is used as an intracanal medicament.10
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