![]() However, the presence of an apical “vapor lock”, i.e., air bubble entrapment, has been shown to impede optimal irrigant exchange throughout the root canal system with syringe and needle (positive pressure) irrigation, contributing markedly to poor canal debridement. Traditionally, irrigants are delivered into the canal with a syringe and a needle. Therefore, the role of irrigation in achieving optimal debridement of the canals cannot be overemphasized. Even in the absence of bacteria, the biofilm matrix alone can result in chronic inflammation, indicating that antimicrobial strategies used in endodontics should result in disruption of the biofilm architecture. Endodontic bacterial biofilms are concentrated within the main canal, and the anatomic eccentricities outlined above. ![]() Biofilms are spatio-temporally organized, adherent masses of microorganisms, encapsulated in their self-produced extracellular matrix. The role of microorganisms in root canal infections has long been established. Where the walls are touched, i.e., scrubbed and/or shaved mechanically, a smear layer is created, and no chelating agent can completely remove it. Both manual and engine-driven instrumentation systems are unable to contact 100% of the root canal wall, implying that, untouched walls retain pulp remnants and biofilms, contributing to post-treatment disease. However, the increasing evidence on the complexity of the root canal anatomy highlighted the challenges in optimal disinfection of the root canal system. ![]() Instrumentation combined with needle-and-syringe irrigation of NaOCl has been shown to reduce the microbial load from root canals using culture-based approaches. Hence, its use is often followed by a demineralizing/chelating agent, typically, ethylenediaminetetraacetic acid (EDTA 10%–17%). Sodium hypochlorite (NaOCl 0.5%–6%), the most commonly used irrigant, is a non-specific proteolytic agent which dissolves pulp tissue, demonstrates antimicrobial and antibiofilm effects, but it is unable to remove any accumulated hard tissue debris. The aim of chemo-mechanical root canal debridement is to remove microbial biofilms, vital and/or necrotic pulp tissue and hard tissue debris generated during instrumentation. ![]()
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