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. Creating a fully tapered .06 preparation, as achieved with can achieve with rotary instrumentation, is an excellent way to increase the efficacy of our irrigation agent. The irrigation agents we recommend are sodium hypochlorite (5.25 percent) and EDTA (17 percent).
Irrigation technology 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 RealWorldEndo.com.
