Volume 9 • 2022 • Issue 1

Q What kinds of irrigation solutions do you use? RSC: I like to keep it simple. Sodium hypochlorite is my preferred irrigation solution. I’m constantly activating my sodium hypochlorite inside the canal. The concentration I use is between 2.5 and 5% to ef fectively kill microorganisms and to remove organic tissue as well as necrotic and vital pulp substrates. Af ter that, I use a liquid solution of 17% ethylenediaminetetraacetic acid (EDTA). It dissolves the smear layer, which has been created by the process of shaping the canal. Then, my final irrigation protocol uses sodium hypochlorite again, which I leave inside the canal for approximately 5 minutes. My mot to is that you can’t irrigate too much and you can’t leave the solution in the canal for too long. These days, our file systems allow us to shape the canal very quickly. However, the chemical processes that disinfect still take time and we can’t rush them. Leaving solution inside the canal Q How do you get the irrigation solution into the right parts of the canals? RSC: My go-to for irrigation is a 30-gauge needle. There are also new flexible plastic needles that aren’t yet available in Canada but that I’m excited about. For now, I use a 30-gauge side vented needle 2mm shorter on my working length so that I can clean and disinfect the apical portion. Q Why is side venting important? RSC: To avoid irrigation accidents, you don’t want to have too much pressure inside the canal. Side venting allows back flow, which is safer and helps prevent extrusion of irrigation solution in the periapical area. Apical extrusion of irrigation solution can occur when the pressure of the solution is excessive or if an irrigating needle is stuck in the root canal. Common symptoms are pain, swelling, bruising and hemorrhage. 3 If an extrusion happens, the damage isn’t permanent, but it’s not pleasant for the patient and can take some time to heal. Another quick tip to prevent extrusions during irrigation is when the needle is inside the canal, keep the needle moving in an up and down motion so that the needle itself doesn’t block the flow of irrigation solution. When the needle is inside the canal, keep the needle moving in an up and down motion so that the needle itself doesn’t block the flow of irrigation solution. 31 Issue 1 | 2022 | SupportingYour Practice