Hydrodynamic disinfection: tsunami endodontics.

Figure 1b: A 10-year post-treatment radiograph reveals excellent healing and confirms the importance of treating root canal systems. Introduction There are enormous differences in opinion regarding the potential to 3-dimensionally clean a root canal system. Elimination of pulpal tissue, bacteria (when present), and their related breakdown products is directly influenced by a series of procedural steps that comprise start-to-finish endodontics. Regrettably, no single beacon of light brightly illuminates the most proven clinical techniques essential for predictably successful endodontics. A review of the literature reveals virtually no agreement on a variety of fundamental clinical issues. As a single example, bacteria are ubiquitous in endodontically failing teeth, yet there is great controversy regarding the very methods used that directly influence their elimination. Debate is ongoing regarding the irrigants, their sequence of use, or the intracanal volume required to promote 3dimensional cleaning. Confusion abounds as to the ideal strength, optimal temperature, or the extent of time required for any given reagent to fulfill its intended purpose. The debridement and disinfection of a root canal system further depends on the apical one-third taper and the terminal diameter of the final preparation; yet again, there is no consensus on how these interrelated preparation objectives serve to directly influence the exchange of any given irrigant. Even though rational treatment approaches are available and precise techniques have been perfected, the dominant clinical reality is the best that endodontics has to offer is only sporadically delivered in everyday practice. This article will briefly review the rationale for treatment and the endodontic objectives. Particular emphasis will be placed on those factors that influence disinfection. The focus of this article will be on hydrodynamic disinfection and a clinical technique designed to facilitate this process. Hydrodynamic Disinfection “Tsunami” Endodontics