Endodontic disinfection – tsunami irrigation

XX There are enormous differences in opinion regarding the potential to three-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, there is no single beacon of light to brightly illuminate 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. There is ongoing debate regarding the irrigants, their sequence of use, and the intracanal volume required to promote three-dimensional cleaning. Confusion abounds as to the ideal strength, optimal temperature, and the extent of time required for any given reagent to fulfill its intended purpose. The debridement and disinfection of a root canal system is further dependent 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 rationale 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.