Open Journal Systems

Cover Image

Irrigants in endodontic treatment

Sajedeh Ghorbanzadeh, Sara Arab Loodaricheh, Sara Samizade, Saeede Zadsirjan


The aim of root canal treatment is to remove virulence factors from this system. Cleaning and shaping of the root canal are at the outmost importance in endodontic treatment. Canal irrigation during the process of cleaning and shaping can lead to the elimination of microorganism, which are not removable through physical methods. Moreover, during the preparation of root canal, manually and by rotary instruments, the smear layer is created that must be eliminated by irrigants. In the present review article, irrigants were investigated in terms of chemical and biological features and their effective and safe ways of usage, along with some information that have been proposed on recent developments of root canal solutions. Furthermore, this topic has been studied regarding its effect on microorganisms and smear layer. In the present article, a review has been conducted through libraries, PubMed, ISI Web of science, Scopus websites, and Google using keywords such as endodontic treatment, intracanal irrigant, anti-bacterial, chlorhexidine, smear layer, and sodium hypochlorite. Diff erent materials have been introduced as root canal irrigants. Although sodium hypochlorite is the most common material used in the endodontic treatment against root canal microorganism, it has certain disadvantages and limitations and could not entirely remove the smear layer. Therefore, there is no irrigant that is capable of providing all the features of an appropriate irrigant individually. To remove the smear layer, ethylene diamine tetra acetic acid is required as the final rinse. High-density sodium hypochlorite (NaOCl) is more effective than 1 and 2% solutions. In order to eliminate the microorganisms of the root canal and the smear layer, it is suggested to use two or more detergents with a proper frequency. Using chlorhexidine as the final detergent creates a lasting impact.


Anti-bacterial materials; chlorhexidine; intracanal irrigant; root canal treatment; smear layer; sodium hypochlorite

Full Text:



Mittal N, Jain J. Antibiotics as an intracanal medicament in endodontics: A review. Indian J Dent 2013;4:29-34.

Paiva SS, Siqueira JF Jr, Rôças IN, Carmo FL, Leite DC, Ferreira DC, et al. Molecular microbiological evaluation of passive ultrasonic activation as a supplementary disinfecting step: A clinical study. J Endod 2013;39:190-4.

Peters OA, Schönenberger K, Laib A. Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography. Int Endod J 2001;34:221-30.

Prado M, Santos Júnior HM, Rezende CM, Pinto AC, Faria RB, Simão RA, et al. Interactions between irrigants commonly used in endodontic practice: A chemical analysis. J Endod 2013;39:505-10.

Boutsioukis C, Psimma Z, van der Sluis LW. Factors affecting irrigant extrusion during root canal irrigation: A systematic review. Int Endod J 2013;46:599-618.

Bürklein S, Tsotsis P, Schäfer E. Incidence of dentinal defects after root canal preparation: Reciprocating versus rotary instrumentation. J Endod 2013;39:501-4.

Nowicka A, Lipski M, Parafi niuk M, Sporniak-Tutak K, Lichota D, Kosierkiewicz A, et al. Response of human dental pulp capped with biodentine and mineral trioxide aggregate. J Endod 2013;39:743-7.

De-Deus G, Brandão MC, Leal F, Reis C, Souza EM, Luna AS, et al. Lack of correlation between sealer penetration into dentinal tubules and sealability in nonbonded root fi llings. Int Endod J 2012;45:642-51.

Carvalho RM, Manso AP, Geraldeli S, Tay FR, Pashley DH. Durability of bonds and clinical success of adhesive restorations. Dent Mater 2012;28:72-86.

Shahravan A, Haghdoost AA, Adl A, Rahimi H, Shadifar F. Effect of smear layer on sealing ability of canal obturation: A systematic review and meta-analysis. J Endod 2007;33:96-105.

Mozo S, Llena C, Forner L. Review of ultrasonic irrigation in endodontics: Increasing action of irrigating solutions. Med Oral Patol Oral Cir Bucal 2012;17:e512-6.

Dutner J, Mines P, Anderson A. Irrigation trends among American association of endodontists members: A web-based survey. J Endod 2012;38:37-40.

Basrani B, Haapasalo M. Update on endodontic irrigating solutions. Endod Top 2012;27:74-102.

Gomes BP, Ferraz CC, Vianna ME, Berber VB, Teixeira FB, Souza-Filho FJ. In vitro antimicrobial activity of several concentrations of sodium hypochlorite and chlorhexidine gluconate in the elimination of Enterococcus faecalis. Int Endod J 2001;34:424-8.

Christensen CE, McNeal SF, Eleazer P. Effect of lowering the pH of sodium hypochlorite on dissolving tissue in vitro. J Endod 2008;34:449-52.

Mohammadi Z. Sodium hypochlorite in endodontics: An update review. Int Dent J 2008;58:329-41.

Radcliff e CE, Potouridou L, Qureshi R, Habahbeh N, Qualtrough A, Worthington H, et al. Antimicrobial activity of varying concentrations of sodium hypochlorite on the endodontic microorganisms Actinomyces israelii, A. naeslundii, Candida albicans and Enterococcus faecalis. Int Endod J 2004;37:438-46.

Vianna ME, Gomes BP, Berber VB, Zaia AA, Ferraz CC, de Souza-Filho FJ. In vitro evaluation of the antimicrobial activity of chlorhexidine and sodium hypochlorite. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:79-84.

Waltimo TM, Orstavik D, Sirén EK, Haapasalo MP. In vitro susceptibility of Candida albicans to four disinfectants and their combinations. Int Endod J 1999;32:421-9.

Haapasalo HK, Sirén EK, Waltimo TM, Ørstavik D,Haapasalo MP. Inactivation of local root canal medicaments by dentine: An in vitro study. Int Endod J 2000;33:126-31.

Portenier I, Waltimo T, Ørstavik D, Haapasalo M. The susceptibility of starved, stationary phase, and growing cells

of Enterococcus faecalis to endodontic medicaments. J Endod 2005;31:380-6.

Byström A, Sundqvist G. Bacteriologic evaluation of the eff ect of 0.5 percent sodium hypochlorite in endodontic therapy. Oral Surg Oral Med Oral Pathol 1983;55:307-12.

Siqueira JF Jr, Rôças IN, Santos SR, Lima KC, Magalhães FA, de Uzeda M. Effi cacy of instrumentation techniques and irrigation regimens in reducing the bacterial population within root canals. J Endod 2002;28:181-4.

Clegg MS, Vertucci FJ, Walker C, Belanger M, Britto LR. The effect of exposure to irrigant solutions on apical dentin biofi lms in vitro. J Endod 2006;32:434-7.

Spangberg L, Engström B, Langeland K. Biologic effects of dental materials 3. Toxicity and antimicrobial effect of

endodontic antiseptics in vitro. Oral Surg Oral Med Oral Pathol 1973;36:856-71.

Liu H, Wei X, Ling J, Wang W, Huang X. Biofilm formation capability of Enterococcus faecalis cells in starvation phase and its susceptibility to sodium hypochlorite. J Endod 2010;36:630-5.

Ozdemir HO, Buzoglu HD, Calt S, Stabholz A, Steinberg D. Effect of ethylenediaminetetraacetic acid and sodium hypochlorite irrigation on Enterococcus faecalis biofilm colonization in young and old human root canal dentin: In vitro study. J Endod 2010;36:842-6.

Baumgartner JC, Mader CL. A scanning electron microscopic evaluation of four root canal irrigation regimens. J Endod 1987;13:147-57.

Torabinejad M, Handysides R, Khademi AA, Bakland LK. Clinical implications of the smear layer in endodontics: A review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:658-66.

Baumgartner JC, Brown CM, Mader CL, Peters DD, Shulman JD. A scanning electron microscopic evaluation of root canal debridement using saline, sodium hypochlorite, and citric acid. J Endod 1984;10:525-31.

Haapasalo M, Orstavik D. In vitro infection and disinfection of dentinal tubules. J Dent Res 1987;66:1375-9.

Orstavik D, Haapasalo M. Disinfection by endodontic irrigants and dressings of experimentally infected dentinal tubules. Endod Dent Traumatol 1990;6:142-9.

Haapasalo M, Shen Y, Qian W, Gao Y. Irrigation in endodontics. Dent Clin North Am 2010;54:291-312.

Machado-Silveiro LF, González-López S, González-Rodríguez MP. Decalcifi cation of root canal dentine by citric acid, EDTA and sodium citrate. Int Endod J 2004;37:365-9.

Khademi A, Feizianfard M. The effect of EDTA and citric acid on smear layer removal of mesial canals of first mandibular molars, a scanning electron microscopic study. J Res Med Sci 2004;9:80-8.

Gutmann JL, Saunders WP, Nguyen L, Guo IY, Saunders EM. Ultrasonic root-end preparation. Part 1. SEM analysis. Int Endod J 1994;27:318-24.

Yamaguchi M, Yoshida K, Suzuki R, Nakamura H. Root canal irrigation with citric acid solution. J Endod 1996;22:27-9.

Hülsmann M, Heckendorff M, Lennon A. Chelating agents in root canal treatment: Mode of action and indications for their use. Int Endod J 2003;36:810-30.

Kandaswamy D, Venkateshbabu N. Root canal irrigants. J Conserv Dent 2010;13:256-64.

Bjorvatn K, Skaug N, Selvig KA. Tetracycline-impregnated enamel and dentin: Duration of antimicrobial capacity. Scand J Dent Res 1985;93:192-7.

Wikesjö UM, Baker PJ, Christersson LA, Genco RJ, Lyall RM, Hic S, et al. A biochemical approach to periodontal regeneration: Tetracycline treatment conditions dentin surfaces. J Periodontal Res 1986;21:322-9.

Haznedaroğlu F, Ersev H. Tetracycline HCl solution as a root canal irrigant. J Endod 2001;27:738-40.

Khademi AA, Mohammadi Z, Havaee A. Evaluation of the antibacterial substantivity of several intra-canal agents. Aust Endod J 2006;32:112-5.

Labahn R, Fahrenbach WH, Clark SM, Lie T, Adams DF. Root dentin morphology after different modes of citric acid

and tetracycline hydrochloride conditioning. J Periodontol 1992;63:303-9.

Sae-Lim V, Wang CY, Choi GW, Trope M. The effect of systemic tetracycline on resorption of dried replanted dogs’ teeth. Endod Dent Traumatol 1998;14:127-32.

Bridges JB, Owens PD, Stewart DJ. Tetracyclines and teeth. An experimental investigation into five types in the rat. Br Dent J 1969;126:306-11.

Fardal O, Turnbull RS. A review of the literature on use of chlorhexidine in dentistry. J Am Dent Assoc 1986;112:863-9.

Gjermo P. Chlorhexidine in dental practice. J Clin Periodontol 1974;1:143-52.

Mohammadi Z, Abbott PV. The properties and applications of chlorhexidine in endodontics. Int Endod J 2009;42:288-302.

Russell AD, Day MJ. Antibacterial activity of chlorhexidine. J Hosp Infect 1993;25:229-38.

Heling I, Chandler NP. Antimicrobial effect of irrigant combinations within dentinal tubules. Int Endod J 1998;31:8-14.

Vahdaty A, Pitt Ford TR, Wilson RF. Efficacy of chlorhexidine in disinfecting dentinal tubules in vitro. Endod Dent Traumatol 1993;9:243-8.

Buck RA, Eleazer PD, Staat RH, Scheetz JP. Effectiveness of three endodontic irrigants at various tubular depths in human dentin. J Endod 2001;27:206-8.

Jeansonne MJ, White RR. A comparison of 2.0% chlorhexidine gluconate and 5.25% sodium hypochlorite as antimicrobial endodontic irrigants. J Endod 1994;20:276-8.

Zamany A, Safavi K, Spångberg LS. The effect of chlorhexidine as an endodontic disinfectant. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:578-81.

Gomes BP, Souza SF, Ferraz CC, Teixeira FB, Zaia AA, Valdrighi L, et al. Eff ectiveness of 2% chlorhexidine gel and calcium hydroxide against Enterococcus faecalis in bovine root dentine in vitro. Int Endod J 2003;36:267-75.

Ferraz CC, Gomes BP, Zaia AA, Teixeira FB, Souza-Filho FJ. In vitro assessment of the antimicrobial action and the mechanical ability of chlorhexidine gel as an endodontic irrigant. J Endod 2001;27:452-5.

Ingle JI, Bakland LK, Baumgartner JC. Ingle’s endodontics 6. USA: PMPH; 2008.

Siqueira JF Jr, Batista MM, Fraga RC, de Uzeda M. Antibacterial effects of endodontic irrigants on black-pigmented gramnegative anaerobes and facultative bacteria. J Endod 1998;24:414-6.

Sena NT, Gomes BP, Vianna ME, Berber VB, Zaia AA, Ferraz CC, et al. In vitro antimicrobial activity of sodium hypochlorite and chlorhexidine against selected single-species biofi lms. Int Endod J 2006;39:878-85.

Molander A, Reit C, Dahlén G. The antimicrobial effect of calcium hydroxide in root canals pretreated with 5% iodine potassium iodide. Endod Dent Traumatol 1999;15:205-9.

Ng YL, Spratt D, Sriskantharajah S, Gulabivala K. Evaluation of protocols for field decontamination before bacterial sampling of root canals for contemporary microbiology techniques. J Endod 2003;29:317-20.

Möller AJ. Microbiological examination of root canals and periapical tissues of human teeth. Methodological studies. Odontol Tidskr 1966;74:Suppl:1-380.

Peciuliene V, Reynaud AH, Balciuniene I, Haapasalo M. Isolation of yeasts and enteric bacteria in root-filled teeth with chronic apical periodontitis. Int Endod J 2001;34:429-34.

Portenier I, Haapasalo H, Rye A, Waltimo T, Ørstavik D, Haapasalo M. Inactivation of root canal medicaments by dentine, hydroxylapatite and bovine serum albumin. Int Endod J 2001;34:184-8.

Portenier I, Haapasalo H, Orstavik D, Yamauchi M, Haapasalo M. Inactivation of the antibacterial activity of iodine potassium iodide and chlorhexidine digluconate against Enterococcus faecalis by dentin, dentin matrix, type-I collagen, and heat-killed microbial whole cells. J Endod 2002;28:634-7.

Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation in endodontics. Br Dent J 2014;216:299-303.

Zehnder M, Schmidlin P, Sener B, Waltimo T. Chelation in root canal therapy reconsidered. J Endod 2005;31:817-20.

Marchesan MA, Pasternak Júnior B, Afonso MM, Sousa- Neto MD, Paschoalato C. Chemical analysis of the flocculate formed by the association of sodium hypochlorite and chlorhexidine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:e103-5.

Basrani BR, Manek S, Fillery E. Using diazotization to characterize the effect of heat or sodium hypochlorite on 2.0% chlorhexidine. J Endod 2009;35:1296-9.

Clarkson RM, Moule AJ, Podlich H, Kellaway R, Macfarlane R, Lewis D, et al. Dissolution of porcine incisor pulps in sodium hypochlorite solutions of varying compositions and concentrations. Aust Dent J 2006;51:245-51.

Giardino L, Ambu E, Becce C, Rimondini L, Morra M. Surface tension comparison of four common root canal irrigants and two new irrigants containing antibiotic. J Endod 2006;32:1091-3.

Torabinejad M, Cho Y, Khademi AA, Bakland LK, Shabahang S. The effect of various concentrations of sodium hypochlorite on the ability of MTAD to remove the smear layer. J Endod 2003;29:233-9.

Torabinejad M, Khademi AA, Babagoli J, Cho Y, Johnson WB, Bozhilov K, et al. A new solution for the removal of the smear layer. J Endod 2003;29:170-5.

Shabahang S, Pouresmail M, Torabinejad M. In vitro antimicrobial effi cacy of MTAD and sodium hypochlorite. J Endod 2003;29:450-2.

Shabahang S, Torabinejad M. Eff ect of MTAD on Enterococcus faecalis-contaminated root canals of extracted human teeth. J Endod 2003;29:576-9.

Johal S, Baumgartner JC, Marshall JG. Comparison of the antimicrobial effi cacy of 1.3% NaOCl/BioPure MTAD to 5.25% NaOCl/15% EDTA for root canal irrigation. J Endod 2007;33:48-51.

Kho P, Baumgartner JC. A comparison of the antimicrobial efficacy of NaOCl/Biopure MTAD versus NaOCl/EDTA against Enterococcus faecalis. J Endod 2006;32:652-5.

Giardino L, Ambu E, Savoldi E, Rimondini R, Cassanelli C, Debbia EA. Comparative evaluation of antimicrobial efficacy of sodium hypochlorite, MTAD, and Tetraclean against Enterococcus faecalis biofi lm. J Endod 2007;33:852-5.

Tay FR, Mazzoni A, Pashley DH, Day TE, Ngoh EC, Breschi L. Potential iatrogenic tetracycline staining of endodontically treated teeth via NaOCl/MTAD irrigation: A preliminary report. J Endod 2006;32:354-8.


  • There are currently no refbacks.