İrrigasyon ve Dezenfeksiyon
Özet
Kök kanal irrigasyonu, endodontik tedavide mekanik preparasyonu tamamlayan ve kök kanal sistemindeki mikrobiyal yükün azaltılmasını sağlayan temel bir basamaktır. Kök kanal anatomisinin kompleks yapısı, mikroorganizmaların isthmuslar, lateral kanallar, apikal dallanmalar ve dentin tübülleri gibi mekanik preparasyonla doğrudan ulaşılamayan alanlarda varlığını sürdürebilmesine neden olmaktadır. Bu nedenle irrigasyonun başarısı, kullanılan solüsyonun antimikrobiyal ve doku çözücü özelliklerinin yanı sıra kanal sistemi içerisindeki dağılımı ve aktivasyonu ile de ilişkilidir. Bu bölümde sodyum hipoklorit, etilendiamin tetraasetik asit, klorheksidin, salin ve distile su gibi başlıca irrigasyon solüsyonlarının özellikleri, etki mekanizmaları, avantajları ve sınırlılıkları ele alınmıştır. Ayrıca irrigasyon solüsyonlarının dentin yüzeyi, mikrosertlik, adeziv bağlanma, kök kanal patları ve post simantasyonu üzerindeki etkileri değerlendirilmiştir. Manuel dinamik aktivasyon, pasif ultrasonik irrigasyon, sonik aktivasyon, lazerle aktive irrigasyon, apikal negatif basınçlı ve multisonik sistemler incelenmiş; güvenli irrigasyon prensipleri ve olası klinik komplikasyonlar özetlenmiştir. Güncel yaklaşımda irrigasyon, yalnızca dezenfeksiyon sağlayan bir işlem değil, endodontik ve postendodontik tedavi başarısını birlikte etkileyen bütüncül bir uygulamadır.
Anahtar Kelimeler: kök kanal irrigasyonu, dezenfeksiyon, irrigasyon aktivasyonu, irrigasyon solüsyonları
Konu Alanı: Diş Hekimliği -> Diş Hekimliği (diğer) -> endodonti
Karamifar K, Tondari A, Saghiri MA. Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities. European endodontic journal. 2020;5(2):54-67.
Figdor D, Sundqvist G. A big role for the very small--understanding the endodontic microbial flora. Aust Dent J. 2007;52(1 Suppl):S38-51.
Gomes B, Aveiro E, Kishen A. Irrigants and irrigation activation systems in Endodontics. Brazilian dental journal. 2023;34(4):1-33.
Haapasalo M, Udnæs T, Endal U. Persistent, recurrent, and acquired infection of the root canal system post‐treatment. Endodontic topics. 2003;6(1):29-56.
Madhu K, Mathew S. Review of microbiology of endodontics and molecular identification of microorganisms from endodontic infections. J Otolaryngol ENT Res. 2018;10(6):417-20.
Sundqvist G. Associations between microbial species in dental root canal infections. Oral microbiology and immunology. 1992;7(5):257-62.
Neelakantan P, Romero M, Vera J, Daood U, Khan AU, Yan A, et al. Biofilms in Endodontics-Current Status and Future Directions. Int J Mol Sci. 2017;18(8).
Swimberghe RCD, Coenye T, De Moor RJG, Meire MA. Biofilm model systems for root canal disinfection: a literature review. International endodontic journal. 2019;52(5):604-28.
Siqueira Junior JF, Rôças IdN, Marceliano-Alves MF, Pérez AR, Ricucci D. Unprepared root canal surface areas: causes, clinical implications, and therapeutic strategies. Brazilian oral research. 2018;32:e65.
Topbas C, Adiguzel O. Endodontic irrigation solutions: A review: Endodontic irrigation solutions. International Dental Research. 2017;7(3):54-61.
Belkadi R, Sanz‐Serrano D, Ventura F, Mercade M. Chitosan‐based endodontic irrigation solutions and TGF‐β1 treatment: Creating the most favourable environment for the survival and proliferation of stem cells of the apical papilla in vitro. International endodontic journal. 2024;57(10):1492-504.
Mohammadi Z, Abbott P. The properties and applications of chlorhexidine in endodontics. International endodontic journal. 2009;42(4):288-302.
Ari H, Yaşar E, Bellí S. Effects of NaOCl on bond strengths of resin cements to root canal dentin. Journal of endodontics. 2003;29(4):248-51.
Basrani B, Haapasalo M. Update on endodontic irrigating solutions. Endodontic topics. 2012;27(1):74-102.
Abdellatif D, Cernera M, Cecere L, Iandolo A, Rengo C, Spagnuolo G, et al. Internally Heated Sodium Hypochlorite for Endodontic Irrigation: A Narrative Review of Efficacy and Clinical Applicability. European endodontic journal. 2025;10(6):456-65.
Raducka M, Piszko A, Piszko PJ, Jawor N, Dobrzyński M, Grzebieluch W, et al. Narrative review on methods of activating irrigation liquids for root canal treatment. Applied Sciences. 2023;13(13):7733.
Gernhardt C, Eppendorf K, Kozlowski A, Brandt M. Toxicity of concentrated sodium hypochlorite used as an endodontic irrigant. International endodontic journal. 2004;37(4):272-80.
Estrela C, Estrela CR, Barbin EL, Spanó JCE, Marchesan MA, Pécora JD. Mechanism of action of sodium hypochlorite. Brazilian dental journal. 2002;13:113-7.
Hülsmann M, Hahn W. Complications during root canal irrigation–literature review and case reports. International endodontic journal. 2000;33(3).
McComb D, Smith DC. A preliminary scanning electron microscopic study of root canals after endodontic procedures. Journal of endodontics. 1975;1(7):238-42.
Baumgartner JC, Mader CL. A scanning electron microscopic evaluation of four root canal irrigation regimens. Journal of endodontics. 1987;13(4):147-57.
Mohammadi Z, Shalavi S, Jafarzadeh H. Ethylenediaminetetraacetic acid in endodontics. Eur J Dent. 2013;7(Suppl 1):S135-s42.
Patterson SS. In vivo and in vitro studies of the effect of the disodium slat of ethylenediamine tetra-acetate on human dentine and its endodontic implications. Oral surgery, oral medicine, and oral pathology. 1963;16:83-103.
Soares JA, Roque de Carvalho MA, Cunha Santos SM, Mendonça RM, Ribeiro-Sobrinho AP, Brito-Júnior M, et al. Effectiveness of chemomechanical preparation with alternating use of sodium hypochlorite and EDTA in eliminating intracanal Enterococcus faecalis biofilm. Journal of endodontics. 2010;36(5):894-8.
Calt S, Serper A. Time-dependent effects of EDTA on dentin structures. Journal of endodontics. 2002;28(1):17-9.
Russell AD, Day MJ. Antibacterial activity of chlorhexidine. The Journal of hospital infection. 1993;25(4):229-38.
Gonçalves LS, Rodrigues RC, Andrade Junior CV, Soares RG, Vettore MV. The Effect of Sodium Hypochlorite and Chlorhexidine as Irrigant Solutions for Root Canal Disinfection: A Systematic Review of Clinical Trials. Journal of endodontics. 2016;42(4):527-32.
Hebling J, Pashley DH, Tjäderhane L, Tay FR. Chlorhexidine arrests subclinical degradation of dentin hybrid layers in vivo. J Dent Res. 2005;84(8):741-6.
Carrilho MR, Geraldeli S, Tay F, de Goes MF, Carvalho RM, Tjäderhane L, et al. In vivo preservation of the hybrid layer by chlorhexidine. J Dent Res. 2007;86(6):529-33.
Zehnder M. Root canal irrigants. Journal of endodontics. 2006;32(5):389-98.
Sen BH, Wesselink PR, Türkün M. The smear layer: a phenomenon in root canal therapy. International endodontic journal. 1995;28(3):141-8.
Torabinejad M, Khademi AA, Babagoli J, Cho Y, Johnson WB, Bozhilov K, et al. A new solution for the removal of the smear layer. Journal of endodontics. 2003;29(3):170-5.
Kokkas AB, Boutsioukis A, Vassiliadis LP, Stavrianos CK. The influence of the smear layer on dentinal tubule penetration depth by three different root canal sealers: an in vitro study. Journal of endodontics. 2004;30(2):100-2.
Ari H, Yaşar E, Belli S. Effects of NaOCl on bond strengths of resin cements to root canal dentin. Journal of endodontics. 2003;29(4):248-51.
Abou Neel EA, Knowles JC, Bozec L. Effect of sodium hypochlorite on adhesive charactersitics of dentin: A systematic review of laboratory-based testing. International Journal of Adhesion and Adhesives. 2019;95:102419.
Dionysopoulos D. Effect of digluconate chlorhexidine on bond strength between dental adhesive systems and dentin: A systematic review. Journal of Conservative Dentistry and Endodontics. 2016;19(1):11-6.
Dotto L, Pereira GKR, Tomm A, Bacchi A, Sarkis-Onofre R. Effect of root canal irrigants on push-out bond strength of endodontic sealers: a systematic review. Journal of Adhesion Science and Technology. 2021;35(16):1701-22.
Virdee S, Farnell D, Silva M, Camilleri J, Cooper P, Tomson P. The influence of irrigant activation, concentration and contact time on sodium hypochlorite penetration into root dentine: an ex vivo experiment. International endodontic journal. 2020;53(7):986-97.
Gu L-s, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR. Review of contemporary irrigant agitation techniques and devices. Journal of endodontics. 2009;35(6):791-804.
Van der Sluis L, Versluis M, Wu M, Wesselink P. Passive ultrasonic irrigation of the root canal: a review of the literature. International endodontic journal. 2007;40(6):415-26.
Gobbo LB, de Araújo LP, Vieira WdA, de-Jesus-Soares A, de Almeida JFA, Ferraz CCR. Impact of passive ultrasonic irrigation on the outcome of non-surgical root canal treatment: a systematic review and meta-analysis of randomized clinical trials. Evidence-Based Dentistry. 2024;25(4):212-3.
Susila A, Minu J. Activated irrigation vs. conventional non-activated irrigation in endodontics–a systematic review. European endodontic journal. 2019;4(3):96.
Chu X, Feng S, Zhou W, Xu S, Zeng X. Cleaning efficacy of EDDY versus ultrasonically-activated irrigation in root canals: a systematic review and meta-analysis. BMC oral health. 2023;23(1):155.
Badami V, Akarapu S, Kethineni H, Mittapalli SP, Bala KR, Fatima SF, et al. Efficacy of laser-activated irrigation versus ultrasonic-activated irrigation: A systematic review. Cureus. 2023;15(3).
Karobari MI, Adil AH, Snigdha NT, da Silva EJNL. GentleWave Versus Established Irrigation Techniques: Current Evidence from a Scoping Review. Journal of endodontics. 2026.
Boutsioukis C, Arias‐Moliz MT. Present status and future directions–irrigants and irrigation methods. International endodontic journal. 2022;55:588-612.