Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2017-11-24, 11:00:53 | version 1.38.0
| feature interview Understanding sonic-powered irrigation An interview with Dr Vittorio Franco Dr Vittorio Franco Thoroughly irrigating the entire root canal system— including isthmi and lateral canals—is important for success of endodontic treatment. Research has shown that sonic activation of irrigants offers signif- icant improvement in cleaning efficacy, since it re- moves considerably more debris and smear layer than needle irrigation. Besides cleaner root canals, it in- creases the effectiveness of disinfectant solutions to support long-term success. We spoke with leading Italian endodontist Dr Vittorio Franco about his daily irrigation protocol, passion for endodontics and ex- perience with EDDY, a sonic-powered irrigation tip. What do you like most about endodontics? Nothing is clearly visible in endodontics, so one has to constantly adapt one’s strategy. In the end, one must discover the anatomy, understand the differ- ence between one’s imagination and reality, and find a good treatment solution. Many recent dental stud- ies have confirmed the importance of retaining the natural dentition and thus of endodontics as opposed to implantology. Now is the right time to be an endo- dontist. We now have more possibilities for preserv- ing natural teeth and that is a wonderful thing. Why is proper rinsing so important, and how can one see when the canal has been cleaned properly? I think that the cleaning of the canal is the most im- portant aspect of an endodontic procedure. Of the three major steps, shaping and obturation are less im- portant than eliminating bacteria from the root canal. The main purpose of endodontic treatment is to clean the canal. Otherwise, root canals can become a good environment for bacteria to grow in. If the dentist re- tains vital tissue that will then become necrotic, it will facilitate bacterial growth. The main reason for re- treatment is the presence of an infection due to poor cleaning in the first place. There are many published studies on the time re- quired for proper irrigation. We have many variables to consider—contact time, refreshment of the solu- tion, amount of tissue/bacteria, volume, temperature, shear stress and so on—so we cannot standardise this process and final result. There are studies that say one needs 30 minutes to achieve the complete elimina- tion of bacteria, but they did not consider activation possibilities. If you ask me how I decide when irriga- tion has been sufficient, from my point of view, the only clinical way to determine whether the irrigating solution is working is from seeing bubbles in the solu- tion. That means that the solution is reacting with something inside the root canal system—obviously if there is no communication like a large foramen or perforation. “If bubbles stop being produced, the clinician can stop cleaning the canal because the sodium hypo- chlorite is probably no longer reacting.” If bubbles stop being produced, the clinician can stop cleaning the canal because the sodium hypo- chlorite is probably no longer reacting. There may still be something inside the canal, but the solution has achieved its best result. That would be my only sug- gestion. What is your irrigation protocol? I start with 5 per cent sodium hypochlorite, which I use for the entire shaping procedure. At the end, I use 17 per cent EDTA, activate it and remove it quickly. Then I use sodium hypochlorite again and activate it up to four times depending on the case. For necrotic cases, I wait until I see the reaction of the irrigant and the substrate. After removal of the sodium hypo- 32 roots 4 2017