irigasi 2015

8/17/2019 IRIGASI 2015

1/45

By : drg. Irfan Dwiandhono,

Sp.KG

IRIGASISALURAN AKAR

Blok Aesthetic Dentistry 1

Kedokteran Gigi

Universitas JenderalSoedirman

8/17/2019 IRIGASI 2015

2/45

Grossman, L.I., Oliet, S., Rio,

C.E.D. 1995. Ilmu Endodontik Dalam

Praktek. EGC. Jakarta

Ford, .R.P., R!odes, J .S., Ford,

".E. #$$#. Endodonti%s Pro&lems'

Sol(in) Clini%al Pra%ti%e. London.

*artin Dunit+

urns, C.R., Co!en, S. Pat!-as o/

!e Pul0. t! Ed.R!odes, J.S. #$$. 2d(an%ed

Endodonti%s Clini%als Retreatment

Sur)er. alor 3 Fran%is . London

Reerensi

8/17/2019 IRIGASI 2015

3/45

1. Mempunyai sifat antimikroba & broad spectrum

2. Mempunyai tegangan permukaan rendah Dapat mengalir

ke daerah yang tidak terjangkau dengan mudah

3. Tidak mutagenic, carcinogenic, atau cytotoic

!. Mempunyai kemampuan untuk melarutkan jaringan

nekrotik atau debris

". Tetap aktif dalam penyimpanan

#. Dapat menonaktifkan endotoksin

$. Mencegah formasi smear layer selama instrumentasi, ataumelarutkannya ketika smear layer terbentuk

%. Membantu debridement sistem saluran akar

. Menjadi pelumas'lubricant yang baik

1(. )fektif mendesinfectkan saluran akar

S!ARA" ID#AL IRIGASI SALURANAKAR

8/17/2019 IRIGASI 2015

4/45

1. *+ailability

2. Tidak mahal

3. emudahan penggunaan -con+enience

!. *de/uate shelf life". emudahan penyimpanan

S!ARA" LAIN IRIGASI SALURANAKAR

8/17/2019 IRIGASI 2015

5/45

Menghilangkan fragmen jaringan pulpa danserpihan dentin yang menumpuk

Memuang deris dari saluran akar lateral

atau asesoris Seagai !elumas

Memunuh kuman

Melarutkan "aringan nekrotik

Bila ditamah larutan kelasi Dapatmenghilangkan smeared layer

$UNGSI IRIGASI SALURANAKRAB

8/17/2019 IRIGASI 2015

6/45

Konsentrasi

Kemampuan #a$%l dalam melarutkan jaringan leihtinggi pada konsentrasi &,'&(

Kontak

Supaya efektif,)airan irigasi harus kontak dengansustrat

Keeradaan jaringan organi)

"aringan organik harus diersihkan supaya )airan irigasidapat efektif

Kuantitas )airan irigasi yang digunakanSemakin tinggi kuantitas )airan irigasi, semakin tinggi juga efekti* tasnya

+kuran jarum irigasi

"arum irigasi ' atau '- gaue sering dipakai karena

penetrasi di dalam saluran akar leih aik

/0K1$2 30#G M4#G+B050K1I6I10S 702+10# I2IG0SI

S07+20# 0K02

8/17/2019 IRIGASI 2015

7/45

1egangan permukaan )airan irigasi

1egangan permukaan rendah penetrasi ke areasempit untuk deridement yang leih aik

1emperatur )airan irigasi

Memanaskan #a$%l akan meningkatkan efekti* tasnya

/rekuensi irigasi

Semakin sering irigasi, semakin aik hasilnya

Diameter saluran akar

Saluran akar yang lear deridement leih aik +mur )airan irigasi

7arutan irigasi yang masih fresh leih e*siendaripada yang sudah lama

/0K1$2 30#G M4#G+B050K1I6I10S 702+10# I2IG0SI

S07+20# 0K02

8/17/2019 IRIGASI 2015

8/45

Sodium 5ypo)hlorite

Iodine Solutions

%hlorhe8idine Glu)onate

4D10 9 4thylene Diamine 1etraa)eti) 0)id%itri) a)id

M10D 9 Mi8ture of 1etra)y)line 0nd Disinfe)tant

40 9 4le)tro)hemi)ally 0)ti;ated ater

!0D 9 !hoto 0)ti;ated Disinfe)tion$one

4ndo8.

%A&A%'%A&A% LARU"AN IRIGASI

8/17/2019 IRIGASI 2015

9/45

Sodium !0o%!lorite is a %lear, 0ale, )reen'

ello- li4uid -it! stron) odor o/ %!lorine. It

is easil mis%i&le -it! -ater and )ets

de%om0osed & li)!t.

First introdu%ed into Endodonti%s &

Gut!erid)e in 1919.

"as &een used as an irri)ant in endodonti%s

/or man ears

It is !i)!l &a%teri%idal and (er e//e%ti(e atdissol(in) ne%roti% material.

Solutions ran)in) in stren)t! /rom $.5 to

5.#5 !a(e &een re%ommended /or use in

endodonti%s

1( Sodi)m *y+ochlorite ,Na-&l.

8/17/2019 IRIGASI 2015

10/45

2 1.$ sodium !0o%!lorite solution s!ould

&e e//e%ti(e in remo(in) root %anal de&ris and

dissol(in) or)ani% matter and e(en at $.5

solution is (er 0otent at ki l l in) entero%o%%i

6o di//eren%e -as /ound e70erimentall

&et-een a solution o/ $.5 and 5.$, &ut -it!

lo-er %on%entrations t!e e//i%a% de%reases

ra0idl, re4uirin) %o0ious irri)ation to remain

e//e%ti(e.Commer%iall a(aila&le sodium !0o%!lorite,

su%! as t!in !ouse!old &lea%!, -ould

normall !a(e a %on%entration o/

a00ro7imatel 8 $.5.

1( Sodi)m *y+ochlorite ,Na-&l.

8/17/2019 IRIGASI 2015

11/45

Deteriorates on stora)e and &e%omes less a%ti(e

-it! time, e70osure to l i)!t or %ontamination

-it! metall i% ions.

!e solutions are o/ten (er alkaline,!0ertoni%, and !i)!l irritant, and t!e ma

re4uire dilution -it! $.5 sodium &i%ar&onate

&e/ore use as an endodonti% irri)ant. !is -ill

redu%e t!e 0" -it!out a//e%tin) t!e &a%teri%idal

0ro0erties.

1( Sodi)m hy+ochlorite ,Na-&l.

8/17/2019 IRIGASI 2015

12/45

Faktor an) mem0en)aru!i e/ekti/itas 6aOCl :

1. ;aktu kontak

Semakin lama 6aOCl kontak den)an saluran akar, e/ekti/itas

antimikro&a 6aOCl semakin le&i! &aik. erutama 0ada

8/17/2019 IRIGASI 2015

13/45

Faktor an) mem0en)aru!i e/ekti/itas 6aOCl :

>. Srin)e iri)asi k!usus

*en))unakan $ )au)e@ se!in))a %airan iri)asi da0at

mendekati a0eks dan side venting se!in))a

%airan iri)asi keluar dan &er)erak ke

sam0in)

8. 2kti(asi Altrasoni%


8/17/2019 IRIGASI 2015

14/45

8/17/2019 IRIGASI 2015

15/45

Beuntun)an ir i)asi den)an men))unakan Sodium "0o%!loride :

Gross De&ridement Dissolut ion o/ so/t t issue

Lu&ri%at ion E%onomi%al

2nti&a%terial and &lea%!in) a%t ion Easi l a(ai la&le

Beru)ian 6aOCl :

• e%ause !i)! tension sur /a%e, i ts a&i l i t to -et dentin is less

• I rr i tant to t issues, i / e7truded 0 eria0i%al l, i t %an result in se(ere %e l lular

dama)e

•

I / %omes in %onta%t, i t %ause in/ lammation o/ )in) i(a &e%ause o/ i ts%austi% nature

• I t %an &lea%! t!e %lot!es i / s0l i t

• I t !as &ad odor and taste

• a0ors o/ sodium !i0o%! lori te %an irr i tate t!e ees

• I t %an &e %orrosi(e to instruments


8/17/2019 IRIGASI 2015

16/45

In%reasin) t!e %on%entration -ill in%rease t!e

rate at -!i%! or)ani% material is dissol(ed, and

ma im0ro(e its e//e%ti(eness as an

anti&a%terial a)ent.

*enaikkan su!u 6aOCl sam0ai $$ C akanmenin)katkan e/ekti/itas

Bonsentrasi an) di)unakan :

5,#5 : se&a)ai antise0tik kuat ta0i toksik

#,5 : &iasa di)unakan se&a)ai larutan

iri)asi

1,#5, 1 atau $,5


8/17/2019 IRIGASI 2015

17/45

"ika #a$%l keluar sampai jaringan periapikal,Komplikasi pemakaian #a$%l yang isa terjadi :

2asa sakit yang menyiksa

!erdarahan periapikal

!emengkakan


8/17/2019 IRIGASI 2015

18/45

!e use o/ saline as t!e sole irri)ant is

not %onsidered a00ro0riate, as normal

solutions are ine//e%ti(e as antimi%ro&ial

a)ents and -ill not dissol(e or)ani%

material.

Dalam kemasan larutan in/us se&a)ai

saline steril

It &asi%all a%ts & /lus!in) a%tion

2s /inal rinse /or root %anals to remo(e

an %!emi%al irri)ant le/t a/ter root %anal

0re0aration

/( Saline isotonik

8/17/2019 IRIGASI 2015

19/45

Bele&i!an :

iokom0ati&le

idak men)iri tasi

8/17/2019 IRIGASI 2015

20/45

Can &e 0ur%!ased as a mout!-as! in a $.#

solut ion.

I t ma &e e//e%ti(e in %on%entrations /rom $.# '

#.$, &ut t!ere is l i t t le 0u&l is!ed % l in i%al e(iden%e.

C!lor!e7idine, -!i le ant i&a%terial , -i l l not dissol(eor)ani% material, and is also relat i(el e70ensi(e.

2lt!ou)! t!e solut ion s!o-ed t!e 0otent ial to

redu%e &a%terial l oad, i t -as not as e//e%ti(e as >

sodium !0o%!lor i te or 1$0o(idone iodine.

i t -as not %onsidered as a 0r imar irr i)ant &e%auseo/ 0oor t issue'di)estin) 0ro0ert ies.

"as )ood su&stanti(it and !as t!e a&il i t to

ad!ere to !dro7a0atite %rstals in dentine. I t !as

&een 0ostulated t!at i t %ould 0otent ial l remain

a%t i(e /ol lo-in) root %anal t reatment

0( &hlorheidine gl)conate

8/17/2019 IRIGASI 2015

21/45

Bele&i!an :

• 2 # solution is used as root ir i)ant in %anals

• 2 $,# solution %an &e used in %ontroll in) 0la4ue a%ti(it

•

I t is more e//e%ti(e on )ram'0osit i(e &a%teria t!an )ram'ne)ati(e&a%teria

Bekuran)an :

• I t is not %onsidered as t!e main irr i)ant in standard endodonti%

t!era0

• I t is una&le to dissol(e ne%roti% t issue remnants

• I t is less e//e%ti(e on )ram'ne)ati(e t!an on )ram'0osit i(e &a%teria

0( &hlorheidine gl)conate

8/17/2019 IRIGASI 2015

22/45

Fun)si :

*en)!ilan)kan smear laer

*elunakkan

8/17/2019 IRIGASI 2015

23/45

8/17/2019 IRIGASI 2015

24/45

ersedia dalam # &entuk :

1. is%ous )el : Di)unakan ketika 0re0arasi

saluran akar se&a)ai 0elunak dentin

#. 24ues solution : di)unakan untukmem&uan) smear laer

.;!en used in series -it! sodium !0o%!lorite

t!e smear laer %an &e remo(ed, allo-in)0enetration o/ t!e anti&a%terial irri)ant dee0er

into in/e%ted dentine tu&ules.

2( #D"A ' Ethylenediaminetetraaceticacid

8/17/2019 IRIGASI 2015

25/45


8/17/2019 IRIGASI 2015

26/45

Sodium !0o%!lorite and saline solutions

are ine//e%ti(e at redu%in) smear laer

!e use o/ sodium !0o%!lor ite or ED2

as a sin)le irri)ant -il l not remo(e all o/

t!e de&ris.

!e rationale t!ere/ore !as &een to

alternate t!ese solutions in !i)! (olume

I t is interestin) t!at usin) t!e solutions

in t!e se4uen%e ED2, sodium!0o%!lori te and ED2 !as 0ro(ed to &e

more e//e%ti(e at remo(in) smear laer

t!an sodium !0o%!lorite , ED2 and

sodium !0o%!lorite


8/17/2019 IRIGASI 2015

27/45

"as &een re%ommended as a 0otent ial

root %anal irri)ant &e%ause E. faecalis

is sensiti(e to it.

!ere !a(e &een re0orts t!at some

strains o/ &a%teria t!at are asso%iated

-it! /ailed root %anal treatment !a(e

sur(i(ed in t!e 0resen%e o/ %al%ium

!dro7ide

!is solution ma &e use/ul as anirri)ant in retreatment %ases.

It is used as a # solution o/ iodine in

8 a4ueous 0otassium iodide

Iodine sol)tion in 3otasi)m Iodide

8/17/2019 IRIGASI 2015

28/45

2 solution o/ 1$ 0o(idoneiodine

?etadine, Seton "ealt!%are, Old!am,

AB@ a%!ie(ed a 1$$ &a%teri al ki l l in all

sam0les o/ E. faecalis as a &io/i lm a/ter

e70osure /or &ot! # and >$ minutes.Po(idoneiodine -as not as e//e%ti(e as

a > solution o/ sodium !0o%!lorite.

Iodine solutions -ere %onsidered to &e a

0otentiall use/ul ad

8/17/2019 IRIGASI 2015

29/45

"#KNIK IRIGASI

0lat yang digunakan :1( Syringe, dengan eragai entuk

jarum :

8/17/2019 IRIGASI 2015

30/45

8/17/2019 IRIGASI 2015

31/45

S!RING# IRIGASI

%ommer)ial endodonti)syringes ha;e a *ne ore toallow deli;ery of irrigant intothe api)al part of the root)anal system.

Gauge ' needles aremanufa)tured with a )ut awaytip to allow irrigant to pass outsideways and redu)e the risk

of api)al e8trusion

8/17/2019 IRIGASI 2015

32/45

S32I#G4 I2IG0SI

Jar)m di4engkokkandan di4eri sto++er

Jar)m tidak 4oleh +as

dalam sal)ran akar*ar)s ada r)ang)nt)k lar)tan kel)arke arah koronal

Jar)m har)s t)m+)l

8/17/2019 IRIGASI 2015

33/45

Irrigating needle

Id l i f i i i

8/17/2019 IRIGASI 2015

34/45

Ideal properties of irrigatingneedle

#eedle should e lunt It should allow a)k

8/17/2019 IRIGASI 2015

35/45

8/17/2019 IRIGASI 2015

36/45

D47I6423 $/ I22IG0#1S

Root %anal irri)ants are normall

introdu%ed into t!e root %anal

sstem usin) a sa/e'ended

endodonti% srin)e. Care must &e taken to ensure t!at

t!e needle ti0 does not &ind, as

irri)ant ma &e /or%ed t!rou)! t!e

a0e7. !e ti0 %an &e 0remeasured and

&ent to a(oid e7trusion and t!e

solution deli(ered slo-l, -it!out

0ressure

8/17/2019 IRIGASI 2015

37/45

Larutan irigasi dikeluarkan perlahan lahan Tanpa tekanan dengan gerakkan memompa Larutan tidak boleh terdorong ke arah apikal Tiap kali melakukan irigasi harus melimpah

kira kira 2 ml tiap irigasi

D#LI5#R! -$ IRRIGAN"S

8/17/2019 IRIGASI 2015

38/45

8/17/2019 IRIGASI 2015

39/45

!re)autions to e taken while irrigation

0;oid wedging the needle into the)anal

0;oid for)ing the solution into )anal 0;oid pla)ing the needle eyond the

api)al area or ;ery near to api)alarea

0;oid using larger gauge needle 0;oid using metalli), auto)la;ale

syringe as they more prone to

reakage

8/17/2019 IRIGASI 2015

40/45

/( #ndosonic

Endosoni%s is a (er use/ul means o/

deli(erin) irri)ant.

*ost 0orta&le ultrasoni% units %an &e

/itted -it! an endosoni% atta%!ment t!at

allo-s t!e deli(er o/ irri)ant Durin) ultrasoni% (i&ration o/ an

endosoni% /ile in t!e root %anal,

streamin) o/ t!e irri)ant is %reated, and

t!is ma !el0 dislod)e material /rom t!e%anal sstem.

It also ensures 0enetration o/ irri)ant into

lateral %anals, -!ere /iles %annot

0enetrate

8/17/2019 IRIGASI 2015

41/45

#ndosonic

+ltrasoni) streamingo))urs est when a small*le ?sie @&A is ;irated

freely within the root )anal

Binding of the *le resultsin a de)rease in streaming. 1he endosoni) *le should

e mo;ed up and down to

fa)ilitate irrigation andpre;ent possile ledging of

the )anal wall

8/17/2019 IRIGASI 2015

42/45

8/17/2019 IRIGASI 2015

43/45

Keuntungan : It )leans the root )anal walls etter than

)on;entional ones It remo;es the smear layer e)iently

It dislodges the deris from the )anal etterdue to a)ousti) e>e)t

Kerugian : +ltrasoni) preparation of the )anal is found to

e unpredi)tale It )an lead to e8)essi;e )utting of )anal walls

and may damage the *nished preparation

#ndosonic

8/17/2019 IRIGASI 2015

44/45

#ndosonic

0 high ;olume ofirrigant )an ee8)hanged with theuse of endosoni)s

+ltrasoni) irrigationwill eliminate a)teriafrom infe)ted root

)anals more e>e)ti;elythan syringe irrigationalone

8/17/2019 IRIGASI 2015

45/45

"*ANK !-U((

& U"-%%-R-6((

irigasi 2015

Documents