Is Sodium Hypochlorite still the best irrigant for endodontics? Or do we have something novel and superior?
How can we improve the efficacy of our endodontic irrigation?
What % of NaOCl should we be using?
https://youtu.be/z5h2FzHpG68Watch PDP203 on YoutubeDr. Brett Gilbert rejoins Jaz Gulati to tackle all things endodontic irrigation after a brilliant episode on pre-emptive endodontics.
Advanced activation and delivery systems could change the game—are we on the brink of a major shift in endodontics?
Protrusive Dental Pearl: Before performing a molar extraction, challenge yourself to first complete an endodontic access on the tooth. This will enhance your understanding of the canal anatomy and improve your precision in sectioning the tooth. By visualizing the canals and the pulpal floor, you’ll refine your angulation for more accurate sectioning.
Need to Read it? Check out the Full Episode Transcript below!
Highlights of this Episode:
This episode is eligible for 0.5 CE credit via the quiz on Protrusive Guidance.
This episode meets GDC Outcomes B and C.
AGD Subject code: 070 Endodontics (Endodontic infections, microbiology and treatment)
Dentists will be able to:
If you liked this episode, be sure to watch the 1st Part – ‘PDP202 – Elective Endodontics? It’s all about Communication’
Click below for full episode transcript:Teaser: When you use a lower percentage, you really aren't reducing or eliminating the risk of sodium hypochlorite accident. If you get 3% sodium hypochlorite out the end of the root, it's going to cause a sodium hypochlorite accident, as will 6%. If you're trying to eliminate risk using a lower concentration, I don't think it's as effective as you think, but you are taking away some of the strength that you're looking for to kill the bacteria and dissolve the tissue. So my advice would be go full.
Teaser:We recognize that training our general dental colleagues on endo is paramount because we don’t want the option of implant to come in place of saving the natural tooth simply because of fear or the fact that they just don’t feel well enough trained to do the endo. So I believe as a dental community, the more we feel comfortable and proficient in endo, the more teeth we save and the better our patients are.
Jaz’s Introduction:Is sodium hypochlorite still the best thing in irrigation? If it is, what percentage should we be using? This one might actually surprise you. Is there ever a time when to use chlorhexidine. Whatever irrigant we’re using, how can we improve its effectiveness?
Hello, I’m Jaz Gulati and welcome to the part two with Dr. Brett Gilbert. How awesome was he? Please do check it out if you haven’t already. We talked about elective endodontics or preemptive endodontics. I love the clarity and the passion in which he speaks with. And he definitely continues it on into this episode. He’s so knowledgeable, he’s so passionate about endodontics in general, but especially the innovation in irrigation.
Because after all, endodontic success is all about killing those bugs. And Brett has so much experience in trying all the different things out there. And towards the second half of this episode, he really talks about what are the innovations. What’s around the corner? What’s the next best thing in irrigation?
But then I also squeeze out of him the all important real world question, which is no matter what clinic you are in the world, how can you improve your irrigation? So we also talk about GP pumping right towards the end. This episode is eligible for CPD or CE credits. This one’s 0. 5 CE credits under the topic of 070 endodontics as Protrusive Education is a PACE approved provider. Make sure you’ve got the Protrusive Guidance app, so you can just answer the questions after this episode.
Dental PearlEvery PDP episode, I give you a Protrusive Dental Pearl, and can you believe we already have 291 episodes? That’s across all the group functions and the interference casts. And combining all the stuff we do in the podcast, we’re almost at 300. We’ve also reached a really cool feat recently, whereby we now we’re ranked in the top 1% of podcasts worldwide in any genre. So I really want to thank you, the listener, the watcher for supporting Team Protrusive. Your support, your subscriptions, your wonderful engagement has meant so much to us and allowed us to create this content and bring on guests just like Brett and all the 200 plus guests we’ve had on. I want to thank all the guests who come on the show as well.
But before we join the main interview, let me give you today’s Protrusive Dental Pearl. How can you improve your endodontic access? Well, let me tell you the secret of improving anything in your dentistry. Any technique you want to improve in dentistry, you just have to do more of it. Now, what I don’t mean is every patient start accessing their first molar, trying to find MB2 just for the fun of it. That would be wrong, but here’s a really cool idea. As you know, every time I extract a molar, 95% of the time I will be sectioning that molar.
So for a lower molar, section around the middle to separate it into its mesial and distal root, and for an upper molar, more often than not, it’s separating it into its three roots. So I’m very pro sectioning, it’s kind to the bone, it makes your extractions easier. Makes extractions more predictable. I already have podcast episodes on this, and I also have sectioning school, my mini masterclass on Protrusive Guidance, if you want to learn more about sectioning.
But here’s how we can kill two birds with one stone. How can you improve your sectioning? Because when you start sectioning, the most difficult thing is getting that angulation of the bur correct, so that you cleanly cut through the fication or the root exactly where you want it. So how about this? The next time you’re going to do a molar extraction, How about you challenge yourself to first do an endodontic access?
The tooth’s coming out anyway, right? So how about with your bur, you go in for the kill. You get to the canals. What this will do is teach you about endodontic anatomy. It’ll teach you about where the canals live. And the more you do this, the more you’ll end up improving when you actually have to do a real access.
It’ll actually make you quicker as well. Because you have nothing to lose in that scenario because the tooth’s coming out anyway, you’re not going to be afraid to perforate. Because the point is, for sectioning, once you can see the canals, you know exactly where to section. When you see the pulpal floor, it makes the angulation of your section so much better.
So, now with the sectioning, you’ve improved your extractions, and now by the fact that you accessed it first, you’ve improved your sectioning, but you’ve also gained more experience in doing an endodontic access. So I hope you enjoy that pearl. Hopefully it’s applicable to you. Any limiting beliefs you have, oh I can’t do this in my clinic for x, y, and z, just do it.
Even if it just means you book an extra five minutes and that five minutes is what you spend on the access. Oh, and please use some good burs. It makes a huge difference to being efficient. Anyway, let’s join Dr. Brett Gilbert on how we can improve our endodontic irrigation.
Main Episode:Irrigation! Okay, so I know you’re really hot on this. So the proper disinfecting protocols, let’s talk about where we are in 2024. Cause I was taught that sodium hypochlorite is the gold standard. So the first question is, is there anything better yet? Are we still relying on 3%, 5.25% wherever it is sodium hypochlorite?
[Brett]We are, but what we’ve learned is a few things that are important to know, which is that the commercial store bought household bleach is not the way to go. And the reason is, is that what we’re dependent on for the antimicrobial bacteriology is to actually have free chlorine ion and the amount of free chlorine ion in bleach, it’s very unstable. It’s very fragile. We think of bleach as this noxious, hardcore substance, but it’s actually very fragile. It’s sensitive to air to light.
It can become contaminated. And even though it’s still, unfortunately, we’ll put a bleach stain on our beautiful new fig scrubs like you’re wearing there Jaz. It doesn’t mean that the free chlorine ion concentration is high. So we want you to be using a proprietary blend sold by a dental company where there are controls, there’s an expiration date.
And most importantly, what we found through our studies is that adding a surfactant to sodium hypochlorite really changes its effectiveness because surfactant lowers the surface tension of the solution, allowing it to flow into th...