Real World Endo Forum


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Endo Questions for the RWE Faculty:

In this area, users are encouraged to ask questions from the RWE Faculty regarding Endodontics in General and the EndoSequence Technique.

Endo Questions for the RWE Faculty:: Passive Ultrasonic Irrigation and Apical Extrusion


Joined: May 2015

Rank: Rookie

Posts: 3

My question is what is the current evidence based protocol for PUI with NaOCl for final Irrigation? I've found articles that say 1mm short of working length, I've heard to stay 3mm short of working length, and watched Dr. Nasseh's video where he recommended just using water instead of NaOCl. Just wondering if there's an evidence based protocol to prevent hypochlorite accident when using this method of final Irrigation.

Joined: November 2013

Rank: Faculty General

Posts: 43

In reply to Jake Modery Dr. Nasseh doesn't recommend using water alone. He uses water and ultrasonics and then adds hypochlorite on top after each water/ultrasonic use, which effectively turns the water in the canal into hypochlorite (he adds full strength bleach on top.) 
I think the fact that there's no protocol shows that there are many different ways of doing it. The key is to keep the broader goals in mind. Making sure you don't get the needle too deep if the canal is too narrow and cause cause the needle to bind and lock which causes hydraulic extrusion of the irrigant is important. So, if you will get the needle that deep, then use a lower concentration of bleach (1%) and make sure your needle is side vented and also loose in the canal (no binding). Irrigate very gently and slowly while moving the needle up and down. Also, use side vented needles and not end venting needles. 
Using larger apical diameter in necrotic teeth is also helpful in removing the biofilm mechanically.