Why I Use... Chlor-XTRA and SmearOFF
Endodontic irrigation system for fast, effective canal cleansing and smear layer removal
The goal of endodontics is to remove infected tissue and any associated bacteria from the canal system, leaving behind a clean system that can be sealed during the obturation phase. That said, what you take out of a root canal is at least as important as what you put into it. Here, Gregori M. Kurtzman, DDS, shares why it’s crucial to pay attention to the details when it comes to choosing an irrigation system, and why he chooses Vista's irrigation system to ensure no debris is left behind.
Gregori M. Kurtzman, DDS
Dr. Kurtzman attended the State University of New York at Fredonia as an undergraduate biology major with a minor in genetics, and received his DDS degree in Washington, DC in 1986. He began his private practice in 1987 in the Norbeck area of Silver Spring, MD. Dr. Kurtzman has completed over 4,500 hours of continuing education in the areas of implant and cosmetic dentistry and has served on the faculty at The University of Maryland in Baltimore teaching clinical restorative dentistry in the Department of Endodontics, Prosthetics, and Operative Dentistry. A Fellow in the Academy of General Dentistry and Pierre Fauchard Academy, he has authored over 700 professional articles and lectures extensively on various dental topics both nationally and internationally.
While the endodontic files on the market today are engineered to be more flexible and tapered than ever before, approximately 35% of the canal surface remains untouched after hand or rotary file instrumentation. This makes irrigation an essential step in cleansing complex anatomy that files simply cannot touch.
Such an important step in the endodontic procedure requires careful consideration, and effective debridement is in part dependent on concentration. An irrigant with a sodium hypochlorite (NaOCl) concentration of at least 5% will provide increased tissue dissolution.
Also, adding surface modifiers to NaOCl increases wettability and allows the irrigant to penetrate deeper into dentinal tubules, improving tissue dissolution and its cleansing effects. One such modified NaOCl is Vista’s Chlor-XTRA, which is 6% concentration and offers
2.5% more wettability when compared to unmodified NaOCl. This has been shown to better inhibit Enterococcus faecalis, the bacteria often associated with endodontic failure. Additionally, Chlor-XTRA dissolves pulp tissue in significantly less time.
EDTA is a frequently used supplemental irrigant for smear layer removal because its chelating action makes it effective in removing the inorganic component of dentin. Similarly, the use of CHX as a final irrigant has proven to provide residual cleansing benefits. Vista’s SmearOFF offers the best of both worlds. A 2-in-1 proprietary mixture of EDTA and CHX, it is formulated with wetting agents and surface modifiers to cleanse while offering better smear layer removal.
Improving the End Result
While I feel confident using Chlor-XTRA and SmearOFF to leave canals thoroughly cleansed and free of debris, anything that can help me offer improved endodontic therapy and procedural efficiency is certainly worth a try. One minute of ultrasonic activation using Vista’s EndoUltra following hand or rotary instrumentation can result in significantly cleaner canals and accessory canal anatomy.
The cordless ultrasonic activator produces cavitation and acoustic streaming in the irrigation solution to actively disrupt the canal debris and smear layer. Ultrasonic agitation with EndoUltra also has been reported to more effectively remove bacteria such as E. faecalis.
