Comparative efficacy of the most common root canal irrigation solutions

INTRODUCTION. Diseases associated with root canal system pathology remain one of the most pressing problems in modern endodontics because of the difficulty of achieving complete elimination of microorganisms from the root canal. The choice of an optimal irrigating solution is a key factor determining the efficacy of disinfection and the long-term prognosis of endodontic treatment.

AIM. To analyze current literature data on the efficacy of the most widely used root canal irrigating solutions and to evaluate their advantages, limitations, and potential for rational clinical application.

MATERIALS AND METHODS. An analysis of contemporary scientific literature on the use of the most common irrigating solutions in endodontics – sodium hypochlorite (NaOCl), chlorhexidine (CHX), and ethylenediaminetetraacetic acid – was performed. A comparative assessment was made of their antimicrobial properties, their capacity to dissolve organic tissue, their effect on dentin structure, features of their clinical use, and their efficacy when applied as part of combined irrigation protocols.

RESULTS. The literature analysis showed that each of the irrigating solutions considered has its own mechanism of action, advantages, and limitations. Sodium hypochlorite remains the “gold standard” of irrigation owing to its high antimicrobial activity and its ability to dissolve organic tissue. At the same time, reducing its concentration in combination with heating and physical activation makes it possible to preserve efficacy while decreasing toxicity and adverse effects on dentin properties. Chlorhexidine is characterized by a broad antimicrobial spectrum, low toxicity, and a pronounced prolonged effect; however, it lacks sufficient tissue-dissolving capacity and requires adherence to the application protocol to prevent the formation of a potentially toxic precipitate upon contact with NaOCl. EDTA effectively removes the smear layer and inorganic components of dentin, improving the permeability of dentinal tubules and the conditions for subsequent obturation. The greatest clinical efficacy is achieved with the combined use of EDTA and NaOCl, which acts on both the organic and inorganic components of the root canal system.

CONCLUSION. None of the currently available irrigating solutions is universally applicable for endodontic treatment. The most justified approach appears to be their rational combined use, taking into account the clinical situation, the concentration employed, and the activation methods, which makes it possible to ensure an optimal balance between the efficacy of antimicrobial treatment, safety, and the quality of endodontic treatment.

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