Intracanal medicaments phenols eugenol CMCP Formocresol Ca(OH)2 chlorhexidine Iodine potassium iodide IKI antibiotic corticosteroid Ledermix root canal endodontic calcium hydroxide camphorated powerpoint presentation

1. Intracanal medicaments
By
Ahmed Mostafa Hussein
Assistant lecturer, Dental Biomaterials Department
Faculty of Dentistry, Mansoura University
2014
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2. Functions
1. Destroy the microorganisms and prevent regrowth.
2. Reduce inter-appointment pain. It is useful in treating
apical periodontitis as a result of overinstrumentation.
3. Useful in weeping canals (constant clear or reddish
exudate, large apical radiolucency, and if cultured, the
drainage will not support bacterial growth)
4. May inhibit root resorption in case of replanted teeth.
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4. Ideal requirements:
1. Effective germicide and fungicide.
2. Non irritating to periapical (PA) tissues.
3. Stable in solution.
4. Have antibacterial effect for prolonged period.
5. Active in presence of blood and serum.
6. Low surface tension.
7. Should not interfere with repair of PA tissues.
8. Should not stain the tooth.
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6. 1. Phenols
 Phenols are ineffective antiseptics under clinical
conditions , it is rarely used as an intra-canal
medicament as it has strong inflammatory
potentials.
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7.  Eugenol has a high irritating potential when
evaluated histologically but it seems to be
extremely soothing clinically to vital tissue.
 camphorated mono-para-chloro-phenol (CMCP)
has decreased tremendously.
 CMCP placed in the pulp chambers loses nearly
90% of their activity within the first 24 hours.
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8. 2. ALDEHYDES
Formo-cresol
 It is a combination of formalin and cresol.
 it is potent toxin with an antimicrobial effectiveness much lower
than their toxicity.
 Formo-cresol is used as a dressing for pulpotomy to fix the retained
pulpal tissue.
 It may be used as an intra-canal medicament when a pulpotomy is
performed as emergency treatment to relieve pain.
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9.  No clinical reason to use formo-cresol as
an antimicrobial agent for endodontic
treatment. The alternatives are better
antiseptics with significantly lower toxicity.
 It is placed on a cotton pellet in the pulp chamber and
the vapor penetrate the entire canal preparation.
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10. 3. Calcium hydroxide Ca(OH)2
 Ca(OH)2 is effective in inhibiting microbial growth
in canals, although it remains controversial.
(see limitations of Ca(OH)2)
 No pain reduction effects.
 Recommended for use in teeth with necrotic pulp
tissue and bacterial contamination.
 Has little benefit with vital pulps.
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11. Form and application:
 Can be placed as a dry powder, a powder mixed with a
liquid such as local anesthetic solution, saline, water or
glycerine to form a thick paste or a paste supplied in a
syringe.
 A lentulo spiral is effective and efficient for placement.
 Removal after placement is difficult. This is especially
true in the apical portion of the root.
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12. Lentulo spiral
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13. Note: Long term use of Ca(OH)2 may be necessary.
However, the use of intracanal medicament for long
periods does not seem to be acceptable in modern
endodontics.
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14. Ca(OH)2 is useful for weeping cases
Weeping cases: the tooth with
1. Constant clear or reddish exudation
2. A large apical radiolucency
3. Often asymptomatic, but it may be tender to
percussion or sensitive to digital pressure over the apex.
4. If cultured, the drainage generally will not support
bacterial growth.
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15. 5. When opened at the start of endodontic
appointment, there is a reddish discharge. At the
succeeding appointment, the exudate will be clear. It
is referred as a weeping canal.
 Canals with exudates were not considered to be
ready for filling.
 Prescribing antibiotics for the patient seems
foolish, because of the frequency of negative
cultures.
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16. Treatment: the treatment of this problem is to dry
the canal with sterile absorbent paper points and
place Ca(OH)2 paste in the canal.
 It is interesting to see a perfectly dry clean canal at
the next appointment that is simple to fill after
minimal further preparation.
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17. Limitations of Ca(OH)2
 Residual Ca(OH)2 can shorten the setting time of
zinc oxide eugenol-based endodontic sealers.
 Ca(OH)2 is not totally effective against E. faecalis
and candida albicans.
 Dentin can inactivate the antibacterial activity of
Ca(OH)2.
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18.  A clinical study has shown that the number of
bacteria-positive canals actually increased after
Ca(OH)2 medication.
 Other studies have also indicated that cultures
changed from negative to positive after Ca(OH)2
placement.
 Therefore, based on the current best available
evidence, Ca(OH)2 has limited effectiveness in
eliminating bacteria from human root canals.
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19. 4. Chlorhexidine (CHX)
 Chlorhexidine (CHX) has been recently used as an
intra-canal medicament.
 A 2% gel is recommended.
 It can be used alone in gel form or mixed with
Ca(OH)2.
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20.  When used with Ca(OH)2, the antimicrobial
activity is greater than when Ca(OH)2 is mixed
with saline, although it remains controversial.
 2% CHX gel was significantly more effective than
Ca(OH)2 combined with 2% CHX or Ca(OH)2
alone, against root dentin infected with E. faecalis
and candida albicans after 7, 15 and 30 days of
incubation.
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21. 5. Iodine potassium iodide (IKI)
 Iodine potassium iodide (IKI) is very effective
antiseptic solution with low tissue toxicity.
 IKI releases vapours with a strong antimicrobial
effect.
 IKI can kill bacteria in infected dentin in 5 minutes
in vitro.
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22. 6. ANTIBIOTICS
 Sulphonamides are used as medicaments by mixing
distalled water or moistened paper point into jar
containing the powder.
 It is indicated in case of acute peri-apical abcess.
 Disadvatage, yellowish tooth discoloration.
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23. 7. Corticosteroid-antibiotic combination
 Corticosteroids are anti-inflammatory agents that may
decrease postoperative pain in certain situations e.g.
irreversible pulpitis and acute apical periodontitis.
 Corticosteroids may be ineffective, particularly with
greater pain levels.
 Corticosteroid-antibiotic combinations are useful in
treating apical periodontitis, occurring either as a
pretreatment symptom or as a result of overi-
nstrumentation.
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24.  Ledermix is a corticosteroid-antibiotic paste, made
in Germany.
 Ledermix is a nonsetting, water-soluble paste, used
as root canal medicament or as direct or indirect
pulp capping agent.
 At the first 24 hours, 30% of the corticosteroid was
released. By the end of 14 weeks, the remaining
70% has been released.
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25.  In case of replanted teeth, immediate intracanal
placement of Ledermix may inhibit root
resorption.
 Note: Intracanal antibiotic paste may cause
bacterial resistance.
 Mixing erythromycin with Ca(OH)2 improved the
effectiveness against E. faecalis as compared to
Ca(OH)2 alone.
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26.  In general, specific information about the
effectiveness of intra-canal antibiotics in infection
control in endodontics is limited.
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27. Questions
What are the indications of
Formocresol
Ca(OH)2
Corticosteroid-antibiotic combination
?
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