Intracanal medicaments 14/12/2014 Assalaam Alekum Intracanal medicaments Dr. Gaurav Garg (M.D.S.) Lecturer, College of Dentistry Al Zulfi, M.U.

Contents Introduction Microbes of the pulp Functions of Intracanal medicaments (ICMs) Ideal requirements of ICMs Classification of ICMs Commonly used ICMs

Introduction An agent used as an adjunct to cleaning and shaping for prevention or treatment of apical periodontitis

Microbes Of The Pulp With apical periodontitis Retreatment cases Fusobacterium, prevotella, pophyromonas, peptostreptococcus, veillonella, spirochetes Retreatment cases Enterococci esp. E. Fecalis, Yeasts Actinomyces

Functions of Intracanal Medicaments Primary function: Disinfection Examples: Antibiotics (Sulpha preparations, Penicillins, Metronidazole, Tetracycline, Clindamycin) Disinfectants (Aldehydes, Halogens, Phenols, Chlorhexidine, Calcium Hydroxide plain and with antimicrobial additives)

Functions of Intracanal Medicaments Secondary Functions: Induction of hard tissue formation/ Apexification (Calcium hydroxide, MTA) Pain control (Ledermix, Corticosteroids, NSAIDs) Control of exudation or bleeding ( Calcium hydroxide & Formocresol) Control of inflammatory root resorption (Calcium hydroxide & Ledermix)

Ideal Requirements of Intracanal Medicaments Potent antibacterial & antifungal agent Potent pulp tissue solvent Non irritant to periapical tissue Long duration of action Have low surface tension No hypersensitivity or allergic reaction No interference with repair of periapical tissues Active in presence of blood, abscess or protein derivatives of the tissue Should be stable & should have longer shelf life Capable of inactivation in culture medium Economic, easily available

Classification of intracanal medicaments Based on chemical nature: Essential oil- Eugenol Phenolic compounds ex: Phenol, camphorated phenol, camphorated mono chlorophenol, cresol, cresatin, thymol III. Aldehydes ex: Formocresol, Glutaraldehyde

Classification of intracanal medicaments IV. Halides Sodium hypochlorite, Iodine - Potassium iodide. V . Steroids VI. Calcium hydroxide VII. Antibiotics VIII. Combinations

COMMONLY USED INTRACANAL MEDICAMENTS

Calcium Hydroxide or CA(OH)2 Introduced by Hermann in 1920 Actions: Acts as a physical barrier for ingress of bacteria Acts as an antiseptic probably because of its high pH(12.5-12.8) Antimicrobial action: Suppresses enzymatic activity and disrupts cell membrane Inhibits DNA replication

Calcium Hydroxide or CA(OH)2 It is available in Paste form: Single paste or in combination with iodoform. Powder form: Powder form is mixed with saline and anesthetic solution. It is placed in the root canal with the help of paper points, spreaders or lentulo spirals.

Indications of Calcium Hydroxide Weeping canals Treatment of phoenix abscess Resorption cases Apexification Pulpotomy For non surgical treatment of periapical lesion Direct and indirect pulp capping As sealer for obturation To decrease postoperative pain after over instrumentation,it is used in combination with Ledermix (1:1)

Disadvantages of Calcium Hydroxide as Intracanal Medicament Difficult to remove from canals Decreases setting time of zinc oxide eugenol based cements limited effectiveness if used only for short time in root canals for disinfecting purposes

CHLORHEXIDINE GLUCONATE Widely used in periodontics because of its antibacterial activity Chlorhexidine exhibit substantivity (persistence in the area of interest), broadspectrum activity and low toxicity, these properties make it well suited for irrigation and dressing applications in endodontics. Effective concentrations commonly used are in range of 0.2-2 percent range.

FORMOCRESOL Contains formaldehyde as its main ingredient Widely used medicament for pulpotomy procedures in primary teeth Composition: Formaldehyde — 19 percent Cresol — 35 percent Water and glycerine — 46 percent Disadvantages: Toxic and Mutagenic

INTRACANAL MEDICAMENTS CONTAINING ANTIBIOTICS Ledermix paste -combination of: Tetracycline antibiotic (Demeclocycline HCl 3.2%) and a corticosteroid (1%Triamcinoloneacetonide), in a polyethylene glycol base

INTRACANAL MEDICAMENTS CONTAINING ANTIBIOTICS Triple Antibiotic paste- Combination of Metronidazole, Ciprofloxacin, and Minocycline.

INTRACANAL MEDICAMENTS CONTAINING ANTIBIOTICS BioPureMTAD (Mixture of tetracycline, acid and detergent) Introduced by Torabinejad & Johnson (2003) This solution contains doxycycline (at a concentration of 3%), citric acid (4.25%) and a detergent, Polysorbate 80 (0.5%)

References ENDODONTICS: Arnaldo castellucci PATHWAYS OF THE PULP (6th Edition): Stephen Cohen, Richard C. Burns PRINCIPLES AND PRACTICE OF ENDODONTICS (3RD Edition): Walton & Torabinejad ENDODONTIC THERAPY (6th Edition): Franklin S. Weine

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