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

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

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

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

5. 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)

6. 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)

7. 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

8. 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

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

10. COMMONLY USED INTRACANAL MEDICAMENTS

11. 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( )
Antimicrobial action:
Suppresses enzymatic activity and disrupts cell membrane
Inhibits DNA replication

12. 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.

13. 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)

14. 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

15. 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 percent range.

16. 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

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

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

19. 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%)

20. 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

21. THANK YOU.....