1. INTRA CANAL MEDICAMENTS

2. Introduction
Disinfection of pulp space is an important step during and after cleaning & shaping.
Certain clinical conditions demand the use of ICM in addition to the chemicomechanical preparation.
Helps in reducing endodontic microflora thus favouring periapical tissue repair.
reducing the endodontic microflora and therefore favoring periapical tissue repair

3. Classification Grossman 1.Essential oils 2.Phenolic compounds
3.Halogens
4.Antibiotics
5.Other-formocresol
-gluteraldehyde
-Cresatin
-N2
-Ca(OH)2
-Quaternary ammonium compounds

4. 1.Phenolic preparations:
Cohen
1.Phenolic preparations:
Phenol
Paramonochlorophenol [C6H4OHCl]
Thymol [C6H3OHCH3C3H7]
Cresol [C6H4OHCH3]
2. Aldehyde preparations:
Formocresol
Tricresol formalin
Gluterldehyde

5. Classification Continu...
3. Halogens: Chloramine -T, IKI. 4. Calcium hydroxide 5. Chlorhexidine 6. Antibiotics PBSCN. Triple antibiotic paste 7. Cortico steroid-antibiotic combination Ledermix 8. Bioactive Glass.

6. Ideal Requirements Effective germicide & fungicide Non irritating
Stable
Prolonged antimicrobial effect
Active in presence of blood,serum & protien derivatives of tissue
Low surface tension
Should not interfere with repair of periapical tissue

7. Ideal requirements Contn… Should not stain tooth structure.
Should not induce cell mediated immune response.
Should be capable of inactivation in culture medium.

8. Uses Helps eliminate bacteria after canal instrumentation
Reduces inflammation & thereby pain
Induces healing & hard tissue formation
Helps eliminate apical exudates
Controls inflammatory root resorption
Prevents contamination between appointments
Helps to dry persistantly wet canals

9. Functions of ICM Primary function Antisepsis Disinfection
Secondary function
Hard tissue formation
Pain control
Exudation control
Resorption control

10. Eugenol Chemical essence of oil of clove Slightly irritating
Anodyne and antiseptic
Trowbridge et al has shown that eugenol inhibited interdental nerve impulses

11. Phenol White crystalline substance Derived from coal tar .
Oldest antimicrobial agent s
Protoplasm poison – Causes necrosis of tissue
Used bcoz of its disinfectant and caustic action
Liquid phenol- (9 :1) ratio.

12. Para Chlorophenol - PCP
Substitution product of phenol in which chlorine replaces one of the hydrogen atoms
On trituration with gum camphor - forms an oily liquid
Recommended : 1% aqueous solution of Para-chlorophenol

13. CMCP 2 parts para-chlorophenol & 3 parts gum camphor
Camphor serves as a vehicle & diluent .
Prolongs antimicrobial effect.
Less irritating to periapical tissue than phenol & eugenol

14. Formocresol Combination of formaldehyde , cresol ,water &glycerine.
Formaldehyde – Strong disinfectant Combines with albumin to form insoluble , non decomposable substance

15. Gluteraldehyde Colorless oil Slightly soluble in water
Strong disinfectant and fixative
Recommended use :2%

16. Cresatin Also known as metacresylacetate Clear, stable, oily liquid
Claimed to have antiseptic & obtundant properties
Antimicrobial effect less than that of formocresol or camphorated para- chlorophenol (Grossman)
Less irritating

17. N2 Paraformaldehyde(primary ingredient)
Used as intracanal medicament & sealer
Eugenol, phenylmercuric borate, lead, corticosteroids, antibiotics .
Antibacterial action - Short lived and dissipated in about a week to 10 days.

18. Halogens Sodium Hypochlorite
Disinfectant action of halogen is inversely proportional to their atomic weight
Chlorine( Low Mol wt), Greatest disinfectant action
Not stable because they interact rapidly with organic matter
Sodium hypochlorite vapors are bactericidal .

19. Chloramine - T
It is a chlorine compound used in concentration of 5%. It
has good antimicrobial qualities.
It can be used when the patient gives a history of allergy of
iodine compounds.
It remains stable for a long period of time.

20. Iodides Consists of 2 parts Iodine crystals,4 parts KI, 94
parts distilled water
Root canal disinfectant use in conc ranging from
2- 5%. (Engstrom and Spangberg)
Highly reactive and combine with proteins in a loosely bound manner so its penetration is not impede

21. Vitapex Contains Calcium hydroxide,iodoform,silicone oil.
Appears to combine best effects of iodoform and calcium hydroxide

22. Quarternary Ammonium Compounds
Lower the surface tension of solutions
QAC are +vely charged & microorganisms are –vely charged - surface active effect results in which compounds clings to the microorganisms and reverses the charge
It acts by inhibition of cell protein synthesis and inhibition of DNA synthesis.

23. Antibiotics Sulphathiazole Pencillin Metronidazole Tetracycline
Clindamycin

24. Poly Antibiotic Paste (PBSC)
Developed by Grossman
The PBSC paste consist of
Penicillin- effective against gram +ve microorganism.
Bacitracin- effective against penicillin resistant microorganisms.
Streptomycin- effective against gram -ve microorganisms.
Caprylate- effective against fungi.

25. Triple Antibiotic Paste
Metronidazole
Ciprofloxacin
Minocycline.

26. Calcium Hydroxide Introduced by Herman in 1920.
It is one of the commonly used ICM.
It is a broad spectrum anti microbial agent.
It s antiseptic action probably relates to its high pH and its leaching action on necrotic pulp tissue

27. - Damaging bacterial cytoplasmic membrane
Calcium Hydroxide..
MOA
Antimicrobial activity of calcium hydroxide is related to the
release of hydroxyl ions in an aqueous environment.
These hydroxyl ions kills bacteria by
- Damaging bacterial cytoplasmic membrane
- Protein denaturation
- DNA damage

28. Viscous – Glycerine, Propylene glycol Oily - Olive oil, CMCP
Calcium Hydroxide..
Vehicles
Aqueous – Water,Saline
Viscous – Glycerine, Propylene glycol
Oily - Olive oil, CMCP

29. Chlorhexidine
It is a cationic bisbiguanide with optimal antimicrobial action
b/w pH
0.5% used as mouth wash
% used for endodontic disinfection
Available as water based soln,gel,liquid mixed with surface
active agents

31. Recent advancements in ICM
Bioactive Glass S53P4
Ozonised oil
Octenidine

32. Conclusion
Since residual bacteria can adversely affect the treatment outcome, the use of ICM has been recommended to compliment the anti bacterial effects of chemico mechanical procedures and eliminate persisting bacteria.
With a wide choice of ICM now available , selection should be made based on the clinical situation and compliance of the patient.

33. Conclusion
Every case should be judged on the advantages and disadvantages of using a intracanal medicament.
After all, what is removed from the root canal is of greater significance with regard to the success of root canal treatment than what is placed in the root canal system.

34. References
Pathways of the Pulp 10th Edition – Stephen Cohen & Kenneth Hargreaves.
Endodontics 6th Edition – John Ingle & K.Bakland.
Endodontic Therapy 6th Edition – Franklin S. Weine
Endodontic practice 12th edition- Grossman
Antibiotics as ICM-review- CDA journal Feb 2009.

35. Thank You…