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
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
1.
2.
3.
4.
5.
6.
7.
8.
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
9. Should be stable & should have longer shelf life
10. Capable of inactivation in culture medium
11. Economic, easily available
CLASSIFICATION OF INTRACANAL
MEDICAMENTS
I.
Based on chemical nature:
Essential oil- Eugenol
II.
Phenolic compounds
ex: Phenol, camphorated phenol, camphorated mono
chlorophenol, cresol, cresatin, thymol
III. Aldehydes
ex: Formocresol, Glutaraldehyde
CLASSIFICATION OF INTRACANAL
MEDICAMENTS
Halides
Sodium hypochlorite, Iodine - Potassium
iodide.
V . Steroids
IV.
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
A. Paste form: Single paste or in
combination with iodoform.

B.

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