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Intracanal Medicaments in Endodontics - Summarized

This simplified lecture will present to you the basic concept of intracanal medicaments, their indication, classification, and their appropriate selection.
Presented to you by Iraqi Dental Academy.
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Intracanal Medicaments in Endodontics - Summarized

  1. 1. Intracanal Medicaments Indication Intracanal medicaments classification Phenols and Aldehydes Calcium Hydroxide Limitations of Calcium Hydroxide Chlorhexidine Gel Mixing CHX with Ca(OH)2 Iodine-Potassium Iodide Ledermix ( Steroid ) Triple Antibiotic Paste Bioactive Glass INTRACANAL MEDICAMENTS INDICATION Although there are some controversy regarding one-visit or multi-visit endodontic treatment. The use of intracanal medicament is generally indicated in case of: • Teeth with necrotic pulp that are been treated in multi-visits. • Teeth that have failed root canal treatment and un- dergoing retreatment • Teeth with periapical pathology INTRACANAL MEDICAMENTS CLASSIFICATION Till now there is no ideal material that server all theses functions completely, several materials has been pro- posed throughout history, including: • Phenols • Aldehydes • Calcium Hydroxide • Chlorhexidine • Iodine-potassium iodide • Corticosteroids • Triple Antibiotic Past • Bioactive glass PHENOLS AND ALDEHYDES They were common intracanal medicaments. Howev- er, their use is no longer recommended. Their compo- nents are cytotoxic, carcinogenic and mutagenic. They are banned in several countries including USA. There is no clinical reason to use Phenols or Aldehydes as an intracanal medicament, the alternatives are better and significantly less toxic. CALCIUM HYDROXIDE One of the most commonly used intracanal medica- ments. And it’s the first choice as intracanal dressing material by most dentists. How to prepare and place? Calcium hydroxide paste is prepared by mixing pow- der with sterile water or saline or local anesthetic solu- tion. The mixture should be thick to carry as many Ca(OH)2 particles as possible, however, do not overd- ried the mix to maintain solubility and high PH. Lentulo Spiral are effective for placing the paste inside the canal. Calcium hydroxide must placed to fill the entire canal to the full working length. Care should be taken not to extrude it beyond the apex. Rotary instru- ments has been suggested for placing the material into Intra-canal Medicaments Osama Asadi, B.D.S, Published for Iraqi Dental Academy Blog After proper instrumentation and irragation of root canal, some dentists may place antibacterial agent inside the canal and seal the cavity with temporary filling for the next appointment. The purpose of such practice is to • reduce the inter-appointment pain • decrease bacterial count and prevent regrowth and • to render the content of canal inert (biologically inactive). LECTURE OUTLINE CHAPTER 1
  2. 2. the prepared root canal. Nevertheless, paper points can do the job. Limitations of Calcium Hydroxide Despite its wide clinical use, it has been presented with some limitations: • The handling and proper placement of material may be difficult. • Removal of the paste also incomplete, even with saline, NaOCl or EDTA, resulting in residual Ca(OH)2 which shorten the setting time of zinc ox- ide eugenol based endodontic sealers, if used. • It’s ineffective againts E. Faecalis, a common end- odontic pathogen, and also ineffective against Can- dida Albican. Although it’s effectiveness well documented in the sci- entific literature, recent researches present a contrary results. So, the use of such material is controversial, some researchers confirm the use of Calcium hydroxide while others suggest its low effectiveness. A recent meta-analysis published at the Korean Acade- my of Conservative Dentistry concluded that Calcium hydroxide has limited antibacterial effect, the micro- organisms were reduced but not completely eliminat- ed after treatment, and some species has resistance to Ca(OH)2. The majority of clinical studies supported that there was no improvement in healing of periapical lesions when Ca(OH)2 was applied between appoint- ments. So, based on the current best available evidence, Calcium hydroxide has limited effectiveness in elimi- nating bacteria from human root canals (source in the last slide). But it remain the best available intracanal medicament choice. CHLORHEXIDINE GEL Chlorhexidine has been recently introduced as intraca- nal medicament. In vitro studies has suggested that CHX has at least as good or even better antibacterial efficacy than Calcium hydroxide. While in Vivo stud- ies the results where controversial. Some studies has suggested its effectiveness while others have suggested controversial results. However, it is a common intracanl medicament and represent the second best available choice. MIXING CHX WITH CA(OH)2 Mixing them has been suggested to increase the an- tibacterial action. However, many studies have been published and the results were not conclusive. The use- fulness of mixing is controversial and not confirmed. IODINE-POTASSIUM IODIDE It’s very effective intracanal medicament with low tox- icity but it’s not available in the market. If you want to use it, you should prepare it manually. It’s prepared by mixing 2 g of iodine in 4 g of potassium iodide, this mixture is then dissolved in 94 ml of distilled water. LEDERMIX ( STEROID ) Is anti-inflammatory agent that reduce pain and in- flammation in the periapical tissue. Ledermix has been advocated as intracanal dressing if the patient reported symptoms of pain and inflammation. However, Ledermix substances can reach the system- ic circulation via diffusion through dentinal tubules, lateral canals and apical foramen. Its use has been re- stricted in the United State. In addition to that, Leder- mixed, which is a steroid, act as antiinfmmatory and reduce the symptoms of pain, but the infection is still there. This could mask the infection and deceive the clinician. Therefore, they are not popular now despite their common use in the past. TRIPLE ANTIBIOTIC PASTE It’s composed of Metronidazole, Ciprofloxacin an Mi- nocycline. It is very effective at eradicate baterial col- onies in root canals. But it has some disadvantages: • Minocyline cause tooth discoloration. • Fear of bacterial resistance • high toxicity to stem cells For tooth discoloration reason, dual paste can be used in place of triple paste. Or use of Ca(OH)2 should be considered. BIOACTIVE GLASS It is a newly presented intracanal medicament. It found to kill bacteria bu the mechanism of action is not ph-re- lated. Some new obturating materials such as Resilon, contain bioactive glass. REFERNENCES • The Korean Academy of Conservative Dentistry, Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review – Part II. in vivo studies • Cohen’s Pathways of Pulp, 11 Edition, Chapter The Core Science of Endodontics, Intracanal Me- dicaments, p. 260 • J Appl Oral Sci., Antibacterial effect of calcium hydroxide combined with chlorhexidine on En- terococcus faecalis: a systematic review and me- ta-analysis 2

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This simplified lecture will present to you the basic concept of intracanal medicaments, their indication, classification, and their appropriate selection. Presented to you by Iraqi Dental Academy. visit us on facebook: or Twitter: Our page on Telegram: @IraqiDental


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