Intracanal Medicaments

1. Intracanal Medicaments
Dr. SV.SATISH
Professor & HOD
Dept of Conservative Dentistry & Endodontics
Navodaya Dental College

2. Definition
The general definition of intracanal
medicaments is “temporary placement of
medicaments with good biocompatibility
into root canals for the purpose of
inhibiting coronal invasion of bacteria from
the oral cavity”.

3. HISTORY
Seribonius in 1045 AD wrote of using oils and
wine in the mouth of a patient in pain. This was
a crude attempt to achieve a topical anesthetic
effect on a tooth to be extracted.
Dental writings through the Middle Ages
indicate the use of oil of cloves, a plant extract
containing a high percentage of eugenol.

4. IDEAL REQUIREMENTS
It should be an effective germicide and
fungicide.
It should be non-irritating to the periapical
tissues.
It should remain stable in solution.
It should have prolonged antimicrobial effect
It should be active in the presence of blood,
serum and protein derivatives of tissues.

5. It should have low surface tension.
It should not interfere with repair of
periapical tissues.
It should not induce cell mediated immune
response.

6. FUNCTIONS
 Eliminate microorganisms: The objective is to
sterilize (destroy all viable microorganisms) or to
disinfect (destroy all pathogens) in the canal space.
 Rendering contents of canal inert: This represents
the attempt usually by chemical means to
“mummify”, fix or neutralize tissue or debris left
intentionally or unintentionally in the pulp space.
 Prevention or control of post treatment pain

7. Enhancing Anesthesia: By reducing the
sensitivity of the inflamed tissue which can be
difficult to anesthetize pulp.
Control of persistent periapical abscess : In
cases of continually “weeping” canal or
significant pain or swelling medicaments have
been suggested as a means of controlling this
difficult situation.

8. Root canal flora
Gram +ve organisms
Streptococci
Staphylococci
Corynebacterium
Yeasts
Gram –ve organisms
• Spirochetes
• Neisseria
• Bacteroides
• Fusobacterium
• Pseudomonas
• Coliform bacteria

9. The commonest organisms of the mouth,
streptococci are also the most frequently
found in root canals.
Among the streptococci is a small resistant
group of enterococci.

10. Various root canal medicaments
 Chlorhexidine
 Formocresol
 Calcium hydroxide
 Antibiotics
 Corticosteroids
 Herbal medicaments

11. Chlorhexidine
 Chlorhexidine (CHX) is a broad spectrum
antimicrobial agent. The property is due to its
cationic bisbiguanide molecular structure.
 It is bacteriostatic at lower concentrations and
bactericidal at higher concentrations.
 Chlorhexidine gluconate gel is widely used in
dentistry as an intracanal medicament

12. Chlorhexidine can be applied in varies forms.
 1. Mouthwash (0.12% and 0.2%),
 2. Gels (1%)- medicament
 3. Varnishes (1%, 10%, 20%, and 35%)

13. Formocresol
Developed by BUCKLEY in 1906.
Contents : 19% formaldehyde 35% cresol
46% H2O and glycerine.
Combination- formalin and cresol in the
proportion of 1:2.

14.  Formocresol combines the protein - coagulating
effect of phenolic compounds with the alkylating
effect of formaldehyde.
 The bactericidal effect of formocresol is good at
levels as low as 2%
 Formocresol is a non- specific bacterial medicament
most effective against aerobic and anaerobic
organisms found in root canals.

15. Causes widespread destruction of living
tissue followed by a persistent
inflammatory reaction.
Studies have reported that formocresol
treated tissue produced a cell mediated
immune response.

16. Calcium hydroxide
 Hermann introduced Ca(OH)2 paste as an ICM
in 1920 .
 Calcium hydroxide paste for intracanal use is a
thick suspension of Ca(OH)2 powder in sterile
water or saline or glycerine

17. Mechanism of Action
It is a highly alkaline substance with a pH of
approximately 12.5. Calcium hydroxide has
antibacterial properties and has the ability to induce
repair and stimulate hard-tissue formation. The
bactericidal effect is conferred by its highly alkaline
pH. The release of hydroxyl ions in an aqueous
environment is related to the antimicrobial property.

18.  Hydroxyl ions are highly oxidizing
free radicals that destroy bacteria by:
 Damaging the cytoplasmic
membrane
 Protein denaturation
 Damaging bacterial DNA

19. ANTIBIOTICS
Antibiotics have a limited role to play as an intracanal
medicament due to the following reasons: –
 No antibiotic can completely eradicate the complex
polymicrobial flora present inside an infected root canal.
 Most antibiotics are bacteriostatic and depend on the host
resistance for dealing with the infection. As the infected
root canal space has no blood supply, the effect of many
antibiotics is limited.

20.  Hence, a combination of antibiotics has been tried to
overcome the above-mentioned limitations. The
most popular intracanal antibiotic combinations
used are: –
 Triple antibiotic paste (TAP): Ciprofloxacin,
metronidazole, and minocycline (1:1:1) in a
macrogol/ propylene glycol vehicle
 Double antibiotic paste: Combination of
ciprofloxacin and metronidazole

21. STEROIDS
Steroids have limited applications as intracanal
medicament and are used exclusively in: – Internal
resorption cases – Traumatic injuries of the teeth
Ledermix: – The most popular steroid-based
intracanal medicament is Ledermix, developed by
Schroeder in 1960. –
Composition ■ Corticosteroid: 1% triamcinolone
acetonide ■ Antibiotic: Demeclocycline

22. Herbal medicaments
Propolis
 Propolis is prepared from resin collected by bees from
trees of poplars, conifers and flowers of genera clusia .
The pharmacologically active constituents in propolis
are flavonoids, phenolics and aromatics.
 Propolis is a good antimicrobial and anti inflammatory
agent, which can serve as a better intracanal irrigant
and intracanal medicament

23. Curcumin
 Turmeric (Curcuma longa) is extensively used as a
spice, food preservative and coloring material in
India, China and South East Asia.
 Curcumin which is the main yellow bioactive
component of turmeric has been shown to have a
wide spectrum of biological actions, including
antimicrobial, anti-inflammatory and anti- oxidant
activities

24. Conclusion
 Endodontic treatment are essentially debridement
procedures to disrupt and remove the microbial
ecosystem that is associated with the disease
process. It is important that clinicians understand
the close relationship between the presence of
microorganisms and endodontic disease
processes to develop an effective rationale for
treatment