Intracanal Medicaments (1).pptx

Dr. AISHWARYA KHARE
PG 1st year

 The ultimate goals of endodontic treatment are complete
removal of bacteria, their byproducts and pulpal remnants
from infected root canals and the complete seal of
disinfected root canals.
 Intracanal medicaments have been thought an essential step
in killing the bacteria in root canals.
 However, in modern endodontics, shaping and cleaning may
be assuming greater importance than intracanal
medicaments as a means of disinfecting root canals.
 The more modern meaning of intracanal dressing is for a
blockade against coronal leakage from the gap between
filling materials and cavity wall.

 Therefore, intracanal medicaments, which were the early
‘shining stars’ of endodontic treatments, seem to have been
retired from the front line, but still retain some significance.

 “Temporary placement of medicaments with good
biocompatibility into root canals for the purpose of
inhibiting coronal invasion of bacteria from the
oral cavity”. (Kawashima et al 2009)

 Beechwood creosote was mentioned in the 1840 article
Creosote and Cotton in Fang Filling.
 In 1884, Richmond recommended applying a small-
sized piece of orangewood with phenol in order to
devitalise the pulp.
 Formocresol, which is categorised into the aldehydes,
was often used as a root canal medicament and played
a major role in root canal treatment since Buckley
referred to it as an effective intracanal medicament in
1904.

 Calcium hydroxide has been used as a component of
pulp-dressing preparations, vital pulp amputation
preparations and as a sealant for root canal fillings
since Hermann applied it to dentistry in 1920.
 It came to be widely used for root canal treatment in
the 1970s and is now regarded as one of the first
choices as a multiple- visit root canal medication.

 • It should be an effective antimicrobial agent
 • It should be nonirritating to the periradicular tissues
 • It should remain stable in solution
 • It should have a prolonged antimicrobial effect
 • It should be active in the presence of blood, serum,
and protein derivatives of tissues
 • It should have low surface tension
 • It should not interfere with the repair of periradicular
tissues
 • It should not stain tooth structure
 • It should not induce a cell-mediated immune
response.
Journal of Oral Research and Review | Volume 11 | Issue 2 | July-December 2019

 To dry persistently wet or the so-called weeping canals
 To eliminate any remaining microbes in the pulp space
 To render root canal contents inert
 To neutralize tissue debris
 To act as a barrier against leakage from an
interappointment dressing in symptomatic cases.
Journal of Oral Research and Review | Volume 11 | Issue 2 | July-December 2019

 According to Grossman intracanal medicament can be
classified as
 1. Essential oils
 • Eugenol
 2. Phenolic compounds
 • Phenol
 • Parachlorophenol
 • Camphorated parachlorophenol
 • Cresol
 • Formocresol
 • Creosote
 • Cresatin
 • Cresanol

 3. N2
 4. Salt of heavy metals
 • Metaphen
 • Merthiolate
 • Mercurophen
 5. Halogens
 • Sodium hypochlorite • Iodides • Chlorhexidine.
 6. Quaternary ammonium compounds
 7. Fatty acids
 • Propionic acid
 • Caproic acid
 • Cuprylic acid
 8. Sulphonamides

 Eugenol is the chemical essence of clove oil and is related
to phenol to some extent.
 It is both an antiseptic and an anodyne and is moderately
more irritating than clove oil.
 It becomes dark with age and is a pale yellow liquid.
 It has little bit anesthetic as well as antiseptic properties and
contain clove like odor .
Application of Intracanal Medicaments: A Review/ IOSR Journal of Dental and Medical Sciences (IOSR-JDMS

 In 1867, Lord Lister used phenol as medicine which is one
of the oldest antiseptic.
 It is derived from coal tar as white crystalline substance and
has a specific odor.
 By adding camphor, menthol or thymol phenol crystal is
become liquefied which consists of 9 parts phenol and 1 part
water commonly known as carbolic acid.
 This phenolic compound is used as sedatives for the pulp
tissue, as root canal medications and as disinfection for
caries cavity preparation, as disinfection before periapical
surgery and for cauterizing tissue tags that resist removal
with broaches or files in dental treatment.
 Phenol is notified as coefficient which is compared with
one time antimicrobials for their disinfectant action.

 It turns dark upon exposure to light and is a colourless
needle like crystals alike phenol.
 Chlorine replaces one of the hydrogen atoms of phenol so
parachlorphenol (C6H4OHCl) compound is formed.
 Crystals of parachlorophenol are soluble in ether, alcohol,
alkalies.
 It forms an oily liquid when it triturated with gum camphor.

 In 1891, Walkhoft introduced camphorated
parachlorophenol consisting of P-chlorophenol and
gum camphor in 2:3 ratio into dentistry as a intra canal
antiseptic.
 It has specific aromatic odor and is transparent light
amber coloured oily liquid.
 The camphor present in camphorated parachlorophenol
reduces irritating effect of pure parachlorophenol and
acting as a diluent and vehicle.
 Grossman brought to light the antimicrobial effect of
camphorated parachlorphenol compared to some other
root canal medicaments.
 Wantulor and Brown proved that the vapours of
camphorated chlorophenol of cresatin has a capability
of passing through the apical foramen.

 CMCP is being prepared using the mining crystals which is
a compound of paramonochlorophenol and camphor in the
ratio of 3:7 when liquefaction happens impulsively.
 CMPC is less irritant, powerful bactericidal agent than
phenol and doesn’t coagulate albumin .

 It is acquired from coal tar with or without containing a
trace of phenol having properties like Ortho, Meta and Para-
isomeric cresol.
 It is found in phenolic odor and is colourless or pinkish
liquid in nature.
 Cresol (C6H4OHCH3) can substitute phenol considering its
3-times more powerful disinfectant capacity .

 It filled the air of most dental orifices having sharp pungent
aromatic odor in the form of clear yellowish oily liquid.
 Only the beechwood variety of creosote should be used in
dentistry due to its better disinfectant, less irritant, and less
toxic effect than phenol .

 Acetic acid ester of metacresol is recognized as
Metacresylacetate or cresatin.
 It is antiseptic/analgesic and clear stable oily liquid of low
volatility having phenolic acetic odor.
 Due its low surface tension, its antibacterial effect is
increased and its effect gets lengthy owing to its low vapour
pressure.
 Grossman has proved that the antimicrobial effect of
cresatin is not as mark as other medicaments of its group. It
is noncaustic, less irritating.

 It is a compound of cresatin, P-chlorophenol and camphor
in 1:1:2 ration.
 It is found more effective than cresatin as an antiseptic and
less irritating than chlorophenol.

 It is used as intracanal medicament and as a sealer containing
paraformaldehyde and phenyl mercuric borate as demonstrated
by Sargenti and Richter.
 The properties present in N2 have permanent disinfectant action
and unusual antiseptic agent that are irritating and toxic with high
degree of antimicrobial activity.
 It has been observed that the antibacterial effect of N2 is of short
duration and degenerate in about 7 to 10 days .

 It is a compound of formalin and cresol in the ratio varies from 1:2 to
1:1 being introduced by Buckley in 1905.
 It has distinctive odor and found in the form of transparent reddish
liquid which is mixture of 3 isomers.
 It is a compound of 19% Formaldehyde, 35% cresol and 46%
Glycerin with water.
 Formaldehyde is volatile and releases antimicrobial vapors when
applied to a cotton pellet for pulp chamber disinfection.
 All formaldehyde preparations are potent toxins with an
antimicrobial effectiveness much lower than their toxicity.
 There is no clinical reason to use formocresol as and antimicrobial
agent for endodontic treatment, based on what is known at this time.

 The salts of the heavy metals are protoplasm poisons which
precipitate albumin and produce new compounds that stain
tooth structure.
 Ammoniated silver nitrate was applied for disinfecting the
root canals long ago and considering its effect resulting
stain to tooth structure its application is now become
limited.
 Metaphen, Merthiolate, mercurophen etc. are strong
disinfectants organic mercurial salts having lesser tendency
to precipitate albumin.
 Its application is limited in endodontic treatment
considering its staining proclivities

 Disinfectant action of the halogens is related its atomic
weight and its action is inversely proportional.
 Chlorine is having greatest disinfectant action among the
members of this group also having lowest atomic weight.
 Sodium hypochlorite and Chloramines are the source of
active chlorine which is used for short term dressing of the
root canal .

 One of the active chlorine releasing compound is
Chloramine T which has excellent antimicrobial qualities.
 In case of Iodine compound sensitivity considering allergic
history, Chloramines (5%) is a good medicaments in
intracanal dressing having low toxicity.
 For disinfecting gutta-percha points, this compound is also
used.

 Iodine is acknowledged for its mild effect on living tissue
for many years.
 Iodine tincture (5% in alcohol) is used for disinfection of
endodontic surgical fields and iodine Potassium iodide
(Iodine 2%, potassium iodide 4%, distilled water 94%) is
used for intracanal medication are the two most common
preparation of Iodine which are used in dentistry.

 Grossman has indicated the wide use of PBSC by dentists.
Sodium caprylate has been substituted by Nystatin as the
antifungal agent in a similar medicament PBSN.
 Both the medicaments in paste form may be injected into the
root canals or impregnated on the paper points.
 For getting desired effect, the drug must be placed in the canal
considering its stability.

 PBSC (Penicillin, bacitracin, and streptomycin, with
caprylate sodium) may interfer the successive culturing
procedure and inactivate penicillin.
 Penicillinase is required to be added. It has to be
transformed on the paper point taken to incubate.
 The usage of PBSC has become obsolete considering the
potential for sensitivity due to topical use of antibiotics and
deteriorating in popularity of intracanal medicament.

 The sulfonamides interfere with bacterial metabolism due to its
bacteriostatic characteristics rather than bactericidal agents and
thereby reduce the micro-organisms more susceptible to destruct
by the defensive mechanism of the body.
 It is used by placing a moistened paper points into a fluffed jar
containing the powder or by adding with sterile distilled water. It
is reported that after usage of sulphonamides, tooth become
yellowish discolour.
 The medication is recommended for using at the moment of
closing the teeth that had been left open on account of acute
periapical abscess.
 In presence of pus, protein breakdown products, tissue debris and
paminobenzoic acid, the effect of sulphonamides are not fruitful .

 Since the introduction to dentistry of calcium hydroxide by
Hermann (1920), this medicament has been indicated to
promote healing in many clinical situations.
 However, the initial reference to its use has been attributed
to Nygren (1838) for the treatment of the `fistula dentalis',
whilst Codman (1851) was the first to attempt to preserve
the involved dental pulp.
 According to Cvek (1989) calcium hydroxide became more
widely known in the 1930s through the pioneering work of
Hermann (1936) and the introduction of this material in the
United States (Teuscher & Zander 1938, Zander 1939)
Fava LRG, Saunders WP
. Calcium hydroxide pastes: classification and clinical indications (Review). International Endodontic
Journal, 32, 257±282, 1999.

 Calcium hydroxide is a white odourless powder with
the formula Ca(OH)2, and a molecular weight of 74.08.
 It has low solubility in water, which decreases as the
temperature rises; it has a high pH (about 12.5-12.8)
and is insoluble in alcohol.
 This low solubility is, in turn, a good clinical
characteristic because a long period is necessary before
it becomes soluble in tissue fluids when in direct
contact with vital tissues.
 The material is chemically classified as a strong base
. Calcium hydroxide pastes: classification and clinical indications (Review). International Endodontic Journal,
32, 257±282, 1999.

 The main actions of calcium hydroxide come from the ionic
dissociation of Ca2. and OH-ions, and the action of these
ions on vital tissue and bacteria generates the induction of
hard tissue deposition and the antibacterial effect.
 In addition to killing bacteria, Ca(OH)2 has the
extraordinary ability to hydrolyze the lipid moiety of
bacterial lipopolysaccharides (LPS), thereby inactivating the
biologic activity of the lipopolysaccharide and reducing its
effect.
 This is a very desirable effect because dead cell wall
material remains after the bacteria have been killed and can
continue to stimulate inflammatory responses in the
periradicular tissue.
Journal, 32, 257±282, 1999.

These pastes should have the following characteristics:
 1. Composed mainly of calcium hydroxide which may be
used in association with other substances to improve some
of the physicochemical properties such as radiopacity, flow
and consistency;
 2. Non-setting;
 3. Can be rendered soluble or resorbed within vital tissues
either slowly or rapidly depending on the vehicle and other
components;
 4. May be prepared for use at the chairside or available as a
proprietary paste;
 5. Within the root canal system they are used only as a
temporary dressing and not as a definitive filling material.

 The easiest method to prepare a calcium hydroxide
paste is to mix calcium hydroxide powder with water
until the desired consistency is achieved.
 However, Leonardo et al. (1982) stated that a paste
prepared with water or other hydrosoluble non-viscous
vehicle does not have good physicochemical
properties, because it is not radio-opaque, is permeable
to tissue fluids and is rendered soluble and resorbed
from the periapical area and from within the root canal.
Fava LRG, Saunders WP. Calcium hydroxide pastes: classification and clinical indications (Review). International Endodontic Journal, 32,
257±282, 1999.

 For these and the following reasons, Leonardo et al.
(1982) recommended the addition of other substances
to the paste:
 1. to maintain the paste consistency of the material
which does not harden or set;
 2 . to improve flow;
 3. to maintain the high pH of calcium hydroxide;
 4. to improve radiopacity;
 5. to make clinical use easier;
 6 . not to alter the excellent biological properties of
calcium hydroxide itself.
Fava LRG, Saunders WP. Calcium hydroxide pastes: classification and clinical indications (Review). International Endodontic Journal, 32,
257±282, 1999.

 In essence, a calcium hydroxide paste for use in endodontics
is composed of the powder, a vehicle and a radiopacifier.
Other substances may be added to improve physicochemical
properties or the antibacterial action.
 It has been asserted that all biological actions of calcium
hydroxide will be progressed by the ionic dissociation in Ca2.
and OH- ions (Leonardo et al. 1982, Estrela 1994).
 The vehicle plays a most important role in the overall process
because it determines the velocity of ionic dissociation
causing the paste to be solubilized and resorbed at various
rates by the periapical tissues and from within the root canal
Journal, 32, 257±282, 1999.

 In general, three types of vehicles are used:
 Aqueous
 Viscous
 Oily
Journal, 32, 257±282, 1999.

Calciject is a calcium hydroxide prefilled, easy-to-use, single-dose syringe system.

 Calcium hydroxide has a thixotropic behavior, i.e., the
material becomes fluid when agitated.
 Thus, calcium hydroxide can be mixed to a very thick
consistency yet it will flow when agitated.
 The placement of large amounts of calcium hydroxide
slurry is desirable to achieve sufficient pH rise and
antibacterial conditions.
 The method of calcium hydroxide placement affects the pH
of the dentin inside the root canal as well as the surrounding
dentin.
 In other words, the antibacterial activity is determined by
the diffusion of hydroxyl ions throughout the root canal
system which requires its effective delivery.
Intracanal deliveary of calcium hydroxide: A literature review

Intracanal delivery of calcium hydroxide: A literature review

 An optimally thick paste can be best applied with a
latch-type paste carrier (lentulo spiral) of appropriate size.
 The filling action is due to the spiral’s action on the canal
walls.
 For maximum effect, the lentulo spiral should be as large as
possible relative to the size of the root canal without binding
to the canal walls and should be placed 2 mm short of the
working length (WL) for medicament insertion.
 Studies have reported that lentulo spirals produced
homogenous fillings.
 A study by Teixeira et al. (2005) concluded that the
placement of calcium hydroxide paste with a lentulo spiral
and the subsequent compaction with the blunt-end of paper
point obtained a higher pH values than using paper points
alone.

 Following are the clinical guidelines and recommendations
for effective intracanal delivery of calcium hydroxide:
 1.. For effective medicament delivery, an optimal canal
preparation is a prerequisite. A minimum apical preparation
till 25 K-file size in curved canals and 40 K-file size in
straight canals must be achieved before medicament
placement.
 2. The use of rigid stainless steel files has limited efficacy in
curved canals.
 3. The use of lentulo spirals, at lower speeds (5000 rpm)
placed 2 mm short of the WL, aided by compaction with the
blunt-end of paper points may be effective in promoting
better antimicrobial efficacy

 4. Master apical file with the rubber stopper adjusted to the
WL is recommended for hand placement, whereas when
using rotary instruments, the rubber stopper should be
adjusted 2 mm short of the WL since rotary instruments
tend to displace and dislodge the filling material beyond the
apex.
 5. The use of sonic devices has been found to be ineffective
due to the dispersion force created by the vibrations.
 To allow radiographic visualization, radiopacifiers such as
barium sulfate, barium, and other compounds containing
iodine and bromine have been added.

 The handling and proper placement of calcium hydroxide is
challenging.
 Moreover removal of calcium hydroxide is often
incomplete, resulting in a residue covering 20% to 45% of
canal wall, even after copious irrigation with saline, hypo,
or EDTA.
 This residual calcium hydroxide can shorten the setting time
of ZOE based sealers.
 It interefere with seal of root fillings and compromise the
quality of treatment.
 It is not totally effective against several endodontic
pathogens including E. faecalis and Candida albicans.
Cohen’s pathways of the pulp south asian edition

 CHX in liquid, gel, or in a controlled-release device has
been suggested as an alternative intracanal medication to
replace Ca(OH)2.
 Chlorhexidine is a broadspectrum antibacterial agent that is
effective against both E. faecalis and Candida albicans .
 In addition to its immediate action on bacteria,
chlorhexidine can be adsorbed onto and subsequently
released from dental tissues, resulting in substantive
antibacterial activity or “substantivity”.
 Such substantivity has been shown in vitro in root canals
medicated with chlorhexidine by using different vehicles
(i.e., liquid, gel, or controlled-release devices)
Antibacterial Efficacy of Chlorhexidine Gluconate Intracanal Medication In Vivo

 HISTORY:-
 Chlorhexidine (CHX) was developed more than 50
years ago at Imperial Chemical Industries in England
and first marketed in the United Kingdom in 1953 as
an antiseptic cream.

 CHX belongs to the polybiguanide antibacterial family,
consisting of two symmetric four-chlorophenyl rings
and two bisguanide groups connected by a central
hexamethylene chain.
 CHX is a strongly basic molecule and is stable as a
salt. CHX digluconate salt is easily soluble in water.

 CHX is a wide-spectrum antimicrobial agent, active against
gram-positive and gram-negative bacteria as well as yeasts.
 Owing to its cationic nature, CHX is capable of
electrostatically binding to the negatively charged surfaces
of bacteria, damaging the outer layers of the cell wall and
rendering it permeable.
 Depending on its concentration, CHX can have both
bacteriostatic and bactericidal effects. At high
concentrations CHX acts as a detergent; by damaging the
cell membrane, it causes precipitation of the cytoplasm and
thereby exerts a bactericidal effect.
 At low sublethal concentrations, CHX is bacteriostatic,
causing low molecular-weight substances (i.e., potassium
and phosphorous) to leak out without the cell being
irreversibly damaged.

 Due to the cationic nature of the CHX molecule, it can be
absorbed by anionic substrates such as the oral mucosa.
 CHX has the ability to bind to proteins such as albumin,
present in serum or saliva, pellicle found on the tooth
surface, salivary glycoproteins, and mucous membranes.
 This reaction is reversible. This reversible reaction of
uptake and release of CHX leads to substantive
antimicrobial activity and is referred to as substantivity. This
effect depends on the concentration of CHX.

 At higher concentrations (>0.02%), a multilayer of CHX is
formed on the surface, providing a reservoir of CHX which
can rapidly release the excess into the environment as the
concentration of CHX in the surrounding environment
decreases.
 This effect depends on the concentration of CHX, but not on
its mode of application, which may be as a liquid, gel, or
controlled-release device.

 During the last few years, researchers have studied the
combination of Ca(OH)2 and CHX, with the concept that
their antimicrobial properties interact in a synergistic
fashion that enhances their efficacy.
 The high pH of Ca(OH)2 was unaffected when combined
with CHX.
 A recent study utilizing a CHX-based protocol of 0.12%
CHX as an irrigant followed by a 7-day intracanal
medication of Ca(OH)2/0.12% CHX has shown promising
results.

 The authors concluded that chemomechanical canal shaping
using 0.12% CHX solution as an irrigant significantly
reduced the number of intracanal bacteria, but it failed to
render the canals bacteria free. Further intracanal
medication with a Ca(OH)2/CHX paste significantly
improved the results by reducing the number of bacteria

 Schroeder(1960) developed the material that is now
commercially marketed as Ledermix paste (Riemser
Arzneimittel AG, Insel Riems, Germany).
 The active ingredients are the potent anti-inflammatory
corticosteroid triamcinolone acetonide in combination with
the broad spectrum antibiotic demeclocycline.
 Ledermix paste contains triamcinolone acetonide as an
antiinflammatory agent, at a concentration of 1%.

 When the Ledermix materials and other similar corticosteroid-
containing formulations were commercially released, there was a
considerable amount of opposition to their use.
 Ledermix paste is a nonsetting, water-soluble paste material for
use as root canal medicament or as a direct or indirect pulp
capping agent.
 These studies show that triamcinolone is released from Ledermix
paste in the root canal and can reach the systemic circulation via
diffusion through dentinal tubules, lateral canals, and the apical
foramen.
 After the first 24 hours, 30% of the triamcinolone was released.
 By the end of 14 weeks, the remaining 70% had been released.

 The efficacy of triple antibiotic paste for elimination of
bacteria was first discussed by Hoshino et al. (1996)
 The triple-antibiotics regimen, composed of metronidazole,
ciprofloxacin, and minocycline.
 Metronidazole: as a nitroimidazole compound, is
particularly toxic to anaerobes and is considered an
antimicrobial agent against protozoa and anaerobic bacteria.
Triple antibiotic paste: momentous roles and applications in endodontics: a review

 Minocycline is bacteriostatic and shows activity against
gram-positive and gram-negative bacteria.
 It also causes an increase in the amount of interleukin-10,
which is an inflammatory cytokine.
 Moreover, ciprofloxacin as a synthetic fluoroquinolone
possesses fast bactericidal action and exhibits high
antimicrobial activity against gram-negative bacteria, whilst
limited activity against gram-positive ones.

 Many anaerobic bacteria are resistant to ciprofloxacin.
Hence, it is often used with metronidazole in treating mixed
infections to compensate for its limited scope.
 Therefore, TAP can affect gram-negative, gram-positive,
and anaerobic bacteria, and this combination can be
effective against odontogenic microorganisms .
 If the TAP is to be used, ciprofloxacin, metronidazole, and
minocycline should be mixed equally (1:1:1) to a final
concentration of 0.1–1.0 mg/mL .

Applications of TAP in endodontics
 1. In the regeneration and revascularization protocol of the
pulp
 2. As an intracanal medicament for the treatment of 1)
Periapical lesions 2) External inflammatory root resorption
3) Root fracture 4) Primary teeth
 3. As an intracanal agent to control flare-ups
 4. As a medicated sealer (to prevent possible re-infection)
 5. As an additive to gutta-percha points in root canal
obturation (known as medicated gutta-percha points)
 6. As an intracanal medicament loaded on a scaffold

 Tooth discoloration is said to be a repercussion of
minocycline as a component of the intracanal medicament
and cited as a drawback of the paste.
 Despite the removal of minocycline from the antibiotic
combination and replacement with Cefaclor (a member of
the second generation cephalosporins), the defacement of
clindamycin and amoxicillin will appear sometimes
immediately after treatment and in some cases after a delay.
 Reynolds et al. believed that if dentinal tubules in the pulp
chamber are coated with a bonding agent, discoloration can
be minimized.

 NISIN: Nisin produced by stains of lactococcus lactis and it
was discovered in 1928.
 It is a naturally occurring antimicrobial peptide and class I
bacteriocin.
 Nisin has been used extensively over 40 years as food
preservative which is safe to human being
 It can interrupt the cellular membrane by persuading leakage
of small intracellular contents from the cell

 PAD: Photosensitization technique has been used in
medicine for some time.
 Tolonium chloride and photoactive agent are abundance in
PAD. It is used in endodontic application considering its
antimicrobial effectiveness.
 Red laser emitting radiation of wavelength 635 nm is used
to activate photosensitizer molecule.
 The light is inserted into the root canal by directing it to the
tip of a small flexible optical fibre with maximum power of
100 m W that ensures harmless to the adjacent tissue.

 The strong oxidizer can act on multiple targets in a
microbial cell generated during the process resulting in
membrane damage, enzyme inactivation and genomic and
plasmid DNA damage causing instantaneous death.
 One of the potential medical application of LAT (Light
activated therapy) is fighting bio-film mediated localized
human infection .
Application of Intracanal Medicaments: A Review/ IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

 ENDOX: By emitting high frequency electrical impulses,
endox endodontic system sterilizes the root canal.
 Endox endodontic system can eliminate both pulp and
bacteria from the entire root canal as claims by manufacture
and sterilization happens as a result of fulguration.
 It has been reported citing a recent study that without
mechanical cleaning, the unit was not able to eliminate pulp
tissue from the root canal.
 The authors realizes that the unit may be utilized as a
substitute to traditional cleaning and shaping without
recommending high frequency electric pulses as a sole
endodontic treatment .

 Research is underway in the use of bioactive glass as an
intracanal medicament. In one study, the glass used was
composed of 53% SiO2 (w/w), 23% Na2O, 20% CaO, and
4% P2O5 and was prepared from reagent-grade Na2CO3,
CaHPO4, 2H2O, CaCO3, and Belgian sand.
 When used in root canals, bioactive glass was found to kill
bacteria, but the mechanism of action was not pH related,
and dentin did not seem to alter its effect.
 Some new obturating materials (e.g., Resilon [Pentron
Clinical Technologies, Wallingford, CT]) contain bioactive
glass.

 Propolis – Honey bee wax
 Propolis is a natural antibiotic resinous material obtained by honey
bees (Apis mellifera L.) from different plant species like trees of
poplars & conifers and mix with wax and other substances.
 It exhibits varying degree of antioxidant, antiviral, anti-inflammatory
, antibacterial, antifungal, antitumor, immunomodulating,
pharmacological properties such as healing, cytostatic & are
cariostatic.
 The main biologically active components present in this antitoxic
natural substance are flavonoids and cinnamic acid derivatives.
Herbendodontics – Phytotherapy In Endodontics: A Review

 Ethanolic preparation of propolis enhances bone
regeneration and induces hard tissue bridge formation in
vital pulp therapy procedures.
 Propolis can be effectively used along with calcium
hydroxide as dressing for elimination endodontic pathogens
especially against E.faecalis.

 Aloe barbadenis – Aloe vera
 Aloe vera contains clear gel surrounded by the green part of
leaf.
 The two active components of aloe vera are aloin and aloe-
emodin.
 In an in vitro study done by Kurian B et al in 2016 showed
MIC (Minimal Inhibitory Concentration) of Aloe vera was
superior to calcium hydroxide in eliminating E. faecalis and
its antibacterial activity increased with time period.
 Compared to other natural extracts, Aloe vera has broad
spectrum antibacterial activity against various oral
pathogens.

 Arctium lappa – Burdock
 The antimicrobial properties of Arctium lappa was studied.
From that it was concluded that the constituents of Arctium
lappa showed a great effect against the most organisms such
as E. faecalis, Staphylococcus aureus, Pseudomonas
aeruginosa, Bacillus subtilis & Candida albicans.
 This antimicrobial potential of the Arctium lappa makes it
use as root canal medicament.

 Glycyrrhiza glabra – Liquorice
 Because of this Glycyrrhizin, it possess antimicrobial effect
especially against E. faecalis
 Liquorice also inhibits most of the cariogenic bacterias like
Streptococcus mutans Its biocompatibility is compared to
that of calcium hydroxide due to the presence of pentacyclic
triterpenoid structure. But it has slightly acidic pH whereas
calcium hydroxide having strong alkaline pH of 12.5

 Citrus limonum - Lemon solution
 Lemon solution has pH of 2.21 with lower acidity. It is
effective in clearing the smear layer thereby acting as a
chelating agent.
 Fresh lemon solution has antibacterial property making it an
ideal root canal medicament without any side effects.
 Abuziad & Eissa et al done a study, in which fresh lemon
solution was shown to have wide antibacterial efficiency
against E. faecalis and hence can be used as an intracanal
medicament.

 Papaine
 Papaine is a proteolytic cysteine enzyme that comes from
the latex of the leaves & fruits of the green adult papaya. It
exhibits significant bacteriostatic and bactericidal effects.
 In the study by Anug Bhardwaj et al, antimicrobial efficacy
of natural extracts of M.citrifolia, papine, A.vera gel, 2%
CHX and calcium hydroxide against E.faecalis were
compared. In that Papaine produced significant results as
compared to that of CHX than other tested agents.

 Eucalyptus globulus – Eucalyptus
 It is an essential oil obtained from the leaf of Eucalyptus
tree. It has anti-inflammatory and antibacterial activities
which can be used as a vehicle for intracanal medicaments.
 Studies have reported that Eucalyptus oil in pure
concentration were effective on Pseudomonas aeroginosa
and Escherichia coli.
 Considering the antimicrobial potential of eucalyptus
essential oil against resistant microorganisms, it is expected
that its association with calcium hydroxide contributes to
the control of endodontic infections.

 Psidium guajava – Guava
 The leaves of guava are rich in guajaverin that inhibits
S.mutans & Staphylococcus aureus formation that lead to
plaque.
 They also contain phenolic compounds, vitamins,
sesquiterpene alcohols, lineol, tannins, tripentenes &
flavonoids.
 These all ingredients make them to exert antiinflammatory,
antimicrobial, antioxidant & antimutagenic properties. The
ethanolic extract of it has higher antimicrobial activity.

 Riccinus communis – Castor
 It is rich in castor acid or ricinoleic acid.
 It can be used as intracanal medicament as well as an
irrigant too.
 In an in vitro study conducted by Marcio Carneiro Valera et
al it was found that castor was able to destroy Candida
albicans and also significantly reduces the amount of E.
faecalis.
 In other study done by Lucas da Fonseca Roberti Garcia et
al, it was observed that calcium hydroxide and Castor oil
paste had better activity than calcium hydroxide and
propylene glycol paste against microorganisms commonly
found in endodontic infections.

Intracanal Medicaments (1).pptx

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Intracanal Medicaments (1).pptx