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Intracanal medicaments /certified fixed orthodontic courses by Indian dental academy

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Intracanal medicaments /certified fixed orthodontic courses by Indian dental academy

  1. 1. Intracanal MedicamentsINDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy. com
  2. 2. Introduction Disinfection – Destruction of pathogenic microorganisms Pre-requisites  Removal of pulp tissue  Cleaning and shaping by biochemical means  Irrigation ICM – Reduces or eliminates microbial flora in root canal
  3. 3. Root canal flora Gram +ve, Gram –ve organisms, yeasts, obligate and facultative anaerobes Factors that delay healing  Trauma  Devitalized tissue  Dead spaces  Accumulation of exudate
  4. 4. Ideal requirements of ICM Effective germicide and fungicide Nonirritating to periapical tissues Remain stable in solution Have a prolonged antimicrobial effect Active in presence of blood, serum and protein derivatives of tissue Low surface tension Not interfere with repair of periapical tissues Not stain tooth structure Capable of inactivation in a culture medium Not induce a cell-mediated immune response
  5. 5. Function of ICM Most are antimicrobial agents  Irrigation and instrumentation reduces microorganisms  ICM destroys those remaining and limits the growth of any new arrivals Corticosteroid-antibiotic combination is useful in treating apical periodontitis
  6. 6. Intracanal Medicaments1. Phenol and related volatile compounds2. PBSC paste3. Sulfonamide and sulfathiazole4. Corticosteroid-antibiotic combination5. Calcium hydroxide6. N27. Halogens8. Quaternary ammonium compounds
  7. 7. 1. Phenol and related compounds Phenol Eugenol CMCP Cresatin Formocresol Glutaraldehyde Cresol, beechwood, creosote, and thymol
  8. 8. 1. Phenol and related compounds Phenol  Protoplasm poison, causes necrosis of soft tissue Eugenol  Antiseptic and anodyne CMCP  2 parts parachlorophenol and 3 parts gum camphor  Has wide antibacterial spectrum, effective against fungi  Much less irritating  Inexpensive and long shelf life
  9. 9. 1. Phenol and related compounds Cresatin  Same actions as CMCP, less irritating Formocresol  Formalin and cresol  Formalin – strong disinfectant  Used in pulpotomy  Nonspecific bactericidal medicament Glutaraldehyde – 2 %  Slightly acidic  Strong disinfectant and fixative
  10. 10. 2. PBSC paste Penicillin – effective against Gm+ve org Bacitracin – effective against penicillin- resistant org Streptomycin – effective against Gm-ve org Caprylate – effective against fungi PBSN – Nystatin instead of Caprylate Disadv – interfere with subsequent culture procedure, allergic reaction to drugs
  11. 11. 3. Sulfonamide and sulfathiazole Yellowish tooth discoloration Used when tooth has been left open after an acute periapical abscess
  12. 12. 4. Corticosteroid-antibiotic combination Highly effective in the treatment of overinstrumentation Corticosteroid – reduces periapical inflammation and relieves pain Antibiotic – prevents overgrowth of microorganisms
  13. 13. 5. Calcium hydroxide Weeping canal  Constant clear or reddish exudation associated with large apical radiolucency  Asymptomatic or tender to percussion  Negative cultures Treatment  Dry the canal with sterile absorbent points  Place calcium hydroxide paste as in apexification Mech of Action  High pH has destructive effect on bacterial cell membranes and protein structures
  14. 14. 5. Calcium hydroxide Mode of application  Ca(OH)2 is mixed with sterile water or saline to a thick paste  Paste is condensed into the root canal to a dense fill
  15. 15. 6.N2 Both ICM and sealer Contains  Paraformaldehyde (primary ingredient)  Eugenol  Phenylmercuric borate  Lead  Corticosteroid  Antibiotics and perfume Antibacterial effect is short lived (7 to 10 days)
  16. 16. 7. Halogens Sodium hypochlorite  Chlorine has greatest disinfectant action  Vapour is bactericidal  Action is short lived Iodides (KI – Potassium iodide)  Used as antiseptics  Iodine is highly reactive  Combines with protein in a loosely bound manner  Destroys microorganisms by forming salts  Action is short lived but less irritating
  17. 17. 8. Cationic Detergents Quaternary ammonium compounds  Odorless and stable solutions  Low surface tension and good cleansing effects  These are +vely charged  React with bacteria which are –vely charged 9-aminoacridine  Mild cationic antiseptic  Stains the tooth structure
  18. 18. Irritation potential of ICM Essentail oils and formocresol – High CMCP and Cresatin – Moderate NaOCl and H O - Less 2 2
  19. 19. Recommendations 2 medicaments chosen as ICM Iodine potassium iodide  Most effective and safest  Very short acting – 3 days Calcium hydroxide  Long acting  Less irritating
  20. 20. Intracanal Medication Method  Absorbent point moistened with ICM is carried into the canal  Medicated cotton pellet is placed in the pulp chamber  Access cavity is sealed with temporary filling material Frequency  Renewed in a week  Not longer than 2 weeks
  21. 21. Thank you for watching