This document provides an overview of intracanal medicaments used in endodontics. It discusses the history, definitions, ideal requirements, indications, functions, and classifications of various medicaments. Specifically, it describes commonly used medicaments like essential oils, phenolic compounds, calcium hydroxide, halides, quaternary ammonium compounds, antibiotics, and herbal medications. It also discusses the rationale, mechanisms of action, and effects of calcium hydroxide, one of the most widely used intracanal medicaments.

1. INTRACANAL MEDICAMENTS
PRESENTED BY
DR SHYMA P
PG STUDENT
DEPT. OF CONSERVATIVE DENTISTRY AND ENDODONTICS

2. CONTENTS
• INTRODUCTION
• HISTORY
• DEFINITION
• RATIONALE
• IDEAL REQUIREMENTS
• INDICATIONS
• FUNCTIONS
• CLASSIFICATION
• ESSENTIAL OILS
• PHENOLIC COMPOUNDS
• CALCIUM HYDROXIDE
• CORTICISTEROIDS

3. CONTENTS
• HALOGENS
• QUATERNARY AMMONIUM
COMPOUNDS
• ANTIBIOTICS
• COMBINATIONS OF ANTIBIOTICS
• INTRACANAL MEDICAMENT
PLACEMENT
• HERBAL MEDICAMENTS
• RECENT ADVANCES
• CONCLUSION
• REFERENCES

4. INTRODUCTION
• INTRACANAL MEDICAMENTS HAVE TRADITIONALLY GONE HAND IN GLOVE
WITH ENDODONTICS.
• INTEGRAL PART AND IMPORTANT FOR SUCCESS OF ROOT CANAL THERAPY.
• PLACEMENT OF A SPECIFIC CHEMICAL DURING INTER-APPOINTMENT PERIOD
FORMS PART OF CHEMICAL PREPARATION OF ROOT CANAL SYSTEM PRIOR TO
OBTURATION.
• INTRACANAL DRESSINGS TEND TO BE EFFECTIVE AGAINST MICRO- ORGANISMS
THAT MAY HAVE PERSISTED DURING ROOT CANAL PREPARATION

5. HISTORY
• SCRIBONIUS, IN 1045 A.D WROTE OF USING OILS AND WINE IN THE
MOUTH OF A PATIENT IN PAIN.
• IN 1800, BEECHWOOD CRESOLE WAS RECOMMENDED FOR RCT
• RICHMOND,1844, ADVOCATED ‘KNOCKING OUT THE PULP’ BY
WHITTLING DOWN ORANGE WOOD TO A SMALL SIZE, SOAKING THE STICK
IN PHENOL AND TAPPING THEM INTO THE EXPOSED PULP CANAL.

6. • 1920 – HERMANN INTRODUCED CALCIUM HYDROXIDE
• 1951 – GROSSMAN USED POLYANTIBIOTIC PASTE KNOWN AS PBSC FOR
ENDODONTIC TREATMENT.
• 1960 – LEDERMIX PASTE WAS DEVELOPED BY SCHROEDER AND TRIADAN

7. DEFINITION
• A MEDICAMENT IS AN ANTIMICROBIAL AGENT THAT IS PLACED INSIDE THE ROOT
CANAL BETWEEN TREATMENT APPOINTMENTS IN AN ATTEMPT TO DESTROY
REMAINING MICROORGANISMS AND PREVENT REINFECTION .
(WEINE,2004)
• THE GENERAL DEFINITION OF INTRACANAL MEDICAMENTS IS “TEMPORARY
PLACEMENT OF MEDICAMENTS WITH GOOD BIOCOMPATIBILITY INTO ROOT CANALS
FOR THE PURPOSE OF INHIBITING AND DESTROYING THE BACTERIA IN THE CANAL
SYSTEM”.
(KAWASHIMA ET AL, 2009)

8. IDEAL REQUIREMENTS
• IT SHOULD BE AN EFFECTIVE GERMICIDE AND FUNGICIDE
• IT SHOULD BE NONIRRITATING TO THE PERIAPICAL 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.
Medicaments: Aids to success in endodontics. Part
1 A review of the literature
Paul V. Abbott, BDSc(WA), Australian dental
journal,1990

9. • IT SHOULD HAVE A LOW SURFACE TENSION.
• IT SHOULD NOT INTERFERE WITH REPAIR OF PERIAPICAL TISSUES.
• IT SHOULD NOT STAIN TOOTH STRUCTURE.
• IT SHOULD NOT INDUCE A CELL MEDIATED IMMUNE RESPONSE.

10. INDICATION
(CHONG AND PITT
FORD’S)
• TO DRY PERSISTENTLY WET CANALS(WEEPING CANALS).
• ELIMINATE ANY REMAINING MICROBES IN THE PULP SPACE.
• RENDER ROOT CANAL CONTENT INERT.
• REDUCE INFLAMMATION OF PERIAPICAL TISSUE
• NEUTRALIZE TISSUE DEBRIS.
• ACT AS A BARRIER AGAINST LEAKAGE FROM TEMPORARY FILLING.
Role of intacanal medicament in root canal treatment,
chong and pitford, International Endodontic Journal,
1992, vol25

11. RATIONALE
• DEGRADE RESIDUAL MICROBIAL BIOFILM AND ORGANIC TISSUES AND TO KILL
REMAINING BACTERIA.
• PREVENT BACTERIAL RECOLONIZATION OF THE ROOT CANAL SYSTEM.
• SUPRESS PAIN AND PROMOTE HEALING.

12. OVER VIEW OF RATIONALE
PRIMARY FUNCTION
• ASEPISIS
• DISINFECTION
SECONDARY FUNCTION
• INDUCTION OF HARD TISSUE
• PAIN CONTROL
• CONTROL OF EXUDATION OR
BLEEDING
• CONTROL OF INFLAMMATORY
ROOT RESROPTION
Harty’s Endodontics

13. ASEPSIS AND DISINFECTION
• ELIMINATION OF PATHOGENIC MICROORGANISMS.
• DISINFECTION ENTAILS MECHANICAL REMOVAL OF TISSUE AND DEBRIS
CONTAINING MICROBES, IRRIGATION AND DRESSING WITH ANTISEPTIC AGENTS.
• DISINFECTION OF THE ROOT CANAL SYSTEM IS A PREREQUISITE FOR A
SUCCESSFUL ENDODONTIC TREATMENT.

14. INDUCTION OF HARD TISSUE FORMATION
• CONTINUE APICAL ROOT DEVELOPMENT.
• TO CLOSE A WIDE FORAMEN
• CREATE A MECHANICAL BARRIER AT A FRACTURE LINE.

15. PAIN CONTROL
• INTRACANAL MEDICAMENTS MAY REDUCE OR ALTER THE INFLAMMATORY
RESPONSE.
• BY ANTIMICROBIAL ACTION OR BY PHARMACOLOGICALLY ALTERING THE
INFLAMMATION AND HENCE REDUCING THE PAIN.
• PHARMACOLOGICAL AGENTS CAUSE PAIN REDUCTION THROUGH DECREASE IN
TISSUE RESPONSES IN INFLAMMATION

16. CONTROL OF EXUDATION OR BLEEDING
• EXUDATION REFLECTS INFLAMMATION
• DRYING OR COAGULATING THE EXUDATING SURFACE.
• CALCIUM HYDROXIDE PACKED AGAINST THE EXUDATING SURFACE MAY
SUCCEED IN DESICCATING THE SURFACE.

17. CONTROL OF INFLAMMATORY ROOT
RESOPTION
• INFLAMMATORY ROOT RESORPTION IS ASSOCIATED WITH INFECTION OF ROOT
CANAL COMBINED WITH PHYSICAL DAMAGE TO CEMENTUM.
• PRIMARY FUNCTION OF TREATMENT IS TO ELIMINATE INFECTION IN ROOT
CANAL.

18. 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
Intracanal antiseptic medication,unique
journal of medical and dental
sciences,vol2,2014

19. • ENHANCING ANESTHESIA: BY REDUCING THE SENSITIVITY OF THE INFLAMED,
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.

20. CLASSIFICATION

21. ACCORDING TO GROSSMAN
ESSENTIAL OILS – EUGENOL
PHENOLIC COMPOUNDS
- PHENOL
- PARA-CHLOROPHENOL
- CAMPHORATED PARA-CHLOROPHENOL
- FORMOCRESOL
- CRESATIN

22. CALCIUM HYDROXIDE
N2
HALOGENS
- SODIUM HYPOCHLORITE
- IODIDES
QUATERNARY AMMONIUM COMPOUNDS
- 9-AMINO ACRIDINE

23. DCNA CLASSIFICATION
• PHENOLICS
EUGENOL
CAMPHORATED
MONOPARACHLOROPHENOL
PARACHLOROPHENOL
CAMPHORATED
PARACHLOROPHENOL
METACRESYLACETATE
CRESOL
CREOSOTE
THYMOL
• ALDEHYDES
FORMOCRESOL
GLUTARALDEHYDE
• HALIDES
SODIUM HYPOCHLORITE
IODINE
POTASSIUM IODIDE

24. • STEROIDS
• CALCIUM HYDROXIDE
• ANTIBIOTICS
• COMBINATIONS

25. Phenol & related compounds
Eugenol
CMCP
Metacresyacetate
Cresol
Thymol
PBSC
Penicillin
Bacitracin
Streptomycin
Caprylate
Sulphonamides
Corticosteroid-antibiotic
combination
Calcium hydroxide
FRAKLIN S WEINE CLASSIFICATION

26. ESSENTIAL OILS
EUGENOL:
• THIS IS THE CHEMICAL ESSENCE OF OIL OF CLOVE.
• WEAK DISINFECTANT.
• SLIGHTLY IRRITATING
• IT IS A CONSTITUENT OF MOST ROOT CANAL SEALER.
• HAS ANESTHETIC ACTION.
• IT IS BOTH ANTISEPTIC AND AN ANODYNE.
• IN HUMANS, IT HAS BEEN EMPLOYED AS AN INTRACANAL DRESSING FOR VITAL AND
NONVITAL DECIDUOUS TEETH (MURATA, 1959).

27. PHENOLIC COMPOUNDS
PHENOL:
• IT IS A WHITE CRYSTALLINE SUBSTANCE DERIVED FROM COAL TAR.
• 9 PARTS PHENOL AND 1 PART WATER
• PHENOL IS A PROTOPLASM POISON AND PRODUCES NECROSIS OF SOFT TISSUE.
• STRONG INFLAMMATORY POTENTIAL--- RARELY USED AS AN ICM.
• IT HAS BEEN USED FOR CAUTERIZING TISSUE TAGS THAT RESIST REMOVAL WITH
BROACHES OR FILES.
PHENOLS HAVE PUNGENT ODOR AND FOUL TASTE.

28. PARACHLOROPHENOL
SUBSTITUTION PRODUCT OF PHENOL IN WHICH CHLORINE REPLACES ONE OF THE
HYDROGEN ATOMS.
• ON TRITURATION WITH GUM CAMPHOR----FORMS AN OILY LIQUID
• HARRISON &MADONIA RECOMMENDED 1% AQUEOUS SOLUTION OF PARA-
CHLOROPHENOL.

29. CAMPHORATED MONOCHLOROPHENOL:
• 30%PARACHLORO PHENOL, 60% CAMPHOR, 10% ETHYL ALCOHOL
• CAMPHORATING PROCESS-- SLOW RELEASE OF PHENOL---LESS IRRITATING
MEDICAMENT
• VEHICLE AND DILUENT AND PROLONGS THE ANTIMICROBIAL EFFECT.
• EXCELLENT ANODYNE ACTIVITY.
• CMCP IS A POWERFUL BACTERICIDAL AGENT THAN PHENOL BUT LESS IRRITATING
• ANVY AND TAYLOR SHOWED THAT 2% AQUEOUS SOLUTION OF CMCP SHOWED
MUCH DEEPER PENETRATION IN THE DENTIN THAN PCP.

30. ACTION OF CMCP
• ITS BACTERICIDAL
 DISRUPTS BACTERIAL CYTOPLASMIC MEMBRANE
 DENATURES PROTEINS
 INACTIVATES ENZYMES
 LIBERATES CHLORINE, A STRONG OXIDIZING AGENT THAT INACTIVATES
ENZYMES WITH SULPHYDRYL GROUP
Siqueira et al 1996

31. 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.
• FORMALIN – STRONG DISINFECTANT
• COMBINES WITH ALBUMIN TO FORM INSOLUBLE , INDECOMPOSABLE SUBSTANCE

32. • THE BACTERICIDAL EFFECT OF FORMOCRESOL IS GOOD AT LEVELS AS LOW AS 2%.
• PLACING AGAINST LIVING TISSUES--NECROSIS FOLLOWED BY A PERSISTENT INFLAMMATORY
REACTION IS SEEN, BECAUSE OF THE PROTEOLIZING EFFECT OF CRESOL AND ALKYLATING EFFECT
OF FORMALDEHYDE.
• BLOCK ET AL HAVE REPORTED, FORMOCRESOL TREATED TISSUE PRODUCES A CELL MEDIATED
IMMUNE RESPONSE.
• FORMOCRESOL IS A NON- SPECIFIC ANTIBACTERIAL MEDICAMENT MOST EFFECTIVE AGAINST
AEROBIC AND ANAEROBIC ORGANISMS FOUND IN ROOT CANALS.
• FORMOCRESOL IS ALSO MUTAGENIC AND CARCINOGENIC- LEWIS ET AL.
INTRACANAL ANTISEPTIC MEDICATIONS, JOURNAL OF MEDICAL AND DENTAL SCIENCES,2014

33. GLUTRALDEHYDE:
• THIS COLORLESS OIL
• SLIGHTLY SOLUBLE IN WATER, SLIGHTLY ACIDIC. LIKE FORMALIN.
• STRONG DISINFECTANT AND FIXATIVE.
• GRAVENMADE AND DANKERT - LOW CONCENTRATION (2%) AS AN INTRACANAL
MEDCAMENT
• LOW MUTAGENICITY
• LOW CYTOTOXICITY

34. CREOSOTE
YELLOWISH OIL
• MAJOR CONSTITUENT- METHYL ETHER OF PYROCATECHIN- (60 – 90%) OF
CREOSOTE.
• BEECHWOOD CREOSOTE HAS LONG BEEN USED IN ENDODONTIC THERAPY.
• SEVERE TISSUE IRRITATION AND NECROSIS.

35. CRESTATIN
• IT IS ALSO KNOWN AS METACRESYLACETATE.
• CLEAR, STABLE, OILY LIQUID OF LOW VOLATILITY.
• ANTISEPTIC AND OBTUNDENT PROPERTIES.
• ANTIMICROBIAL EFFECT IS LESS THAN THAT OF FORMACRESOL OR CPCP – GROSSMAN.
• IT IS LESS IRRITATING TO THE TISSUE- SCHILDER AND AMSTERDAM.
• IT HAS GOT EXCELLENT ANODYNIC QUALITIES AND THEREFORE USEFUL AFTER PULPECTOMY.
• BARNETT AND COLLEGUES REPORTED THAT IT WAS MORE IRRITATING THAN EUGENOL IN
DOG’S PULP.

36. CALCIUM HYDROXIDE
• INTRODUCED BY HERMANN IN 1920
• COMMONLY USED ICM.
• BROAD SPECTRUM ANTI MICROBIAL AGENT
• HIGH PH --- ANTISEPTIC ACTION
• BYSTROM ET AL SHOWED THAT CA (OH)2 PASTE EFFECTIVELY ELIMINATED
ALL MICROORGANISMS IN INFECTED ROOT CANALS WHEN THE DRESSING
WAS MAINTAINED FOR 4 WEEKS.
Properties and application of Ca(OH)2 in endodontics and dental
traumatology-Z. Mohammedi International Endodontic Journal,2011

38. INDICATIONS
• WEEPING CANALS
• TREATMENT OF PHOENIX ABSCESS
• RESORPTION CASES
• APEXIFICATION
• DURING PULPOTOMY
• NON SURGICAL TREATMENT OF
PERIAPICAL LESIONS
• DIRECT AND INDIRECT CAPPING
• SEALER IN OBTURATION
• COMBINATION OF CA(OH)2 WITH
LEDERMIX--- DECREASE POST OP
PAIN DUE TO OVER
INSTRUMENTATION.
Harty’s Endodontics in clinical practice

39. EFFECTS OF CA(OH)2
PHYSICAL
• PHYSICAL BARRIER FOR INGRESS
OF BACTERIA.
• DESTROYS THE REMAINING
BACTERIA BY LIMITING SPACE FOR
MULTIPLICATION
CHEMICAL
• HIGH PH --- ANTISEPTIC ACTION
• DISTRUPTS CELL MEMBRANE–
SUPPRESSES THE ENZYMATIC
ACTIVITY
• HYDROLYSIS LIPID PART OF LPS
Antimicrobial activity of Ca(OH)2 in
Endodontics,
Chonnam med. J,2012

40. MECHANISM OF ACTION
• ANTIMICROBIAL ACTIVITY OF CA(OH)2 IS DEPENDENT ON THE RELEASE OF
HYDROXYL IONS IN AN AQUEOUS ENVIRONMENT.- SIQUEIRA.
• HYDROXYL IONS ARE HIGHLY OXIDATIVE FREE RADICALS THAT SHOW EXTREME
REACTIVITY WITH SEVERAL BIOMOLECULES---SIQUEIRA AND LOPES
THE LETHAL EFFECTS
DAMAGE TO THE BACTERIAL CYTOPLASMIC MEMBRANE
 DENATURATION OF PROTEINS,
 DAMAGE TO THE DNA

41. MECHANISM OF ACTION

44. ANTIBACTERIAL PROPERTIES
• ANTIBACTERIAL EFFECTS IN THE ROOT CANAL SYSTEM AS LONG AS A HIGH PH IS
MAINTAINED.
• AN IN VIVO STUDY SHOWED THAT ROOT CANALS TREATED WITH CA(OH)2 HAD
FEWER BACTERIA THAN DID THOSE DRESSED WITH CAMPHORATED PHENOL OR
CAMPHORATED MONOCHLOROPHENOL.
• 7-DAY APPLICATION OF A CA(OH)2 MEDICAMENT WAS SUFFICIENT TO REDUCE
CANAL BACTERIA TO A LEVEL THAT GAVE A NEGATIVE CULTURE.
• NUMBER OF E. FAECALIS WERE DECRESED WITHIN DENTINAL TUBULES IN 24 H.
• LESS VISCOUS PREPARATIONS OF CA(OH)2 WERE MORE EFFECTIVE IN THE
ELIMINATION OF E. FAECALIS FROM DENTINAL TUBULES THAN WERE VISCOUS
PREPARATIONS.
Properties and application of Caoh2 , Int.
end.j,2011
Antimicrobial activity of Ca(OH)2 in Endodontics,
Chonnam med. J,2012

45. • ELECTROPHORETICALLY ACTIVATED CA(OH)2 REVEALED NO VIABLE BACTERIA IN
DENTINAL TUBULES TO A DEPTH OF 500 ΜM FROM THE ROOT CANAL SPACE
WITHIN 7 DAYS. LIN ET AL.
• E. FAECALIS CELLS IN THE EXPONENTIAL GROWTH PHASE HAVE BEEN SHOWN TO
BE THE MOST SENSITIVE TO CA(OH)2 AND ARE KILLED WITHIN 3 S TO 10 MIN.

47. EFFECTS ON ENDOTOXIN
• ENDOTOXIN--- GRAM-NEGATIVE BACTERIA--- LIPOPOLYSACCHARIDE (LPS).
• LIPID A- TOXIC EFFECTS.
• CHRONIC PERIAPICAL LESIONS, THERE IS A GREATER PREVALENCE OF GRAM-
NEGATIVE ANAEROBIC BACTERIA DISSEMINATED THROUGHOUT THE ROOT
CANAL SYSTEM.
• BECAUSE THESE AREAS ARE NOT REACHED BY INSTRUMENTATION, THE USE OF A
ROOT CANAL MEDICAMENT IS RECOMMENDED .
• AN IN VITRO STUDY DEMONSTRATED THAT CA(OH)2 HYDROLYZED THE HIGHLY
TOXIC LIPID A MOLECULE THAT IS RESPONSIBLE FOR THE DAMAGING EFFECTS
OF ENDOTOXIN
Int. journal of Endodontics,2011

48. • IN VIVO STUDIES, REVEALED THAT ENDOTOXIN CAUSED THE FORMATION OF
PERIAPICAL LESIONS AND THAT CA(OH)2 INACTIVATED BACTERIAL LPS---
NELSON-FILHO ET AL
• CA(OH)2 SIGNIFICANTLY REDUCED OSTEOCLAST DIFFERENTIATION.

50. ANTIFUNGAL ACTIVITY
• C. ALBICANS CELLS ARE HIGHLY RESISTANT TO CA(OH)2.
• REASON
 C. ALBICANS SURVIVES AT A WIDE RANGE OF PH VALUES.
 CA(OH)2 PASTES MAY PROVIDE THE CA2+ IONS NECESSARY FOR THE GROWTH AND
MORPHOGENESIS OF CANDIDA
STUDIES
• CA(OH)2 IN CAMPHORATED PARAMONOCHLOROPHENOL (CPMC)/GLYCERIN HAD THE
MOST PRONOUNCED ANTIFUNGAL EFFECTS--SIQUEIRA ET AL

51. COMBINATION OF CA(OH)2 AND
CHLORHEXIDINE
• CHLORHEXIDINE-- OPTIMAL ANTIMICROBIAL ACTIVITY-- 5.5 TO 7.0
• CHX WAS MORE EFFECTIVE THAN CA(OH)2 IN ELIMINATING E. FAECALIS FROM
INSIDE DENTINAL TUBULES.
• ANTIBACTERIAL EFFECT BY MIXING CA(OH)2 POWDER WITH 0.5% CHX--CHX
HAD A REDUCED ANTIBACTERIAL ACTION--- HAENNI ET AL
Antimicrobial activity of
CaOH2,CMJ,2012

52. • 2% CHX GEL WAS THE MOST EFFECTIVE AGENT AGAINST E. FAECALIS INSIDE
DENTINAL TUBULES, FOLLOWED BY A CA(OH)2/2% CHX MIXTURE, WHEREAS
CA(OH)2 ALONE WAS TOTALLY INEFFECTIVE, EVEN AFTER 30 DAYS.– INVITRO
STUDIES
• 2% CHX WITH CA(OH)2 WAS MORE EFFECTIVE THAN CA(OH)2 IN WATER.
Antimicrobial activity of
CaOH2,CMJ,2012

53. • CALCIUM HYDROXIDE AND CHLORHEXIDINE COMBINATIONS WERE MORE
EFFECTIVE-ALEXANDRA ALMYROUDI
• EXCELLENT INTRACANAL MEDICAMENT PLACED IN THE ROOT CANAL FOR
ONE WEEK (RICHARD KOMOROWSKI AND ASSOCIATES).
• ACTIV POINTS (ROEKO) THAT RELEASE CHLORHEXIDINE FROM GUTTA-
PERCHA MATRIX HAVE BEEN MARKETED WHICH CAN BE USED AS
INTRACANAL MEDICAMENT

54. BUFFERING ACTION OF DENTIN ON CA(OH)2
• EFFECT OF DENTINE ON THE ANTIBACTERIAL ACTIVITY OF CA(OH)2 CAN BE
ATTRIBUTED TO THE BUFFERING ACTION OF DENTINE AGAINST ALKALI.
• BOTH LABORATORY AND IN VIVO STUDIES HAVE SHOWN THAT BUFFERING BY
DENTINE, PARTICULARLY IN THE SUBSURFACE LAYERS OF THE ROOT CANAL
WALLS, MIGHT BE THE MAIN FACTOR BEHIND THE REDUCED ANTIBACTERIAL
EFFECT OF CA(OH)2

55. AVAILABILITY AS INTRACANAL MEDICAMENT
• PASTE FORM- SINGLE PASTE/ COMBINATION WITH IODOFORM
• POWDER FORM- MIXED WITH SALINE

57. AQUEOUS VEHICLE
• ADVANTAGE :CA2+ AND OH− ARE RAPIDLY RELEASED.
• HIGH DEGREE OF SOLUBILITY OF THE PASTE ALLOWS DIRECT CONTACT OF THE IONS
WITH THE TISSUE AND TISSUE FLUIDS, WHICH IS THEN RESORBED BY MACROPHAGES.
• DISADVANTAGE: MULTIPLE APPOINTMENTS OF CA(OH)2 DRESSINGS

58. • WATER: STERILE WATER,DISTILLED WATER, STERILE DISTILLED WATER, BIDISTILLED
WATER, AND STERILE BIDISTILLED WATER.
• ANESTHETIC SOLUTIONS: WITH OR WITHOUT A VASOCONSTRICTOR, HAVE BEEN USED
AS A VEHICLE FOR CA(OH)2.
• MAIN ADVANTAGE :READILY AVAILABLE, STERILE, AND EASY TO HANDLE.
• ANESTHETIC SOLUTIONS HAVE AN ACIDIC PH, WHEN MIXED WITH THE CA(OH)2
POWDER,
• THE FINAL PASTE HAS A HIGH PH REQUIRED FOR IONIC RELEASE.

59. CHLORHEXIDINE: CHLORHEXIDINE, WHEN ADDED TO CA(OH)2, ENHANCES ITS ANTIBACTERIAL
PROPERTY.
METHYLCELLULOSE AND CARBOXYMETHYLCELLULOSE:
MAISTO AND CAPURRO (1964) INTRODUCED A PASTE THAT IS MADE UP OF EQUAL VOLUMES OF
CA(OH)2 POWDER AND IODOFORM, WHICH IS MIXED WITH A 5% AQUEOUS SOLUTION OF
METHYLCELLULOSE.
ANIONIC DETERGENT SOLUTION:
DETERGENTS ARE ADDED TO CA(OH)2 POWDER TO DECREASE ITS SURFACE TENSION AND
FACILITATE IONIC PENETRATION.
THIS ALLOWS CA(OH)2 TO ACT DEEPER INTO THE TISSUES.

60. VISCOUS VEHICLES
• WATER-SOLUBLE SUBSTANCES THAT RELEASE CA2+ AND OH− IONS MORE SLOWLY
FOR EXTENDED PERIODS.
• DUE TO THEIR HIGHER MOLECULAR WEIGHT, THEY PROMOTE LOWER SOLUBILITY OF
THE PASTE WHEN COMPARED WITH AQUEOUS VEHICLES.
• ADVANTAGE :CAN BE LEFT IN THE ROOT CANAL FOR A LONGER PERIOD OF TIME;
HENCE, THE NUMBER OF APPOINTMENTS NEEDED IS LESS.

61. • GLYCERIN:
• IT IS A VISCOUS, NONTOXIC, COLORLESS, TRANSPARENT LIQUID WITH A CHARACTERISTIC ODOR
AND SWEET TASTE
• SOLUBLE IN WATER AND DUE TO ITS HYGROSCOPIC NATURE, IT CAN BE EASILY REMOVED.
• STEINER ET AL. (1968) FIRST INTRODUCED A PASTE COMPOSED OF CA(OH)2, CAMPHORATED
PARACHLOROPHENOL, BARIUM SULFATE, AND GLYCERIN.
• THIS PASTE IS USED FOR ROOT-END CLOSURE OF IMMATURE NONVITAL TEETH.
• POLYETHYLENE GLYCOL:
• IT IS A POLYMER OF ETHYLENE GLYCOL AND WATER.
• VISCOUS AND COLORLESS LIQUID WITH A CHARACTERISTIC ODOR.

62. • PROPYLENE GLYCOL:
• A DIHYDRIC ALCOHOL, IS A CLEAR, COLORLESS, ODORLESS LIQUID
• IT IS NONTOXIC AND CAN BE MIXED WITH WATER, ACETONE, OR ALCOHOL IN ANY
PROPORTION.

63. OILY VEHICLE
• NON–WATER-SOLUBLE SUBSTANCES THAT ALLOW THE LOWEST SOLUBILITY OF
CA(OH)2 AND CAUSE LESS DIFFUSION OF THE IONS WITHIN THE TISSUES.
• IT ALLOWS INTERACTION FOR A LONGER PERIOD OF TIME WITHIN THE ROOT CANAL.

64. • OLIVE OIL:
• IT IS INSOLUBLE IN WATER BUT FAIRLY SOLUBLE IN ALCOHOL.
• IT MUST BE STORED IN AN AMBER-COLORED FLASK.
• IT IMPROVES THE PHYSICAL PROPERTIES OF CA(OH)2.

65. • CAMPHORATED PARACHLOROPHENOL:
• INTRODUCED BY WALKHOFF IN 1891, IS AN OILY VEHICLE
• ESSENTIAL OIL WITH LOW SOLUBILITY IN WATER.
• IT COMPRISES 33%–37% PARACHLOROPHENOL AND 63%–67% CAMPHOR.
• THE LIBERATION OF THE CHLORINE IN THE PRESENCE OF PHENOL
CONTRIBUTES TO THE ANTIBACTERIAL EFFECT OF CA(OH)2.

66. • METACRESYLACETATE:
• IT WAS FIRST INTRODUCED TO DENTISTRY BY COOLIDGE IN 1912 FOR THE
TREATMENT OF NECROTIC PULPS.
• IT IS AN OILY LIQUID WITH ANTIBACTERIAL,ANALGESIC, AND SEDATIVE
PROPERTIES.
• WHEN CA(OH)2 IS MIXED WITH METACRESYLACETATE, CALCIUM CRESYLATE
AND ACETIC ACID ARE FORMED.

67. OTHER VEHICLES
RADIOPACIFIERS
• CALCIUM HYDROXIDE MIXED WITH ANY VEHICLE LACKS RADIOPACITY AND IS NOT CLEARLY SEEN
RADIOGRAPHICALLY.
• TH E ADDITION OF RADIOPAQUE MATERIALS ALLOWS IDENTIFICATION OF LATERAL AND ACCESSORY
CANALS AND RESORPTIVE DEFECTS.
• THE RADIOPACITY CAN BE IMPROVED BY ADDING BARIUM SULFATE (ONE PART) TO THE CA(OH)2 POWDER
• (EIGHT PARTS) BEFORE THE PREPARATION OF THE PASTE.
• RADIOPACITY CAN ALSO BE IMPROVED BY ADDING IODOFORM OR BISMUTH CARBONATE.
• IODINE COMPOUNDS FUNCTION AS VEHICLES AS WELL AS RADIOPAQUE AGENTS, AND THEY ARE LESS
TOXIC
THAN BISMUTH AND BARIUM SALTS.

68. CLINICAL PROTOCOL
• CA(OH)2 SHOULD COME IN CONTACT WITH THE TISSUE TO ACT.
• CA(OH)2 POWDER IS MIXED WITH STERILE WATER OR SALINE.
• MIXTURE SHOULD BE THICK TO CARRY AS MUCH CA(OH)2 PARTICLES AS
POSSIBLE
• PLACED USING LENTULOSPIRALS.
• HOMOGENOUS FILLING UPTO THE WORKING LENGTH.

70. Intracanal delivery of calcium hydroxide: A literature review
Bhalla VK, Chockattu SJ - Saudi Endod J

71. USE IN WEEPING CANALS
• CONSTANT CLEAR/ REDDISH EXUDATE
• DRY THE CANAL WITH PAPER POINTS– PLACE CALCIUM HYDROXIDE--- NEXT
APPOINTMENT--- CANAL IS DRY--- READY FOR OBTURATION
MECHANISM:
• WEEPING STAGE– ACIDIC PH--- CA(OH)2 RENDERS IT BASIC
OR
• CAUSTIC EFFECT BURNS RESIDUAL INFLAMED TISSUE
Endodontic therapy, 6th edition,
franklin S weine

72. LIMITATIONS OF CALCIUM HYDROXIDE
• INCOMPLETE REMOVAL FROM CANALS--- RESIDUAL COVERAGE OF 20- 40%
• SHORTEN THE SETTING TIME OF ZINC OXIDE EUGENOL BASED SEALERS.
• INTERFERES WITH THE SEAL OF ROOT FILLING.
• ABILITY OF CA(OH)2 TO COMPLETELY ERADICATE BACTERIA FROM ROOT
CANALS HAVE BEEN QUESTIONED.
Textbook of endodontics, John j
Ingle

73. • CALCIUM HYDROXIDE AS AN INTRACANAL MEDICATION FOR POSTOPERATIVE PAIN DURING
PRIMARY ROOT CANAL THERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS WITH TRIAL
SEQUENTIAL ANALYSIS OF RANDOMISED CONTROLLED TRIALS
JOURNAL OF EVIDENCE BASED DENTAL PRACTICE MARCH 2022
• MUHAMMAD ZUBAIRAHMADABDURRESADAFBKHALID AMERDADCAMANIALMOHAIMEEDDIGHO
J.ONAKPOYABE
• LIMITED EVIDENCE SUGGESTS THAT CH MAY BE AN EFFECTIVE INTRACANAL MEDICAMENT
FOR CONTROLLING INTERAPPOINTMENT PAIN. COMBINATION THERAPIES APPEAR TO BE
MORE EFFECTIVE THAN USING CH ALONE.

74. N2
• INTRODUCED BY SARGENTI AND RICHTER(1961)
• PARAFORMALDEHYDE AND PHENYL MERCURIC BORATE-PRIMARY INGREDIENT.
• ANTIBACTERIAL EFFECT- SHORT LIVED, DISSIPATED IN ABOUT A WEEK TO 10
DAYS.
• N2 - DENIED BY COUNCIL OF DENTAL THERAPEUTICS OF ADA.

75. HALOGENS
IODIDES
• HIGHLY REACTIVE COMBINES WITH PROTEINS AND FORMS SALTS WHICH
DESTROYS MICRO ORGANISMS.
• POTASSIUM IODIDE IS RELATIVELY HIGH ANTIBACTERIAL AND RELATIVELY LOW
TOXIC.
• 4GM OF KI+2GM IODINE +94CC OF DISTILLED WATER
• SOLUTION IS FLOODED INTO THE CANALS AS IT DOES NOT VOLTALIZE AND THE
CHAMBER IS COVERED WITH DRY COTTON PELLET AND TEMPORARY SEAL IS
GIVEN.

76. • DEMONSTRATED MINIMAL CYTOTOXICITY TO HOST TISSUE- ENGSTROM AND
SPANGBERG
DISADVANTAGES:
1) IT MAY CAUSE STAINING OF THE TOOTH.
2) ALLERGIC REACTION.

77. CHLORAMINE-T
• CHLORINE COMPOUND USED IN CONCENTRATION OF 5%.
• GOOD ANTIMICROBIAL QUALITIES
• GOOD ALTERNATIVE WHEN A HISTORY OF ALLERGY PREVENTS THE USE OF
IODINE COMPOUNDS.
• USED FOR DISINFECTING GUTTA-PERCHA POINTS
• REMAINS STABLE FOR A LONG TIME IF STORED IN COLD AND PROTECTED FROM
LIGHT

78. QUATERNARY AMMONIUM COMPOUNDS
• ODORLESS AND STABLE SOLUTIONS.
• LOWER THE SURFACE TENSION OF LIQUIDS.
• INITIALLY CONSIDERED IDEAL ANTISEPTICS, BUT MORE RECENTLY HAVE SHOWN
TO HAVE SIGNIFICANT TOXICITY.
• QAC ARE +VELY CHARGED & MICROORGANISMS ARE –VELY CHARGED -
SURFACE ACTIVE EFFECT RESULTS IN WHICH COMPOUNDS CLINGS TO THE
MICROORGANISMS AND REVERSES THE CHARGE.

79. .
• Eg.9-AMINOACRIDINE BELONGS TO THE GROUP OF MILD CATIONIC
ANTISEPTICS.
• INHIBITS BACTERIAL PROTEIN SYNTHESIS.

80. SALTS OF HEAVY METALS
• SALTS OF SILVER, COPPER AND MERCURY COAGULATE PROTEINS, ACT AS
ENZYME INHIBITORS.
• MERCURY SALTS ARE GOOD ANTISEPTICS FOR DISINFECTING NON-LIVING
MATERIALS.
• Eg.MERCUROPHEN, METAPHEN, MERCUROCHROME AND MERTHIOLATE, PHENYL
MERCURIC BORATE.
• LESS EFFECTIVE BY THE TISSUE FLUID PROTEINS PRESENT IN THE ROOT CANAL.
• STAIN TOOTH STRUCTURE
• TOXIC

81. ANTIBIOTICS AS INTRACANAL MEDICAMENT
PBSC PASTE/ GROSSMANS PASTE (1951)
• CONTAINS :
POTASSIUM PENICILLIN G (10,00,000 UNITS)
BACITRACIN (10,000 UNITS)
STREPTOMYCIN PASTE (1GM)
SODIUM CAPRYLATE (1GM)

82. • ACTIONS OF CONSTITUENTS OF PBSC:
• PENICILLIN -EFFECTIVE AGAINST GRAM POSITIVE MICROORGANISMS
• BACITRACIN -EFFECTIVE AGAINST PENICILLIN RESISTANT MICROORGANISMS
• STREPTOMYCIN -EFFECTIVE AGAINST GRAM NEGATIVE ORGANISMS
AVAILABLE IN PASTE FORM THAT MAY BE INJECTED INTO ROOT CANALS OR IMPREGNATED
ON PAPER POINTS.
• THESE COMPOUNDS WERE ALL SUSPENDED IN A SILICONE VEHICLE.
• BANNED BY FDA IN 1975- ALLERGIC REACTION TO PENICILLIN
• LATER, NYSTATIN REPLACED CAPRYLATE SODIUM AS AN ANTIFUNGALAGENT IN A
SIMILAR MEDICAMENT, PBSN.

83. • SEPTOMIXINE FORTE
• CONSIST OF DEXAMETHASONE 50 MG
 NEOMYCIN SULFATE 10 G
 POLYMYXIN B SULFATE 20,000,000 UNITS
• EVEN THOUGH CLINICALLY EFFECTIVE, BUT TRIAMCINOLONE IS CONSIDERED TO HAVE
LESS SIDE EFFECTS COMPARED TO DEXAMETHASONE
• NEITHER OF THE TWO ANTIBIOTICS—NEOMYCIN AND POLYMYXIN B SULFATE—IS
CONSIDERED SUITABLE AGAINST THE COMMONLY REPORTED ENDODONTIC FLORA
BECAUSE OF THEIR INAPPROPRIATE SPECTRA OF ACTIVITY.

84. SUPHONAMIDES
• SULPHONAMIDES AND SULPHATHIOZOLE---MIXED WITH STERILE DISTILLED WATER.
• SUGGESTED FOR USE IN CLOSING TEETH THAT HAD BEEN LEFT OPEN AFTER ACUTE
PERIAPICAL ABSCESS.
• DISADVANTAGE:
 YELLOWISH TOOTH DECOLOURATION.
 INEFFECTIVE AGAINST ENTEROCOCCI AND PSEUDOMONAS AERUGINOSA.

85. METRONIDAZOLE
• EFFECT AGAINST SEVERAL GRAM-NEGATIVE ANAEROBIC MICROORGANISMS.
• SUGGESTED FOR USE IN IRRIGATING SOLUTIONS, AS AN INTRACANAL DRESSING
AND FOR PARENTERAL APPLICATIONS IN COMBINATION WITH PENICILLIN.
• IT HAS LIMITED ACTIVITY AGAINST ENTEROCOCCI.

86. TETRACYCLINE
• TETRACYCLINE SHOWS AFFINITY FOR HARD TISSUES AND MAY BE RETAINED ON
TOOTH SURFACES.
• IT IS USED IN PERIODONTICS WITH GOOD CLINICAL AND BACTERIOLOGICAL
RESULTS,
• THE DERIVATIVE DOXYCYCLINE FORMS THE ANTIBIOTIC INGREDIENT IN
LEDERMIX.
• ANTIMICROBIAL SPECTRUM IS QUITE NARROW----- INEFFECTIVE AGAINST
SEVERAL ENDODONTIC PATHOGENS.

87. CLINDAMYCIN
• LIMITED ANTIBACTERIAL EFFICACY COULD BE DEMONSTRATED.
• AN EXPERIMENTAL DELIVERY DEVICE FOR CLINDAMYCIN IN THE ROOT
CANAL HAS BEEN REPORTED.

88. COMBINATIONS

89. CORTICOSTEROID-ANTIBIOTIC
COMBINATIONS
LEDERMIX
• GLUCOCORTICOSTEROID ANTIBIOTIC COMPOUND.
• DEVELOPED BY SCHROEDER AND TRIADAN IN 1960
• CONTROL PAIN AND INFLAMMATION
ANTIBACTERIAL ACTION
Steroids in root canal treatment,Int. j
pharmaceutical science, vol6,2014
Amtibiootics in edodontics, int.j applied dental
science, vol3,2017

90. CONTENTS
TRIAMCINOLONE ACETONIDE 1%
ZINC OXIDE
DIMETHYL CHLORTETRACYCLINE HYDROCHLORIDE 3.2%
CANADA BALSAM
CALCIUM HYDROXIDE

91. • A 50:50 MIXTURE OF LEDERMIX PASTE AND CALCIUM HYDROXIDE HAS BEEN
ADVOCATED AS AN INTRACANAL DRESSING IN CASES OF
1.PULPLESS INFECTED ROOT CANALS
2.PULP NECROSIS AND INFECTION WITH INCOMPLETE ROOT FORMATION
(APEXIFICATION)
3.PERFORATIONS
4.INFLAMMATORY ROOT RESORPTION
5.INFLAMMATORY PERIAPICAL BONE RESORPTION
6.LARGE PERIAPICAL RADIOLUCENT LESIONS.

92. • CAPABLE OF DIFFUSING THROUGH DENTINAL TUBULES AND CEMENTUM TO
REACH THE PERIODONTAL AND PERIAPICAL TISSUE.
• MOSKOW ET AL SHOWED TRIAMCINALONE DECREASED PAIN AFTER 24 HOURS
BUT NO SIGNIFICANT DIFFERENCE AFTER 48 OR 72 HOURS.

93. • AFTER 7 DAYS OF EXPERIMENT, ALL TESTED SUBSTANCE HAD LOW LEVELS OF
INFLAMMATORY CELLS.
• THEREFORE, CORTICOSTEROID-BASED MEDICATIONS CAN BE USED FOR PERIODS
NO LONGER THAN 7 DAYS. RAMOS E ET
AL 2012
• LEDERMIX PASTE CAUSES TOOTH DISCOLORATION IF KEPT IN THE CANAL FOR
MORE THAN 2 WEEKS.
• IT SHOULD BE PLACED 2-3 MM BELOW THE CEJ

94. TRIPLE ANTIBIOTIC PASTE
• ACCORDING TO HOSHINO ET AL.
• ANTIBIOTIC––RATIO IS 1:1:1
MINOCYCLINE (100MG)
CIPROFLOXACIN (200MG)
METRONIDAZOLE (500MG)
CARRIER (MP) – MACROGOL OINTMENT, PROPYLENE GLYCOL IN RATIO 1:1

95. • METRONIDAZOLE - NITRO IMIDAZOLE COMPOUND, EFFECTIVE AGAINST
ANAEROBIC ORGANISMS.
CAUSE DNA DAMAGE AND LYSIS OF CELL.
• MINOCYCLINE - BACTERIOSTATIC, INHIBITS PROTEIN SYNTHESIS BY BINDING TO
30S RIBOSOME IN SUSCEPTIBLE ORGANISMS.
• CIPROFLOXAIN- BACTERICIDAL ACTION - INHIBITS THE ENZYME BACTERIAL
DNA GYRASE

96. Journal of International
Oral Health ¦ Volume 12 ¦
Issue 3 ¦ May-June 2020

97. EFFECT OF TAP ON TOOTH STRUCTURE
• EFFECT ON DENTIN
• STUDIES HAVE REPORTED THAT TAP HAS A DEMINERALIZING EFFECT ON DENTIN, BRINGING ABOUT
SPECIFIC CHANGES IN ITS MECHANICAL PROPERTY LEADING TO THE BRITTLENESS OF THE TOOTH.
• WHEN USED AT A HIGHER CONCENTRATION, 1G/ML, TAP TREATMENT CAUSES A SIGNIFICANT
REDUCTION IN MICROHARDNESS AT 500 ΜM FROM THE PULP DENTIN COMPLEX COMPARED WITH MTA
AT THE SAME CONCENTRATION.
• THIS IS BECAUSE OF MINOCYCLINE, WHICH CAUSES CALCIUM CHELATION FROM THE DENTIN .
• EFFECT ON TOOTH COLOUR
• MAJOR DRAWBACKS OF TAP IS DISCOLOURATION OF THE TOOTH, FOR WHICH MINOCYCLINE IS
RESPONSIBLE.
• RESOLVED BY THE USE OF OTHER MEDICAMENTS LIKE AMOXICILLIN AND CEFACLOR.
• THE USE OF DENTIN BONDING AGENTS ALSO, TO A GREAT EXTENT, HAS BEEN PROVEN TO PREVENT
TOOTH DISCOLOURATION .

98. • EFFECT ON STEM CELLS.
• IT PLAYS A SIGNIFICANT ROLE IN PRESERVING THE HEALTH OF THE APICAL STEM
CELL AND, THUS, IN PROVIDING A MICROBE-FREE ENVIRONMENT, ENABLING THE
STEM CELLS TO PROLIFERATE AND HELP IN REGENERATION .
• THOUGH MATERIALS LIKE CALCIUM HYDROXIDE CAN BE USED, THEIR TOXIC
EFFECT ON THE APICAL PAPILLA LEADS TO THE AVOIDANCE OF THE USE OF SUCH
MATERIALS.

99. DOUBLE ANTIBIOTIC PATE (DAP)
• DOUBLE ANTIBIOTIC PATE (DAP) CONTAINING ONLY CIPROFLOXACIN AND
METRONIDAZOLE
• TOOTH DISCOLOURATION IS ONE OF THE MAJOR DRAWBACKS OF TAP

100. MODIFIED TRIPLE ANTIBIOTIC PASTE
• MTAP WAS DONE BY MIXING THE POWDERS OF THE VARIOUS ANTIBIOTICS AND
WERE COMPOUNDED IN EQUIVALENT PARTS OF MTAP, WHICH HAD
METRONIDAZOLE CIPROFLOXACIN AND CEFACLOR WITH THE DISTILLED WATER

101. ODONTOPASTE
INTRODUCED IN 2008
• ZINC-OXIDE BASED ROOT CANAL PASTE WITH CLINDAMYCIN HYDROCHLORIDE
5% AND 1% TRIAMCINOLONE ACETONIDE FORMULATED
• IT IS BACTERIOSTATIC AND PREVENTS BACTERIAL REPOPULATION IN THE ROOT
CANAL SYSTEM.
• STEROID REDUCE THE POST OPERATIVE PAIN AND INFLAMMATION
• DOES NOT STAIN TEETH
Antibiotics in endodontics - A concise review
Dr. Ramaprabha Balasubramaniam and Dr. Srilekha
Jayakumar, international journalof applied sciences

102. • FREQUENCY OF MEDICATION :
• IN ACCORDANCE WITH GENERAL PRINCIPLES OF ROOT CANAL MANAGEMENT,
DISINFECTANT DRESSING SHOULD BE PREFERABLY BE RENEWED IN A WEEK AND NOT
LONGER THAN 2 WEEKS BECAUSE DRESSINGS BECOME DILUTED BY PERIAPICAL
EXUDATES AND ARE DECOMPOSED BY INTERACTION WITH THE MICROORGANISMS.

103. TIME OF USE OF INTRACANAL MEDICAMENT
• MINIMUM INTER-APPOINTMENT TIME -10 DAYS
• THE LENGTH OF TIME A MEDICAMENT WILL REMAIN EFFECTIVE DEPENDS ON
 SIZE OF THE APICAL FORAMEN.
SIZE OF THE DENTINAL TUBULE
PRESENCE OF SMEAR LAYER
ABSENCE OF CEMENTUM
PRESENCE OF PULPAL TISSUE
TYPE OF MEDICAMENT BEING USED
Medicament aid is successful Endodontic practice-
P. Abbott, Australian dental journal

104. DRYING OF CANAL
• ABSORBENT PAPER POINTS OF APPROPRIATE SIZE
• AVOID PLACING PAPER POINTS BEYOND APICAL FORAMEN (OPEN APEX)
• WIDE CANALS - WRAPPING COTTON WOOL AROUND HAND FILE

105. • LENTULO SPIRAL ROOT FILLERS
• USED IN LOW SPEED HANDPIECE
• SIZE USED DEPEND ON THE SIZE PREPARED ROOT CANAL
• SMALL AMOUNT OF PASTE IS PLACED ON THE SPIRAL AND SPIRAL PLACED IN
THE CANAL
• ONCE THE SPIRAL IS IN THE CANAL , MOTOR RUN AT LOW SPEED IN FORWARD
DIRECTION

106. • NOT ADVANCED FURTHER THAN 3MM SHORT OF WORKING LENGTH
• SPIRAL MOVED VERTICALLY IN AND OUT OF THE CANAL SEVERAL TIMES
• MOTOR SHOULD BE KEPT RUNNING UNTIL THE SPIRAL LEAVES THE RC EFFECTIVE
AT COATING THE CANAL
• TO ENSURE THE CANAL IS FILLED - REPEAT 2 OR 3 TIMES
• NOT USED IN FINE OR SHARPLY CURVED CANALS

107. HAND REAMER
• ROTATED BACK AND FORTH IN AN ANTICLOCKWISE DIRECTION AND MOVED
VERTICALLY IN AND OUT OF THE CANAL
• LESS PREDICTABLE - POOR FILL
• CONSEQUENTLY SMALL QUANTITY AVAILABLE WITHIN THE CANAL

108. COVERING THE CANAL ORIFICES
DRY COTTON WOOL
• TO PREVENT PARTICLES FALLING INTO THE CANAL DURING PLACEMENT OR
REMOVAL OF TEMPORARY FILLING MATERIAL
• BARRIER TO SEPARATE THE FILLING MATERIAL AND MEDICAMENT AND AIDS
EASY ACCESS AT SUBSEQUENT APPOINTMENTS.

109. SEALING THE MEDICATION
• TO PREVENT CONTAMINATION FROM ORAL MICROFLORA AND LEAKAGE OF THE
MEDICAMENT INTO THE MOUTH
• THE CANAL IS SEALED AFTER PLACING A SECOND STERILE DRY COTTON PELLET OVER
THE MEDICATED PELLET OR PLACING A SEAL OF TEMPORARY STOPPING OVER THE
MEDICATED PELLET AND COMPLETING THE DOUBLE SEAL WITH A TEMPORARY OUTER
SEAL OF CAVIT, ZOE AND IRM

110. REQUIREMENTS
• IMPERVIOUS TO FLUIDS
• HERMETICALLY SEALS THE ACCESS CAVITY
• HARDEN WITHIN FEW MINUTES
• WITHSTANDS FORCES OF MASTICATION
• EASY TO MANIPULATE AND REMOVE
• HARMONIZE WITH THE COLOR OF TOOTH STRUCTURE

111. • MATERIALS: ZNOE,CAVIT, IRM

112. DOUBLE SEAL
• INDICATIONS
• OCCLUSAL FORCES OR WEARING OF THE TEMPORARY FILLING OCCURS
• LONG TERM DRESSING SITUATIONS
IF CAVIT IS USED AS SEALING MATERIAL-- OVERLAY WITH DURABLE MATERIAL
SUCH AS GIC

113. HERBAL MEDICAMENTS
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
Nojval intracanal medicaments and future
scope, Int.j Pharm Bio Sci,2014

114. ARCTIUM LAPPA
THIS PLANT IS POPULAR ALL OVER THE WORLD FOR ITS THERAPEUTIC
APPLICATIONS.
IT IS FOUND TO HAVE ANTIMICROBIAL ACTION AGAINST MICROORGANISMS
CAUSING ENDODONTIC INFECTIONS.
IT IS A POTENTIAL INTRACANAL MEDICAMENT.

115. PROPOLIS
PROPOLIS IS PREPARED FROM RESIN COLLECTED BY BEES FROM TREES OF
POPLARS CONIFERS AND FLOWERS OF GENERA CLUSIA .
GOOD ANTIMICROBIAL AND ANTI-INFLAMMATORY AGENT, WHICH CAN
SERVE AS A BETTER INTRACANAL IRRIGANT AND INTRACANAL
MEDICAMENT.

116. • A COMPARATIVE EVALUATION ON MICROBIAL EFFICACY OF PROPOLIS, NAOCL
AND SALINE WHEN USED AS INTRACANAL IRRIGANTS INDICATED THAT THE
PROPOLIS HAS ANTIMICROBIAL ACTIVITY EQUAL TO THAT OF NAOCL .
• PROPOLIS CAN BE USED AS SHORT-TERM INTRACANAL MEDICATION IN CASES
OF PULP AND PERIAPICAL INFLAMMATORY PROCESSES .
• MILD PERIAPICAL INFLAMMATION HAS BEEN NOTICED AFTER EXPOSURE TO THE
PROPOLIS PASTE .

117. RECENT ADVANCES

118. BIOACTIVE GLASS
RESEARCH IS UNDERWAY IN THE USE OF BIOACTIVE GLASS AS AN INTRACANAL
MEDICAMENT.
• IN ONE STUDY GLASS USED,COMPOSED OF 53% SIO2, 23% NA2O, 20% CAO AND
4% P2O5 WAS PREPARED FORM REAGENT –GRADE NA2CO3, CAHPO4, 2H2O,
CACO3AND BELGIAN SAND.
• WHEN USED IN ROOT CANALS BIO-ACTIVE GLASS WAS FOUND TO KILL BACTERIA
AND DENTIN DID NOT SEEM TO ALTER ITS EFFECT.

119. NISIN
• NISIN IS A NATURALLY OCCURRING ANTIMICROBIAL PEPTIDE AND WAS DISCOVERED
IN 1928, PRODUCED BY STRAINS OF LACTOCOCCUS LACTIS.
• NISIN IS AN ANTIBIOTIC PEPTIDE AND A CLASS 1 BACITRACIN.
• NISIN IS SAFE TO HUMAN AND IS USED EXTENSIVELY AS A FOOD PRESERVATIVE OVER
40 YEARS.
• THE MODE OF ACTION-- DUE TO INTERACTION WITH THE PHOSPHOLIPID
MEMBRANE OF THE TARGET BACTERIAL CELL.
• NISIN DISRUPTS THE CELLULAR MEMBRANE INDUCING LEAKAGE OF SMALL
INTRACELLULAR CONTENTS FROM THE CELL.

120. CA(OH)2 POINTS
CA(OH)2 POINTS
• COMBINES THE EFFICACY OF CA(OH)2 58% IN A MATRIX OF 42% GUTTA PERCHA
• AVAILABLE IN PACKETS OF 60, ISO SIZES 15- 140
• MOISTURE IN THE CANAL ACTIVATES CA(OH)2 AND PH IN THE CANAL RISES TO 12
WITHIN MINUTES.
• THESE POINTS ARE FI RM AND FLEXIBLE SO THEY CAN BE EASILY INTRODUCED AS WELL AS
EASILY REMOVED (EVEN AFTER SEVERAL MONTHS) FROM THE ROOT CANAL.
• THE CHP CORRESPONDING TO THE LAST APICAL INSTRUMENT OR ONE SIZE SMALLER
SHOULD BE KEPT PASSIVELY IN THE ROOT CANAL. IN OVAL CANALS,
• ADDITIONAL POINTS CAN BE PLACED ON THE SIDES OF THE MAIN POINT.

121. CA (OH)2 PLUS POINTS
• 52-54% CA(OH)2 IN 35-37% GUTTA PERCHA
• CONTAINS TENISIDE WHICH REDUCES SURFACE TENSION.
• 3 FOLD HIGHER RELEASE THAN ACTIVE POINTS.
• INCREASED WETTABILITY OF CANAL SURFACE
• CALCIUM HYDROXIDE PLUS POINTS HAVE SODIUM CHLORIDE AND
SURFACTANT WHICH ARE HIGHLY WATER SOLUBLE AND ARE RESPONSIBLE
FOR IMPROVED DISSOCIATION OF IONS.
Antimicrobial activity of Ca(OH)2 in Endodontics,
Mohammedi Z, S. shalavi, Int. Endodo

122. • A DROP OF STERILE WATER CAN BE USED WITH THE POINT FOR INITIAL RELEASE OF
IONS.
• HOWEVER, AFTER INSERTING THE POINT IN THE CANAL, SUFFCIENT FLUID FLOWS INTO
THE SPACE BETWEEN THE CANAL WALL FROM THE DENTINAL TUBULES AND THE APICAL
REGION TO ACTIVATE THE CA(OH)2 EVEN WITHOUT ADDITIONAL WATER.
• CHP CAN PROVIDE ACTIVE IONS WITHIN THE ROOT CANAL FOR APPROXIMATELY 1–3
WEEKS, AFTER WHICH IT HAS TO BE REPLACED OR REMOVED.

123. • THE NOVEL POLYMERIC GEL MATRIX TRIPLE ANTIBIOTIC PASTE (TAOP) WAS
FORMULATED AS THERMO-MODULATED IN SITU HYDROGEL, BY BLENDING
CHITOSAN-CARBOPOL AND POLOXAMER GELS WITH CLINDAMYCIN (5%),
METRONIDAZOLE (5%), AND DOXYCYCLINE (1%).
• DAHAKE, P.T., BALIGA, S.M., KUMBAR, V.M. ET AL. CYTOTOXICITY OF NOVEL
POLYMERIC GEL MATRIX TRIPLE ANTIBIOTIC PASTE—AN IN VITRO
STUDY. REGEN. ENG. TRANSL. MED. 7, 21–29 (2021).

124. INT ENDOD J. 2022 MAY
• COMPARED WITH TRADITIONAL INTRACANAL MEDICAMENTS, ANTIMICROBIAL
PEPTIDES (AMPS) ARE PROMISING ALTERNATIVES WITH HIGH ANTIMICROBIAL
POTENCY, GOOD BIOCOMPATIBILITY AND LOW BACTERIAL RESISTANCE.
• AMPS ARE MOSTLY CATIONIC OLIGOPEPTIDES EITHER DERIVED FROM NATURAL
SOURCES (E.G. BACTERIA, FUNGI, PLANTS, AND ANIMALS) OR DESIGNED BY
COMPUTATIONAL METHODS.
• THE USE OF NANOPARTICLES AND ANTIMICROBIAL PEPTIDES AS INTRACANAL
MEDICAMENTS IS PROMISSORY, AND MORE RESEARCH IN THIS AREA IS ENCOURAGED.
Present status and future directions of intracanal medicaments
Ronald Ordinola‐Zapata, 1 W. Craig Noblett, 1 Alejandro Perez‐Ron, 2 Zhou Ye, 3 , 4 and Jorge Vera 5

125. BIOCOMPATABILITY OF INTRACANAL
MEDICAMENTS

126. CALCIUM HYDROXIDE
• CALCIUM HYDROXIDE INTRODUCED INTO THE PERIAPICAL REGION APPEARS TO BE
WELL TOLERATED AND IS SUBSEQUENTLY RESORBED MARTIN & CRABB .
• BINNIE & ROWE DRESSED IMMATURE PREMOLARS IN DOGS WITH CALCIUM
HYDROXIDE AND DISTILLED WATER AND OBSERVED A MINIMAL INFLAMMATORY
RESPONSE IN THE PERIAPICAL TISSUES WITH CONTINUED ROOT FORMATION.
• SOME STUDIES HAVE SHOWN CALCIUM HYDROXIDE TO HAVE A DETRIMENTAL
EFFECT ON PERIODONTAL TISSUES WHEN USED AS AN INTRACANAL MEDICAMENT
DURING ROUTINE ENDODONTIC THERAPY.

127. LEDERMIX PASTE
• LEDERMIX HAS BEEN FOUND TO BE SAFE TO PERIAPICAL TISSUES BY BARKER &
LOCKETT , WHO OBSERVED A NORMAL HISTOLOGICAL APPEARANCE OF THE
PERIAPICAL TISSUES 3 MONTHS AFTER THE APPLICATION OF LEDERMIX IN DOG
ROOT CANALS.
• TEPEL ET AL. FOUND AN INFILTRATE OF INFLAMMATORY CELLS IN THE
PERIAPICAL TISSUE AFTER THE USE OF LEDERMIX IN RATS WITH EXPERIMENTALLY
INDUCED APICAL PERIODONTITIS.

128. • SELTZER EXPRESSED CONCERN THAT THE INTRACANAL USE OF
CORTICOSTEROIDS, WHICH HAVE AN EFFECT ON INFLAMMATORY CELLS AND
PROTEIN SYNTHESIS, MAY INTERFERE WITH PHAGOCYTOSIS WITH RESULTANT
IMPAIRED AND DELAYED TISSUE REPAIR.
• ABBOTT SUGGESTED THAT THE INTRADENTAL USE OF LEDERMIX PASTE AND
LEDERMIX CEMENT IS UNLIKELY TO RESULT IN ANY SYSTEMIC SIDE‐EFFECTS.

129. PHENOLS AND PHENOL DERIVATIVES
• COMPOUNDS HAVE BEEN PROVEN TO BE TISSUE IRRITATING AND HIGHLY TOXIC
(ENGSTRÖM & SPÅNGBERG , SPÅNGBERG ET AL. ) AND TO HAVE LIMITED
ANTIMICROBIAL EFFECTIVENESS (BYSTRÖM ET AL. ).
• COMBINATION OF HIGH TOXICITY AND LIMITED CLINICAL EFFECTIVENESS
EXCLUDE THE PHENOL‐BASED COMPOUNDS FROM THE RECOMMENDED LIST OF
CONTEMPORARY INTRACANAL ANTIBACTERIAL MEDICAMENTS.

130. CONCLUSION
• INTRACANAL MEDICAMENTS IN ENDODONTICS HAVE BEEN USED FOR NUMBER
OF REASONS IN THE PAST AND CURRENTLY.
• THE DECISION TO WHETHER OR NOT TO PLACE AN INTRACANAL MEDICAMENT
IS STILL THE PRACTITIONER’S CHOICE AND A CONTROVERSY.
• OFTEN, DIFFERENT CHEMICALS OR DRUGS ARE COMBINED IN A “COCKTAIL” IN
ATTEMPT TO ELICIT A VARIETY OF EFFECTS WITH A SINGLE APPLICATION.

131. • MICROORGANISMS NEED NOT BE DROWNED IN CAUSTIC DRUGS WHEN THEY
CAN BE EASILY REMOVED WITH PROPER CHEMOMECHANICAL PREPARATION OF
THE ROOT CANAL.
• IT IS CLEAR FROM RESEARCH IS THE TOXICITY AND POTENTIAL ALLERGY OF THE
COMMONLY USED INTRACANAL MEDICAMENTS (WITH EXCEPTION OF
INTRACANAL STEROIDS AND CALCIUM HYDROXIDE WHICH HAVE SHOWN
PROMISING RESULTS).
• HOWEVER, INTRACANAL MEDICAMENTS SERVE AS AN ADJUNCT TO THE
PREVENTION OR TREATMENT OF APICAL PERIODONTITIS.

132. REFERENCES
• COHEN’S PATHWAY TO PULP- 11TH EDITION
• TEXTBOOK OF ENDODONTICS- JOHN J INGLE
• GROSSMAN’S ENDODOMTIC PRACTICE- 13TH EDITION
• HARTY’S ENDODONTICS IN CLINICAL PRACTICE
• ENDODONTIC SCIENCE- CARLOS ESTRELA
• TEXTBOOK OF ENDODONTICS- NAGESWAER RAO
• TEXTBOOK OF ENDODONTIC- KOHLI
• ESSENTIALS OF ENDODONTICS – VIMAL K SIKRI

133. • MOHAMMADI Z,DUMMER PMH. PROPERTIES AND APPLICATION OF CALCIUM HYDROXIDE IN
ENDODONTIC AND DENTAL TRAUMATOLOGY.INT ENDOD J.2011
• FAVA LRG,SAUNDER WP. CALCIUM HYDROXIDE PASTE:CLASSIFICATION AND CLINICAL
INDICATIONS.INT ENDOD J.1999
• AMBIKATHANYA UK.INTRACANAL ANTISEPTIC MEDICATIONS:A REVIEW.UNQ J MED DENT SCI.2014
• Z MOHAMMADI*, S SHALAVI1 AND M YAZDIZADEH2 ANTIMICROBIAL ACTIVITY OF CALCIUM
HYDROXIDE IN ENDODONTICS: A REVIEW. CMJ 2012
• ANTIBIOTICS IN ENDODONTICS - A CONCISE REVIEW, DR. RAMAPRABHA BALASUBRAMANIAM AND
DR. SRILEKHA JAYAKUMAR
• ANTIMICROBIAL ACTIVITY OF CA(OH)2 IN ENDODONTICS, MOHAMMEDI Z, S. SHALAVI, INT. ENDODO
• JOURNAL OF EVIDENCE BASED DENTAL PRACTICE MARCH 2022