intracanal medicament-Dr.Jayakanth K

1. INTRACANAL MEDICAMENTS
Dr.JAYAKANTH.K

2. • Disinfection of pulp space is an important step during and
after cleaning and shaping.
• It primarily involves cleaning and shaping the root canal space
with endodontic instruments along with irrigants.
• However, in certain clinical conditions, the polymicrobial
nature of the endodontic infection demands the use of an
intracanal medicament in addition to the irrigants

3. • Functions of intra canal medicaments:
 Destroy the remaining bacteria and also limits
the growth of new arrivals.
 Useful in treatment of apical periodontitis-
for example in cases of inflammation caused
due to over instrumentation

4. Ideal properties of intra canal medicaments
• 1. It should be effective germicide and fungicide.
• 2. It should be non-irritating to pulpal tissue.
• 3. It should remain stable in the solution.
• 4. It should have prolonged antimicrobial action.
• 5. It should remain active in presence of blood, pus,protein
derivatives etc.
• 6. It should have low surface tension.
• 7. It should not interfere with repair of periapical tissue.
• 8. It should not stain tooth.
• 9. It should be capable of inactivation in the culture media.
• 10. It should not induce immune response.

5. ƒ
 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 inter-appointment
dressing in symptomatic cases
Chong and Pittford’s Indications of
Intracanal Medicaments
Grossman 13TH Edtn

6. Classification of intracanal medicaments

7. • Essential oils
-Eugenol :
It has been used in endodontics for many years
This substance is the chemical essence of oil of cloves and is
related to phenol.
Effects of eugenol are dependent on tissue concentrations of the
eugenol
These are divided into low dose (beneficial effects) and high
dose (toxic effects). Low doses show anti-inflammatory activity
while high doses exert cytotoxic effects.

8. PHENOLIC COMPOUNDS (Phenols)
• It was used for many years for its disinfectant and
caustic action.
• However, it has strong inflammatory potential, so, at
present, it is rarely used as an intracanal
medicament.
• Liquefied phenol (Carbolic acid) consists of 9 parts of
phenol and 1 part of water.

9. • Parachlorophenol
• Parachlorophenol has been a very popular
component of dressing as phenol is no longer used in
endodontics because of its high toxicity to efficacy
ratio.
• Composition
• This is substitution product of phenol in which
chlorine replaces one of the hydrogen atoms
(C6H4OHCl).
• On trituration with gum camphor, these products
combine to form an oily liquid.

10. Camphorated Mono-
parachlorophenol
(CMCP)
• One of the most commonly used
medicament in endodontics
presently, even though its use has
decreased considerably in the past
few years
• Composition
2 parts of para-chlorophenol
+
3 parts gum camphor
↓
Camphorated
monochlorophenol (CMCP)

11. • Camphor is added to parachlorophenol (PCP)
because :
 1. Has diluent action
 2. Prolongs the antimicrobial effect
 3. Reduces the irritating effect of PCP
 4. Serves as a vehicle for the solution

12. Cresatin
• As reported by Schilder and Amsterdam, Cresatin
possesses the same desirable qualities and actions as
that of CMCP, yet even less irritating to periapical
tissues.
• Composition
• This substance is clear, stable, oily liquid of low
volatile nature known as Metacresyl acetate.

13. FORMOCRESOL
• Formocresol contains formaldehyde as its main
ingredient
• Composition of formocresol
• Formaldehyde — 19 percent
• Cresol — 35 percent
• Water and glycerine — 46 percent

14. PARAFORMALDEHYDE
• It is polymeric form of formaldehyde.
• It slowly decomposes to give out formocresol, its monomer.
• Its properties are similar to formaldehyde that is toxic, allergenic and
genotoxic in nature.
• All phenolic and similar compounds are highly volatile with low surface
tension.
• Therefore, if they are placed on a cotton pellet in the chamber of a tooth
during treatment, the vapors will permeate the entire canal preparation,
so, placement on a paper point is unnecessary.
• Only tiny quantity of medication is needed for effectiveness, otherwise,
chances of periapical irritation are increased.

15. CALCIUM HYDROXIDE
• Introduced by HERMAN in 1920
• Highly alkaline with a pH of 12.5
• Most widely used intra canal medicament
• Mechanism of action:
• 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.

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

17. Chemical actions
• It shows antiseptic action probably because of its high pH and
its leaching action on necrotic pulp tissues.
• It also increases the pH of circumpulpal dentin when placed
into the root canal.
• Suppresses enzymatic activity and disrupts cell membrane
Inhibits DNA replication by splitting it.
• It hydrolyses the lipid part of bacterial lipopolysaccharide
(LPS) and thus inactivates the activity of LPS.
• This is a desirable effect because dead cell wall material
remains after the killing of bacteria which may cause
infection.

18. • Calcium hydroxide is available in:
• a. Paste form: Single paste or in combination with iodoform.
• b. Powder form: Powder form is mixed with saline and
anesthetic solution.
• For placement in root canals it is coated with the help of
paper points, spreaders or lentulo spirals

19. Vehicles for Ca(OH)2
• The vehicle used to mix Ca(OH)2 and the manner in which it is
dispensed has a significant role to play in achieving maximum
antibacterial effects as an intracanal medicament in
endodontics.
• According to Fava and Saunders, the vehicles can be classified
as follows:
1. Aqueous—e.g. sterile water, normal saline
2. Viscous—glycerine, polyethylene glycol, and propylene
glycol

20. • The other medicaments combined with Ca(OH)2 in order to
achieve synergistic antimicrobial effect include CMCP and
0.12% chlorhexidine.
• Commercially, calcium hydroxide for intracanal disinfection is
available as a nonsettable form which can be removed with
minimum instrumentation

22. • Disadvantages of Calcium Hydroxide as Intracanal
Medicament
• 1. Difficult to remove from canals
• 2. Decreases setting time of zinc oxide eugenol based
cements.
• Studies have shown limited effectiveness of calcium hydroxide
if used only for short time in root canals for disinfecting
purposes. It is because of following reasons:
• i. Low solubility and diffusibility of calcium hydroxide makes
it difficult to attain rapid increases in pH.
• ii. Different formulations having different alkaline potential
iii. Inability to reach inaccessible areas like isthmus,
ramification and canal irregularities.
• iv. Bacteria loaded deeper in dentinal tubules are not affected
by calcium hydroxide.
• v. Inhibition of action of calcium hydroxide by dentinal protein
buffering.

23. Chlorhexidine digluconate
• Chlorhexidine digluconate (CHX) has been recommended
both as a root canal irrigant and as an intracanal medicament.
As a medicament, it can be used as:
• 2% CHX gel
• Mixture of CHX and Ca(OH)2 CHX has been shown to be
effective against both E. faecalis and Candida albicans.

24. Quaternary Ammonium Compounds
• They are positively charged compounds which attract
negatively charged microorganisms they have low
surface tension for example Aminoacridine.
• Aminoacridine is a mild antiseptic which is more
effective than creatin but less effective than CMCP.
• It is used more as an irritant than intracranial
medicament.

25. PBSC Paste
• As mentioned by Grossman, PBSC has enjoyed wide use among dentists.
The constituents of the paste are as follows:
o Penicillin—effective against gram-positive microorganisms
o Bacitracin—effective against penicillin-resistant microorganisms
o Streptomycin—effective against the gram-negative microorganisms
o Caprylate (sodium salt)—effective against fungi.
o Nystatin replaces sodium caprylate as the an antifungal agent and is
available in form of PBSN.
• Both are available in a paste form that may be injected into root canals or
impregnated on paper points.
• Because there is no volatility, the drug must be placed in the canal to have
effect in that area.

26. Corticosteroid-antibiotic combinations
• Medications that combine antibiotic and corticosteroid
elements are highly effective in the treatment of over
instrumentation; they must be placed into the inflamed
periapical tissue by a paper point or reamer to be effective.
• Ledermix is one of best known corticosteroidantibiotic
combination. The corticosteroid constituent reduces the
periapical inflammation and gives almost instant relief of pain
to the patient who complains of extreme tenderness to
percussion after canal instrumentation.
• While the antibiotic constituents present in the corticosteroid
antibiotic combination prevent the overgrowth of
microorganisms when the inflammation subsides.

27. • LEDERMIX PASTE COMPOSITION
• Demeclocycline hydrochloride
plus
• Triamcinolone acetonide
(Lederle pharmaceuticals, germany)