Covers all the medicaments available in the market used in root canal treatment. Includes the newe medicaments in endodontics

1. INTRACANAL
MEDICAMENTS
DR. SURABHI SOUMYA
(SECONDYEAR POST GRADUATE STUDENT)

2. • “ 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

3. CONTENTS
q INTRODUCTION
q HISTORY
q CLASSIFICATION
q IDEAL
REQUIREMENTS
q INDICATION
q USES
q MODE OF ACTION
q INDIVIDUAL
MEDICAMENTS

4. qLIMITATIONS
qRECENT ADVANCES
qSUMMARY & CONCLUSION

5. INTRODUCTION
ØEndodontic treatment is directed towards
the prevention and control of pulpal and
periradicular infections.
ØComplete chemo mechanical preparation
may be considered an essential step in
root canal disinfection
ØHowever, total elimination of bacteria is
difficult to accomplish (Bystrom &
Sundqvist 1981, 1985. Siqueira et al.
1997a)
ØBy remaining in the root canal between
appointments intracanal medicaments may
help to eliminate surviving bacteria
(Bystrom & Sundqvist 1985)

6. HISTORY
Ø1865 : Development of aseptic – antiseptic
era in medicine
Ø1867 : Lister suggested the use of phenol
spray in the operating room to keep down
infection
Ø1890 : Phenol gave way to salts of heavy
metals principally bichlorides of mercury and
silver nitrate (protoplasmic poison)
Ø1910 : Ehrlich stated the idea of sterilizing
agent that would destroy microorganisms but
would not injure the tissue cells.
Ø1920 : Herman introduced Calcium hydroxide
as an intracanal medicaments

7. CLASSIFICATION
GROSSMAN

8. ØEugenol
ØPhenolics
ØCamphorated monoparachlorophenol (CMCP)
ØParachlorophenol (PCP)
ØCamphorated parachlorophenol
ØMetacresylacetate (Cresatin)
ØCresol
ØCreosote (beechwood)
ØThymol
Ø Aldehydes
I. Formocresol
II. Glutaraldehyde
Ø Halides
I. Sodium hypochlorite
II. Iodine-potassium iodide
Ø Steroids
Ø Calcium hydroxide
Ø Antibiotics
Ø Combinations
ACCORDING
TO WALTON
(1984):

9. qeffective germicide and fungicide.
qnon-irritating to pulpal tissue
qremain stable in the solution
qprolonged antimicrobial action
qremain active in presence of blood and pus, etc.
qlow surface tension
qshould not interfere with repair of periapical tissue
qshould not stain tooth
qcapable of inactivation in the culture media
qshould not induce immune response.

10. WHYARETHEY
INDICATED.?
ØHelp to dry
persistently wet
canals
Ø To provide a
barrier against
leakage of
coronal seal
which might
allow entry of
microorganisms
into root canal.
Ø To reduce
inflammation of
periapical tissues
or to manage the
remnants of vital
pulp if time does
not allow its
complete removal
ØTo eliminate a few
microorganisms
remaining in root
canal after
chemomechanical
preparation.

11. PRIMARY
qAntimicrobial activity –
deeper penetrating
microorganisms such as
E.fecalis
qAntisepsis
qDisinfection
qHard-tissue formation
qPain control
qExudation control
qResorption control
SECONDARY
FUNCTIONS

12. MODEOFACTION
Denaturation
of cell proteins
: Phenols,
thymol, cresol
and eugenol.
Cell membrane
destruction :
detergents such
as germicides
Enzymatic
inhibitors :
Iodine, chlorine,
heavy metals.
They bind with
the SH group of
the bacterial
enzymes
Protoplasmic
poison : Phenol

13. INDIVIDUAL
MEDICAMENTS

14. ESSENTIAL
OILS
• It is the chemical essence of oil of
clove and is related to phenol
• Effects of eugenol are dependent on
tissue concentrations of the eugenol
• These are divided into low dose (anti
inflammatory effects) and high dose
(toxic effects)
EUGENOL

15. PHENOLIC
COMPOUNDS
• Rationale for use- their role as general
disinfecting agents in the past
• MOA
ØAt lower conc. - inactivate essential
enzyme systems and may also cause
bacterial cell wall lysis (Hugo & Russel
1998).
ØAt higher conc. – precipitation of the
cytoplasmic cell proteins (O'Connor &
Rubino 1991).
• However, it has a strong
inflammatory potential , so, at
present it’s rarely used
1. PHENOL
Liquified phenol ( carbolic acid) - 9:1 vol

16. 2. PARACHLOROPHENOL
• Composition:
ØThis is substitution product of phenol in
which chlorine replaces one of the
hydrogen atoms (C6 H4 OHCl)
• On trituration with gum camphor, these
products combine to form an oily liquid
• Used as- 2 % aqueous solution

17. 3. CAMPHORATED
MONOPARACHLORO
PHENOL (CMCP)
• Composition
2 parts of para-chlorophenol (35%)
+
3 parts gum camphor (65%)
↓
Camphorated monochlorophenol
(CMCP)
Camphor is added to parachlorophenol
(PCP) because it
1. Has diluent action
2. Prolongs the antimicrobial effect
3. Reduces the irritating effect of PCP
4. Serves as a vehicle for the solution

18. Avny et al 1973 andTaylor
et al 1976 have shown that
aqueous solution of para
chlorophenol penetrates
deeper into the dentinal
tubules than camphorated
chorophenol

19. ALDEHYDES
ØIntroduced by Buckley in 1905
ØComposition:
• Formaldehyde -19% (19-37%)
• Cresol - 35 %
• Water and Glycerine - 46 %
ØFormalin : cresol - 1:2 to 1:1
ØFormaldehyde ( main ingredient )- volatile
and releases antimicrobial vapors if applied
on a cotton pellet for pulp chamber
disinfection.
ØDisadvantages- toxic and mutagenic
1. 1. FORMALDEHYDE
FORMOCRESOL

20. ZONEOFFIXATION
ZONE OF POOR
CELLULAR NECROSIS
Ø Farther away
where the
concentration
of formocresol
is less
ØCoagulation necrosis of tissues
at the amputation site (
protein denaturation)
ØInactivates the oxidative
enzymes
ØFixation of tissue and renders
the canal inert & resistant to
enzymatic breakdown
ZONE OF CHRONIC
INFLAMMATION
Ø Apical to the
zone of cellular
necrosis
Ø Blends into the
normal tissue
MOA
ZOF
ZOCN
ZOCI
VITAL TISSUE
FORMOCRESOL

21. 2. PARAFORMALDEHYDE
• It is polymeric form of formaldehyde and is
commonly found as component of some
root canal obturating materials like
endomethasone
• 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,
hence only tiny amount are placed on a
cotton pellet in the chamber of a tooth
during treatment

22. 3. GLUTARALDEHYDE
ØColorless oil, slightly soluble in
water and thereby has a slightly
acidic reaction
ØLike formalin, it is a strong
disinfectant and fixative
Ø2% Glutaraldehyde was
recommended for use as intracanal
medicament by S'Gravenmade
and Dankert
ØFormaldehyde produced an
immunologic reaction through
theT cells, according toVan
Velzen, but glutaraldehyde did
not.

23. CALCIUM
HYDROXIDE
ØThe use of calcium hydroxide in
endodontics was introduced by
Hermann in 1920
ØStrong alkaline substance, which
has a pH of approximately 12.5.
Ø In an aqueous solution, calcium
hydroxide dissociates into
calcium and hydroxyl ions

24. INDICATIONS

25. qPhysical properties
ØPhysical barrier for ingress of bacteria
ØDestroys the remaining bacteria by limiting
space for multiplication and holding substrate
for growth.
q Biological properties
Ø Antimicrobial activity (BystroÈm et al. 1985)
Ø Tissue-dissolving ability (Hasselgren et al. 1988, Andersen et al. 1992)
Ø Inhibition of tooth resorption (Tronstad 1988)
Ø Induction of repair by hard tissue formation (Foreman & Barnes 1990)
Ø Because of such effects, calcium hydroxide has been recommended for use in
several clinical situations (Heithersay 1975, Fava 1991)
PROPERTIES:

26. ANTI MICROBIAL
ACTIVITY
Ø Most of the endodontopathogens are unable to survive in
the highly alkaline environment provided by calcium
hydroxide (Heithersay 1975)
Ø Since the pH of calcium hydroxide is about 12.5, several
bacteria commonly found in infected root canals are
eliminated after a short period when in direct contact with
this substance (Bystroem et al. 1985)
Ø Antimicrobial activity of calcium hydroxide is related to the
release of hydroxyl ions in an aqueous environment
Ø Hydroxyl ions are highly oxidant free radicals (Freeman
& Crapo 1982).
J. F. Siqueira Jr1 & H. P. Lopes.Mechanisms of antimicrobial activity of
calcium hydroxide: a critical review. International Endodontic Journal.
1999 (32)361-369

27. Mechanism of anti microbial activity
• Enterococci, tolerate very
high pH values, varying from
9 to 11 (Atlas 1997)
• Fungi generally also exhibit a
wide pH range, growing
within a range of 5±9 pH
(Atlas 1997)
• Strains of P. intermedia, F.
nucleatum and P. gingivalis
may show stable growth in
alkaline pH values
(approximately 8.0±8.3)
(Marsh et al. 1993)

28. Ø Clinical studies using root canal sampling procedures have revealed
conflicting results
Ø Cvek et al. (1976) revealed that 90% of the samples taken from root
canals 3 months after medication with calcium hydroxide mixed with
Ringer's solution showed no microbial growth
Ø Bystrom et al. (1985) demonstrated. that calcium hydroxide effectively
eliminated all microorganisms when the medicament was maintained for
4 weeks
Ø Reit & Dahlen (1988) found that infection persisted in 26% of the
canals after 2 weeks of dressing with calcium hydroxide
Ø Sjogren et al. (1991) have reported that intracanal medication with
calcium hydroxide for 1 week effectively eliminated bacteria in the root
canal in 100% of the cases
Timeperiodneededforcalcium
hydroxidetooptimallydisinfecttheroot
canalsystem?
J. F. Siqueira Jr1 & H. P. Lopes - Mechanisms of antimicrobial activity of calcium
hydroxide: a critical review. IEJ 1999 (32)361-369

29. VEHICLES
q AQUEOUS
Ø Water, saline,
dental
anaesthetics
Ø Ringer's solution,
aqueous
suspension of
methylcellulose
or
carboxymethylcel
lulose.
q VISCOUS
Ø Glycerine
Ø Polyethyleneglycol
Ø Propylene glycol
q OILY
Ø Olive oil
Ø Silicone oil
Ø Camphor
Ø Metacresylacetate
and some fatty
acids such as oleic,
linoleic and
isostearic acids
Fava 1991, Holland 1994, Lopes
et al1996 described three types
of vehicles are used
J. F. Siqueira Jr1 & H. P. Lopes - Mechanisms of antimicrobial activity of calcium hydroxide: a
critical review. IEJ 1999 (32)361-369

30. LABORATORY
STUDIES
Ø Mehrvarzfar et al compared
bioactive glass with
Ca(OH)2 and found that
both exhibited antimicrobial
effects against E.
faecalis and that
Ca(OH)2 showed a superior
disinfecting effect
Ø Blanscet et al found that
the higher the
concentration of the
Ca(OH)2 paste was, the
larger were the zones of
inhibition observed
Antimicrobial susceptibility
tests
Restor Dent Endod. 2014
Nov;39(4):241-252

31. StudiesreportingCa(OH)2tobe
lesseffective

32. Effectofcalciumhydroxidewhenmixed
withdifferentvehicles
Ø Gomes et al reported that Ca(OH)2 mixed with water or glycerin showed
little or no effect, whereas Ca(OH)2 mixed with camphorated
paramonochlorophenol (CMCP) was significantly more effective
Ø The pastes with oily vehicles showed larger zones of inhibition than those
with aqueous or viscous vehicles

33. ADDITIONAL BENEFITS OF USING
Ca(OH)2 + CHX
Ø Zerella et al compared the antibacterial activity of calcium
hydroxide mixed either with water or with 2% chlorhexidine
in vivo.
Ø Pure calcium hydroxide completely disinfected 12 out of 20
teeth.
Ø While that with Ca(OH)₂ -CHX paste disinfected 16 out of 20
teeth.
Ø Sequeira et al examined bacterial reduction in teeth with
apical periodontitis after instrumentation and irrigation with
0.12% CHX soultion.
Ø After finishing the chemomechanical preparation 7 of 13 teeth
showed growth
Ø After Ca(OH)₂ -CHX placement for 7 days- only one of 13
teeth showed bacterial growth
INGLE 6th Ed.

34. COMMERCIALLY
AVAILABLEFORMS

35. Ø Available in ISO sizes of 15 to 140
Ø Combine the efficiency of calcium
hydroxide in matrix of bio-inert
gutta-percha.
Ø 28mm in length
Ø A distinctive brown color which
differentiates thm form the gutta
percha points (GPP)
Ø Effective alternative to calcium
hydroxide paste
Ca(OH)2
POINTS
CASE REPORTS ON THE CLINICAL USE OF
CALCIUM HYDROXIDE POINTS AS AN
INTRACANAL MEDICAMENT-
ENDODONTOLOGY

36. ADVANTAGES
1. Minimal or no residue left
2. No smearing around the
access cavity during insertion
3. Firm for easy insertion and
flexible enough to follow the
natural canal curvature
4.Time saving as the points are:
-Ready to use
-No mixing required
-Ease of insertion and
removal with help of tweezers
DISADVANTAGES
1.Action is short lived-7 days
2. Lack of sustained release
3. Radiolucent
calcium hydroxide plus points have:
Ø 3 times high calcium release than calcium hydroxide
points due to highly water soluble components like
tensides and sodium chloride
Ø Superior pH
Ø Increased wettability
Ø Increased release of zinc oxide compared to normal
GP points thus increasing its antibacterial effects
Ø Sustained alkaline pH for 7 days as against 3 days
which was seen with calcium hydroxide points.

37. Ø Available as Metapex,Vitapex,Diapex,
Calplus
Ø Composition
Ø Calcium hydroxide
Ø Iodoform
Ø Silicon oil and inert excipients
Ø Radio opacifiers ( BaO)
CALCIUMHYDROXIDEAND
IODOFORM
Ø Advantages
Ø Improved radiopacity and increased
antimicrobial effect
Ø Non hardening paste with oil base
Ø Prolonged release of calcium
hydroxide
Ø Excellent biocompatibility with no
toxic effects on cells
Ø Easy handling and easy direct
application
Ø Can be used in conjunction with
gutta percha points and regular root
canal sealers

38. Contemp Clin Dent. 2011 Oct-
Dec; 2(4): 291–295.

39. UseofCalciumHydroxideinWeeping
CanalCases..!
Ø For teeth with weeping canal, we dry the
canals with sterile absorbent paper points and
place calcium hydroxide in the canal
Ø By next appointment we find a dry canal,
ready for obturation
Ø It happens because pH of periapical tissues is
acidic in weeping stage which gets converted
into basic pH by Calcium hydroxide
Ø Some say that caustic effect of calcium
hydroxide burns the residual chronic inflamed
tissue and also calcium hydroxide builds up
the bone in the lesion due to its calcifying
action.

40. CHLORHEXIDINE
DIGLUCONATE
• CHX is used as an irrigating solution
during or at the end of instrumentation
• Recently interest has been focused on
the effectiveness of CHX in gel form
or as a mixture with Ca(OH)₂ -
intra canal medicament.
Mechanism of action
• At low concentrations – alters the
cell membrane permeability
• At high concentrations – coagulation
of intracellular components
Efective against both gram positive and
negative bacteria as well as yeast

41. •Topical chlorhexidine based solution
(20% CHX) with a rapid, non-irritant
and broad spectrum action
•Its bactericidal spectrum covers both
aerobic and anaerobic organisms
•Its low surface tension ensures
complete saturation of the canal.
SEPTODONTR420%
chlorhexidine
Ø used are in range of 0.2-2%
Ø Innovative attempts are being made to utilize the disinfecting
properties of chlorhexidine in gutta-percha points, however
it’s still under research

42. HALOGENS
ØMainly used as an irrigant, sometimes
used as an intracanal medicament
(2.5%)
ØThe disinfectant action of halogens is
inversely proportional to their atomic
weights
ØChlorine (lowest atomic weight), has
the greatest disinfectant action among
the members of this group
ØMentz found sodium hypochlorite as
effective intracanal medicament as well
as irrigant
1. CHLORINE
SODIUM HYPOCHLORITE

43. 2. IODIDES
ØIodine is highly reactive, combining with
proteins in a loosely bound manner so that
its penetration is not impeded
ØDestroys micro-organisms by forming salts
that are inimical to the life of the organism
ØIodine is used as
I. Iodine potassium iodide (which
consists of iodine crystals-2 parts,
potassium iodide 4 parts, and distilled
water 94 parts)
II. Iodophors - organic iodine containing
compounds that release iodine over time
qIodophors
ØPotent antimicrobial agent
ØLow toxicity
ØUsed in a paste formulation (permanent
root canal filling)

44. Ø Currently 2% of
iodine and 4%
aqueous KI are used
as irrigating solution
and short-term
dressing- (Engstrom
and Spangberg)
Ø More recently, these
formulations of iodine
are used as a
constituent in GP
points
Ø Spangberg et al
evaluated IKI solution
both in vitro and in vivo
and found it to be one
of the least irritating
medicaments
Ø IKI 2% is an effective
disinfectant and can kill
bacteria in infected
dentin in 5 minutes in
vitro
FEWSTUDIES
Ø Disadvantages:
Ø Stains the clothes if
spilt
Ø Allergic to some
patients
Ø Walkhoff’s paste:
Ø Iodoform + CMCP (Walkhoff
1882)
Ø Disadvantage: high toxicity
(Gutierrez and Guzman 1968)

45. N2 BY
SARGENT
ØA compound containing
paraformaldehyde as its primary
ingredient
ØClaimed to be both an intracanal
medicament and a sealer.
ØContains eugenol, phenylmercuric
borate, and at times, additives including
lead, corticosteroids, antibiotics
ØAntibacterial effect of N 2 is short
lived and dissipated in 7-10 days.
ØUnusual antimicrobial properties-
denied by ADA for use in dental
therapeutics

46. ANTIBIOTICS USED
AS ICM
Ø PBSC , PBSN
Ø LEDERMIX
Ø SEPTOMIXINE FORTE
Ø CLINDAMYCIN
Ø TAP
RATIONALE FOR LOCAL
APPLICATION OF
ANTIBIOTICS
ØMore effective mode for
delivering antibiotics because
-They can be delivered to the area of
interest without any systemic effects,
particularly possibilities of allergic
reactions, toxicity, side effects,and
development of resistant strains of
microbes

47. PBSC
Composition:
ØPenicillin - effective against gram-
positive microorganisms
ØBacitracin - effective against penicillin-
resistant microorganisms
ØStreptomycin - effective against the
gram-negative microorganisms
ØCaprylate (sodium salt)—effective
against fungi
ØNystatin replaces sodium caprylate as
an antifungal agent and is available in form
of PBSN
Ø Availability: paste form that may be
injected into root canals or
impregnated on paper points.
Disadvantage:
Reports of allergic
reaction to the drug
have been
presented

48. ØDeveloped by Schroeder &Triadan in 1960
ØGluco-corticosteroid antibiotic compound
dispensed using polyethylene glycol base
ØCorticosteroid ( triamcinolone acetonide
1%)- control pain and inflammation.
ØAntibiotic component (demeclocycline HCl
3.2%)- to compensate for what was perceived
to be a possible corticoid-induced reduction
in the host immune response.
LEDERMIX
Zahed mohammadi. Antibiotics as Intracanal
Medicaments: A Review.CDA Journal 2009;37: 99-108
New Zealand Endodontic
JournalVol 34 July 2006

49. FEW STUDIES ON
LEDERMIX
Intracanal Medicaments Revisited- Jack Lin, New Zealand Endodontic Journal, July 2006

50. Ehrmann et al investigated the relationship of
postoperative pain to three different
medicaments placed in the root canal after a
complete biomechanical debridement of the root
canal system and found that painful teeth with
AAP that had been dressed with Ledermix paste
gave rise to less pain than that experienced by
patients who had a dressing of calcium hydroxide,
or no dressing at all
Ehrmann EH, Messer HH,Adams GG,The relationship Of
intracanal medicaments to postoperative pain in
endodontics.
POST OP PAIN
Kim et al. investigated the effects of
the Ledermix paste as an intracanal
medicament on discoloration of
mature teeth, and found that
sunlight exposure had caused
dark grey-brown staining of the
teeth in the Ledermix groups but
this did not occur when the teeth
were kept in the dark.
Kim ST,Abbott PV, McGinley P,The effects of
Ledermix paste on discoloration of mature
teeth IEJ, 2000.
DISCOLORATION

51. LEDERMIX+CA(OH)2 Advocated by
Schroeder initially
for the treatment
of necrotic teeth
with incomplete
root formation -
Athanassiadis B
et al 2007
50-50 mixture
of Ledermix and
Ca(OH)2 is
advocated for
intracanal dressing
q Uses:
Ø infected root canals,
Ø pulp necrosis and infection with incomplete root
formation (as an initial dressing prior to using
calcium hydroxide alone for apexification),
Ø perforations,
Ø inflammatory root resorption,
Ø for treatment of large periapical radiolucent
lesions
AbbottPV,Medicaments:
aidstosuccessin
endodontics.AustDentJ,
1990
WHY..?
vmixture results in slower release and
diffusion of the active components
vhelps to maintain the sterility of the canal
for longer and also maintains a higher
concentration of all components within the
canal
Abbott PV et al - Effect of combining Ledermix and Ca(oh)2
pastes on the diffusion of corticosteroid and tetracycline
through human tooth roots in vitro. Endod DentTraumatol

52. DISADVANTAGES

53. SEPTOMIXINEFORTE
q contains 2
antibiotics
Ø Neomycin and
polymixin B
sulphate, and
Ø Corticosteroid
(dexamethasone-
.05%)
Neither of these antibiotics can be
considered effective against the
commonly reported endodontic
bacteria because of their
inappropriate spectra of activity
Abbott PV Aust Dent J 1990.
ØNeomycin -
bactericidal against
gram-negative bacilli
but it is ineffective
against bacteroides
and related species,
as well as against
fungi.
Polymyxin B sulphate is
effective against
grampositive bacteria,
as shown by Tang et al
(Oral Dis 2004;
10:389-97).
Ø Routine one-week application of Septomixine Forte was
not effective in inhibiting residual intracanal bacterial
growth between appointments.
Ø Triamcinolone is considered to have less systemic side
effects than dexamethasone.

54. CLINDAMYCIN Ø Protein synthesis inhibitor
Ø Effective against many of the endodontic pathogens including actinomyces,
eubacterium, fusobacterium, microaerophilic streptococci, peptococcus,
peptostreptococcus, veillonella, prevotella,and porphyromonas
Ø Particularly effective in vitro against black-pigmented prevotella and porphyromonas
species Zahed mohammadi. Antibiotics as Intracanal Medicaments: A
Review.CDA Journal 2009;37: 99-108
Ø Molander et al. investigated the effect of clindamycin on
root canal infection when placed as an intracanal dressing
and found that clindamycin offered no advantage over
conventional root canal dressings, such as calcium hydroxide
STUDIES ON CLINDA
Molander AOral Surg Oral Med Oral
Pathol Oral Radiol Endod 2003;
96:744-50

55. TRIPLE
ANTIBIOTIC
PASTE
Ø TAP was largely developed by Hoshino and colleagues
Ø Composed of –
Ø Metronidazole- particularly toxic to anaerobes and is considered an
antimicrobial agent against protozoa and anaerobic bacteria.
Ø Minocycline- bacteriostatic and shows activity against gram-positive and
gram-negative bacteria ( inhibits T cell activity)
Ø Ciprofloxacin- exhibits high antimicrobial activity against gram-negative
bacteria (causes damage to the cell walls)
ciprofloxacin,
metronidazole, and
minocycline should
be mixed equally
(1:1:1) to a final
concentration of
0.1–1.0 mg/mL

56. Ø As an intracanal medicament:
Ø Kim and Kim reported that TAP showed a larger inhibition zones against E. faecalis
than calcium hydroxide
Ø As an intracanal agent to control flare-ups
Ø TAP has shown to be more effective than calcium hydroxide in diabetic patients to
prevent flare ups in between appointments
Ø The combination of the 3 existing antibiotics seems to be able to defeat bacterial
resistance and subsequently result in increased antimicrobial action
FEWSTUDIESONTAP
Parhizkar A, et al -Restor Dent Endod. 2018 Aug

57. MODIFIEDTAP
Ø CLIN-m triple antibiotic nanofibers as a
viable alternative to minocycline-based
antibiotic pastes because
Ø remarkable antimicrobial effect
Ø cell-friendly
Ø and stain-free properties
Minocycline
replaced with
Joe January 2018,
Ø greater discoloration was seen
with TAP containing minocycline as
compare to TAP containing
cefaclor
Ø Clindamycin
Ø Cefaclor
Ø Amoxicillin
Ø Arestin
DOUBLE ANTIBIOTIC
PASTE:
Minocyclin is excluded
(discoloration)
Trope M, Dent Clin North
Am. 2010
JCD, July-August
2018

58. SULFONAMIDES ØMOA- competitive inhibition of
enzymes
ØSulfanilamide and Sulfathiazole are
used as medicaments by mixing with
sterile distilled water or by placing a
moistened paper point into a fluffed jar
containing the powder
ØYellowish tooth discoloration has been
reported after use
ØSulfonamides are usually
recommended while giving closed
dressing in a tooth which had been left
open after an acute periapical abscess.

59. METRONIDAZOLE
ØMetronidazole is a nitroimidazole
compound that exhibits a broad
spectrum of activity against protozoa
and anaerobic bacteria
ØMechanism
Ø Metronidazole readily permeates
bacterial cell membranes.
ØIt then binds to DNA, disrupting its
helical structure, and leads to very rapid
cell death

60. BIOACTIVE
GLASS
ØBioactive glasses of the SiO2-Na2O-CaO-
P2O5 have recently been suggested as topical
root canal disinfectants -Zehnder et al
ØMechanism- bioactive glasses disinfect their
environment via continuous release of alkaline
species in a wet environment
ØAdministered- as slurries that can be applied
by means of a counter-angle handpiece and a
lentulo spiral (Peters et al. 2005)
ØAdvantage-in contrast to calcium hydroxide,
bioactive glasses do not weaken the dentin
structure (Marending et al. 2009)
Ø They release calcium, phosphate, sodium, and
silica, and thus change slowly into pure inert
calcium phosphate particles (Sepulveda et
al.2002)
45S5 (PerioGlas® , NovaBoneProducts,
LLC- Alachua USA). It is composed of
53% SiO 2(w/w), 23% Na 2 O, 20% CaO
and 4% P 2 O 5 with a particle size
ranging from 20-63

61. NANOTECHNOLOGY
Ø Various nanoparticles have gained popularity as antimicrobial agents as a result of
their broad spectrum of activity and biocompatibility - Neal AL et al 2008
Ø Nanoparticulates exhibit higher antibacterial activity as a result of their polycationic/
polyanionic nature with higher surface area and charge density, resulting in greater
degree of interaction with the bacterial cell - Kishen A et al 2008

62. Ø Size of nanoparticulates plays an important role
in their antibacterial activity, smaller particles
shows higher antibacterial activity than the
macroscaled ones - Busscher HJ et al 2008,
Sanvicens N et al 2008.
Ø Nanoparticulates such as chitosan (CS-np)
and zinc oxide (ZnO-np) are known to
possess significant antibacterial properties.
The electrostatic
attraction with the
negatively charged
bacterial cell, leads to the
altered cell wall
permeability causing
leakage of the
intracellular components
and death of the cell -
Jung BO 1999 , Rabea EI 2003.
MOA

63. Ø Direct or close contact between the
nanoparticulates and the bacterial membrane
appeared to be essential for the ROS toxicity which
causes effective peroxidation - Stoimenov PK et al
2005
Ø In addition, CS-np and ZnO-np possess several
important properties for clinical application such
ü Effective against E fecalis
ü Biocompatible
ü Color (white),
ü Cost-effectiveness (as compared with bioactive
glass)
ü Availability and ease of modification.

64. LATEST
Ø Egs-
ØMorinda citrifolia
ØTriphala
ØCurcumin
Øand propolis
ØNissin
ØCurcumin (diferuloylmethane)
Øyellow bioactive component of turmeric
Øwide spectrum of biological actions, including antimicrobial,
anti-inflammatory, and antioxidant activities
ØIts antibacterial activity against E. faecalis has been
documented in many studies.
ØThere are various studies suggesting the efficacy of these
medicaments on the outcome of endodontic therapy.
NATURAL REMEDIES
being evaluated as irrigants and
intracanal medicaments
Intracanal medicaments –
Their use in modern
endodontics: A narrative
review, Kumar, et al.- 2019
Journal of Oral Research
and Review |

65. Journal of scientific
research,April 2016

66. Journal of Endodontics, 2014
REMOVAL OF INTRACANAL
MEDICAMENTS

67. JOE 2014

68. LIMITATIONS OF INTRA
CANAL MEDICAMENTS
For an intracanal,
medicament to be
effective, it should
remain active during
the time of inter
appointment, which
does not happen
not in every case
Clinical
effectiveness
of sustained
release
delivery
systems is
unknown.
Therapeutic action of
medicaments depends
upon its direct contact
with tissues. But these
substances may not
reach all the areas
where bacteria and
tissues are present.

70. REFERENCES
Ø Cohens Pathways of pulp (11th Ed)
Ø Ingle 7th Ed
Ø Nisha Garg 4th Ed
Ø Grossman 5th Ed
Ø J. F. Siqueira Jr1 & H. P. Lopes.Mechanisms of antimicrobial activity of
calcium hydroxide: a critical review. International Endodontic Journal.
1999 (32)361-369
Ø Zahed mohammadi.Antibiotics as Intracanal Medicaments:A
Review.CDA Journal 2009;37: 99-108
Ø Abbott PV, Systemic release of corticosteroids following intra-dental
use. Int Endod J 25:189-91, 1992.
Ø Pierce A, Heithersay G, Lindskog S, Evidence for direct inhibition of
dentinoclasts by a corticosteroid/antibiotic endodontic paste. Endod
DentTraumatol 4:44-45, 1988.