This document provides an overview of intracanal medicaments used in endodontics. It discusses the history, rationale, objectives and classifications of intracanal medicaments. Various types of medicaments are described including essential oils, phenolic compounds, aldehydes, halogens, calcium hydroxide, and antibiotics. Calcium hydroxide is highlighted as a commonly used medicament due to its high pH and ability to disinfect root canals and promote tissue healing. The document also reviews the ideal properties, applications, and limitations of intracanal medicaments.

1. INTRACANAL
MEDICAMENTS
DR. AKANKSHA GAONKAR
Department of conservative dentistry and
endodontics
Maratha Mandal dental college, Belagavi

2. CONTENTS
 Introduction
 History
 Definition
 Rationale
 Ideal requirements of an Intracanal medicament
 Objectives
 Indications of Intracanal medicaments
 Classification of Intracanal medicaments
-Grossman
- Franklin Weine
- DCNA
 Intra canal medicaments
- Essential oils

3. - Aldehydes
- Halogens
- Calcium hydroxide
- Chlorhexidine
- Sulfonamides
- Antibiotics
- Corticosteroid antibiotic combination
- Herbal medicaments
 Recent advancements
 Application of intracanal medicaments
 Frequency of medication
 Root canal microflora
 Conclusion
 References
- Phenolic compounds

4. INTRODUCTION
 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.
 Intracanal medicaments are used for root canal
disinfection as part of controlled asepsis in an infected
root canal and their role is secondary to shaping and
cleaning of the root canal.

5. HISTORY
 The historical origins of intracanal medicaments date back to
very early times.
 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.
 Thus, phenolics, which include eugenol (this may be
differentially classified as an essential oil), parachlorophenol,
camphorated parachlorophenol, camphorated
monoparachlorophenol, cresatin (metacresylacetate), cresol,
thymol and creosote, are drugs with a long history in the
dental field that begins in the 1800s.

6.  Many combinations of these drugs were prepared and
played major roles in root canal treatment from the 19th to
the 20th century.
 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.

7. DEFINITION
A chemical agent sealed within the root canal
system; used between appointments as an anodyne
and/or antimicrobial agent.
(American Association of Endodontists)
“Temporary placement of medicaments with good
biocompatibility into root canals for the purpose of
inhibiting coronal invasion of bacteria from the oral
cavity”.
International Dental Journal (2009) Vol. 59/No.1

8. RATIONALE
 The main rational behind intracanal medicament is to
kill the bacteria inside the root canal and to avert
reinfection.
 Furthermore, anaerobic bacteria may invade the dentinal
tubules of the canals with necrotic pulps.
 The medicament should inhibit microbial re-
colonization of the cleaned parts of the root canal
system by preventing
1. Residual microorganisms from growing
2. New microorganisms invading

9. 1.Helps eliminate bacteria after canal instrumentation.
1.Reduces inflammation
1.Helps eliminate apical exudates
1.Prevents contamination between appointments
1.Induces healing of calcified tissues
1.Control inflammatory root resorption
Australian Dental Journal 1990;35:5.

10. Requirements of an Ideal Root Canal
Medicament:
Effective
antimicrobial agent
Nonirritating to the
periradicular tissues
Remain stable in
solution
Have a prolonged
antimicrobial effect
Active in the
presence of blood,
serum, and protein
derivatives of tissue
Low surface tension
Not interfere with
the repair of
periradicular tissues
Not stain tooth
structure
Not induce a cell-
mediated immune
response.
(GROSSMAN)

11. OBJECTIVES
 1. Destruction of micro-organisms: The main objective is to
kill all viable microorganisms or to disinfect all pathogens
in the canal space.
 2. Rendering contents of canal inert: It notifies the activities
by using chemicals which “mummify” fix or otherwise
deactivate the tissue or debris remains in the pulp space. If
this process is applied successfully, it can deactivate those
residual bacteria remains in pulp space.
 3. Prevention or control of post-treatment pain: The main
indication is to lessen or alter the inflammatory effect.
Medicament will execute this with its antimicrobial action
or by pharmacologically altering the inflammatory effect.

12.  4. Enhancing Anesthesia: In the condition when pulp is
difficult to anesthetize, suitable agents can be
administered to reduce the sensitivity of the inflamed
pulp. The pulp could be removed during appointments
with less anesthetic difficulty.
 5. Control of persistent periapical abscess: The sign of an
active periapical inflammatory lesion can be identified by
significant pain in canal or swelling after treatment or
recurrently “weeping” canal. To subside this difficult
situation, intra canal medicaments have been suggested.

13. Chong and Pittford’s Indications of
Intracanal Medicaments:
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.

16. Phenol and related compounds
eugenol
camphorated paramonochlorophenol
metacresylactate
cresol
thymol
PBSC
penicillin
bacitracin
streptomycin
caprylate
Sulphonamides
 Corticosteroid- antibiotic combinations
 Calcium hydroxide
According to Franklin S Weine

18. ESSENTIAL OILS
It has been used in endodontics for many
years.
This substance is the chemical essence of
oil of clove and is related to phenol.
Effects of eugenol are dependent on
tissue concentrations of the eugenol.
Eugenol

19.  Uses of eugenol
• Used as an intracanal medicament.
• Used as a root canal sealers.
• Part of temporary sealing agents.

20. PHENOLIC COMPOUNDS
It is one of the oldest antimicrobial agents
used in medicine , introduced by Lord Lister
into medicine in 1867.
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.
PHENOL

21. • Liquefied phenol (Carbolic acid) consists of 9 parts of
phenol and 1 part of water.
• It is a nonspecific protoplasm poison that has an optimal
antibacterial effect at 1% to 2%.
• Many dental preparations use much too high a concentration
of phenol (e.g., in the range of 30%). At such a
concentration, the antimicrobial effect in vivo is lower than
optimal and of very short duration.
• Phenolic compounds are often available as camphorated
solutions. Camphoration results in a less toxic phenolic
compound because it slows the release of toxins to the
surrounding tissues.

22. It 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.
Concentration: 1% aqueous solution is preferred.
Uses: Used as a dressing of choice for infected tooth.
PARACHLOROPHENOL

23.  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.
CAMPHORATED PARACHLOROPHENOL

24.  Composition
2 parts of parachlorophenol + 3 parts gum camphor
Camphorated monochlorophenol (CMCP)
CAMPHORATED
MONOPARACHLOROPHENOL (CMCP)

25.  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 colourless or pinkish liquid in nature.
 Cresol (C6H4OHCH3) can substitute phenol
considering its 3-times more powerful disinfectant
capacity.
CRESOL(TRICRESOL)

26. 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.
CRESATIN

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

28. ALDEHYDES
 Formaldehyde, paraformaldehyde and glutaraldehyde
are commonly used intracanal medicaments in root
canal therapy.
 These are water-soluble protein denaturing agents and
are considered among the most potent disinfectants.
 All formaldehyde preparations are potent toxins with
an antimicrobial effectiveness much lower than their
toxicity.

29. Formocresol contains formaldehyde as its main ingredient
and is still widely used medicament for pulpotomy
procedures in primary teeth but its toxic and mutagenic
properties are of concern.
Composition of formocresol
• Formaldehyde — 19%
• Cresol — 35%
• Water and glycerine — 46%
FORMOCRESOL

30. • It is polymeric form of formaldehyde and is
commonly found as component of some root
canal obturating material 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.
PARAFORMALDEHYDE

31.  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 .
N2

32. HALOGENS
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 .

33.  Chlorine compound has excellent antimicrobial properties.
 It is a chlorine compound with a good antimicrobial action.
 It is used in the concentration of 5%.
 It remains stable for a long-period of time.
 It can be used to disinfect gutta-percha points, and can be used in
patients allergic to iodine.
CHLORINE
CHLORAMINE-T

34.  Iodine in the form of Iodine potassium iodide (IKI), is a very
effective antiseptic solution with low tissue toxicity. IKI is an
effective disinfectant for infected dentin and can kill bacteria
in infected dentin in 5 minutes in vitro.
 IKI releases vapors with a strong antimicrobial effect.
 The solution can be prepared by mixing 2 g of iodine in 4 g
of potassium iodide; this mixture then is dissolved in 94 ml
of distilled water.
IODINE

35. CALCIUM HYDROXIDE
 Hermann introduced the use of Ca(OH)2 in endodontics in
1920.
 It is a crystal that is poorly soluble in water and only
induces localised effects.
 The bactericidal effects are caused by its high pH (12.5-
12.8), which prevents the growth and survival of bacteria,
most of which cannot survive pH 11 or above.

36.  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.
Hydroxyl ions are highly oxidizing free radicals that
destroy bacteria by:

37.  Ca(OH)2 is a slow-acting antiseptic.
Direct-contact experiments in vitro show that a 24-
hour contact period is required for complete killing
of enterococci.
Another study of 42 patients found that NaOCl canal
irrigation reduced the bacteria level by only 61.9%,
but use of Ca(OH)2 in the canals for 1 week resulted
in a 92.5% reduction. These researchers concluded
that Ca(OH)2 should be used in infected cases to
more predictably obtain disinfection.

38.  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.

39.  Calcium hydroxide is reported to be effective in
controlling the inflammatory exudates from the periapical
region, and the mechanism behind this action may be
related to its antimicrobial properties, contraction of
capillaries, and formation of an apical plug.

40.  Vehicles:
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.
The other medicaments combined with Ca(OH)2 in order to
achieve synergistic antimicrobial effect include CMCP and
0.12% chlorhexidine.

41.  Commercially, calcium hydroxide for intracanal disinfection is
available as a non-settable form which can be removed with
minimum instrumentation.
 The mixture should be thick to carry as many Ca(OH)2
particles as possible.
 This slurry is best applied with a Lentulo spiral. For maximum
effectiveness, the root canal must be filled homogeneously till
the working length.
 Because calcium hydroxide does not vaporise, it must be
placed in tight contact with the root canal walls because its
effectiveness depends on the degree of contact with the walls
as well as its antibacterial activity.
PLACEMENT

42.  The aim of this study was to investigate in vitro the
antimicrobial activity of calcium hydroxide in combination
with several vehicles against some microorganisms
commonly isolated from root canals.
 It was concluded that diffusion and antimicrobial activity of
calcium hydroxide were affected by the type of vehicle
used.

43. Limitations of Calcium Hydroxide
 The handling and proper placement of Ca(OH)2 present a
challenge to the average clinician.
 Also, the removal of Ca(OH)2 is frequently incomplete,
resulting in a residue covering 20% to 45% of the canal wall
surfaces, even after copious irrigation with saline, NaOCl, or
EDTA.
 Residual Ca(OH)2 can shorten the setting time of zinc oxide
eugenol–based endodontic sealers.
 Most notably, it may interfere with the seal of the root filling
and compromise the quality of treatment.

44.  An additional concern is that Ca(OH)2 is not totally
effective against several endodontic pathogens, including
E. faecalis and Candida albicans.
 Recently the ability of Ca(OH)2 to completely eradicate
bacteria from the root canal has been questioned.
In vitro studies have shown that dentin can inactivate the
antibacterial activity of Ca(OH)2
Other studies have also indicated that Ca(OH)2 could not
predictably eliminate bacteria or that cultures changed from
negative to positive after Ca(OH)2 placement.

47. • Some studies have supported the antimicrobial effect of
Ca(OH)2, others have questioned its efficacy.
• The antimicrobial effect of Ca(OH)2 is related to the hydroxyl
ions released in an aqueous environment, which affects
cytoplasmic membranes, proteins, and the DNA of
microorganisms.
• Ca(OH)2 has a wide range of antimicrobial effects against
common endodontic pathogens, but it is less effective against
specific species such as E. faecalis or C. albicans.
• The addition of vehicles or other agents might contribute to the
antimicrobial effect of Ca(OH)2.
• Although it remains controversial, it seems that by mixing
Ca(OH)2 with CHX, the antimicrobial activity of Ca(OH)2 can
be increased.

48.  CHX in liquid, gel, or in a controlled-
release device has been suggested as an
alternative intracanal medication to replace
Ca(OH)2.
 Chlorhexidine exhibits substantivity ,
broadspectrum activity and low toxicity,
these properties make it well suited for
irrigation and dressing applications in
endodontics.
CHLORHEXIDINE(CHX)

50.  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.

51.  As suggested, Chlorhexidine may be a useful adjunct in
the treatment of inflammatory root resorption which
can reduce the inflammatory resorption significantly
compared to non-medicated teeth.
 Jose F Siqueira et al had conducted a study on the
elimination of candida albicans infection of the
radicular dentin by applying Chlorhexidine mixed with
zinc oxide which observed highly effective in killing
candida albicans within dentin.

52. SULFONAMIDES
 Sulfanilamide and Sulfathiazole are used as
medicaments by mixing with distilled water or by
placing a moistened paper point into a fluffed jar
containing the powder.
 Yellowish tooth discoloration has been reported
after use.
 Sulfonamides are usually recommended while
giving closed dressing in a tooth which had been
left open after an acute periapical abscess.

54. POLY ANTIBIOTIC PASTE (PBSC)
- by Grossman(1951)
Penicillin (1,000,000 units of potassium penicillin G)-
effective against gram positive microorganism.
Bacitracin (10,000 units)- effective against penicillin
resistant microorganisms.
Streptomycin (1gm)- effective against gram negative
microorganisms.
Caprylate (1gm)- sodium salt, effective against fungi.

55. PBSN:
Penicillin—effective against gram-positive microorganisms
Bacitracin—effective against penicillin-resistant
microorganisms
Streptomycin—effective against the gram-negative
microorganisms
Nystatin—effective against fungi.
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.

56. TRIPLE ANTIBIOTIC PASTE
 The triple-antibiotics regimen,
composed of metronidazole,
ciprofloxacin, and minocycline, was first
tested for its effectiveness against
Escherichia coli–infected dentin in vitro.
 The same research group also tested its
bactericidal efficacy against microbes
from carious dentin and infected pulp.
They found that the mixture of
antibiotics is sufficiently potent to
eradicate the bacteria.

57.  Triple antibiotic powder, either mixed with normal saline or
2% chlorhexidine, produced the largest zone of inhibition
against E. faecalis.
 The triple antibiotic paste is very effective against E. faecalis.
Concentrations used:
1:1:1 - Hoshino et al ,1996
1:3:3- Takushige T et al, 2004

58. One potential concern of using an intracanal
antibiotic paste is that it may cause bacterial
resistance.
Intracanal use of minocycline can cause tooth
discoloration, creating potential cosmetic complications.

59. Infection persists despite the use of antiseptic medication.
Apical foramen has been inadvertently widened by
over instrumentation and in an immature teeth with
wide apical foramen.
Inter appointment time is more than 14 days.
INDICATIONS FOR ANTIBIOTIC PASTES

60. CORTICOSTERIODS-
ANTIBIOTICS COMBINATIONS
 Highly effective in the treatment of over
instrumentation.
 Placed in the inflamed tissue by a paper point or
reamer to be effective.
 The steroid constituent reduces the periapical
inflammation and gives instant relief of pain.

61. SEPTOMIXINE FORTE &
PULPOMIXINE
 Septomixine Forte and Pulpomixine both contain the
corticosteroid dexamethasone (0.05 per cent and 1.0 per
cent, respectively) as the anti-inflammatory component.
 While dexamethasone is an effective anti-inflammatory
agent, other corticosteroid agents such as triamcinolone
are known to be more potent in their local reaction and
with less systemic side effects .

63. LEDERMIX
 Schroeder developed the material that is now commercially
marketed as Ledermix paste.
 Ledermix paste is a glucocorticosteroid-antibiotic
compound.

64.  Ledermix paste placed in the root canal has been
shown to be capable of diffusing through the dentinal
tubules and cementum to reach the periodontal and
periapical tissues.
 It can be used in all cases involving inflammation
and/or infection associated with the root canal system
and periapical tissues, even if the apical foramen is
blocked or closed.

65.  The placement of Ledermix paste in the root canal
space has been reported to add to the efficacy of the
treatment of periapical infection and has been
reported to reduce the incidence of pain following
initial canal debridement.
 Ledermix paste is a non-setting , water-soluble paste
material for use as root canal medicament or a direct
or indirect pulp capping agent.

66. Ledermix paste has also been shown histologically to
eliminate experimentally induced external
inflammatory root resorption in vivo.
A study also reported that Ledermix paste had no damaging
effects upon the periodontal membrane and that this paste
was an effective medication for the treatment of progressive
root resorption in traumatically injured teeth.

67.  COMBINING MEDICAMENTS
Several reports have discussed the effect of
combining Ledermix paste with calcium
hydroxide in a 50:50 mixture.
A higher success rate was reported over
conventional calcium hydroxide therapy,
especially in producing calcified bridging and in
preventing an acute exacerbation of an already
existing inflammation.

68. Combining Ledermix paste with Pulpdent paste in a 50:50
mixture as a root canal dressing has been investigated.
An in-vitro study showed that
the rates of release of the
active components of
Ledermix paste were slower
when combined with
Pulpdent paste.
This has the effect of making
the dressing last longer than
when Ledermix paste was
used alone (more than three
months compared with
approximately two months).
The slower release rate also
helps to maintain the sterility
of the canal and the tooth root
by maintaining a higher
concentration within the canal
itself.
This appears to be
advantageous in the treatment
of extremely large periapical
lesions.

70.  Considering the ineffectiveness , potential side effects and
safety concerns of synthetic drugs, the herbal alternatives
for endodontic usage might prove to be advantageous.
Easy
availability
Cost
effectiveness
Increased
shelf life
Low toxicity
Lack of
microbial
resistance

72. Propolis
 Propolis is prepared from resin collected by bees
from trees of poplars, conifers and flowers of
genera clusia .
 Propolis is a good antimicrobial and anti-
inflammatory agent, and therefor can serve as a
good intracanal irrigant and intracanal
medicament.
 Propolis can be used as short-term intracanal
medication in cases of pulp and periapical
inflammatory processes.

73. Curcumin
 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.

74.  A study showed that there was a gradual decrease in
the anti-bacterial activity of curcumin at 3 and 7
days which may be due to the buffering ability of
dentin. Curcumin does not affect the micro hardness
of root dentin and is a potential intracanal
medicament.
AR Prabhakar et al. 2013
 Pulpotomy treatment using turmeric powder in
primary teeth has shown good clinical and
radiographic success.
Purohit R et al, 2017

75. 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.

76. Nissin
 Nissin is a naturally occurring antimicrobial peptide,
produced by Streptococcus lactis sub species lactis.
 It has antimicrobial activity against a wide range of bacteria
and their spores.
 The few experiments which have been done using nisin
have shown that it can kill all the bacteria effectively in the
canal and the results were comparable to calcium hydroxide.
Turner et al, 2004

77.  Mode of action:
Not completely understood but is likely that it interacts
with phospholipid membrane of the target bacterial cell.
It disrupts the cellular membrane inducing leakage of
small intracellular contents from the cell.
The delivery mechanism of Nisin is by
dissolving it in sterile water.

79. MEDICATED GUTTA-PERCHA
New gutta-percha points containing
Ca(OH)2 in a 50% to 51% concentration
in place of zinc oxide is available in the
market which makes easier placement
and removal of Ca(OH)2 .

80. BIOACTIVE GLASS
 Research is underway in the use of bioactive glass as an
intracanal medicament.
 Some new obturating materials (e.g., Resilon [Pentron
Clinical Technologies, Wallingford, CT]) contain
bioactive glass.

81. 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.

82. ODONTOPASTE
 It is a zinc oxide-based root canal paste with 5% clindamycin
hydrochloride and 1% triamcinolone acetonide.
 Clindamycin is effective against many endodontic pathogen
including Streptococci, Peptostreptococcus, Actinomyces, Fus
obacterium, Eubacterium, Propionobacterium, Microaerophili
c, Peptococcus, Porphyromonas, Veillonella and Prevotella.
 Clindamycin paste as an intracanal dressing has good
antibacterial effect. This antibiotic provides a bacteriostatic
activity, and acts as interim dressing material preventing
bacterial repopulation within the root canal.
 The steroid part, triamcinolone acetonide, can temporarily
reduce inflammation and postoperative pain.

84. Mode of application is an important aspect in the
selection of an intracanal medicament.
Two methods are basically followed for placement.
1. The medicament can be placed in the pulp
chamber by placing it on a cotton pellet
2. Prepared medicament can be flooded in the root
canal(injection technique).

85. 1. Pulp chamber is thoroughly dried up with sterile cotton
pellets and paper points.
2. Bottle containing medicament is inverted to allow the
liquid to cling to the side near the mouth of the bottle.
3. The sterile cotton pellet is lightly wiped on the inside,
picking up some of the liquid.
4. The cotton pellet is then squeezed in a sterile gauze
sponge. The amount of medicament remaining in the
pellet is more than sufficient to render its temporary
antibacterial action.

86. 5. The medicated pellet is placed only in the pulp chamber.
6. The pulp chamber is sealed to prevent recontamination
from marginal leakage or actual loss of seal before the
next appointment.
7. A fast setting temporary cement (zinc oxide eugenol
based) gives a seal superior to other materials.
8. A thickness of 3-5mm is necessary to ensure an effective
seal.

88. INJECTION TECHNIQUE

89. Most respondents (48.8%) were in the habit of using
injecting syringes to insert paste-based ICMs, significantly
outweighing the lentulo spiral users (23.8%) (p=0.009), with
no significant differences between GDPs and endodontists
(p=0.386)

90.  Antiseptic or disinfectant dressings should
preferably be changed after a week and not
longer than two weeks.
because it will be diluted by the periapical exudates
and decomposes by the interaction with the bacteria
in the root canal.

91. Root canal microflora

92.  Anaerobes:
Gram positive cocci – Peptostreptococcus
Gram positive bacilli - Lactobacilli, Propionibacterium ,
Actinomyces & Eubacterium
Gram negative cocci - Veillonella parvula
Gram negative bacilli -Bacteroides & Fusobacterium
 Aerobes:
Streptococci
Staphylococcus
Diptheroids

94. Aim: The aim is to determine the difference in antibacterial
effectiveness between a combination of calcium hydroxide
with 2% CHX digluconate or 25% propolis as an intracanal
medicament against E. faecalis (in vitro) bacteria.
Conclusion: The combination of calcium hydroxide with
propolis 25% more effective than the mixture of calcium
hydroxide with 2% CHX digluconate as root canal medicament
against E. faecalis bacteria.

95. Aim: To evaluate and compare the effect of antibacterial intracanal
medicaments on inter-appointment flare-up in diabetic patients.
Conclusions: Calcium hydroxide and triple antibiotic paste are effective
for managing inter-appointment flare-ups in diabetic patients. Triple
antibiotic paste is more effective than calcium hydroxide in preventing the
occurrence of flare-up in diabetic patients.

96. Aim: To compare the antimicrobial effect of Calcium hydroxide
paste (CaOH), Chlorhexidine gluconate (CHX) gel and
AntibioticCorticosteroid paste against Streptococcus mutans,
Enterococcus faecalis and Candida albicans in root canal lumen
and radicular dentin.
Conclusion: CHX was the best medication used to eliminate the
different tested organisms at the two experimental sites. S. mutans
was the most sensitive microorganism to the whole tested
medications, while C. albicans was the most resistant one.

100. Usage of intra-canal medications (ICMs) in different scenarios of
non-vital cases

101. CONCLUSION
 The uses of intracanal medicaments in endodontics
have number of reason considering its ill effects such
as mutagenic, carcinogenic and periradicular tissue
irritation.
 The treatment aspect of this medicaments has been
improved to certain extent by culture tests taking into
account of the sensitivity of the drugs to certain
groups of bacteria but not its by-product.

102.  From the start of extirpation of the pulp to the
obturation, disinfection process is followed
continuously applying intracanal medicaments to
disinfect the canal, make it inert, dry, reduce
postoperative pain and prevent re-infection.
 In present day dental practice, intracanal
medicaments are being applied in certain conditions
for gaining utmost success of root canal treatment.

103. REFERENCES
 Grossman's Endodontic Practice-13th edition
 Arnaldo Castellucci vol 1
 Wein’s Endodontic Therapy – 5th edition
 Vimal K Sikri- Essentials of endodontics- 2nd edition
 Application of Intracanal Medicaments: A Review Himadri pal, Arpita
sarkar, Lopamoodra das, Subrata saha, Subir Sarkar
 Medicaments: Aids to success in endodontics. Part 1 A review of the
literature Paul V. Abbott, BDSc(WA), MDS(Adel), FRACDS(Endo)-
Australian Dental Journal 1990.

104.  Antimicrobial effect of different intracanal medications on
various microorganisms D.A. Attia, A.M. Farag, I.K. Afifi,
A.M. Darrag - D.A. Attia et al. / Tanta Dental Journal 12
(2015)
 Root canal medicaments-Nobuyuki Kawashima, Reiko
Wadachi and Hideaki Suda Tokyo, Japan Thai Yeng and
Peter Parashos Melbourne, Australia-International Dental
Journal (2009) Vol. 59/No.1