This simplified lecture will present to you the basic concept of intracanal medicaments, their indication, classification, and their appropriate selection. Presented to you by Iraqi Dental Academy. visit us on facebook: https://www.facebook.com/Iraqi.Dental.Academy/ or Twitter: https://twitter.com/IQDentalAcademy Our page on Telegram: @IraqiDental

1. Intracanal Medicaments Indication
Intracanal medicaments classification
Phenols and Aldehydes
Calcium Hydroxide
Limitations of Calcium Hydroxide
Chlorhexidine Gel
Mixing CHX with Ca(OH)2
Iodine-Potassium Iodide
Ledermix ( Steroid )
Triple Antibiotic Paste
Bioactive Glass
INTRACANAL MEDICAMENTS INDICATION
Although there are some controversy regarding
one-visit or multi-visit endodontic treatment. The use
of intracanal medicament is generally indicated in case
of:
• Teeth with necrotic pulp that are been treated in
multi-visits.
• Teeth that have failed root canal treatment and un-
dergoing retreatment
• Teeth with periapical pathology
INTRACANAL MEDICAMENTS
CLASSIFICATION
Till now there is no ideal material that server all theses
functions completely, several materials has been pro-
posed throughout history, including:
• Phenols
• Aldehydes
• Calcium Hydroxide
• Chlorhexidine
• Iodine-potassium iodide
• Corticosteroids
• Triple Antibiotic Past
• Bioactive glass
PHENOLS AND ALDEHYDES
They were common intracanal medicaments. Howev-
er, their use is no longer recommended. Their compo-
nents are cytotoxic, carcinogenic and mutagenic. They
are banned in several countries including USA.
There is no clinical reason to use Phenols or Aldehydes
as an intracanal medicament, the alternatives are better
and significantly less toxic.
CALCIUM HYDROXIDE
One of the most commonly used intracanal medica-
ments. And it’s the first choice as intracanal dressing
material by most dentists.
How to prepare and place?
Calcium hydroxide paste is prepared by mixing pow-
der with sterile water or saline or local anesthetic solu-
tion. The mixture should be thick to carry as many
Ca(OH)2 particles as possible, however, do not overd-
ried the mix to maintain solubility and high PH.
Lentulo Spiral are effective for placing the paste inside
the canal. Calcium hydroxide must placed to fill the
entire canal to the full working length. Care should be
taken not to extrude it beyond the apex. Rotary instru-
ments has been suggested for placing the material into
Intra-canal Medicaments
Osama Asadi, B.D.S, Published for Iraqi Dental Academy Blog
After proper instrumentation and irragation of root canal, some dentists may place antibacterial agent inside
the canal and seal the cavity with temporary filling for the next appointment. The purpose of such practice is to
• reduce the inter-appointment pain
• decrease bacterial count and prevent regrowth and
• to render the content of canal inert (biologically inactive).
LECTURE OUTLINE
CHAPTER
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2. the prepared root canal. Nevertheless, paper points can
do the job.
Limitations of Calcium Hydroxide
Despite its wide clinical use, it has been presented with
some limitations:
• The handling and proper placement of material may
be difficult.
• Removal of the paste also incomplete, even with
saline, NaOCl or EDTA, resulting in residual
Ca(OH)2 which shorten the setting time of zinc ox-
ide eugenol based endodontic sealers, if used.
• It’s ineffective againts E. Faecalis, a common end-
odontic pathogen, and also ineffective against Can-
dida Albican.
Although it’s effectiveness well documented in the sci-
entific literature, recent researches present a contrary
results. So, the use of such material is controversial,
some researchers confirm the use of Calcium hydroxide
while others suggest its low effectiveness.
A recent meta-analysis published at the Korean Acade-
my of Conservative Dentistry concluded that Calcium
hydroxide has limited antibacterial effect, the micro-
organisms were reduced but not completely eliminat-
ed after treatment, and some species has resistance to
Ca(OH)2. The majority of clinical studies supported
that there was no improvement in healing of periapical
lesions when Ca(OH)2 was applied between appoint-
ments. So, based on the current best available evidence,
Calcium hydroxide has limited effectiveness in elimi-
nating bacteria from human root canals (source in the
last slide). But it remain the best available intracanal
medicament choice.
CHLORHEXIDINE GEL
Chlorhexidine has been recently introduced as intraca-
nal medicament. In vitro studies has suggested that
CHX has at least as good or even better antibacterial
efficacy than Calcium hydroxide. While in Vivo stud-
ies the results where controversial. Some studies has
suggested its effectiveness while others have suggested
controversial results.
However, it is a common intracanl medicament and
represent the second best available choice.
MIXING CHX WITH CA(OH)2
Mixing them has been suggested to increase the an-
tibacterial action. However, many studies have been
published and the results were not conclusive. The use-
fulness of mixing is controversial and not confirmed.
IODINE-POTASSIUM IODIDE
It’s very effective intracanal medicament with low tox-
icity but it’s not available in the market. If you want to
use it, you should prepare it manually. It’s prepared by
mixing 2 g of iodine in 4 g of potassium iodide, this
mixture is then dissolved in 94 ml of distilled water.
LEDERMIX ( STEROID )
Is anti-inflammatory agent that reduce pain and in-
flammation in the periapical tissue. Ledermix has been
advocated as intracanal dressing if the patient reported
symptoms of pain and inflammation.
However, Ledermix substances can reach the system-
ic circulation via diffusion through dentinal tubules,
lateral canals and apical foramen. Its use has been re-
stricted in the United State. In addition to that, Leder-
mixed, which is a steroid, act as antiinfmmatory and
reduce the symptoms of pain, but the infection is still
there. This could mask the infection and deceive the
clinician. Therefore, they are not popular now despite
their common use in the past.
TRIPLE ANTIBIOTIC PASTE
It’s composed of Metronidazole, Ciprofloxacin an Mi-
nocycline. It is very effective at eradicate baterial col-
onies in root canals. But it has some disadvantages:
• Minocyline cause tooth discoloration.
• Fear of bacterial resistance
• high toxicity to stem cells
For tooth discoloration reason, dual paste can be used
in place of triple paste. Or use of Ca(OH)2 should be
considered.
BIOACTIVE GLASS
It is a newly presented intracanal medicament. It found
to kill bacteria bu the mechanism of action is not ph-re-
lated. Some new obturating materials such as Resilon,
contain bioactive glass.
REFERNENCES
• The Korean Academy of Conservative Dentistry,
Antimicrobial effect of calcium hydroxide as an
intracanal medicament in root canal treatment: a
literature review – Part II. in vivo studies
• Cohen’s Pathways of Pulp, 11 Edition, Chapter
The Core Science of Endodontics, Intracanal Me-
dicaments, p. 260
• J Appl Oral Sci., Antibacterial effect of calcium
hydroxide combined with chlorhexidine on En-
terococcus faecalis: a systematic review and me-
ta-analysis
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