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Intracanal medicaments

Intracanal medicaments phenols eugenol CMCP Formocresol Ca(OH)2 chlorhexidine Iodine potassium iodide IKI antibiotic corticosteroid Ledermix root canal endodontic calcium hydroxide camphorated powerpoint presentation

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Intracanal medicaments

  1. 1. Intracanal medicaments By Ahmed Mostafa Hussein Assistant lecturer, Dental Biomaterials Department Faculty of Dentistry, Mansoura University 2014 1
  2. 2. Functions 1. Destroy the microorganisms and prevent regrowth. 2. Reduce inter-appointment pain. It is useful in treating apical periodontitis as a result of overinstrumentation. 3. Useful in weeping canals (constant clear or reddish exudate, large apical radiolucency, and if cultured, the drainage will not support bacterial growth) 4. May inhibit root resorption in case of replanted teeth. 2
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  4. 4. Ideal requirements: 1. Effective germicide and fungicide. 2. Non irritating to periapical (PA) tissues. 3. Stable in solution. 4. Have antibacterial effect for prolonged period. 5. Active in presence of blood and serum. 6. Low surface tension. 7. Should not interfere with repair of PA tissues. 8. Should not stain the tooth. 4
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  6. 6. 1. Phenols  Phenols are ineffective antiseptics under clinical conditions , it is rarely used as an intra-canal medicament as it has strong inflammatory potentials. 6
  7. 7.  Eugenol has a high irritating potential when evaluated histologically but it seems to be extremely soothing clinically to vital tissue.  camphorated mono-para-chloro-phenol (CMCP) has decreased tremendously.  CMCP placed in the pulp chambers loses nearly 90% of their activity within the first 24 hours. 7
  8. 8. 2. ALDEHYDES Formo-cresol  It is a combination of formalin and cresol.  it is potent toxin with an antimicrobial effectiveness much lower than their toxicity.  Formo-cresol is used as a dressing for pulpotomy to fix the retained pulpal tissue.  It may be used as an intra-canal medicament when a pulpotomy is performed as emergency treatment to relieve pain. 8
  9. 9.  No clinical reason to use formo-cresol as an antimicrobial agent for endodontic treatment. The alternatives are better antiseptics with significantly lower toxicity.  It is placed on a cotton pellet in the pulp chamber and the vapor penetrate the entire canal preparation. 9
  10. 10. 3. Calcium hydroxide Ca(OH)2  Ca(OH)2 is effective in inhibiting microbial growth in canals, although it remains controversial. (see limitations of Ca(OH)2)  No pain reduction effects.  Recommended for use in teeth with necrotic pulp tissue and bacterial contamination.  Has little benefit with vital pulps. 10
  11. 11. Form and application:  Can be placed as a dry powder, a powder mixed with a liquid such as local anesthetic solution, saline, water or glycerine to form a thick paste or a paste supplied in a syringe.  A lentulo spiral is effective and efficient for placement.  Removal after placement is difficult. This is especially true in the apical portion of the root. 11
  12. 12. Lentulo spiral 12
  13. 13. Note: Long term use of Ca(OH)2 may be necessary. However, the use of intracanal medicament for long periods does not seem to be acceptable in modern endodontics. 13
  14. 14. Ca(OH)2 is useful for weeping cases Weeping cases: the tooth with 1. Constant clear or reddish exudation 2. A large apical radiolucency 3. Often asymptomatic, but it may be tender to percussion or sensitive to digital pressure over the apex. 4. If cultured, the drainage generally will not support bacterial growth. 14
  15. 15. 5. When opened at the start of endodontic appointment, there is a reddish discharge. At the succeeding appointment, the exudate will be clear. It is referred as a weeping canal.  Canals with exudates were not considered to be ready for filling.  Prescribing antibiotics for the patient seems foolish, because of the frequency of negative cultures. 15
  16. 16. Treatment: the treatment of this problem is to dry the canal with sterile absorbent paper points and place Ca(OH)2 paste in the canal.  It is interesting to see a perfectly dry clean canal at the next appointment that is simple to fill after minimal further preparation. 16
  17. 17. Limitations of Ca(OH)2  Residual Ca(OH)2 can shorten the setting time of zinc oxide eugenol-based endodontic sealers.  Ca(OH)2 is not totally effective against E. faecalis and candida albicans.  Dentin can inactivate the antibacterial activity of Ca(OH)2. 17
  18. 18.  A clinical study has shown that the number of bacteria-positive canals actually increased after Ca(OH)2 medication.  Other studies have also indicated that cultures changed from negative to positive after Ca(OH)2 placement.  Therefore, based on the current best available evidence, Ca(OH)2 has limited effectiveness in eliminating bacteria from human root canals. 18
  19. 19. 4. Chlorhexidine (CHX)  Chlorhexidine (CHX) has been recently used as an intra-canal medicament.  A 2% gel is recommended.  It can be used alone in gel form or mixed with Ca(OH)2. 19
  20. 20.  When used with Ca(OH)2, the antimicrobial activity is greater than when Ca(OH)2 is mixed with saline, although it remains controversial.  2% CHX gel was significantly more effective than Ca(OH)2 combined with 2% CHX or Ca(OH)2 alone, against root dentin infected with E. faecalis and candida albicans after 7, 15 and 30 days of incubation. 20
  21. 21. 5. Iodine potassium iodide (IKI)  Iodine potassium iodide (IKI) is very effective antiseptic solution with low tissue toxicity.  IKI releases vapours with a strong antimicrobial effect.  IKI can kill bacteria in infected dentin in 5 minutes in vitro. 21
  22. 22. 6. ANTIBIOTICS  Sulphonamides are used as medicaments by mixing distalled water or moistened paper point into jar containing the powder.  It is indicated in case of acute peri-apical abcess.  Disadvatage, yellowish tooth discoloration. 22
  23. 23. 7. Corticosteroid-antibiotic combination  Corticosteroids are anti-inflammatory agents that may decrease postoperative pain in certain situations e.g. irreversible pulpitis and acute apical periodontitis.  Corticosteroids may be ineffective, particularly with greater pain levels.  Corticosteroid-antibiotic combinations are useful in treating apical periodontitis, occurring either as a pretreatment symptom or as a result of overi- nstrumentation. 23
  24. 24.  Ledermix is a corticosteroid-antibiotic paste, made in Germany.  Ledermix is a nonsetting, water-soluble paste, used as root canal medicament or as direct or indirect pulp capping agent.  At the first 24 hours, 30% of the corticosteroid was released. By the end of 14 weeks, the remaining 70% has been released. 24
  25. 25.  In case of replanted teeth, immediate intracanal placement of Ledermix may inhibit root resorption.  Note: Intracanal antibiotic paste may cause bacterial resistance.  Mixing erythromycin with Ca(OH)2 improved the effectiveness against E. faecalis as compared to Ca(OH)2 alone. 25
  26. 26.  In general, specific information about the effectiveness of intra-canal antibiotics in infection control in endodontics is limited. 26
  27. 27. Questions What are the indications of Formocresol Ca(OH)2 Corticosteroid-antibiotic combination ? 27
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