Intracanal Medicaments - 1

INTRA CANAL MEDICAMENTS
Introduction
Disinfection of pulp space is an important step
during and after cleaning & shaping.
Certain clinical conditions demand the use of ICM
in addition to the chemicomechanical preparation.
Helps in reducing endodontic microflora thus
favouring periapical tissue repair.
Classification
Grossman
1.Essential oils
2.Phenolic compounds
3.Halogens
4.Antibiotics
5.Other-formocresol
-gluteraldehyde
-Cresatin
-N2
-Ca(OH)2
-Quaternary ammonium compounds
Cohen
1.Phenolic preparations:
Phenol
Paramonochlorophenol [C6H4OHCl]
Thymol [C6H3OHCH3C3H7]
Cresol [C6H4OHCH3]
2. Aldehyde
preparations:
Formocresol
Tricresol formalin
Gluterldehyde
Classification
Continu...
3.
Halogens:
Chloramine -T, IKI.
4.
Calcium hydroxide
5. Chlorhexidine
6. Antibiotics
PBSCN.
Triple antibiotic paste
7. Cortico steroid-antibiotic combination
Ledermix
8. Bioactive Glass.
Ideal Requirements
Effective germicide & fungicide
Non irritating
Stable
Prolonged antimicrobial effect
Active in presence of blood,serum & protien derivatives of
tissue
Low surface tension
Should not interfere with repair of periapical tissue
Contn…
Ideal requirements
Should not stain tooth structure.
Should not induce cell mediated immune response.
Should be capable of inactivation in culture
medium.
Uses
Helps eliminate bacteria after canal instrumentation
Reduces inflammation & thereby pain
Induces healing & hard tissue formation
Helps eliminate apical exudates
Controls inflammatory root resorption
Prevents contamination between appointments
Helps to dry persistantly wet canals
Functions of ICM
Primary function
Antisepsis
Disinfection
Secondary function
Hard tissue formation
Pain control
Exudation control
Resorption control
Eugenol
Chemical essence of oil of clove
Slightly irritating
Anodyne and antiseptic
Trowbridge et al has shown that eugenol inhibited
interdental nerve impulses
Phenol
White crystalline substance
Derived from coal tar .
Oldest antimicrobial agent - 1800s
Protoplasm poison – Causes necrosis of tissue
Used bcoz of its disinfectant and caustic action
Liquid phenol- (9 :1) ratio.
Para Chlorophenol - PCP
Substitution product of phenol in which chlorine replaces one of
the hydrogen atoms
On trituration with gum camphor - forms an oily liquid
Recommended : 1% aqueous solution of Para-chlorophenol
CMCP
2 parts para-chlorophenol & 3 parts gum camphor
Camphor serves as a vehicle & diluent .
Prolongs antimicrobial effect.
Less irritating to periapical tissue than phenol & eugenol
Formocresol
Combination of formaldehyde , cresol ,water &glycerine.
Formaldehyde – Strong disinfectant Combines with albumin to
form insoluble , non decomposable substance
Gluteraldehyde
Colorless oil
Slightly soluble in water
Strong disinfectant and fixative
Recommended use :2%
Cresatin
Also known as metacresylacetate
Clear, stable, oily liquid
Claimed to have antiseptic & obtundant properties
Antimicrobial effect less than that of formocresol or
camphorated para- chlorophenol (Grossman)
Less irritating
N2
Paraformaldehyde(primary ingredient)
Used as intracanal medicament & sealer
Eugenol, phenylmercuric borate, lead, corticosteroids,
antibiotics .
Antibacterial action - Short lived and dissipated in about a
week to 10 days.
Halogens
Sodium Hypochlorite
Disinfectant action of halogen is inversely proportional to
their atomic weight
Chlorine( Low Mol wt), Greatest disinfectant action
Not stable because they interact rapidly with organic
matter
Sodium hypochlorite vapors are bactericidal .
Chloramine - T
It is a chlorine compound used in concentration of 5%. It
has good antimicrobial qualities.
It can be used when the patient gives a history of allergy of
iodine compounds.
It remains stable for a long period of time.
Iodides
Consists of 2 parts Iodine crystals,4 parts KI, 94
parts distilled water
Root canal disinfectant use in conc ranging from
2- 5%. (Engstrom and Spangberg)
Highly reactive and combine with proteins in a loosely bound
manner so its penetration is not impede
Vitapex
Contains Calcium hydroxide,iodoform,silicone
oil.
Appears to combine best effects of iodoform and calcium
hydroxide
Quarternary Ammonium Compounds
Lower the surface tension of solutions
QAC are +vely charged & microorganisms are –vely charged
- surface active effect results in which compounds clings to
the microorganisms and reverses the charge
It acts by inhibition of cell protein synthesis and inhibition
of DNA synthesis.
Antibiotics
Sulphathiazole
Pencillin
Metronidazole
Tetracycline
Clindamycin
Poly Antibiotic Paste (PBSC)
Developed by Grossman
The PBSC paste consist of
Penicillin- effective against gram +ve microorganism.
Bacitracin- effective against penicillin resistant microorganisms.
Streptomycin- effective against gram -ve microorganisms.
Caprylate- effective against fungi.
Triple Antibiotic Paste
Metronidazole
Ciprofloxacin
Minocycline.
Calcium Hydroxide
Introduced by Herman in 1920.
It is one of the commonly used ICM.
It is a broad spectrum anti microbial agent.
It s antiseptic action probably relates to its high pH and its
leaching action on necrotic pulp tissue
Calcium Hydroxide..
MOA
Antimicrobial activity of calcium hydroxide is related to the
release of hydroxyl ions in an aqueous environment.
These hydroxyl ions kills bacteria by
- Damaging bacterial cytoplasmic membrane
- Protein denaturation
- DNA damage
Calcium Hydroxide..
Vehicles
Aqueous –
Viscous –
Oily -
Water,Saline
Glycerine, Propylene glycol
Olive oil, CMCP
Chlorhexidine
It is a cationic bisbiguanide with optimal antimicrobial action
b/w pH 5.5-7.0
0.5% used as mouth wash
0.12 - 2% used for endodontic disinfection
Available as water based soln,gel,liquid mixed with surface
active agents
Recent advancements in ICM
Bioactive Glass S53P4
Ozonised oil
Octenidine
Conclusion
Since residual bacteria can adversely affect the
treatment outcome, the use of ICM has been
recommended to compliment the anti bacterial
effects of chemico mechanical procedures and
eliminate persisting bacteria.
With a wide choice of ICM now available , selection
should be made based on the clinical situation and
compliance of the patient.
Conclusion
Every case should be judged on the advantages
and disadvantages of using a intracanal
medicament.
After all, what is removed from the root canal is
of greater significance with regard to the success
of root canal treatment than what is placed in the
root canal system.
References
Pathways of the Pulp 10th Edition – Stephen
Cohen & Kenneth Hargreaves.
Endodontics 6th Edition – John Ingle & K.Bakland.
Endodontic Therapy 6th Edition – Franklin S.
Weine
Endodontic practice 12th edition- Grossman
Antibiotics as ICM-review- CDA journal Feb 2009.