Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr.

Bestoon Mohammed

Intra-Canal Medicaments
Microorganisms have been well known to play a role in pulpal and periapical diseases.
However, chemical (irrigation) and mechanical (shaping+debridement) are often not
sufficient, and many bacteria may remain in the root canal system, therefore intra-canal
medicaments have been used. When treatment cannot be completed in one appointment, the
surviving intra canal bacteria often proliferate between appointments so an intra canal
medicament should be used.

Functions of intracanal medicaments

1. Eliminate microorganisms: The objective is to sterilize (destroy all viable microorganisms)
or to disinfect (destroy all pathogens) in the canal space.

2. Rendering contents of canal inert. This represents the attempt usually by chemical means
to “mummify”, fix or neutralize tissue or debris left intentionally or unintentionally in the
pulp space.

3. Control inflammatory root resorption, and prevent contamination between appointments.

4. Induce healing.

5. Prevention or control of post treatment pain.

6. Control of persistent periapical abscess in weeping canal.

A root canal medicament should have the following properties

1. It should be effective germicide and fungicide.

2. It should be non-irritating to pulpal tissue.

3. It should have prolonged antimicrobial action.

4. It should remain active in the presence of blood and pus, etc.

5. It should have low surface tension.

6. It should not interfere with repair of periapical tissue.

7. It should not stain the tooth.

8. It should be capable of inactivation in the culture media.

9. It should not induce immune response.

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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

Classification of intra-canal medicament

1. Phenol and related volatile compounds.

Phenol was used for many years for its disinfectant and caustic action. However, because it
has strongly inflammatory potential, at present it is rarely used as an intracanal medicament.

Eugenol although the compound has high irritating potential when evaluated histologically,
it seems to be extremely soothing clinically to vital tissue. It is used as an intracanal
medicament after partial or complete pulpectomy.

Camphorated monoparachlorophenol (CMCP) It has a wide antibacterial spectrum

and is effective against fungi as well. CMCP is much less irritating to periapical tissue than
either phenol or eugenol without sacrificing antimicrobial action. It is placed on a cotton
pellet in the pulp chamber of a tooth in treatment and the vapors will penetrate the entire
canal preparation.

Formocresol, a combination of formalin and cresol, is used as a dressing for pulpotomy to

fix the retained pulpal tissue. It may also be used as an intratreatment medicament when a
pulpotomy is performed as emergency treatment to relieve pain, in situations where pulp
inflammation is confined to the pulp chamber.

2. PBSN and PBSC: The constituents of the paste are as follows: Penicillin,
bacitracin, and streptomycin, with neomycin (PBSN) for neomycin as an
antifungal agent. Nystatin replaces sodium caprylate as the antifungal agent in a similar
medicament, PBSN. 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.

3. Sulfonamides: Sulfanilamide 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. Yellowish tooth discoloration has been reported after use. The medication is

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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

suggested for use when closing teeth that had been left open after an acute periapical abscess.

4. Corticosteroid-antibiotic combinations. Medications that combine

antibiotic and corticosteroid elements are highly effective in the treatment of over
instrumentation; they must be placed into the inflamed periapical tissue by a paper point or
reamer to be effective.

The corticosteroid constituent reduces the periapical inflammation and gives almost instant
relief of pain to the patient who has complained of extreme tenderness to percussion after
canal instrumentation. The antibiotic constituents are present so that no overgrowth of
microorganisms will occur with the inflammatory response diminished.

Ledermix (Antibiotic preparations):

 Is a corticosteroid-antibiotic paste containing 1% triamcinolone and

3% demeclocycline, Used as an initial dressing if the patient
presents with endodontic symptoms.

 It has a short duration of action, only 1-2 days maximum, so its

antibacterial effect is not that high.

 It is presented as a single paste in a tube so there is no need to mix

this material prior to use.

 LEDERMIX Paste has two main therapeutic actions; one reduces

inflammation whilst the other reduces the viable microbial flora
within the root canal system.

 A disadvantage of ledermix is that it causes staining, it will stain

the teeth a brownish color because of the tetracycline.

5. Calcium hydroxide Ca (OH):

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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

It is the most commonly used dressing for treatment of the vital pulp. It
also plays a major role as an inter-visit dressing in the infected root canal
system, especially a persistent weeping canal.

Weeping Canal: A constant clear or reddish exudation associated with a large apical
radiolucency. The tooth often is asymptomatic, but it may be tender to percussion or sensitive
to digital pressure over the apex. When opened at the start of the endodontic appointment, a
reddish discharge may well up, whereas at a succeeding appointment the exudates will be
clear. Some pressure is present, but not nearly as much as with an acute periapical abscess. A
similar condition will still be present at the next appointment. This is referred to as a weeping
canal.

Calcium hydroxide is a slow acting agent and, the dressing has to be left in the root canal
for at least one full week.

Calcium hydroxide pastes are used also in endodontics as a temporary canal filling material
for multiple purposes including:
1. Stimulate continue root development.
2. Prevention of external root resorption following traumatic injuries.
3. Create an apical barrier following over instrumentation.

Advantages of Calcium hydroxide:

1. Initially bactericidal then bacteriostatic.

2. Promotes healing and repair.

3. High pH ( pH= 11 )

4. Inexpensive and easy to use.

5. Radiopaque

Disadvantage of Calcium hydroxide:

1. Removal of Ca(OH)2 is frequently incomplete even after copious irrigation

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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

2. Can shorten the setting time of sealers.

6. Chlorhexidine as irrigants and intracanal medicaments:

Chlorhexidine (CHX) is a broad-spectrum antimicrobial agent effective against gram-

positive and gram-negative bacteria. It has cationic molecular component that attaches to
negatively charged cell membrane areas, causing cell membrane lyses. Its use as an
endodontic irrigant is based on it is substantively long lasting antimicrobial effect. Recently
Chlorhexidine available as gutta-percha point (active point) for temporary root canal filling
and for emergency root canal treatment. Active point consists of chlorhexidine diacetate
(5%), gutta-percha, ZnO, BaSO4, and coloring agents. Normally, active point remains in the
canal for 1-3 weeks, but in specific clinical cases, it should be replaced every 2- 3 days.

Sealing agents for inter-treatment dressings

Need for sealing agents because endodontic treatment usually takes two or more
appointments, some type of temporary sealing agent needed to close the access cavity
between visits. The material selected must provide for effective closure against
microorganisms and salivary contamination, which would bring irritants to the periapical
tissue if allowed free passage. The access- sealing agent must also retain the intracanal
medicament, if used, within the tooth to allow effectiveness for the drug.

Fortunately, zinc oxide powder with eugenol (ZOE) provides an excellent seal

Cavit was introduces for use in Endodontics. Both are easy to apply, and Cavit may be
removed with a spoon excavator, not even requiring a bur.

Recently a light-cured material, TERM (Temporary Endodontic Restorative Material), has

been introduced. Its major advantages are the ease with which it may be used, since it may be
placed with a syringe from sterile prepacked compules, and it is set by exposure to visible
light for 20 seconds.

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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

TEMP
ORIZA
TION
Points to
remember :
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

 Pulp
chamber and
cavity walls
should be
dry.
 A
minimum
depth of 3 to
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

4 mm is
required.
 At least 3
mm thick in
the cingulum
area.
 Care must
be taken not
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

to
incorporate
cotton fibers
into the
restorative
material.
 Packing
into the
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

access
opening with
a plastic
instrument in
increments
from the
bottom up
and pressing
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

against the
cavity
walls and
into
undercuts.
 Excess is
removed,
and the
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

surface
smoothed
with moist
cotton
pellet.
 The patient
should avoid
chewing on
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

the tooth for

at least an
hour.

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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

TEMP
ORIZA
TION
Points to
remember :
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

 Pulp
chamber and
cavity walls
should be
dry.
 A
minimum
depth of 3 to
15
Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

4 mm is
required.
 At least 3
mm thick in
the cingulum
area.
 Care must
be taken not
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

to
incorporate
cotton fibers
into the
restorative
material.
 Packing
into the
17
Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

access
opening with
a plastic
instrument in
increments
from the
bottom up
and pressing
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

against the
cavity
walls and
into
undercuts.
 Excess is
removed,
and the
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

surface
smoothed
with moist
cotton
pellet.
 The patient
should avoid
chewing on
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Intracanal Medicament 2020-2021 (Lec.11) Assist. Prof. Dr. Bestoon Mohammed

the tooth for

at least an
hour.
Temporization
Technical procedure
1. Pulp chamber and cavity walls should be dry.
2. A minimum depth of 3 to 4 mm is required.
3. At least 3 mm thick in the cingulum area.
4. Care must be taken not to incorporate cotton fibers into the restorative material.
5. Packing into the access opening with a plastic instrument in increments from the bottom
up and pressing against the cavity walls and into undercuts.
6. Excess is removed, and the surface smoothed with moist cotton pellet.
7. The patient should avoid chewing on the tooth for at least an hour.

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