KOTHIWAL DENTAL COLLEGE AND RESEARCH CENTRE,
MORADABAD
PULPECTOMY
DEPARTMENT OF PEDODONTICS
MEDICAMENTS
USED IN PRIMARY
TEETH
P R E S E N T E D B Y- G U I D E D BY-
S A DA F A M N A
D R . U . P. S I N G H
INTERN D R . R A J I N I N A G PA L
ROLL NO-55 D R. C H A N D RA KA R C H A M A N
D R . G A R I M A T YA G I
D R . S H R A D H A G U P TA
INTRODUCTION
Intracanal Medicament is a cardinal step in killing
the bacteria in root canals and is considered to be an
integral part of the success of Root Canal Therapy.
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.
Grossman’s Requirements of an Ideal
Root Canal Medicament
a) It should be an effective antimicrobial agent.
b) It should be nonirritating to the periradicular tissues.
c) It should remain stable in solution.
d) It should have a prolonged antimicrobial effect.
e) It should be active in the presence of blood, serum, and
protein derivatives of tissue.
f) It should have low surface tension.
g) It should not interfere with the repair of periradicular
tissues.
h) It should not stain tooth structure.
Indications of Intracanal
Medicaments
Todry persistently wet or the so-called weeping
canals.
-Weeping canal is a canal from which constant
clear or reddish exudation is appeared. This
exudate is associated with a large periapical
radiolucency. The tooth is difficult to treat as when
opened, exudate stops but it again reappears in
next appointment.
To eliminate any remaining microbes in the pulp
space
Indications of
Intracanal
Medicaments
To render root canal contents inert
To neutralize tissue debris
To act as a barrier against leakage from an
interappointment dressing in symptomatic cases
Functions of Intracanal
Medicaments
• Destroy the remaining bacteria and also limits the growth of new
arrivals.
• Useful in cases of inflammation caused due to over
instrumentation.
• Antisepsis and disinfection of the canal.
• Pain control.
• Control of exudation.
• Hard tissue formation.
An ideal intracanal
medicament should have
following properties:
1. It should be effective germicide and fungicide.
2. It should be non-irritating to pulpal tissue.
3. It should remain stable in the solution.
4. It should have prolonged antimicrobial action.
5. It should remain active in presence of blood and pus, etc.
6. It should have low surface tension.
7. It should not interfere with repair of periapical tissue.
8. It should not stain tooth.
9. It should be capable of inactivation in the culture media.
10. It should not induce immune response.
Clinical
Note-
Intracanal antibiotics are no longer recommended as
many of the antibiotics tested are bacteriostatic in nature
and thereby prevent the growth of microorganisms
without killing them.
Phenol and related volatile compounds were used for
many years by endodontists and general practitioners for
disinfection and caustic action. Camphorated
monochlorophenol (CMCP) was one of the most
commonly used medicaments for many years, but not
anymore.
Clinical Note-
Formocresol, though used by pedodontics
extensively, is not in clinical use in contemporary
endodontics as an intracanal medicament.
Eugenol was once used for its obtundant action
and mild antimicrobial action. It is now considered
as a periradicular tissue toxin and its use is no
longer recommended.
COMMONLY USED
INTRACANAL MEDICAMENTS
1. Essential oils — Eugenol
2. Phenolic compounds—
i. Phenol
ii. Paramonochlor
iii. Camphorated phenol
iv. Cresatin
v. Aldehydes
a.Formocresol
b.Paraformaldehyde
c.Glutaraldehyde
COMMONLY USED INTRACANAL
MEDICAMENTS
3. Calcium hydroxide
4. Halogens
i. Chlorine-sodium Hypochlorite
ii. Iodine
– 2% I2 in 5% KI solution, i.e. iodophores.
– 5 percent I2 in tincture of alcohol
5. Chlorhexidine gluconate
6. Antibiotics
7. Corticosteroid-antibiotic combination
CHARACTERISTICS OF VARIOUS INTRACANAL
MEDICAMENTS
Essential Oils
Eugenol
It has been used in endodontics for many
years. Effects of eugenol are dependent on tissue
concentrations of the eugenol.
Uses of Eugenol
1. Used as an intracanal medicament.
2. Used as a root canal sealers.
Phenolic Compounds
Phenol
It has strong inflammatory potential, so
it is rarely used as an intracanal
medicament.
Uses
a. It is used for disinfection before periapical surgery.
b. It is also used for cauterizing tissue tags that resist removal with
broaches or files.
Parachlorophenol
This is substitution product of phenol in which chlorine replaces one of
the hydrogen atoms. It is used as a dressing of choice for infected tooth.
Camphorated Monoparachlorophenol (CMCP)
Composition
2 parts of para-chlorophenol + 3 parts gum camphor ↓
Camphorated monochlorophenol (CMCP)
It is used as a dressing of choice for infected teeth.
Aldehydes
Formocresol
Composition of Formocresol Formaldehyde – 19 percent
Cresol – 35 percent
Water and glycerine – 46 percent
Uses
Used as dressing for pulpotomy to fix the
retained pulpal tissue.
Paraformaldehyde:
It is polymeric form of formaldehyde and is commonly found as
component of some root canal obturating materials like
endomethasone.
Calcium Hydroxide
Various functions of calcium
hydroxide which have been reported are as follows:
1. It shows antiseptic action probably because of its high pH.
2. It hydrolyses the lipid part of bacterial lipopolysaccharide (LPS) and
thus inactivates the activity of LPS.
3. It is medicament of choice in “Weeping Canal” cases.
Halogens
Chlorine
Sodium hypochlorite: This compound is sometimes used as an
intracanal medicament.
Iodides: Iodine is highly reactive, combining with proteins in a
loosely bound manner so that its penetration is not impeded. It is
also a very potent antibacterial agent of low toxicity.
PBSC Paste
The constituents of the paste are as follows:
Penicillin: Effective against gram-positive microorganisms.
Bacitracin: Effective against penicillin-resistant microorganisms.
Streptomycin: Effective against the gram-negative microorganisms.
Caprylate (sodium salt): Effective against fungi.
Corticosteroid Antibiotic Combinations
Medications that combine antibiotic and corticosteroid
elements are highly effective in the treatment of over
instrumentation. The corticosteroid constituent reduces
the periapical inflammation and gives almost instant
relief of pain, while the antibiotic constituents prevent
the overgrowth of microorganisms when the
inflammation subsides.
P- Penicillin
B- Bacitracin
S- Streptomycin
C- Caprylate
INTRACANAL MEDICAMENTS USED
IN ENDODONTIC DENTISTRY
The two antimicrobial intracanal medicaments
recommended in contemporary endodontic practice
are as follows:
1. Calcium hydroxide
2. Chlorhexidine digluconate
CALCIUM HYDROXIDE
Calcium hydroxide, Ca(OH)2, has been used by endodontists throughout
the world since Hermann introduced it to dentistry in 1920.
It is a highly alkaline substance with a pH of approximately 12.5.
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:
Damaging the cytoplasmic membrane
Protein denaturation
Damaging bacterial DNA
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.
Commercially, calcium hydroxide for intracanal disinfection is
available as a nonsettable form which can be removed with
minimum instrumentation
II. CHLORHEXIDINE DIGLUCONATE
Chlorhexidine digluconate (CHX) has been recommended both as a
root canal irrigant and as an intracanal medicament. 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.
TRIPLE ANTIBIOTIC
PASTE
Triple antibiotic paste is a combination of three
antibiotics namely
minocycline(100mg),ciprofloxacin(200mg),metroni
dazole(500mg)and propylene glycol, saline as
carrier.
Triple antibiotic powder, either mixed with normal
saline or 2% chlorhexidine, produced the largest
zone of E.faecalis.
RECENT
ADVANCEMENTS
Bioactive glass: Bioactive glass as an intracanal medicament
is still under investigation. It isn't as effective as 2%
chlorhexidine, although it is better than Ca(OH)2 [22].
Triple antibiotic paste: Root canal infection is caused by a
polymicrobial infection that includes both aerobic and
anaerobic bacteria by combining metronidazole,
ciprofloxacin and minocycline.
PAD: For a long time, the photosensitization approach has
been employed in medicine. PAD is rich in tolonium chloride
and photoactive agent.
ENDOX: The endox endodontic system sterilizes the root
canal by producing high frequency electrical impulses.
PLACEMENT OF
INTRACANAL
MEDICAMENT
1. Copiously irrigate the canal to remove debris present if any.
2. Place the master apical file in the canal.
3. Dry the canal using absorbent paper points.
4. Apply the intracanal medicament on a sterile cotton pellet and place it
in the pulp chamber.
5. Over this place another sterile cotton pellet.
6. Finally seal the cavity with a temporary restorative material.
REFERE
NCE
GROSSMAN ‘S ENDODONTIC PRACTICE (13th edition)
Textbook of Operative Dentistry-Nisha Garg (4th
edition).
THANK YOU
