INTRACANAL MEDICAMENTS

CONTENTS
• Calcium hydroxide
• Definition
• Metapex
• History
• Nisin
• Properties of intracanal medicaments
• Herbal usage in endodontics
• Classification
• Bioactive glass
• Eugenol
• Silver nanoparticles
• Phenolic compounds
• Conclusion
• Camphorated mono parachloro phenol
• References
• Formocresol
• N2
• Poly antibiotic paste
• Corticosteroids -antibiotic containing
• Ledermix
• Triple antibiotic paste
• Chloromine
• Iodine
What are intracanal medicaments?

Antimicrobial medicaments that are placed in the root canal, in case of multi
appointment endodontic treatment of a tooth, especially the one with the
necrotic pulp, in which the bio mechanic instrumentation and irrigation with
antimicrobial solution may not completely eradicate micro organisms and
further disinfection may be necessary, are called intracanal dressing, also called
inter appointment medicaments.

OR

A chemical agent sealed within the root canal system; used between
appointments as an anodyne and/or antimicrobial agent.
History

 Seribonius in 1045AD wrote of using oils and wine in the mouth of the patient in pain. This
was a crude attempt to achieve a topical anesthetic effect on a tooth to be extracted.

 Dental writings through the middle ages indicate the use of oil of cloves, a plant extract
containing a high percentage of eugenol.

 In 1800 specific medicament were recommended for endodontic treatment.

 1884, Richmond advocated “knocking out the pulp” by whittling down orangewood to a
small size, soaking the stick in phenol and tapping this into exposed pulp canal.

 Phenol was added to preserve and sterilize the contents of canal and to alleviate pain.
Rationale

• Destroy residual microorganisms and their toxins that have not been
removed during canal preparation.

• Furthermore, anaerobic bacteria may invade the dentinal tubules of the

canals with necrotic pulps.

• The medicament should inhibit microbial re-colonization of the cleaned parts

of the root canal system by preventing
-residual microorganisms from growing
-new microorganisms invading through lateral communications.
Which microorganisms?
• In most cases, gram-positive organisms are present

• In some cases, gram-negative organisms

• In a few cases, yeasts.

• These organisms are found most often in various combinations rather than
as a single species.
• The microbial flora of the root canals is likely to comprise organisms that can
survive on dead pulp tissue, that is, saprophytes, as they can grow in an
environment of low oxygen tension.

• The endodontic problem is primarily one of eliminating gram-positive

organisms because they are the most abundant, consisting chiefly of
streptococci and staphylococci.
PROPERTIES OF AN IDEAL INTRACANAL MEDICAMENT

• It should be an effective antimicrobial agent

• It should be nonirritating to the periradicular tissues
• It should remain stable in solution
• It should have a prolonged antimicrobial effect
• It should be active in the presence of blood, serum, and protein derivatives of
tissues
• It should have low surface tension
• It should not interfere with the repair of periradicular tissues
• It should not stain tooth structure
• It should not induce a cell‑mediated immune response.
When to use? (INDICATIONS OF INTRACANAL MEDICAMENTS)

• To dry persistently wet or the so‑called weeping canals

• To eliminate any remaining microbes in the pulp space
• To render root canal contents inert
• To neutralize tissue debris
• To act as a barrier against leakage from an interappointment dressing in
symptomatic cases.
Classification
According to Grossman (1990)

1. Essential oils
• Eugenol
2. Phenolic compounds
• Phenol
• Parachlorophenol
• Camphorated parachlorophenol
• Cresol
• Formocresol
• Creosote
• Cresatin
• Cresanol
3. N2
4. Salt of heavy metals 7. Fatty acids
• Metaphen • Propionic acid
• Merthiolate • Caproic acid
• Mercurophen
• Cuprylic acid
5. Halogens 8. Sulphonamides
• Sodium hypochlorite
• Iodides
• Chlorexidine

6. Quaternary ammonium
compounds
• 9-aminoacidine
According Franklin S Weine (1995)

1. Phenol and related compounds;

Eugenol
Camphorated paramonochlorophenol
Metacresyacetate
Cresol
Thymol
2. PBSC
Penicillin
Bacitracin
Streptomycin
Caprylate
3. Sulphonamides
4. Corticosteroid – antibiotic combinations
5. Calcium hydroxide
Eugenol
Eugenol is the chemical essence of oil of clove and is somewhat
related to phenol.

It is slightly more irritating than oil of clove and is both an antiseptic
and an anodyne.

It is a pale yellow liquid which becomes dark with age.

It has a clove like odour from which it is derived and has slight anaesthetic
as well as antiseptic properties.
PHENOLIC COMPOUNDS

Phenol is one of the oldest antiseptic

 White crystalline substance derived from coal tar.

 It is used as sedatives for the pulp tissue, as root canal medications and as disinfection.

 Phenol is a nonspecific protoplasm poison that has an optimal antibacterial effect at 1% to

2%
 Rarely used as root canal antiseptic because of its
-- strong inflammatory potential
-- pungent aroma
-- relative inferiority as a germicide when compared to other
commonly used root canal antiseptics.
FORMULATIONS:

-Parachlorophenol
-Metacresylacetate
-Cresol

Mechanism of action
 The antibacterial action of phenol is derived from its ability to disrupt and
penetrate the cell wall of bacteria-------precipitate protoplasmic protein.

 Cytocidal action-----it is as toxic to viable tissues as it is to bacteria.

 In lower concentrations or in some of its altered forms---- action is less,

inactivates essential enzyme systems.
Parachlorophenol
• 1% aqueous form is most commonly used

• It penetrates deeper into the dentinal tubules

Cresatin (metacrestyl acetate)

• It is a derivative of metacresol with low surface tension.

• Non irritating and exhibits sedative properties.

Creosote (beechwood creosote)

• It is antibacterial and antifungal

•
CAMPHORATED MONO PARACHLORO PHENOL (CMCP)

 Developed by Walkoff in 1891.

 Consists of 2 parts of parachlorophenol and 3 parts of gum camphor.

 Transparent, oily, light, amber colored liquid, having a characteristic

aromatic odor.

 Wide antibacterial spectrum.

 Camphor serves as a vehicle and reduces the irritating effect of pure PCP
and prolongs antimicrobial effect.

 less irritating to periapical tissues compared to eugenol and has long shelf
life.
 FORMOCRESOL

 Buckley in 1906, mixed 19% formaldehyde with 35% cresol and 46% water
and glycerine.

 combination of formalin and cresol in the ratio of 1:2 or 1:1.

 Formalin is a strong disinfectant that combines with albumin to form an

insoluble, undecomposable substance and fixes the tissues.
• When it is placed against living tissues, necrosis
followed by a persistent inflammatory reaction is
seen because of:
1)Proteolizing effect of cresol
2)Alkylating effect of formaldehyde

• Han and Loo have recommended using low

concentration of formocresol, since it is toxic and
delays healing.
N2

 It is a compound containing paraformaldehyde as the primary ingredient.

 It is used as both intracanal medicament and sealer.

 It contains -- eugenol and phenylomercuric borate

-- small amounts of lead

-- cortricosteriods

-- antibiotics
 The properties present in N2 have permanent disinfectant action and

unusual antiseptic agent that are irritating and toxic with high degree of

antimicrobial activity.

 It has been observed that the antibacterial effect of N2 is of short duration

and degenerate in about 7 to 10 days.

ANTIBIOTICS
POLY ANTIBIOTIC PASTE (PBSC)
Penicillin – Effective against gram positive micro organisms

Bacitracin – effective against penicillin resistant microorganisms

Streptomycin – Effective against gram negative microorganisms

Caprylate – Effective against fungi

• Ineffective against anaerobic species.

• PBSC is banned for endodontic use primarily because of the risks of
sensitization and allergic reactions attributed to penicillin.
CORTICOSTERIODS- ANTIBIOTICS COMBINATIONS

 Highly effective in the treatment of over instrumentation.

 Placed in the inflamed tissue by a paper point or reamer to be effective.
 The steroid constituent reduces the periapical inflammation and gives instant
relief of pain.

Some of the combinations used are:-

Terra-cortil
Cortisporin
Mycolog
Ledermix (gluco corticosteroid- antibiotic combination)

• Developed by Schroeder and Tridon

• It is available in a polyethylene glycol form combining

tetracycline antibiotic
demeclocycline
HCL (at a concentration of 3.2%) and
corticosteroid triamcinolone acetoxide (concentration 1%).

• Ledermix paste is a nonsetting, water-soluble paste.

• It is antibiotic and anti inflammatory

• Also available as powder and liquid form. It may be of fast or slow setting cement.

• Powder:
Liquid :
Triaminolone acetonide
-Eugenol and rectified terpentine
Dimethylchlortetracycline hydrochloride.
Zinc oxide
Canada balsam.
Calcium hydroxide and rosin

• A 50:50 mixture of Ledermix paste and calcium hydroxide has been advocated as an
intracanal dressing in cases of:

1. Pulpless infected root canals

2. Pulp necrosis and infection with incomplete root formation (apexification)
3. Perforations
4. Inflammatory root resorption
5. Inflammatory periapical bone resorption
6. Large periapical radiolucent lesions
•Corticosteroid based preparations have shown to cause an increased degree of inflammatory
response, maximum being at 28 days.

•After 7 days of experiment, all tested substance had low levels of inflammatory cells.

•Therefore, corticosteroid-based medications can be used for periods no longer than 7 days.
(Ramos E et al, 2012)
Triple Antibiotic Paste
• Combination of three antibiotics namely minocycline (100mg), ciprofloxacin
(200mg), metronidazole (500mg).

• Triple antibiotic powder, either mixed with normal saline or 2% chlorhexidine,

produced the largest zone of inhibition against E. faecalis.

• Concentrations used:
1:1:1 - Hoshino et al ,1996
1:3:3- Takushige T et al, 2004
Mechanism of action
• The efficacy of TAP in endodontic therapy lies in its broad spectrum
antimicrobial activity.

• By combining three antibiotics with different targets and modes of action, TAP
effectively disrupts the microbial ecosystem within the root canal, thereby
reducing the bacterial load and aiding in the resolution of infection.

• This is particularly important in cases where a single antibiotic might not be

effective due to the presence of bacteria with varying sensitivities and
resistance patterns.
Minocycline

• broad-spectrum antibiotics
• bacteriostatic
• It inhibits the activity of collagenases. Doing this permits the growth of
natural healthy cells and helps in the regenerative procedure

Metronidazole

• It is a nitroimidazole chemical with a wide range of anti-anaerobic and anti-

protozoal activity.

• It kills the bacteria by perforating and entering their membranes and

attaching itself to their DNA, causing the helical structure to be disrupted and
the cell to die quickly.
Ciprofloxacin

• second-generation fluoroquinolone antibiotics

• used to treat bacterial infections because of their high tissue penetration.
Applications of TAP in endodontics

1. In the regeneration and revascularization protocol of the pulp

2. As an intracanal medicament for the treatment of 1) Periapical lesions

2) External inflammatory root resorption
3) Root fracture
4) Primary teeth

3. As an intracanal agent to control flare-ups

4. As a medicated sealer (to prevent possible re-infection)

5. As an additive to gutta-percha points in root canal obturation (known as medicated gutta-

percha points)

6. As an intracanal medicament loaded on a scaffold.

Effect of TAP on tooth structure

Effect on Dentin: Studies have reported that TAP has a demineralizing effect on
dentin, bringing about specific changes in its mechanical property leading to the
brittleness of the tooth

Effect on Tooth Colour: One of the major drawbacks of TAP is discolouration of

the tooth, for which minocycline is responsible. The problem can be resolved by
the use of other medicaments like amoxicillin and cefaclor.

Effect on Stem Cells: TAP is an important material used for the purpose of
regeneration. It plays a significant role in preserving the health of the apical stem
cell and, thus, in providing a microbe-free environment, enabling the stem cells
to proliferate and help in regeneration
DRAWBACKS OF TAP
• Discoloration of dentine

• Negative effect on dentine microhardness and flexural strength

• Undesirable effect on stem cells

• Removal of the Medicament

TECHNIQUE OF USING ANTIBIOTIC PASTES
 To avoid dilution of paste or inactivation of one or more of its constituents- an absorbent
point is first inserted into the canal to check that the irrigant has been completely
removed.

 Instrument used to handle the paste should be sterile and dry and it should not be hot as
heat destroys the antibiotic.

 It is necessary to ensure that they touch the entire canal wall.

 done by transferring the paste to the pulp chamber with a plastic instrument and then
propelling it apically along the root canal with a paste carrier.

 This pattern of instrument, also known as ‘spiral root filler’ or “ rotary paste filler” (made in
various widths and may be used in conjunction hand piece).

 Care must be taken not to drive the paste periapically due to chemical irritation and the
risk of sensitivity.
 Qamar S, Jayanna R, Ahuja VR. Comparative Evaluation of Antimicrobial Efficacy of Calcium Hydroxide,
Chlorhexidine, and Triple Antibiotic Paste in Different Combination Forms as Intracanal Medicaments
against Enterococcus faecalis in Primary Teeth: An In Vivo Randomized Clinical Trial. Int J Clin Pediatr Dent.
2023 May-Jun;16(3):448-452. doi: 10.5005/jp-journals-10005-2599. PMID: 37496940; PMCID: PMC10367303.

CONCLUSION:
• A mix of TAP and 2% CHX gluconate solution is a very potent and effective combination to
eliminate E. faecalis counts to a significant level in primary teeth.
• Calcium hydroxide [Ca(OH)2] and 2% CHX gluconate combination is also an effective
unification to combat E. faecalis but less efficacious than TAP and 2% CHX gluconate
amalgamation.
HALOGENS
• Chlorine and iodine are commonly used antiseptics.
• They are potent oxidizing agents and with bactericidal effects

Chloramine

• Chlorine compound with excellent antimicrobial properties.

• Chloramine (5%) which has a low toxicity

• Used for disinfecting gutta percha points and remains stable for a long period if stored in
cold and protected light.
IODINE
• Used for many years and is known for its mild effect on living tissues.

• Two most common preparations used in dentistry are

-- Iodine tincture (5% in alcohol)
-- Iodine potassium iodide (iodine 2%,
potassium iodide 4%,
distilled water 94%).

** Iodine tincture-- disinfection of endodontic surgical fields

** Iodine potassium iodide-- for intracanal medication
CALCIUM HYDROXIDE
• Introduced by Herman in 1920.
Initially bactericidal then bacteriostatic.
Promotes healing and repair.
High pH stimulates fibroblasts.
Advantages Neutralizes low pH of acids.
Stops internal resorption.
Inexpensive and easy to use.

Does not exclusively stimulate dentinogenesis.

Does exclusively stimulate reparative dentin.
Associated with primary tooth resorption.
May dissolve after one year with cavosurface dissolution. limitations
May degrade during acid etching.
Degrades upon tooth flexure.
Marginal failure with amalgam condensation.
Does not adhere to dentin or resin restoration.
Properties
Structure
1. Arrangement= amorphous matrix, crystalline fillers. 6. Chemical Properties:
Solubility- 0.3-0.5
2. Bonding= covalent; ionic.
7. Mechanical Properties:
3. Defects=pores, cracks. Elastic mod=588
Compressive strength >24 hr=138
4. Setting reaction= acid base reaction.
8. Biologic Properties:
5. Physical Properties: Biocompatible
linear co efficient of thermal expansion= low.
Thermal conductivity= insulator.
Electrical conductivity= insulator.
pH=12.5-12.8.
Mechanism of action
• Its antimicrobial action is due to its high pH which dissolves
necrotic tissue remnants and bacteria and their byproducts.

• Repair of periapical tissues after RCT of teeth with

periapical lesions was better when calcium hydroxide was
used as an ICM.

• In cases of apical periodontitis, root canal dressing with

calcium hydroxide produce definite signs of healing.
Calcium hydroxide in Weeping Canals:
• Sometimes a tooth undergoing root canal treatment shows constant clear or reddish
exudate associated with periapical radiolucency.

• Tooth can be asymptomatic or tender on percussion.

• When opened in next appointment, exudates stops but it again reappear in next
appointment, this is known as “weeping canal”.

• For such teeth dry the canals with sterile absorbent paper points and place calcium
hydroxide in canal.
Vehicles

• Calcium hydroxide paste for use in endodontics is composed of the powder, a

vehicle and a radiopacifier.

• According to Fava (1991),

The ideal vehicle should:
1. Allow a gradual and slow Ca². and OH- ionic release
2. Allow slow diffusion in the tissues with low solubility in tissue fluids
3. Have no adverse effect on the induction of hard tissue deposition

• There are three types of vehicles used:

1. Aqueous
2. Viscous
3. Oily
Aqueous vehicles

 sterile water, distilled water, anesthetic solutions, ringer’s solution, methylcellulose,

carboxy methylcellulose.

Viscous vehicles

 glycerine, polyethylene glycol, propyleneglycol.

(calen, calen+CMCP)

Oily vehicles

 Olive oil, fatty acids, camphorated parachlorophenol, metacresylaceytate, eugenol.

(endoapex, vitapex)
Gomes et al. Braz. Dent. J. 2002;13(3)
In vitro antimicrobial activity of calcium hydroxide pastes and their vehicles against selected
microorganisms

 The aim of this study was to investigate in vitro the antimicrobial activity of
calcium hydroxide in combination with several vehicles against some
microorganisms commonly isolated from root canals.

 The pastes with oily vehicles showed significantly larger mean zones of
inhibition compared to those with aqueous or viscous vehicles.

 It was concluded that diffusion and antimicrobial activity of calcium hydroxide

were affected by the type of vehicle used.
METAPEX

Premixed calcium hydroxide paste containing Iodoform with improved

radiopacity and increased antimicrobial effect.

Indications:

 Apexifications and hard tissue formations.

 Temporary or permanent filling material for infected root canals.
 Treatment of root resorption.
 Perfect cavity liner under all filling material.
 Can be used in conjunction with gutta percha points and regular root
canal sealants.
Composition:

Barium sulfate
Iodoform
Silicon oil and inert excipients

Product benefits:

• Improved radiopacity and increased antimicrobial effect.

• Non hardening paste with oil base.

• Prolonged release of calcium hydroxide helps create secondary dentine.

• Excellent bio-compatibility with no toxic effects on cells.

• Easy handling and easy direct application.

NISIN

• naturally occurring antimicrobial peptide.

• discovered in 1928 and is produced by strains of Lactobacillus lactis.

• It is safe to humans and is used extensively in food preservation, mainly in

meat and dairy product and is approved for use in unlimited concentration.

• The mode of action is not completely understood but is likely that it interacts
with phospholipid membrane of the target bacterial cell.

• It disrupts the cellular membrane inducing leakage of small intracellular

contents from the cell.
Antibacterial Efficacy of Nisin and Calcium Hydroxide with a Proton Pump Inhibitor as an
Intracanal Medicament 1 Suresh Mitthra, 2 Teena Ans Abraham, 3 Arunajatesan Subbiya, 4
Kesavaram Padmavathy, 5 Krishnan Mahalakshmi 6 Balasubramaniam Anuradha, 7
Paramasivam Vivekanandha

CONCLUSION
The results of the present study concluded that:

• The antimicrobial efficacy of nisin as an intracanal medicament was similar to CHX 2%.
• Pantoprazole with calcium hydroxide was not effective against E. faecalis.
Herbal Usage In Endodontics
Considering the ineffectiveness , potential side effects and safety concerns of synthetic drugs,
the herbal alternatives for endodontic usage might prove to be advantageous.

• Cost effectiveness
• Easy availability
• Increased shelf life
• Low toxicity
• Low microbial resistance
PROPOLIS ARTICUM NEEM GREEN TEA
LAPPA

TRIPHALA MORINDA GERMAN TEA TREE

CITRIFOLIA CHAMOMILE OIL
Comparative Evaluation of Propolis, Metronidazole with Chlorhexidine, Calcium Hydroxide and Curcuma Longa
Extract as Intracanal Medicament Against E.faecalis– An Invitro Study

Conclusion
Within the limitations of this study, it can be concluded that propolis showed better
antimicrobial properties against E.faecalis than other medicaments while metronidazole and
chlorhexidine combination and Curcuma Longa were better than calcium hydroxide.
Bioactive glass

• Research is underway in the use of bioactive glass as an intracanal

medicament.

• It contains the oxides of sodium, calcium, phosphorous and silicone.

• It decreases the bacterial viability of several gram +ve facultative bacteria

such as E. Faecalis, S. sanguis, S. mutans, C. albicans and gram –ve bacteria
like actinobacillus, actinomycetecomitans and P.gingivalis.

• When used in root canals, bioactive glass was found to kill bacteria, but the
mechanism of action was not pH related, and dentin did not seem to alter its
effect
Silver Nanoparticles

• Studies show that AgNPs as intracanal medicaments have potent antibacterial effects
against E. faecalis, F. nucleatum, and C. albicans, comparable to Ca(OH)2 and CHX

• AgNPs in gel form were used as a vehicle for Ca(OH)2

• MOA: The positively charged AgNPs, with a large surface area, interact with the negatively
charged cell membrane and exert an antimicrobial effect. They interact with the bacterial
membrane’s “building elements” leading to changes in structure and degradation and,
finally, cell lysis

• AgNPs, when combined with Ca(OH)2, reduced the colony-forming units (CFUs) of E. faecalis
within one week of the application when compared to Ca(OH)2 alone
Disadvantages

• Bacteria may develop resistance to them

• Ag ions may cause gray-black discoloration of a crown over time

• The biodistribution and toxicity studies in rats and mice showed that AgNPs administered by
inhalation, ingestion, or intravenous or intraperitoneal injections are found in blood and are
toxic to the lungs, liver, kidneys, intestines, and brain

• However, further in vivo clinical trials are needed to determine the effective AgNP
antibacterial concentrations and plausible adverse effects.
PLACEMENT OF MEDICAMENTS

SYRINGE DELIVERY
• Probably the easiest way of applying a medicament.
• Calcium hydroxide preparations come in different concentrations and in
different formats.
• Disposable plastic tips are excellent, as there is no risk of cross-infection
• Metal syringe tips must be autoclaved between patients.
• It is important to place a fine file along the bore of the needle to ensure that
the tip does not become blocked
• The syringe tips on most commercial systems can be premeasured to prevent
extrusion.
HAND FILE
• A file can be used to place the medicament in the canal

• The agent should be smeared on the walls of the root canals, and can be carried
to the working length by gently rotating the file in an anti-clockwise direction.

• If it is mixed to a thick paste consistency a plugger can be used to ensure that

the material is carried completely to all parts of the prepared root canal system.
SPIRAL ROOT FILLERS
• These devices are used in a low speed handpiece and can be obtained in
different sizes. The size used will depend on the size of the prepared root canal.
• A small amount of paste material is placed on the spiral and the spiral is placed
in the tooth.
• Once the spiral is in the canal, the motor is started and should be run at a low
speed and in the forward direction.
• The spiral is advanced into the root canal while in motion.
• It should not be advanced any further than 3 mm short of the working length.
• The spiral is moved vertically in and out of the canal several times and on
the final withdrawal the motor should be kept running until the spiral leaves
the root canal.
• The spiral root filler is very effective at coating the canal walls with the paste
material and the canal lumen is filled as the spiral is withdrawn.
• To ensure the canal is completely filled with medicament, the process should
be repeated two or three times for each canal.
• The spiral should be kept short of the apical foramen so that the material is
not forced beyond the foramen.
• Spiral should not be used in fine or sharply curved canals if they have not
been instrumented and enlarged.
• In these cases, a hand reamer should be used.
MESSING GUN

The stiffer pastes mixed to requirement may be loaded using amalgam carriers
such as the messing gun.
CALCIUM HYDROXIDE POINTS

• Calcium hydroxide containing points are available.

• They are not considered to be very effective, as little calcium hydroxide is

released into the root canal
Advantages of Calcium hydroxide points
1. Minimal or no residue left
2. No smearing around the access cavity during insertion
3. Firm for easy insertion and flexible enough to follow the natural canal curvature
4. Time saving as the points are:
_ Ready to use
_ No mixing required
_ Ease of insertion and removal with help of tweezers
5. Insertion of points down the apex is easy and ensures that calcium hydroxide is released
through canals
Disadvantages
1. Action is short lived
2. Lack of sustained release
3. Radiolucent
FREQUENCY OF MEDICATION

In accordance with general principles of root canal management, disinfectant

dressing should preferably be renewed in a week and not longer than 2 weeks
because dressing become diluted by periapical fluid and are decomposed by
interaction with the microorganisms.
SUMMARY

• Endodontic treatment are essentially debridement procedures to disrupt and

remove the microbial ecosystem that is associated with disease process.

• It is important that clinicians understand the close relationship between the

presence of microorganisms and endodontic disease processes to develop an
effective rationale for treatment.
REFERANCES

 Ingles endodontics 7th edition

 GROSSMAN’S ENDODONTIC PRACTICE- 12TH EDITION
 Essential’s of endodontics Vimal K Sikre 2nd edition
 Antibacterial Efficacy of Nisin and Calcium Hydroxide with a Proton Pump Inhibitor as an Intracanal Medicament
1 Suresh Mitthra, 2 Teena Ans Abraham, 3 Arunajatesan Subbiya, 4 Kesavaram Padmavathy, 5 Krishnan
Mahalakshmi 6 Balasubramaniam Anuradha, 7 Paramasivam Vivekanandhan
 Application of Intracanal Medicaments: A Review Himadri pal1 , Arpita sarkar2 , Lopamoodra das3 , Subrata
saha4 , Subir sarkar5
 Review Article Calcium Hydroxide in Dentistry Baranwal R*, Singh BD**, Dubey A***, Avinash A***
 Comparative Evaluation of Antimicrobial Efficacy of Calcium Hydroxide, Chlorhexidine, and Triple Antibiotic
Paste in Different Combination Forms as Intracanal Medicaments against Enterococcus faecalis in Primary Teeth:
An In Vivo Randomized Clinical Trial Seema Qamar1 , Rashmi Jayanna2 , Vipin R Ahuja
 Review Article Components and outcome of triple antibiotic paste and its application in endodontic infections
Ainaa Abdulmoeen Alsharif1*, Khalid Abdulghani Qul2 , Arwa Nasser Al Qahtani3 , Omar Ahmad Alomem4 , Ali
Hassan Albariqi3 , Ameerah Mohammed Alshahrani3 , Raghda Mansour Rayes5 , Abdulelah Hussain Alanazi6 ,
Rakan Naif Almutairi7 , Abdulaziz Abdulrahman Almuntashiri8 , Rahaf Abdullah Houmady9
 Comparative Evaluation of Propolis, Metronidazole with Chlorhexidine, Calcium Hydroxide and Curcuma Longa
Extract as Intracanal Medicament Against E.faecalis– An Invitro Study Shruti Saha1 , Rashmi Nair2 , Hemant
Asrani 3
 Role of Calcium Hydroxide in Endodontics : A Review Mohammed Mustafa1 , Saujanya KP2 , Deepak Jain3 .
Sangameshwar Sajjanshetty4 ,Arun A5 . Laxmi Uppin6 ,Mahnoor Kadri
 Review Article Silver Nanoparticles as an Intracanal Medicament: A Scoping Review Azra Kaukab,1 Sumit Gaur ,
1 Rupali Agnihotri , 2 and Vani Taneja
 Triple Antibiotic Paste: A Suitable Medicament for Intracanal Disinfection Krutika Malu , Monika Khubchandani
 Triple antibiotic paste: momentous roles and applications in endodontics: a review Ardavan Parhizkar , 1
Hanieh Nojehdehian , 1* Saeed Asgary
 Triple Antibiotic Paste and Alternative Medicaments in Endodontics: A Literature Review Priyake D Palipana1 ,
SS Kalubowila2 , Isharajini PS Gamage3
 Triple Antibiotic Paste as an Intracanal Medicament in Root Canal Treatment Vincent Nguyen1 , Dominic Pham
 Triple antibiotic paste versus nano calcium hydroxide as an intracanal medicament in human primary molars: a
randomized clinical trial
THANK YOU!!
Mechanism of action
The protein-binding properties and the inhibition of the
enzymes that can break the pulp tissue down together result
in 'fixation' of the pulp tissue by formocresol and render it
inert and resistant to enzymatic breakdown.

When the concentration of formocresol is decreased, there

is a zone of poor cellular definition and necrosis.

Apical to this is a zone of chronic inflammation, which

blends into normal tissue.
• it was found that concentrations superior or equal to 300 μg/mL decreased E. faecalis growth by
more than 90%