Intracanalmedicaments

IntroductionAn agent used as an adjunct to cleaning

and shaping for prevention or treatment

of apical periodontitis.

FunctionsPrimary

Antisepsis

Disinfection

SecondaryHard tissue formation

Pain control exudation

Resorption control

Secondary functionsPain during and after treatment can occur and

associated tissue reaction include:

Exudation

Transudation

swelling

resorption

Pain control• Pain is mostly associated with infection and the

primary means of pain control is infection control

Control of exudation or bleeding

• Persistant exudation in the root canal may

oocur.Exudation reflects inflammation.

• Therefore treatment is aimed at dealing with

potential infection as well as drying or coagulation

the site

Controlling inflammatory root resorption

• Inflammatory root resorption is most aggressive and

destructive

• It is associated with infection of root canal

combined with physical damage to the cementum,

so again a primary function of treatment is to

eliminate infection in root canal system

Induction of hard tissue formation

• It is often desirable to allow hard tissue to form to

continue apical root development to close wide

foramen or to create a mechanical barrier at a

fracture line

Micobes of pulp• With apical periodontitis

o Fusobacterium, prevotella, pophyromonas, veillonella, spirochetes

• Retreatment caseso Enterococci esp. E. Fecalis, Yeasts

• Actinomyces

Antimicrobial agents• Antibiotics

o Sulpha preparations

o Penicillin

o Metronidazole

o Tetracycline

Antimicrobial agents

• Sulpha preparations

• Effective against gram-negative and gram positive

microorganism

2.Metronidazole

• Effective against gram negative anaerobic

microorganisms

3.Tetracycline

• It shows affinity for hard tissues and may be retained

on tooth surface.

• There might resistance to tetracycline occurs and

spectrum is quite narrow

Disinfectantso Aldehydes

o Halogens

o Phenols

o Chlorhexdine

o Calcium Hydroxide

Disinfectants

• They act by direct toxicity to microbes

• They have a broader antibacterial spectrum than

antibiotics

Aldehydes• Formaldehdye, paraformaldehyde and

glutaraldehyde have been widely used.

• They are water soluble and protein denaturing

agents and are most potent disinfectants

• Formocresol is an aqueous solution contaning

cresol,formaldehyde and glycerine,used for

pulpotomy procedures,but its toxic and mutagenic

properties are concerned

Halogens• Includes chlorine and iodine which are used in

various formulations

• They are potent oxidizing agents with rapid

bactericidal effects

• Sodium hypochlorite is currently the irrigating

solution of choice

• Necrotic tissue and debris are dissolved

• Effective conc 0.5-5.25%

Phenol derivative• No longer used because of its high toxicity

• Includes paramonochlorophenol,thymol and

eugenol

• But has high toxicity and limited antimicrobial effect

Chlorhexidine• Broad spectrum activity and less toxicity

• Effective conc is 0.2-2% range

• Innovative attempts to utilize the disinfecting

properties of it include its inclusion in gutta purcha

points for root canal filling

Calcium hydroxide• Antibacterial agents with high pH

• Physically restricts bacterial colonization of the

canal space

• It is applied as a thick creamy suspension

Antibacterial effect of irrigation and

dressing• Addition of sodium hypochlorite increases the

number of bacteria free canal substantially

• The number of bacteria free canal may be further

increase when a dressing of calcium hydroxide is

place

Disadvantages• Tissue toxicity

• Carcinogenic

• May stain the teeth

• Allergic reactions

• Induction of inflammatory response

Factors• Tissue condition

• Condition of tooth

• Smear layer