intracanal_medicament in endodontics.pptx

intracanal medicament in endodontics for 3rd year.pptx

1. Intra-canal medicaments

2. Originally, endodontics was mainly a therapeutic procedure in which drugs were used to destroy microorganism, fix or mummify vital tissue and affect the sealing of the root canal space. The drugs commonly used were caustic such as phenol and it’s derivatives which were shown to produce adverse effects on the periapical tissues. Gradually, the reliance on drugs has been replaced by emphasis on thorough canal debridement. But drugs are still being used as intratreatment dressings, although an ever increasing number of endodontists use them only for symptomatic cases. Introduction

3. Primary function Disinfection Secondary function Induction of hard tissue formation. Pain control. Control of exudation or bleeding. Control of inflammatory root resorption. Function of intra-canal medicaments

4. Effective germicide and fungicide. Non irritating to periapical tissues (PA). Stable in solution. Have prolonged antibacterial effect. Active in presence of blood and serum. Low surface tension. Should not interfere with repair of PA tissues. Should not stain the tooth. Ideal requirements

5. Eugenol L ow doses show anti-inflammatory activity while high doses exert cytotoxic effects.

6. Phenolic compounds: Phenol was used for many years for its disinfectant and caustic action. However, it has strong inflammatory potential, so at present, it is rarely used as an intra-canal medicament.

7. Camphorated Monoparachlorophenol (CMCP): It is probably the most commonly used medicament, even though it’s use has decreased considerably in the past few years.

8. Camphor is added to parachlorophenol (PCP) because it: Has diluent action. Prolongs the antimicrobial effect. Reduces the irritating effect of PCP. Serves as a vehicle for the solution. Used as dressing of choice for infected teeth.

9. Cresatin ( metacresy acetate) Cresatin possesses the same desirable qualities and actions as that of CMCP, yet even less irritating to periapical tissues.

10. Aldehydes: Formaldehyde, paraformaldehyde and glutaraldehyde are commonly used intra canal medicaments in root canal therapy. These are water-soluble protein denaturing agents and are considered among the most potent disinfectant, but they are quite toxic and allergic and some even may be carcinogenic. Formocresol contains formaldehyde as its main ingredient and still widely used medicament for pulpotomy procedures in primary teeth but its toxic and mutagenic properties are of concern.

11. Clinical Tips: All phenolic and similar compound are highly volatile with low surface tension. If they are placed on a cotton pellet in the pulp chamber, vapors will penetrate the entire canal preparation. Therefore, paper point is not needed for their application. Only tiny quantity of medication is needed for effectiveness, otherwise chances of periapical irritation are increased.

12. Calcium hydroxide: Introduced by Hermann in 1920. Effects of calcium hydroxide: Physical Acts as physical barrier for ingress of bacteria. Destroy the remaining bacteria by limiting space for multiplication and holding substrate for growth.

13. 2.Chemical: Antiseptic (high pH and its leaching action on necrotic pulp tissues). Increase the pH of circumpulpal dentin. Suppresses enzymatic activity and disrupts cell membrane. Inhibits DNA replication by splitting it. It hydrolyses the lipid part of bacterial lipopolysaccharide(LPS). This is a desirable effect because dead cell wall material remains after the killing of bacteria which may cause infection.

14. Calcium hydroxide is available in: Past form : single past or in combination with iodoform. Powder form : powder form is mixed with saline and anesthetic solution. For placement in root canals, its coated with the help of paper points, spreader or lentulo spirals.

15. Indication of calcium hydroxide: In weeping canals. In the treatment of phoenix abscess. In resorption cases. For apexification . During pulpotomy. For non surgical treatment of periapical lesion. In cases of direct and indirect pulp capping. As sealer for obturation. To decrease post operative pain after over instrumentation, it is used in combination with ledermix (1:1).

16. Calcium hydroxide shows limited effectiveness if used only for short time in root canals because of following reasons: low solubility and diffusiblity of calcium hydroxide makes it difficult to attain rapid increasing in pH. Different formulation having different alkaline potential. In ability to reach inaccessible areas. Bacteria loaded deeper in dentinal tubules are not affected by calcium hydroxide. Inhibition of action of calcium hydroxide by dentinal protein buffering.

17. Advantages of Ca (OH)2 I nhibits root resorption . Stimulates periapical healing. Encourage mineralization. Disadvantages of Ca (OH)2 D ifficult to remove from canals. Decreases setting time of zinc oxide eugenol (ZOE) based cements.

18. Sometimes, a tooth undergoing root canal treatment shows constant clear or reddish exudation associated with periapical radiolucency. Tooth can be asymptomatic or tender on percussion. When opened in next appointment, exudates stops but it again reappears in next appointment. This is known as “ weeping canal”

19. Ca (OH)2 is useful for weeping cases: In these cases, tooth with exudates is not ready for filling, since culture reports normally show negative bacterial growth, so antibiotics are of no help in such cases. For such teeth: dry the canals with sterile absorbent paper points. Place calcium hydroxide in the canal. By next appointment, its ready for obturation.

20. It happens because : pH of periapical tissues is acidic in weeping stage which gets converted into basic pH by calcium hydroxide. Caustic effect burns the residual chronic inflamed tissue. calcifying action.

21. Chlorhexidine (CHX): Chlorhexidine (CHX) has been recently used as intra canal medicament. A 2% gel is recommended. It can be used alone in gel form or mixed with Ca (OH)2 “the antimicrobial activity is greater”. CHX exhibit substantivity (persistence in the area of interest), broad-spectrum activity and low toxicity, these properties make it well suited for dressing applications.

22. Halogens: Chlorine and iodine are the basis of a number of oxidising antiseptics commonly used in endodontic practice.

23. Iodine : Iodine has been used for many years and is known for its mild effect on living tissue. Iodine potassium iodide(IKI) is very effective antiseptic solution with low tissue toxicity. IKI release vapours with a strong antimicrobial effect. IKI can kill bacteria in infected dentin in 5 minute in vitro.

24. Antibiotics : S ulphonamides are used as medicaments by mixing distalled water or moistened paper point into jar containing the powder. It is indicated in case of acute periapical abscess. Disadvantages, yellowish tooth discoloration.

25. PBSC past: By Grossman. P enicillin-against gram-positive microorganisms . B acitracin- against penicillin- resistant microorganisms. S treptomycin-against the gram-negative microorganisms. C aprylate (sodium salt)- against fungi.

26. PBSN: N ystatin -replaces sodium caprylate – antifungal agent. PBSC interferes culturing procedures- penicillinase is added to culture media to inactive penicillin.

27. Corticosteroid- antibiotic combinations Medications that combine antibiotic and corticosteroid elements are highly effective in cases of over instrumentation. They must be placed in to the inflamed periapical tissue by a paper point or reamer. Tetra- cortril , cortisporin , mycolog , and other combinations are available for their use in endodontics .

28. Bioactive glass as intra canal medicament. Intra canal medicaments from nature: Propolis Curcumin Casearia sylvestris Green tea Lemon solution is a rich source of citric acid. Fresh lemon solution can be used as an intra canal medicament. It is effective against E faecalis . Nissin is a naturally occurring antimicrobial peptide, produced by streptococcus lactis sub species. Studies show that it is effective in elimination of EF from root canal and is more effective than Ca (HO)2.

29. Ledermix : is one of the best known corticosteroid- antibiotic combination. The corticosteroid constituent reduced the periapical inflammation and gives almost instant relief of pain to the patient who complains of extreme tenderness or percussion after canal instrumentation. The antibiotic constituents prevent the overgrowth of microorganisms when the inflammation subsides.

30. Placement of intra canal medicament: Copiously irrigate the canal to remove debris if present. Place the master apical file in the canal. Dry the using absorbent paper points. Place the intra canal medicament on a sterile cotton pellet and place it in the pulp chamber. Over this another sterile cotton pellet is placed, which is finally sealed with a temporary restorative material.

31. Limitation of intra canal medications: For an intra canal medicament to be effective, it should remain active during the time of inter appointment, which does not happen in every cases. Therapeutic action of medicaments depend upon its direct contact with tissues. But these substances may not reach all the areas where bacteria and tissue are present.

32. Thank you Dr. Amel E lawami /Endodontic/ 4 th year/ LIMU