Intracanal Medicaments.pptx

Intracanal Medicaments

1. Intracanal Medicaments Dr. SV.SATISH Professor & HOD Dept of Conservative Dentistry & Endodontics Navodaya Dental College

2. Definition The general definition of intracanal medicaments is “ temporary placement of medicaments with good biocompatibility into root canals for the purpose of inhibiting coronal invasion of bacteria from the oral cavity”.

3. HISTORY Seribonius in 1045 AD wrote of using oils and wine in the mouth of a 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 .

4. IDEAL REQUIREMENTS It should be an effective germicide and fungicide. It should be non-irritating to the periapical tissues. It should remain stable in solution. It should have prolonged antimicrobial effect It should be active in the presence of blood, serum and protein derivatives of tissues.

5. It should have low surface tension. It should not interfere with repair of periapical tissues. It should not induce cell mediated immune response .

6. FUNCTIONS Eliminate microorganisms : The objective is to sterilize (destroy all viable microorganisms) or to disinfect (destroy all pathogens) in the canal space. 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. Prevention or control of post treatment pain

7. Enhancing Anesthesia : By reducing the sensitivity of the inflamed tissue which can be difficult to anesthetize pulp. Control of persistent periapical abscess : In cases of continually “weeping” canal or significant pain or swelling medicaments have been suggested as a means of controlling this difficult situation.

8. Root canal flora Gram + ve organisms Streptococci Staphylococci Corynebacterium Yeasts Gram – ve organisms Spirochetes Neisseria Bacteroides Fusobacterium Pseudomonas Coliform bacteria

9. The commonest organisms of the mouth, streptococci are also the most frequently found in root canals. Among the streptococci is a small resistant group of enterococci.

10. Various root canal medicaments Chlorhexidine Formocresol Calcium hydroxide Antibiotics Corticosteroids Herbal medicaments

11. Chlorhexidine Chlorhexidine (CHX) is a broad spectrum antimicrobial agent. The property is due to its cationic bisbiguanide molecular structure. It is bacteriostatic at lower concentrations and bactericidal at higher concentrations. Chlorhexidine gluconate gel is widely used in dentistry as an intracanal medicament

12. Chlorhexidine can be applied in varies forms. 1. Mouthwash (0.12% and 0.2%), 2. Gels (1%)- medicament 3. Varnishes (1%, 10%, 20%, and 35%)

13. Formocresol Developed by BUCKLEY in 1906. Contents : 19% formaldehyde 35% cresol 46% H2O and glycerine . Combination- formalin and cresol in the proportion of 1:2.

14. Formocresol combines the protein - coagulating effect of phenolic compounds with the alkylating effect of formaldehyde. The bactericidal effect of formocresol is good at levels as low as 2% Formocresol is a non- specific bacterial medicament most effective against aerobic and anaerobic organisms found in root canals.

15. Causes widespread destruction of living tissue followed by a persistent inflammatory reaction. Studies have reported that formocresol treated tissue produced a cell mediated immune response.

16. Calcium hydroxide Hermann introduced Ca(OH)2 paste as an ICM in 1920 . Calcium hydroxide paste for intracanal use is a thick suspension of Ca(OH)2 powder in sterile water or saline or glycerine

17. Mechanism of Action It is a highly alkaline substance with a pH of approximately 12.5. 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.

18. Hydroxyl ions are highly oxidizing free radicals that destroy bacteria by: Damaging the cytoplasmic membrane Protein denaturation Damaging bacterial DNA

19. ANTIBIOTICS Antibiotics have a limited role to play as an intracanal medicament due to the following reasons : – No antibiotic can completely eradicate the complex polymicrobial flora present inside an infected root canal. Most antibiotics are bacteriostatic and depend on the host resistance for dealing with the infection. As the infected root canal space has no blood supply, the effect of many antibiotics is limited.

20. Hence, a combination of antibiotics has been tried to overcome the above-mentioned limitations. The most popular intracanal antibiotic combinations used are: – Triple antibiotic paste (TAP): Ciprofloxacin, metronidazole, and minocycline (1:1:1) in a macrogol/ propylene glycol vehicle Double antibiotic paste : Combination of ciprofloxacin and metronidazole

21. STEROIDS Steroids have limited applications as intracanal medicament and are used exclusively in: – Internal resorption cases – Traumatic injuries of the teeth Ledermix : – The most popular steroid-based intracanal medicament is Ledermix , developed by Schroeder in 1960. – Composition ■ Corticosteroid: 1% triamcinolone acetonide ■ Antibiotic: Demeclocycline

22. Herbal medicaments Propolis Propolis is prepared from resin collected by bees from trees of poplars, conifers and flowers of genera clusia . The pharmacologically active constituents in propolis are flavonoids, phenolics and aromatics. Propolis is a good antimicrobial and anti inflammatory agent, which can serve as a better intracanal irrigant and intracanal medicament

23. Curcumin Turmeric (Curcuma longa) is extensively used as a spice, food preservative and coloring material in India, China and South East Asia. Curcumin which is the main yellow bioactive component of turmeric has been shown to have a wide spectrum of biological actions, including antimicrobial, anti-inflammatory and anti- oxidant activities

24. Conclusion Endodontic treatment are essentially debridement procedures to disrupt and remove the microbial ecosystem that is associated with the 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