Root Intracanal Medicaments

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CONTENTS

INTRA CANAL MEDICATIONS

Medicaments are effective antimicrobial agents.With the number of microorganisms reduced by irrigation and instrumentation ,the medicament destroys those remaining and limits the growth of any new arrivals

Ideal requirements

     According to the Grossman

1.            It should be effective antimicrobial agent

2.            Should be nonirritating to the periradicular tissues

3.            Should be stable in solution

4.            Should have a prolonged antimicrobial effect

5.            Should be active in the presence of blood, serum and protein derivatives of tissues

6.            It should not stain tooth structure

7.            It should not induce a cell mediated immune response

According to Chong and Pittford, intracanal medicaments may be indicated for the following reasons

1)            To dry persisently wet or the so called weeping canals

2)            To eliminate any remaining microbes in the pulp spaces 

3)            To render root canal contents inert

4)            To neutralize tissues debris

5)            To act as a barrier against leakage from an interappointment dressing in symptomatic cases

·                     Corticosteroid-antibiotic combinations are useful in treating apical periodontitis ,occuring  either as a pretreatment symptom or as a result of overinstumentation

·                     Volatile medicaments should never be used to determine  through  retention  of their scent on the cotton pellet taken from the chamber, whether the material used to seal the access  cavity has been effective 

PHENOLS

·                     Used for many years for its disinfectant and caustic action

·                     Because it has strongly inflammatory potential at present it is rarely used as intracanal medicament

·                     It may be used for disinfection before cauterizating tissue tags that resist removal with broaches of files

EUGENOL

·                     It is a constituent of most root canal sealers and is used as part of many temporary sealing agents

·                     Although the compound has a high irritating potential when evaluating it seems to be extremely soothing, clinically, to vital tissues because of some caustic action to the nerve endings

·                     It is used as a intracanal medicament after partial or complete pulpectomy

FORMOCRESOL

·                     A combination of formalin and cresol , is used as a dressing for pulpotomy  to fix the retained pulpal tissue

·                     May also be used as a intracanal medicament when a pulpotomy is performed as emergency treatment to relieve pain in situation where pulp inflammation is confined  to the pulp chamber

Disadv -Found to be carcinogenic

CALCIUM HYDROXIDE

As a medicament for weeping canals.The canal should be dried with paper points and place  paste Ca(OH)2  in the canal , similar to done to gain apexification in teeth with open apices and nonvital pulp

Mechanism of action

·                     Ca(OH)2   Believed to be closely related to the pH of the periapical  tissues, which must be acidic in the weeping stage. The pH is converted by the paste to a more basic envt

·                     It is believed that the calcifying potentiaL of the medicament starts to build up the bone in the lesion

CHLORHEXIDINE DIGLUCONATE

·                     As a medicament it can be used as

1)            2%CHX gel

2)            Mixture of CHX and Ca(OH)

·                     it has shown to be effective against both Ent faecalis and candida albicans in invitro studies