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Introduction Intracanal medicaments - PHENOLS - ALDEHYDES & HALOGENS - ANTIBIOTICS & STEROIDS-LEDERMIX - CALCIUM HYDROXIDE - MTA Conclusion Reference
y Teeth exposed to injuries limits vital function of
pulp. y Pulp has minimal healing strength - lacks epithelial bridge - poor ability to regenerate - peri-radicular inflammation y Endodontic materials aims at: - eliminating pathogens - provide adequate seal - stimulate hard tissue formation
Intracanal medicaments can be classified into:
y Phenols y Aldehydes y Halogens y Quaternary ammonium compounds y Antibiotics and corticosteroids y Calcium hydroxide y MTA
Primary function antimicrobial activity Antisepsis Disinfection
Secondary function Hard tissue formation Pain control Exudation control resorption control
y Phenol /carbolic acid y Aqueous parachlorophenol (ACP) contains 1-2% y y y y
parachlorophenol Antimicrobial actions Camphorated parachlorophenol has 35% parachlorophenol . CMCP is the most toxic and irritating compound Biocompatibility is poor due to tissue necrosis and toxicity.
y They are water-soluble, protein denaturing
agents and are considered to be among the most potent of the disinfectant y 19% formaldehyde and 35%cresol dissolved in 46%glycerine and water (formocresolpulpotomy) y cytotoxic, mutagenic, and carcinogenic
y Chlorine, an active ingredient of NaOCl and
iodine, y Iodine-potassium iodine (2% iodine plus 4% potassium iodide and 94% distilled water) y minimal toxicity to host tissues and is a bactericidal agent y potent oxidizing
Antibiotics and corticosteroids
y penicillin ( bacitracin) y Three main concerns
-Sensitization. -Development of bacterial drug resistance -Limited spectrum
y Composition: y -Fine hydrophilic particles of tricalcium y y y y
aluminate -Tricalcium silicate -Silicate oxide -Tricalcium oxide -Bismuth oxide
The following properties of MTA have been reported:
y 1. Biocompatibility y 2. Great sealing capacity y 3. Antibacterial effect y 4. No mutagenic potential y 5. Low cytotoxicity y 6. Stimulation of formation of mineralized tissue y 7. Coverage by cementum y 8. Aid in periodontal ligament regeneration y 9. Lead to biological response in osteoblastic cells
y MTA can induce biological responses in
y The formation of dentin adjacent to the MTA
occurs due to its sealing ability, which prevents micro leakage, to its biocompatibility, alkalinity, or due to other properties such as the capacity to stimulate cytokine release by the bone cells.
y MTA mechanism of action is similar to that of
calcium hydroxide.(David E. Witherspoon, Joel C. Small, and Gary Z. Harris Mineral
trioxide aggregate pulpotomies: A case series outcomes assessment .J Am Dent Assoc 2006 137(5): 610-
Non reinforced zinc oxide eugenol iodoform paste
y Contents y
y iodoform- bacteriostatic and increased
radiopacity-80.8% y camphor- 4.860% y para-chlorophenol -2.025% y Menthol-1.215 %
y good pulpal healing y resorptive properties y bactericidal to microorganisms in root canal if y y y y y
mixed with formocresol lose only 20% of potency over 10 year period Resorbs from periapical area by action of macrophages in 1-2 weeks Does not set to a hard mass Insertion and removal easy Harmless
y iodine allergy y discoloration of teeth y iodoform is irritating to the periapical tissues y cause cemental necrosis
Calcium hydroxide has been recommended for use as intracanal medicament based on its:
y high alkaline nature y tissue dissolving properties y and antimicrobial effects in gram positive and gram negative bacteria found in infected root canals. y It has been demonstrated that calcium hydroxide alters some biological properties of bacterial cell wall
y The anti bacterial property of calcium
hydroxide is related to the release of hydroxyl ions in as aqueous environment. Hydroxyl ions are highly oxidizing free radicals that destroy bacteria through damage to the cytoplasmic membrane and through protein denaturation.
hydroxide: a comparison of techniques, revisited., J Endo 30(4): 225, 2004)
(Torres C.P, intracanal placement of calcium
The potential problems that can be associated with calcium hydroxide may be
y Toxicity - initial and long-term y Increased replacement resorption y Increased ankylosis y May promote inflammatory resorption
y Is a highly effective anti-inflammatory cortisone
derivative combined with a broad-range antibiotic.
Medicinal active substance:
1g paste contains: y Triamcinolone acetonide 10.0 mg y Demeclocycline calcium 30.21 mg
Medicinal inactive substance:
y Triethanolamine, y Calcium chloride y Zinc Oxide y Macrogol 3000 y Macrogol 400 y Sodium Sulphite Anhydrous y Sodium Calcium Edetate, y Colloidal Silicon Dioxide y Purified Water.
y Triamcinalone is a highly active steroid providing
potent anti-inflammatory action and demeclocycline is a broad spectrum antibiotic effective against a large range of Gram positive and Gran negative bacteria.
y In addition, triamcinlone has been shown to
directly inhibit the spreading of dentinoclasts. Ledermix inhibits the spread of dentinoclasts, it may provide added benefits in the control of inflammatory root resorption, particularly when mixed with calcium hydroxide.(Ec Bryson. Effect of immediate
intracanal placement of ledermix on healing of replanted dog teeth after extended dry times. J dental traumatology.issn 1600-4469 2002; 18:316-321)
DESCRIPTION y Polyantibiotic paste for Infected root canals ,peri-apical treatment,pulpal gangrene with granuloma, abscess. PROPERTIES Contains:
y Dexamethasone - acts as an anti-inflammatory agent y Three antibiotics and one antifungal, chosen for their
very wide bacterial spectrum, which preclude resistance phenomena.
y DESCRIPTION y Treatment for preservation of dental pulp vitality. y USES
- Deep cavities without exposure of the pulp: local application to the floor of the tooth cavity. -Carious or traumatic exposure of pulp with recent pulpitis: local application to the opening and to the floor of the cavity. -Acute pulpitis with necrosis of the pulp: local application to the floor of the tooth cavity. CONTRA-INDICATIONS y Product should not be used in patients known to be hypersensitive to any of the active ingredients in the past
y The use of intracanal medicaments is basically to prevent or treat apical periodontitis which may develop from failure of endodontic treatment. y Thus their primary function is to prevent canal infection or to inactivate bacteria already infecting the root canal. Intracanal medicaments are antimicrobial in nature. y Form all the medicaments reviewed, there were three materials that exhibited theses properties effectively and had features that would be considered nearly ideal properties after evaluating the ratio of risk to advantage. The materials are Calcium hydroxide, MTA and Ledermix paste.
y y y y y y y y y y y y y
F,J.Harty. Harty·s endodontis in clinical practice.Elsever .2004. page 98 Nygard Ostby B (1971) Introduction to endodontics. Oslo, Norway:Universitetsforlaget. Frank AL, The intracanal use of sulfathiazole in endodontics to reduce pain. Journal of the american Dental Association. 77,102-106. Chongs BS, Pitt Ford TR (1992). The role of intracanal medication in root canal treatment. Internation Endodontic Journal 25:97-106. BystromA. (1985). The antibacterial effet of camphorated paramonochlorophenol,camphorated phenol and calcium hydroxide in the tratment of infected root canals. Endodontics and Dental Traumatology. 1:170-175 Spangberg l, biological effects of endodontic antimicrobial agents, J Endo. 5 (6):166 Torres C.P, intracanal placement of calcium hydroxide: a comparison of techniques, revisited., J Endo 30(4): 225, 2004 RICHARD S. SCHWARTZ MINERAL TRIOXIDE AGGREGATE: A NEW MATERIAL FOR ENDODONTICS J Am Dent Assoc, Vol 130, No 7, 967-975 Gerald k.21ST-CENTURY ENDODONTICS. J Am Dent Assoc 2000 131(1): 39S-46S David E. Witherspoon, Joel C. Small, and Gary Z. Harris Mineral trioxide aggregate pulpotomies: A case series outcomes assessment .J Am Dent Assoc 2006 137(5): 610-618. Ec Bryson. Effect of immediate intracanal placement of ledermix on healing of replanted dog teeth after extended dry times. J dental traumatology.issn 1600-4469 2002; 18:316-321 Burnett S, Walker J. Comparison of ferric sulfate, formocresol, and a combination of ferric sulfate/formocresol in primary tooth vital pulpotomies: a retrospective Radiographic survey. J Dent Child 2002; 69: 44-48.
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