‫باسل عوض‬

21610740

Intracanal Medicament

Introduction
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According to Kawashima et al., intracanal medicament is defined as temporary
placement of medicaments with good biocompatibility into root canals and used as an
adjunt to cleaning and shaping for the purpose of inhibiting coronal invasion of
bacteria.
Intracanal medicaments have a long history of use as interim appointment dressings.
They have been employed for the following three purposes: (1) to reduce inter
appointment pain. (2) to decrease the bacterial count and prevent regrowth. (3) to
render the canal contents inert.

Indication of use
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1.If root canal treatment is not completed in a single appointment, antimicrobial
agents are recommended for intracanal antisepsis to prevent the growth of
microorganisms between appointments. In the past, numerous antimicrobial agents
have been used , provided relatively short- term antisepsis. These included traditional
phenolic and fixative agents such as: camphorated monochlorophenol, formocresol.

2.Prevention or control of post treatment pain.

3.Control of persistent periapical abscess: In weeping canal.

IDEAL REQUIREMENTS OF INTRACANAL

MEDICAMENTS
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1.It should be not irritating to the periapical tissues.
2.It should be have prolonged antimicrobial effect.
3.It should be active in the presence of blood, serum and protein derivatives of
tissues.
4.It should have low surface tension and easily diffusible.
5.It should not interfere with repair of peripaical tissues.
6. It should not stain the tooth structure.
7.It should be effective.
8.It should be easy to handle (mix & place and remove).
9.It should not be very expensive.
10.It should not induce a cell mediated immune response.

TYPES OF MEDICAMENTS
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1.Phenolics:Eugenol, CMCP, Parachlorophenol, Camphorated parachlorophenol
(CPC), Cresol, Thymol.

2.Aldehydes:.Formacresol, Glutaraldehyde.

3.Halides: Iodine – potassium iodine, Naocl.

4.Steroids.

5.Heavy metal salts.

6.Ca(OH)2.

7.Antibiotics.

8.CHX

8.Combinations.

Discussion
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The current intracanal dressing of choice is calcium hydroxide . studies have shown
calcium hydroxide to be an effective antimicrobial agent . Other studies have shown
it to be an effective inter appointment dressing over several weeks. Several different
techniques for placing calcium hydroxide into root canals have been proposed, such
as amalgam carriers, vertical pluggers, McSpadden compactors, Lentulo drills, files
and special syringes.
calcium hydroxide Introduced by Herman in 1920. It is one of the commonly used ICM. It
is a broad spectrum anti microbial agent. It s antiseptic action probably relates to its high pH
and its leaching action on necrotic pulp tissue.
It is best used in Weeping canals, where there is a constant clear or reddish exudate
associated with large periapical lesion. The tooth will be often asymptomatic, culture will be
usually - ve with no support of bacterial growth.In such cases calcium hydroxide is a
excellent medicament to be used.

Calcium hydroxide is best used in paste form when one anticipates an excessive delay
between appointments. Calcium hydoxide has highest effect on endotoxin. i.e. inhibits
lipopolysaccharides. Repair of periapical tissues after RCT of teeth W/ periapical lesions
was better when calcium hydoxide was used an ICM or dressing before obturation. In cases
of apical periodontitis, root canal dressing with calcium hydroxide produce definite signs of
healing after only few days.

FORM AND APPLICATION: Can be placed as a dry powder, a powder mixed with a liquid
such as local anesthetic solution, saline, water or glycerine to form a thick paste or a paste
supplied in a syringe. A lentulo spiral is effective and efficient for placement. Removal after
placement is difficult. This is especially true in the apical portion of the root.

LIMITATIONS OF CA(OH)2 : Residual Ca(OH)2 can shorten the setting time of

zinc oxide eugenol-based endodontic sealers. Ca(OH)2 is not totally effective against
E. faecalis and candida albicans. Dentin can inactivate the antibacterial activity of
Ca(OH)2.

CHLORHEXIDINE GLUCONATE: Chlorhexidine (CHX) has been recently used as

an intra-canal medicament. A 2% gel is recommended. It can be used alone in gel
form or mixed with Ca(OH)2. It is broad spectrum antimicrobial agent. CHX is also
shown to be an excellent intra canal medicament. Its action may be due to sustained
release of the chemical(substantivity). Studies have shown that calcium hydroxide
and CHX combination was more effective. CHX is active against a wide range of
aerobic an anerobic bacteria as well as candida spices.

Conclusion
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The ultimate goals of endodontic treatment are complete removal of bacteria, their
byproducts and pulpal remnants from infected root canals and the complete seal of
disinfected root canals. Intracanal medicaments have been thought an essential step in
killing the bacteria in root canals; however, in modern endodontics, shaping and
cleaning may be assuming greater importance than intracanal medicaments as a
means of disinfecting root canals. Until recently, formocresol and its relatives were
frequently used as intracanal medicaments, but it was pointed out that such
bactericidal chemicals dressed in the canal distributed to the whole body from the
root apex and so might induce various harmful effects including allergies.
Furthermore, as these medicaments are potent carcinogenic agents, there is no
indication for these chemicals in modern endodontic treatment. Today,
biocompatibility and stability are essential properties for intracanal medicaments. The
more modern meaning of intracanal dressing is for a blockade against coronal
leakage from the gap between filling materials and cavity wall. Calcium hydroxide
has been determined as suitable for use as an intracanal medicament as it is stable for
long periods, harmless to the body, and bactericidal in a limited area. It also induces
hard tissue formation and is effective for stopping inflammatory exudates. Single-
visit endodontics, where intracanal medicaments are not used, is generally not now
contraindicated and various reports have shown that the clinical outcomes between
single- and multiple- visit endodontics are similar. There is no reason to counsel
against single-visit endodontics: however, if multiple-visit endodontics is chosen,
calcium hydroxide is recommended to be used as an intracanal medicament.

References
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1.Grossman’s ENDODONTIC PRACTICE (13TH edition).
2.Ingle j.i and bakland (7th edition ).
3.Root Canal Medicaments
Nobuyuki Kawashima 1 , Reiko Wadachi, Hideaki Suda, Thai Yeng, Peter Parashos