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“ Intracanal medicaments”

“ Intracanal medicaments” . Contents: . Introduction Definition History Classification Ideal requirements Phenolic compounds. Aldehydes Halides Steroids Antibiotcs Calcium hydroxide CHX & other newer medicaments Conclusion References. Introduction: .

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“ Intracanal medicaments”

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  1. “Intracanal medicaments”

  2. Contents: Introduction Definition History Classification Ideal requirements Phenolic compounds

  3. Aldehydes Halides Steroids Antibiotcs Calcium hydroxide CHX & other newer medicaments Conclusion References

  4. Introduction: Presence of micro org & their by products in RCS provokes host response. Complexity of RCS-not all micro-org/pulp remanents-removed during canal preprn. ICM should inhibit micro-recolonization.

  5. Definition: ICM are antiseptic agents in the chemical form to the walls of the pulp cavity with the object of eliminating micro org present even after cleaning & irrigation of the RCS.

  6. History: • 1045 AD - Seribonius wrote of using oils and wine in the mouth of a patient in pain. • Dental writings through the middle ages indicate the use of oil of cloves, a plant extract containing a high percentage of eugenol

  7. 1840 - Beechwoodcreosate was mentioned in article ‘Creosate and cotton in Fang filling.’ • 1884 - Richmond advocated “Knocking out the pulp” by whittling down orangewood to a small size, soaking the stick in phenol and tapping this into exposed pulp canal.

  8. Phenol was added to preserve & sterilize the contents of canal & to alleviate pain. Formulations with sulphonamides and later antibiotics were tried as intracanal medicaments.

  9. 1930 - Hermann introduced calcium hydroxide , which gained popularity in endodontics in the early 1980s and has been widely used as ICM even today

  10. Classification:- Cohen 1.Phenolic preparations: Phenol/carbolic acid eg:paramonochlorophenol, thymol,cresol 2. Formaldehyde preparation: formocresol tricresol formalin 3. Halogen: chlorine:eg-chloramine T Iodine- IKI 4. Calcium hydroxide 5. Bioactive glass 6. Superoxidized water

  11. Grossman • 1.Essential oils:eugenol 2.Phenolic compounds: 3.Halogens: 4.Antibiotics 5.Other:formocresol gluteraldehyde Cresatin N2 Ca(OH)2 Quaternary ammonium compounds

  12. IDEAL REQUIREMENTS : • Effective germicide & fungicide. • Non irritating to the periapical tissues. • Remain stable in solution. • Prolonged antimicrobial effect.

  13. Active in the presence of blood serum & protein derivatives of tissues. • Low surface tension. • Not interfere with repair of periapical tissues.

  14. Capable of penetrating the tissue deeply. • Not stain tooth structure. • Easily introduced into the canal.

  15. Not induce a cell mediated immune response. • Capable of being inactivated or neutralized in culture medium. • Inexpensive with a long shelf life.

  16. Eugenol It has been used in endodontics for its antimicrobial & its anodyne (pain relieving) effects. It is a pale yellow liquid which becomes dark on exposure to air, because of oxidation.

  17. It has a clove like odour. Slight anesthetic as well as antiseptic property. Slightly more irritating than clove oil.

  18. Trowbridge et al has shown that eugenol inhibit interdental nerve impulses. The ability of eugenol to inhibit nerve activity reportedly account for its anodyne property.

  19. PHENOL : (C6H5OH) This white crystalline substance has a characteristic odour, which is derived from coal tar. Liquefied phenol (carbolic acid) consists of 9 parts of phenol and 1 parts of water.

  20. Phenol is a protoplasm poison and produces necrosis of soft tissue.

  21. USES : Disinfection of infected root canals As caustic for destroying pulp remnants.

  22. PARA-CHLOROPHENOL (C6H5OHCL) Substitution product of phenol in which Cl replaces 1 of the H atoms. These colorless needle like crystals, like phenol turn dark upon exposure to light. The crystals are soluble in alcohol, ether, alkalies & slightly soluble in H2O.

  23. On trituration with gum camphor, these substance combine to form an oily liquid. 1% aqsoln of parachlorophenol is recommended. Periapical tissue irritation is less.

  24. Camphorated para-chlorophenol Introduced into dentistry as a root canal antiseptic by Walkhoff in 1891. Composed of 2 parts parachlorophenol & 3 parts gum camphor. Transparent, oily, light amber colored liquid having a characteristic aromatic odor.

  25. Camphor serves as a vehicle and a diluent & reduces irritating effect of pure parachlorophenol. Prolongs the antimicrobial effect. Less irritant than eugenol & phenol. Long shelf life & cheap.

  26. Camphorated paramonochlorophenol (CMCP) Composed of 70 parts of gum camphor & 30 parts of parachlorophenol. CMCP is oily liquid with characteristic aromatic odour.

  27. Volatility and low surface tension ensures diffusion throughout the pulp spaces. So it can be used in minimal amounts. It has wide antibacterial spectrum & is effective against fungi is well. Inexpensive & long shelf life.

  28. cresol (tricresol) This mixture of ortho meta & para-isometric Cresol. Obtained form coal tar & may contain a trace of phenol. Colorless/pinkish liquid with a phenolic odor. App 3 times more effective as a disinfectant than phenol.

  29. Cresol is also a substitution product of phenol,likephenol,cresol is a protoplasm poison, although it produces less necrosis than phenol.

  30. N2 / Sargenti paste: • Term coined by Sargenti to describe second nerve ,that is placed during treatment • He coloured the material red so that it coincides with the colour of pulp.

  31. Old N2-Paraformaldehyde as its primary ingredient-carcinogenic. And ingredients- Eugenol, phenyl mercuric borate, lead, corticosteroids, antibiotics & perfumes. Highly toxic

  32. New N2 is basically a ZOE Sealer, significant content is PbO & smaller amount of Organic Hg & large amount of Formaldehyde, 6-8% Paraformaldehyde & sometimes it contains hydrocortisone & prednisolone.

  33. Aldehydes:Formaldehyde 19% formaldehyde + 35% cresol dissolved in 46% glycerine and water Bacteriocidal medicament Effective against aerobic and anaerobic organisms

  34. Formalin – Strong disinfectant Combines with albumin to form insoluble , indecomposable substance Highly irritating effect on soft tissue Formocresol used against living tissue - necrosis followed by persistent inflammatory reaction

  35. Mutagenic and carcinogenic potential. • Used in pulpotomy procedure in primary teeth

  36. Glteraldehyde : Colorless oil Slightly soluble in water Strong disinfectant and fixative Toxic to periradicular tissue Recommended 2% Can cause hypersensitivie response.

  37. Cresatin: Also known as metacresylacetate Clear, stable, oily liquid Claimed to have antiseptic & obtundant properties Antimicrobial effect less than that of formocresol or camphorated para- chlorophenol

  38. Halides –NaOCl: Disinfectant action of the halogens is inversely proportional to their atomic weights. Chlorine, with the lowest atomic weight, has the greatest disinfectant action.

  39. Chlorine disinfectants are not stable b’coz they interact rapidly with organic matter. This action is of short duration, therefore the compound should preferably be applied to the root canal every other day which is not practicle.

  40. Sodium hypochlorite is an effective intracanal medicament as well as irrigant (Mentz). Sodium hypochlorite vapors are bactericidal (Ellerbruh and Murphy)

  41. Iodides : Antiseptic Low toxicity and good antibacterial effect in-vitro Highly reactive and combine with proteins in a loosely bound manner so its penetration is not impeded Destroys microorganisms by forming salts

  42. Drawbacks: -Tooth staining -Long term efficacy not known -Potential for allergic response

  43. Steroids : Steroids are highly effective in the Rx in case of over-instrumentation. They must be placed in the inflammed tissue by a paper point/reamer to be effective. They are more effective in vital pulps than the necrotic pulp tissue.

  44. Prednisolone, triamcinalone, hydrocortisone Also available-ointments.

  45. The steroid constituent reduces the periapical inflammation & gives instant relief of pain. The antibiotic constituents are present to prevent over growth of µorg.

  46. Steroid-antibiotic combinition Terrocortil Cortisporin Mycalog Ledermix

  47. Ledermix is one of the best known corticosteriods- antibiotic combination. It has paste and a cement. • Paste: • Triamicnoloneacetonide • Demethyl chlortetracycline calcium • Cement : • CaCl2 • NaSO4 • Carbo wax. • Water

  48. It is also available as powder & liquid form. • Powder: • Triamcinaloneacetonide • Demethylchlortetracycline hydrochloride. • ZnO • Canada balsam. • Ca(OH)2 & rosin. • Liquid : • Eugenol & rectified terpentine.

  49. Ledermixpastecan cause discolourationof teeth, particularly if the paste is left within the pulp chamber. Demeclocycline in the Ledermix paste is known to diffuse through dentinal tubules & after 14 weeks about 2/3rd of the demeclocycline was released in an in vitro study (Abbottet al. 1988).

  50. Antiboitics :Sulfonamides Sulfonilanide & sulfanizole are used as medicaments by mixing with sterile distilled H2O/by placing a moistened paper point into a fluffed jar containing the powder. This medication is suggested for use as intra canal medicament in acute periapical abscess. Demerit: Yellowish tooth discoloration

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