types,advantages,disadvantages and factors

1. Intracanal
medicaments

2. Introduction
An agent used as an adjunct to cleaning
and shaping for prevention or treatment
of apical periodontitis.

3. Functions
Primary
Antisepsis
Disinfection
Secondary
Hard tissue formation
Pain control exudation
Resorption control

4. Secondary functions
Pain during and after treatment can occur and
associated tissue reaction include:
Exudation
Transudation
swelling
resorption

5. Pain control
• Pain is mostly associated with infection and the
primary means of pain control is infection control

6. Control of exudation or
bleeding
• Persistant exudation in the root canal may
oocur.Exudation reflects inflammation.
• Therefore treatment is aimed at dealing with
potential infection as well as drying or coagulation
the site

7. Controlling inflammatory
root resorption
• Inflammatory root resorption is most aggressive and
destructive
• It is associated with infection of root canal
combined with physical damage to the cementum,
so again a primary function of treatment is to
eliminate infection in root canal system

8. Induction of hard tissue
formation
• It is often desirable to allow hard tissue to form to
continue apical root development to close wide
foramen or to create a mechanical barrier at a
fracture line

9. Micobes of pulp
• With apical periodontitis
o Fusobacterium, prevotella, pophyromonas, veillonella, spirochetes
• Retreatment cases
o Enterococci esp. E. Fecalis, Yeasts
• Actinomyces

10. Antimicrobial agents
• Antibiotics
o Sulpha preparations
o Penicillin
o Metronidazole
o Tetracycline

11. Antimicrobial agents
• Sulpha preparations
• Effective against gram-negative and gram positive
microorganism

12. 2.Metronidazole
• Effective against gram negative anaerobic
microorganisms

13. 3.Tetracycline
• It shows affinity for hard tissues and may be retained
on tooth surface.
• There might resistance to tetracycline occurs and
spectrum is quite narrow

14. Disinfectants
o Aldehydes
o Halogens
o Phenols
o Chlorhexdine
o Calcium Hydroxide

15. Disinfectants
• They act by direct toxicity to microbes
• They have a broader antibacterial spectrum than
antibiotics

16. Aldehydes
• Formaldehdye, paraformaldehyde and
glutaraldehyde have been widely used.
• They are water soluble and protein denaturing
agents and are most potent disinfectants
• Formocresol is an aqueous solution contaning
cresol,formaldehyde and glycerine,used for
pulpotomy procedures,but its toxic and mutagenic
properties are concerned

17. Halogens
• Includes chlorine and iodine which are used in
various formulations
• They are potent oxidizing agents with rapid
bactericidal effects
• Sodium hypochlorite is currently the irrigating
solution of choice
• Necrotic tissue and debris are dissolved
• Effective conc 0.5-5.25%

18. Phenol derivative
• No longer used because of its high toxicity
• Includes paramonochlorophenol,thymol and
eugenol
• But has high toxicity and limited antimicrobial effect

19. Chlorhexidine
• Broad spectrum activity and less toxicity
• Effective conc is 0.2-2% range
• Innovative attempts to utilize the disinfecting
properties of it include its inclusion in gutta purcha
points for root canal filling

20. Calcium hydroxide
• Antibacterial agents with high pH
• Physically restricts bacterial colonization of the
canal space
• It is applied as a thick creamy suspension

21. Antibacterial effect of
irrigation and
dressing
• Addition of sodium hypochlorite increases the
number of bacteria free canal substantially
• The number of bacteria free canal may be further
increase when a dressing of calcium hydroxide is
place

22. Disadvantages
• Tissue toxicity
• Carcinogenic
• May stain the teeth
• Allergic reactions
• Induction of inflammatory response

23. Factors
• Tissue condition
• Condition of tooth
• Smear layer