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Intracanal Medicaments And Temporization

NIDAL HABAHBEH Sundos Abuzaid Sun. 24-2-2013

Intracanal Medicaments And Temporization

Intracanal Medicaments : It's any antiseptic agent in the chemical form that applied to the walls of the root canals with the objective of eliminating microorganisms present before or even after cleaning and irrigating the root canal system. -Why do we have to use these medications ( Functions ) ? 1.Reduction of the number of microorganisms, Sometimes its hard on us to finish the whole treatment in only one visit so in order not to leave the canals open until the next visit we close it by these medications to prevent bacteria from invasion. 2.Prevention the growth and re-growth of any new microorganisms. 3.Disinfection of root canal system. 4.Suppression of interappointment pain by reducing inflammation (anti-inflammatory action ). 5.Render the canal contents inert. 6.Facilitation of periapical tissues healing

Mainly the most important property is its Anti-bacerial action, to prevent the growth or re-growth of bacteria .

What is the ideal criteria that should present in any intracanal medication to be called a TRUE intracanal medicament and TRUE anti-bacterial agent ?

Ideal requirements : 1.Should be an effective germicide & fungicide. 2.Should NOT irritate periapical tissues. 3.Should remain stable in solution. 4.Should have prolonged antibacterial activity . 5.Should have low surface tension ( This is important ) Any material with a low Surface tension will lead to high penetration inside the root canal system , otherwise when it has a high surface tension it will lead to a slow penetration. 6.Should be active in the presence of serum, blood & protein derivatives of tissues. 7.Should be easily placed & removed. 8.Should NOT stain the tooth structure. 9.Should NOT induce a cell mediated immune response. 10.Should be economically cheap with a long shelf life. Unfortunately we dont have an itracanal medicament with all those criteria , thus there is nothing called An Ideal Medicament . Types of Intracanal medicaments : You dont have to memorize all the types names, The dr. will concentrate on the most commonly used agents .

Phenolics:
. Eugenol )(

We will talk about each one , but first of all you have to know that phenol is very toxic because they can get easily into the systemic circulation and will cause a very intense inflammatory reaction .

PHENOLIC COMPOUNDS

e unpleasant odor & foul taste. They are ineffective.

EUGENOL he chemical essence of oil of clove.

sa temporary sealing material and endo cements and endo temporary fillings PARACHLOROPHENOL (PCP) oIt is a substitution product of phenol. oIt penetrates deep into dentinal tubules. o1% solution has shown destruction of microorganisms. oIt produces mild inflammation.

CAMPHORATED MONOPARACHLOROPHENOL (CMCP) Camphor.

criteria ) METACRESYLACETATE (CRESATIN)

( This is its best

ritating among other phenolics. But its not used any more nowadays .

ALDEHIDES
FORMOCRESOL This is the most common agent used in pulpotomy, pulpotomy is the removel of the only superfacilal infected layer of the pulp , we put this fixative agent and wait for five minutes and continue our treatment . So its mainly used as executive agent in pediatric dentistry .

-specific bactericidal agent most effective against aerobes & anaerobes.

. -7 days ( a week ).

GLUTARALDEHYDE And its not used

anymore but formaticol yes.

Halides
- SODIUM HYPOCHLORITE(NaOCl) ** The famous one ** Its the most commont widely used irrigant and intracanal medicament in orthhodontics Its a very important anti bacterial agent , it has a good tissue dissolving ability(hypix or chlorox ), concentration is usually 0.5 5.25 % gredient.

ts rapidly with organic matter , thats why we have to renew it in a very short period of time.

very TOXIC to periapical tissues

. We have something called

hypochlorite accidents in which sodium hypochlorite is forced outside the root , the patient will immiadetlywill feel sever pain , numbness , necrosis , bleeding, immidate swelling , and hematoma . we have to be carefull while using it.

- IODINE POTASSIUM IODIDE

. We can combine it with calcium hydroxide

STEROIDS
. It has an anti-inflammatory action thats why it decreses pain - nce suggests that they may be ineffective, particularly with greater pain levels. periodontitis.Nowadays its not used . - CALCIUM HYDROXIDE ( very COMMON intracanal medicament ) THIS IS IMPORTANTS , FOCUS HERE Introduced by Hermann in 1920. Used for short & long term durations. Short period of time for one or two weeks making the canal free of bacteria between intra appointment visits , for the long period of time its used for Apexogenesis to promote hard tissur barrier (only once) and inibit bacterial growth between visits ,mostly for children.* check the note downward . It is a broad spectrum antimicrobial agent. Its antibacterial action is related to its high pH BUT remember it doesnt decrease pain between visits as steroids It may aid in dissolving necrotic tissue remnants and bacteria and their by-products and promote hard tissue formation. It demonstrates no pain-reduction effects. It has been recommended for use in teeth with necrotic pulp tissue, it has no rule in vital tooth .

Apexogenesis is a procedure that addresses the shortcomings involved with capping

the inflamed dental pulp of an incompletely developed tooth. The goal of apexogenesis is the preservation of vital pulp tissue so that continued root development with apical closure may occur. Most or all of the coronal pulp is removed, often to the level of the canal orifices, and calcium hydroxide paste is placed as a wound dressing

- The way of application : A powder that will be mixed with water or saline or glyserine until its a clear creamy texture ,with this instrument in the picture which is dental spiral , its also called a root canal filler .Then apply it inside the canal with the Hand spreader , its very important to apply the calcium to all canal's walls from inside and reach all the area . Unfortunately its very difficult to any chemical agent to reach each area inside a canal , its somehow complicated .

So we have to make sure that we : 1. Reached the apical area of the canal 2.Reached all the walls of the cavity There is two types of calcium hydroxide , Setting( Dycal CH )its used as a floor beneath the fillings and the Non-setting CH that we are talking about , that we can put it using a finger spreader or a file in an anti-clockwise motion to prevent it from forcing outside the tooth .

* CALCIUM HYDROXIDE Limitations: - Its very difficult to remove all non-setting CH from the root canal system , so most of the time we leave remnants which might interfere with the setting of root canal sealers , wich will put our filling in danger - It is NOT effective against E. faecalis ( entrococus.faecalis) & C. albicans ( These are the most common bacteria following failed RCT ) - Dentin can inactivate the antibacterial activity of non-setting Ca(OH)2 .

-CHLORHEXIDINE usually used in periodontics as a mouth wash but in different consentration which is 0.2%

here we use 2% gel is recommended. activity & enhance the periradicular healing.

It doesnt remove smear layer ( the layer left after instrumentation of root canal system that must be removed before complete any procedure )

ANTIBIOTICS

there are so many formulas , the doctor said he will go over them quickly as they arent important and aren't used anymore in endodontics .

-PBSC - resistant bacteria. MOs.

-SULFONAMIDES

-GROSSMANS PASTE . this was a very famous formula in 50's and 60's it has many names and was used as antibacterial agent

INTRACANAL MEDICAMENTS Limitations :

Which is difficult because of the complex anatomy of root canals .

TEMPORIZATION
The doctor go over it very quickly , I think you have to go back to the slides since he mentioned that this is important - It is used to prevent coronal leakage - TEMPORIZATION Types : i.Cavit. ii.IRM. iii.GIC. iv.TERM.

-CAVIT resistance . -IRM has a good Improved wear resistance but leaks more than the cavit -GIC

lease of fluoride. Poor mechanical properties and low wear resistance . . It can be found either in a liquid form or capsulated

-TERM . Un fill resin , Temporary Endodontic Restorative Material. . A specially formulated light-polymerized composite materials. . good improved wear resistance. . Provides a moisture-free seal, which is very important . How to apply it : we have to dry the pulp champer before applying a minimumal 34 mm of the temporary filling material , dont use very large cotton pellet below the filling , sometimes its not necessarily to use cotton at all . it should be put in increments and we should check the occlusion of the patient .

Picture : we have gutta percha in the canals below then a thin minimumal as possible cotton increment and a minimum 3-4 mm of the temporary filling .

This picture is from the book : In the first tooth on the left there is no cotton roll here , which is right , but it will be difficult to remove the temporary filling from the orifice , but the one on the right is wrong because there is a very big layer of cotton which will leave a very small space for the temporary filling and this will not withstand the occlusal forces .

Remember not to put the filling in one single shot , put it in increments against the wall , condense it and finish it .

Check the slides for extra information . Good Luck .

Sundos M. Abuzaid