5 Intracanal Medication.ppt

8/10/2019 5 Intracanal Medication.ppt

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Intracanal Medication


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Intracanal medicaments have a long history of

use as interim appointment dressings. They havebeen employed for the following three purposes:

(1) to reduce interappointment pain.

(2) to decrease the bacterial count and prevent

regrowth.

(3)to render the canal contents inert.


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If root canal treatment is not completed

in a single appointment, antimicrobialagents are recommended for intracanal

antisepsis to prevent the growth of

microorganisms between

appointments.


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In the past, numerous antimicrobial

agents have been used , providedrelatively short-term antisepsis.

These included traditional phenolic andfixative agents such as: camphorated

monochlorophenol, formocresol .


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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 interappointment dressing

over several weeks .


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Several different techniques for placingcalcium hydroxide into root canalshave been proposed, such as amalgam

carriers, vertical pluggers, McSpaddencompactors, Lentulo drills, files andspecial syringes.


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The Weeping Canal

One of the most perplexing conditions totreat is the tooth with constant clear orreddish exudation associated with a large

apical radiolucency.The tooth often is asymptomatic , but itmay be tender to percussion or sensitive

to digital pressure over the apex.


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When opened at the start of the endodontic

appointment, a reddish discharge may willup, whereas at a succeeding appointment the

exudates will be clear.

Some pressure is present, If the tooth is leftopen under a rubber dam for 15 to 30minutes,

it may be closed up by absorbing the

exudates with an aspirator and paper points,however, a similar condition will still be

present at the next appointment.


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The canal has already been enlarged to a

more than acceptable size.

This is referred to as WEEPING CANAL .

classically those with exudates were notconsidered to be ready for filling.


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One is always in a quandary as to the

correct method for treating such canal .


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The answer to this problem is to dry thecanal with sterile absorbent paper points .

and place calcium hydroxide paste in

the canal .It is absolutely to see a perfectly dry cleancanal at the next appointment that is

simple to fill after minimal furtherpreparation .


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)apexificationend closure (-Root

It means creation of an artificial barrier across

an open apex.

Success depends on the debridement of the

pulp space & complete coronal seal.

Placing Ca(0H)2 provides a suitable medium to

permit apical closure

Princip

les&

PracticeofEndodontics


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Technique:- The technique is divided into 3 phases:

1. Access.

2. Instrumentation.

3. Placement of Ca(OH)2 or MTA.

Principles&Practice

ofEndodontics


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Technique:

1. Preparing large access after isolation.

1. Removing the necrotic pulp with large

Hedstrom file.

2. Determining the working length (slightly short

of the radiographic apex).

3. Instrumentation is performed with copious

irrigation.

Principle

s&

Practice

ofEndodontics


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5. Drying the canal with sterile paper points.

6. Applying Ca(OH)2 paste containing Barium

Sulfate in the canal with caution not to push

it too much periapically.

7. Making a radiograph before temporization to

assure that the canal space is filled withoutvoids.

Principles&

Practiceof

Endodontics


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Principles&

Practiceof

Endodontics


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A

B

Principles&

Practiceof

Endodontics


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Recall Schedule:- The patient is recalled in 4-6 weeks.

- In each recall a radiograph is made, so if the

material does not appear dense, it must be

washed out & repacked.

- If it was dense, with no clinical symptoms or

signs, there is no need to be replaced.

- Recall is then scheduled for 3 & 6 months.

Principles&

Practiceof

Endodontics


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-If healing has progressed well after 1 year,Ca(OH)2 is removed.

-

The hard tissue is often not visibleradiographically but detected tactically.

- If the apex is still open, Ca(OH)2 is replaced &

patient is recalled in 3 months.

Principles&

Practiceof

Endodontics


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Obturation:- The canal is cleaned &

irrigated copiously & thendried.

-Modified lateral condensationtechnique is used.

-After obturation , recallappointments scheduled up to

4 years.

Principles&

Practiceof

Endodontics


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The paste must reach the apical portion of the

canal to stimulate the tissues to form a calcific

barrier .

therefore a syringe may by used to ensure proper

depth of placement . a stopper is placed on the

needle portion at the proper working length, and a

uniform paste is easily delivered to the correct

position in the canal .


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Root-End Closure (Apexification) with MTA:

1. Anesthesia & preparing a large access to allow

debridement.

2. Disinfection of the canal by applying Ca(OH)2 paste

for 1 week.

3. Removing of Ca(OH)2 in the subsequent appointment

& applying MTA.

4. Radiographic evaluation of the MTA placement.

Principles&

Practiceof

Endodontics


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5. Placing of moist cotton pellet over the

material to ensure setting.

6. Obturating of the remainder of the

canal with gutta-percha, & performing

the final restoration.

Principles&

Practiceof

Endodontics


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A

B

C

Principles&

Practiceof

Endodontics

5 Intracanal Medication.ppt

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