Intracanal medicaments Nilesh Deshpande JR-II Department of pediatric and preventive dentistry 1.

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Transcript of Intracanal medicaments Nilesh Deshpande JR-II Department of pediatric and preventive dentistry 1.

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  • Intracanal medicaments Nilesh Deshpande JR-II Department of pediatric and preventive dentistry 1
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  • An important objective of endodontic therapy is the removal of necrotic infected pulp and dentinal debris from the root canal system of infected or non-vital teeth. Failure to use an irrigating solution during BMP results in considerable amount of debris to be left behind in the root canal system ultimately leading to endodontic failure. Hence for obtaining an optimum level of disinfection of the root canal system chemo-mechanical preparation is a must. INTRODUCTION 2
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  • HISTORY Prior to 1940s Water was the most commonly used irrigant as it was: 1.Readily available. 2.Inexpensive. 3.Provided a lubricating effect during instrumentation. 3
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  • During 1940s proteolytic enzymes like streptokinase, streptodomase, papain, etc. were being used as irrigating solutions because of their tissue dissolving property. In 1943, Grossman introduced the concept of using oxidizing agents as irrigants. In 1945, Daniel formulated an irrigating solution comprising of a amino-acridine. In 1970s chelating agents were used increasingly because of their biologically acceptable properties. 4
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  • IDEAL REQUIREMENTS It should be an effective germicide and fungicide. It should be non-irritating to the periapical tissues. It should remain stable in solution. It should have prolonged antimicrobial effect It should be active in the presence of blood, serum and protein derivatives of tissues. It should have low surface tension. It should not interfere with repair of periapical tissues. It should not stain tooth structure It should not induce cell mediated immune response. It should be capable of inactivation in a culture medium. 5
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  • CATEGORIES OF USE That is conditions or situations for which intracanal medicaments have been advocated. Elimination microorganisms. Rendering contents of canal inert Prevention or control of post treatment pain Enhancing Anesthesia Control of persistent periapical abscess 6
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  • CLASSIFICATIONS A.According to DCNA 1.Phenolics - Eugenol - Camphorated monoparachlorophenol (CMCP) - Parachlorophenol (PCP) - Camphorated parachlorophenol (CPC) - Metacresylacetate (Cresatin) - Cresol - Creosote (Beechwood) - Thymol 2.Aldehydes - Formocresol - Glutaraldehyde 3.Halides - Sodium hypochlorite - Iodine - Potassium iodide 4.Steroids 5.Calcium hydroxide 6.Antibiotics 7.Combinations 7
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  • B.According to Grossman 1.Essential oils - Eugenol 2. Phenolic compound - Phenol - Para chlorophenol - Camphorated para chlorophenol - Formocresol - Glutaraldehyde - Cresatin 3.Halogens - sodium hypochlorite - Iodides 4. Quaternary Ammonium compounds - 9-amino acridine 8
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  • From a biological stand point, sterile normal saline is the best irrigant to use because it causes. I.Least apical tissue irritation or damage. II.Biocompatible. III.Least amount of cell lysis. Physiologic Saline 10
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  • Disadvantages: Does not remove the smear layer. Flushes out some of the superficial debris from the root canal system. Has poor antibacterial properties. However irrigation followed by ultrasonic and sonic instrumentation have been reported to be almost as effective as 0.5 to 2.5% sodium hypochlorite irrigation in reducing the number of bacteria in infected root canals. 11
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  • Phenol It is the oldest compound for controlling microorganisms. It was introduced by Lord Lister in 1867. It is white crystalline substance, and has a characteristic odor derived from coal tar. Phenol is a protoplasmic poison and produces necrosis of soft tissues by its ability to penetrate and disrupt the cell wall of bacteria and subsequently the protoplasm. Liquefied phenol consists of 9 parts of phenol and 1 part water. Highly effective in 1 to 2% concentration. 12
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  • Camphorated Phenol This contains 30% phenol, 60% camphor, 10% ethyl alcohol. It is the least toxic of the phenolic compounds. It has excellent antimicrobial effect and also relieves pain. Camphorating process aims at developing a less caustic medicament as a result of the slow release of phenol. Camphor serves as a vehicle and diluent. 13
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  • Monochlorophenol (MCP) -It is a derivative of phenol and has three isomers of which paramonochlorophenol is the most effective. - Mono chlorophenol is more effective antiseptic and is also more toxic than phenol. 14
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  • Camphorated Paramonochlorophenol (CMPCP) (Developed by Walkhoff 1891) - Contains : 35% monochlorophenol 65% camphor - Its antimicrobial effect is good. - Highly toxic to the tissues. - It is used in the form of vapor forming intracanal medicament. The vapors can pass through the apical foramen. 15
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  • Formocresol Developed by BUCKLEY in 1906 Contents : 19% formaldehyde 35% cresol 46% water Glycerine. or is a combination of formalin and cresol in the proportion of 1:2 Formocresol combines the protein - coagulating effect of phenolic compounds with the alkylating effect of formaldehyde. The bactericidal effect of formocresol is good at levels as low as 2%. 16
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  • It is a strong poison and causes widespread destruction of living tissue followed by a persistent inflammatory reaction. Studies have reported that formocresol treated tissue produced a cell mediated immune response. 17
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  • Glutaraldehyde -It is a colorless slightly soluble in H 2 O. -Slightly acidic -It is a strong disinfectant and fixative -Used in concentration of 2% - Extent of toxicity is less compared to formaldehyde. Its molecular weight is high compared to formaldehyde hence does not penetrate into the periapical tissues. 18
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  • Glutaraldehyde was preferred to formaldehyde: Irreversible bonding with proteins. Limited diffusion into tooth structure. No periapical irritation. Appears to cause a softening of dentin for limited duration, facilitating the mechanical preparation of the root canal. Greater reduction in microorganisms with glutaraldehyde 2% can be attributed to the fixative property rendering the microorganisms inert and non- toxic. 19
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  • Cresatin Also known as metacresylacetate It is a clear, stable, oily liquid of low volatility. It has both antiseptic and obtundant properties Compared to formocresol or camphorated parachlorophenol the antimicrobial effect of cresatin is less 20
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  • Creosote It is a mixture of phenol and phenol derivatives Beachwood creosote has long been used in endodontic therapy. There are several reports on severe tissue irritation and necrosis 21
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  • Alcohols Ethyl alcohol and Isopropyl alcohol are used. These denature protiens in high concentration. Denaturing takes place in presence of water, hence 70% is prefered to 95% They are not recommended as intracanal medicament 22
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  • Eugenol It is the chemical essence of oil of clove. It is related to phenol It is both an antiseptic and an obtundant It is slightly more irritating than oil of clove. Studies have reported that eugenol inhibited intradental nerve impulses A few reports of allergy to eugenol have been reported. 23
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  • Heavy metal salts Salts of silver, copper and mercury are used. They coagulate protiens and act as enzyme inhibitors. They are toxic. The mercury salts are rendered less effective by the tissue fluid proteins present in the root canal. Hence they are not often used. 24
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  • N 2 Contains :Paraformaldehyde Phenylmercuric borate Eugenol. Additional ingredients like lead, corticosteroids, antibiotics. - It is claimed to be both intracanal medicament and a sealer - Claims that N 2 has a permanent disinfectant action and unusual antimicrobial properties have been denied by the council on Dental Therapeutics of the American Dental Association. - The antibacterial effect of N 2 is short lived about a week to 10 days. 25
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  • SODIUM HYPOCHLORITE Is one of the most popular irrigating solutions. It has been used as an irrigant for well over 4 decades. It was first recommended as an antiseptic solution by HENRY DAKIN in 1915 and was called as DAKINs SOLUTION during the time of World War-I (NaOCl buffered with sodium bicarbonate). 0.5% NaOCl solution was then used as a treatment for infected wounds. 26
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  • Manufactured: It is made by bubbling chlorine gas through NaOH to form equal amounts of sodium hypochlorite and sodium chloride (NaOH gas NaOCl + NaCl 2 ) 27
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  • Properties of NaOCl: Antibacterial action Strong dissolution property: Fresh tissue Necrotic tissue Fixed tissue Lubricant for effective instrumentation. Bleaching action on discolored teeth. NaOCl has been used in various concentrations ranging from 0.5- 5.25%. Most commonly used concentration 2.5% 28
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  • ACTIONS: Antibacterial: NaOCl exerts its antibacterial action either by: 1.Direct contact with microorganisms. 2.Vapour action. Destruction of the bacteria takes place in two phases: Penetration into the bacterial cell. Chem