Scr.7 - Intracanal Medicaments and Temporization

7/30/2019 Scr.7 - Intracanal Medicaments and Temporization

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Intracanal Medicaments AndTemporization

NIDAL HABAHBEH

Sundos Abuzaid

Sun. 24-2-2013


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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 eliminatingmicroorganisms present before or even after cleaning and irrigating theroot canal system.

-Why do we have to use these medications ( Functions ) ?

1.Reduction of the number of microorganisms, Sometimes its hardon us to finish the whole treatment in only one visit so in order notto leave the canals open until the next visit we close it by thesemedications to prevent bacteria from invasion.

2.Prevention the growth and re-growth of any newmicroorganisms.

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, toprevent the growth or re-growth of bacteria .

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


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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 highpenetration 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 & proteinderivatives 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 allthose criteria , thus there is nothing called An Ideal Medicament .

Types of Intracanal medicaments :You dont have to memorize all the types names, The dr. willconcentrate on the most commonly used agents .

Phenolics:

. Eugenol ()


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

PHENOLIC COMPOUNDS

e unpleasant odor & foul taste.

They are ineffective.

EUGENOLhe chemical essence of oil of clove.

s atemporary sealing material and endo cements and endo temporaryfillings

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.


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CAMPHORATED MONOPARACHLOROPHENOL (CMCP)

Camphor.

( This is its bestcriteria )

METACRESYLACETATE (CRESATIN)

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

ALDEHIDES

FORMOCRESOLThis is the most common agent used in pulpotomy, pulpotomy isthe removel of the only superfacilal infected layer of the pulp , weput this fixative agent and wait for five minutes and continue ourtreatment . So its mainly used as executive agent in pediatricdentistry .

-specific bactericidal agent most effective againstaerobes & anaerobes.

.

-7 days ( a week ).


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GLUTARALDEHYDE

And its not used

anymore but formaticol yes.

Halides

- SODIUM HYPOCHLORITE(NaOCl) ** The famous one **Its the most commont widely used irrigant and intracanalmedicament in orthhodontics

Its a very important anti bacterial agent , it has a good tissuedissolving ability(hypix or chlorox ), concentration is usually 0.55.25 %

gredient.

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

very TOXIC to periapical tissues. We have something called

hypochlorite accidents in which sodium hypochlorite is forcedoutside the root , the patient will immiadetlywill feel sever pain ,

numbness , necrosis , bleeding, immidate swelling , andhematoma . we have to be carefull while using it.

- IODINE POTASSIUM IODIDE


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. 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 intracanalmedicament )THIS IS IMPORTANTS , FOCUS HERE

Introduced by Hermann in 1920.

Used for short & long term durations. Short period of time for oneor two weeks making the canal free of bacteria between intraappointment visits , for the long period of time its used forApexogenesis to promote hard tissur barrier (only once) and inibitbacterial growth between visits ,mostly for children.* check thenote downward .

It is a broad spectrum antimicrobial agent.

Its antibacterial action is related to its high pH BUT remember itdoesnt decrease pain between visits as steroids

It may aid in dissolving necrotic tissue remnants and bacteriaand their by-products and promote hard tissue formation.

It demonstrates no pain-reduction effects.

It has been recommended for use in teeth with necrotic pulptissue, it has no rule in vital tooth .


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- 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 toapply 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 .

involved with cappingis a procedure that addresses the shortcomingsApexogenesisthe 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

d, often to the level of theclosure may occur. Most or all of the coronal pulp is remove

canal orifices, and calcium hydroxide paste is placed as a wound dressing


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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 canalsystem , so most of the time we leave remnants which mightinterfere with the setting of root canal sealers , wich will put ourfilling 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-settingCa(OH)2 .

-CHLORHEXIDINEusually used in periodontics as a mouth wash but in differentconsentration which is 0.2%

here we use 2% gel is recommended.

activity & enhance the periradicular healing.


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It doesnt remove smear layer ( the layer left afterinstrumentation of root canal system that must be removed beforecomplete any procedure )

ANTIBIOTICSthere are so many formulas , the doctor said he will go over themquickly as they arent important and aren't used anymore inendodontics .

-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 .


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TEMPORIZATION

The doctor go over it very quickly , I think you have to go back tothe 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 thecavit

-GIC


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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 3-4 mm of the temporary filling material , dont use very largecotton pellet below the filling , sometimes its not necessarily to use

cotton at all . it should be put in increments and we should checkthe occlusion of the patient .

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


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This picture is from the book :

In the first tooth on the left there is no cotton roll here , which isright , but it will be difficult to remove the temporary filling fromthe orifice , but the one on the right is wrong because there is avery big layer of cotton which will leave a very small space for thetemporary 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

Scr.7 - Intracanal Medicaments and Temporization

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