Intracanal medicaments (1)
- 2. Definition The general definition of intracanal medicaments is “temporary placement of medicaments with good biocompatibility into root canals for the purpose of inhibiting coronal invasion of bacteria from the oral cavity”.
- 3. FUNCTIONS Eliminate microorganisms: The objective is to sterilize (destroy all viable microorganisms) or to disinfect (destroy all pathogens) in the canal space. Rendering contents of canal inert: the attempt usually by chemical means to “mummify”, fix or neutralize tissue or debris left intentionally or unintentionally in the pulp space. Prevention or control of post treatment pain
- 4. Enhancing Anesthesia: By reducing the sensitivity of the inflamed tissue which can be difficult to anesthetize pulp. Control of persistent periapical abscess : In cases of continually “weeping” canal or significant pain or swelling medicaments have been suggested as a means of controlling this difficult situation. In
- 6. Predominantly consists of- aerobic and facultative anaerobic microflora. • Intact non-vital teeth – bacteroides, peptococcus, peptostreptococcus, fusiform, bacilli and corynebacterium.
- 7. Mazarella and colleagues 1955, Mcdonalds and associates 1957, Brown and Rudolph 1957 Gram +ve organisms Streptococci Staphylococci Corynebacterium Yeasts Gram –ve organisms Spirochetes Neisseria Bacteroides Fusobacterium Pseudomonas Coliform bacteria
- 8. Classification of root canal medicaments • I. Phenolic agents • II. Halogens • a) Iodine compounds • b)ChloramineT • c) Iodine –potassium iodine • d)Sodium hypochloride • III. Non -phenolic biocides • a) Alcohols e.g.; ethanol • b) Aldehydes e.g; formaldehyde • c) Biguanides e.g; chlorohexidine • d) Quaternary ammonium compounds • IV. Calcium hydroxide • V. Corticosteroids • VI.Antibiotics • VII.Herbs
- 11. Disadvantages: Phenol and phenolic derivatives are highly toxic to mammalian cells. Induce inflammation at much low concentration. Penetration of cytotoxic vapors into periodontium is reported It loses its effectiveness within short period of time.
- 12. Halogens
- 16. CHX is a strong base and it is more stable in the form of its salts. The salts originally employed were acetate and hydrochlorite, both of which suffer from relatively poor water solubility and were largely replaced by the digluconate which is a highly water soluble salt. Aqueous solutions of CHX are more stable within the pH range from 5 to 8.The antimicrobial activity of CHX is pH-dependent, being the optimum range from 5.5 to 7.0, within which is the pH of body surfaces and tissues . It readily dissociates at the physiological pH, releasing the positively charged CH component. 0.12% and 0.2% Chlorhexidine solutions showeda significant decrease in streptococcus mutans after 24 hours. Kulkarni VV et al 2003
- 17. Studies show that Chlorhexidine is more effective in elimination of E. faecalis inside dentinal tubules. Chlorhexidine both alone and along with calcium hydroxide showed more antibacterial efficacy against E faecalis than calcium hydroxide alone. Nidhi sinha et al, 2013
- 18. Calcium hydroxide Hermann introduced Ca(OH)2 paste as an ICM in 1920 . • Microbial control, • Dissolve organic remnants, • Heal periapical inflammation, • Inhibit inflammatory root resorption, • Stimulate hard tissue formation and • Serve as a temporary obturating material between appointments. Indications of CalciumHydroxide
- 20. LIMITATION OF CALCIUM HYDROXIDE Limited effectiveness in short term use for disinfecting dentinal tubules. Low solubility and diffusibility Removal of calcium hydroxide is frequently incomplete which leads to decrease in setting time of zinc oxide based root canal sealants. Calcium hydroxide as a disinfectant has limited use in retreatment cases as it has no effect on E. Faecalis and Candida species.
- 21. Mechanism
- 24. Its antimicrobial action is related to its high pH, of bacterialwhich results in the inactivation membrane enzymes.
- 27. Studies done to test the antibacterial efficacy of calcium hydroxide show that calcium hydroxide is ineffective against E. Faecalis. It resists calcium hydroxide for about 10 days. Calcium hydroxide shows limited action against facultative anaerobes and Candida species but is effective against obligate anaerobes. Hemanshi kumar. An in vitro evaluation of the antimicrobial efficacy of Curcuma longa, Tachyspermum ammi, chlorhexidine gluconate, and calcium hydroxide on Enterococcus faecalis. Journal of conservative dentistry. Year : 2013 Volume : 16 Issue : 2 Page : 144- 147
- 28. Antibiotics Used Alone and in combination with otherdrugs. Antibiotics are indicated in a small minority of cases when root canal infection persists despite other antiseptics. Example; Ledermix paste or polyantibiotic paste (PBSC) are used.
- 29. PBSCpaste/ Grossman’s paste CONTAINS: Potassium penicillin G (10,00,000 units) Bacitracin (10,000 units) Streptomycin paste (1gm) Sodium caprylate / Nystatin(1gm) PBSC contained penicillin to target gram-positive organisms, bacitracin for penicillin-resistant strains, streptomycin for gram-negative organisms, and caprylate sodium to target yeasts.
- 30. Ineffective against anaerobes. I n 1975 – banned due to allergic reactions due to penicillin.
- 31. CORTICOSTERIODS- ANTIBIOTICS COMBINATIONS Highly effective in the treatment of over instrumentation. Placed in the inflamed tissue by a paper point or reamer. periapical The steroid constituent reduces the inflammation and gives instant relief of pain. The antibiotic constituents are present so that no over growth of micro organisms occurs.
- 32. Ledermix paste is a glucocorticosteroid antibiotic Ledermix compound. Ledermix paste was developed by Schroeder and Triadan in 1960 and was released for sale in Europe by Lederle Pharmaceuticals in 1962. The primary interest of Schroeder and Triadan in the development of Ledermix paste was based on the use of corticosteroid to control pain and inflammation.
- 33. Constituents Tetracycline antibiotic Demeclocycline HCL-3.2% Triamcinolone acetonide – 1% Polyethylene glycol
- 35. 1:1 mixture of Ledermix paste and calcium hydroxide has been advocated as an intracanal dressing in cases of - 1. Pulpless infected root canals, 2. Pulp necrosis and infection with incomplete root formation (apexification), 3. Perforations, 4. Inflammatory root resorption, 5. Inflammatory periapical bone resorption 6. Large periapical radiolucent lesions.
- 36. Corticosteroid based preparations have shown to cause an increased degree of inflammatory response, maximum being at 28 days. After 7 days of experiment, all tested substance had low levels of inflammatory cells. Therefore, corticosteroid-based medications can be used for periods no longer than 7 days. Ramos E et al 2012
- 37. TRIPLE ANTIBIOTIC PASTE Triple antibiotic paste is a combination of three antibiotics namely minocycline (100mg), ciprofloxacin (200mg) , metronidazole (500mg) and propyelene glycol, saline as carrier. (Sato et al 1996) Triple antibiotic powder, either mixed with normal saline or 2% chlorhexidine, produced the largest zone of inhibition against E. faecalis.
- 38. PBSCPaste The Triple-Antibiotics Paste is very effective against E.faecalis
- 39. Concentrations used 1:1:1 - Hoshino et al,1996 1:3:3- Takushige T et al,2004 Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, et al. In vitro antibacterial susceptibility of bacteria from infected root dentin to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J. 1996;29:125–30 Takushige T, Cruz EV, Moral AA, Hoshino E. Endodontic treatment of primary teeth using a combination of antibacterial drugs. Int Endod J. 2004;37:132–8
- 40. Takushige et al. (2004) evaluated the efficacy of poly-antibiotic paste consisted of ciprofloxacin, metronidazole, and minocycline, on the clinical outcome of so-called “Lesion Sterilization and Tissue Repair,” LSTR, therapy in primary teeth with periradicular lesions.
- 41. Herbal medicaments • Literature has addressed many plants with potential source for new therapies in endodontics. • The studies listed have shown important medicinal activities of plants, with great demand to inhibit or suppress bacteria and their biofilm. • However there is scarce information on the quality, Safety and greater efficiency of these products for use in endodontics. • As most of the studies are carried out in vitro, more of these compounds should be subjected to animal and human studies to determine their effectiveness, side effects, toxicity and drug interactions
- 42. Natural and herbal products have been used inmedicine and dentistry since time unknown. Use of plant products in medicine is known as phytomedicine or phytotherapy. Since chemical and synthetic products are expensive and cause cytotoxic reactions and are not very efficient in elimination of bacteria, herbal products are used. Sharad Kamat et al
- 43. Propolis Propolis is prepared from resin collected by bees from trees of poplars, conifers and flowers of genera clusia . The pharmacologically active constituents in propolis are flavonoids, phenolics and aromatics. Propolis is a good antimicrobial inflammatory agent, which can serve and anti- as a better intracanal irrigant and intracanal medicament.
- 44. Propolis can be used as short-term intracanal medication in cases of pulp and periapical inflammatory processes. Fabiane Bortoluci da Silva etal.
- 45. Curcumin Turmeric (Curcuma longa) is extensively used as a spice, food preservative and coloring material in India, China and South East Asia. I t has been used in traditional medicine for the treatment of numerous diseases.
- 46. Curcumin is the main yellow bioactive component of turmeric which has been shown to have a wide spectrum of biological actions, including antimicrobial, anti- inflammatory and anti- oxidant activities.
- 47. Method of preparation The dried rhizomes of turmeric were grounded to fine powder under hygienic conditions to form a turmeric powder. This turmeric powder, distilled water, and radiolucent material were mixed on a glass slab with the help of stainless steel spatula, and mixing ratio of turmeric powder, distilled water, and radiolucent material was 1:3:3. Rajiv N Purohit et al2017.
- 48. A study showed that curcumin was able to demonstrate complete eradication of E. faecalis. Another study showed that there was a gradual decrease in the anti bacterial activity of curcumin at 3 and 7 days which may be due to the buffering ability of dentin. Curcumin does not affect the micro hardness of root dentin and is a potential intracanal medicament. AR Prabhakar et al. 2013
- 49. pulpotomy treatment primary teeth has using shown turmeric good powder in clinical and radiographic success. Purohit R et al, 2017
- 50. Arctium Lappa all over the world for itsThis plant is popular therapeutic applications. It is found to have antimicrobial action against microorganisms causing endodontic infections. It is a potential intracanal medicament.
- 51. Nissin Nissin is a naturally occurring antimicrobial peptide, produced by Streptococcus lactis sub species lactis. I t has antimicrobial activity against a wide range of bacteria and their spores. Studies show that it is effective in elimination of E faecalis from root canal and is more effective than calcium hydroxide. Hemadri M et al.2011
- 52. Conclusion procedures to disrupt and remove the microbial ecosystem that is associated with the disease process. It is important that clinicians understand the close relationship between the presence of microorganisms and endodontic disease processes to develop an effective rationale for treatment. Endodontic treatment are essentially debridement
- 53. References Endodontic therapy- Weine Endodontic Practice- Gross man Endodontics – Ingle Cohen & Burns , 8th edition Materail used in Dentistry – S Mahalaxmi