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1. Intracanal
Medicaments
INDIAN DENTAL ACADEMY
Leader in continuing dental
education
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com

2. Introduction
 Disinfection – Destruction of pathogenic
microorganisms
 Pre-requisites
 Removal of pulp tissue
 Cleaning and shaping by biochemical means
 Irrigation
 ICM – Reduces or eliminates microbial
flora in root canal
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3. Root canal flora
 Gram +ve, Gram –ve organisms, yeasts,
obligate and facultative anaerobes
 Factors that delay healing
 Trauma
 Devitalized tissue
 Dead spaces
 Accumulation of exudate
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4. Ideal requirements of ICM
 Effective germicide and fungicide
 Nonirritating to periapical tissues
 Remain stable in solution
 Have a prolonged antimicrobial effect
 Active in presence of blood, serum and protein derivatives
of tissue
 Low surface tension
 Not interfere with repair of periapical tissues
 Not stain tooth structure
 Capable of inactivation in a culture medium
 Not induce a cell-mediated immune response
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5. Function of ICM
 Most are antimicrobial agents
 Irrigation and instrumentation reduces
microorganisms
 ICM destroys those remaining and limits the
growth of any new arrivals
 Corticosteroid-antibiotic combination is
useful in treating apical periodontitis
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6. Intracanal Medicaments
1. Phenol and related volatile compounds
2. PBSC paste
3. Sulfonamide and sulfathiazole
4. Corticosteroid-antibiotic combination
5. Calcium hydroxide
6. N2
7. Halogens
8. Quaternary ammonium compounds
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7. 1. Phenol and related compounds
 Phenol
 Eugenol
 CMCP
 Cresatin
 Formocresol
 Glutaraldehyde
 Cresol, beechwood, creosote, and thymol
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8. 1. Phenol and related compounds
 Phenol
 Protoplasm poison, causes necrosis of soft tissue
 Eugenol
 Antiseptic and anodyne
 CMCP
 2 parts parachlorophenol and 3 parts gum camphor
 Has wide antibacterial spectrum, effective against fungi
 Much less irritating
 Inexpensive and long shelf life
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9. 1. Phenol and related compounds
 Cresatin
 Same actions as CMCP, less irritating
 Formocresol
 Formalin and cresol
 Formalin – strong disinfectant
 Used in pulpotomy
 Nonspecific bactericidal medicament
 Glutaraldehyde – 2 %
 Slightly acidic
 Strong disinfectant and fixative
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10. 2. PBSC paste
 Penicillin – effective against Gm+ve org
 Bacitracin – effective against penicillin-
resistant org
 Streptomycin – effective against Gm-ve org
 Caprylate – effective against fungi
 PBSN – Nystatin instead of Caprylate
 Disadv – interfere with subsequent culture
procedure, allergic reaction to drugs
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11. 3. Sulfonamide and sulfathiazole
 Yellowish tooth discoloration
 Used when tooth has been left open after an
acute periapical abscess
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12. 4. Corticosteroid-antibiotic
combination
 Highly effective in the treatment of
overinstrumentation
 Corticosteroid – reduces periapical
inflammation and relieves pain
 Antibiotic – prevents overgrowth of
microorganisms
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13. 5. Calcium hydroxide
 Weeping canal
 Constant clear or reddish exudation associated with
large apical radiolucency
 Asymptomatic or tender to percussion
 Negative cultures
 Treatment
 Dry the canal with sterile absorbent points
 Place calcium hydroxide paste as in apexification
 Mech of Action
 High pH has destructive effect on bacterial cell
membranes and protein structures
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14. 5. Calcium hydroxide
 Mode of application
 Ca(OH)2 is mixed with sterile water or saline to a
thick paste
 Paste is condensed into the root canal to a dense
fill
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15. 6.N2
 Both ICM and sealer
 Contains
 Paraformaldehyde (primary ingredient)
 Eugenol
 Phenylmercuric borate
 Lead
 Corticosteroid
 Antibiotics and perfume
 Antibacterial effect is short lived (7 to 10 days)
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16. 7. Halogens
 Sodium hypochlorite
 Chlorine has greatest disinfectant action
 Vapour is bactericidal
 Action is short lived
 Iodides (KI – Potassium iodide)
 Used as antiseptics
 Iodine is highly reactive
 Combines with protein in a loosely bound manner
 Destroys microorganisms by forming salts
 Action is short lived but less irritating
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17. 8. Cationic Detergents
 Quaternary ammonium compounds
 Odorless and stable solutions
 Low surface tension and good cleansing effects
 These are +vely charged
 React with bacteria which are –vely charged
 9-aminoacridine
 Mild cationic antiseptic
 Stains the tooth structure
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18. Irritation potential of ICM
 Essentail oils and formocresol – High
 CMCP and Cresatin – Moderate
 NaOCl and H O - Less
2 2
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19. Recommendations
 2 medicaments chosen as ICM
 Iodine potassium iodide
 Most effective and safest
 Very short acting – 3 days
 Calcium hydroxide
 Long acting
 Less irritating
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20. Intracanal Medication
 Method
 Absorbent point moistened with ICM is carried into the
canal
 Medicated cotton pellet is placed in the pulp chamber
 Access cavity is sealed with temporary filling material
 Frequency
 Renewed in a week
 Not longer than 2 weeks
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21. Thank you for watching
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