Intracanal Medication

Intracanal medicaments have a long history of

use as interim appointment dressings. They have
been 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.

If root canal treatment is not completed

in a single appointment, antimicrobial
agents are recommended for intracanal
antisepsis to prevent the growth of
microorganisms between
appointments.

In the past, numerous antimicrobial

agents have been used , provided
relatively short-term antisepsis.
These included traditional phenolic and
fixative agents such as: camphorated
monochlorophenol, formocresol .

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 .

Several different techniques for placing

calcium hydroxide into root canals
have been proposed, such as amalgam
carriers, vertical pluggers, McSpadden
compactors, Lentulo drills, files and
special syringes.

The Weeping Canal

One of the most perplexing conditions to
treat is the tooth with constant clear or
reddish exudation associated with a large
apical radiolucency.
The tooth often is asymptomatic , but it
may be tender to percussion or sensitive
to digital pressure over the apex.

When opened at the start of the endodontic

appointment, a reddish discharge may will
up, whereas at a succeeding appointment the
exudates will be clear.
Some pressure is present, If the tooth is left
open 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.

The canal has already been enlarged to a

more than acceptable size.
This is referred to as WEEPING CANAL .
classically those with exudates were not
considered to be ready for filling.

One is always in a quandary as to the

correct method for treating such canal .

The answer to this problem is to dry the

canal with sterile absorbent paper points .
and place calcium hydroxide paste in
the canal .
It is absolutely to see a perfectly dry clean
canal at the next appointment that is
simple to fill after minimal further
preparation .

Root-end closure (apexification)

Success depends on the debridement of the

pulp space & complete coronal seal.

Endodontics

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

permit apical closure

Principles & Practice of

It means creation of an artificial barrier across

an open apex.

Root-end closure (apexification)

- The technique is divided into 3 phases:

1. Access.
2. Instrumentation.
3. Placement of Ca(OH)2 or MTA.

Principles & Practice of Endodontics

Technique:

Root-end closure (apexification)

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.

Principles & Practice of Endodontics

Technique:

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 without
voids.

Principles & Practice of Endodontics

Root-end closure (apexification)

Principles & Practice of Endodontics

Root-end closure (apexification)

Principles & Practice of Endodontics

Root-end closure (apexification)

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 & Practice of Endodontics

Root-end closure (apexification)

- If healing has progressed well after 1 year,

Ca(OH)2 is removed.
- The hard tissue is often not visible
radiographically but detected tactically.
- If the apex is still open, Ca(OH)2 is replaced &
patient is recalled in 3 months.

Principles & Practice of Endodontics

Root-end closure (apexification)

Obturation:
- The canal is cleaned &
irrigated copiously & then
dried.
- Modified lateral condensation
technique is used.
- After obturation , recall
appointments scheduled up to
4 years.

Principles & Practice of Endodontics

Root-end closure (apexification)

Root-end closure (apexification)

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 .

Root-end closure (apexification)

Root-end closure (apexification)

Recently, interest has centered on the use of

MTA for apexification.This material has
demonstrated good biocompatibility and ability
to seal, and its high pH may
impart some antimicrobial properties.

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 & Practice of Endodontics

Root-end closure (apexification)

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 & Practice of Endodontics

Root-end closure (apexification)

Principles & Practice of Endodontics

Root-end closure (apexification)