Intracanal

medicaments in
Multiple visit
pulpectomies
RAKSHANA.S
CRI
Definition:
It is defined as “temporary placement
of medicaments with good biocompatibility into
root canals for the purpose of inhibiting coronal
invasion of bacteria from the oral cavity”.
(Kawashima et al, 2009)
 Why?
•Eliminate microorganisms
•Rendering contents of canal inert
•Prevention or control of post treatment
pain
•Enhancing anesthesia
•Control of persistent periapical abscess
 Grossman’s requirements of an ideal
intracanal medicaments
• Effective antimicrobial agent
• Non irritating to the periradicular tissues
• Remain stable in solution
• Prolonged antimicrobial effect
• Active in the presence of blood, serum, and protein
derivatives of tissue
• Have low surface tension
• Not interfere with the repair of periradicular tissues
• Not stain tooth structure
• Not induce a cell mediated immune response
 Chong and Pittford’s Indications of
intracanal medicaments
•To dry persistently wet or the so-called
weeping canals
•To eliminate any remaining microbes in the
pulp space
•To render root canal contents inert
•To neutralise tissue debris
•To act as a barrier against leakage from an
inter-appointment dressing in symptomatic
cases.
 Types
PHENOLICS: HALIDES:
• NaOCl
• Eugenol • Iodine-potassium iodide
• CMCP • Chloramine T
• Parachlorophenol STEROIDS- glucocorticosteroids
• CPC
• Cresol HEAVY METALS- metaphen

• Thymol Ca(OH)2

Antibiotics-pulpomixine,
ALDEHYDES ledermix pastes
• Formocresol
• Glutaraldehyde Combinations(ledermix &
Ca(OH)2)
Microflora in deciduous root canal:
• Anaerobes:
Gram positive cocci-
Peptostreptococcus
Gram positive bacilli-
Lactobacilli, Propionib-
acterium, Actinomyces
& Eubacterium
Gram negative cocci-
Veilonella parvula
Gram negative bacilli-
Bacteriodes, Fusobacterium
•Aerobes:
Streptococci
Staphylococcus
Diptheroids
 Formocresol
•Developed by Buckley in 1906
•Contents: 19% formalin, 35%cresol in a vehicle
of 46% water and glycerine at a pH of 5.1
(approx)
•It is necessary to dilute before
use.
•Ability to prevent tissue autolysis by the
complex chemical binding of formaldehyde with
protein.

•It has a bactericidal effect.

•It is a non specific bacterial medicament most

effective against aerobic and anaerobic
organisms found in root canals.
•Causes widespread destruction of living tissue
followed by a persistent inflammatory reaction

•Permanent tooth hypoplasia

•Systemic distribution
•Antigenicity
•Mutagenicity and carcinogenicity
•Dermatitis and pharyngitis

DEBATE STILL GOES ON.

 Mechanism of action
•It acts through the aldehyde group of
formaldehyde, forming bonds with the side
groups of amino acids of both the bacterial
proteins and with remaining pulp tissue.

•It is therefore both a bactericidal and

devitalising agent.
 Glutaraldehyde
•It is colorless oil slightly soluble in water
•It is a strong disinfectant and has better fixative
properties with true crosslinking.
•2%glutaraldehyde as an intracanal medicament
•Antimicrobial action is bacteriostatic
•Larger molecule size to prevent
diffusion out of foramen.
•Low mutagenicity/cytotoxicity
•Low shelf life (14 days)
• It is a chemically bifunctional reagent.

• Forms strong intra and inter molecular protein

bonds, leading to superior fixation by cross-
linkage.

• Results in alkylation of sulfhydryl, hydroxyl,

carboxyl, and amino groups of microorganisms,
which alters RNA, DNA, and protein synthesis.
 Iodine
• It is highly reactive that combines with proteins
and forms salts which probably destroys
microorganisms
• Iodine-potassium iodide is relatively high
bactericidal and relatively low toxic.
• It releases vapours with a strong antimicrobial
effect
• It can kill bacteria in infected dentin in 5minutes in
vitro
• Causes staining of the tooth
• Allergic reaction
 Selection procedure
• 40 healthy children were selected of both genders
• Age group 4 and 11 years
• The child had a primary molar with the one of the
following diagnosis:
Chronic pulpitis, chronic periapical abscess, acute
exacerbation of chronic pulpitis, acute exacerbation
of chronic periapical abscess
• Primary molar had minimal mobility and restorable
crown
• Minimal root or bone resorption is seen
radiographically.
4 groups:

•Group 1- Formocresol
•Group 2- 2% glutaraldehyde
•Group 3- Iodine-Potassium iodide
•Group 4- Placebo (distilled water)
Collection of
bacterial sample.

 Transfer of
bacterial sample
Sample in
transport
medium
 Test tube scores:
Slight and clear Dense and moderate
 Growth assessment
No growth Growth present
Results
 Discussion
• The treatment procedure is carried out in 3 visits
with a period of 5-7 days.
• At the 3rd visit if the tooth was asymptomatic, it
was obturated with ZOE.
• Formocresol and 2%Glutaraldehyde- proves
longer duration of effectiveness under both open
and sealed conditions of the pulp chamber.
• Anaerobic infections occur when there is a
compromised blood supply or antecedent infection
by aerobic bacteria both of which produce a milieu
with a low oxygen reduction potential.
•Formocresol and 2%Glutaraldehyde- better
antibacterial efficacy compared to iodine-
potassium iodide
•Iodine-potassium iodide have longer
bactericidal effect but its duration of
antimicrobial efficacy was very short.
•Due to vapor forming activity and bactericidal
action iodine-potassium iodide is a better
medicament than 2%Glutaraldehyde which is
bacteriostatic.
•In group 4- reduction in count was mainly
attributed to extirpation and irrigation carried
out during the procedure.
 Conclusions
•The antibacterial efficacy of Formocresol and
2%Glutaraldehyde was higher when compared
to iodine-potassium iodide.
•Use of formocresol resulted in significant
reduction of counts in aerobic and anaerobic
bacteria after placement of closed dressing.
•Iodine-potassium iodide did not show any
significant antibacterial efficacy against both
aerobes and anaerobes.
Thank you..