Volume 18, Issue 1 Ver. Ahmed dental college and hospital 4-Professor, Department of pedodontic and preventive dentistry, DR. Ahmed dental college and hospital 5- Professor and H. D, Department of pedodontic and preventive dentistry, DR.
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Volume 18, Issue 1 Ver. Ahmed dental college and hospital 4-Professor, Department of pedodontic and preventive dentistry, DR. Ahmed dental college and hospital 5- Professor and H. D, Department of pedodontic and preventive dentistry, DR. Ahmed dental college and hospital Corresponding Author: Himadri pal Abstract: Elimination of microorganisms from the root canal is the main procedure for endodontic treatment. Cleaning and shaping is not so much effective for reducing bacterial count in root canals.
This procedure may fail due to survival of resistant microorganisms in dentinal tubules and canals due to inaccessibility of mechanical instrument and irrigation. Non-toxic Intracanal medicament are capable of destroying bacteria, reducing inflammation and stimulating hard tissue formation which is useful in success of root canal treatment after completion of chemomechanical preparation.
The antimicroial activities of medicaments act against obligate and facultative anaerobic bacteria commonly found in root canals.
Irrigants and invasive medicaments can be adopted for chemical treatment of root canals. Comprehensive research is required to identify a suitable intracanal medicament because no such medicament completely fulfills all the categories. However, Calcium Hydroxide is a gold standard medicament with many disadvantages.
Keyword: Microorganisms, Intracanal medicament, Chemomechanical preparation, Irrigants, Calcium Hydroxide Date of Submission: Date of acceptance: I. Introduction The main etiological factor of pulp and periradicular diseases is Microorganisms1. If bacteria invade into root canals, infection, necrosis and apical periodontitis occurs.
The first and foremost criterion of endodontic treatment is to remove and deactivate all types of microorganisms in the root canal 2. There are mainly three stages of endodontic treatment procedure like,biomechanical preparation, disinfection and obturation of the root canal3.
However, its role is secondary while applying controlled asepsis technique in an infected root canal4. Different medicaments with different chemical natures are applied to eradicate multiple microorganisms with single dose in different ratio5. For disinfecting root canals advanced technology are developed, like, photoactivated disinfection, ultrasonics, endox, ozone, lasers and electrochemically activated water. Long effective intracanal medicaments are applied to inactivate bacterial inflammatory consequences between endodontic appointments.
Justification of intracanal antiseptic medicament: The main rational behind intracanal medicament is to kill the bacteria inside the root canal and to avert reinfection. In absence of nutrients, the bacteria remains after obturation in root canal may die. If they survive, they may flourish. The bacteria which remain in dentinal tubules cannot be removed through chemo mechanical preparation.
If the root canal is not dressed properly with antiseptic medicaments between the visits, the residual bacteria may increase in same number as it was in the starting stage of treatment. Thus the use of effective intracanal medication for disinfection of root canal is necessitated6. Medicament with long effect and least irritated to periradicular tissue has to be introduced to infiltrate the dentinal tubule eliminating bacteria when time does not allow to complete the treatment at one visit.
As the effect of intracanal medicaments is longer than irrigants, it is generally recommended to fill the root canal between appointments with intracanal medicaments. Ideal properties of intracanal Medicaments: a. It should bear germicide and fungicide effect. It should be non-irritating. It should act in solution DOI: It should have a long lasting antibacterial effect.
It has to act in presence of blood, serum and protein derivatives of tissue. It must penetrate the tissue deeply. It should keep quiet while repairing periapical tissues. It should leaststrenuous to tooth structure i.
It should be easily employed into the root canal. It has to bear characteristic which may keep it inactivated or neutralized in culture medium. It should prevent coronal microleakage and not diffuse through the temporary restoration7. Objectives of intracanal medicaments 1.
Destruction of micro-organisms: The main objective is to kill all viable microorganisms or to disinfect all pathogens in the canal space. If this process applied successfully, it can deactivate those residual bacteria remains in pulp space.
Prevention or control of post-treatment pain: The main indication is to lessen or alter the inflammatory effect. Medicament will execute this with its antimicrobial action or by pharmacologically altering the inflammatory effect. Pain with inflammation can be reduced by this application. Chemical or pharmacological action of medicament by direct application on sensory nerves in the pulp or periapical tissues may also regulate the pain.
Enhancing Anesthesia: In the condition when pulp is difficult to anesthetize, suitable agents are being administered to reducethe sensitivity of the inflamed pulp. The pulp could be removed during appointments with less anesthetic difficulty.
To subside this difficult situation, intra canal medicaments have been suggested. Direct access of this agent is required in the periapical lesions. The agent in the canal space would have direct access to the periapical lesions. For this it can restore a healthy balance5. Factors influencing antiseptic action Antisepsis is a condition which can prevent or arrest the growth or micro-organisms on living tissues.
In case of breach in the chain of asepsis, antiseptic measures are required to prevent infection in vital pulp extirpation. To prevent micro-organisms growth, irrigating solutions and inter appointment dressings with antibacterial effect may be administered8. It is evident that the residual microbial population of the canal will increase in number following root canal preparation if intra canal medicament is not used.
Antiseptic medicament having capabilities of killing all species of micro-organisms liable to be present is required to be used. The medicaments are required to be active in the presence of protein derivatives and should not limit its own diffusion by precipitation of albumin when tissue fluid may enter through apical foramen.
It should also be easily diffusible to reach organisms placed in the minor irregularities of the canal. Diffusion of the agent in an apical direction is obviously suggested9. Drugs antibiotics : For root canal antisepsis, highly perform bactericidal antibiotics are used. The selected properties of the antibiotics are: 1 In presence of tissue fluid they are not inactive. It is seen there is no such single antibiotic effective against all micro-organism present in contaminated root canals.
So, a combination of antibiotics or one or more antibiotics with chemical antiseptic is required. But there is some drawbacks of antibiotics: 1 Microorganism resistant strains may develop.
DOI: For treating root canal infection and periapical irritation, administering antibiotic paste is usually effective than chemical antiseptics as antibiotics are less irritant to periapical tissue. However, it is not clear to use antibiotic paste in widened apical foramen with immature teeth or caused by unintentionally over use of instrumentation.
It is evident that chemical antiseptics lose effectiveness more rapidly than antibiotic preparation within a root canal. Hence the use of antibiotic preparation is advantageous when the interval between second last visit and the visit at which the tooth is root filled count as far as 14 days.
Considering the allergic reaction, a patient should not be administered a preparation containing an antibiotic which is known to be case sensitive9. Micro-organisms: While selecting intracanal dressings, microbial composition of infected root canals is an important factor.
These intracanal medicaments come in contact in different types of micro-organisms. As a result of this it inhibits osteoclastic activities in root resorption and stimulate tissue repair. Location of micro-organisms: It is a matter of concern for treating the complexity of an infected pulp necrosis which is related to mere presence of bacterial organisms throughout the pulp chamber and the fact that they may be lodged in areas such as lateral canals, isthmuses, crevices and dentinal tubules where instrument and disinfection could not get access.
It is difficult task for a clinician for cleaning the entire circumferences of oval shaped canals due to presence of necrotic tissue and debris. Another difficult task is the bacteria present in dentinal tubules. The aspects which stimulate the antiseptic action are- 1.
Trauma: The tooth should be disoccluded at times under treatment. Devitalized tissue: It will restrict the disinfection or repair, if present in the root canal or periapical tissue. Dead space: The medicament should be applied into the root canal in such a way that it may contact with tissue to be sterilized. Accumulation of exudate: As the exudate accumulates, it should be allowed to drain or be removed.
It is pertinent to change the root canal dressings once or twice a week for renewing the medication and for removing the exudate by means of absorbent points.
Foreign body: Root resection or curettage should be executed to eradicate the foreign body present in the periapical tissue7. Prevention, minimization and elimination of infection are the principles of judicious endodontic therapy which are difficult tasks within the condition of a canal system Classification: According to Grossman6 intracanal medicament can be classified as 1. Eugenol: Eugenol is the chemical essence of clove oil and is related to phenol to some extent.
It is both an antiseptic and an anodyne and is moderately more irritating than clove oil. It becomes dark with age and is a pale yellow liquid. It has little bit anesthetic as well as antiseptic properties and contain clove like odor6. Phenol: In , Lord Lister used phenol as medicine which is one of the oldest antiseptic. It is derived from coal tar as white crystalline substance and has a specific odor. By adding camphor, menthol or thymol phenol crystal is become liquefied which consists of 9 parts phenol and 1 part water commonly known as carbolic acid.
This phenolic compound is used as sedatives for the pulp tissue, as root canal medications and as disinfection for caries cavity preparation, as disinfection before periapical surgery and for cauterizing tissue tags that resist removal with broaches or files in dental treatment.
Phenol is notified as coefficient which is compared with one time antimicrobials for their disinfectant action.
Parachlorophenol: It turns dark upon exposure to light and is a colourless needle like crystals alike phenol. Chlorine replaces one of the hydrogen atoms of phenol so parachlorphenol C6H4OHCl compound is formed.
Overview on the Current Antibiotic Containing Agents Used in Endodontics
Intracanal medicaments have been thought as an important step in killing the bacteria in root canals; however, in modern endodontics, shaping and cleaning has been emphasized greater importance than intracanal medicaments as a means of disinfecting root canals. Furthermore, biocompatibility and stability are essential properties for intracanal medicaments. The more modern meaning of intracanal dressing is for a blockade against coronal leakage from the gap between filling materials and cavity wall. Calcium hydroxide has been determined as suitable for use as an intracanal medicament as it is stable for long periods, harmless to the body, and bactericidal in a limited area.
ANTIBACTERIAL EFFICACY OF INTRACANAL MEDICAMENTS ON BACTERIAL BIOFILM: A CRITICAL REVIEW
The results of the analysis demonstrated inefficacy of intracanal medicaments on bacterial biofilm. DISCUSSION Systematic reviews, associated or not to meta-analyses, represent major positions at the evidence pyramid towards a direct decision making, capable to indicate clinical procedures certificated by more trustable arguments. The major difficulty found in the present study was the great deal of available information, and the large number of investigations with agreeing and disagreeing conclusions. Scientifically based evidence that confirms the efficacy of intracanal medicaments on bacterial biofilm involves a profound reflection and discussion, regardless of the limits and caution with the methodology 16 , 17 , 21 , 36 , Longitudinal studies signalize that there is yet no accurate solution to eliminate or disrupt the root canal bacterial biofilm. However, the results of this critical review confirmed that root canal preparation, with careful disinfection and use of intracanal substances that provide good antimicrobial efficacy, tissue dissolution capacity, and acceptable biocompatibility, will definitely improve the prognosis of the treatment of apical periodontitis 25 , From a total of 91 articles, 8.