Intracanal Medication

Question 1

Chong & Pitt Ford 1992

Answer 1

• Eliminate any remaining microbes after instrumentation
• Reduce periradicular inflammation and pain
• Help eliminate apical exsudate
• Prevent or arrest inflammatory root resorption
• Barrier aigainst leakage from temporary filing

Question 2

Biocompatibility after initial toxicity. Encourage periapical healing. Inhibition of root resorption. Tissue dissolving ability. Detoxification of residual endotoxins

Answer 2

Siqueira 1999

Question 3

Siqueira 1999 (Ca(OH)2)

Answer 3

Biocompatibility after initial toxicity. Encourage periapical healing. Inhibition of root resorption. Tissue dissolving ability. Detoxification of residual endotoxins

Question 4

Properties of Ca(OH)2

Wang 1988

Answer 4

Dentin buffering decrease its efficacy

Question 5

Efficacy of Ca(OH)2

Byström 1985

Answer 5

Pedictable negative cultures from infected root canals can be obtained by using Ca(OH)2 intracanal medicament

Question 6

Efficacy of Ca(OH)2

Shupping 2000

Answer 6

Ca(OH)2 medicament results in more predictable elimination of bacteria from root canal

Question 7

Efficacy of Ca(OH)2

Peters 2002

Answer 7

Bacterial regrowth occured despite the Ca(OH)2

fewer voids using a lentulo spiral 2mm short to the WL and #40 with 0.04

Question 8

CHX gel is effective against E. Faecalis and C. Albicans

Answer 8

Ercan 2006

Question 9

Vehicles of Ca(OH)2

Zerella 2005

Answer 9

Precipitation of CHX due to high pH of Ca(OH)2 could have made CHX less effective. Deprotonation of CHX at pH>8 leads to reduced solubility (decrease of effectiveness of CHX when mixed with Ca(OH)2).

Question 10

E. Faecalis

Stuart 2006

Answer 10

• E. Faecalis is a Gram+ facultative anaerobe
• Primary infection : 4 - 40%. Retreatment with PA lesion : 24 - 77%
• Resists intracanal medicaments
• Synthesis of stress proteins
• Binds to dentin and invades dentinal tubules
• Form biofilms in medicated canals and establish mono-infections in medicated canals
• Endure prolonged periods of starvation

Question 11

Sundqvist 1998 (E.faecalis)

Answer 11

The failure rate of retreatment is higher when E.faecalis is present at the time of root filing

Question 12

Antibiotics (intracanal medication) Chu 2006

Answer 12

Antibiotic/steroid combinations or Ca(OH)2 as intracanal medicaments have similar outcomes.

Question 13

Antibiotics (intracanal medication)

Windley 2006

Answer 13

Triple ATB paste is effective in disinfection of immature teeth with periodontitis

Question 14

CHX

Oncag 2003

Answer 14

NaOCl had significantly less antimicrobial effect than CHX2%. CHX had lower toxicity than NaOCL

Question 15

CHX

Zamary 2003

Answer 15

Canals with final rinse CHX 2% had lower cultivable bacteria than those with NaOCl

Question 16

CHX

Delgado 2010

Answer 16

CHX gel 2% is more effective at eliminating E. faecalis as an intracanal medicament than Ca(OH)2 alone

Question 17

CHX

Delgado 2013

Answer 17

CHX gel 2% is more effective at eliminating C.Albicans as an intracanal medicament than Ca(OH)2 alone

Question 18

CHX

Okino 2004

Answer 18

CHX were unable to dissolve tissue

Question 19

CHX

Yamashita 2003

Answer 19

CHX don’t remove smear layer

Question 20

CHX don’t remove smear layer

Answer 20

CHX

Yamashita 2003

Question 21

CHX were unable to dissolve tissue

Answer 21

CHX

Okino 2004

Question 22

CHX

Akisue 2010

Answer 22

NaOCl with CHX : formation of precipitate should be avoid

Question 23

NaOCl with CHX : formation of precipitate should be avoid

Answer 23

CHX

Akisue 2010

Question 24

Dentin buffering decrease efficacy of Ca(OH)2

Answer 24

Properties of Ca(OH)2

Wang 1988