Medicaments in endodontics
I. Irrigants
1. Sodium hypochlorite
Consentrations 1,5 – 6%, mostly 2,5% -6% Non stable chemical. Principle of action: ioxisation
and chloration. Wide spectrum of microbs affected. Dissolvs organic materiál – rests of
dental pulp, biofilm. It can be activated with ultrasound, sonic activator and laser.
2. Chlorhexidin
Antiseptic agent.(Chlorhexidini gluconas) Chlorhexidin is bisbiguanid effective against wide
spectrum of microbs partly also vuruses. For root canal irrigation 0,12% or 0,2% roztok. Birret
taste and discoloration of teeth (brown colour).
No combination with NaOCl – toxic precipitate.
3. EDTA
Ethylendiaminotertaacetic acid – chelator.Is is able to create complex compounds with
calcium - it dissolves inorganic part of smear layer. It is used in combination with other
orrogants since its antimicrobial effect is low.
4. Citric acid
Similar effect as EDTA dissolvs inorganic part of smear layer. Combination with other
irrigants. Concentration 10%- 40%.
5. Saline solution
0,9% solution of sodium chloride. In case of complication, surgical procedures in
endodontics, widely open apex, isotonic, no antimicrobial effect.
II. Disinfectants and antiseptics
II.a Cacium hydroxide
Alcalic - pH12,5.
Low solubility cca z 1 %. Suspensions or cements. Suspension can be prepared mixing of
calciumhydroxide with water. Ready made materials contain glycerin, methylcelulose.
These are suspensions.
There are also cements mixed of base and catalyst. Paste A contains calcium hydroxide and
plastificator N-etyltoluensulfonamid, paste B salicylates, disalicylates and fillers (baryum
sulphate, calciumsulphate, titanium dioxide). Also one component lightcuring materials are
available. Their effect is lower.
Effect of calciumhydroxide on dental pulp:
1. Stimulation of dentinogenesis.
2. Stimulation of differentiation of new odontoblasts.
3. Stimulation of tertiary dentin formation
4. Strong antimicrobial effect
5. Hemostasis
6. Dessication
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II.b Bioactive – hydraulic cements
Effect is similar to calciumhydroxide, they are not temporaries but they set into hard materiál. – they
have tight seal. The most known is mineraltrioxid aggregate – MTA. Indication vitalm pulp therapy –
pulpotomy, complications, apexifications.
II.c Disinfectants
Strong chemicals based on phenolic agents and formalin. They can be found at the market. But they
are not recommendednany longer.
III. Necrotising agent
They are used in special cases when the root canal treatment cann not be preforemed using local
anaesthesia. These medicaments are based on paraphormaldehyd, contain local anaesthetic Lidocain
and, eugenol, Peru balsam and vehiculum. It must be covered hermetically using temporary
filling materiál (one component materiál Cavit and zinkoxidphosphate cement).
IV. Antibiotics
They are indicated in case of complications when the patient has systemic symptoms. Local usage of
antibiotics is obsolete.
V. Anaestetics
Infiltration anaesthesia, nerve blocked anaestesia, PDL, intrapulpal anaesthesia are used in
Lubrikancia
VI. Lubricants
Are recommended for better effect of root canal instruments. These gels contain EDTA, carbamide
peroxide and vehicuum (gel). However sodium hypochloride has good lubrication effect due to
dissolution of organic material.