Root canal therapy

and Agents used in

root canal therapy
Dr. Roomana
Lecturer
Pharmacology department
Steps of root canal therapy
 Local anesthesia
 2 % lidocaine
 Infiltration in maxilla(pulpal anesthesia achieved in 10-15 min
 Inferior alveolar block in mandible ( pulpal anesthesia in 3 –6 mins)
 Isolation by application of rubber dam or cotton rolls
 Patient are protected from laceration by instruments
 From swallowing or aspirating instruments
 Risk of aerosol is minimized
 Access opening
 Fissure bur attached with high speed hand piece to get straight line
access that extends through surface of tooth to pulp chamber
 Location of canals
 Removal of chamber roof and pulpectomy.
Rubber dam
 Working length
 File placed in canal and radiograph taken , tip of file 1 mm short of
radiographic apex
 Stopper should physically contact in coronal reference point
 Cleaning and shaping of root canals
 removes necrotic pulp
 Shaping involves enlarging canals with the help of files in order to
create flared preparation that is most favorable for procedures like
sealing , obturation etc.
 Irrigation and lubrication
 Carried out during cleaning and shaping for chemical cleansing
with saline.
 Application of intra-canal medicaments and
temporary filling.
 On 2nd appointment
 Removal of filling , drying of canals with paper points.
 Then application of sealer usually endomethasone.
 Filling of canals with gutta percha , it comes in
preformed cones whose dimension match the size of
the file that have been used to prepare the canal.
K files
Paper points
Gp points
Pharmacological agents used in RCT
 Irrigatingsolutions
 Chelating agents
 Intra-canal medicaments
Irrigating solutions
 Distilled water
 Saline
 Sodium hypochlorite *(Important)
 Sodium hypochlorite in conjunction with
hydrogen peroxide or EDTA
 30% solution of urea
 Solution of chloramine
Ideal properties of irrigating solution
 Organic tissue solvent
 Inorganic tissue solvent
 Antimicrobial action
 Nontoxic
 Low surface tension
 lubricant
Saline
 Isotonicwith tissues
 Doesn’t have antimicrobial effect
Sodium hypochlorite*
 Most common irrigant known as household bleach
 Mechanical flushing of debris from canal
 Low surface tension** so dissolves organic tissue in canal
 Antimicrobial
 Lubricant
 Mechanism*
 Destruction of necrotic tissue:

Free chlorine in NaOCl dissolves necrotic tissue by

breaking down proteins into amino acids thus is a reducing
agent.
 Destruction of bacteria:

Destruction of bacteria takes place in 2 phases

 Penetration into bacterial cell wall
 Chemical combination with protoplasm of bacterial cell
and destruction.
 0.5% to 2.5% concentration
 2.5% decreases the potential for toxicity yet maintains
tissue dissolving and antimicrobial activity
 Clear straw coloured solution.
 Unstable when diluted so stored in cool place and
protected from drying
 5.2% solution dissolves the entire pulp in 20 minutes to
2 hours
 Disinfection is initially slow but increases rapidly
 Placement into canal
 Irrigating needle with syringe is placed loosely
in the canal
 Irrigant does not move apically more than 1
mm beyond the irrigation tip so deep placement
with small needles enhances irrigation
 During rinsing, needle is moved constantly up
and down to prevent binding of the needle.
Combination of NaOCl 2.5%and
hydrogen peroxide 3%
 The effervescent in which it mechanically
bubbles and pushes debris out of the root canal
through the least resistant orifice into the
chamber
 The solvent action of the sodium hypochlorite
on the organic debris of pulp tissue
 The disinfecting and bleaching action by
solutions
 Always use NaOCl at last because hydrogen
peroxide can react with pulp debris and blood
to form gas .
 Any trapped gas within the tooth will cause
continuous pulpal pain
 NaOCl is used after irrigation of root canal
with EDTA which removes the smear layer
Chelating agents
 Chelating agents are claimed to remove the
inorganic component of the smear layer from
root canal dentin, being commonly used for
final irrigation during endodontic treatment 
 EDTA (Ethylenediaminetetraacetic acid) 
 R-C prep
 EDTAC

the combination of EDTA with a wetting

agent Cetrimide
 Purpose
 Lubrication
 Emulsification
 Decalcify calcified canals
 Formulated for clinical use and can be selected
in either a viscous suspension or aqueous
solution
 Discourages tissue adherence and accelerates
emulsification by leaving a favorable pilot hole
which facilitates introduction of next
sequentially larger instrument.
 Chelators are used for shorter periods of time
as their protracted use can soften dentin and
predispose to iatrogenic events.
EDTA 17 %
 Relatively nontoxic
 Only slightly irritating in weak solutions
 Forms highly unstable soluble, metal chelates in
combination with heavy metals of alkaline earth
ions
 Functions by forming a calcium-chelate with a
calcium ion of dentin.
 The dentin thereby becomes more friable and
easier to instrument.
Effects of EDTA
 Irrigation to remove smear layer by softening of
dentin
 Antimicrobial
 Extent of deminerlization of EDTA is
propotional to exposure time
 In 5 mins, deminerization is 20 to 30microns
depth in dentin
 Capable of moderate degree of irritation
Placement into canal
 Inserted by depositing a few drops in pulp
chamber with a syringe or plastic pipette and
then carefully pumping the solution into the
root canal with a file root canal system
EDTAC
 Its salt may be used to chelate calcium ions of tooth
structure and decalcify dentin
 The formula is
 Disodium salt of EDTA 17 g
 Distilled water 100 ml
 Sodium hydroxide 9.25 ml
 If desired 0.84 g of disinfectant CETAVLON is added
 This is 15 % solution of EDTA with ph 7.3 with
cetavlon
RC prep
 Combination of EDTA and urea peroxide
 Also a lubricant for root canal
 Encourages floatation of pulpal remnants and
dentinal mud which reduces probability of
blocking the canal.
 Intra-canal medicaments
 Use as interim appointment dressing
 To reduce inter-appointment pain
 To decrease bacterial count and regrowth
 To render canal content inert.
Intracanal medicaments
 Phenolics
 Camphorated monoparachlorophenol
 Eugenol
 Cresol
 Creosote
 Thymol
 Aldehydes
 Formocresol
 glutaraldehyde
 Halides
 NaOCl
 KI
 Steroids
 Calcium hydroxide
 Antibiotics
 Combinations
Phenols and aldehydes
 Nonspecificaction ..destroys host tissue
 Don’t reduce inter appointment pain
Calcium hydroxide(Important)
 Effective in inhibiting microbial growth in root canal by
 Alkaline ph
 Dissolving necrotic tissue
 Release of hydroxyl ions
 Low solubility ..slow releasing system in root canal
 Physical obturation of canal , block accumulation of exudate ,
reducing potential for nutrient support for bacteria.
 Recommended for use in teeth with necrotic pulp tissue
 Available in 2 forms
 Dry powder : mixed with liquid such as anesthetic
solution ,saline ,water or glycerin.
 Or in form of paste: supplied in syringe.
 Placed into the canal by LENTULOSPIRAL.
OTHERS
 CMCP (camphor mono-chlorophenol )
 Highly toxic
 Loses much of its activity in1-5 days
 Vapor forming medicament
 Applied on absorbent paper point or cotton pellet
and placed in pulp space
 Potassium iodide
 Excellent antimicrobial activity and minimal activity
 Loses its activity in one day
 Corticosteroids
 Anti inflammatory
 Reduces post operative pain
 Used in irreversible pulpitis and acute apical
periodontitis
 Chlorhexidine
 2 % gel
 Or mixed calcium hydroxide the activity is greater
 Doesn’t remove the smear layer