26 Intracanal Dressings
A temporary intracanal dressing is necessary when an endodontic treatment cannot be completed in a single visit because an empty root canal system will be recolonized by bacteria within a short time. In infected cases with pulpal necrosis, the application of an intracanal medication in addition to chemo-mechanical preparation is recommended in order to reduce the number of remaining microorganisms.
However, the extent to which the application of calcium hydroxide might increase the rate of clinical success remains unclear (Sathorn et al., 2007). The current standard medication is an aqueous solution of calcium hydroxide (Rödig and Hülsmann, 2005), but the use of chlorhexidine (CHX) gel or a combination of calcium hydroxide and CHX has been discussed (Rödig, 2006, Turk et al., 2009).
For patients with acute pain, the application of Ledermix (Riemser, Greifswald, Germany) has been suggested, primarily in Europe (this combination of antibiotics and corticosteroids is not available worldwide). The use of chlorphenol-containing dressings is not recommended because these substances have severe cytotoxic effects and exhibit questionable antimicrobial activity.
26.1 Drying the root canals
Left: The standard procedure for thoroughly drying the root canals comprises the repeated use of sterile paper points inserted to working length.
Middle: The dryness of the paper points is assessed by visual inspection and stroking the paper point against a mouth mirror or the rubber dam.
Right: If the withdrawn paper point exhibits any evidence of apical secretions or hemorrhage, a definitive root canal obturation is not indicated at this time.
26.2 Application of the dressing
Left and middle: The placement of the dressing should be performed with a Lentulo spiral or a thin injection needle (Ultracal, Ultradent, South Jordan, UT, USA) which provides application to the apical part of the root canal system.
Right: Following initial application the dressing is compacted apically (courtesy of T. Attin).
