|Year : 2014 | Volume
| Issue : 2 | Page : 85-88
Efficacy of Ledermix as a root canal medicament in symptomatic teeth: A clinical study
M Kundabala1, S Jagadish2, S Ramya3
1 Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Mangalore, India
2 Department of Conservative Dentistry and Endodontics, Government Dental College, Bengaluru, Karnataka, India
3 Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, India
|Date of Web Publication||15-Oct-2014|
Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Mangalore
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Intracanal medication is adjunct to cleaning and shaping in reducing postoperative pain and tenderness in symptomatic teeth. The present clinical study aimed to investigate the effectiveness of Ledermix paste as intracanal medicament in symptomatic teeth using the eugenol as control. Access cavity was prepared for 30 symptomatic teeth,Intracanal medicament was placed. Incidence of post access pain and tenderness were evaluated. Ledermix showed faster action than eugenol in reducing symptoms i.e.within 72 hrs.
Clinical Relevance To Interdisciplinary Dentistry
- Intracanal medicament is very important to control the infection and symptoms even after the root canal therapy for better prognosis
- With good longacting intracanal medication ,prognosis of post-endo restoration will be better and it helps in clinical success of the cases.
Keywords: Antimicrobial, bacteria, endodontics, intracanal medicaments
|How to cite this article:|
Kundabala M, Jagadish S, Ramya S. Efficacy of Ledermix as a root canal medicament in symptomatic teeth: A clinical study. J Interdiscip Dentistry 2014;4:85-8
|How to cite this URL:|
Kundabala M, Jagadish S, Ramya S. Efficacy of Ledermix as a root canal medicament in symptomatic teeth: A clinical study. J Interdiscip Dentistry [serial online] 2014 [cited 2020 Sep 19];4:85-8. Available from: http://www.jidonline.com/text.asp?2014/4/2/85/142944
| Introduction|| |
The ultimate goals of endodontic treatment are to remove as many bacteria, their byproducts, and pulpal remnants from the infected root canal system and then to create an preparation with antimicrobial agents, such as chemical irrigants and/or intracanal dressings, environment in which any remaining organisms cannot survive by sealing the disinfected root canals completely.  The success of infected root canal treatment is dependent on inactivation help us to achieve the goal through the use of a combination of aseptic treatment techniques. Root canal can contribute for endodontic microbiota reduction.  The choice of which intracanal medicament to use is dependent on having an accurate diagnosis of the condition being treated of microorganisms present in the biofilm and planktonic ambiance. Thorough chemomechanical preparation, antimicrobial irrigating solutions, and intracanal medicaments
Microbial invasion of the root canal system is time related and bacterial species dependent. Hence, early endodontic treatment of a tooth should minimize the number of micro-organisms lodged in the dentinal tubules. Micro-organisms in dentinal tubules may constitute a reservoir from which root canal and surrounding tissue infection and re-infection may occur.  Bacteria located inside dentinal tubules are protected from host defense cells, systemic antibiotics and chemo-mechanical preparation. Due to the potential risk of adverse effects following systemic application, and the effectiveness of systemic antibiotics in necrotic pulpless teeth and the periradicular tissues, the local application of antibiotics may be more effective mode of delivery in endodontics.  Therefore, endodontic medicaments must be able to penetrate into dentinal tubules and kill bacteria within them.  Periradicular tissue repair can be encouraged by the use of intracanal medicaments by creating an environment that is conducive to bone and/or cemental repair.
Pain before, during and after endodontic therapy is of serious concern both to the patient and to the endodontist. To deal with symptoms, antiinflammatory agents have to be incorporated with these intracanal medicaments. The primary interests in developing Ledermix paste was based on the use of corticosteroids to control pain and inflammation associated with pulp and periapical diseases. 
Medicaments such as Ledermix (Lederle Pharmaceuticals, Wolfsratshausen, Germany) are capable of diffusing through dentinal tubules and cementum to reach the periodontal and periapical tissues. Abbott et al. showed that the dentinal tubules were the major supply route of the active components to the periradicular tissues, whereas the apical foramen was not as significant as a supply route. 
Medicaments that combine antibiotics and corticosteroid elements are highly effective in root canal therapy. The corticosteroid constituent reduces periapical inflammation and gives almost instant relief of pain and reduces inflammation of the periapical region of the patient who complains of extreme tenderness to percussion after the canal instrumentation and the antimicrobial properties are catered by antibiotics.
An antibiotic/corticosteroid combination, Ledermix has been extensively used in various parts of the world in paste and cement forms as both a vital pulp dressing and a root canal medicament. Components of the medicament are given in [Table 1]. Studies have shown the placement of Ledermix paste to reduce the incidence of pain following initial canal debridement. , Hence, present study was conducted to confirm the efficacy of Ledermix paste in controlling pain and tenderness in symptomatic teeth during the root canal therapy.
| Materials and methods|| |
Thirty symptomatic, both anterior and posterior teeth were selected for the study, irrespective of age and sex. The cases included had pain in relation to particular tooth and tenderness on percussion. The cases with medical complications, teeth with anatomical difficulties like calcified canals, severe dilacerations and teeth with endo-perio lesions were excluded from the study. Teeth were randomly grouped into two groups (Group I and II) of 15 teeth each. Varying degrees of pain and tenderness were evident in all the teeth that were subjected for analysis. Following the caries removal, teeth were disinfected with Moller's technique (30% H 2 O 2 for 1 min before access preparation after the access H 2 O 2 for 10 s +2% tincture iodine for 1 min. I2 is deactivated with 5% sodium thiosulphate). Standard access cavities were prepared for all the teeth under rubber dam as described by Ingle. Pulp extirpation, if any was done with sterile barbed broach (SPIRO® COLORINOX® , Dentsply, Maillefer). Cleaning and shaping are done using step-back technique with K-files (COLORINOX® , Dentsply, Maillefer) and 2.5% NaOCl and saline irrigation. Group I was treated with Ledermix (Lederle Pharmaceuticals, Wolfsratshausen, Germany) as intracanal medicament, coating it using letulospirals and Group II with eugenol liquid, by keeping the eugenol soaked cotton in the pulp chamber. Postaccess clinical evaluation was carried out to evaluate incidence and severity of pain and tenderness and the responses were recorded after 24 h, 72 h, 1-week and 2 weeks and data were recorded. Grading for pain and tenderness is given in [Table 2] and [Table 3].
|Table 2: Incidence of pain in two different groups at different time intervals|
Click here to view
| Results|| |
Within 2 weeks, all the teeth became asymptomatic. Severity of pain and tenderness were noted [Table 4] and [Table 5] and statistical analysis was done with Fishers exact test df = 12. χ2 = 62.43 (P = 0.017) for pain and 63.305 for tenderness (P = 0.035). Ledermix reduced the pain faster than Eugenol. According to the results, there is a reduction of pain in 24 h showing a co-relationship between pre and postoperative pain. In the present study, after 72 h, Ledermix showed excellent results with 100% relief of symptoms which was statistically significant, whereas, in Group II, pain persisted in few cases even after 72 h. One of the cases showed severe postoperative pain after 72 h in Group II, could be because of over-instrumentation. There was no difference in the severity of pain experienced between posterior and anterior teeth in the present study. No adverse systemic reactions were found in any of the cases.
| Discussion|| |
The present clinical study aimed to investigate the effectiveness of Ledermix paste as intracanal medicament in symptomatic teeth using the eugenol as control. Since Ledermix paste satisfy the general requirements of root canal medicaments, an attempt has been made to validate the benefits of Ledermix paste in symptomatic teeth.
The inter-appointment medication of root canals is shown to be a predictable means of eliminating bacteria from root canal systems and a reliable method for reducing periapical inflammation and stimulating hard tissue formation. In general, it takes 10-15 days for an inflammation to subside. The use of antiinflammatory medicaments can provide rapid relief of symptoms. Corticosteroids have been suggested for the management of postoperative pain in endodontics. ,
Corticosteroid efficacy in decreasing inflammation secondary to instrumentation was shown by Smith et al. in a histological study in which dogs were used. It has been considered that the topical contact of the steroid preparation to the pulp or periapical tissues can bring about symptomatic relief from endodontically related pain .  Nevertheless, corticosteroids have also been shown to interfere with the repair process. This interference includes an inhibition of fibroblastic proliferation and a decrease in polymorphonuclear leukocyte locomotion. In addition, corticosteroids interfere with the immune response, which could disseminate bacteria leading to infectious disease. Considering these potential pitfalls, some investigators have advocated supplemental use of an antibiotic to help control infection. Ledermix paste has both a corticosteroid-triamcinolone and an antibiotic-demethyl chlortetracycline. To take benefits of both Ledermix was used in this study. ,
In the present study, pre and postoperative signs and symptoms such as pain and tenderness have been tabulated. Severity and intensity of pain was recorded before starting treatment.Pain was grouped under the categories-mild pain, moderate pain and severe pain. The patients subjectively rated their pain on a scale of 0-100 as "none," "mild," "moderate," and "severe" (0 = none, 1-33 = mild, 34-66 = moderate, 67 and above = severe).  Tenderness was also recorded at the same intervals and grouped as mild, moderate and severe tenderness. When the tooth caused discomfort for a heavy blow with a metal instrument, it was considered mildly tender. When the tooth was tender for a light blow, it was considered moderately tender. When the tooth was severely painful even on light finger pressure, it was considered as severely tender [Table 4] and [Table 5].
Genet et al. conducted a study on the postoperative pain reduction and found that, usually, there is a reduction in endodontic pain to a tolerable level within 3 days, which is in agreement with the present study.  Ledermix showed 100% relief of symptoms and eugenol definitely reduced the pain within 72 h, which concludes intracanal medicaments help in the reduction of symptoms postoperatively. However, intracanal medication is no panacea and does not substitute or is an alternative for poor debridement. The present study is in agreement with the study done by O'Keefe on painful teeth that have undergone endodontic therapy and found a significant relationship between pre and postoperative pain.  The present study showed total relief from postoperative pain and tenderness after 72 h in Group II where the Ledermix was used as intracanal medicament during the endodontic therapy. In Group I, where eugenol was used as intracanal medicament, total relief from pain and tenderness was found only after 2 weeks. This shows Ledermix is a very effective intracanal medicament for symptomatic teeth. Further studies are required with more sample size to prove the results of the present study.
The present study concluded:
- Intracanal medication is adjunct to cleaning and shaping in reducing postoperative pain and tenderness in symptomatic teeth
- Ledermix is a better intra canal medicament than eugenol in reducing postoperative pain in symptomatic teeth during root canal therapy
- Ledermix acts quicker than eugenol in reducing symptoms that is within 72 h
- Postoperative pain and tenderness were completely controlled, both with Ledermix and eugenol within 2 weeks
- No adverse systemic reactions found in any patients while using Ledermix.
| Acknowledgment|| |
We thank Dr. Alex Moule, Endodontist, Brisbane, Australia for providing the Ledermix paste and giving us the professional guidance.
| References|| |
|1.||Kawashima N, Wadachi R, Suda H. Tokyo, Japan Thai Yen gang Peter Parashos Melbourne, Australia; FDI Science Committee Project 4-00. Int Dent J 2009;59:5-11. |
|2.||Estrela C, Estrela CR, Decurcio DA, Hollanda AC, Silva JA. Antimicrobial efficacy of ozonated water, gaseous ozone, sodium hypochlorite and chlorhexidine in infected human root canals. Int Endod J 2007;40:85-93. |
|3.||Akpata ES, Blechman H. Bacterial invasion of pulpal dentin wall in vitro. J Dent Res 1982;61:435-8. |
|4.||Mohammadi Z, Abbott PV. On the local applications of antibiotics and antibiotic-based agents in endodontics and dental traumatology 2009;42:555-67. |
|5.||Siqueira JF Jr, Lopes HP. Mechanisms of antimicrobial activity of calcium hydroxide: A critical review. Int Endod J 1999;32:361-9. |
|6.||Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J 2007;52:S64-82. |
|7.||Abbott PV. Medicaments: Aids to success in endodontics. Part 1. A review of the literature. Aust Dent J 1990;35:438-48. |
|8.||Ehrmann EH. The effect of triamcinolone with tetracycline on the dental pulp and apical periodontium. J Prosthet Dent 1965;15:144-52. |
|9.||Ehrmann EH, Messer HH, Adams GG. The relationship of intracanal medicaments to postoperative pain in endodontics. Int Endod J 2003;36:868-75. |
|10.||Moskow A, Morse DR, Krasner P, Furst ML. Intracanal use of a corticosteroid solution as an endodontic anodyne. Oral Surg Oral Med Oral Pathol 1984;58:600-4. |
|11.||Negm MM. Intracanal use of a corticosteroid-antibiotic compound for the management of posttreatment endodontic pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:435-9. |
|12.||Smith RG, Patterson SS, El-Kafrawy AH. Histologic study of the effects of hydrocortisone on the apical periodontium of dogs. J Endod 1976;2:376-80. |
|13.||Abbott PV, Hume WR, Pearman JW. Antibiotics and endodontics. Aust Dent J 1990;35:50-60. |
|14.||Langeland K, Langeland LK, Anderson DM. Corticosteroids in dentistry. Int Dent J 1977;27:217-51. |
|15.||Hume WR, Massey WL. Keeping the pulp alive: The pharmacology and toxicology of agents applied to dentine. Aust Dent J 1990;35:32-7. |
|16.||Genet JM, Hart AA, Wesselink PR, Thoden van Velzen SK. Preoperative and operative factors associated with pain after the first endodontic visit. Int Endod J 1987;20:53-64. |
|17.||O'Keefe EM. Pain in endodontic therapy: Preliminary study. J Endod 1976;2:315-9. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]