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PubMed1999

Growth inhibition of Streptococcus anginosus (milleri) by three calcium hydroxide sealers and one zinc oxide-eugenol sealer.

The inhibition of growth of Streptococcus anginosus (milleri) by three calcium hydroxide sealers--calciobiotic root canal sealer (Hygienic Corporation, Akron, OH), Sealapex (Kerr Division, Sybron Corporation, Romulus, MI), and Apexit (Vivadent, USA, Amherst, NY)--was compared with a zinc oxide-eugenol sealer: Roth (Roth International, Chicago, IL). Sixteen brain heart infusion agar plates were inoculated with S. anginosus. Each plate was divided into five separate areas. In each area, a 0.1 ml droplet of a given sealer was placed such that each plate had five areas with the same sealer. There were four plates (for each of the four sealers) for a total of 20 observation areas to evaluate each sealer. The plates were incubated at 37 degrees C in a 5% CO2 atmosphere. After varying periods of incubation, the zones of inhibition of bacterial growth were observed and measured. Roth sealer had a statistically significant larger mean zone of inhibition than the calcium hydroxide sealers. However, all of the sealers exhibited clinically relevant antimicrobial activity. It is likely that the eugenol in the Roth sealer is responsible for its greater antimicrobial activity.

Analysis of Variance↗
PubMed2004

Effect of calcium hydroxide and chlorhexidine based gutta-percha points on gingival fibroblasts and epithelial tumor cells.

AIMS AND METHODS: The aim of the present study was to demonstrate the possible effect of different endodontic calcium hydroxide and chlorhexidine-based gutta-percha points, on two different human cell culture systems. Two different calcium hydroxide (Roeko, Langenau, Germany) and one chlorhexidine (Activ Point/Roeko, Langenau, Germany) gutta-percha points were tested with gingival fibroblasts and epithelial tumor cells over a period of six days (n = 12). Conventional gutta-percha points (VDW, Munich, Germany) and cells that were not exposed to any substances served as controls (n = 12). Study parameters included cell vitality, cell count, protein synthesis and cell proliferation. RESULTS: All tested materials induced cell growth specific alterations. Chlorhexidine-based gutta-percha points showed a significant lower protein synthesis with both, gingival fibroblasts (0.013 +/- 0.009 mg/ml) and epithelial tumor cells (0.07 +/- 0.039 mg/ml), when compared with the controls (p > 0.05). Protein synthesis increase of the epithelial tumor cells (0.581 +/- 0.013 mg/ml, control) was observed with the conventional gutta-percha points (0.688 +/- 0.078 mg/ml) and with both gutta-percha points containing different calcium hydroxide-based formulations (0.776 +/- 0.115 and 0.7 +/- 0.047 mg/ ml). CONCLUSIONS: Under the conditions of this study, chlorhexidine containing gutta-percha points showed the highest effect on cell growth inhibition. No significant differences were observed between the tested material and the two different cell culture types.

Adult↗
PubMed2006

In vitro evaluation of the susceptibility of endodontic pathogens to calcium hydroxide combined with different vehicles.

The aim of this study was to investigate in vitro the antimicrobial activity of calcium hydroxide [Ca(OH)2] in combination with different vehicles against endodontic pathogens. For such purpose, a broth dilution test was performed. Pastes were prepared with Ca(OH)2 powder and the following vehicles: sterile water, glycerin, camphorated monochlorophenol (CMCP), CMCP + glycerin, polyethyleneglycol and CMCP + polyethyleneglycol. The time required for the pastes to produce negative cultures against the tested microorganisms was recorded and analyzed statistically using the Kruskal Wallis test at 5% significance level. Timing for pastes to eliminate the aerobic and facultative anaerobic microorganisms ranged from 6 to 24 h, while strict anaerobic microorganisms were inhibited within 30 s to 5 min. Microbial susceptibility, ranked from weakest to strongest, can be presented as follows: Enterococcus faecalis (the most resistant microorganism), Candida albicans, Staphylococcus aureus, Porphyromonas gingivalis, Porphyromonas endodontalis and Prevotella intermedia (the last two microorganisms required the same time to be eliminated). In conclusion, calcium hydroxide pastes needed more time to eliminate facultative than anaerobic microorganisms. These findings suggest that the antimicrobial property is related both to paste formulation and to microbial susceptibility.

Anti-Bacterial Agents↗
PubMed1994

Placement of calcium hydroxide in simulated canals: comparison of glycerin versus water.

Calcium hydroxide (Ca(OH)2) is an intracanal medicament used as an antimicrobial agent, temporary obturant, and for apexification. Placement should be controlled for the maximum biological effect. This study evaluated and compared the effectiveness of delivery of Ca(OH)2 mixed with water or with glycerin as to (a) length of placement and (b) density of fill at different levels. Fifty-six simulated canals with moderate curvature were prepared to #60 using the step-back technique. Ca(OH)2 was mixed with either water (28 canals) or glycerin (28 canals) into a thick paste and placed with lentulo spirals. Radiographs were made and blindly assessed. Results showed that glycerin was statistically significantly superior (p < 0.05) to water as to (a) length of fill and (b) density in the coronal, middle, and apical thirds. Of particular interest was the apical third, in which 0% of water and 50% of glycerin Ca(OH)2 pastes were completely dense.

Calcium Hydroxide↗
PubMed2006

A quantitative assessment of efficacy of various calcium hydroxide removal techniques.

This study evaluated the amount of calcium hydroxide [Ca(OH)(2))] remaining in canals after removal with various techniques including combinations of NaOCl with EDTA irrigation, hand filing, rotary instrumentation, or ultrasonics. The mesial canals of 12 mandibular molars were uniformly instrumented. Teeth were sectioned longitudinally along the length of the instrumented canals. Acrylic jigs were fabricated, allowing reapproximation of the opposing segments. After Ca(OH)2 placement into the canals, four techniques were used for its removal. In the first method, the master apical file was placed to working length in between two 5-ml rinses of NaOCl. The other three techniques combined with the first method either a 2.5-ml EDTA rinse, a rotary file (MAF size) to working length, or passive ultrasonication. Results showed that no technique removed all Ca(OH)2. Rotary and ultrasonic techniques, while not different from each other, removed significantly more Ca(OH)2 than irrigant only techniques. The irrigant only techniques were not different from each other.

Calcium Hydroxide↗
PubMed1996

Canal debridement: effectiveness of sodium hypochlorite and calcium hydroxide as medicaments.

The action of chemicals such as calcium hydroxide (Ca(OH)2) and sodium hypochlorite (NaOCl) that are used as tissue solvents may be enhanced by prolonged contact. The objective of this study was to determine if sealing Ca(OH)2 and NaOCl into the canal space would improve debridement of both the main canal and areas inaccessible to files. Mesial root canals of 75 freshly extracted mandibular molars were step-back hand-instrumented. Another six molars were controls. Either Ca(OH)2, NaOCl, or no medication was sealed in the canals for 1 or 7 days. Canals were finally irrigated with H2O and prepared for histological evaluation. The cleanliness of main canals and inaccessible areas (isthmi and fins) at the apical, middle, and coronal thirds was examined, scored, and compared by nonparametric statistical analysis. Results showed no significant differences among different groups in either the 1-day or 7-day time intervals in either the main canal or inaccessible areas. Instrumentation combined with NaOCl irrigation alone accounted for the removal of tissue in the main canal. In conclusion, in this system, prolonged contact with Ca(OH)2 and NaOCl was similarly ineffective; neither contributed significantly to canal debridement.

Analysis of Variance↗
PubMed2000

An investigation of the relative efficacy of Buckley's Formocresol and calcium hydroxide in primary molar vital pulp therapy.

OBJECTIVE: To compare the clinical and radiological outcomes following two different, single visit vital pulp therapy techniques, in cariously exposed primary molar teeth. SETTING: A paediatric dental clinic within the Dental Hospital, Newcastle upon Tyne, UK. SUBJECTS: Fifty two child patients were sequentially enrolled in the clinical investigation, 26 males and 26 females with an age range of 3.3-12.5 years. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). The total number of teeth treated was 84. DESIGN: Recruitment was on the basis of strict inclusion criteria. Coronal pulp amputation was prescribed only in teeth with vital, cariously exposed pulp tissue. Treatment was undertaken between October 1994 and December 1996. All cases were reviewed using predefined clinical and radiological criteria. The statistical tests used were logistic regression of a triple nested data structure, chi-squared analysis of equality of treatment and probability of success with relation to subject age. RESULTS: Eighty-four cariously exposed primary molars required vital pulp therapy. Forty six (55%) teeth were included in the F group and 38 (45%) allocated to the C group. Five teeth were lost to follow-up, leaving 79 teeth: forty four (56%) in group F and 35 (44%) in group C. Eighty four percent (37/44) of teeth treated with formocresol and 77 percent (27/35) treated with calcium hydroxide were classed as clinically and radiographically successful at the cut-off date, December 1997, after a mean clinical review of 22.5 months (range 6.1-38.5 months) and a mean radiographic review of 18.9 months (range 1.3-36.9 months). CONCLUSION: This investigation confirms the clinical efficacy of a one-fifth dilution of Buckley's Formocresol as an agent in pulp treatment of cariously exposed, vital primary molar teeth. However, calcium hydroxide in its pure, powder form is a clinically acceptable alternative when combined with strict selection criteria for this method of restorative care. There was a statistically insignificant difference in successful clinical and radiological outcome between the two treatment groups. Success was unrelated to the duration of time taken to achieve haemostasis and the presence or absence of bleeding after placement of the medicament.

Calcium Hydroxide↗
PubMedDate not supplied

Comparison of mineral trioxide aggregate and calcium hydroxide as pulpotomy agents in young permanent teeth (apexogenesis).

PURPOSE: The purpose of this study was to compare mineral trioxide aggregate (MTA) with calcium hydroxide (Ca(OH)2) clinically and radiographically as a pulpotomy agent in immature permanent teeth (apexogenesis). METHODS: Fifteen children, each with at least 2 immature permanent teeth requiring pulpotomy (apexogenesis), were selected for this study. All selected teeth were evenly divided into 2 test groups. In group 1, the conventional Ca(OH)2pulpotomy (control) was performed, whereas in group 2, the MTA pulpotomy (experimental) was done. The children were recalled for clinical and radiographic evaluations after 3, 6, and 12 months. RESULTS: The follow-up evaluations revealed failure due to pain and swelling detected at 6 and 12 months postoperative evaluations in only 2 teeth treated with Ca(OH)2. The remaining 28 teeth appeared to be clinically and radiographically successful 12 months postoperatively. Calcific metamorphosis was a radiographic finding in 2 teeth treated with Ca(OH)2 and 4 teeth treated with MTA. CONCLUSIONS: Mineral trioxide aggregate showed clinical and radiographic success as a pulpotomy agent in immature permanent teeth (apexogenesis) and seems to be a suitable alternative to calcium hydroxide.

Aluminum Compounds↗
PubMed2002

Loss of hydroxyl ions from gutta-percha points with calcium hydroxide in their composition: an in vivo study.

The aim of this study was to quantify variations in the pH of calcium-hydroxide, gutta-percha cones that had remained for 1 week inside the root canals of molars or premolars whose endodontic treatment could not be concluded in a single visit. All teeth were instrumented and dried before the placement of the points. The cones were removed, and placed in vials with distilled water. Additional, new gutta-percha cones were also studied as a control. The pH was measured by a pH meter, model CRISON MicropH 2001. The average pH mensurations obtained for new, calcium-hydroxide, gutta-percha points was 10.11; for cones that were used 1 week, it was 7.08. There was a statistically significant difference observed between the two groups by the Student's t test (p > 0.001). After 7 days, a significant decrease takes place in the alkalinity of these points.

Alkalies↗
PubMed2004

Intracanal placement of calcium hydroxide: a comparison of techniques, revisited.

The goal of this in vitro study was to compare the effectiveness of three different placement techniques of calcium hydroxide paste in a curved canal. An acrylic resin block with a 44-degree curvature was instrumented to a #40 Flex-R file. The canal was filled with radiopaque calcium hydroxide paste using the following techniques: group 1, the paste was injected with an Ultradent tip; group 2, the paste was injected as in group 1 and followed by a size 35 Lentulo to working length; and group 3, the paste was placed with a size 35 Lentulo only, to working length. Each technique was performed 25 times. The radiodensity of the simulated canal was measured at 1, 3, 5, and 7 mm from the canal terminus. At 1 mm, the Lentulo was significantly better than the other two techniques. At 3 mm, the Lentulo technique and the combined technique were better than the Ultradent tip alone.

Calcium Hydroxide↗
PubMed2002

In vitro antimicrobial activity of calcium hydroxide pastes and their vehicles against selected microorganisms.

The aim of this study was to investigate in vitro the antimicrobial activity of calcium hydroxide in combination with several vehicles against some microorganisms commonly isolated from root canals. Antimicrobial activity was determined by the agar diffusion method. Stainless-steel cylinders were placed on each inoculated agar medium. The test medicaments and their controls were placed inside the cylinders. The zones of growth inhibition were measured and recorded after incubation for each plate and the results were analyzed statistically (ANOVA). The in vitro antimicrobial effects of the medications were ranked from strongest to weakest as follows: Ca(OH)2 + CMCP + glycerine, Ca(OH)2 + CMCP, Ca(OH)2 + glycerine, Ca(OH)2 + anesthetic, Ca(OH)2 + saline, Ca(OH)2 + H2O, Ca(OH)2 + polyethyleneglycol. The pastes with oily vehicles showed significantly larger mean zones of inhibition compared to those with aqueous or viscous vehicles. It was concluded that diffusion and antimicrobial activity of calcium hydroxide were affected by the type of vehicle used.

Analysis of Variance↗
PubMed1997

The effects of sodium hypochlorite and calcium hydroxide on tissue dissolution and root canal cleanliness.

In this in vitro study, we investigated the efficacy of sodium hypochlorite (NaOCl) and calcium hydroxide (Ca(OH)2) in dissolving necrotic tissue and cleaning root canals. In the first part of the study, 0.5% NaOCl solution and Ca(OH)2 paste and solution were tested with samples of necrotic bovine muscle in different treatment modes and for different periods. The necrotic tissue was weighed before and after the test and the percentage of weight change calculated. In the second part of the study, 40 extracted single-rooted human teeth were hand instrumented and then subjected to different irrigation regimens. The cleansing efficacy in root canals of 0.5% NaOCl with Ca(OH)2 pretreatments and ultrasonics was examined using scanning electron microscopy. A solution of 5% NaOCl was significantly more effective than 0.5% NaOCl as a solvent of necrotic tissue. Calcium hydroxide was an effective solvent for necrotic tissue as a paste but not as a solution. Pretreatment of necrotic tissue with Ca(OH)2 increased its solubility in 0.5% NaOCl. While 5% NaOCl plus ultrasonic irrigation produced cleaner root-canal walls at the middle and apical thirds, 0.5% NaOCl used with the same technique achieved no root-canal cleaning. However, pretreatment of root canals with Ca(OH)2 paste increased the effectiveness of 0.5% NaOCl plus ultrasonic irrigation, except in the coronal third of the root canal.

Animals↗
PubMed1996

Endodontic treatment of teeth with apical periodontitis using calcium hydroxide: a long-term study.

The aim of this study was to evaluate clinically and radiographically the long-term results of endodontic therapy. A total of 172 mature teeth with periapical radiolucencies with and without symptoms were treated endodontically using calcium hydroxide paste as the intracanal medicament and a calcium hydroxide containing root canal sealer. In 58 teeth, the dressing was accidentally or intentionally extruded into the lesions. All cases were followed up for a period of 2-5 years. The teeth in which the dressing was extruded did not show a different healing pattern from the ones treated conventionally. The complete healing rate for all cases was 80.8% while incomplete healing had taken place in 7.6% of the cases.

Adolescent↗
PubMed1995

Effect of calcium hydroxide paste dressing on uninstrumented root canal wall.

Dissolution of soft tissues on the uninstrumented root canal wall by an intracanal dressing of calcium hydroxide paste was examined by scanning electron microscopy (SEM). The roots of human extracted teeth were split longitudinally into halves, and the pulp tissue was removed by forceps. Then, the halves were divided randomly into three groups. Specimens in the control group were given no treatment. Specimens of the 1-wk group were stored for 7 days in calcium hydroxide-saline paste under the condition of 100% humidity and 37 degrees C. Specimens of the 4-wk group were stored for 28 days in the same manner, but washed and replaced into new paste every week. Root canal walls of these specimens were compared under a scanning electron microscope. A layer of odontoblasts was observed in the control group, whereas it had disappeared completely in the 1- and 4-wk groups. However, the predentin remained almost intact in the 1-wk group, and although the surface was eroded, in the 4-wk group. It was found that calcium hydroxide paste dressing could dissolve the odontoblastic cell layer, but had little effect on predentin.

Calcium Hydroxide↗
PubMed2002

Microbial susceptibility to calcium hydroxide pastes and their vehicles.

The aim of this study was to investigate the susceptibility of some microorganisms commonly isolated from root canals to calcium hydroxide in combination with several vehicles by the agar diffusion method. Stainless-steel cylinders were placed on each inoculated agar medium. The test medications and their controls were placed inside the cylinders. The zones of growth inhibition were measured and recorded after the incubation period for each plate, and the results were analyzed statistically. Enterococcus faecalis was most resistant, whereas the anaerobic Porphyromonas endodontalis was more susceptible to all medications, followed by P. gingivalis and Prevotella intermedial intermedia. Ca(OH)2 + CMCP + glycerin showed significantly larger mean zones of inhibition when compared with the other medications. We conclude that anaerobic Gram-negative bacteria are more susceptible to calcium hydroxide pastes than facultative Gram-positive microorganisms.

Actinomyces↗
PubMed2003

Effect of Er:YAG laser and EDTAC on the adhesiveness to dentine of different sealers containing calcium hydroxide.

AIM: To evaluate the effect of 15% EDTAC solution and Er:YAG laser irradiation on the adhesiveness to dentine of root canal sealers containing calcium hydroxide. METHODOLOGY: The crowns of 60 maxillary human molars were ground until dentine was exposed. The teeth were divided into three groups of 20 teeth: group I, the dentine surface received no treatment; group II, 15% EDTAC solution was applied to the dentine; group III, the dentine received Er:YAG laser application (11 mm focal distance with perpendicular incidence to dentine surface; 4 Hz frequency; 200 mJ energy; 2.25 W potency; 62 J total energy; 1 min application time). Aluminium cylinders filled with the sealers, Sealer 26, Apexit, Sealapex and CRCS, were then applied to the treated surfaces. Adhesiveness was measured with a universal testing machine, with traction results given in MegaPascals (MPa). These results were submitted to anova tests. RESULTS: Statistical analysis showed significant differences (P < 0.01) amongst adhesiveness values of the sealers and treatments tested. Thus, sealers could be ranked in decreasing adhesiveness values: Sealer 26, CRCS, Apexit, Sealapex. Er:YAG laser irradiation and EDTAC solution application increased adhesiveness values only for Sealer 26 and Apexit. Laser irradiation was superior to EDTAC application only for Sealer 26 adhesiveness values. CONCLUSIONS: Er:YAG laser is as efficient as EDTAC solution in increasing adhesiveness of root canal sealers containing calcium hydroxide to human dentine.

Adhesiveness↗
PubMed1989

[Clinico-pathological studies on the effects of calcium hydroxide eugenol preparations to the human vital pulp tissues].

The present paper reports results of a study to evaluate clinico-pathologically the effects of calcium hydroxide eugenol preparations on exposed pulp tissues in permanent human teeth. The experiments were performed on 80 vital human teeth from patients ranging in age from 12 to 54 years. The experimental teeth were arbitrarily divided into the following 4 groups. Group CRCS: 20 cases treated with CRCS (Hygienic, Akron, Ohio, USA). Group KEZ: 20 cases treated with Dentalis KEZ (Neo Dental Chemical Products, Tokyo, Japan). Group CE: 20 cases treated with calcium hydroxide eugenol (positive control) Group E: 20 cases treated with pure eugenol (negative control). After local anesthesia, the experimental teeth were isolated with rubber dums or cotton rolls. Following preparation of Black's simple class 1 cavities with a diamond instrument mounted high-speed air turbine, the pulp was intentionally exposed by means of a steel bur mounted electric engine. The cavity and exposed pulp surface were cleaned with saline and dried on absorbent material. Then the experimental materials (agents) were applied to exposed pulp surface. The cavity was lined with gutta-percha temporally stopping, and the remainder was filled with silver amalgam. The teeth were clinically observed at various intervals from immediately to 530 days after treatment and then extracted under local anesthesia and prepared for histopathological study. Decalcified sections were stained with hematoxylin and eosin. 1) CLINICAL OBSERVATIONS: During the observation period, symptoms occurred in the following: Group CRCS: 4 (20%) out of 20 cases. Group KEZ: 4 (20%) out of 20 cases. Group CE: 6 (30%) out of 20 cases. Group E: None of 20 cases No spontaneous pain was observed in these groups. 2) Clinical evaluations Group: CRCS: 16 cases (80%) were good, 3 cases (15%) were satisfactory, and 1 cases (5%) were failure. Group KEZ: 16 cases (80%) were good, 1 cases (5%) were satisfactory, and 3 cases (15%) were failure. Group CE: 14 cases (70%) were good, 4 cases (20%) were satisfactory, and 2 cases (10%) were failure. Group E: 20 cases (100%) were good. 3) Histopathological observations. Various kinds and degree of pulp changes were occurred in each group. Hyperemia and round-cell infiltration resulting from damage caused by treatment and medicaments were frequent in each group. No suppurative inflammation occurred in group CE. Pulp cicatrization and apposition of dentin on pulp chamber walls were observed frequently in each groups. Hard tissue formation was observed in numerous cases of group CE and in some cases in group CRCS and KEZ.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2002

Influence of calcium hydroxide dressing on the obturation of simulated lateral canals.

The purpose of this in vitro study was to evaluate what influence an interappointment dressing with calcium hydroxide might have on the ability to subsequently obturate simulated lateral canals. Twenty extracted single-rooted human teeth were instrumented at the working length to a #35 file before creating three simulated lateral canals on the mesial and distal surfaces of the root, one in each third, using a #15 engine reamer. After enlarging the root canals to a #45 file, the teeth were randomly divided into two groups of 10. In both groups AH26 was used as the sealer. In group A, the obturation was performed immediately using Ultrafil. In group B, root canals were filled with calcium hydroxide and incubated for 7 days. The teeth were then reinstrumented, irrigated with 2.5% sodium hypochlorite solution, dried with paper points, and obturated as in group A. Teeth in group A showed a larger number of filled lateral canals compared with those in group B. Statistical significant differences were observed when comparing the same third in the two groups (apical third p < 0.05, middle third p < 0.01, and coronal third p < 0.01). No differences were found among the different thirds in the same group (p > 0.05).

Bismuth↗