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Calcium hydroxide as a root canal filling material in primary teeth--a pilot study.

A pilot study was carried out in five mandibular primary molars using calcium hydroxide (Ca(OH)2) Paste as root canal filling material to find out an alternative to the routinely used zinc oxide eugenol (ZnOE), which is non-resorbable and causes deflection of succedaneous teeth. The six month clinical and radiographic follow-up carried out at 2 months interval, revealed that the treated teeth with Ca(OH)2 as root canal filling material were successful, showing no pain and tenderness to percussion. A tendency for decrease in size of radiolucency was seen. Two teeth showed complete healing of the periradicular radiolucency. Depletion of Ca(OH)2 paste was seen from the root canals even prior to physiological resorption of roots in 2 out of 5 treated teeth.

Calcium Hydroxide↗

pH changes and calcium ion diffusion from calcium hydroxide dressing materials through root dentin.

The purpose of this study was to evaluate Ca2+ and OH- diffusion properties through root dentin by using different calcium hydroxide (CH) dressing materials. Twenty-eight single-rooted teeth were instrumented and external defects were created on the root surface. 17% EDTA was used to eliminate the smear layer. All surfaces except the external defects were sealed, and the teeth were placed in normal saline. Ca2+ concentrations and the pH in the saline were determined for 3 days as the control period. After removing the teeth from normal saline, they were filled with: (i) DT Temporary Dressing CH; (ii) CH powder and normal saline; (iii) TempCanal; and (iv) CH points. The teeth were then placed in normal saline, and Ca2+ concentrations and pH values were measured at 1, 3, 7, 14, and 28 days. Nonsetting CH pastes gradually released Ca2+, whereas this increase was absent from CH points. None of the test materials induced a pH increase in the media during the observation period. This study demonstrated that, when nonsetting CH pastes are applied to the root canal, diffusion of Ca2+ without an increase in pH to the surrounding media occurs. This implies that these type of material are more suitable than CH points for treatment of external root resorption.

Calcium Hydroxide↗

Calcium hydroxide as an interim treatment dressing.

A case involving the demineralization of osseous matrix surrounding an intact, necrotic lateral incisor undergoing orthodontic therapy is presented. The treatment involved calcium hydroxide as an interim treatment dressing in conjunction with endodontic therapy. Mechanisms involved in repair are discussed.

Adolescent↗

[Study of some physical and biological properties of an endodontic sealer composed of calcium hydroxide].

The authors present a study of the physical and biological properties of a new endodontic cement known as Sealapex. In its composition the presence of calcium hydroxide is introduced in order to induce calcification of the periapical tissue. Our results using glass round cover slips implanted on the subcutaneous tissue of mice indicated a persistent foreign body reaction (60 days). The physical properties studied compared to N-Rickert ciment indicated, a decreased leakage. Adhesivity tests didn't give us significant values. Laboratorial studies and clinical trials are necessary to a complete acceptance of this new ciment in endodontic treatment.

Animals↗

Immunohistochemical expression of fibronectin and tenascin after direct pulp capping with calcium hydroxide.

The aim of this study was to investigate the expression of 2 extracellullar matrix glycoproteins, fibronectin (FNC) and tenascin (TNC), following direct pulp capping with calcium hydroxide (CH). Third molars scheduled for extraction were used. Standardized class I cavities with pulp exposures were prepared. After control of bleeding, CH powder was applied in the exposure sites, which were covered with CH cement (Dycal; Dentsply) and the cavities were filled with zinc oxide-eugenol cement. Three teeth were extracted at each post-treatment period (1, 7, 14, and 30 days). Demineralized and paraffin-embedded specimens were stained for histologic technique (hematoxylin-eosin) and for immunohistochemical analysis. Anti-TNC and anti-FNC monoclonal antibodies were used with the streptavidin-biotin complex method. Generally, similar patterns of immunohistochemical expression were observed for TNC and FNC in the pulp tissue as a whole. In the exposure site, TNC immunostaining increased over time, exhibiting a thicker immunostaining pattern within 30 days. The imunohistochemical technique showed expression of both glycoproteins during pulp healing process.

Calcium Hydroxide↗

The study of modified calcium hydroxides with surfactants for acid gas removal during incineration.

The primary objective of the present work is to use additives to extend the sulfation reaction of the calcium hydroxide (Ca(OH)2) used to control SO2 emission from incineration processes. There are two reasons for adding surfactants (surface-active agent): (1) to provide an appropriate dispersion of the Ca(OH)2', thus preventing particle agglomeration due to humidity; (2) to alter the sulfation reaction environment by adsorbing heterogeneous materials on the surface of the Ca(OH)2 to extend the adsorption equilibrium. A dry scrubber integrated with a fabric filter was employed to study the effect of surfactants on the removal efficiency of acid gas in the flue gas with Ca(OH)2 as the sorbent. The operating parameters evaluated include: (1) the different surfactants (calcium lignosulfonate, sodium lignosulfonate, alkyl naphthalene sodium sulfonate and beta-naphthalene sodium sulfonate condensates) and (2) the composition of acid gas (i.e. sulfur dioxide (SO2), nitrogen oxide (NO) and hydrogen chloride (HCl)). The results show that modified Ca(OH)2 with surfactants could effectively decrease the emission of acid gas during incineration. Different additives had individual absorption efficiencies on different acid gases. On the whole, sodium lignosulfonate and beta-naphthalene sodium sulfonate condensates had better sorption capacity for SO2 and NO, but not for HCl. In addition, when SO2 coexisted with NO and HCl, the concentration of NO and HCl will result in decrease or increase of the removal efficiency of SO2.

Air Movements↗

Reaction of rat connective tissue to implanted dentin tube filled with mineral trioxide aggregate, Portland cement or calcium hydroxide.

The subject of this study was to observe the rat subcutaneous connective tissue reaction to implanted dentin tubes filled with mineral trioxide aggregate, Portland cement or calcium hydroxide. The animals were sacrificed after 7 or 30 days and the undecalcified specimens were prepared for histological analysis with polarized light and Von Kossa technique for mineralized tissues. The results were similar for the studied materials. At the tube openings, there were Von Kossa-positive granules that were birefringent to polarized light. Next to these granulations, there was an irregular tissue like a bridge that was Von Kossa-positive. The dentin walls of the tubes exhibited in the tubules a structure highly birefringent to polarized light, usually like a layer and at different depths. The mechanism of action of the studied materials has some similarity.

Aluminum Compounds↗

A laboratory study of the effect of calcium hydroxide mixed with iodine or electrophoretically activated copper on bacterial viability in dentinal tubules.

AIM: The aim of this laboratory study was to evaluate the ability of calcium hydroxide (CH), CH/iodine-potassium iodide (IKI) and electrophoretically activated copper to kill bacteria in dentinal tubules. METHODOLOGY: In an in vitro model of dentinal tubule infection, 42 cylindrical root specimens, prepared from freshly extracted bovine teeth were used. After removal of the smear layer, intracanal dentinal tubules were infected with Enterococcus faecalis for 3 weeks. CH alone or preparations of CH with copper or IKI were placed in the root canal for 1 week. In specimens containing copper/CH, an electrophoretic current(5 mA/5 min) was applied using two electrodes follow-ing placement of the medicament in the canal. Powder dentine samples obtained from the canal wall using ISO sizes: 025, 027, 029, 031 and 033 burs were examined for the presence of viable bacteria by inoculating agar plates and counting colony forming units (cfu). RESULTS: A significant difference was found between the experimental groups and the positive control group. CH and CH/IKI significantly (P < 0.001)reduced bacterial viability in dentinal tubules to a depth of 200 microm. Specimens with CH/IKI had significantly fewer viable bacteria than CH alone in tubules between the depths of 200-500 microm. Treatment with CH/copper and electrophoresis was most effective: specimens showed no viable bacteria in dentinal tubules to a depth of 500 microm from the root-canal space. CONCLUSIONS: IKI or electrophoretically activated copper additives can significantly improve the antibacterial properties of CH in dentinal tubules.

Animals↗

Calcium hydroxide paste in the maxillary sinus: a case report.

A case is reported in which a perforation of the sinus floor of the maxillary sinus occurred with extrusion of a calcium hydroxide paste during routine root canal treatment of a maxillary premolar. All clinical manifestations are described as well as the results of a follow-up evaluation.

Adult↗

Apical diffusion of calcium hydroxide in an in vitro model.

An in vitro agar model was developed to study the effect of intracanal medicaments on periapical tissues and was used to study the diffusion of three calcium hydroxide (Ca(OH)2) medicaments of varying viscosity through simulated root canals with various sizes of apical foramina. Experimental medicaments were added to pipette tips used to represent tooth roots, which were fixed in syringes containing brain heart infusion agar and calcium-reactive dye. OH and Ca concentrations were measured in the agar at 30 minutes and 24 hours. Ca concentration and pH increased with larger aperture sizes, and higher pH and Ca diffusion was produced by a 10% Ca(OH)2 solution than was produced by Pulpdent or a Ca(OH)2 paste. The results suggest that the properties of the Ca(OH)2-containing vehicle could affect the action of the medicament in the periapical tissues.

Analysis of Variance↗

Identification of cultivable microorganisms from root canals with apical periodontitis following two-visit endodontic treatment with antibiotics/steroid or calcium hydroxide dressings.

The study was aimed at comparing the efficacy of disinfection of root canals with periapical radiolucencies when treated with either antibiotics/steroid medicaments (Ledermix or Septomixine) or a calcium hydroxide paste (Calasept). Microbiological samples were taken before and after two-visit endodontic treatment from 88 canals with apical periodontitis. All of the canals but one (87 of 88) had cultivable growth before treatment. After dressing with Ledermix, Septomixine, or Calasept, the percentages of canals remained with positive growth were 48% (13 of 27), 31% (8 of 26), and 31% (11 of 35), respectively. The chi(2) tests showed there were no significant differences in the number of canals with positive growth or mean colony forming units counts after instrumentation, irrigation and dressing. In the Ledermix group, 38 strains of bacteria were recovered. The Septomixine group had 25 strains, and the Calasept group had 25 strains. Gram-positive facultative anaerobic cocci (including staphylococci and streptococci) were more prevalent than the Gram-negative obligate anaerobic rods after treatment in all three groups. Similarities in the reduced number of canals with residual growth, and the prevalence of Gram-positive facultative anaerobic cocci suggest that the use of different inter-appointment dressings produced similar microbiological outcomes. However, factors other than the antimicrobial effectiveness of intracanal medicaments may also be responsible for the results observed.

Anti-Bacterial Agents↗

Effect of calcium hydroxide as a supplementary barrier in the radicular penetration of hydrogen peroxide during intracoronal bleaching in vitro.

AIM: To examine pH changes in the cervical external root surface, when calcium hydroxide was used as a supplementary barrier to the protective base material during intracoronal bleaching. METHODOLOGY: Twenty-eight single-rooted human premolars extracted for orthodontic reasons were instrumented with K-Flex files, obturated with gutta-percha and subjected to thermocatalytic bleaching. The teeth were divided into four groups. In group A, a glass-ionomer cement barrier was placed at the cemento-enamel junction (CEJ) level and in group C, the barrier was placed 1 mm apical to the CEJ. In groups B and D, Ca(OH)2 was placed in contact and apical to the glass-ionomer cement at the CEJ and 1 mm apical to the CEJ, respectively. The teeth were placed in vials containing distilled water and the pH values of the medium surrounding the teeth were recorded after 1, 2, 4, 10 and 15 days, following renewal of the medium. RESULTS: The pH in the medium became acidic in all groups. No statistically significant differences existed between groups for all the experimental days (P = 0.790). CONCLUSION: The placement of Ca(OH)2 as a supplementary barrier during intracoronal bleaching did not have a significant effect in reversing the acidic pH created at the external root surface in vitro. Its potential effect during these procedures in vivo needs to be further investigated.

Adult↗

Healing of intrabony defects following treatment with an oily calcium hydroxide suspension (Osteoinductal). A controlled clinical study.

The purpose of the present clinical study was to evaluate the healing of deep intrabony defects following the application of an oily calcium hydroxide suspension (OCHS). Thirty patients suffering from chronic periodontitis, each of whom displayed one intrabony defect, were randomly treated with access flap surgery (AFS) and the application of OCHS (test) or with AFS alone (control). The following clinical parameters were recorded at baseline and at 6 months after therapy: plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL). No differences in any of the investigated parameters were observed at baseline between the two groups. At 6 months after therapy, the test group showed a reduction in mean PD from 7.7+/-1.5 to 2.9+/-0.9 mm (P<0.001) and a change in mean CAL from 9.6+/-2.1 to 5.5+/-2.5 mm (P<0.001). In the control group, the mean PD was reduced from 6.9+/-0.9 to 3.7+/-0.9 mm (P<0.001) and the mean CAL changed from 8.5+/-2.5 to 6.4+/-2.7 mm (P<0.001). OCHS resulted in statistically significant higher PD reductions (P<0.01) and CAL gains (P<0.05) than AFS alone. Within the limits of the present study, it can be concluded that: (1) at 6 months after surgery both therapies resulted in statistically significant PD reductions and CAL gains and (2) treatment with OCHS resulted in statistically significant higher CAL gains than treatment with AFS alone.

Adult↗

Determination of the p-monochlorophenol residue in the calcium hydroxide + P-monochlorophenol combination used as an intracanal dressing in pulpless teeth of dogs with induced chronic periapical lesion.

To determine the presence of p-monochlorophenol in the calcium hydroxide (Calen) + p-monochlorophenol combination after its use as intracanal dressing, periapical lesions were induced in 60 root canals of upper and lower premolars of four dogs. After biomechanical preparation, the root canals received the intracanal medication, which was removed from the apical third after 2, 4, 7, and 14 days for chemical analysis by spectrophotometry. The results showed a p-monochlorophenol loss of approximately 50.0% in the dressing after 48 h, with no further significant loss after longer periods of times. p-Monochlorophenol was still present in the medication after 14 days.

Analysis of Variance↗

Stability constants of Ca-alkyl salicylate complexes and their effect on the dissolution of calcium hydroxide dental cements.

The proton-ligand stability constants (pKa) and Ca-ligand stability constants (log beta) of the five types of alkyl salicylate were determined and the dissolution of the calcium hydroxide cements prepared from those salicylates was examined in water. The dissolution of the cements containing monoesters decreased with the increase in their pKa and log beta values. The cement containing diester showed lower dissolution than that estimated from those values. This seems to be related to the polymeric structure of the cement matrix consisting of the complex of the diester with calcium.

Calcium Hydroxide↗

TNF-alpha release in monocytes after exposure to calcium hydroxide treated Escherichia coli LPS.

Lipopolysaccharide (LPS), a cell wall component of Gram negative anaerobic bacteria, has been implicated in the pathogenesis of periapical disease resulting from infected root canals. Calcium hydroxide [Ca(OH)2] has been shown to be an effective medicament in such infections, reducing the microbial titre within the canal. It has been proposed that the therapeutic effect of Ca(OH)2 may also be the result of direct inactivation of LPS. The aim of this study was to investigate whether the toxic potential of an Escherichia coli LPS could be reduced or eliminated by Ca(OH)2. Four concentrations of E. coli LPS ranging from 1-1000 ng/ml sterile water were incubated in duplicate either with 25 mg Ca(OH)2 or sterile water alone. Controls consisted of Ca(OH)2 without LPS or sterile water only. Monocytes were collected from peripheral blood by centrifuging through a gradient and plated to a specific density. Adherent monocytes were incubated for 4 days at 37 degrees C with 5% CO2 in M199 medium with 10% autologous serum. The different LPS solutions were added to the wells on day 5. After 4 h the supernatants were collected and quantitatively assayed for TNF-alpha using a commercial ELISA kit. Statistical analysis was performed with ANOVA. Results indicated that Ca(OH)2 is able to eliminate the ability of an E. coli LPS to stimulate TNF-alpha production in peripheral blood monocytes (P < 0.0001).

Calcium Hydroxide↗

A scanning electron microscopic evaluation of root canal wall cleanliness after calcium hydroxide removal using three irrigation regimens.

AIMS: The aims of this in vitro study were to evaluate debris and smear layer elimination capability effectiveness of 5.25% sodium hypochlorite (NaOCl) after calcium hydroxide removal from the root canal and to determine if ethylenediaminetetraacetic acid (EDTA) and citric acid have any additional effects on debris and smear layer removal. METHODS AND MATERIALS: All irrigation regimens are associated with ultrasonics. Thirty-six pulpless single-rooted teeth were divided into three groups on the basis of the irrigation regimen, namely 5.25% NaOCl alone, 5.25% NaOCl with 17% EDTA pH 7 (NaOCl-EDTA), and 5.25% NaOCl with 50% citric acid (NaOCl-CA). All root canals were instrumented with the Protaper rotary system (Dentsply-Maillefer, Ballaigues, Switzerland) using a crown-down approach. The apical foramen of each tooth was enlarged to a size 30 with a 0.09 taper. After longitudinal sectioning, the dentin walls were microphotographed using scanning electron microscopy (SEM) at a 1500x magnification. Using a grid and a 5-step scale these microphotographs were scored by three investigators in order to evaluate debris and smear layer residuals. Data were statistically evaluated using Kruskal-Wallis and Mann-Whitney tests. RESULTS: In the coronal third the lowest score obtained with NaOCl-CA was similar to NaOCl-EDTA. When using NaOCl-EDTA, mean debris scores were similar to the control group (NaOCl) and lower than NaOCl-CA in the middle and apical thirds. Regarding the mean smear layer score, NaOCl-CA was the lowest in the coronal, middle, and apical thirds with a statistically significant difference (p < 0.001). CONCLUSION: When the total surface of the root was evaluated, NaOCl-EDTA was superior in removing debris, but the association of NaOCl-CA enabled the most effective removal of the smear layer.

Calcium Hydroxide↗

[Effect of adhesive composite resin on pulp and capping of pulp with calcium hydroxide base (Dycal) in deciduous teeth of young dogs].

This study was designed to investigate the effect of adhesive composite resin (Clearfil SC Bond) on dental pulp and the effect of calcium hydroxide base (Dycal) on the protection of the pulp, using 66 deciduous teeth of young dogs. After forming a cavity (class 5) on the labial aspect in each tooth, the teeth were divided by the modes of plugging into 4 groups; stopping alone (Group S), stopping and capping with Dycal (Group D+S), capping with Dycal and resin (Group D+R) and capping with resin alone (Group R). After decalcification, the specimen was embedded in celloidin, sliced into thin sections and stained with hematoxylin and eosin for histopathological examination. Histological changes were examined at 3 days, 1 week, 2 weeks and 4 weeks. The following are the results obtained. 1. In Group S, slight histological changes were observed at 3 days and 1 week. However, the changes began to diminish after the 2nd week and disappeared in the 4th week. 2. In Group R, the severest histological changes persisted throughout the course of observation. The changes were not diminished even in the 4th week. Thus, the resin seemed to exert a strong and long-lasting stimulative effect against the pulp. 3. In Group D+S and D+R, the histological changes were more serve at 3 days and 1 week compared to those found in Group S, but these were diminished after the 2nd week. This seemed to suggest that the pulp was stimulated to a certain degree by Dycal but also, Dycal protected the pulp from stimulation of the resin. 4. Capping of the pulp seemed necessary in vital teeth with resin restoration.

Animals↗