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PubMedDate not supplied

Comparison of apexification with mineral trioxide aggregate and calcium hydroxide.

PURPOSE: The aim of this study was to compare mineral trioxide aggregate (MTA) with calcium hydroxide [Ca(OH)2] clinically and radiographically as materials used to induce root-end closure in necrotic permanent teeth with immature apices (apexification). METHODS: Fifteen children, each with at least 2 necrotic permanent teeth requiring root-end closure (apexification), were selected for this study. All selected teeth were evenly divided into 2 test groups. In group 1, the conventional calcium hydroxide apexification (control) was performed, whereas in group 2, the MTA apexification (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 persistent periradicular inflammation and tenderness to percussion detected at 6 and 12 months postoperative evaluation in only 2 teeth treated with Ca(OH)2. The remaining 13 teeth appeared to be clinically and radiographically successful 12 months postoperatively. None of the MTA-treated teeth showed any clinical or radiographic pathology. CONCLUSIONS: Mineral trioxide aggregate showed clinical and radiographic success as a material used to induce root-end closure and is a suitable replacement for calcium hydroxide for the apexification procedure.

Aluminum Compounds↗
PubMed2006

Influence of rubber dam isolation on human pulp responses after capping with calcium hydroxide and an adhesive system.

OBJECTIVE: The objective was to evaluate the influence of rubber dam isolation on the response of human pulps capped with calcium hydroxide and an adhesive system. METHODS AND MATERIALS: Direct pulp capping was performed in 40 caries-free human premolars scheduled for extraction as part of orthodontic treatment. The teeth were randomly divided into 8 groups (n = 5) according to the combination of treatment factors: capping agent (adhesive resin or calcium hydroxide), isolation (rubber dam or cotton pellets only), and period of evaluation (30 or 60 days). Class 2 cavities were prepared, and pulp exposures were created on the occlusal floor. After capping, all teeth were restored with Z-100 placed incrementally. After 30 or 60 days, patients were asked about their symptoms, teeth were extracted, and serial sections were evaluated. The data were subjected to a nonparametric test. RESULTS: Overall, the histologic features showed that the pulp response was worse for groups capped with adhesive. For adhesive-capped groups, the pulp response varied from pulp necrosis to acute inflammatory cell infiltrate, and most of the pulps capped without rubber dam isolation showed severe inflammatory cell infiltrate involving the coronal pulp with chronic abscesses. For the calcium hydroxide groups, all specimens showed dentin bridge formation, regardless of the type of isolation used. CONCLUSION: Calcium hydroxide should be used as the material of choice for pulp capping with or without rubber dam isolation. The use of adhesive systems in vital pulp capping is contraindicated, especially if rubber dam isolation is not implemented.

Adhesives↗
PubMed2004

The effect of two different calcium hydroxide combinations on root dentine microhardness.

AIM: To evaluate the effect of a calcium hydroxide and glycerine mix and a calcium hydroxide and water mix on the microhardness of human root dentine. METHODOLOGY: Eleven freshly extracted maxillary canine and central incisor teeth were used. The teeth were sectioned transversally to produce a total of 22 dentine discs from the middle-third of the root. The specimens were divided into two groups of 11 discs each. Dentine samples were treated with either a Ca(OH)2-glycerine combination or a Ca(OH)2-distilled water combination for 1, 3 and 7 days. Dentine microhardness was measured with a Knoop indenter with a load of 100 g for 15 s before and during the experimental period. Each root disc received a series of three indentations around the pulp space, 1 mm from canal wall. RESULTS: Statistical analysis showed that both combinations significantly decreased dentine microhardness after 3 and 7 days (P < 0.01). The reduction in dentine microhardness following the use of a Ca(OH)2-glycerine combination was significantly greater than that after a Ca(OH)2-distilled water combination after 3 and 7 days (P < 0.01). CONCLUSION: The use of Ca(OH)2 combinations for intracanal dressing softens dentine.

Calcium Hydroxide↗
PubMed1991

Effect of immediate calcium hydroxide treatment and permanent root-filling on periodontal healing in contaminated replanted teeth.

The effect of immediate permanent root-filling and immediate intracanal calcium hydroxide treatment on experimentally contaminated and necrotized periodontal membranes (PDM) in avulsed and subsequently replanted monkey teeth was studied. Almost the entire root surface in the non-endodontically treated control teeth were covered with inflammatory resorption. A significant shift towards ankylosis not associated with root resorption (greater than 80% of the total root surface area) was noted following calcium hydroxide treatment. About two thirds of the root surfaces from the teeth with permanent root fillings showed surface resorptions or ankylosis preceded by root resorption. The root surface area which would have been covered by inflammatory resorption, unless endodontic treatment had been implemented, were instead predominantly covered by either surface resorption (permanent root filling) or ankylosis (calcium hydroxide treatment). Ankylosis compared with surface resorption may in the long term lead to progressive loss of root substance due to replacement resorption. It was concluded that calcium hydroxide may be an excellent initial intracanal treatment in teeth with healthy PDM, but care should be taken not to risk unnecessary development of ankylosis by prolonged treatment of teeth with compromised PDM.

Alveolar Process↗
PubMed1980

Reactions of the dental pulp to microbial provocation of calcium hydroxide treated dentin.

The purpose of the present study was to determine whether treatment of dentin with calcium hydroxide reduces pulp irritation caused by microbial products. The experiment was carried out in three young monkeys. Cavities were prepared on the buccal tooth surface deep into dentin of 62 teeth. Calcium hydroxyde mixed with distilled water was placed in one group of cavities. A set of control cavities received treatment with saline soaked filter-paper discs. The calcium hydroxide dressing and the saline discs were separated from the oral cavity for a period of 14 or 60 d by a Teflon disc and a layer of zinc oxide-eugenol cement. At the end of these periods the content of each cavity was removed and substituted by lyophilized material from cultivated plaque bacteria. After 3 d of exposure the monkeys were killed and the teeth subjected to histologic treatment. Assessments made in the light microscope revealed that pulps subjacent to calcium hydroxide-treated dentin in the majority of cases showed no or only slight infiltrates of inflammatory cells. In controls, 13 out of 22 pulps showed severe inflammatory cell infiltrates or total pulp tissue necrosis. It was concluded that treatment of dentin with calcium hydroxide may reduce the possibility for bacterial components to cause pulp tissue damage.

Animals↗
PubMed1997

The effect of a calcium hydroxide paste on wound healing and osseointegration of dental implants. A pilot study in beagle dogs.

The aim of this investigation was to evaluate the effect of a new calcium hydroxide suspension (Osteoinductal) on the healing process of endosseous dental implants after placement. The material, composed of 25% calcium hydroxide, 25% Oleum pedum tauri and 50% vaselinum album, was developed with the intention to accelerate and to increase the mineralized bone to implant contact during the healing phase. Eight adult beagle dogs were used in this study. Prior to the beginning of the study the dogs had all mandibular premolars extracted. After the extraction sites had healed for 3 months, implant osteotomies were performed. On one side of the mandibular premolars extracted. After the extraction sites had healed for 3 months, implant osteotomies were performed. On one side of the mandible Osteoinductal was applied into the osteotomies before placement of the implants, whereas the other side did not receive Osteoinductal. A total of 48 implants were placed with two losses during the entire study period. Two dogs were sacrificed 1 week, 2 weeks, 4 weeks and 3 months after implant placement. The specimens were evaluated histologically and histomorphometrically. In the histological evaluation an intense inflammatory reaction towards the calcium hydroxide suspension was found leading to a destruction of the bone surrounding the implants after 1 and 2 weeks. A giant cell reaction against the test material was visible at 4 weeks. At 3 months no inflammatory and no giant cell reaction could be depicted in the test group. The mean direct bone to implant contact or inflammatory tissue to implant contact showed no differences between test and control group for 1 and 2 weeks. Although statistically not significant, there was a clinical significant difference in the mineralized bone to implant contact between test and control group for the last two timepoints (i.e. 4-week specimens: test group 2.3 +/- 0.9%, control group 26.8 +/- 11.1%; 3-month specimens: test group 10.5 +/- 12.7%, control group 60.7 +/- 13.7%). This study indicates that the use of the calcium hydroxide suspension Osteoinductal has a detrimental effect on wound healing and osseointegration of dental implants and cannot be recommended for use with dental implants.

Alveolar Process↗
PubMed1995

Mechanism of action of calcium and hydroxyl ions of calcium hydroxide on tissue and bacteria.

The biological and bacteriological action of calcium hydroxide confer to its current success as an intracanal dressing. For this reason the mechanism of action of calcium and hydroxyl ions on tissue and bacteria deserves further study. The objective of the present paper is to analyze and discuss the mechanism of action of calcium and hydroxyl ions on anaerobic bacteria, starting from the isolated study of the influence of pH on these bacteria , as well as the mechanism of action of calcium hydroxide on tissue.

Bacteria, Anaerobic↗
PubMedDate not supplied

Histopathological evaluation of subcutaneous tissue reaction in mice to a calcium hydroxide paste developed for root canal fillings.

We aimed to evaluate the subcutaneous tissue reaction to a new calcium hydroxide paste for root canal fillings developed by Neo Dental Chemical Products Co., Tokyo, Japan. We injected calcium hydroxide paste and a water-based control subcutaneously into the dorsal area of 6-week-old anaesthetized male ddY mice. The tissue surrounding the injection sites was removed from mice in each group, 2 days, 1 week, 3 weeks and 12 weeks after the injection, and histopathologically examined. We found necrotic and degenerative changes, as well as foreign body reaction or proliferation of granulation tissue in specimens from both groups until 3 weeks after the injection. Some lymphocyte infiltration was observed in the 12-week specimens of the control group only. We conclude that calcium hydroxide paste is safe to use as a root canal filling material.

Animals↗
PubMed1995

In vitro study of the indirect action of calcium hydroxide on the anaerobic flora of the root canal.

The aim of this study was to evaluate in vitro a possible mechanism involved in the antimicrobial action of calcium hydroxide, namely absorption of carbon dioxide from the root canal. Twenty obligate and 20 facultative anaerobic bacteria isolated from infected root canals and identified to species level were used. For each bacterial species a standard concentration was achieved and 0.1 ml of the inoculum was spread on blood agar plates, which were consecutively incubated in an anaerobic chamber for 5-7 days. One experimental and one control group were studied: the experimental group included one plate with the bacterial species as well as one open plate containing 32 g calcium hydroxide paste at a mixing ratio of 6:4. Both plates were incubated in an anaerobic chamber for 72 h. The control group included only one plate containing the same bacterial species and was incubated under the same conditions. After a 72-h incubation, the number of the recovered bacteria were counted in both groups. Statistical analysis showed that the number of bacteria recovered from the control group was significantly lower than that of the experimental group, but no particular resistance of any bacterial species to calcium hydroxide could be detected. This finding strongly suggests that the ability of calcium hydroxide to absorb carbon dioxide may contribute to its antibacterial activity.

Absorption↗
PubMed1997

Effect of calcium hydroxide dressing on seal of permanent root filling.

Low apical leakage along root fillings following an application of calcium hydroxide was reported in a few methylene blue dye penetration studies. It has been found recently that methylene blue is decolored by calcium hydroxide, indicating that the short penetration of methylene blue may not be due to a tight seal only. Of the 80 roots of human maxillary central incisors used in this study, 40 roots (group 1) received calcium hydroxide root canal dressing whereas another 40 roots (group 2) did not. All the roots were then obturated with gutta-percha and Tubli-Seal sealer. Leakage along 20 filled roots in each group was measured using a modified fluid transport model at 48 h, 2, 4, 8 and 16 weeks after obturation; whereas leakage of another 20 filled roots in each group was measured using dye penetration with 1% methylene blue. Using the fluid transport model, no significant difference was found between the two groups at any time interval (P = 0.4847, 0.3875, 0.9490, 0.4786, 0.9148 respectively after 48 h, 2, 4, 8 and 16 weeks); using the methylene blue penetration method, leakage in group 1 (with root canal dressing) was significantly less than that in group 2 (without root canal dressing) (P = 0.0374). The contradiction in results from the different models indicated that problems existed with the models.

Calcium Hydroxide↗
PubMed2003

The pH changes of four different calcium hydroxide mixtures used for intracanal medication.

The purpose of this study was to determine the pH values of calcium hydroxide mixtures in combination with either distilled water, two different local anaesthetic solutions or physiological saline solution, which are commonly used as a dressing materials during endodontic treatment. The pH of each vehicle prior to mix with calcium hydroxide and subsequently each prepared combination was determined using a digital pH meter. The pH measurements were determined at 3 min, 10 min, 1 h, 24 h, 48 h and 7 days. The results of this study indicated that four different water-based vehicles demonstrated similar pH changes range within pH 11-12 when mixed with calcium hydroxide.

Anesthetics, Local↗
PubMed2000

Pulp capping with adhesive resin-based composite vs. calcium hydroxide: a review.

The results of some short-term experiments suggest that direct capping of a vital pulp with the modern resin-based composite systems may be as effective as capping with calcium hydroxide. Total cavity etching with 10% phosphoric acid seems to be safe for the exposed pulp, but unless annulled by calcium hydroxide 35% phosphoric acid may be disastrous. For hemostasis and cleaning of the pulp wound both sodium hypochlorite and saline seem suitable, whereas the effectiveness of a 2% chlorhexidine solution is questionable. Although hard-setting calcium hydroxide cements may induce the formation of dentin bridges, they appear not to provide an effective long-term seal against bacterial factors. Within a few years, the majority of mechanically exposed and capped pulps show infection and necrosis due to microleakage of such capping materials and tunnel defects in the dentin bridges. It is unknown whether newer types of resin containing calcium-hydroxide-products will act as a permanent barrier. The cytotoxicity of the resin-based composites and the temperature rise during polymerisation may not be of concern, but microleakage, sensitisation and allergic reactions may pose problems. Based on available data, pulp capping with resin-based composites may be said to be promising, but more and long-term research is mandatory before the method can be recommended.

Acid Etching, Dental↗
PubMed1989

Tubular permeability to calcium hydroxide and to bleaching agents.

Recent reports of clinical cases suggest that cervical root resorption may follow bleaching of endodontically treated teeth. Inflammatory root resorption may be arrested by placement of calcium hydroxide into the root canal. The dentinal tubules are assumed to be a possible route of action for both agents. pH Values of the medium surrounding the tooth after placement of bleaching agents and calcium hydroxide within the root canals were determined in this study. Thirty extracted single-rooted human teeth were divided into three equal groups. The pulp cavity of the experimental teeth was filled with either bleaching agents or calcium hydroxide. In the control group it was left empty. Dipping in paraffin sealed the access cavity and the apical foramina and isolated the teeth except at the cervical root surface. The teeth were placed in vials containing distilled water and the pH of the medium was measured after 1 h, 3 days, and 7 days following renewal of the medium. The level of the pH in the first group increased, indicating that the bleaching agents leaked from the root canal to the medium surrounding the teeth. The pH in other two groups did not change noticeably. The results suggest that bleaching agents may leak from the root canal toward the periodontal tissues but calcium hydroxide does not alkalinize the medium surrounding the teeth. Leakage of the bleaching agents through dentin may, therefore, be considered as a possible etiological factor that initiates an inflammatory process around the teeth that may be followed by cervical root resorption.

Calcium Hydroxide↗
PubMed1996

Intracanal pH changes of calcium hydroxide pastes exposed to carbon dioxide in vitro.

It has been suggested that the main benefit of using calcium hydroxide as an intracanal medicament lies in its bactericidal effect, provided that the pH of the paste is above 12.5. The purpose of this study was to measure changes in the pH of several calcium hydroxide pastes sealed in root canals for 30 days. Sixty-two extracted, single-rooted human teeth were endodontically prepared using K-files up to size 60. The teeth were separated at random into six equal groups to be filled with either Calxyl, Hydrocalcium, or a paste made by mixing calcium hydroxide powder with either distilled water, camphorated p-monochlorophenol, local anesthetic solution, or Solvidont. Cavidentin was used to seal the coronal orifice of the teeth that were placed individually in vials containing 10 mL distilled water. Five vials of each group were exposed to air at room temperature, whereas the other five vials were exposed to carbon dioxide in a closed container. The pH of the paste in the root canal was measured after 30 days. There was no significant (p > 0.01) change in the pH (mean 13.11) of the pastes placed in teeth before and after exposure to air, whereas the pH of the pastes in teeth exposed to carbon dioxide was significantly (p < 0.01) reduced (mean 12.54). There was no significant difference in pH between the six preparations. After 30 days of exposure to carbon dioxide, they still maintained a purportedly bactericidal pH within the root canal.

Analysis of Variance↗
PubMed1988

The tissue reactions after capping of dog teeth with calcium hydroxide experimentally crammed into the pulp space.

The pulps of 48 permanent dog teeth, incisors and canines, were evaluated histopathologically after capping treatment with pure calcium hydroxide placed by two methods: the experimental method, in which the calcium hydroxide was crammed into the pulpal space via the exposure site, and the usual method of direct pulp capping (controls). The results were recorded after periods of 2, 15, and 69 days. The healing process with hard-tissue formation was more evident in the experimentally capped teeth, despite the fact that pulpal necrosis occurred in a higher proportion of these teeth after use of this method of placement of the calcium hydroxide.

Animals↗
PubMed1999

Antimicrobial evaluation of calcium hydroxide in infected dentinal tubules.

The objective of this study was to evaluate the antimicrobial activity of calcium hydroxide in infected dentinal tubules. Four microorganisms, strains of ATCC (Streptococcus faecalis (ATCC-29212), Staphylococcus aureus (ATCC-6538), Bacillus subtilis (ATCC-6633), and Pseudomonas aeruginosa (ATCC-27853)) and one mixture of these were used. These strains were inoculated in brain heart infusion (BHI) and incubated at 37 degrees C for 24 h. Sixty-three human maxillary central incisors were prepared and sterilized by autoclaving. Five groups of 12 teeth each were contaminated for 28 days using new 24-h cultures every 72 h, prepared and adjusted to tube 2 of the MacFarland scale (6 x 10(8) cells/ml). Root canals were then irrigated with 5 ml of saline, dried, and completely filled with calcium hydroxide paste. At intervals of 0, 48, and 72 h, and 7 days, dressings were removed and teeth were immersed in 5 ml of BHI and incubated at 37 degrees C for 48 h to observe the growth and multiplication of the microorganisms. Three uninoculated teeth were maintained in a humid environment as an aseptic control. These teeth were immersed in BHI and maintained at 37 degrees C for 7 days to determine microbial growth. Bacterial growth was shown by turbidity of the culture medium and confirmed by seeding these broths on BHI agar at 37 degrees C for 24 h. The positive BHI tubes were selected, and inoculum was spread on the surface of BHI agar, followed by the same incubation conditions. Gram stain was conducted from BHI growth and from colonies growing on solid medium. Calcium hydroxide in infected dentinal tubules showed no antimicrobial effect on S. faecalis, S. aureus, B. subtilis, P. aeruginosa, or on the bacterial mixture used throughout the experiment.

Bacillus subtilis↗
PubMed2003

Direct capping of human pulps with a dentin bonding system or with calcium hydroxide cement.

OBJECTIVE: To study human pulp reactions to direct cappings with a dentin adhesive compared with a calcium hydroxide cement, especially with respect to formation of hard tissue in the exposure site. STUDY DESIGN: Direct pulp cappings were made in 34 caries-free premolars scheduled for extraction due to orthodontic treatment. Half of the teeth were capped with a dentin adhesive, the other half with a calcium hydroxide cement. After periods of from 7 to 70 days, the teeth were extracted and processed for light microscopical examination. RESULTS: No postoperative sensitivity was experienced. A slight inflammatory reaction was seen in both groups in the short observation period. In the long observation period, significantly more "dentin bridging" was seen in the calcium hydroxide group than in the dentin adhesive group (P < .05). CONCLUSION: The findings from the present limited material is in accordance with previous findings from human studies and contraindicate use of dentin adhesives for direct pulp capping.

Adolescent↗