Effect of four vehicles on the pH of calcium hydroxide and the release of calcium ion

An in vitro comparison of calcium ions release and diffusion ability of calcium hydroxide-based intracanal medicament in combination with three different vehicles like propolis, chitosan, and propylene glycol

Context

Calcium hydroxide, which is an intracanal medicament, is widely used in endodontics. Improvements can be made to its effectiveness, as calcium hydroxide is dependent on the vehicle.

Aim

The study aims to compare and evaluate the release and diffusion ability of calcium hydroxide when mixed with - propolis, chitosan, and propylene glycol.

Methods

For this study, 33 single-rooted extracted premolar teeth have been decoronated. After the working length and enlargement of the canals had been established, different preparations of calcium hydroxide with vehicles such as propolis, chitosan, and propylene glycol were loaded into the canals. Atomic absorption spectrophotometry was used to analyze the release of calcium ions in three groups, while a digital pH meter was used to determine an acid change.

Results

Atomic absorption spectrophotometry showed sustained releases of calcium ions and the digital pH meter showed increased diffusion capacity in the propylene glycol paste group in comparison to the other two groups.

Conclusion

Propylene glycol vehicle made it easier to enter calcium hydroxide into the dentinal tubules.

The Vehicles of Calcium Hydroxide Pastes Interfere with Antimicrobial Effect, Biofilm Polysaccharidic Matrix, and Pastes' Physicochemical Properties

The objective of the present study was to investigate the pH, volumetric alteration, antimicrobial action, and effect on biofilm matrix polysaccharides of calcium hydroxide (CH) pastes with different vehicles available in endodontics: CH + propylene glycol (CHP), UltraCal XS^®, Metapaste^®, and Metapex^®. The pH was analyzed at different time intervals using a pH meter. For volumetric alteration, a microtomographic assay was performed before and after immersion in water. Enterococcus faecalis was chosen for microbiological tests. The bacterial viability and extracellular matrix were quantified with direct contact evaluation (dentin blocks) and at the intratubular level (dentin cylinders) using LIVE/DEAD BacLight and Calcofluor White dyes via confocal laser scanning microscopy (CLSM). Kruskal-Wallis and Dunn's tests were used to analyze pH and direct contact assays, while one-way ANOVA and Tukey tests were used to analyze volumetric alteration and intratubular decontamination (α = 0.05). Higher pH values were obtained during the initial days. Volumetric alterations were similar in all groups. Lower bacterial viability was obtained for dentin blocks and cylinders when CH pastes were used. UltraCal XS and Metapex had lower values for the extracellular matrix. The pH of all CH pastes decreased with time and did not promote medium alkalization for up to 30 days. CH paste can reduce bacterial viability through direct contact and at an intratubular level; however, UltraCal XS and Metapex are involved with lower volumes of extracellular matrices.

Effect of a calcium hydroxide-based intracanal medicament containing N-2-methyl pyrrolidone as a vehicle against Enterococcus faecalis biofilm

This study investigated the effect of a calcium hydroxide (CH) paste (CleaniCal^®) containing N-2-methyl pyrrolidone (NMP) as a vehicle on Enterococcus faecalis (E. faecalis) biofilms compared with other products containing saline (Calasept Plus™) or propylene glycol (PG) (Calcipex II^®).

An oxygen-releasing device to improve the survival of mesenchymal stem cells in tissue engineering

Supplying oxygen to inner areas of cell constructs to support cell proliferation and metabolism is a major challenge in tissue engineering involving stem cells. Developing devices that incorporate oxygen release materials to increase the availability of the localized oxygen supply is therefore key to addressing this limitation. Herein, we designed and developed a 3D-printed oxygen-releasing device composed of an alginate hydrogel scaffold combined with an oxygen-generating biomaterial (calcium peroxide) to improve the oxygen supply of the microenvironment for culturing adipose tissue-derived stem cells. The results demonstrated that the 3D-printed oxygen-releasing device alleviated hypoxia, maintained oxygen availability, and ensured proliferation of the embedded cells, whilst also reducing hypoxia-induced apoptosis. The introduction of this 3D-printed oxygen-releasing device could enhance the survival of embedded stem cells.

Removal efficacy and cytotoxicity of a calcium hydroxide paste using N-2-methyl-pyrrolidone as a vehicle

Objectives

This study investigated the removal efficacy and cytotoxicity of a newly developed calcium hydroxide paste (cleaniCal, Maruchi) using N-2-methyl-pyrrolidone (NMP) as a vehicle in comparison with ApexCal (Ivoclar Vivadent) and Calcipex II (Nishika), which use different vehicles such as polyethylene glycol and propylene glycol, respectively.

Materials and Methods

Thirty maxillary premolars with oval-shaped canals were divided into 3 groups and the teeth were filled with one of the pastes. After removal of the paste, micro-computed tomographic (μ-CT) imaging was obtained to assess the volume of residual paste in the root canal of each tooth. The teeth were then split longitudinally and the area of the paste-coated surface was evaluated by stereomicroscopy. The cytotoxicity of each product was assessed using an agar overlay assay. The effect of each vehicle on cell viability was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The data were analyzed using one-way analysis of variance and Tukey's tests to detect any significance (p < 0.05).

Results

In the μ-CT and stereomicroscopic analysis, cleaniCal exhibited less remnants of medicament than ApexCal and Calcipex. cleaniCal showed a higher cytotoxicity than the other pastes in the agar overlay assay. Furthermore, NMP exhibited lower cell viability compared to the other vehicles.

Conclusions

cleaniCal showed better removal efficacy compared to the other products. However, clinicians should be aware of the higher cytotoxicity of the NMP-based material and consider its possible adverse effects on periradicular tissue when it is overfilled.

Antibacterial efficacy of several intracanal medicaments for endodontic therapy

The antibacterial efficacy of intracanal medicaments for 2 and 7 days, in open apex root canals contaminated with Enterococcus faecalis biofilms was compared. One hundred and thirty-eight standardized uniradicular human roots were inoculated with E. faecalis. Colony forming units (CFU) were recorded before and after medication. Samples were divided in two (2/7 days), and subdivided (n=8/group): triple antibiotic paste (TAP); double antibiotic paste (DAP); dental base paste (DBP), consisting of calcium hydroxide, propylene glycol and calcium carbonate; DBP+0.2% chlorhexidine (CHX); DBP+0.2% cetrimide (CTR); DBP+0.2% CHX+0.2% CTR; 2.5% sodium hypochlorite (NaOCl); and distilled water. At both periods TAP, DAP, DBP+0.2% CHX, DBP+0.2% CTR and DBP+0.2% CHX+0.2% CTR exhibited no growth (NG) of E. faecalis. Distilled water and 2.5% NaOCl obtained the lowest CFU reduction. No growth with DBP was reached only at 7 days. CHX and/or CTR pastes were as effective as DAP and TAP. A 2-day period provided an effective disinfection.

Antimicrobial Activity and Physicochemical Properties of Calcium Hydroxide Pastes Used as Intracanal Medication

INTRODUCTION

The aim of the present study was to evaluate the pH, calcium release, solubility, and antimicrobial action against biofilms of calcium hydroxide + saline solution, Calen (SS White Artigos Dentários Ltd, Rio de Janeiro, Brazil) (CH/P), Calen camphorated paramonochlorophenol (CMCP) (CH/CMPC), and calcium hydroxide + chlorhexidine (CH/CHX) pastes.

METHODS

The pH of the pastes was determined with a calibrated pH meter placed in direct contact with each paste. The root canals of acrylic teeth (N = 10) were filled with the previously mentioned intracanal dressings and immersed in ultrapure water to measure hydroxyl (pH meter) and calcium ion release (atomic absorption spectrophotometer) at time intervals of 3, 7, 15, and 30 days. To assess solubility, the root canals of acrylic teeth (N = 10) were filled with the previously mentioned pastes and scanned by micro-computed tomographic imaging before (initial) and after 7, 15, and 30 days of immersion in ultrapure water. The solubility of each specimen was the difference between the initial and final volume scanning. For antimicrobial analysis, monospecies and dual-species biofilms were in vitro induced on dentin blocks (N = 20). Afterward, they were treated with the pastes for 7 days. Live/dead dye and a confocal microscope were used to measure the percentage of living cells. Data were statistically compared (P < .05).

RESULTS

The highest OH^- ion release values were found in 3 and 30 days. Ca²⁺ releases were greater in CH/CMCP. CH/P and CH/CMCP showed a higher percentage of volume loss values. CH/CHX presented the greatest antimicrobial action.

CONCLUSIONS

CH/P and CH/CMPC showed higher solubility values in the period analyzed. Seven days of contact may be insufficient for calcium hydroxide + saline solution, CH/P, and CH/CMCP pastes to kill bacterial cells in the biofilms studied. Chlorhexidine added to CH favored greater effectiveness against the previously mentioned bacterial biofilms.

Dentinal Tubule Disinfection with Propolis & Two Extracts of Azadirachta indica Against Candida albicans Biofilm Formed on Tooth Substrate

Aim:

This study evaluates the disinfection of dentinal tubules using Propolis, Azadirachta indica (alcoholic and aqueous extracts), 2% chlorhexidine gel and calcium hydroxide against Candida albicans biofilm formed on tooth substrate.

Materials & Method:

One hundred and five human teeth were infected with Candida albicans for 2 days. Samples were divided into 7 groups. Group I- Propolis, Group II- Alcoholic extract of Azadirachta indica, Group III- Aqueous extract of Azadirachta indica, Group IV- 2% Chlorhexidine, Group V- Calcium hydroxide, Group VI- Ethanol and Group VII- Saline (negative control). At the end of 1,3 and 5 days, the antimicrobial efficacy of medicaments against Candida albicans was assessed at the depths of 200 µm and 400 µm.

Results:

The overall percentage inhibition of fungal growth (at 200 µm and 400 µm depth) was 99.2% with 2% chlorhexidine gel. There was no statistical difference between propolis, alcoholic extract of Azadirachta indica (neem) and 2% chlorhexidine.

Conclusion:

Propolis and alcoholic extract of Azadirachta indica performed equally well as that of 2% Chlorhexidine.

An In-vitro Evaluation of the pH Change Through Root Dentin Using Different Calcium Hydroxide Preparations as an Intracanal Medicament

CONTEXT

The aim of the study was to evaluate the pH variation in the surrounding medium after the use of two different vehicles of Calcium hydroxide - Saline (aqueous), Propylene glycol (viscous) and Calcium hydroxide containing guttapercha points over a period of 7 days as an intracanal medicament.

MATERIALS AND METHODS

Sixty single rooted premolars were decoronated at the cementoenamel junction and cleaned and shaped uptil size 40 master apical file. External defects were made on the mesial surface in the coronal third of the roots and divided randomly into 4 groups. One control and three experimental. In the control - group I the root canals were left empty. In the experimental groups - group II was filled with Ca(OH)2 + saline, group III was filled with Ca(OH)2 + propylene glycol and group IV the root canals were filled with Calcium hydroxide points. The coronal accesses were sealed with 3mm of Cavit G and all the surfaces of the root except the defect were covered with 3 coats at Nail varnish. The samples were then placed in air tight vials containing 2ml of distilled water. The vials were kept in an incubator and the pH of the surrounding medium was measured using a digital pH meter after 1,3,5 and 7 days respectively.

RESULTS

A statistically significant difference (p<0.05) existed between the experimental groups over the observation period. At day 1, a high pH was recorded by the calcium hydroxide points and saline groups and a lower pH by the propylene group. At day's 3 and 5, the maximum pH was recorded by the propylene glycol group and minimum by the calcium hydroxide points and saline groups. At day 7, the pH of all the groups had dropped, with propylene glycol recording the maximum pH followed by saline and lastly calcium hydroxide points.

CONCLUSION

Within the limitations of this study, a viscous vehicle is better among other vehicles, calcium hydroxide paste of propylene glycol provided the highest 7 days release of hydroxyl ions.

Evaluation of calcium ion release and change in pH on combining calcium hydroxide with different vehicles

Introduction:

Intracanal medicaments have traditionally been used in endodontics to disinfect root canals between appointments. Calcium hydroxide is widely used as an intracanal medicament for disinfection and to promote periapical healing. It is stable for long periods, harmless to the body, and bactericidal in a limited area. The efficacy of calcium hydroxide as a disinfectant is dependent on the availability of the hydroxyl ions in the solution that depends on the vehicle in which the calcium hydroxide is carried. In general, three types of vehicles are used: Aqueous, viscous or oily. Some in vitro studies have shown that the type of vehicle has a direct relationship with the concentration and the velocity of ionic liberation as well as with the antibacterial action when the paste is carried into a contaminated area.

Aim of the Study:

To evaluate the calcium ion release and measure the change in pH of the environment that occurred when calcium hydroxide was combined with different vehicles (distilled water, propylene glycol, calcium hydroxide containing gutta-percha points and chitosan) over different time periods.

Materials and Methods:

Forty single rooted mandibular first premolar teeth were decoronated for this study. Working length was established and the root canals were enlarged and irrigation accomplished with 2 ml of NaOCl solution after every file. The teeth were then randomly divided into four groups. The canals were then packed with different preparations of calcium hydroxide using the following vehicles-distilled water, propylene glycol, gutta-percha points and chitosan. Calcium ion release in different groups was analyzed using an ultraviolet spectrophotometer at 220 nm. The change in pH of was determined using a pH meter. Results were statistically evaluated using one-way ANOVA test.

Result:

For calcium ion release, Group 2 showed cumulative drug release of 81.97% at the end of 15 days, whereas Group 1, 3 and 4 showed a release of 99.53, 17.98, 74.93% respectively with a significant difference among all groups. Group 1 reached the highest Ca²⁺ level (39.79%) at the end of 1 day but showed almost complete release of calcium hydroxide at the end of 15 days. Group 3 showed least calcium ion release (17.98%) at 15 days. Group 4 showed a sustained release of Ca⁺² ions from 74% at 15 days to 95% at the end of 30 days. After the 1^st h; Group 1 showed the highest pH level (11.8). However, pH reduced to 7.8 at the end of 30 days in this group. Group 2 showed the highest pH value (10.35), followed by Group 4 (10.32) after 30 days.

Conclusion:

Chitosan can be used as a promising vehicle for calcium hydroxide to maintain an alkaline pH and to allow sustained release of calcium ions in the root canal system.

Retrievabilty of calcium hydroxide intracanal medicament with Chitosan from root canals: An in vitro CBCT volumetric analysis

AIM

This study compared the amount of aqueous-based and oil-based calcium hydroxide [Ca(OH)2 ] remaining in the canal, after removal with two different chelators 17% EDTA and 0.2% Chitosan in combination with ultrasonic agitation.

MATERIALS AND METHODS

Cleaning and shaping of root canals of 28 mandibular premolar was done and canals were filled either with Metapex or Ca(OH)2 mixed with distilled water. Volumetric analysis was performed utilizing cone beam-computed tomography (CBCT) after 7 days of incubation. Ca(OH)2 was removed using either 17% EDTA or 0.2% Chitosan in combination with ultrasonic agitation. Volumetric analysis was repeated and percentage difference was calculated and statistically analysed using Kruskal-Wallis and Mann-Whitney U test.

RESULTS

Both the chelators failed to remove aqueous-based as well as oil-based Ca(OH)2 completely from the root canal. Aqueous-based Ca(OH)2 was easier to be removed than oil-based Ca(OH)2. 0.2% Chitosan was significantly more effective for removal of oil-based Ca(OH)2 (P < 0.01) while both 17% EDTA and 0.2% Chitosan were equally effective in removing aqueous-based Ca(OH)2 .

CONCLUSION

Combination of 0.2% Chitosan and ultrasonic agitation results in lower amount of Ca(OH)2 remnants than 17% EDTA irrespective of type of vehicle present in the mix.

Diffusion of hydroxyl ions from calcium hydroxide and Aloe vera pastes

This study evaluated the diffusion through the dentinal tubules of hydroxyl ions from different calcium hydroxide (CH) pastes containing Aloe vera. Sixty single-rooted bovine teeth were used. The tooth crowns were removed, the root canals were instrumented and the specimens were assigned to 4 groups (n=15) according to the intracanal medication: Group CH/S - CH powder and saline paste; Group CH/P - CH powder and propylene glycol paste; Group CH/A - calcium hydroxide powder and Aloe vera gel paste; Group CH/A/P - CH powder, Aloe vera powder and propylene glycol paste. After placement of the root canal dressings, the teeth were sealed coronally and apically with a two-step epoxy adhesive. The teeth were placed in identified flasks containing deionized water and stored in an oven with 100% humidity at 37 °C. After 3 h, 24 h, 72 h, 7 days, 15 days and 30 days, the deionized water in the flasks was collected and its pH was measured by a pH meter. The obtained data were subjected to statistical analysis at a significance level of 5%. The results demonstrated that all pastes provided diffusion of hydroxyl ions through the dentinal tubules. The combination of Aloe vera and CH (group CH/A) provided a constant release of calcium ions. Group CH/A/P showed the highest pH at 24 and 72 h. In conclusion, the experimental pastes containing Aloe vera were able to enable the diffusion of hydroxyl ions through the dentinal tubules.

Antifungal effectiveness of various intracanal medicaments against Candida albicans: an ex-vivo study

Background

To investigate the antifungal activity of propolis, triple antibiotic paste (TAP), 2% chlorhexidine gel and calcium hydroxide with propylene glycol on Candida albicans-infected root canal dentinal tubules at two different depths (200 μm and 400 μm) and two time intervals (day 1 and 7).

Methods

A total of 90 extracted human teeth were sectioned below the cementoenamel junction and the apical part of the root to obtain 6 mm of the middle third of the root. The root canal was enlarged to an internal diameter of 0.9 mm using Pesso Reamer size no. 2 (Mani®, UT, Japan), followed by canal irrigation and autoclaved. The specimens were infected for 21 days with C. albicans. Then, the specimens were divided into five groups prior to placement of intracanal medicaments. Group 1 (propolis), Group 2 (triple antibiotic paste), Group 3 (2% chlorhexidine Gel), Group 4 (calcium hydroxide with propylene glycol), and Group 5 (sterile saline as negative control). At the end of 1 and 7 days, dentine shavings were collected at two depths into the dentinal tubules (200 μm and 400 μm), and the total numbers of colony forming units were calculated for assessing the remaining vital viable fungal population. The values were analysed statistically using non-paramatric Kruskal-Wallis and Mann–Whitney-U tests to compare the median reduction of Candida albicans between all intracanal medicaments. Probability values of P < 0.05 were set as the reference for statistically significant results.

Results

The reduction in number of colony forming units was statistically significant in all groups compared to the control group (sterile saline), except propolis at day 1 (400 μm depth).

Conclusion

Propolis was less effective than triple antibiotic paste, 2% chlorhexidine gel and calcium hydroxide with propylene glycol against C. albicans on day 1 at 400 μm deep inside the dentinal tubules, but equally effective after 7 days at both depths.

Effect of indomethacin on surface treatment and intracanal dressing of replanted teeth in dogs

PURPOSE

This study evaluated the healing process of teeth replanted after root treatment and intracanal dressing with indomethacin alone or indomethacin with calcium hydroxide (Ca[OH]2).

MATERIALS AND METHODS

Through a case-control study, 24 teeth of 6 adult dogs were extracted, dried, and divided into 4 groups according to the root surface treatment protocols performed before replantation and the intracanal medication used after replantation. In group 1 (negative control), root surfaces were treated by immersion in a 0.9% saline solution and then replanted. In the other groups, the roots were immersed for 10 minutes in Ca(OH)2 (group 2), indomethacin (group 3), or a solution of indomethacin and Ca(OH)2 (group 4). After 2 weeks, group 1 teeth were subjected to single-visit root canal treatment and obturation with gutta-percha and sealer consisting of zinc oxide and eugenol. The teeth in the other groups were subjected to intracanal dressing with the same material used for immersion. After an additional period of 28 weeks, the animals were euthanized and the jaws containing the replanted teeth were processed for histologic analysis. Histometric values were statistically analyzed, with significance set at a P value less than or equal to .05.

RESULTS

Group 1 exhibited significantly more normal periodontium than group 4 (P = .02). Total resorption was greater in group 4 than in group 1 (P = .02). No statistically significant difference in the percentage of surface resorption or in total inactive resorption was observed between the groups.

CONCLUSIONS

The findings of this study suggest that intracanal dressing and topical root treatment with Ca(OH)2 with or without indomethacin is not recommended for teeth dried for 50 minutes, but the use of indomethacin alone as root surface treatment for delayed tooth replantation deserves further study using longer drying periods. In addition, the present results suggest that a single-visit root canal, performed up to 2 weeks after replantation, might be indicated for teeth dried for up to 50 minutes.

Mixing with propylene glycol enhances the bond strength of mineral trioxide aggregate to dentin

INTRODUCTION

Mixing mineral trioxide aggregate (MTA) with different proportions of propylene glycol (PG) improves its handling property. The aim of this study was to evaluate the effect of PG on MTA-dentin push-out bond strength.

METHODS

Seventy-five 2-mm-thick midroot sections were prepared from single-rooted human extracted teeth. The lumen of each slice was enlarged with Gates-Glidden burs. The slices were randomly divided into 3 groups (n = 25). In each group, 0.3 mL of the liquid was mixed with 1 g MTA (Angelus, Londrina, Brazil). The liquid vehicles used in groups 1-3 were 100% distilled water (DW), 20% PG-80% DW, and 100% PG, respectively. After incubation, the push-out strength of the samples was measured using a universal testing machine. The samples were then cut in halves and examined under a stereomicroscope to determine the failure pattern. One-way analysis of variance followed by the Tukey post hoc test was used to compare the push-out strength among groups.

RESULTS

There were statistically significant differences between groups (P < .001). The push-out strength in group 1 (DW) was significantly lower than groups 2 and 3 (P < .001 and P = .022, respectively). However, there was no significant difference between groups 2 (DW-PG) and 3 (PG).

CONCLUSIONS

Mixing MTA with PG increased its push-out bond strength to dentin. In the present study, the most suitable ratio was 80% DW-20% PG.

Antibacterial action of calcium hydroxide vehicles and calcium hydroxide pastes

AIM

To evaluate the in vitro action of vehicles alone and with calcium hydroxide against different bacterial species.

METHODS

Agar plates were inoculated with the microbial suspensions, and wells were made and filled with the calcium hydroxide pastes and the vehicles used to prepare the pastes. The zones of inhibited bacterial growth were recorded, and the resulting measurements were statistically analyzed.

RESULTS

Enterococcus faecalis was the most resistant microorganism to all medicaments. Calcium hydroxide + p-monochlorophenol; calcium hydroxide + p-monochlorophenol-propylene glycol pastes; and p-monochlorophenol, p-monochlorophenol-propylene glycol, and chlorhexidine gluconate gel alone showed the largest zones of inhibition against all the tested microorganisms.

CONCLUSIONS

The vehicle used to prepare the calcium hydroxide paste might contribute to its antibacterial action. Chlorhexidine gluconate gel used alone, and camphorated p-monochlorophenol and camphorated p-monochlorophenol-propylene glycol as vehicles of calcium hydroxide, could be recommended, in an antimicrobial sense.

Influence of dentin from the root canal walls and the pulp chamber floor on the pH of intracanal medicaments

INTRODUCTION

The objective of this study was to evaluate the alterations in the pH of calcium hydroxide (Ca[OH]2), 2% chlorhexidine (CHX) gel, and their combination after adding dentin powder from the root canal walls and the pulp chamber floor.

METHODS

Ca(OH)2 paste, 2% CHX gel, and their combination were examined. Dentin powder was obtained from the root canal walls and the pulp chamber floor of bovine teeth and added as 1.8% to the volume of the medications. The pH values of the mixtures were assessed immediately after preparation, after 24 hours, and on days 7 and 14. Data were analyzed statistically by analysis of variance and the Student's t test (P = .05).

RESULTS

pH values of Ca(OH)2 were always above 12 in the presence or absence of dentin powder during the 14 days of the study. A significant decrease in pH values of Ca(OH)2 was observed after 14 days when dentin from the root canal wall was added (P < .001). The pH values of CHX gel were significantly increased by the presence of dentin (P = .001). The t test showed a significant difference in the increase of the pH values when the different dentin types were added (P = .002). The pH of the Ca(OH)2 and CHX gel combination was not influenced by dentin powder from the root canal walls, and a reduction was observed after 14 days, exactly like in the control group. The pH values of the combination did not alter after 14 days when pulp chamber floor dentin was added.

CONCLUSIONS

The different dentin types variably affect the pH of Ca(OH)2 paste, 2% CHX gel, and their combination in the studied periods.

Hydroxyl and calcium ions diffusion from endodontic materials through roots of primary teeth - in vitro study

The purpose of this research was to evaluate the diffusion of calcium (Ca+2) and hydroxyl (OH-) ions from materials with a calcium hydroxide base - Ca(OH)2 through the intact roots of deciduous teeth. This diffusion of ions is important for periapical healing. Forty-six deciduous teeth were selected and instrumented to their working length with #40 files. The teeth were washed during cleaning and shaping with a 1% sodium hypochlorite (NaOCl) solution. The canals were dried with paper points. The teeth were divided into 4 groups based on the sealer type, with 10 specimens in each group. A fifth group of 6 teeth without sealer constituted the control group. The materials used as sealers were: Ca(OH)2 paste associated to propylene glycol (CaPE) thickened at the proportion of 2:1 w/v; UFSC (Federal University of Santa Catarina) paste - a mixture of 0.3g of zinc oxide with 0.3g of Ca(OH)2 with 0.2ml of olive oil 1:1 w/w; Vitapex® and Sealapex®. The coronal access was sealed with a glass ionomer after the root had been filled with each sealer. A one-third apical surface and foramen was hard-pressed with Araldite®. The teeth were stored individually in flasks containing saline solution at 37ºC and 100% humidity. The OH- and Ca+2 ions diffusion levels were determined using a pH meter and an atomic absorption spectrometer. Data were collected at 48 hours and at intervals of 7, 30, 45 and 60 days. Statistical analysis was performed using ANOVA to compare groups. In the pH evaluation, the CaPE group presented the largest OH- ions diffusion, which peaked at sixty days (p=0.0309), when compared to the other groups (p<0.0001). In relation to amount of Ca+2 ions released, the CaPE paste showed the best results, followed by the UFSC's paste. These results suggest that the CaPE paste was the material that allowed the highest diffusion of OH- and Ca+2 ions.

Disinfection of dentinal tubules with two different formulations of calcium hydroxide as compared to 2% chlorhexidine: As intracanal medicaments against Enterococcus faecalis and Candida albicans: An in vitro study

Aim:

To evaluate the disinfection of dentinal tubules using calcium hydroxide with propylene glycol and calcium hydroxide with iodoform in silicone oil, as compared to 2% chlorhexidine gel.

Materials and Methods:

The antimicrobial efficacy of the medicaments against E.faecalis and C.albicans were assessed in vitro, using a dentinal tubule model at depths of 200 μm and 400 μm in extracted single rooted teeth. Saline was taken as the negative control (Group I)

Results:

All three medicaments used in this study exerted antibacterial and antifungal activity. Group II (calcium hydroxide with propylene glycol) and Group IV (2% chlorhexidine gel) had the highest antimicrobial activity and the differences between their antibacterial activities were not statistically significant. Group III (calcium hydroxide with iodoform in silicone oil) and Group IV had the highest antifungal activity and the differences between their antifungal activities were not statistically significant. The inhibition of growth at 200 μm and 400 μm was uniform, with no statistical difference.

Conclusions:

Two percent chlorhexidine gel was effective against both E.faecalis and C.albicans. Calcium hydroxide with propylene glycol was the most effective intracanal medicament along with 2% chlorhexidine against E.faecalis, whereas, calcium hydroxide with iodoform in silicone oil was the most effective intracanal medicament along with 2% chlorhexidine against C.albicans.

In vitro sustained release of calcium ions and pH maintenance from different vehicles containing calcium hydroxide

INTRODUCTION

Calcium hydroxide is widely used as an intracanal medicament in endodontics. Its therapeutic effects depend on the dissociation of calcium hydroxide into calcium and hydroxyl ions, which, in turn, depends on the vehicle used. The purpose of this in vitro study was to evaluate the sustained release of calcium ions and the pH change of calcium hydroxide over a period of 30 days when formulated with propylene glycol, polyethylene glycol 6000, chitosan, and guar gum.

METHODS

Various formulations were prepared and placed inside the root canals of human teeth and were suspended in glass vials containing distilled water. At specific time intervals, the calcium ion concentration was analyzed using an ultraviolet spectrophotometer. pH changes of the medium were measured at various time intervals up to 30 days.

RESULTS

Results revealed that chitosan formulation showed the maximum sustained release of calcium ions compared with the other three formulations. All the formulations exhibited high alkaline pH upto 30 days.

CONCLUSION

From the results of this in vitro study, it can be concluded that chitosan can be used as a promising vehicle for for the sustained release of calcium ions from the calcium hydroxide in the root canal system.

Biocompatibility of acetazolamide pastes in the subcutaneous tissue of rats

This aim of this study was to investigate the biocompatibility of two experimental acetazolamide (AZ)-based pastes in the subcutaneous tissue of rats. Both pastes contained AZ as the main component in similar concentration. The vehicle in experimental paste 1 was saline, while experimental paste 2 was prepared with propylene glycol. Sixty polyethylene tubes were sealed at one end with gutta-percha (GP), which served as a control. Half of the tubes were filled with paste 1 and half with paste 2. The tubes were implanted in the subcutaneous tissue of 15 rats, being 4 tubes for each animal. The animals were killed 7, 15 and 45 days after surgery and the specimens were processed in laboratory. The histological sections were stained with hematoxylin and eosin and were analyzed by light microscopy. Scores were assigned to level of inflammatory process: 1- none; 2- mild; 3- moderate; 4- severe. The data were analyzed statistically by the Kruskal-Wallis test (p< or =0.05). Paste 1 produced an inflammatory process at 7 days. However, the intensity of this inflammation decreased with time and was nearly absent at 45 days. No statistically significant difference (p>0.05) was observed between the control (GP) and paste 1. However, paste 2 produced inflammatory response at all study periods and differed significantly (p<0.05) from the control. In conclusion, in the present study, the experimental AZ-based paste 1 was considered as biocompatible as the control matrial (GP), while experimental paste 2 was irritating to rat subcutaneous tissue.

Nonsurgical management of a nonvital tooth with orthodontically induced external root resorption and extensive periapical pathology

The purpose of this article is to report a rare case of orthodontically induced external root resorption of a maxillary left central incisor with a large periapical radiolucency; it was treated successfully with a conservative approach that included the use of calcium hydroxide. The tooth was nonvital and had grade III mobility. It was treated endodontically for 2 years with an interim filling of calcium hydroxide mixed with propylene glycol. After 2 years, the postoperative intraoral periapical radiograph showed good periapical healing with complete resolution of periapical radiolucency. There was a significant reduction in the mobility of the tooth, from grade III to grade I.

Vehicle influence on calcium hydroxide pastes diffusion in human and bovine teeth

The purpose of this study was to compare the pH and calcium ion liberation after use of calcium hydroxide pastes with different paste vehicles in human or bovine teeth. Ninety-two single-rooted human and bovine roots were used. The roots were instrumented and an external cavity preparation was performed. The roots were divided in to human and bovine groups. Each group was subdivided into four subgroups (SB) according to the vehicle:SB1, detergent; SB2, saline; SB3, polyethylenoglycol + camphorated paramonochlorophenol (Calen PMCC) and SB4, polyethylenoglycol + furacyn paramonochlorophenol (FPMC). Specimens were immersed into saline solution at 37 degrees C and after 7 and 14 days pH and calcium ion measurements were made. The results were analyzed by anova and Tukey tests (P < 0.05). There was no statistical difference between bovine and human teeth in the pH analysis (P < 0.05), but bovine teeth provided larger calcium ion liberation than human teeth. Calen PMCC was statistically more effective for pH increase and calcium ion liberation in all analyses, followed by FPMC and saline. Detergent showed the lowest pH alterations and calcium ion liberation. The period of 14 days showed more calcium ionic liberation than the 7-day period.

Removal Efficiency of Calcium Hydroxide Intracanal Medicament With Two Calcium Chelators: Volumetric Analysis Using Spiral CT, An In Vitro Study

The vehicles used to carry calcium hydroxide intracanal medicament are many and may affect the retrieval. Access cavities were prepared in 40 single rooted anterior teeth, cleaning and shaping was done and filled with either Metapex or pure calcium hydroxide powder in distilled water. After 7 days the calcium hydroxide was retrieved using either 17% EDTA or 10% citric acid in combination with ultrasonic agitation. Volume analysis was done using spiral computed tomography. The percentage difference was calculated and statistically analyzed using Kruskal-Wallis and Mann-Whitney U test. 10% citric acid showed better removal efficiency than 17% EDTA for Metapex (p = 0.003). The 17% EDTA showed excellent removal efficiency of powder form of calcium hydroxide in distilled water than Metapex (p < 0.001). Ten percent citric acid removed powder form of calcium hydroxide in distilled water better than Metapex (p = 0.05).

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.

Evaluation of pH levels and calcium ion release in various calcium hydroxide endodontic dressings

OBJECTIVE

The purpose of this study was to evaluate Ca(2+) release and pH of 3 calcium hydroxide-based products used routinely as intracanal dressings, as well as the new gutta-percha points with calcium hydroxide.

STUDY DESIGN

The pH and Ca(2+) release were assessed using Calen with camphorated paramonochlorophenol, saline calcium hydroxide paste, LC paste (Lopes and Costa paste-calcium hydroxide with olive oil), and calcium hydroxide containing gutta-percha points. The materials were inserted in polyethylene tubes and immersed in deionized water. The pH variation and Ca(2+) release were monitored periodically for 4 weeks.

RESULTS

After 72 hours, materials 1 and 2 raise the pH from 9.6 and 8.2 to 11.4 and 11.3, respectively, while a small change was observed for materials 3 and 4. The calcium concentration released from materials 1, 2, 3, and 4 after 72 hours was 6.54, 4.98, 1.31, and 1.74 mg/dL, respectively.

CONCLUSION

Calen plus camphorated paramonochlorophenol and saline calcium hydroxide paste exhibited the highest calcium release and pH levels.

Determination of pH and calcium ion release provided by pure and calcium hydroxide-containing AHPlus

AIM

To compare in vitro the pH and calcium ion release provided by pure and calcium hydroxide-containing AHPlus.

METHOD

Pure and modified AHPlus, the latter containing 5 and 10% (w/w) calcium hydroxide added during spatulation, were used. The material was spatulated and stored in 10 tubes that were 1 cm long and 1.5 mm in diameter, and then immersed in 20 mL deionized water before the materials had set. Ten tubes with zinc oxide and eugenol were used as controls. Four millilitres of water was removed from the flasks after 24 and 48 h, and after 7, 14 and 30 days, and pH and calcium release were measured with a pH meter and by atomic absorption spectrophotometry, respectively. The results obtained at each time point were compared statistically.

RESULTS

A more alkaline pH for AHPlus supplemented with 5 and 10% calcium hydroxide was recorded when compared to pure AHPlus; there were significant differences at 14 and 30 days (P<0.05). The results of calcium ion release showed no significant difference between pure AHPlus and zinc oxide plus eugenol (P>0.05). The comparisons between the AHPlus containing 10% calcium hydroxide with AHPlus containing 5% calcium hydroxide, pure AHPlus, zinc oxide plus eugenol demonstrated significant differences (P<0.05) at all periods. The comparisons between AHPlus containing 5% calcium hydroxide with pure AHPlus and zinc oxide plus eugenol demonstrated significant differences (P<0.05) at all periods of evaluation.

CONCLUSIONS

The addition of 5 and 10% calcium hydroxide to AHPlus cement favoured a more alkaline pH and greater calcium ion release.

Diffusion of Ca(OH)2 Associated with Different Vehicles: Chromatographic Study (High-performance Liquid Chromatography)

Using high-performance liquid chromatography (HPLC), small amounts of liquid samples in which 25 premolar human teeth were immersed were evaluated. Each tooth was immersed separately in 800-ml flasks with distilled ultra-pure deionized water and remained there for 1678 h after the filling of their canals with Ca(OH)2 associated with different vehicles: group 1: polyethylene glycol and colophon (Calen); group 2: glycerin and camphorated paramonochlorophenol; group 3: camphorated paramonochlorophenol; group 4: glycerin and tricresol formol; and group 5: anesthetic solution (Citanest). Five polyethylene tubes were filled with each of these pastes and placed unsealed in similar flasks. At the end of this period, HPLC analyses of the aqueous medium related to each group were performed to detect other substances that had diffused from the pastes used in the canals of the teeth other than calcium and hydroxyl ions. Although the groups presented different maximum peaks when there was no barrier, they all showed higher values than when the tooth was present. At least 15 substances other than Ca2+ and OH- were detected in the aqueous medium of group 4. Analyzing the HPLC graphs, we concluded that not only Ca2+ and OH-, but also a considerable quantity of other components of the pastes diffused through the dentine and reached the external root surface.

Influence of different vehicles on the pH of calcium hydroxide pastes

The main known benefit of calcium hydroxide as an intracanal medicament lies in the bactericidal effect conferred by its pH. The objective of this work was to determine the influence of the vehicle on the pH of calcium hydroxide pastes after usage in patients and in vitro. The incisor root canals of 180 patients were instrumented and filled with calcium hydroxide pastes containing distilled water, chlorhexidine, propylene glycol, anesthetic solution, camphorated p-monochlorophenol and camphorated p-monochlorophenol-propylene glycol. The pH of the paste in the patients' root canals was measured at 7, 14 and 21 days. Similarly, pH was measured in vitro up to 21 days. The pH of all the pastes remained constant throughout the time periods assessed. The calcium hydroxide-water combination showed significantly higher pH values than the other pastes in clinical use. Comparative analysis showed that the pH values of the anesthetic solution, camphorated p-monochlorophenol and camphorated p-monochlorophenol-propylene glycol were significantly higher in vitro. The type of vehicle was shown to influence the final pH of the pastes. However, the alkalinity of all pastes was maintained over time under the experimental conditions.

Ca2+ Diffusion Through Dentin of Ca(OH)2 Associated with Seven Different Vehicles

This investigation measured the diffusion of Ca2+ through dentin by using Ca(OH)2 associated with various vehicles. After mechanical preparation and removal of smear layer, 41 human premolar teeth were stored individually in flasks containing 800 ml of ultra-pure deionized water for 2855 h. The Ca2+ concentration was measured by atomic absorption spectrophotometry as a function of time. These measurements were divided into two phases: dissolution, to check the loss of Ca2+ from the tooth structure itself, for which all canals were kept empty and open in the absence of medication for 1168 h, and diffusion, in which the specimens were divided into 10 groups (3 control groups: group 1 = water control, group 2 = sealing control, and group 3 = open canal dissolution control; 7 experimental groups in which the whose canals were filled with Ca(OH)2 paste associated with the following vehicles: group 4 = saline; group 5 = polyethylene glycol (Calen); group 6 = glycerin and camphorated parachlorophenol group 7 = camphorated paramonochlorophenol; group 8 = glycerin; group 9 = glycerin and tricresol formaldehyde (TCF); and group 10 = anesthetic solution. This phase lasted 1687 h. A total of 1058 measurements of Ca2+ were made. Regression analysis was used for statistical evaluation. We concluded that diffusion occurred differently for each group: the medications used in the root canals interacted with the dentinal structure or among themselves; the medication coated the dentinal tubule, facilitating the diffusion of Ca2+ into the external part of the root.

Calcium hydroxide's association with different vehicles: In vitro action on some dentinal components

OBJECTIVE

Calcium hydroxide, Ca(OH)(2), is a common intracanal medicament. Ca(OH)(2) powder can be mixed with different vehicles and used as a paste for temporary intracanal treatment. The vehicle may influence the dissociation of calcium hydroxide into ions. We sought to evaluate the level of pH and to quantitatively estimate the release of proteins, hydroxyproline, and phosphorus from pieces of radicular dentin kept in different Ca(OH)(2) solutions.

STUDY DESIGN

Twenty-eight extracted incisors were maintained for 35 days in Ca(OH)(2) aqueous solutions prepared in chlorhexidine digluconate, propylene glycol (PG), anesthetic solution, camphorated monochlorophenol (CMCP), and CMCP-PG. The control solution contained Ca(OH)(2) without vehicle.

RESULTS

The pH values changed little during the experiment. The concentrations of proteins, hydroxyproline, and phosphorus rose for all the solutions under study. Statistical analysis of the data from the control and the experimental groups revealed an increase in the concentration of proteins when chlorhexidine, anesthetic solution, and PG were used; a rise in hydroxyproline levels when CMCP-PG, CMCP, and PG solutions were used; and an increase in phosphorus when PG and chlorhexidine vehicles were used.

CONCLUSION

The test solutions with the root dentin remained alkaline. A release of proteins, hydroxyproline, and phosphorus was observed.

Influence on pH of vehicle containing glycerin used with calcium hydroxide

- The pH values of the external aqueous medium, relative to the roots of 41 human premolar teeth filled with Ca(OH)2 in to several vehicles, were evaluated in the present study. After root canal biomechanical preparation and smear-layer removal, the teeth were stored individually, immersed in flasks containing 800 ml of ultra-pure deionized water for a period of 118 days. A pH meter was used to analyse the pH values as a function of time. The measurements were divided into phase 1: dissolution, in which all canals remained empty and open in the absence of medicament for 48 days, and phase 2: diffusion, in which the specimens were divided into 10 groups which consisted of three control groups: group 1, water control; group 2, sealing control; and group 3, opened canal dissolution control, and seven experimental groups, with five teeth each, whose canals were filled with Ca(OH)2 paste associated with the following vehicles: group 4, saline solution; group 5, polyethylene glycol (Calen); group 6, glycerin and parachlorophenol (PMCC); group 7, PMCC; group 8, glycerin; group 9, glycerin and formo cresol (FC); and group 10, anesthetic solution. This phase lasted for 70 days. A total of 1058 measurements of the pH values were made. Regression analysis was used for statistical evaluation. The results show that all groups containing polyol in the composition of the paste had a trend to acidification in the interval between filling and 14 days later (therapeutic period) and, at the end of the experiment (1687 h to 70 days after canal filling), the pH was slightly alkaline. We conclude that polyhydroxy alcohol (glycerin and polyethylene glycol, Calen) diffusion enhances acidification of the aqueous medium.

Clinical aspects of pulpal-periodontal lesions

It is well known that the main purpose of dentistry is to keep teeth in the oral cavity so that they may fulfill their various roles. This case report demonstrates a method to treat a situation involving a pulpal-periodontal lesion, by using a simple and efficient combined therapy. The clinician can thereby determine the cause of the lesion (pulpal and/or periodontal) and subsequently establish the correct treatment, thus improving the prognosis of the case.

Penetration of propylene glycol into dentine

AIM

This study aimed to evaluate penetration of propylene glycol into root dentine.

METHODOLOGY

Safranin O in propylene glycol and in distilled water were introduced into root canals with and without artificial smear layer. Dye diffusion through dentinal tubules was determined spectrophotometrically. The time required for dye to exit through the apical foramen using propylene glycol and distilled water as vehicles was also determined. The extent and areas of dye penetration on the split surfaces of roots were assessed using Adobe Photoshop and NIH Image Software.

RESULTS

Propylene glycol allowed dye to exit faster through the apical foramen. The area and depth of dye penetration with propylene glycol was significantly greater than with distilled water (P < 0.0001). Smear layer significantly delayed the penetration of dye.

CONCLUSION

Propylene glycol delivered dye through the root canal system rapidly and more effectively indicating its potential use in delivering intracanal medicaments.

Influence of root canal dressings and sealers on repair of apical periodontitis after endodontic treatment

OBJECTIVE

The objective of this study was to evaluate the histopathologic response of periapical tissues after root canal treatment of necrotic dog teeth with chronic apical periodontitis by using 2 calcium hydroxide-based root canal dressings and 2 root canal sealers.

STUDY DESIGN

Seventy-eight root canals were instrumented by using 5.25% sodium hypochlorite as the irrigating solution, after which a calcium hydroxide paste (Calen/PMCC or Calasept) was placed for 30 days as a dressing. The root canals were then filled by using cold lateral gutta-percha condensation and an endodontic sealer (Sealapex or AH Plus). After 360 days, the animals were killed by anesthetic overdose; then, the teeth were histologically prepared, sectioned, and stained with hematoxylin and eosin for optical microscopic analysis of apical and periapical tissue repair.

RESULTS

Statistical analysis showed that the poorest histopathologic results were observed in the Calasept/AH Plus group and that the Sealapex sealer overall resulted in better apical repair than the AH Plus sealer. The histopathologic results of Calen/PMCC paste with both AH Plus and Sealapex and Calasept paste with only Sealapex were statistically similar but were different from the results of Calasept with AH Plus.

CONCLUSIONS

The results of this study in the dog showed differences in apical and periapical tissue repair of teeth with chronic apical periodontitis by using 2 calcium hydroxide root canal dressings and 2 sealers. More research is necessary to determine the best combination of dressings and sealers.

Effect of calcium hydroxide form and placement on root dentine pH

AIM

The aim of this study was to measure variations in dentinal pH following the placement of various forms of calcium hydroxide in either the root canal or the pulp chamber.

METHODOLOGY

Extracted single-rooted human teeth were prepared, and the root canals instrumented using a conventional technique. Three cavities were drilled through the root dentine to within 1 mm of the canal wall at the cervical, middle and apical thirds. A total of 125 teeth were randomly divided into five groups; group 1: pure aqueous calcium hydroxide paste (calcium hydroxide/distilled water solution) was placed in the root canal; group 2: the same aqueous calcium hydroxide paste was placed in the pulp chamber; group 3: Hycal, a new form of calcium hydroxide paste, was placed in the pulp chamber; group 4: calcium hydroxide gutta-percha points were placed in the root canal; group 5: control group, wet canal (distilled water) without medication. The access cavities and apical ends were sealed, and the teeth were placed in individual vials containing phosphate-buffered saline, and stored at 37 degrees C. The pH was measured in the dentinal cavities at 8 h and at 1, 2, 3, 7, 14, and 21 days using a calibrated microelectrode.

RESULTS

At 8 h and 1, 2, and 3 days, the highest pH values were obtained when the aqueous calcium hydroxide paste was placed in the pulp chamber. At 7 days, the pH had increased in the Hycal group without being significantly different from the aqueous calcium hydroxide paste placed either in the root canal or in the pulp chamber. At 14 days, Hycal( had the highest pH values (pH 10.65); however, at 21 days no significant difference was noted amongst these first three groups. Control group values ranged from 7.88 to 8.60; the pH created by the calcium hydroxide gutta-percha points was lower than for the control group. Whatever the product or placement location, cervical pH was similar to middle pH, and greater than apical. However, there was no significant difference between the three when all groups were combined. Overall, aqueous calcium hydroxide paste placed in the pulp chamber provided the highest pH values during the experiment, except at day 14. The aqueous calcium hydroxide paste placed in the root canal or Hycal had similar values at days 7 and 21.

CONCLUSIONS

Under the conditions of this study, an aqueous calcium hydroxide paste placed in the pulp chamber increased dentinal pH more than the other techniques. The pH of dentine is affected by the form of calcium hydroxide used.

Influence of mixing vehicle on dissociation of calcium hydroxide in solution

The antimicrobial effects of aqueous preparations of calcium hydroxide have been demonstrated in the past. Calcium hydroxide, when dissolved in water, dissociates into hydroxide and calcium ions. The presence of hydroxide ions in a solution makes it antimicrobial. Recently it was shown that the use of glycerin as a mixing vehicle facilitates placement of calcium hydroxide in the root canals. The influence of nonaqueous mixing vehicles on the dissociation of calcium hydroxide is not clearly understood. In this study the conductivity of aqueous and nonaqueous solutions of calcium hydroxide was measured. The conductivity values for saturated solutions of calcium hydroxide in water was 7.3+/-3 mS/cm. The conductivity of calcium hydroxide in pure glycerin or propylene glycol was essentially zero. It was concluded that use of nonaqueous mixing vehicles may impede the effectiveness of calcium hydroxide as a root canal dressing.

Calcium hydroxide pastes: classification and clinical indications

REVIEW ARTICLE: Calcium hydroxide has been used in endodontology for many years. The aim of this paper is to review the various formulations of calcium hydroxide that have been described, with specific reference to the vehicle used to carry the compound. The requirements for a vehicle are described, and ex vivo and in vivo studies reviewed. Vehicles can be classified into aqueous, viscous and oily, the clinical properties of calcium hydroxide changing depending on the vehicle. The review also describes the use of various active components that have been added to calcium hydroxide, including antimicrobial and anti-inflammatory agents. This review will help clinicians to make informed judgements about which formulations of calcium hydroxide should be used for specific endodontic procedures.

Connective tissue responses to calcium hydroxide-based root canal medicaments

AIM

The objective of the present study was to evaluate the tissue inflammatory response induced by calcium hydroxide pastes, with or without paramonochlorophenol and camphor.

METHODOLOGY

Isogenic BALB/c mice were inoculated into the subcutaneous tissue with either 0.1 mL of a suspension of Calen, Calen with camphorated paramonochlorophenol, Calen with paramonochlorophenol, Calasept paste or phosphate-buffered saline (control). After 6, 12 and 24 h and 2, 3, 5, 7 and 15 days, three animals in each group were sacrificed and the excised lesions processed for histopathological evaluation of the inflammatory response. Events monitored and graded included the assessment of vascular congestion, oedema, haemorrhage, inflammatory infiltrate, necrosis and tissue repair.

RESULTS

The pastes induced an inflammatory response at every observation period, although the intensity, duration and extension of inflammation varied. Calen paste always produced an initial short-term inflammatory response whilst the other pastes produced extended reactions. All pastes allowed repair to take place by the end of the experimental period, although the speed of this process varied between the materials. Calen presented the best biocompatibility; the phenolic compound caused greater tissue response, which was even more severe in the absence of camphor. Calasept paste was damaging and the repair process slower.

CONCLUSIONS

All calcium hydroxide formulations caused an inflammatory response. The severity and longevity of the responses varied between pastes as a result of the various antiseptic agents. Although irritating, repair was apparent with all formulations.