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Endodontics: All You Need to Know
Saju George, DMD
Contemporary Endodontics
Princeton NJ
September 2015
Process - Endodontics
Medicaments Irrigation
Cleaning
Calcium hydroxide
endodontics
Ideal requirements
Antibacterial in nature
Decrease inflamation of periapical tissues
Neutralize tissue debris
Should act as second line of defence against leakage of temporary
filling
Dry persistently wet canals.
Intra canal medicaments
Classification
Setting materials liners, subliners , root canal sealers
Non- setting materials Root canal medicaments
Calcium hydroxide
Actions
As an intracanal medicament for antibacterial effect
To induce root end closure
To dry persistently wet canals
As a dressing in resorption and avulsion cases
As a tissue solvent & for pre-treatment
Calcium hydroxide
Introduction
Calcium hydroxide
In the absence of bacteria, there will be no pulpal or periapical
inflamatory reaction and damaged tissues can heal Moller
Actions -Antibacterial
Why do we use Calcium hydroxide as an
intra canal dressing?
Calcium hydroxide
Actions -Antibacterial
Why do we use Calcium hydroxide as an
intra canal dressing?
Calcium hydroxide
Introduction
Calcium hydroxide
Bacteria play a decisive role in the development of apical
periodontitis Kakehashi
Presence of an empty canal between appointments can lead to
increase in the bacteria Trom & Sundquvist
History
Herman 1930 Used calyxl as a pulp capping agent
Sciaky & Pisanti Calcific bridge was mineralised
1960 by calcium from systemic
circulation
Calcium hydroxide
History
Kaiser 1964 Treated non-vital teeth with open apices
Frank 1966 Procedure that produced root end closure
Stenier & Van hassel Root end closure was histologically
similar to cementum
Calcium hydroxide
Classification- Non setting
Material Vehicle
Pulpdent Methyl cellulose
Hypocal Methyl cellulose
Reogan Methyl cellulose
Analar Ca(OH)2 Water
Calcium hydroxide
Actions - Pre-treatment
Pre-treatment with calcium hydroxide enhances the tissue
dissolving effect of NaOCL
Hasselgren et al
Calcium hydroxide
Actions -Pre treatment
30 min pre-treatment, 90min dissolution time with NaOCL
24Hrs/ 7 days pre-treatment,60 min dissolution time(0.5
NaOCL)
Calcium hydroxide had the ability to completely
disintegrate necrotic tissue Hasselgren et al
Calcium hydroxide
Actions - Dissolution
Tissue dissolution
Does calcium hydroxide have any tissue dissolving
effects,and if so,how potent is it in comparison with sodium
hypochlorite?
Calcium hydroxide
Comparison - Dissolution
Calcium hydroxide Sodium hypochlorite
30% decrease in weight in 1Hr 15%tissue loss in 15
minutes
Same weight for next 30 mins 1/2 tissue loss in 1 Hr
50% decrease in weight in 20 Hrs All tissue gone in 2 Hrs
97 % loss in 1 week
Calcium hydroxide Vs Sodium hypochlorite
Actions- Dissolution
Tissue dissolving ability- Does oxygen matter ?
Anaerobic conditions did not affect solvent action
NaOCL decreased tissue size in first 1-2 hours with no effect on
tissue texture
Calcium hydroxide was slower to affect size
Calcium hydroxide
Actions - Antibacterial
Antibacterial effect of calcium hydroxide
pH of calcium hydroxide
Action on bacterial lippopolysaccharidde
Diffusion of calcium hydroxide in tooth & tissue
role of the hydroxyl ions
Time as a factor for maximum effect
Calcium hydroxide
Actions - Antibacterial
Time effect on antibacterial action
10 min application of Ca(OH)2 was
ineffective
7 day application efficiently eliminated
bacteria sjogren et al
13/14 strains that survive were anaerobic
bacteria
Enterococcus faecalis did not survive
Ca(OH)2 treatment for a week .Sjogren et al
Calcium hydroxide
Actions - Antibacterial
Effective against a wide variety of bacteria
Compared with phenolic compounds, they are
as effective but less toxic
Compared with potassium iodide, there were
fewer culture reversals
Calcium hydroxide
Actions - Anti bacteial
< 1 Minute • 1-3 minutes
Strep. sanguis Strep. Mutans
S. salivarius S. morbillorum
S. milleri Lacto bacillus casei
S. milis Actinomyces isralii
S. intermedius • 3-6 minutes
Campylobacter fetus Arachnia propionica
Caphocytophaga ochracea Eubacterium alactolyticum
Bifidobacterium dentium • >6 minutes
Wolinella recta Enterococcus faecalis
Actinobacillus
Actinomycetemcomitans
Bystrom, 1986
Calcium hydroxide
Actions - Anti bacterial
Lipopolysaccharide may have a
significant effect on host tissues and
residual LPS in root canals may affect
endodontic treatment
Safavi Nichols
Calcium hydroxide
Actions - Anti bacterial
Calcium hydroxide effect on bacterial
lippopolysaccharidde ( LPS)
LPS is implicated in osteoclast mediated
bone resorption
LPS is shed from cell wall during growth
and cell lysis
LPS may exert significant changes on host
tissue due to sensitivity of monocytes and
immune cells to it
Calcium hydroxide
Actions - Antibacterial
Increased ph destroys bacteria
Has a non specific effect within confines of
canal Gordon-1985
Most organisms are destroyed at ph 9.5
but survive to pH 11 or greater Hugo-1971
Calcium hydroxide detoxifys LPS
Calcium hydroxide
Actions - Anti bacterial
Calcium hydroxide detoxifys LPS by
removing esterified fatty acids and
altering its chemical conformation
Safavi Nichols
Calcium hydroxide
Actions - Ph
Calcium hydroxide
pH zones with Ca(OH)2
Placement - Conventional
Calcium hydroxide in the chamber and
files rotated in counter clockwise manner
With lentulo spirals
Calcium hydroxide
Placement
Water Vs Glycerin
Partially water soluble for antibacterial
effect
Agreeable taste
Non poisonous properties
Does not evaporate from mix
Humectant nature
Calcium hydroxide
Conclusions
It should be used in re-treatment cases
In necrotic teeth with or without lesions in bone
In partially vital teeth
It does not have to be used in Vital cases
Calcium hydroxide
Conclusions
Calcium hydroxide
Calcium hydroxide seems to be the one that comes close to satisfying the
requirements for an ideal medicament,with a good margin of safety
during use.
Questions
? ?
Calcium hydroxide