Effectiveness of calcium hydroxide in reducing bacterial load comparing with chemo-mechanical preparation- A systematic review

Abstract

Aim: To determine and compare to what extent the intra-canal medicament like calcium hydroxide along with chemo-mechanical preparation reduces the bacterial load in infected root canals. Methodology: PubMed Cental, Medline, Google Scholar and hand search was carried out using the keywords calcium hydroxide (Ca(OH)2) , intra-canal medicament(ICM) and chemo-mechanical preparation. Selection Criteria: Clinical trials in which bacterial samples were evaluated at 3 intervals (Baseline, after chemo-mechanical preparation, after dressing with intra canal medicament ICM and trials which use Ca(OH)2 with any vehicle as ICM, but not compared with any other ICM were selected for this review. The data collection form was customized. The primary outcome measures were reduction of bacterial populations in infected root canals. Results: Seven clinical trials that met all inclusion criteria involving 117 participants were reviewed. Included studies showed significant difference in bacterial reduction after chemo-mechanical preparation and placement of Ca(OH)2 dressing for a week. In all included trials, Ca(OH)2 reduced bacterial load further compared with chemo-mechanical preparation. Conclusion: Ca(OH)2 as an inter-appointment medication promoted further decrease in the bacterial bioburden to levels significantly below those achieved by the chemo-mechanical procedures alone. Intra-canal medicament such as Ca(OH)2 should be considered for bacterial reduction along with chemo-mechanical preparation for long term success. Key Words: Intra-canal medicament, calcium hydroxide, Root canal treatment, bacterial load, Pulpitis