Outcome Assessment of Teeth with Necrotic Pulps and Apical Periodontitis Treated with Long-term Calcium Hydroxide

Abstract

IntroductionThe aim of this retrospective, cohort case series was 2-fold: (1) to evaluate the outcomes of teeth with necrotic pulps and apical periodontitis using long-term calcium hydroxide (Ca[OH]2) (healing was assessed via the periapical index [PAI] system) and (2) to explore the possible association of fractures in relation to long term Ca(OH)2 exposure. MethodsA total of 242 cases, diagnosed with pulpal necrosis and apical periodontitis, were treated with long-term Ca(OH)2 using a standardized protocol. Injectable and powdered Ca(OH)2 were placed sequentially in the root canal system. All cases were re-evaluated within a 3-month period until radiographic healing was observed. Clinical and radiographic evaluations were performed annually. Pre- and postoperative periapical radiographs were evaluated using the PAI system. ResultsOf the 242 cases, 219 participants completed their treatment with annual follow-up. The average Ca(OH)2 time was 5.4 months with a range of 1–12 months. Overall, by the latest follow-up visit, 90.0% (197/219) were classified as "healed." The overall mean preoperative and postoperative PAI scores were 4.07 (±0.80) and 1.76 (±0.70), respectively. Kappa statistics showed an almost perfect agreement for inter-rater (κ = 0.91) and intrarater (κ = 0.95) reproducibility for both examiners. ConclusionsWithin the limitations of this study, the use of long-term Ca(OH)2 in the treatment of teeth with necrotic pulps and apical periodontitis resulted in a predictable high outcome. There was no association observed between long-term Ca(OH)2 use and the incidence of fractures during this study. Ca(OH)2 is a suitable material of choice as an interappointment dressing for teeth diagnosed with pulpal necrosis and apical periodontitis.