Intracanal Calcium Hydroxide Research Articles

Effectiveness of mechanical vs. chemomechanical methods in removing intracanal calcium hydroxide medication: a randomised trial.

To compare the mechanical and chemomechanical methods for removing calcium hydroxide medication from the root canal system. The triple-blind, randomised clinical trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan, from December 16, 2022, to June 15, 2023, and comprised patients having necrotic teeth and chronic apical pathosis. They were randomised into groups A and B. On the initial visit, after access opening and chemomechanical preparation, calcium hydroxide paste was placed as an intracanal medication in both groups. the patients were recalled after two weeks. In Group A, calcium hydroxide was removed from the canals using a rotary master apical file, while in Group B, an endoactivator was used to sonically agitate the endodontic irrigant. Verification of placement was done by using a periapical radiograph. Data was analysed using SPSS 26. Of the 98 individuals assessed initially, 60(61.22%) were included; 34(57%) females and 26(43%) males with age ranging from 19 to 57 years. There were 27(45%) incisors, 22(36.7%) premolars and 11(18.3%) canines. There were 30(50%) patients in each of the 2 groups. The intergroup difference was not statistically significant (p=0.43). Tooth arch did not significantly correlate with the removal method (p=0.79). Both methods were found to be equally effective in removing water-based calcium hydroxide medication from the endodontic system. NCT05744661.

Importance of intracanal calcium hydroxide medication between sessions in chronic dentoalveolar abscesso (clinical case)

Importance of intracanal calcium hydroxide medication between sessions in chronic dentoalveolar abscesso (clinical case)

Evaluation of Fracture Strength of Roots to Determine the Duration Limit of Activated Ethylene Diamine Tetraacetic Acid Irrigation for Intracanal Calcium Hydroxide Dressing Removal In Vitro

This study evaluated the effect of the use of EDTA solution at various intervals to remove intracanal calcium hydroxide medication on fracture resistance. One hundred and one extracted lower premolar teeth were randomly allocated into one control group (n = 5), two main experimental groups (CH(+), with calcium hydroxide dressing, and CH(−), without calcium hydroxide dressing), with four subgroups (EDTA intervals: 1 min, 3 min, 5 min, 10 min, n = 12). Ready-to-use injectable calcium hydroxide was used for the samples in the four CH(+) subgroups, and the samples were kept in an incubator at 37 °C and 100% humidity for seven days. All samples (CH(+), CH(−)) were irrigated with 17% EDTA, which was accompanied by activation with EndoActivator for 1, 3, 5, and 10 min, and then rinsed with 2.5% NaOCl in a standardized manner. The obturation was conducted using the warm obturation technique; experiments were conducted with a universal testing device, and their fracture strength was recorded. Compliance with the normal distribution was examined with ±2 skewness coefficients. Two-way ANOVA, Tukey’s, one-way ANOVA, and Dunnett’s tests were used for statistics (p < 0.050). A statistically significant difference was found between the mean values of the force between the groups (p = 0.009). The mean strength of the tooth at fracture that CH(−) was 401.7, CH(+) was 335.35. There was no statistically significant difference between the mean values of the forces according to time intervals (p = 0.387). While there was no significant difference among the experimental groups (p = 0.229), the mean fracture strength of the negative control group was found to be significantly higher (p < 0.001). The highest fracture resistance was observed in the nonprepared group. Irrigation with EDTA for up to 5 min showed more acceptable fracture resistance results than the other groups. Using calcium hydroxide significantly and negatively affected the root strength.

Comparative evaluation of novel chelating agents for retrievability of intracanal calcium hydroxide using different irrigation protocols: An in vitro study

ABSTRACT Aim: The aim of the study is to evaluate and compare the efficacy of glycolic acid (GA), phytic acid, chitosan nanoparticles, and ethylenediaminetetraacetic acid (EDTA) for the removal of intracanal calcium hydroxide (Ca [OH] 2) dressing using needle irrigation and passive ultrasonic irrigation (PUI). Materials and Methods: Seventy-two mandibular premolars were decoronated and roots were prepared to apical size 30. Ca(OH)2 paste was filled in the canals and samples were stored for 1 week after which they were irrigated using different irrigants and irrigation techniques. The residual Ca(OH)2 was analyzed on split surface of samples under stereomicroscope and scanning electron microscope. Scoring was done for each sample and results were tabulated. The data were subjected to analysis using Mann–Whitney U-test with the level of significance set to 5%. Results: Removal of Ca(OH)2 was maximum in chitosan group aided by PUI and was minimum when GA or EDTA was used for needle irrigation, as observed under stereomicroscope. Removal of Ca(OH)2 from the coronal third was maximum followed by middle and then apical third. Phytic acid and chitosan were proven to be of maximum efficacy for removal of intracanal Ca(OH)2 removal in the middle third among all the groups, especially when used with PUI. Needle irrigation using EDTA and GA was least efficacious. Conclusion: Chitosan and phytic acid can be used for better removal of Ca(OH)2 dressing, especially in the coronal and middle thirds of the root canal. The efficacy of intracanal dressing retrieval can be enhanced by passive ultrasonic activation.

Effect of Occlusal Reduction on Postoperative Pain during Root Canal Treatment in Teeth with Symptomatic Apical Periodontitis

INTRODUCTION: Pain management after root canal treatment is a very important issue in clinical practice. Occlusal reduction has been widely used after root canal treatment to reduce post treatment pain and flare up. The purpose of this study was to evaluate the effect of occlusal reduction on postoperative pain in teeth with symptomatic apical periodontitis. MATERIALS AND METHODS: Seventy mandibular molar teeth with symptomatic apical periodontitis requiring root canal treatment were included in this study. Each patient who met the inclusion criteria had a serial number allocated, ranging from 1 to 70. The patients were divided into two groups i.e, occlusal reduction group and without occlusal reduction group according to the odd and even numbers on the list. After administration of local anesthesia, the root canals were instrumented, and an intracanal calcium hydroxide dressing was placed. Following confirmation with articulating paper, occlusal reduction group received a 2 mm reduction in occlusal contacts. Preoperative pain before start of the procedure and postoperative pain 6 days after instrumentation were recorded on visual analogue scale. Data was evaluated by chi-square test and Man Whitney U test with p-value <0.05 considered as statistically significant. RESULTS: There was no significant difference in postoperative pain between two groups (p>0.05) after root canal preparation. CONCLUSIONS: Occlusal surface reduction did not provide any further reduction in postoperative pain for teeth with symptomatic apical periodontitis compared with no occlusal reduction

“Assessment Of Human Root Dentin's Fracture Resistance To Intra-Canal Calcium Hydroxide, Mineral Trioxide Aggregate, And Calcium Phosphate Cement”.

Background: The use of Ca(OH)2 in Endodontics was undisputed till date. Amidst its various merits, recently it has been observed that Ca(OH)2 treated teeth for extended periods show high failure rate because of unusual preponderance to root fracture. Newer materials like MTA and CPC have shown promising results in multiple endodontic applications including apexification. Objective: The aim of the present study is to compare the in vitro changes in the fracture resistance of human root dentin when exposed to intracanal Ca(OH)2 , MTA and CPC. Methodology: 60 freshly extracted single rooted teeth were selected and divided into four following groups of 14 teeth each Group I –saline group (control group) Group II - Ca(OH)2 group Group III – MTA group Group IV – CPC group Coronal access and endodontic instrumentation was done using specified instruments and techniques. The prepared canal was filled with saline solution, Ca(OH)2 paste, MTA and CPC and sealed with bonded composite resin and teeth were immersed in saline. After 30 days and 180 days the roots of 7 teeth from each group were sectioned horizontally into 1mm thick disks depending upon length of root into 4-5 sections and each disk was placed under a universal testing machine and the peak load at fracture was recorded.Results: Results showed that the mean peak load at fracture of Group I (saline group) was higher in both 30 days and 180 days specimen. Ca(OH)2 group showed a decrease in the fracture resistance as compared to all other groups in 30 and 180 day specimen.Conclusion and Interpretation: Based on results, both MTA and CPC can be efficiently used as an alternative to Ca(OH)2.

INTRA-CANAL ANTIBIOTIC PASTES MAY PROMOTE THICKER DENTIN WALLS AND CALCIUM HYDROXIDE MAY PROMOTE MORE APICAL CLOSURE.

Báez, Viviana; Corcos, Lorena; Morgillo, Florencia; Imperatrice, Lorena; Gualtieri, Ariel Félix (2022). Meta-analysis of regenerative endodontics outcomes with antibiotics pastes and calcium hydroxide. The apex of the iceberg. J Oral Biol Craniofac Res 12(1): 90-98. Non-funded study TYPE OF STUDY/DESIGN: Systematic review and meta-analysis.

The use of passive ultrasonic irrigation and photodynamic therapy as an adjuvant in endodontic retreatment associated with endoperiodontal injury

Endodontic retreatment continues to be a challenge for Endodontics, as well as supporting techniques that aim to improve and assist in the elimination of microorganisms that have infected root canal systems and led to the development of peripicopathies, such as Passive Ultrasonic Irrigation (PUI) and Photodynamic Antimicrobial Therapy (aPDT) have been frequently used. Thus, the aim of this paper is to report a clinical case of endodontic retreatment of tooth 47 with a diagnosis of endoperiodontal injury associated with periapical lesion. The treatment was carried out in two sessions, using as intracanal medication calcium hydroxide with parachlorophenol with camphor, PUI in both final irrigations and previously the root filling was performed with aPDT. At the end of the treatment it was possible to observe a reduction in the radiolucent areas, suggesting the beginning of bone repair. This case report suggests that PUI and aPDT associated with endodontic retreatment can improve disinfection, favoring the regression of periapical alterations and, consequently, favoring the bone repair process.

Evaluation of antibacterial effect of silver nanoparticles paste with and without curcumin as intracanal medication

BackgroundThe purpose of the current study was to compare the antibacterial activity of silver nanoparticles AgNPs paste and silver nanoparticles AgNPs with curcumin paste as intracanal medications versus calcium hydroxide Ca(OH)2 paste. Thirty extracted, human teeth with single roots were decoronated and mechanically prepared. After sterilization, roots were inoculated with Enterococcus faecalis for 10 days. Roots were separated into three groups in accordance to kind of intracanal medications used; Group A, silver nanoparticles AgNPs (Nanogate company, Cairo, Egypt). Group B, silver nanoparticles AgNPs with curcumin (Nanogate company, Cairo, Egypt). Group C, calcium hydroxide Ca(OH)2 (Metapaste, META BIOMED). First microbiological samples (S1) were collected from the canal, before insertion of intracanal medication. Intracanal medications were kept in root canals in all groups for 7 days; then second microbiological samples (S2) were collected from the canals after medicament removal. After the colony forming units CFUs have been counted, the data were statistically analyzed.ResultsIn the three tested groups, the highest bacterial count was found in (S1), while the least bacterial count was found in (S2) with statistical significant difference between them.ConclusionsThe effect of AgNPs paste and AgNPs with curcumin paste was superior to Ca(OH)2 paste. AgNPs with curcumin paste had the best antibacterial effect.

Effectiveness of intracanal calcium hydroxide medicament in treating periapical lesions: a systematic review

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Alghamdi F, Alkhattab O. Effectiveness of intracanal calcium hydroxide medicament in treating periapical lesions: a systematic review. Journal of Stomatology. 2022;75(1):44-54. doi:10.5114/jos.2022.114502. APA Alghamdi, F., & Alkhattab, O. (2022). Effectiveness of intracanal calcium hydroxide medicament in treating periapical lesions: a systematic review. Journal of Stomatology, 75(1), 44-54. https://doi.org/10.5114/jos.2022.114502 Chicago Alghamdi, Faisal, and Omar Alkhattab. 2022. "Effectiveness of intracanal calcium hydroxide medicament in treating periapical lesions: a systematic review". Journal of Stomatology 75 (1): 44-54. doi:10.5114/jos.2022.114502. Harvard Alghamdi, F., and Alkhattab, O. (2022). Effectiveness of intracanal calcium hydroxide medicament in treating periapical lesions: a systematic review. Journal of Stomatology, 75(1), pp.44-54. https://doi.org/10.5114/jos.2022.114502 MLA Alghamdi, Faisal et al. "Effectiveness of intracanal calcium hydroxide medicament in treating periapical lesions: a systematic review." Journal of Stomatology, vol. 75, no. 1, 2022, pp. 44-54. doi:10.5114/jos.2022.114502. Vancouver Alghamdi F, Alkhattab O. Effectiveness of intracanal calcium hydroxide medicament in treating periapical lesions: a systematic review. Journal of Stomatology. 2022;75(1):44-54. doi:10.5114/jos.2022.114502.

Influence of photodynamic therapy and intracanal medication on Martens hardness, elastic modulus and bond strength of glass-fiber posts to endodontically treated root dentin

BackgroundThe purpose of this in vitro study was to evaluate the influence of photodynamic therapy (PDT) with methylene blue photosensitizer (PS) and calcium hydroxide intracanal medication on Martens hardness (MH), elastic modulus (Eit) and adhesive bond strength of glass-fiber posts in different thirds of intraradicular dentin. MethodsNinety-six bovine teeth were distributed into the following 6 experimental groups: a negative control irrigated with deionized water; a positive control irrigated with deionized water and filled with calcium hydroxide intracanal medication (Ca[OH]2); Ca[OH]2 + methylene blue 50 mg/L without activation; Ca[OH]2 + methylene blue 100 mg/L without activation; Ca[OH]2 + methylene blue 50 mg/L activated by red laser; and Ca[OH]2 + methylene blue 100 mg/L activated by red laser (n = 16). MH and Eit were measured using an ultramicrodurometer under load action of 3 mN (n = 8). Adhesive bond strength was measured using the push-out test in a universal testing machine (n = 8), and representative samples underwent scanning electron microscopy. Data on MH, Eit, and bond strength were subjected to normality tests and analyzed by ANOVA and Tukey's test (α = 0.05). ResultsMethylene blue PS, activated or not by red laser, associated with calcium hydroxide medication did not promote significant difference as compared to the control groups irrigated with deionized water, associated or not with the use of intracanal medication, regarding mechanical properties and bond strength (p > 0.05). Experimental groups showed no difference between the thirds regarding root canal depth (p > 0.05), except for the positive control group, in which the apical third showed higher Eit values than the middle third (p = 0.0324). There was a predominance of mixed failure in all experimental groups, excepted the red laser-activated group treated with the highest concentration of methylene blue, which showed predominance of adhesive failure. ConclusionsPDT with methylene blue PS at 50 mg/L, associated with intracanal calcium hydroxide medication is a satisfactory alternative for endodontic treatment as there is no interference in the mechanical properties and bond strength among glass-fiber posts to intraradicular dentin at any depth of the root canal.

Comparison of Intracanal Calcium hydroxide, Mineral trioxide aggregate (MTA) and Portland cement to induce pH changes in simulated root resorption defects in human teeth -An in vitro study

Comparison of Intracanal Calcium hydroxide, Mineral trioxide aggregate (MTA) and Portland cement to induce pH changes in simulated root resorption defects in human teeth -An in vitro study

In Vitro Assessment of Intracanal Calcium Hydroxide Removal Using Various Irrigation Systems: An SEM Study

The aim of this research was to assess the effectiveness of three different irrigation systems in elimination of calcium hydroxide [Ca(OH)2]from root canals. This in vitro research included ninety recently extracted mandibular premolar teeth with a solitary root. The sample teeth were subjected to disinfection employing sodium hypochlorite at 5.25%. The root canal preparation was performed followed by placement of premixed Ca(OH)2 within every canal. The sample teeth were then randomly allocated into one of the three experimental groups (each comprising 30 samples) as follows: Group 1, NaviTip FX irrigation system; group 2, Vibringe sonic irrigation system; and group 3, EndoVac apical negative pressure irrigation system. Following the preparation, each of the sample teeth was examined beneath a scanning electron microscope (SEM) at a magnification of 1000×. An intragroup comparative analysis revealed that the highest Ca(OH)2 elimination was seen at middle third (0.82 ± 0.09, 0.30 ± 0.11) in NaviTip FX irrigation system and Vibringe sonic irrigation system, respectively. Higher Ca(OH)2 was eliminated at the apical third (0.26 ± 0.02) by the EndoVac irrigation system. At coronal third, maximum Ca(OH)2 removal was seen in EndoVac irrigation system (0.49 ± 0.03). A statistically significant difference was noted amid Vibringe sonic irrigation and EndoVac irrigation systems. The intergroup evaluation of Ca(OH)2 elimination at coronal, middle, and apical third showed a statistically significant difference between NaviTip FX irrigation and Vibringe sonic irrigation as well as between NaviTip FX irrigation and EndoVac irrigation at a p value of 0.001. The difference between EndoVac irrigation and Vibringe sonic irrigation was not statistically significant. Amid the limitations of this research, this research concludes that none among the irrigation methods employed could totally eliminate the Ca(OH)2 off the root canals. Nevertheless, EndoVac apical negative pressure irrigation has slightly superior potential in eliminating Ca(OH)2 from the root canals in comparison with Vibringe sonic irrigation as well as the NaviTip FX irrigation system. Even though the Ca(OH)2 is largely suggested as medicament, its elimination at the point of canal obturation is likewise significant and complex as any remaining portion may avoid sealer diffusion inside the dentinal tubules, consequently substantially escalating the apical leakage of endodontically treated teeth.

Using biodentine for non-surgical endodontic re-treatment of maxillary central incisor associated with severe external apical root: A case report with 2-years follow-up

A patient reported with pain and sinus opening in relation to a previously root canal treated maxillary central incisor. Intraoral radiograph revealed periapical radiolucency with shortening of root indicating external apical inflammatory root resorption associated with failed endodontic treatment. Nonsurgical re-treatment was started and intracanal calcium hydroxide (CaOH) was placed for four weeks. The tooth was obturated with Biodentine. At 6, 12, and 24 months follow-up, the patient was asymptomatic and radiograph revealed satisfactory healing. Inflammatory apical root resorption due to failed root canal treatment could compromise the root length and prognosis. Early arrest of such resorption is indicated by nonsurgical re-treatment using CaOH for root canal disinfection and obturating with bioactive material such as Biodentine, which results in the successful arrest of resorption and periapical healing.

Nonsurgical management of trauma-induced inflammatory internal- external root resorption: A case report

Root resorption is one of the serious consequences of dental trauma. If left untreated, it may lead to loss of significant portion of the root, rendering the tooth unsalvageable. This report documents the nonsurgical management of a previously traumatized maxillary lateral incisor (#22) with a large periapical lesion, severely affected by inflammatory communicating internal- external root resorption. A cone beam computed tomography was advised, to aid in diagnosis and treatment planning. Endodontic treatment comprised of copious irrigation with 1.5% sodium hypochlorite and 2% chlorhexidine gluconate, intracanal calcium hydroxide dressings and mineral trioxide aggregate (MTA) placement in apical 5mm.Follow up at 6 months showed arrest of resorptive process and initiation of periapical healing. At 12 months, complete radiographic healing in the absence of clinical signs and symtoms was evident.

Cone Beam Computed Tomography Analysis of Three Method of Intracanal Calcium Hydroxide Placement

Cone Beam Computed Tomography Analysis of Three Method of Intracanal Calcium Hydroxide Placement

Effect of intracanal calcium hydroxide dressing on the push out bond strength of AH Plus, MTA Fillapex®, and endosequence BC sealer

Aim: This study aimed to compare the effect of intracanal calcium hydroxide dressing on the push-out bond strength of AH Plus, mineral trioxide aggregate (MTA) Fillapex®, and endosequence BC sealer. Methodology: Sixty single-rooted human mandibular premolars were decoronated and subjected to biomechanical preparation with the help of a ProTaper rotary file up to size F2. Half of the samples worked as control and the other half that worked as experimental group was treated with calcium hydroxide intracanal medicament. All the samples were divided into three groups (n = 20), according to the sealer used. The samples were obturated using endosequence BC sealer, AH Plus, and MTA Fillapex. Each sample was sectioned horizontally into three parts: cervical, middle, and apical. The sample so prepared was subjected to universal testing machine for the evaluation of the push-out bond strength of the sealers. Results: Endosequence BC sealer showed the best results, followed by AH Plus sealer and MTA Fillapex sealer. In addition, the push-out bond strength decreased significantly after the use of intracanal calcium hydroxide medicament (ApexCal). Push-out bond strength also decreased from cervical to middle followed by apical third. Conclusion: Calcium hydroxide intracanal medicament dressing reduced the push out bond strength of all the three sealers used in the study.

Antibacterial activity of various calcium hydroxide solvents against Fusobacterium nucleatum and Enterococcus faecalis

Fusobacterium nucleatum and Enterococcus faecalis are the most common types of bacteria found in root canal failure. Various ways are done to eliminate such pathogens, one of them by adding various solvents to increase the antibacterial activity of intracanal calcium hydroxide medication. The purpose of this study was to determine the antibacterial activity of various calcium hydroxide solvents against Fusobacterium nucleatum and Enterococcus faecalis. The antibacterial activity of chlorhexidine 2%, glycerin, povidone-iodine 2% and distilled water (control group) as calcium hydroxide solvents were tested in vitro. Zone of inhibition of solvents was observed. The results showed that the remarkable inhibition of the bacterial growth was shown by adding glycerin solvent to calcium hydroxide. This activity was due to its ability in increasing alkaline activity of calcium hydroxide. Hence, glycerin solvent of calcium hydroxide can be used to increase antibacterial activity against root canal microbes.

A Comparative Evaluation of Intracanal Calcium Hydroxide Removal with Hand File, Rotary File, and Passive Ultrasonic Irrigation: An In Vitro Study.

Aim:The aim of this study was to compare the effectiveness of hand file (K-file), rotary file (HERO shaper), and passive ultrasonic irrigation (PUI; U-file) in removing Ca(OH)2 from the root canal.Materials and Methods:Thirty single-rooted teeth were collected and decoronated to standardize the length to 14 mm. Cleaning and shaping were conducted using HERO shaper rotary files (up to no. 25, 4% taper). Ca(OH)2 powder was mixed with normal saline and filled into the canals using lentulo spiral and the orifice was sealed with zinc oxide eugenol. After 7 days of incubation, samples were divided into three groups of 10 samples each: Group I (hand files)—no. 20 K-file; Group II (rotary files)—no. 25, 4% HERO shaper; Group III (PUI)—no. 20 U-file. Ca(OH)2 paste was removed using 2 mL of 3% sodium hypochlorite solution followed by 1-minute activation of the respective file system. All the samples were finally irrigated with 17% ethylenediaminetetraacetic acid and flushed with distilled water.Results:Ultrasonic group was more effective in removing Ca(OH)2 followed by HERO shaper and hand file.Conclusion:It was concluded that PUI had the highest ability to remove Ca(OH)2 from the root canal walls.

Removal of calcium hydroxide medicament from root canal walls - a review of the different techniques

Introduction: Calcium hydroxide is used widely as an intracanal medication dressing due to its antibacterial activity. It is left into the root canal for a different period of time. Intracanal calcium hydroxide is usually removed by the use of instrumentation and irrigation. The residual material may interact with the root canal sealer and interfere with its sealing ability. Aim : The aim of this article is to review the literature in order to compare the main techniques that can be used to remove calcium hydroxide from the root canal system. Results: Intracanal calcium hydroxide is usually removed by the use of continuous irrigation, in conjunction with rotary or hand instruments, sonic or ultrasonic activation of the irrigants. Conclusion: None of the described techniques is able to provide a complete removal of the intracanal calcium hydroxide from the root canal walls in all clinical cases, because of the complexity of the root canal system of every tooth. There is no standard protocol and different techniques should be applied and combined in order to achieve clean root canal walls before the definitive obturation of the root canal system.