J Indl'n Soc P,do P,,,, Denl S'plembel 2001
'"
A mixture of Ca(OH)2 paste and ZnO powder as a root canal filling
material for primary teeth: a preliminary study
Chawla H,S. ' . Mathul V.P. " Gauba K. c. Goyal A , d. Chandlgarh.
POSTGRADUATE INSTITUTE OF MEDICAL EDUCATION & RESEARCH
Q he present pilot study was conducted on five primary
mandibular second molars requiring endodontic treatment to
evaluate the clinical and radiographic success of root canal
fflUng material which was a mixture of calcium hydroxide
paste (1 cm), Zinc oxide powder (15 gms) and distilled water
using hand operated lentulo spirals. All the five cases on
clinics/evaluation after 2,4,6,9, and 12 months were found
to be asymptomatic with no history of pain, tenderness or
abnormal mobility. Immediate post·operative radiographic
evaluation revealed adequate root canal filling in al/ cases.
The obturated material remain ed upto the apex of root canals
till the beginning o{ physiologic root resorption. The roots of
the primary teeth as well as the filling material mentioned
above were seen to resorb at the same rate In one casV
(J Indian Soc Pedo Prey Dent 2001; 19:3:107-109)
KEY WORDS: Pediatric EndodontiCS, Root canal filling
material, Ca(OH) 2' Zinc Oxide
Zinc Oxide eugenOl (ZnOE), which is commonly used
as a root canal obturation material in primary teeth does
not get resorbed with the physiological resorption of the
tooth 1.S. The extrusion of this material in 'the inter·radicular
and periapical areas, which sometimes occurs, also resists
resorption. This may lead to the retention of the material
after exfoliation of the primary tooth and cause deflection
of the path of eruption ot the permanent successor 1•2.
The eugenol content of this material also has been shown
to Induce cytotoxic and foreign body reactions, when placed
in contact with vital tissues . ZnOE, despite its wide usage,
does not fulfil the requirements of an ideal root canal
material in pediatric endodontics. The other material that
has been employed for root canal filling in primary teeth
is iodoform pasteS. 9 . Though it has shown promiSing results,
the report of six cases of encephalopathy resulting from
8. Professor and Head
b. Formel Resident
c. Additional Prolessor
d. AssocIate Pro1essor
Departmant 01 Pedodontics & Preventi ve Dentistry
Olal Health Sciences Centre
iodoform-use as a component of BIPP paste used as
dreSSing for surgical wounds after head and neck surgeryl0
places a question mark for its continued use as a root
canal filling material. Another material which has been
recentty tried is Calcium hydroxide. It has shown good
success rate 11 . 1S but in some cases it has been shown
to resorb from the root canal earlier than the root of the
primary teeth during physiologic resorption. However, in
terms of healing of peri-radicular radiolucencies, Ca(OHb
has shown an edge over ZnOE because of its well proven
anti-bacterial and Oesto-inductive properties 16 .17 •
In view of the above stated observations, an ideal root
canal obturation material for the primary teeth should
have all the properties of calcium hydroxide paste but
with a slower rate of resorption; it was hypothesized that
a mixture of calcium hydroxide paste and Zinc Oxide
powder may exhibit desirable properties. The present pilot
study was conducted to evaluate this mixture Ca(OH)2 +
ZnOE as a root canal obturation material in primary teeth.
MATERIAL AND METHODS
The study was conducted on 4 to 9 year old children in
five primary mandibular second molars requiring endodontic
treatment. Care was taken to select teeth with adequate
bone support, no internal or gross external resorption
and pathological mobility.
The teeth were treated under local anesthesia and rubb9f
dam . Standard root canal procedure con sisted of access
cavity preparation . location at canals , pulp removal with
thin barbed broaches, diagnostic radiograph to measure
the working length , bio-mechanical (selective) preparation
upto ISO size file #35 or 40 as has been detailed in the
previous study12. The root canal irrigation was carried
out using sodium hypochlorite (2.S0/0 ) and l.V.
metronidazole solution (O.S %). The last irrigating solution
used was metronidazole which was left in the canals
(nol dried with paper points) . The root canal tilling material
was prepared by mixing of calcium hydroxide paste (1
cm), Zinc oxide powder (15 gms) and distilled water. The
'03 Chawla H.S .. ',hthur V.P . Gauba K.. Goyal A.
Fig. 1: Mhcture of Ca(OH)2 sand ZnoE pushed In rool canals of
8 primary molar
Fig. 3: Primary molar shown in Fig. 1 & 2, clinically mobile and
about to exfoliate
root canal tilling was carried out with hand operated lenlulo-
spirals in the wet canals. The cavity was sealed with
quick setting ZnOE . An Immediate post-operative
radiograph was taken to assess the adequacy of the fill.
The teeth were later restored with a permanent filling
material, silver amalgam or posterior composite resin.
The clinical and radiographic evaluations were done at
2,4,6,9 and 12 months. The Criteria used for clinical
evaluation were: functional tooth with no mobility and
absence of pain on percussion. The radi9graphic evaluation
induded the parameters: (a) the resorption of the projected
or Qverpushed material; (b) resolution of periapical/inter-
radiuclar radiolucency and (c) resorption of the material
from the root canal alongwith physiologic resorption of
the root.
Fig. 2: Root canal filling matarial and root being resorbed at the
same time In the primary molar shown In Fig. 1.
RESULTS AND DISCUSSION
All the 5 cases on clinical evaluation after 2.4 ,6,9 and
12 months were asymptomatic i.e. with out history of
pain. Clinical examination showed no tenderness or
abnormal mobility. Immediate post-oprative radiographs
revealed the root canal filling to be adequate in all the
cases: there was no over pushing of the material in any
of the cases. On subsequent roentgengraphic examinations
at 2,4,6,9 and 12 months. it was observed that two cases,
that showed pre-operative radiolucency in the peri-apical!
inter-radicular region , healed in about 4-6 months period
with complete obliteration of the radiolucent area and
regaining of normal bony trabecular pattern. The root
canal treatment was found to be successful in all the
teeth, after one year of evaluation . It was further noted
that the obturated material remained upto the full length
of the root canal till the time of beginning of physiologic
root resorption . The physiological root resorption was
noticed in two of these cases during the follow-up period.
The root of the primary tooth as well as the filling was
seen to resorb at the same rate in one case whereas
faster in the other. (Fig. 1-3) . The above observation of
faster resorption in one tooth and same resorption in
another. calls for a long term study on a larger sample
size and longer duration of follow-up to evaluate the exact
property of this mixture vis-a-vis calcium hydroxide.
The consistency of the mixture of Calcium Hydroxide
and Zinc Oxide powder using 1 cm of the paste and 15
gms of the powder and distilled water was finalised after
mixing different amounts of zinc-oxide powder in the same
length 01 the paste. It was found that when mixed in the
J Indl.n Soc Pedo PreY Dent September 2001
given proportion, it gave sufficient materIal and the right
consistency. The fact that no over push was observed In
any of the cases also goes in favour of the right consIstency
".
8. Reddy V.v.S. , FlH"nandes, Clinical and Radiological evaluetion
of Zinc oXIde eugenol and Malate's pasle as obturating materials
In Infected primary molars·nlne months study. J Indian Soc

ot the mixture. The selective fitling of the root canal which Pedo Prev Dent 1996; 14: 39-44.

was carried out taking into consideration the differences 9.
in the thickness of the outer and the inner walls of the
root canal of the primary teeth whIch occurs due to the
eruptive pressure from the physiologic resorption also 10.
would have contributed towards no over pushing of this
material in the inter-radicular ar8as.
11
The finding of the present study reveals that the mixture
of Ca(OH)2 and ZnO powder was effective to resorb the
Mass E. and Zilber man U. l. Endodontic treatment 01 int.cted
primary teeth using Mais\o's paste. J Dent Child t989: 56:
117-120.
Roy P.M., Harry P. , Calileux A. and Allain P. Dangers of BIsmuth
Iodofor m Paraffin Paste. Lancet 1994; 344: 1708
Chawla H.S., Mani S.A., Tewari A. and Goyal A . Calcium
hydroxide as a root canal IlIling material in primary teeth-A
pilot study. J Indian Soc p.dQ PreY Dent 1998; 16-3.

rarefaction in 2-6 months in two cases coupled with the
clinical and radiographic success rate. This opens a new
avenue of research in the direction of using the mixture
of two materials to find out ~he exact proportions· that
would have the same rate of resorption as that of the
primary root.
REFERENCES
12. Kielbassa A.M., Anin T., Schaller H.G. and Hellwig E.
Endodontic therapy In a pos1irradlated chi\cl Review of literature
and report of a case. Ouintessence Int 1995; 26: 405 -411 .
13. Rosendahl R. and Weinert-Grodd A. Root canal treatment of
primary molars with Infected pulps using calcium hydroxide
• as a root canal filling . J Clln Pedlatr Dent 1995: , 9: 255-
258.

1. Sadrlan R. and Coli J.A. A long term follow up on the retention 14. Nadkarni U. , Damle S.G. ComparatJve evaluation of calcium
rate of zinc oxide eugellolfilier aftar primary tooth pUlpectomy. hydrol(ide eugenol as root canal filling materials for primary
Pediatr Dent 1993 ; 15(4): 249-252. molars : A clinical and radiographic study. J Indian Soc Pedod
Prey Dent 2000 ;19(1): 1-11 .
2. Kennedy D.B. Pediatric Operative Dentistry. Dental Practitioner
Handbook No. 2 1 Bri stol John Wr ight & Sons 1976: 232·239. 15. Mani SA , Chawla H.S., Tewari A. , Goyal A. Evaluation of
Calcium hydroxide paste and Zinc oxide eugenol as a root
3. Flanz C.M. Barr E.S. and Hidl.s J.M. Radiographic evaluetion
can.1 filling material In prImary teeth. J Dent Child 2000:
of pulpal therapy for primary anterior teeth . J Dent Child
67(2): 142-147.
1989; 56: 182·85.
16. Hendry J. A., Dummett CO and Burrel W. Comparison 01 calcium
4. Barr E. S. Fla ltz C .M. and Hicks J.M .. A retrOSPEtctlve
hydroxIde and zinc oxlde and eugenol pulpectOmies In prImary
radiographic evaluation of primary molar pulpectomies. Padlaff
teelh of dogs. Oral Surg 1;82: 54: 445·451 .
Dent 1991 : 13: 4· 9.
17. Stevens R.H .. Grossman. Evaluation of the ant!mlcrobl.'
5. Garcia· Godoy F. Evaluation of an iodoform paste In root can.1
potential of calcium hydroxiM as an Intra·canal medicament.
therapy for Infected primary teeth. J Dent Child 1987; 54: 30-
J Endod ,~: 9: 372·774.
34.

6. Rifk in A. A simple, affective, safe technique for the root canal

Reprint r&quests to ;
treatment of abscessed teeth . J Dent Child 1980; 47: 435-
Dr. H. S. Chawla,
441 .
Professor and Head,
7. Holan G., Fuks and Fuks A.B. A comparlslon of pulpectomies Department of Pedodontics .nd Prewntive Dentistry,
using ZOE and KRI paste In primary molars : retrospective Oral Health Sciences Centre,
study. Pediatr Dent 1993; 15: 403·407. PGIMER. Chandlgarh.