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CALCIUM HYDROXIDE
INTRODUCTION HISTORY COMPOSITION OF CALCIUM HYDROXIDE PROPERTIES OF CALCIUM HYDROXIDE BIOCOMPATIBILITY OF CALCIUM HYDROXIDE CLASSIFICATION & CLINICAL INDICATIONS MECHANISM OF ACTION APPLICATIONS OF CALCIUM HYDROXIDE CONTROVERSIES REGARDING CALCIUM HYDROXIDE REFERENCES CONCLUSION
JOURNEY!!
CaCo3
(900-1200c)
CaO
CaO +H2O
Ca(OH)2
Other uses
Catalyst paste:
* Calcium hydroxide-50-60%- Principal reactive ingredient
* Zinc oxide *Zinc sterate-0.5%- accelerator * Ethylene toulene sulfonamide-39.5%, oily compound, acts as carrier
2 paste: equal parts of base & catalyst Powder form Ca(OH)2 in endodontics messing gun, vertical compaction, injectable formulations,
lentilospirals, hand file, paper points, Pastinject (specifically designed paste carrier), the MacSpadden compactor, combinations.
Mixing equal parts Starts acid base reaction Results in weakly bonded composite structure Chelates of Ca alkyl salicylate & water(the reaction byproduct) forms the continuous phase & the unreacted ingredient forms the interrupted phase Mass is hydrolytically unstable & contains a large % of unreacted Ca(OH)2 Ca ions & OH ions & salicylate ions are released continuously from the mass
Ca(OH)2
Initial response: necrosis to depth of 1/> mm, coagulates any hemorragic exudate
In weeks to months, necrotic zone undergoes dystrophic calcification which appears to be stimulus for dentine bridge formation
MAISTO 1975 classified Ca(OH)2 as an alkaline paste HOLLAND 1994 classified Ca(OH)2 according to vehicles used MAISTO, GOLDBERG, LEONARDO et al told their characteristics.
Importance:
a) Aqueous: rapid ionic dissociation, high solubility appli. disadvantage? b) Viscous: slow dissociation of ions over extended periods (due to its mol. wt) remains in RCs for 2-4 months appli. periodical redressing of RCs c) Oily: lowest solubility & diffusion
Ringers solution:
AT CHAIRSIDE
Glycerin: Viscous, colorless, characteristic Propyleneglycol: its Polyethylenegl odour, sweetish in chemically dihydric ycol: slightly taste, mol wt. alcohol with syrupy hygroscopic 92.02, hygroscopic consistency, (intracanal hygroscopic, non lubricant) toxic, mol wt. 76.09 used in
At chairside Olive oil: non soluble in water, chemically esters of fatty acids of oleic,
linoleic, palmitoleic, estearic & linolenic acids promotes low solubility of Ca(OH)2 but has improved handling properties
Camphorated parachorophenol:
Walkhoff 1891, 33-37% parachorophenol ,63-67% camphor disinfection action of parachlorophenol is due to liberation of chlorine in the presence of phenol camphor is essential oil wit low solubility in water, hence oily vehicle
PROPRIETARY BRANDS
AQUEOUS:
Calxyl (oldest by Hermann 1920) Pulpdent & tempcanal Cavital Reogan Calasept Calnex Hypocal etc
Bioco mpatib le
OILY VEHICLES
Endoapex L&C Vitapex
OTHERS
Flohr (1936)- dentinal chips Methylcresilate Collagen gel Multical = Ca(OH)2(34%)+barium sulphate 15%+ chloro-timonal(51%)
Bismuth salts
Some degree of toxicity
Metinyol (prednisolone- sulphacetamide with neomycin) with Ca(OH)2 Otosporin (polymixin B sulphate + neomycin) with Ca(OH)2 Ledermix (triamcinolone acetonide & demethylchlorotetracycline Ca) with Ca(OH)2 is very popular
Metronidazole + CHX + Ca(OH)2 Metranidazole + ciproflox + polyethyleneglycol 1000 + Ca(OH)2 CHX is added as vehicle(surfactant)
Setting
NO EFFECTS *Hydrex
*MPC
*Cal-Mer vii
Non-Setting
MATERIAL VEHICLE
Analar Ca(OH)2
Pulpdent Hypo-Cal
Water
Methycellulose Methycellulose
Reogan
Methycellulose
Antimicrobial, tissue dissolving ability, inhibition of tooth resorption, induction of hard tissue formation
This removes another H+ from 2nd FA, generating another lipidic peroxide
b) Protein denaturation:
Enzymes have optimum activity & stability in a narrow range around neutrality Alkalinization due to Ca(OH)2
Enzymes maintains its covalent structure but the polypeptide chain is randomly unraveled
Induces breakdown of ionic bonds that maintain the tertiary structure of proteins
OH reacts with bact. DNA Induces splitting of the strand Genes are lost DNA replication is inhibited
12.2 8-11
7.4-9.6
INEFFICACY OF Ca(OH)2 AGAINST BACT. PRESENT IN DT MAY BE DUE TO a) Buffering ability of dentine: protons donors b) Arrangement of bact. in the DT c) Anatomical variations
Hence CMCP + CaOH posses high radius of action, eliminates bact in distinct vicinity
PHYSICAL BARRIER
Physiochemical barrier, precludes the proliferation of residual micro organisms
Ist: as it possess antibact prop. acts as chemical barrier IInd: physical barrier against bact penetration, withholds substrate or growing & by limiting space for its growth
Local buffering action to inflammatory byproducts, alkaline pH neutralizes lactic acid secreted by osteoclasts
PERIAPICAL RESPONSE
LINERS:
BASES
PULP PROTECTION
INDIRECT PULP CAPPING
Osteoodontoblast
Osteodentin
Odontoblasts
Dentine bridge
PULPOTOMY
APEXOGENESIS
Tooth with immature root with vital pulp
Apexogenesis
APEXIFICATION
APICAL PLUG
WEEPING CANALS
TREATMENT OF PERFORATIONS
DENTINE DESENSITIZOR
MICROLEAKAGE DETECTOR
(Leinfelder et al, 1986)
Resorption or stimulation ??
Is it a true sealer??
Ca(OH)2
Composite resin
Composite resin
Ca(OH)2
Ca(OH)2
GIC
With MTA
With Ca(OH)
Ca(OH)2
Solubility
Sealing Microleakage pH Biocompatibility
Compressive strength-7.6, 3.8MPa Dentinal bridge Setting time
Appointment Cost
MTA
Solubility
Sealing Microleakage pH Biocompatibility
Compressive strength-70MPa Dentinal bridge Setting time
Appointment Cost
Contact with blood & moisture Contact with blood & moisture
A Catholicon??
IEJ 1999; 32, 361-9 IEJ 1999; 32, 257-82 IEJ 1990; 23, 283-97 J Dent 1991; 19, 3-13 JOE 2009; 35(4), 475-79 J.Appl.oral sci 2003; 11(4) Quint. Int 1990; 21(7), 589-97 Pediatric dent 2006; 28, 399-404 IEJ 2002; 36, 225-231 Am J of Dent 2002; 15(4) Am J of Dent 2006; 19(3) OOOE nov 2003 IEJ 2006(systematic review)
Endodontic practice; Louis Grossman, Seymour Oliet, Carlos E Del Rio-11th edition Endodontic therapy; Franklin Weine- 6th edition Ingles endodontics; Ingle, Bakland, Baumgartner- 6th edition Pathways of pulp; Cohen, Hargreaves- 9th edition Operative dentistry; Sturdevants art and science of operative dentistry; Roberson , Heymann, Swift- 5th edition Operative dentistry. Modern theory and practice; Marzouk, Simonton, Gross- 1st edition Seltzer & Benders Dental pulp; Kenneth M Hargreaves, Harold E Goodis Essentials of traumatic injuries to the teeth; J O Andreasen & F M Andreasen www.google.com
Tooth
Bacteria
Ca(OH)2
Merik Lake