Calcium hydroxide

1. Interappointment intracanal medicament

2. Pulp capping agents
3. Root canal sealers

Calcium hydroxide is a white odourless powder and is chemically classified as a strong base 12.5
pH; in contact with aqueous fluids, it dissociates into calcium and hydroxyl ions.

The hydroxyl group is considered to be the most important component of Ca(OH)2 as it provides
an alkaline environment, which encourages repair and active calcification. The alkaline pH
induced not only neutralizes lactic acid from osteoclasts, thus preventing dissolution of the
mineral components of dentine, but could also activate alkaline phosphatases that play an
important role in hard-tissue formation.

ZONES FORMED WHILE HEALING WITH CALCIUM HYDROXIDE [OCD]

1. ZONE OF OBLITERATION- Pulp tissue immediately in contact with calcium hydroxide

is completely distorted because of its caustic (BURN) effect of drug.
2. ZONE OF COGULATION NECROSIS – a weaker chemical effect reaches the subjacent
more apical tissues and results in zone of coagulation necrosis also called “Schroders
layer of firm necrosis”
3. Line of demarcation- this line forms between the zone of coagulation necrosis &
adjacent vital pulp tissue.
This line is formed by the reaction between calcium hydroxide and tissue protiens to
form proteinate globules.

EFFECT OF VEHICLE

The vehicle plays the most important role in overall process because it determines the velocity of
ionic dissociation causing the paste to be solubilized and resorbed at various rates by the
periapical tissues and from within the root canal . [iej 32-57, 282,1999]

According to Fava (1991), the ideal vehicle should:

1 allow a gradual and slow Ca2‡ and OHÿ ionic release

2 allow slow diffusion in the tissues with low solubility in tissue fluids

3 have no adverse effect on the induction of hard tissue deposition.

In general, three types of vehicles are used:

1. Water soluble
2. Viscous/oily
3. Aqueous

1. The first group is represented by water soluble substances including water, saline,
dental anesthetics, Ringer’s solution, aqueous suspension of methyl cellulose or
carboxymethyl cellulose, and anionic detergent solution. When calcium hydroxide is
mixed with one of these substances, Ca2+ and OH− ions are rapidly released .This type
of vehicle promotes a high degree of solubility. The root canal may become empty in
a short period, delaying the healing process. From a clinical standpoint, this means
that root canal must be redressed several times until the desired effect is achieved,
thereby increasing the number of appointments.

2. Some viscous are also water-soluble substances that release Ca2‡ and OHÿ ions more
slowly for extended periods. They promote a lower solubility of the paste, probably
because of their high molecular weights .

High molecular weight of these vehicles minimizes the dispersion of calcium

hydroxide into the tissue and maintains the paste in the desired area for longer
intervals; this factor prolongs the action of the paste, and Ca2‡ and OHÿ ions will be
given off at lower velocity. It is through this mechanism that these pastes remain in
direct contact with vital tissues for extended time intervals. As a viscous
vehiclecontaining paste may remain within the root canal , the number of
appointments and re-dressings of the root canal is drastically reduced . Some
examples of viscous vehicles are glycerine, polyethyleneglycol and propylene glycol.

3. Oily vehicles are non-water-soluble substances that promote the lowest solubility and
diffusion of the paste within the tissues (Lopes 1987, Marques et al. 1994, Lopes et
al. 1996). Pastes containing this kind of vehicle may remain within the root canal for
longer than the pastes containing aqueous or viscous vehicles. Some examples of oily
vehicles are olive oil, silicone oil, camphor (the essential oil of camphorated
parachlorophenol), metacresylacetate and some fatty acids such as oleic, linoleic and
isostearic acids.

In summary, Compared with water-soluble agents, viscous and oily vehicles prolong the
action of the calcium hydroxide.

Root resorption
Ca(OH)2 has an active influence on the local environment around a resorptive area by
reducing osteoclastic activity and stimulating repair. . This is directly related to the alkaline
pH of Ca(OH)2, which permeates through the dentine. Hardtissue resorption, with its
enzymatic activity, takes place in an acidic pH Ca(OH) creates an alkaline environment in
which the reaction is reversed and hard-tissue deposition can take place (Estrela & Holland
2009). The phenomenon of pH change towards the periphery is increased, especially where
resorption has exposed dentine.
The initial treatment of choice for internal root resorption is to pack the canal and the
resorption lacuna with Ca(OH)2 paste. The Ca(OH)2 will tend to necrotize remaining tissue in
the lacuna, and the necrotic remnants are then removed by irrigation with sodium
hypochlorite. The defect can then be filled with gutta percha and MTA.

In summary, by creating an alkaline environment, Ca(OH)2 inhibits osteoclast activity and

stimulates hard-tissue deposition. However, MTA can be used to repair teeth during the
management of internal root resorption.

Perforations
Ca(OH)2 as a main ingredient were not suitable for crestal and furcation perforations
because of the initial inflammatory response to these materials, which could lead to
breakdown of the supporting tissues.
On the other hand, In contact with tissue fluids, Ca(OH)2 may be displaced (Schuurs et al.
2000) with the result that a reliable seal cannot be achieved; in such situations, a more
conventional restorative material such as MTA is required.

Canals with exudate

The best way to stop the exudate in such cases is to dry the canal with sterile paper points
and to place Ca(OH)2 paste in the canal. The possible mechanism of action of Ca(OH)2 in
these cases is related to its basic pH, which converts the acidic pH of periapical tissues to a
more basic environment.
Two other theories have also been proposed:
1. The calcifying potential of Ca(OH)2 may start to build up bone in the lesion and
2. The caustic action of Ca(OH)2 cauterises residual chronically inflamed tissue

ANTI BACTERIAL
ANTIFUNGAL
ANTI ENDOTOXIN