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Safe and easy way to use calcium hydroxide as a temporary dressing
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JOURNAL OF ENDODONTICS
VOL.19, NO. 6, JUNE1993
Copyright © 1993 by The American Association of Endodontists
CLINICAL AID Safe and Easy Way to Use Calcium Hydroxide as a Temporary Dressing Mario Roberto Leonardo, CD, PT, Ariano Penteado Sim6es Filho, CD, PT, Roberto Miranda Esberard, CD, LD, Idomeo Bonetti Filho, CD, DR, and Renato de Toledo Leonardo, CD, DR
Calcium hydroxide is used for several clinical applications in endodontic therapy (1, 2). The majority of studies that used this substance, in order to show its biological properties, were done with the pure calcium hydroxide (3-5). The results of these studies are excellent (Fig. l) but the physicochemical properties of pure calcium hydroxide offers some disadvantages. It is radiolucent, permeable to fluids, highly soluble in the periapical region, and without viscosity, adherence, or flow. Moreover, this substance is not easy to apply into the root canal. Thus, in order to obtain a calcium hydroxide product with better clinical properties Leonardo (6), Silva (7), and Bonetti Filho (8) have analyzed, both in vitro and in vivo, 13 different formulations of this substance. The best results (Fig. 2) among these formulations were reached using the following paste: 2.5 g of calcium hydroxide p.a., 0.5 g of zinc oxide p.a., 0.05 g of hydrogenized colophony, and 1.75 ml of polyethylene glycol 400, The polyethylene glycol 400 is a clear, colorless, slightly hygroscopic, viscous vehicle that allows a slower release of hydroxyls and Ca 2÷ ions than aqueous vehicles (9). This paste is packed in sterile anesthesia cartridges (Calen; S. S. White-Artigos Dentfirios Ltda., Rio de Janeiro, Brazil) and dispensed in a special cartridge-type syringe (ML Endodontic Syringe; S. S. WhiteArtigos Dentfirios Ltda.). Using any disposable dental needles, 27-gauge long, this calcium hydroxide paste will flow well and can be easily placed into the root canal.
FiG 1. A, Postoperative radiograph of maxillary right central incisor at the 15-day follow-up examination. The puipal stump was covered with a plug of calcium hydroxide (arrow) and the remainder of the canal was filled with gutta-percha points and Rickert's sealer. B, The pulpal stump is vital and free from inflammatory cells (hematoxylin and eosin stain; original magnification x40). C, Greater magnification of B (hematoxylin and eosin stain; original magnification x80).
sterile glycerin in order to allow easy flow of the paste. The glycerin cartridge is removed and the calcium hydroxide paste cartridge is placed into the ML Endodontic Syringe. When the screw handle is twisted, the paste will be extruded easily through the needle. The needle must be placed deeply into the root canal. The paste is extruded gradually as the needle is slowly backed from it (Fig. 3). After each application the calcium hydroxide cartridge must be carefully cleaned and stored until next use. The temporary restoration must be efficient in order to avoid leakage which could cause secondary contamination of the root canal.
MATERIALS AND METHODS The following materials were used: calcium hydroxide paste cartridges, (Calen; S. S. White-Artigos Dent/~rios Ltda.), special cartridge-type syringes (ML Endodontic, Syringe; S. S White-Artigos Dent/lrios Ltda.), sterile glycerin stored in sterile anesthetic cartridges, and disposable 27-gauge dental needle. Place the disposable dental needle with rubber stop marking the working length in the ML Endodontic Syringe. In order to obtain easier access to the root canal the needle must be bent. The lumen of the needle should be lubricated with
Dr. Mario keonardo is professor and chairman and Dr. SimSes Filho, Dr. Esberard, Dr. Bonetti Filho, and Dr. Toledo Leonardo are professors, Department of Endodontics, Araraquara Dental School, UNESP, Sao Paulo, Brazil.
319
320
Leonardo et al.
Journal of Endodontics
FIG 2. Mesial root of lower second premolar of dog. Intentional perforation of the apex was done with files up to #30 and the canal filled with a plug of calcium hydroxide (arrow). The rest of the canal is filled with gutta-percha points and Proco-Sol. Cementum-like apposition has occurred in the canal wall (C) 6 months after treatment (hematoxylin and eosin stain; original magnification x40).
FIG 3. A, Maxillary right central incisor. The calcium hydroxide (Calen) as a temporary dressing is applied gradually into the root canal as the needle is slowly backed out. B, Periapical radiograph of the same tooth showing the temporary dressing in the root canal.
References 1. Heithersay GS. Stimulation of root formation in incompletelydeveloped pulpless teeth. Oral Surg 1970;29:620-30. 2. Frank AL. Calcium hydroxide: the ultimate medicament? Dent Clin North Am 1979;23:691-703. 3. Holland GR. Periapical response to apical plugs of dentin and calcium hydroxide in ferret canines. J Endodon 1984;10:71-4. 4. Safavi KE, Dowden WE, Introcaso JH, Langeland K. A comparison of antimicrobial effects of calcium hydroxide and iodine-potassium iodide. J Endodon 1985;11:454-6. 5. Leonardo MR, Leal JM, Sim~)es Filho AP. Pulpectomy: immediate root canal filling with calcium hydroxide. Concept and procedures. Oral Surg 1980; 49:441-50.
6. Leonardo MR. Contribuic~o para a repara~;&oapical e periapical postratamento de canals radiculares [Thesis]. Araraquara, S. P.: Faculdade de Odontologia, 1973. 7. Silva LAB. Rizog6nese incompleta: Efeito dos curativos de "demora" e "expectante", no tratamento de canais radiculares de dentes de c&es com rea£&o periapicalcr6nica. Avalia£&oradiogr&ficae histol6gica [Thesis]. Araraquara: Faculdadede Odontologia, 1991. 8. Bonetti Filho, I. Avalia~;&oda biocompatibilidadede quarto tecnicas de obtura#&o de canals radiculares. Estudo em dentes de c&es [Thesis]. Araraquara, S. P.: Faculdadede Odontologia, 1990. 9. Leonardo MR, Leal JM. Endodontia: Tratamento de canals radiculares. 2nd ed. S&o Paulo, Brazil: Editorial Medica. Panamericana, 1991:460-94.
Y o u M i g h t Like to K n o w Studies of circadian factors in myocardial ischemia and sudden death show that the incidence of mortality and morbidity from these causes is high in the early morning and wanes as the day progresses (N Engl J Med 313:1315). Could it be that " . . . early to rise" isn't healthy? Zachariah Yeomans
JOURNAL OF ENDODONTICS
VOL.19, NO. 6, JUNE1993
Copyright © 1993 by The American Association of Endodontists
CLINICAL AID Safe and Easy Way to Use Calcium Hydroxide as a Temporary Dressing Mario Roberto Leonardo, CD, PT, Ariano Penteado Sim6es Filho, CD, PT, Roberto Miranda Esberard, CD, LD, Idomeo Bonetti Filho, CD, DR, and Renato de Toledo Leonardo, CD, DR
Calcium hydroxide is used for several clinical applications in endodontic therapy (1, 2). The majority of studies that used this substance, in order to show its biological properties, were done with the pure calcium hydroxide (3-5). The results of these studies are excellent (Fig. l) but the physicochemical properties of pure calcium hydroxide offers some disadvantages. It is radiolucent, permeable to fluids, highly soluble in the periapical region, and without viscosity, adherence, or flow. Moreover, this substance is not easy to apply into the root canal. Thus, in order to obtain a calcium hydroxide product with better clinical properties Leonardo (6), Silva (7), and Bonetti Filho (8) have analyzed, both in vitro and in vivo, 13 different formulations of this substance. The best results (Fig. 2) among these formulations were reached using the following paste: 2.5 g of calcium hydroxide p.a., 0.5 g of zinc oxide p.a., 0.05 g of hydrogenized colophony, and 1.75 ml of polyethylene glycol 400, The polyethylene glycol 400 is a clear, colorless, slightly hygroscopic, viscous vehicle that allows a slower release of hydroxyls and Ca 2÷ ions than aqueous vehicles (9). This paste is packed in sterile anesthesia cartridges (Calen; S. S. White-Artigos Dentfirios Ltda., Rio de Janeiro, Brazil) and dispensed in a special cartridge-type syringe (ML Endodontic Syringe; S. S. WhiteArtigos Dentfirios Ltda.). Using any disposable dental needles, 27-gauge long, this calcium hydroxide paste will flow well and can be easily placed into the root canal.
FiG 1. A, Postoperative radiograph of maxillary right central incisor at the 15-day follow-up examination. The puipal stump was covered with a plug of calcium hydroxide (arrow) and the remainder of the canal was filled with gutta-percha points and Rickert's sealer. B, The pulpal stump is vital and free from inflammatory cells (hematoxylin and eosin stain; original magnification x40). C, Greater magnification of B (hematoxylin and eosin stain; original magnification x80).
sterile glycerin in order to allow easy flow of the paste. The glycerin cartridge is removed and the calcium hydroxide paste cartridge is placed into the ML Endodontic Syringe. When the screw handle is twisted, the paste will be extruded easily through the needle. The needle must be placed deeply into the root canal. The paste is extruded gradually as the needle is slowly backed from it (Fig. 3). After each application the calcium hydroxide cartridge must be carefully cleaned and stored until next use. The temporary restoration must be efficient in order to avoid leakage which could cause secondary contamination of the root canal.
MATERIALS AND METHODS The following materials were used: calcium hydroxide paste cartridges, (Calen; S. S. White-Artigos Dent/~rios Ltda.), special cartridge-type syringes (ML Endodontic, Syringe; S. S White-Artigos Dent/lrios Ltda.), sterile glycerin stored in sterile anesthetic cartridges, and disposable 27-gauge dental needle. Place the disposable dental needle with rubber stop marking the working length in the ML Endodontic Syringe. In order to obtain easier access to the root canal the needle must be bent. The lumen of the needle should be lubricated with
Dr. Mario keonardo is professor and chairman and Dr. SimSes Filho, Dr. Esberard, Dr. Bonetti Filho, and Dr. Toledo Leonardo are professors, Department of Endodontics, Araraquara Dental School, UNESP, Sao Paulo, Brazil.
319
320
Leonardo et al.
Journal of Endodontics
FIG 2. Mesial root of lower second premolar of dog. Intentional perforation of the apex was done with files up to #30 and the canal filled with a plug of calcium hydroxide (arrow). The rest of the canal is filled with gutta-percha points and Proco-Sol. Cementum-like apposition has occurred in the canal wall (C) 6 months after treatment (hematoxylin and eosin stain; original magnification x40).
FIG 3. A, Maxillary right central incisor. The calcium hydroxide (Calen) as a temporary dressing is applied gradually into the root canal as the needle is slowly backed out. B, Periapical radiograph of the same tooth showing the temporary dressing in the root canal.
References 1. Heithersay GS. Stimulation of root formation in incompletelydeveloped pulpless teeth. Oral Surg 1970;29:620-30. 2. Frank AL. Calcium hydroxide: the ultimate medicament? Dent Clin North Am 1979;23:691-703. 3. Holland GR. Periapical response to apical plugs of dentin and calcium hydroxide in ferret canines. J Endodon 1984;10:71-4. 4. Safavi KE, Dowden WE, Introcaso JH, Langeland K. A comparison of antimicrobial effects of calcium hydroxide and iodine-potassium iodide. J Endodon 1985;11:454-6. 5. Leonardo MR, Leal JM, Sim~)es Filho AP. Pulpectomy: immediate root canal filling with calcium hydroxide. Concept and procedures. Oral Surg 1980; 49:441-50.
6. Leonardo MR. Contribuic~o para a repara~;&oapical e periapical postratamento de canals radiculares [Thesis]. Araraquara, S. P.: Faculdade de Odontologia, 1973. 7. Silva LAB. Rizog6nese incompleta: Efeito dos curativos de "demora" e "expectante", no tratamento de canais radiculares de dentes de c&es com rea£&o periapicalcr6nica. Avalia£&oradiogr&ficae histol6gica [Thesis]. Araraquara: Faculdadede Odontologia, 1991. 8. Bonetti Filho, I. Avalia~;&oda biocompatibilidadede quarto tecnicas de obtura#&o de canals radiculares. Estudo em dentes de c&es [Thesis]. Araraquara, S. P.: Faculdadede Odontologia, 1990. 9. Leonardo MR, Leal JM. Endodontia: Tratamento de canals radiculares. 2nd ed. S&o Paulo, Brazil: Editorial Medica. Panamericana, 1991:460-94.
Y o u M i g h t Like to K n o w Studies of circadian factors in myocardial ischemia and sudden death show that the incidence of mortality and morbidity from these causes is high in the early morning and wanes as the day progresses (N Engl J Med 313:1315). Could it be that " . . . early to rise" isn't healthy? Zachariah Yeomans