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Transcript of CaOH Pallavi
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Cherapunji, Meghalaya.
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CALCIUM HYDROXIDE
Presented by:Dr. Pallavi B. Gopeshetti,CODS, Dvg.
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JOURNEY!!
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CaCo3 (900-1200c) CaO
CaO+H2O Ca(OH)2
Synonyms: calcium hydrate, caustic lime, hydrated lime,lime, limehydrate, slaked lime
Other uses
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Amorphous matrix with crystalline fillers
H H
O O
Ca
Available as 2 paste form1 paste form
powder liquid form
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2 paste form
Base paste:
*Glycol salicylate-40%, reacts with Ca(OH)2 & ZnO* Tribasic calcium phosphate
* Calcium tungstate (barium sulphate)- radio opacity*Zinc oxide
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
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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), theMacSpadden compactor, combinations.
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Mixing equal parts
Starts acid base reaction
Results in weakly bonded composite structure
Chelates of Ca alkyl salicylate & water(the reaction byproduct) forms thecontinuous 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
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Ca(OH)2
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High alkaline pH
Modified forms: resins
Extreme cytotoxicity Buffering actions
Initial response: necrosis todepth of 1/> mm, coagulatesany hemorragic exudate
In weeks to months, necroticzone undergoes
dystrophic calcification whichappears to be stimulus
for dentine bridge formation
Neutrophilsinfiltrate into sub necrosis zone
After 5-8 weeks,only slight inflammation remains
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Biocompatibility with other restorative materials:
Setting reactionn properties
Amalgam &direct restorative mats
Zinc oxide eugenol
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chairside prep
proprietary brands are available
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.
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Easiest method: mix Ca(OH)2 wit waterdrawbacks?: no good physiochemical prop.
Hence, LEONARDO recommended addition of othersubstances
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CLINICAL IMPORTANCE OF THE VEHICLES
Velocity of ionic dissociation
Solubility & resorption rates
According toFAVA, ideal vehicle shoulda) Allow a gradual & slow Ca+ & OH- ionic release
b) Allow slow diffusion in the tissues with low solubility in the tissuefluids
c) Have no adverse effect on the induction of hard tissue deposition
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Fava, Holland, Lopes et al
Aqueous (water)
Viscous Oily (non-water soluble)
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
TYPES OF VEHICLES & ITS IMPORTANCE
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AT CHAIRSIDE:
Water:
Saline : 9gm NaCl+1000ml water
Anaesthetic solution :easily available, sterile & easy to handle
interesting point
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Ringers solution: NaCl-8.6gmKCl-0.3%
CaCl-0.33gm
water-1000ml
Methylcellulose & Carboxymethlycellulose: 5%-3%2 pastes: Ist: monomer of methlycellulose
a chemical initiator
Ca(OH)2particles
IInd: catalyst
Ca(OH)2particles
Methylcellulose monomers polymerize into a porous mesh work matrix & carriesCa(OH)2to P-D organ without involving it in chemical reaction
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Anionic detergent solutions:reduces surface tension& facilitate substance penetration of Ca(OH)2
deeper into the tissues
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AT CHAIRSIDE
various pharmaceutical preps.
Adv: a) strong antibacterial action against common microrganisms in RCs
b) hygroscopic: sustained release of Ca(OH)2
c) consistency: improved handling properties
Glycerin:Viscous,colorless,
characteristicodour, sweetish in
taste, mol wt.
92.02, hygroscopic(intracanallubricant)
Polyethyleneglycol:slightly
hygroscopic
Propyleneglycol:itschemically dihydricalcohol with syrupy
consistency,hygroscopic, nontoxic, mol wt. 76.09
used in
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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)2but has improved handling properties
Fatty acids:New B: P= Ca(OH)2powder 100%L= olive oil 100%
New B2: P= Ca(OH)265%
bismuth carbonate 15%
resin & ZnO 20%
L= fatty acids 85% & glycol 15%
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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
Metacrylacetate: acetic ester metacresol in combination wit benzene Oily liquid wit antibacterial, analgesic & sedative properties
Less cytotoxic than CMCP
When mixed with Ca(OH)2= CA cresilate & acetic acid
Acetic acid suffers an ionic dissociation & gives off H+ which decreases PH
Eugenol:oil of cloves
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PROPRIETARY BRANDS
AQUEOUS:
Calxyl (oldest by Hermann 1920) Pulpdent & tempcanal
Cavital
Reogan
Calasept
Calnex
Hypocal etc
VISCOUS:
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VISCOUS:
Calen
Calen + camphorated parachlorophenol(0.15ml):Controversies: whyuse cytotoxic CMCP??
Biocompatib
le
Lowliberation of
P-chlorophenol,not enough
forcytotoxicity
P-chlorophenol isreleased, PH ishigh, so protein
denaturation oftissues, hencephysical barrier
to deeperpenetration of P-
chlorophenol
Extendedantibacte
rialspectrum
CMCP+Ca(OH)2
Ca-P-cholrophenol
ate, a weaksalt
Water + salt,takes up H+ &goes back in toP-chlorophenol.gives off OH-
from water sohigh PH
maintained
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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%)
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CALCIUM HYDROXIDE & OTHER SUBSTANCES
RADIOGRAPHIC CONTRAST MEDIA: Why needed?
Atomic wt.> than Ca Ex.: barium sulphate, bismuth, compounds containing iodine & bromide
Bismuth salts
Some degree of toxicity
Soluble Barium salts
Extremely toxic material
Hence, iodine compounds, 3 types
Soluble iodine organic sub.
Non soluble organic substance
Slowly absorbable iodine oils
Diatrizoate& iothalamate paste
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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)
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SETTING & NON SETTING CALCIUM HYDROXIDE
*Dycal (original formula)
*Reocap
*Procal
*Dycal (new formula)
*Life
*Renew
*Reolit
*MPC*Hydrex
*Cal-Mer vii
STRONGEFFECTS
MEDIUMEFFECTS
NOEFFECTS
MATERIAL VEHICLE
Analar Ca(OH)2 Water
Pulpdent Methycellulose
Hypo-Cal Methycellulose
Reogan Methycellulose
Setting
Non-Setting
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Antimicrobial, tissue dissolving ability, inhibition of tooth resorption, induction of
hard tissue formation
Mechanism of antibacterial activity:Related to its release of OH- ions
OH ions are highly oxidant free radicals
Shows high reactivity by reacting with biomolecules
Reactivity is high & indiscriminate hence rarely diffuse away from the siteof application
a) Damage to bact cytoplasmic membrane:
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a) Damage to bact. cytoplasmic membrane:
OH ionsThis removes Peroxide themselves
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OH ionsinduce lipidperoxidation
Destruction ofphospholipids,
structuralcomponents of the
cellular mem
OH removes Hatoms from
unsaturated FAgenerating a free
lipid radical
Free lipidic
radical reactswit O2
Forms lipidicperoxideradical
another H+ from2ndFA, generating
another lipidicperoxide
act as free radicals,initiating an
autocatalytic chainreaction
Further lossof unsaturated
FA
Extensive
mem.damage
b) Protein denaturation:
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b) Protein denaturation:
Loss of
biologicalactivity of the
enzyme &disruption of
cellularmetabolism
Enzymes haveoptimum activity& stability in anarrow range
aroundneutrality
Alkalinizationdue to Ca(OH)2
Cellularmetabolism is
highlydependent on
enzymaticactivity
Enzymes maintainsits covalent
structure but thepolypeptide chainis randomlyunraveled
Inducesbreakdown ofionic bonds that
maintain thetertiary
structure of
proteins
c) Damage to the DNA
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c) Damage to the DNA
OH reacts with bact. DNA
Induces splitting of the strand
Genes are lost
DNA replication is inhibited
Cellular activity is disarranged
ROOT CANAL DISINFECTION
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ROOT CANAL DISINFECTION When in direct contact
Buffering systems
Bact. in dentinal tubules
PH values of Ca(OH)2 decreases in more distinct areas
12.28-11
7.4-9.6
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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
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PHYSICAL BARRIER
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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 orgrowing & by limiting space for its growth
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BIOCHEMICAL ACTIONS: THERORIES OF MINEALISATION
EPITACTIC THEORY:Initiators: Chondratin sulphate
Vit D dependent proteins
Phosphoproteins
Phospholipids
Inhibitor: Pyrophosphate ions.
Pyrophosphates- Alkaline Phosphates group
CALCIUM HYDROXIDE INDUCED MINERALISATION
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CALCIUM HYDROXIDE INDUCED MINERALISATION
Ca ions + alkaline pH
'Ca solely from dental pulp,
Ca acts as initiator ratherthan a substrate for repair
Local buffering action to inflammatory
byproducts, alkaline pHneutralizes lactic acid secreted by osteoclasts
CaOH exerts mitogenic & osteogenic effectsenzymatic pathwaymineralization
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THE DENTINE BRIDGE
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THE DENTINE BRIDGE
High pH materials
Low pH materials
PERIAPICAL RESPONSE
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PERIAPICAL RESPONSE
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LINERS:
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BASES
PULP PROTECTION
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PULP PROTECTION
INDIRECT PULP CAPPING
DIRECT PULP CAPPING
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Tissue with extensiveinflammatory response
Basophilic layer
Necrotic layer
AFTER PROCEDURE
Layer
ofcalcium carbonategranules
Osteo-odontoblast
1-2 WEEKS LATER
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4-5 WEEKS LATER
Osteodentin
Odontoblasts
Dentinebridge
A FEW MONTHS LATER
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PULPOTOMY
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APEXOGENESIS
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Tooth with immatureroot with vital pulp
After amputation of
vital pulp(pulpotomy)
Apexogenesis
Dentine bridge
Ca(OH)2
Dressing material
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APEXIFICATION
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HORIZONTAL ROOT FRACTURES
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APICAL PLUG
INTRACANAL MEDICAMENT(ROUTINE & LONG TERM)
INFECTED ROOT CANALS/PERIAPICAL LESIONS
WEEPING CANALS
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ROOT RESORPTIONS (idiopathic/replantation/ transplantation)
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TREATMENT OF PERFORATIONS
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ROOT CANAL SEALER
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DENTINE DESENSITIZOR
MICROLEAKAGE DETECTOR(Leinfelder et al, 1986)
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Is it acomplete Resorption
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Othercapping
agents??
completeroot canalmedicamen
t??
Resorptionor
stimulation??
Is it a truesealer??
Its physicalproperties??
Dentinalbridge??
Is itperfect??
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Am J of Dent 2002; 15(4) & Am J of Dent 2006; 19(3)
OOOE 2003
IEJ 2006
(systematic review)
*Leakage freerestorations,
*Less defectsin bridge
Composite
resin
Ca(OH)2
More dentinebridging,
Aged restorationsare not leakageproof,
biocompatibility
Composite
resin
Ca(OH)2
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Am J of Dent 2006; 19(3)
Composite resin > GIC > Ca(OH)2
*Leakage freerestorations,
*Less defectsin bridge
GIC
Ca(OH)2
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JOE 1998; 24(4)
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Othercapping
agents??
Will MTArule overCaOH??
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With MTA
With Ca(OH)
Pediatric dent 2006; 28, 399-404
Ca(OH)2 MTA
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Solubility Solubility
Sealing Sealing
Microleakage Microleakage
pH pH
Biocompatibility Biocompatibility
Compressive strength-7.6,3.8MPa
Compressivestrength-70MPa
Dentinal bridge Dentinal bridge
Contact with blood & moisture Contact with blood & moistureSetting time Setting time
Appointment Appointment
Cost Cost
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ACatholicon??
Will MTArule overCaOH??
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IEJ 1999; 32, 361-9
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, 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,
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p yCarlos E Del Rio-11thedition
Endodontic therapy; Franklin Weine- 6thedition
Ingles endodontics; Ingle, Bakland, Baumgartner- 6th
edition Pathways of pulp; Cohen, Hargreaves- 9thedition Operative dentistry;
Sturdevants art and science of operative dentistry;Roberson , Heymann, Swift- 5thedition Operative dentistry. Modern theory and practice;
Marzouk, Simonton, Gross- 1stedition
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
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Ca(OH)2
Bacteria
Tooth
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