Technical aspects involved in the removal of calcium hydroxide intracanal medication

Authors

  • Luciana Jorge Moraes Silva Graduate Program, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo
  • Roberto Ruggiero Braga Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo
  • Oscar Faciola Pessoa School of Dentistry, Federal University of Pará

DOI:

https://doi.org/10.11606/issn.2357-8041.v20i2p96-105

Keywords:

Calcium Hydroxide, Root Canal Irrigants, Chelating Agents, Ultrasonics.

Abstract

The search for an effective method of microbial control has been a constant concern in endodontics. The aim of this literature review was to discuss the technical aspects related to the removal of intracanal calcium hydroxide. As an adjunct to sanifi cation and microbial control, calcium hydroxide [Ca(OH)2] intracanal medication is more suitable in cases of pulp necrosis and chronic periapical lesions. However, it is not easily removed from the root canal, and its residue can affect the interface quality of the endodontic fi lling, especially when a resin sealer is used. The removal effi cacy of Ca(OH)2 medication has been investigated using several products and techniques, such as auxiliary chemicals, recapitulation with memory instrument and passive ultrasonic activation. The literature unanimously recognizes the persistence of residues with all the reported methods, particularly in the apical third, and ultrasonic activation has shown the best results in the removal of Ca(OH)2 medication.

Downloads

Download data is not yet available.

Author Biographies

  • Luciana Jorge Moraes Silva, Graduate Program, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo

    Doutoranda do Programa de Pós-Graduação da Faculdade de Odontologia da Universidade de São Paulo

    Mestrado em Clínica Integrada - Faculdade de Odontologia da USP

    Professora Assistente II da Faculdade de Odontologia da Universidade Federal do Pará

  • Roberto Ruggiero Braga, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo
    Professor Titular do Departamento de Biomateriais e Biologia Oral da Faculdade de Odontologia da Universidade de São Paulo.
  • Oscar Faciola Pessoa, School of Dentistry, Federal University of Pará

    Mestrado em Endodontia  - Faculdades de Odontologia da USP

    Doutorado em Endodontia - Faculdades de Odontologia da USP

    Professor de Endodontia da Universidade Federal do Pará

    Coordenador do Curso de Odontologia do Centro Univeritário do Pará

References

Nair PN. On the causes of persistent apical periodontitis: a review. Int Endod J. 2006 Apr;39(4):249-81.

Kawashima N, Wadachi R, Suda H, Yeng T, Parashos P. Root canal medicaments. Int Dent J. 2009 Feb;59(1):5-11.

Sjogren U, Figdor D, Persson S, Sundqvist G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. Int Endod J. 1997 Sep;30(5):297-306.

Siqueira JF, Jr., Lopes HP. Mechanisms of antimicrobial activity of calcium hydroxide: a critical review. Int Endod J. 1999 Sep;32(5):361-9.

Pashley DH, Kalathoor S, Burnham D. The effects of calcium hydroxide on dentin permeability. J Dent Res. 1986 Mar;65(3):417-20.

Çalt S, Serper A. Dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide. J Endod. 1999 Jun;25(6):431-3.

Schilder H. Filling root canals in three dimensions. 1967. J Endod. 2006 Apr;32(4):281-90.

Kim SK, Kim YO. Influence of calcium hydroxide intracanal medication on apical seal. Int Endod J. 2002 Jul;35(7):623-8.

Barbizam JV, Trope M, Teixeira EC, Tanomaru-Filho M, Teixeira FB. Effect of calcium hydroxide intracanal dressing on the bond strength of a resin-based endodontic sealer. Braz Dent J. 2008;19(3):224-7.

Kenee DM, Allemang JD, Johnson JD, Hellstein J, Nichol BK. A quantitative assessment of efficacy of various calcium hydroxide removal techniques. J Endod. 2006 Jun;32(6):563-5.

van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007 Jun;40(6):415-26.

Salgado RJ, Moura-Netto C, Yamazaki AK, Cardoso LN, de Moura AA, Prokopowitsch I. Comparison of different irrigants on calcium hydroxide medication removal: microscopic cleanliness evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Apr;107(4):580-4.

Balvedi RP, Versiani MA, Manna FF, Biffi JC. A comparison of two techniques for the removal of calcium hydroxide from root canals. Int Endod J. 2010 Sep;43(9):763-8.

Rödig T, Hausdörfer T, Konietschke F, Dullin C, Hahn W, Hülsmann M. Efficacy of D-RaCe and ProTaper Universal Retreatment NiTi instruments and hand files in removing gutta-percha from curved root canals – a micro-computed tomography study. International Endodontic Journal. 2012.

Goode N, Khan S, Eid AA, Niu LN, Gosier J, Susin LF, et al. Wall shear stress effects of different endodontic irrigation techniques and systems. J Dent. 2013 Apr 19.

Van der Sluis LW, Wu MK, Wesselink PR. The evaluation of removal of calcium hydroxide paste from an artificial standardized groove in the apical root canal using different irrigation methodologies. Int Endod J. 2007 Jan;40(1):52-7.

Law A, Messer H. An evidence-based analysis of the antibacterial effectiveness of intracanal medicaments. J Endod. 2004 Oct;30(10):689-94.

Leonardo MR, Hernandez ME, Silva LA, Tanomaru-Filho M. Effect of a calcium hydroxide-based root canal dressing on periapical repair in dogs: a histological study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Nov;102(5):680-5.

Siqueira JF, Jr., Magalhaes KM, Rocas IN. Bacterial reduction in infected root canals treated with 2.5% NaOCl as an irrigant and calcium hydroxide/camphorated paramonochlorophenol paste as an intracanal dressing. J Endod. 2007 Jun;33(6):667-72.

Rafter M. Apexification: a review. Dental traumatology : official publication of International Association for Dental Traumatology. [Review]. 2005 Feb;21(1):1-8.

Wigler R, Kaufman AY, Lin S, Steinbock N, Hazan-Molina H, Torneck CD. Revascularization: a treatment for permanent teeth with necrotic pulp and incomplete root development. J Endod. 2013 Mar;39(3):319-26.

Mohammadi Z, Dummer PMH. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Blackwell Publishing Ltd; 2011. p. no-no.

Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J. 2007 Mar;52(1 Suppl):S64-82.

Gomes BPFA, Ferraz CCR, Garrido FD, Rosalen PL, Zaia AA, Teixeira FB, et al. Microbial Susceptibility to Calcium Hydroxide Pastes and Their Vehicles. J Endod. 2002;28(11):758-61.

Baik JE, Jang KS, Kang SS, Yun CH, Lee K, Kim BG, et al. Calcium hydroxide inactivates lipoteichoic acid from Enterococcus faecalis through deacylation of the lipid moiety. J Endod. 2011 Feb;37(2):191-6.

Tronstad L, Andreasen JO, Hasselgren G, Kristerson L, Riis I. pH changes in dental tissues after root canal filling with calcium hydroxide. J Endod. 1981 Jan;7(1):17-21.

Nerwich A, Figdor D, Messer HH. pH changes in root dentin over a 4-week period following root canal dressing with calcium hydroxide. J Endod. 1993 Jun;19(6):302-6.

Orstavik D, Kerekes K, Molven O. Effects of extensive apical reaming and calcium hydroxide dressing on bacterial infection during treatment of apical periodontitis: a pilot study. Int Endod J. 1991 Jan;24(1):1-7.

Soares JA, Leonardo MR, Tanomaru Filho M, Silva LA, Ito IY. Residual antibacterial activity of chlorhexidine digluconate and camphorated p-monochlorophenol in calcium hydroxide-based root canal dressings. Braz Dent J. 2007;18(1):8-15.

Nandini S, Velmurugan N, Kandaswamy D. Removal efficiency of calcium hydroxide intracanal medicament with two calcium chelators: volumetric analysis using spiral CT, an in vitro study. J Endod. 2006 Nov;32(11):1097-101.

Rodig T, Vogel S, Zapf A, Hulsmann M. Efficacy of different irrigants in the removal of calcium hydroxide from root canals. Int Endod J. 2010 Jun;43(6):519-27.

Tasdemir T, Celik D, Er K, Yildirim T, Ceyhanli KT, Yesilyurt C. Efficacy of several techniques for the removal of calcium hydroxide medicament from root canals. Int Endod J. 2011 Jun;44(6):505-9.

da Silva JM, Silveira A, Santos E, Prado L, Pessoa OF. Efficacy of sodium hypochlorite, ethylenediaminetetraacetic acid, citric acid and phosphoric acid in calcium hydroxide removal from the root canal: a microscopic cleanliness evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Dec;112(6):820-4.

Wiseman A, Cox TC, Paranjpe A, Flake NM, Cohenca N, Johnson JD. Efficacy of sonic and ultrasonic activation for removal of calcium hydroxide from mesial canals of mandibular molars: a microtomographic study. J Endod. 2011 Feb;37(2):235-8.

Arslan H, Topcuoglu HS, Karatas E, Barutcigil C, Aladag H, Topcu KM. Effect of the smear layer in the removal of calcium hydroxide from root canal walls. J Conserv Dent. 2012 Apr;15(2):113-7.

Ballal NV, Kumar SR, Laxmikanth HK, Saraswathi MV. Comparative evaluation of different chelators in removal of calcium hydroxide preparations from root canals. Aust Dent J. 2012 Sep;57(3):344-8.

Bodrumlu E, Avsar A, Hazar Bodrumlu E, Cicek E. The effects of calcium hydroxide removal methods on bond strength of Epiphany SE with two irrigation protocols. Acta Odontol Scand. 2013 May-Jul;71(3-4):989-93.

Khaleel HY, Al-Ashaw AJ, Yang Y, Pang AH, Ma JZ. Quantitative comparison of calcium hydroxide removal by EndoActivator, ultrasonic and ProTaper file agitation techniques: an in vitro study. J Huazhong Univ Sci Technolog Med Sci. 2013 Feb;33(1):142-5.

Lambrianidis T, Margelos J, Beltes P. Removal efficiency of calcium hydroxide dressing from the root canal. Journal of endodontics. [Comparative Study]. 1999 Feb;25(2):85-8.

Lambrianidis T, Kosti E, Boutsioukis C, Mazinis M. Removal efficacy of various calcium hydroxide/chlorhexidine medicaments from the root canal. Int Endod J. 2006 Jan;39(1):55-61.

Silva JMd, Andrade Junior CV, Zaia AA, Pessoa OF. Microscopic cleanliness evaluation of the apical root canal after using calcium hydroxide mixed with chlorhexidine, propylene glycol, or antibiotic paste. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Feb;111(2):260-4.

Pashley DH, Michelich V, Kehl T. Dentin permeability: effects of smear layer removal. J Prosthet Dent. 1981 Nov;46(5):531-7.

Margelos J, Eliades G, Verdelis C, Palaghias G. Interaction of calcium hydroxide with zinc oxide-eugenol type sealers: a potential clinical problem. J Endod. 1997 Jan;23(1):43-8.

Ricucci D, Langeland K. Incomplete calcium hydroxide removal from the root canal: a case report. Int Endod J. 1997 Nov;30(6):418-21.

Hosoya N, Kurayama H, Iino F, Arai T. Effects of calcium hydroxide on physical and sealing properties of canal sealers. Int Endod J. 2004 Mar;37(3):178-84.

Goldberg F, Artaza LP, De S. Influence of calcium hydroxide dressing on the obturation of simulated lateral canals. J Endod. 2002 Feb;28(2):99-101.

Zehnder M. Root canal irrigants. Journal of Endodontics. [Review]. 2006 May;32(5):389-98.

Violich DR, Chandler NP. The smear layer in endodontics - a review. Int Endod J. 2010 Jan;43(1):2-15.

Çalt S, Serper A. Time-dependent effects of EDTA on dentin structures. J Endod. 2002 Jan;28(1):17-9.

Hsieh YD, Gau CH, Kung Wu SF, Shen EC, Hsu PW, Fu E. Dynamic recording of irrigating fluid distribution in root canals using thermal image analysis. Int Endod J. 2007 Jan;40(1):11-7.

Falk KW, Sedgley CM. The influence of preparation size on the mechanical efficacy of root canal irrigation in vitro. J Endod. 2005 Oct;31(10):742-5.

Boutsioukis C, Lambrianidis T, Kastrinakis E, Bekiaroglou P. Measurement of pressure and flow rates during irrigation of a root canal ex vivo with three endodontic needles. Int Endod J. 2007 Jul;40(7):504-13.

Huang TY, Gulabivala K, Ng YL. A bio-molecular film ex-vivo model to evaluate the influence of canal dimensions and irrigation variables on the efficacy of irrigation. Int Endod J. 2008 Jan;41(1):60-71.

Nielsen BA, Craig Baumgartner J. Comparison of the EndoVac system to needle irrigation of root canals. J Endod. 2007 May;33(5):611-5.

Plotino G, Pameijer CH, Grande NM, Somma F. Ultrasonics in endodontics: a review of the literature. J Endod. 2007 Feb;33(2):81-95.

Weller RN, Brady JM, Bernier WE. Efficacy of ultrasonic cleaning. J Endod. 1980 Sep;6(9):740-3.

Lee SJ, Wu MK, Wesselink PR. The efficacy of ultrasonic irrigation to remove artificially placed dentine debris from different-sized simulated plastic root canals. Int Endod J. 2004 Sep;37(9):607-12.

Mayer BE, Peters OA, Barbakow F. Effects of rotary instruments and ultrasonic irrigation on debris and smear layer scores: a scanning electron microscopic study. Int Endod J. 2002 Jul;35(7):582-9.

Downloads

Published

2014-06-26

Issue

Vol. 20 No. 2 (2014)

Section

Critical Review

License

Authors are requested to send, together with the letter to the Editors, a term of responsibility. Thus, the works submitted for appreciation for publication must be accompanied by a document containing the signature of each of the authors, the model of which is presented as follows:

I/We, _________________________, author(s) of the work entitled_______________, now submitted for the appreciation of Clinical and Laboratorial Research in Dentistry, agree that the authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).

Date: ____/____/____Signature(s): _______________