CaOH Pallavi

8/13/2019 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

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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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M ik L k

CaOH Pallavi

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