Influence of different forms of calcium hydroxide and chlorhexidine intracanal medicaments on the outcome of endodontic treatment of teeth with chronic apical periodontitis

Abstract

Introduction/Objective The aim of this study was to determine clinical and radiographic periapical healing of teeth with apical periodontitis treated with different formulations of calcium hydroxide (CH)-paste (CH-paste) and gutta-percha points (CH-GP)-as well as those of chlorhexidine (CHX)-gel (CHXgel) and gutta-percha points (CHX-GP)-12 months after therapy. Methods Eighty patients with chronic apical periodontitis were randomly allocated to four treatment groups according to the intracanal medicament used: CH-paste, CH-GP, CHX-gel, and CHX-GP group. Seventy-eight patients were analyzed clinically and radiographically 12 months postoperatively. The periapical index (PAI) was used for the radiographic evaluation of treatment. Results Overall outcome was classified according to radiographic evaluation only, since clinical success was observed in all the patients. In all the groups, significant reduction in PAI scores was observed (p < 0.001). The proportions of healed teeth (PAI ≤ 2) were 73.7%, 60%, 68.4%, and 65% in CH-paste, CH-GP, CHX-gel and CHX-GP group, respectively, with no significant differences between the groups. Conclusion The results suggest that there are no differences between investigated CH-and CHX-delivery systems regarding treatment outcome of teeth with apical periodontitis.

Calcium Hydroxide as Intracanal Medicament in Pulp Necrosis with Periapical Lesion : A Case Report

“…Calcium hydroxide is a strong base material with high pH (12.5) chemically and only slightly soluble in water with a solubility of 1.2 g/l, at a temperature of 25°C [4][5][6]8,11,12]. There are three main types of calcium hydroxide vehicles: Water-soluble substances such as water, saline, anesthetic solutions, carboxymethylcellulose, methylcellulose and ringers solution; viscous vehicles such as glycerin, polyethyleneglycol (PEG) and propylene glycol; and oil-based vehicles such as olive oil, silicone oil, camphor (the oil of camphorated parachlorophenol), some fatty acids (including oleic, linoleic, and isostearic acids), eugenol and metacresylacetate.…”

“…Hydroxyl ions are highly oxidant-free radicals with high reactivity and bioactivity. The lethal effects of hydroxyl ions on bacteria cells relates to its ability to damage the cytoplasmic membrane of bacteria, denaturate their proteins and damage the DNA [4][5][6]8,[11][12][13][14][15].…”

“…When Calcium hydroxide is applied as intracanal medicament, moisture of root canal activates calcium hydroxide and pH increases up to 12 in a few minutes. The application of calcium hydroxide at intervals of at least 1-4 weeks is able to eliminate and reduce bacteria surviving even after biomechanical preparation [4][5][6]8,11]. Calcium hydroxide showed effective clinical results in reducing exudate due to its hygroscopic effects and stimulates repair of apical and periapical tissues.…”

The efficiency of canal cleaning with reciprocating movements instruments - SEM study

“…An effective endodontic treatment involves the complete elimination of microorganisms from the canal system and the prevention of reinfection with adequate mechanical instrumentation, irrigation, and medication [13,17]. Numerous studies confirm that efficient canal cleaning is difficult to achieve and that the quality of cleaning is reduced starting from the crown and the middle part of the canal according to the apical segment, primarily because of the inaccessibility and inadequate diameter of the apex preparation, i.e.…”

“…The concept of preparation by a single instrument significantly reduces preparation time, but also allows endodontists to devote more time to irrigation techniques in order to increase the efficiency of cleaning and disinfection of a complex canal system [3,5,13]. Endodontic practice confirms that the fundamental cleaning of the canal system is difficult to achieve and that the particular problem is the apical segment of the canal [2,3,5].…”