Review of calcium hydroxide

The Effect of Calcium Hydroxide Pastes on Isolated Vital Nerve Fibers

INTRODUCTION

Calcium hydroxide pastes (CHPs), commonly used for disinfecting root canals during endodontic treatment, are generally considered safe. However, accidental extrusions result in minimal injuries and little to no discomfort, except when extruded pastes come into contact with nerve bundles, such as the inferior alveolar nerve. Currently, there is a lack of information about the possible role of specific paste vehicles on the extent of nerve injury. The purpose of this study was to compare the role that paste vehicles, such as water or methylcellulose, may play when nerve fibers are exposed to CHP.

METHODS

Isolated sciatic nerves of Sprague-Dawley rats were exposed to either water-based or methylcellulose-based CHP for varying durations of time (30, 60, or 90 minutes). Histopathological changes, including axonal edema, myelin alterations, and loss of cellular outlines, were assessed, and the degrees of changes were compared using chi-square intraclass correlation coefficient tests.

RESULTS

Both groups exposed to the pastes demonstrated varying degrees of histopathologic changes, including axonal edema, myelin changes, and loss of cellular outlines, at different exposure times. The water-based calcium hydroxide paste induced these changes more rapidly than the methylcellulose-based paste. Similar patterns were observed in the scanning electron microscopic findings. Exposure time emerged as an important difference in the effects of the 2 pastes. In each of these tests, all observations of water-based paste exposure were rated as moderate to severe, whereas the observed cellular changes (axonal, myelin, and intact cellular outline) were rated as mild to moderate after exposure to methylcellulose-based paste for the same exposure durations. The chi-square tests indicated a statistically significant association between the material and each of the outcomes (axonal changes: χ²15 = 81.0, P < .001; myelin changes: χ²15 = 81.0, P < .001; intact cellular outline, χ²15 = 81.0, P < .001). The intraclass correlation coefficient value was 0.93.

CONCLUSIONS

The study demonstrates that axonal and myelin damage increase with longer exposure times, with water-based CHP causing more damage than methylcellulose-based CHP at each time point.

A paradigm shift from calcium hydroxide to bioceramics in direct pulp capping: A narrative review

For many years, calcium hydroxide (CH) was the preferred material for direct pulp capping (DPC), occupying an elevated position. The collapse of this paradigm is due to the emergence of bioceramics with less pulpal inflammation and superior mineralization abilities than CH. The goal of the current article was directed to: (1) review the history of DPC "the idea of an exposed pulp as a hopeless organ has given way to one of healing and optimism," (2) classify the bioceramics in dentistry, and (3) explain and compare the mechanism by which dentin barriers for CH and bioceramics are formed. A comprehensive literature search of the database was conducted using PubMed, Google Scholar, and Scopus utilizing the following terms: Biodentine, calcium hydroxide, calcium aluminate, calcium phosphate, calcium silicate, direct pulp capping, NeoMTA Plus, Quick-Set2, and TotalFill. Reference mining of the selected publications was utilized to discover other studies and strengthen the results. Only works written in English were taken into consideration, and there were no restrictions on the year of publication. Bioceramic materials might be used as an intriguing substitute for CH. Compared to CH, they induced more positive pulpal reactions.

Evaluation of the reasons for failure in teeth with vital amputation treatment

AIM

This study aims to evaluate the primary teeth undergoing amputation due to dental caries or trauma clinically and radiologically.

MATERIAL AND METHODS

The amputation treatment of 90 primary teeth of 58 patients (Female: 20, Male: 38) aged 4-11 years was evaluated clinically and radiologically. Calcium Hydroxide was used for amputation in this study. Composite or amalgam was preferred as filling material in the same session of the patients. Clinical/radiological (Periapical/Panoramic X-ray) examination was performed on the teeth that were unsuccessful in treatment, on the day of the patient's complaint, and at the end of 1 year in the others.

RESULTS

According to the clinical and radiological findings of the patients, 14.4% of the boys and 12.3% of the girls were unsuccessful. Amputation in male was a need in the 6-7 age group with a rate of 44.6% at most. Amputation in females was a need in the 8-9 age group with a rate of 52% at most.

CONCLUSION

Success in amputation treatment depends on the tooth, the dentist, and the dental material applied.

An in vitro anti-inflammatory effect of Thai propolis in human dental pulp cells

OBJECTIVE

To explore the potential for development of Thai propolis extract as a pulp capping agent to suppress pulpal inflammation from dental pulp infections. This study aimed to examine the anti-inflammatory effect of the propolis extract on the arachidonic acid pathway, activated by interleukin (IL)-1β, in cultured human dental pulp cells.

METHODOLOGY

Dental pulp cells, isolated from three freshly extracted third molars, were first characterized for their mesenchymal origin and treated with 10 ng/ml of IL-1β in the presence or absence of non-toxic concentrations of the extract from 0.08 to 1.25 mg/ml, as determined by the PrestoBlue cytotoxic assay. Total RNA was harvested and analyzed for mRNA expressions of 5-lipoxygenase (5-LOX) and cyclooxygenase-2 (COX-2). Western blot hybridization was performed to investigate COX-2 protein expression. Culture supernatants were assayed for released prostaglandin E2 levels. Immunofluorescence was conducted to determine involvement of nuclear factor-kappaB (NF-kB) in the inhibitory effect of the extract.

RESULTS

Stimulation of the pulp cells with IL-1β resulted in the activation of arachidonic acid metabolism via COX-2, but not 5-LOX. Incubation with various non-toxic concentrations of the propolis extract significantly inhibited upregulated COX-2 mRNA and protein expressions upon treatment with IL-1β (p<0.05), resulting in a significant decrease in elevated PGE2 levels (p<0.05). Nuclear translocation of the p50 and the p65 subunits of NF-kB upon treatment with IL-1β was also blocked by incubation with the extract.

CONCLUSIONS

Upregulated COX-2 expression and enhanced PGE2 synthesis upon treatment with IL-1β in human dental pulp cells were suppressed by incubation with non-toxic doses of Thai propolis extract via involvement of the NF-kB activation. This extract could be therapeutically used as a pulp capping material due to its anti-inflammatory properties.

Novel Magnetic Composite Materials for Dental Structure Restoration Application

In general, magnetic nanoparticles are not often used in dental applications due to some limitations of these materials, such as aggregation problems and low mechanical and chemical resistance but also esthetic problems due to their black color. Our research presents the synthesis of novel magnetic dental composite materials based on magnetic nanoparticles, functionalized and properly coated to overcome the limitations of using magnetic nanoparticles in dental applications. The composites were prepared using a preparation flow containing several integrated reaction steps used previously sequentially. An adequate and deep characterization of dental magnetic composites has been carried out in order to demonstrate that each limitation has been successfully overcome. It was proved that each component brings particular benefits in dental interventions: Fe₃O₄ nanoparticles have biocompatible, non-toxic properties and also antimicrobial effects; the SiO₂ layer significantly increases the mechanical strength of the material; and the Ca(OH)₂ layer initiates local calcification and significantly improves the color of the dental composite material. Due to magnetic properties, an innovative application approach on the tooth surface can be achieved under an external magnetic field, which, compared to conventional methods, has a major impact on reducing the occurrence of dental caries under filling materials as well as on reducing microfractures.

Molecular Insight into the Pozzolanic Reaction of Metakaolin and Calcium Hydroxide

The reaction mechanism of the pozzolanic reaction of metakaolin (MK) from the atomic point of view has not yet been explored. To explain the process and mechanism of the pozzolanic reaction from the atomic point of view, molecular insight into the pozzolanic reaction of MK and calcium hydroxide (CH) was analyzed through the reaction molecular dynamics (MD) simulation. The results show that the pozzolanic reaction of MK and CH can be essentially regarded as the CH decomposition and penetration into MK. Also, the structure evolution after the pozzolanic reaction shows that the water molecules cannot penetrate the MK structure till the participation of Ca²⁺ and OH^- ions of CH. The Ca²⁺ and OH^- ions have strong interaction with MK and drill into the MK structure, followed by the destruction of a part of the MK structure and water penetration. The final structure of CH removed by MK can be regarded as the precursor of the CASH gel structure.

Efficacy of Calcium Hydroxide/Saline versus Calcium Hydroxide/Artemisia persica Essential Oil as Intracanal Medicament to Improve Radiographic Visualization of Periapical Lesions in Necrotic Teeth: A Randomized Clinical Trial

Objectives

This study aimed to compare the efficacy of calcium hydroxide (CH)/saline and CH/Artemisia persica (A. persica) essential oil as an intracanal medicament for radiographic resolution of periapical (PA) lesions in necrotic teeth.

Materials and Methods

This randomized clinical trial was conducted on 22 patients with necrotic teeth and PA lesions presenting to two private endodontic offices. The patients were randomly divided into two groups (n = 11) to receive CH/saline (control group) and CH/A. persica essential oil (10%) (intervention group) as intracanal medicaments between treatment sessions. The size of PA radiolucency was measured on parallel PA radiographs taken before treatment and also at 1 and 3 months after completion of treatment. The mean time of healing of PA lesions was also compared between the two groups. Data were analyzed by the independent t-test, chi-square test, and Fisher's exact test (alpha = 0.05).

Results

No significant difference was found between the two groups regarding the changes in the size of PA lesions, relative healing percentage, and speed of healing, neither at 1 nor at 3 months postoperatively (P > 0.05). Regarding the presence/absence of clinical symptoms in the second treatment session, the intervention group showed greater resolution of symptoms, although the difference did not reach statistical significance (P > 0.05).

Conclusion

According to the present results, it appears that the addition of A. persica essential oil to CH for application as intracanal medicament does not add any particular advantage.

Exosome-Based Cell Homing and Angiogenic Differentiation for Dental Pulp Regeneration

Exosomes have attracted attention due to their ability to promote intercellular communication leading to enhanced cell recruitment, lineage-specific differentiation, and tissue regeneration. The object of this study was to determine the effect of exosomes on cell homing and angiogenic differentiation for pulp regeneration. Exosomes (DPSC-Exos) were isolated from rabbit dental pulp stem cells cultured under a growth (Exo-G) or angiogenic differentiation (Exo-A) condition. The characterization of exosomes was confirmed by nanoparticle tracking analysis and an antibody array. DPSC-Exos significantly promoted cell proliferation and migration when treated with 5 × 10⁸/mL exosomes. In gene expression analysis, DPSC-Exos enhanced the expression of angiogenic markers including vascular endothelial growth factor A (VEGFA), Fms-related tyrosine kinase 1 (FLT1), and platelet and endothelial cell adhesion molecule 1 (PECAM1). Moreover, we identified key exosomal microRNAs in Exo-A for cell homing and angiogenesis. In conclusion, the exosome-based cell homing and angiogenic differentiation strategy has significant therapeutic potential for pulp regeneration.

Physicochemical and Antibacterial Properties of Conventional and Two Premixed Root Canal Filling Materials in Primary Teeth

In this study, some physicochemical and antibacterial properties of three root canal filling materials for primary teeth, Calplus “CP” (Prevest DenPro, Lewes, DE, USA), Bio-C Pulpecto “Bio-CP” (Angelus, Basil, Londrina, Paraná, Brazil), and Zinc Oxide and Eugenol “ZOE” (Prevest DenPro, Lewes, DE, USA) were compared. For each material, the pH, solubility, contact angle, and crystalline microstructure under SEM were evaluated. Their antibacterial activity against Enterococcus faecalis was determined through direct tests. The Kruskal−Wallis test was used to analyze the results using a one-way analysis of variance on ranks. All the materials had an alkaline pH at 3, 24, and 72 h, with CalPlus having the highest (p < 0.05). Bio-CP was more soluble during the evaluation period (24 h) than ZOE and CalPlus (p < 0.05). Bio-CP and ZOE demonstrated the creation of crystallite structures on their surfaces after immersion in PBS at 37 °C, whereas CalPlus showed none. The lowest contact angle was observed for Bio-CP (53 ± 1.5°); contact angles of (86 ± 4°) and (96 ± 1°), respectively, were observed after 10 s of the deposition of the water drop for CalPlus and ZOE. In conclusion, according to this study, there is still a need to develop new filling materials for primary teeth. ZOE, CalPlus and Bio-CP demonstrated different physicochemical and antibacterial properties, but none of the materials had optimal properties and could be considered the most suitable filling material for primary teeth pulpectomy. Bioceramics in their current state are not an alternative. The physicochemical and antibacterial properties still need improvement to fit the intricate anatomy of primary teeth.

Decarbonisation of calcium carbonate in sodium hydroxide solutions under ambient conditions: effect of residence time and mixing rates

The decarbonisation of CaCO₃ is essential for the production of lime (Ca(OH)₂ and CaO), which is a commodity required in several large industries and the main precursor for cement production. CaCO₃ is usually decarbonised at high temperatures, generating gaseous CO₂ which will require post-process capture to minimise its release into the environment. We have developed a new process that can decarbonise CaCO₃ under ambient conditions, while sequestering the CO₂ as Na₂CO₃·H₂O or Na₂CO₃ in the same stage. Here, the effects of increasing stirring rates and residence times on reaction efficiency of the key reaction occurring between CaCO₃ and NaOH solution are studied. It is shown that the reaction is enhanced at lower stirring rates and longer residence times up to 300 seconds of contact between the reactants. The mass balance performed for Ca and CO₂ revealed that up to the 95% of the process CO₂ embodied in CaCO₃ was sequestered, with maximum capture rate assessed at nn moles CO₂ captured per second of reaction progress. A deeper insight into the precipitation of Na₂CO₃·H₂O or Na₂CO₃ under different reaction conditions was gained, and SEM-EDX analysis enabled the observation of the reaction front by detection of Na migrating towards inner regions of partially-reacted limestone chalk particles.

Efficiency of Endosonic Blue, Eddy, Ultra X and Endoactivator in the removal of calcium hydroxide paste from root canals

We investigated the efficiency of Endosonic Blue, EDDY, Ultra X and EndoActivator in removing calcium hydroxide from artificially created apical grooves in root canal walls. In Materials and Methods: A total of 60 single-root maxillary central incisors, root canals were created and the roots were divided into two longitudinal parts. In the most suitable root piece, artificial grooves were created in the apical section and filled with calcium hydroxide. Calcium hydroxide in the grooves was removed using EDDY, Ultra X, Endosonic Blue or EndoActivator, and the remnants in the grooves were examined under a stereomicroscope. EDDY and Ultra X removed significantly more calcium hydroxide than Endosonic Blue and EndoActivator. The performance of EDDY and Ultra X or Endosonic Blue and EndoActivator was comparable. Therefore, EDDY and Ultra X are more effective than Endosonic Blue and EndoActivator in removing calcium hydroxide from apical grooves in root canal walls. No technique could achieve complete calcium hydroxide removal.

The effects of root canal perforation repair materials on the bond strength of fiber posts

INTRODUCTION

This study aimed to evaluate the effect of calcium hydroxide and bioceramics used in perforation repair on the bonding strength of fiber posts via a push-out test.

METHODOLOGY

This study used 106 extracted single-rooted human mandibular premolar teeth. Root canal preparations were performed with a rotary file system and perforations were created in the middle third of each tooth. The samples were randomized into two main experimental groups, one with calcium hydroxide and one without. Each group had four subgroups in which different bioceramic cements were applied (n = 11) and a control group (n = 9). The root canals perforations were repaired using MTA, Biodentine, Bioaggregate, and Endosequence BC root repair material. A fiber post was applied to each tooth and a push-out test was performed. The samples were examined at 40× magnification with a digital microscope in order to identify fracture type.

RESULTS

Bonding strength was calculated in MPa. A statistical analysis showed that the calcium hydroxide had no effect on the bonding strength of the fiber posts. A comparison of the perforation repair materials revealed that Biodentine in the calcium hydroxide group and Bioaggregate in both groups decreased the bonding strength compared to the other materials (p < 0.05). The most common failure type was adhesive failure between the dentin and resin cement (38.16%).

CONCLUSIONS

The use of different perforation repair materials can affect the bonding strength of fiber posts. Therefore, the choice of perforation repair material should be made on an individual basis.

Comparative assessment of titanium-prepared platelet-rich fibrin, EndoSequence root repair material, and calcium hydroxide as pulpotomy agents in permanent teeth with irreversible pulpitis: A randomized controlled trial

Context:

Pulpotomy is a procedure in which part of an exposed vital pulp is removed, usually as a means of preserving the vitality and function of the remaining part.

Aim:

The aim is to compare the effectiveness of Dycal (CH), EndoSequence, and Titanium-prepared platelet-rich fibrin with EndoSequence (T-PRF) as pulpotomy agents in mature permanent molars with irreversible pulpitis.

Settings and Design:

Sixty permanent mandibular molars with carious exposure and symptoms of irreversible pulpitis were randomly allocated to three groups.

Subjects and Methods:

Full pulpotomy was performed using Dycal, EndoSequence, and T-PRF with EndoSequence as pulpotomy agents. Pain intensity was analyzed using a Numeric Rating Scale score at baseline 24 h, 7 days, 6 months, and 1 year. The clinical and radiographic evaluations were done at 6 months and 1 year.

Statistical Analysis:

Nonparametric tests (Kruskal–Wallis, Chi-square) were applied to analyze the data as the normality test does not follow a normal distribution.

Results:

T-PRF and EndoSequence showed effective results when compared clinically, and there was no significant difference between radiographic success rates among the three groups at (P = 0.325 at 6 months, 0.466 at 12 months) follow-up.

Conclusion:

T-PRF and EndoSequence showed higher success rates among Dycal, EndoSequence as pulpotomy agents in teeth with irreversible pulpitis.

Evaluation of the diffusion of calcium hydroxide-based medicaments through the dentinal tubules and apical foramen: A mass spectrometry study

Aims:

This mass spectrometry study investigated the diffusion of hydroxyl and calcium ions from a calcium hydroxide intracanal medicament (Pulpdent^®) when used alone or mixed in equal parts with a steroid–antibiotic paste (Ledermix^®).

Materials and Methods:

The pH (using pH meter) and calcium ion concentration (using inductively coupled plasma-mass spectrometry) of the diffused medicaments were assessed using endodontically prepared human extracted teeth with either a sealed or a patent apex, at time intervals of 1, 3, 8, 24, and 168 h.

Statistical Analysis:

A one-way ANOVA was used to explore differences between and within groups, with Tukey–Kramer/Games–Howell posttests.

Results:

In both situations tested, Pulpdent^® showed greater release of both calcium and hydroxyl ions than when mixed in equal parts with Ledermix^®. Greater initial release of both ions occurred in roots with a patent apex, but by 1 week there was no significant difference between the two. If a 50:50 combination of Pulpdent^® paste and Ledermix^® paste is used, there is a lower release of calcium ions and hydroxyl ions than using Pulpdent^® paste alone.

Conclusion:

With both Pulpdent^® paste alone and Pulpdent^® paste mixed equally with Ledermix^® paste, the major pathway for movement of hydroxyl ions and calcium ions is diffusion through the dentine of the root, with the apex playing only a minor role.

Tubular Dentin Regeneration Using a CPNE7-Derived Functional Peptide

We aim to examine the effects of a newly developed peptide derived from CPNE7 (Cpne7-DP) in tertiary dentin formation and peritubular space occlusion, and comprehensively evaluate its potential as a bioactive therapeutic agent. Human dental pulp cells (HDPCs) and a mouse pre-odontoblast cell line, MDPC-23, were chosen for in vitro studies to characterize lineage-specific cell responses after Cpne7-DP treatment. Whether Cpne7-DP reproduces the dentin regenerative potential of CPNE7 was tested using a beagle dog model by generating dentinal defects of various degrees in vivo. Peritubular space occlusion was further examined by scanning electron microscopy and microleakage test, while overall mineralization capacity of Cpne7-DP was tested ex vivo. CPNE7 promotes tubular dentin formation under both shallow and deep dentinal defects, and the functional peptide Cpne7-DP induces odontoblast-like differentiation in vitro, mineralization ex vivo, and tubular dentin formation in in vivo beagle dog dentin exposure and pulp exposure models. Moreover, Cpne7-DP leads to peritubular space occlusion and maintains stability under different conditions. We show that CPNE7 and its derivative functional peptide Cpne7-DP promotes dentin regeneration in dentinal defects of various degrees and that the regenerated hard tissue demonstrates the characteristics of true dentin. Limitations of the current dental materials including post-operative hypersensitivity make biological repair of dentin a field of growing interest. Here, we suggest that the dual functions of Cpne7-DP in tubular dentin formation and peritubular space occlusion are promising for the treatment of dentinal loss and sensitivity.

Effect of calcium hydroxide mixed with lidocaine hydrochloride on postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis: a preliminary randomized controlled prospective clinical trial

OBJECTIVES

To investigate the effect of calcium hydroxide mixed with lidocaine HCl on postoperative spontaneous pain.

MATERIALS AND METHODS

Sixty patients having irreversible pulpitis and symptomatic apical periodontitis with a preoperative spontaneous pain and percussion pain which was more than 50 on a visual analogue scale (100 mm VAS) were included in this study. After the preparation of the root canals, the patients were randomly distributed into two groups according to the calcium hydroxide vehicle, control group (mixed with saline) and calcium hydroxide mixed with lidocaine HCl (n = 30). Postoperative spontaneous pain scores were recorded by a VAS every day for a week. Data were analysed using one-way analysis of variance, chi-squared test and Mann-Whitney U tests (p = 0.05).

RESULTS

The calcium hydroxide mixed with lidocaine HCl group resulted in significantly less pain compared with the calcium hydroxide mixed with saline group during days 1 to 4 (p < 0.05). There were no significant differences between the groups in terms of postoperative percussion pain levels (p > 0.05).

CONCLUSION

Within the limitations of this study, it can be concluded that the calcium hydroxide mixed with lidocaine HCl can be beneficial in reducing postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis.

CLINICAL RELEVANCE

The calcium hydroxide mixed with lidocaine HCl can be beneficial in reducing postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis.

CLINICAL REGISTRATION NUMBER

TCTR20181121003.

The use of Calcium Hydroxide in the Treatment of Abscesses in the Cheek of the Rabbit Resulting from a Dental Periapical Disorder

Abscesses on the jaws of 10 rabbits resulting from diseased premolar or molar teeth were treated by extraction of diseased teeth and injection of calcium hydroxide paste into the abscess cavity. The abscesses did not recur (follow-up period 3–38 months, median 24 months).

Comparative Evaluation of Ocimum sanctum and Calcium Hydroxide Mix as an Obturating Material in Deciduous Molars: An In Vivo Study

Aim and Objectives

To evaluate clinical and radiographic efficacy of a mix of O. sanctum (tulsi extract) and calcium hydroxide as an obturating material in primary molars and to compare these findings with commercially available iodoform with calcium hydroxide paste (metapex).

Materials and Methods

The present study was conducted on sixty children age group 4-7 years requiring multiple visit pulpectomy for their primary molars. The teeth selected were randomly divided into two groups. One group received Metapex and other group received Tulsi extract with calcium hydroxide as an obturating material. Clinical and radiographic evaluation were done between both the groups.

Results

There was no significant difference in the clinical and radiographic success rate between both the groups.

Conclusion

Tulsi extract with calcium hydroxide can be used as an obturating material in primary molars.

How to cite this article

Agarwal S, Gupta S, Tandon S, et al. Comparative Evaluation of Ocimum sanctum and Calcium Hydroxide Mix as an Obturating Material in Deciduous Molars: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(6):617-621.

Effects of Nel-like molecule-1 and bone morphogenetic protein 2 combination on rat pulp repair

Nel-like molecule-1 (NELL-1) is a novel highly specific growth factor that can induce osteoblast differentiation and bone formation as well as odontoblast differentiation. Recent studies have suggested that NELL-1 can synergistically increase bone formation and regeneration with bone morphogenetic protein 2 (BMP2) and inhibit adverse effects induced by BMP2. This study aimed to evaluate the combined effects of NELL-1 and BMP2 on rat pulp repair. The experiment used healthy non-carious maxillary first molars from 60 Wistar rats. Exposed pulps were capped with NELL-1 plus BMP2, NELL-1 alone, and BMP2 alone, and each was absorbed onto a sterile collagen sponge. In the control samples, the collagen sponge alone and Dycal were used as capping agents. After l, 2 and 4 weeks, the rats were sacrificed. The formation of reparative dentin, as well the situation of pulp repair, was detected by hematoxylin-eosin (HE) staining; moreover, the expression of dentin specific protein-dentin sialophosphoprotein (DSPP) and the pro-inflammatory cytokines interleukin-6 (IL6) and interleukin-8 (IL8) was detected by immunohistochemical staining. Quantitative real-time PCR experiment was used to investigate the mRNA levels of IL6 and IL8. The results showed that pulp capping with NELL-1 plus BMP2 in rats had superior ability in inducing reparative dentin formation with dentin tubules and in reducing the inflammatory cell response compared with the other groups. These findings suggested that combined use of NELL-1 and BMP2 could positively regulate pulp repair.

Promotion of Dental Pulp Wound Healing in New Zealand White Rabbits’ Teeth by Thai Propolis Product

This study examined and compared wound healing between Thai propolis product and calcium hydroxide paste as pulp-capping agents after partial pulpotomy in New Zealand white rabbits. Forty incisor teeth from 10 rabbits were treated. Thirty-six teeth received class V cavity preparations with partial pulpotomy and application of either propolis or calcium hydroxide paste. Similar cavity preparations were performed in 2 teeth without any capping material as a positive control, whereas 2 teeth without the cavity preparation served as a negative control. Histological evaluation showed that both groups had dentin bridge formation. Dentinal tubules in the dentin bridge were more orderly arranged in the Thai propolis group than in the calcium hydroxide group. Wound healing and the median number of hyperemic blood vessels were not statistically significant different between the 2 groups. Thai propolis product may be used as a pulp-capping agent.

Non-surgical endodontic management of immature permanent mandibular first molar: a 3 year follow-up

BACKGROUND

Deep carious lesions in immature permanent molars with pulp necrosis pose a serious challenge to contemporary paedodontic practice. A further complex clinical scenario is an immature permanent molar with varying root formation in both roots. This case report demonstrates the successful management of an immature permanent mandibular first molar.

CASE REPORT

An 8-year-old boy was referred for endodontic management of 36 by a general practitioner. After clinical and radiographic evaluation, a diagnosis of recurrent chronic periapical abscess with abrupt root closure in the mesial root and cessation of root closure in the distal root was made. Apexification was undertaken in three appointments. In the first appointment, under local analgesia and isolation, the mesial canals were prepared to size #F3 with rotary Protaper Universal and the distal canal was left unprepared. Both canals were irrigated with 5% sodium hypochlorite and calcium hydroxide intracanal medicament was placed. One week later, the mesial canals were obturated and a 4 mm white MTA apical plug was placed in the distal canal. Partial extrusion of the MTA was seen periapically. After 24 h, the hard-setting of the MTA plug was verified, remainder of the distal canal was obturated and core filling was placed followed by a preformed metal crown as an intermediate restoration.

FOLLOW-UP

The patient was asymptomatic and showed resolution of the lesion, normal thickness of the PDL space with continuity of the lamina dura after 12 months. Extruded MTA was partially resorbed. Three years follow-up showed complete resorption of the extruded MTA and an intact lamina dura.

Clinical and Molecular Perspectives of Reparative Dentin Formation: Lessons Learned from Pulp-Capping Materials and the Emerging Roles of Calcium

The long-term use of calcium hydroxide and the recent increase in the use of hydraulic calcium-silicate cements as direct pulp-capping materials provide important clues in terms of how reparative dentin may be induced to form a "biological seal" to protect the underlying pulp tissues. In this review article, we discuss clinical and molecular perspectives of reparative dentin formation based on evidence learned from the use of these pulp-capping materials. We also discuss the emerging role of calcium as an odontoinductive component in these pulp-capping materials.

Effect of Calcium Hydroxide as a Root Canal Dressing Material on Dentin Fracture Strength In Primary Teeth- In Vitro Study

OBJECTIVES

The aim of the present study was to assess the effect of calcium hydroxide as a root canal dressing material on dentin microtensile fracture strength in human primary teeth in vitro.

STUDY DESIGN

Thirty primary anterior teeth with root canals packed with calcium hydroxide were divided into groups of ten and immersed in saline at room temperature for 7, 30 and 90 days. Ten teeth with root canals filled with sterile saline were the control group. Microtensile fracture strength was measured in Mechanical tester Lloyd testing machine.

RESULTS

There was a significant difference (P < 0.05) between the fracture strength of the calcium hydroxide-filled teeth after 90 days (19.1 MPa) compared with the control (35.8 MPa). Dentin microtensile fracture strength of the calcium hydroxide-filled teeth decreased at an average of 0.142 MPa per day.

CONCLUSION

Calcium hydroxide placed in root canals for an extended time had a significantly negative effect on root strength. Long-term success of root canal treatment in primary anterior teeth is estimated as 65% with most of the failures result from trauma recurrence.

CLINICAL RELEVANCE

Our results stress the need to evaluate the pros and cons of root canal treatment compared to extractions of non-vital primary incisors.

Antimicrobial activity of Psidium cattleianum associated with calcium hydroxide against Enterococcus faecalis and Candida albicans: an in vitro study

OBJECTIVE

Evaluate, in vitro, the antimicrobial activity of Psidium cattleianum leaf extracts combined with calcium hydroxide against Enterococcus faecalis and Candida albicans biofilm.

MATERIALS AND METHODS

Dentin specimens obtained from extracted bovine incisors were infected during 14 days with E. faecalis ATCC 29212 and C. albicans ATCC 10231. The specimens were filled with calcium hydroxide pastes prepared with the following vehicles: Psidium cattleianum ethanolic, Psidium cattleianum propylene glycolic, distilled water, and saline as control. After 24 h, 3, 7, and 14 days, the canals were irrigated with sterile saline and dried. Dentin samples were collected from the canals with burs of increasing diameters. To determine the number of colony-forming units (CFU), samples were inoculated onto BHI agar supplemented with yeast extract (0.5%), at 37 °C, for 48 h, in CO₂ enriched atmosphere. Comparisons among the groups for the variation factors were performed by ANOVA and Tukey's test.

RESULTS

Ethanolic and propylene glycolic extracts showed significantly higher antimicrobial activity against E. faecalis (p < 0.01) when compared with distilled water. The ethanolic extract exhibited in 24 h the same antibacterial activity that propylene glycolic extract and distilled water after 7 and 14 days. For C. albicans, all were effective in reducing the number of CFU at all periods.

CONCLUSION

The P. cattleianum ethanolic extract presented the fastest and highest antimicrobial activity against E. faecalis, significantly reducing the microbial load in 24 h. All medications were effective against C. albicans.

CLINICAL RELEVANCE

The antibacterial potential of P. cattleianum and its biological compatibility associated with calcium hydroxide indicate promising applications in the field of dentistry.

In vivo Outcomes of Indirect Pulp Treatment in Primary Posterior Teeth: 6 Months' Follow-up

Background:

Indirect pulp treatment (IPT) is a minimally invasive procedure based on the application of a protective liner on the affected dentin, thereby preserving the pulp vitality.

Aim:

This study aims to evaluate and compare the clinical and radiographic outcomes of IPT when a layer of calcium hydroxide (Dycal), mineral trioxide aggregate (MTA), or Biodentine was placed over the affected dentin in primary molars.

Materials and Methods:

A clinical trial with sample size of 45 primary molars between the age group of 4–9 years, of which 15 teeth were considered, each for Group I (Dycal), Group II (MTA), and Group III (Biodentine). Measurements on digitized radiographs were made at baseline, 3, and 6 months using Corel Draw software.

Results:

One-way ANOVA and post hoc tests indicated a statistically significant difference in dentin thickness (P < 0.05) in all the groups. Within Group I, the thickness of dentin was 0.066 ± 0.009 mm at 3 months and 0.099 ± 0.011 mm at 6 months. In Group II, 0.081 ± 0.010 mm at 3 months and 0.123 ± 0.016 mm at 6 months. In Group III, 0.102 ± 0.021 mm at 3 months and 0.154 ± 0.022 mm at 6 months.

Conclusions:

Clinically, 100% success rate was observed in all the groups whereas radiographically, Biodentine was superior to both the groups.

Demineralized bone matrix used for direct pulp capping in rats

Objectives

To evaluate the wound healing process following direct pulp capping with demineralized bone matrix (DBM) and calcium hydroxide (Ca(OH)₂).

Methods

Fifty 8-weeks-old SPF Wistar male rats were divided into two groups: one was the DBM treated group, and the other was the Ca(OH)₂ treated group. Pulpotomy was performed on the maxillary first molar of one side of each rat, and the another side was left as the blank control. Rats were sacrificed after each observation period (1, 3, 7, 14 and 28 days) and specimen slices were made. Hematoxylin-Eosin (HE) staining was used for observing the changes of pulp tissue, and immunohistochemical staining was used for observing the expression of reparative dentinogenesis-related factors runt transcription factor 2 (Runx2), type I collagen (COL I), osteocalcin (OCN) and dentin sialoprotein (DSP).

Results

Inflammatory cell infiltration (ICI) and pulp tissue disorganization (PTD) could be observed in both the DBM and Ca(OH)₂ groups at all observation periods. The DBM group showed slighter ICI on 1 and 28 days and milder PTD on 28 days, with a significant difference (P<0.05). Reparative dentin formation (RDF) could initially be observed on 14 days postoperatively, and the DBM group showed more regular and thinner RDF with significant differences on 14 and 28 days compared with the Ca(OH)₂ group (P<0.05). In both groups, the expression of Runx2, COL I, DSP and OCN were positive. Generally, the expression of these four factors in the DBM group was stronger than the Ca(OH)₂ group on the same observation periods.

Conclusions

DBM had the ability of inducing odontoblast differentiation and promoting dentinogenesis. DBM could initiate physiologic wound healing in pulp and had the ability to promote reparative dentin formation. Consequently, DBM may be an acceptable alternative for direct pulp capping.

Review suggests direct pulp capping with MTA more effective than calcium hydroxide

Data sourcesPubMed, the Cochrane Library, Embase, and the Web of Knowledge.Study selectionRandomised controlled trials (RCTs) or retrospective non-randomised trials (RNTs) of direct pulp capping in patients comparing mineral trioxide aggregate (MTA) with calcium hydroxide (CH) were considered.Data extraction and synthesisTwo reviewers independently abstracted data. Risk of bias for the RCTs was assessed using the Cochrane risk of bias tool and RNTs were assessed according to the methodological index for non-randomised studies. Different study designs were analysed separately.ResultsThirteen studies were included, ten of which were RCTs. Meta-analysis demonstrated a significantly higher success rate for MTA compared with the CH-capped groups. For RCT studies (2 studies, 405 teeth): OR = 2.26; (95% CI, 1.33-3.85; P = .003) and for RNTs (3 studies - 526 teeth): OR = 2.88; (95% CI, 1.86-4.44; P < .00001). Nine studies (325 teeth) compared the inflammatory response with MTA showing significantly less inflammation compared with CH samples (OR = 4.56; 95% CI, 2.65 7.83; P < .00001). Nine studies (325 teeth) compared dentine bridge formation with a higher percentage of calcified dentin bridge formation in the MTA than CH-capped groups (OR = 3.56; 95% CI, 1.89 6.70; P < .0001).ConclusionsMTA has a higher success rate and results in less pulpal inflammatory response and more predictable hard dentin bridge formation than CH. MTA appears to be a suitable replacement of CH used for direct pulp capping.

Measurement of pH and calcium ions release from different calcium hydroxide pastes at different intervals of time: Atomic spectrophotometric analysis

AIM

To evaluate the effect of different vehicles on pH and release of calcium ions from calcium hydroxide (CH) paste from apical third of root canals.

METHODS

40 single rooted extracted human mandibular premolars were instrumented with RevoS files (MicroMega) up to ISO size 40. The teeth were divided into 4 groups on the basis of vehicle as follows: Group I - calcium hydroxide mixed with 2% chlorhexidine; Group II - calcium hydroxide mixed with propylene glycol; Group III - calcium hydroxide mixed with glycerine; and Control - calcium hydroxide mixed with double distilled water. Each group had two subgroups (n = 5) on the basis of the calcium hydroxide delivery. Subgroup A - calcium hydroxide paste placed with spiral filler (Lentulospiral) subgroup B - calcium hydroxide paste placed with flat wire filler (Paste Inject). pH and calcium ion release was evaluated at 24 h, 48 h, 7th day, 15th day and 30th day using a pH meter and atomic absorption spectrophotometer respectively.

RESULTS

The calcium release from various groups was highest for CH+glycerine (Group III) followed by CH+chlorhexidine (Group I), CH+propylene glycol (Group II) and CH+double distilled water (control). At all the intervals the differences in calcium ion release among the groups were statistically significant (p < 0.05), except on day 7. Delivery technique did not have a significant effect on calcium ion release. Highest pH values were recorded from CH+glycerine group at day 30 for both the delivery systems, however rise in pH from day 1 to day 30 were non-significant in all groups with both delivery systems.

CONCLUSION

Demonstrable changes in calcium ion release occurred from the calcium hydroxide mixed with various vehicles and CH+glycerine group showed the maximum calcium ion release at all intervals and highest pH day 30.

Simvastatin inhibits the expression of inflammatory cytokines and cell adhesion molecules induced by LPS in human dental pulp cells

AIM

To investigate the effect of simvastatin on lipopolysaccharide (LPS)-stimulated inflammatory cytokines, cell adhesion molecules and nuclear factor-κB (NF-κB) transcription factors in human dental pulp cells (HDPCs).

METHODOLOGY

The effect of LPS and simvastatin on human dental pulp cell (HDPCs) viability was measured using a 3-[4, 5-dimethylthiazol-2-yl]-2, 5 diphenyltetrazolium bromide (MTT) assay. The expression of inflammatory cytokines and cell adhesion molecules was evaluated by reverse-transcription polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assay (ELISA) and Western blot analysis. NF-κB transcription factors were evaluated by Western blot analysis. Statistical analysis was performed with analysis of variance (anova).

RESULTS

The viability of cells exposed to different concentrations of E. coli LPS, P. gingivalis LPS and simvastatin was not significantly different compared with that of control cells (P > 0.05). LPS significantly increased interleukin (IL)-1β (P < 0.05) and IL-6 mRNA expression (P < 0.05) and vascular cell adhesion molecule-1 (VCAM-1) (P < 0.05) and intercellular adhesion molecule-1 (ICAM-1) protein expression (P < 0.05) in HDPCs. Treatment with simvastatin significantly attenuated LPS-stimulated production of IL-1β, IL-6, VCAM-1 and ICAM-1 (P < 0.05). Treatment with simvastatin decreased LPS-induced expression of p65 and phosphorylation of IκB and also significantly decreased the phosphorylation of p65 and IκB in the cytoplasm and the level of p65 in the nucleus (P < 0.05).

CONCLUSIONS

Simvastatin has a suppressing effect on LPS-induced inflammatory cytokine, cell adhesion molecules and NF-κB transcription factors in HDPCs. Therefore, simvastatin might be a useful candidate as a pulp-capping agent in vital pulp therapy.

Efficacy of Erbium, Chromium-doped:Yttrium, Scandium, Gallium, and Garnet Laser Irradiation Combined with Resin-based Tricalcium Silicate and Calcium Hydroxide on Direct Pulp Capping: A Randomized Clinical Trial

INTRODUCTION

The purpose of this randomized clinical study was to evaluate the efficiency of erbium, chromium-doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser irradiation combined with a resin-based tricalcium silicate material and calcium hydroxide in direct pulp capping for a 6-month follow-up period.

METHODS

A total of 60 teeth of 60 patients between the ages of 18 and 41 years were recruited for this study. Sixty permanent vital teeth without symptoms and radiographic changes were randomly assigned to the following 4 groups (n = 15): Gr CH, the exposed area was sealed with calcium hydroxide (CH) paste; Gr laser CH, the treated area was sealed with CH paste after Er,Cr:YSGG laser irradiation at an energy level of 0.5 W without water and with 45% air; Gr TheraCal, TheraCal LC (Bisco, Schaumburg, IL) was applied directly to the exposed pulp; and Gr Laser TheraCal, TheraCal LC was applied after irradiation with an Er,Cr:YSGG laser. At the 1-week and 1-, 3-, and 6-month recall examinations, the loss of vitality, spontaneous pain, reactions to thermal stimuli and percussion, and radiographic changes were considered as failure.

RESULTS

The success rates in the CH and TheraCal groups were 73.3% and 66.6%, respectively. These rates did not reveal any significant difference. In both laser groups, success rates were 100%. The Er,Cr:YSGG laser-irradiated TheraCal and Er,Cr:YSGG laser-irradiated CH groups showed statistically higher success rates than the TheraCal and CH groups, respectively.

CONCLUSIONS

Er,Cr:YSGG laser irradiation at 0.5 W without water combined with pulp capping agents can be recommended for direct pulp therapy.

Calcium hydroxide medication in primary molars using different preparations and placement techniques: an in vitro study

AIM

This was to compare the effectiveness of different preparations and delivery techniques of calcium hydroxide paste as an intracanal medicament in primary molar root canals.

METHODS

Extracted lower primary second molars roots (72) were randomly assigned to the four experimental groups. After complete root canal preparation with TF rotary nickel titanium up to .06/30 file, a mix of calcium hydroxide/ distilled water was delivered by lentulo spiral (group 1) or a syringe (group 2). UltraCal(®) XS was placed by lentulo spiral (group 3) and a syringe (group 4). Digital radiographs were taken in both buccal and proximal directions before and after calcium hydroxide placement to evaluate the quality of filling. The mean percentages of filled calcium hydroxide area by subtracted digital radiograph, and the quality assessments between four experimental groups, were compared by using Two-way ANOVA and Fisher's exact test respectively. A p value of less than 0.05 was considered statistical significance.

RESULTS

There was no statistically significant difference in the mean percentages of the filled calcium hydroxide area among different preparations and delivery techniques (p ≥ 0.05). The syringe technique had statistically significant fewer of air inclusions than when using the lentulo spiral with the mix of calcium hydroxide group (p < 0.05). The completeness of obturation and the quality of filling at apical part were not different among groups (p ≥ 0.05).

CONCLUSION

Syringe technique was a simpler handling method that presented similar filling quality but fewer porosities than lentulo spiral technique in primary molar root canals.

An In-vitro Evaluation of the pH Change Through Root Dentin Using Different Calcium Hydroxide Preparations as an Intracanal Medicament

CONTEXT

The aim of the study was to evaluate the pH variation in the surrounding medium after the use of two different vehicles of Calcium hydroxide - Saline (aqueous), Propylene glycol (viscous) and Calcium hydroxide containing guttapercha points over a period of 7 days as an intracanal medicament.

MATERIALS AND METHODS

Sixty single rooted premolars were decoronated at the cementoenamel junction and cleaned and shaped uptil size 40 master apical file. External defects were made on the mesial surface in the coronal third of the roots and divided randomly into 4 groups. One control and three experimental. In the control - group I the root canals were left empty. In the experimental groups - group II was filled with Ca(OH)2 + saline, group III was filled with Ca(OH)2 + propylene glycol and group IV the root canals were filled with Calcium hydroxide points. The coronal accesses were sealed with 3mm of Cavit G and all the surfaces of the root except the defect were covered with 3 coats at Nail varnish. The samples were then placed in air tight vials containing 2ml of distilled water. The vials were kept in an incubator and the pH of the surrounding medium was measured using a digital pH meter after 1,3,5 and 7 days respectively.

RESULTS

A statistically significant difference (p<0.05) existed between the experimental groups over the observation period. At day 1, a high pH was recorded by the calcium hydroxide points and saline groups and a lower pH by the propylene group. At day's 3 and 5, the maximum pH was recorded by the propylene glycol group and minimum by the calcium hydroxide points and saline groups. At day 7, the pH of all the groups had dropped, with propylene glycol recording the maximum pH followed by saline and lastly calcium hydroxide points.

CONCLUSION

Within the limitations of this study, a viscous vehicle is better among other vehicles, calcium hydroxide paste of propylene glycol provided the highest 7 days release of hydroxyl ions.

Direct pulp capping in an immature incisor using a new bioactive material

Preservation of the pulp in a traumatized immature fractured incisor tooth is of prime importance in order to achieve apexogenesis, a natural apical closure. The main factor influencing this is pulpal protection by a bioactive material proving optimum marginal seal in preventing any microleakage. This case report presents an 8-year-old female diagnosed with Ellis Class 3 fracture of immature tooth 11 involving the mesial pulp horn. Under rubber dam isolation, a partial pulpotomy was performed and the pulp was sealed using a new bioactive material BIODENTINE to stimulate apexogenesis, dentine replacement and pulp protection. The fractured segment was reattached for optimum esthetics, which was a concern for the patient. The patient was followed-up for 1, 3, 6 and 12 months, which revealed continued apical closure and maintenance of pulp vitality. The patient remained asymptomatic. This case report provides evidence for the potential use of Biodentine as an effective pulp capping material in the future.

Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part I. In vitro studies

The goal of endodontic treatment is the prevention and control of pulpal and periradicular infections. Calcium hydroxide (Ca(OH)2) has been widely used in endodontics as an intracanal medicament to eliminate the remaining microorganisms after chemomechanical preparation. The purpose of this article is to review the antimicrobial properties of Ca(OH)2 as an intracanal medicament in root canal treatment. The first part of this review details the characteristics of Ca(OH)2 and summarizes the results of in vitro studies related to its antimicrobial effect. The antimicrobial effect of Ca(OH)2 results from the release of hydroxyl ions when it comes into contact with aqueous fluids. Ca(OH)2 has a wide range of antimicrobial effects against common endodontic pathogens, but is less effective against Enterococcus faecalis and Candida albicans. The addition of vehicles or other agents might contribute to the antimicrobial effect of Ca(OH)2.

Efficacy of ethylene-diamine-tetra-acetic acid associated with chlorhexidine on intracanal medication removal: a scanning electron microscopy study

The aim of this study was to evaluate the effectiveness of 17% ethylene-diamine-tetra-acetic acid (EDTA) used alone or associated with 2% chlorhexidine gel (CHX) on intracanal medications (ICM) removal. Sixty single-rooted human teeth with fully formed apex were selected. The cervical and middle thirds of each canal were prepared with Gates Glidden drills and rotary files. The apical third was shaped with hand files. The specimens were randomly divided into two groups depending on the ICM used after instrumentation: calcium hydroxide Ca(OH)(2) +CHX or Ca(OH)(2) +sterile saline (SS). After seven days, each group was divided into subgroups according to the protocol used for ICM removal: instrumentation and irrigation either with EDTA, CHX+EDTA, or SS (control groups). All specimens were sectioned and processed for observation of the apical thirds by using scanning electron microscopy. Two calibrated evaluators attributed scores to each specimen. The differences between the protocols for ICM removal were analyzed with Kruskal-Wallis and Mann-Whitney U tests. Friedman and Wilcoxon signed rank tests were used for comparison between the score of debris obtained in each root canal third. Remains of Ca(OH)(2) were found in all specimens independently of the protocol and ICM used (P > 0.05). Seventeen percent EDTA showed the best results in removing ICM when used alone (P < 0.05), particularly in those associated with CHX. It was concluded that the chelating agent 17% EDTA significantly improved the removal of ICM when used alone. Furthermore, the type of the vehicle associated with Ca(OH)(2) also plays a role in the ICM removal.

Analysis of the carbonatation process of nanosized Ca(OH)2 particles synthesized by exchange ion process

Calcium hydroxide nanoparticles in hydro-alcoholic dispersion are introduced as an effective conservation material for carbonatic substrates, thanks to their promising carbonation efficacy in ambient air. However, the current methods to synthesize such dispersions are characterized by some drawbacks that strongly limit applications. The aim of this work is to investigate structure, morphology and carbonatation efficacy of calcium hydroxide nanoparticles in aqueous suspension, produced by our alternative and original method of synthesis, based on the use of an ion exchange resin. Actually, the method allows to produce pure, nanosized and reactive Ca(OH)2 particles, operating at room temperature, without intermediate steps to eliminate undesired compounds, drastically reducing the time, and with a potential ability to be easily scaled up to provide larger amounts of nanoparticles. By X-ray diffraction techniques, we have investigated reactivity of the synthesized nanoparticles, in relation to the carbonatation process in air, by varying the suspension concentration. Preliminary results on the kinetics of the carbonatation process are presented too. Morphological analysis, performed by transmission electron microscopy, shows both hexagonal particles, often quarries, of side dimensions less than 100 nm, and spherical particles (<50 nm).

A new approach to facilitate apexogenesis using soft tissue diode laser

Traumatic injuries occur commonly in children and adolescents and the prevalence of such injuries has increased over the last decade. Such injuries may result in pulpal exposure, which can endanger tooth vitality. Therefore, the treatment for such injuries should be carefully planned so as to preserve the pulp vitality. Teeth with immature roots pose a great challenge for the clinician and procedures like pulpotomy may prove effective as a treatment strategy. Such procedure may ensure continued root development and apexogenesis. Lasers have varied applications in the dental practice such as oral surgical procedures, cavity preparation, disinfection etc. This article is a case report on the use of diode laser for pulpotomy in a young permanent tooth with traumatically exposed pulp in an 8-year-old male.

A Survey of Standard Protocols for Endodontic Treatment in North of KSA

The objective of this study was to collect information regarding methods, materials, and attitudes employed during the endodontic treatment by dentists in north of Saudi Arabia. A questionnaire was designed and distributed among 300 dentists in north of Saudi Arabia to collect the data about the standard protocols of endodontic treatment. The collected data was analyzed by using the SPSS 10 computer software. Out of a total of 300 surveyed dentists, the 66% response rate showed that this study was true representation of the endodontic treatment performed by the dentists in north of Saudi Arabia. 152 (76%) were general dentists and 48 (24%) were endodontists. 18 (9%) were using rubber dam as the method of isolation during endodontic treatment. 173 (86.5%) were using only measurement radiographs for working length determination and 27 (13.5%) were using both electronic apex locator and measurement radiographs. 95 (47.5%) of the respondents were using standardized technique and 25 (12.5%) were using step-down as a root canal preparation technique. 127 (63.5%) of the respondents were using lateral condensation technique, with gutta percha points for root canal obturation.