Ca(OH)2 contraindicated to be used on the deciduous Dentition as it effect on the process of resorption.

Nevertheless, some authors said that you could use it in young primary teeth; the problem is when the primary is next to gift space to permanent... in resorption process. I would like to hear opinion of other colleagues.

Thank you and best regards.

Few studies supported the use of calcium hydroxide in deciduous dentition.

Evaluation of a calcium hydroxide/iodoform paste (Vitapex) in root canal therapy for primary teeth.-Nurko C, Garcia-Godoy F; The Journal of Clinical Pediatric Dentistry [1999, 23(4):289-294]

The one-session technique presented in this clinical evaluation is supported in part by the high clinical and radiographic success rate obtained. The principal advantages of the Vitapex paste are that it resorbs from the apical tissues in one week to two months, is apparently harmless to permanent tooth germs, is radiopaque, does not set to a hard mass, and is easily inserted and removed.

Hi Alain,

Calcium Hydroxide can surely be used in primary teeth keeping in mind few of its properties, that is : It has high pH which has an advantage to use (Being bactericidal) but it's rate of resorption is high, that is it resorbs much faster than root of primary teeth. Hence if you use plane Calcium hydroxide to obturate the root canals, after few months during your follow up you may see empty canals!, more over CaOH is less radioopaque, hence it is dificult to appriciate completeness of obturation.Hence calcium hydroxide is usually used as a combination instead of its pure form. Eg: Vitapex/Metapex (CaOH+ Iodoform+oily additives) are considered as near ideal obturating materials for primary teeth.other materials include Maisto paste, Walkahoff Paste, KRI paste etc. Rather research has shown Zinc oxide eugenol resorbs sloweer than root there by interfering with eruption (sometimes)

I agree with the other answers.

You have to put in balance benefits and risks (for the germ). If you need to disinfect and conserve the deciduous tooth, the best way is CaOH2. But in that case, I'd prefer to fill the root canal at the next appointment with ZnO and Eugenol paste. It's action against resorption is already low (time between two appointment) in that way to use it.

Thank you very much for all of you colleagues, every single answer was very helpful.... my best regards.

Great question and discussion, very helpful to get my concepts clear

Thank you Zafar you can share it on social networks for better results and discussion. A pleasure for me to help you. Best regards

If you wish true healing to occur rather than tissue fixation, then calcium hydroxide should be used. The commercial brands are buffered and do not suffer from the caustic nature of calcium hydroxide the way we used to use it. The incidence of resorption is around 20% which is negligible in light of the healing responses and its use can also depend on timing of tooth exfoliation. Take a look at: Ravi GR, Subramanyam RV. Calcium hydroxide-induced resorption of deciduous teeth: A possible explanation. Dent Hypotheses 2012;3:90-4. The better we understand what we are using and not just base our choices on anecdotal evidence, the more of a true profession we will be. Very little is absolute in what we do, and we must be able to integrate science with our clinical tendencies.

Dear Prof. Gutmann, always is pleasure for me count with your comments and advices. Thank you very much one more time and best regards.

El gusto es mio, mi amigo!

I would presume that it could be but for what reason?  Glass ionomers work well in covering pulpal exposures in both deciduous and adult dentitions.  They have been shown to form dentinal bridges in adult teeth and should do the same in deciduous teeth.  And if doing a pulpotomy in a a deciuous tooth the glass ionomer both obliterates the pulp chamber and seals the chamber to allow a composite to be placed until the tooth is normally exfoliated.  I have does these for at least the last 20 years in my private practice and for 8+ years before teaching in academics and in faculty practices.

Thank you Prof. Stanley

Calcium dihydroxide can certainly be used in primary teeth when there is iatrogenic or accidental pulpal exosure, the new glass ionomers are good choice over the CaOH but if these teeth show symptoms or tendens to ankylation then I would extract at once. I personally would question composites in such teeth....but that is the beauty of dentistry that there are many good ways to good results

Thank you Sigurjon for your intervention.... Best regards

I never use ca(OH) alone for primary teeth, as it is not recommended yet in case of direct pulp capping or pulpectomy in primary teeth. I use ca(OH) with idoform (metapex) in obturation of primary teeth. success rate specially for infected canals is very good.

Thank you Gazala for your opinion... best regards.

Hi  doc, Calcium hydroxide in combination with Iodoform is used as an obturating material for primary teeth  in the form of Metapex widely.

As  an agent for direct or indirect pulp capping agent  many still hold apprehensions regards calcium hydroxide as it does have the ability to induce differentiation of osteoclastic cells and hence lead to internal resorption when placed along infected pulplal tissue

Due to the advent of fantastic endodontic instruments pulpotomy in primary teeth is not really an encouraged practice at present. A partial pulpotomy in iatrogenic and traumatic(short time duration) exposures has shown positive results of secondary dentine formation. The idea is calcium hydroxide in contact with uninfected pulp[ should allow osteoblastic activity and hence form reparative dentine.

Although new literature is showing promising results for the use of glass ionomer as pulp capping agent.. it is still not widely practiced and does need further  research evidence...

Another common practice is use of calcium hydroxide paste in infected root canals as a dressing for a visit in primary teeth. This helps to sterilise the root canal and obturation with any other material like meatapex can follow.

Hope this clarifies the topic for you to some extent.

Wish you the very best.

Thank you very much Shoba for your answer... best regards for you.

Its very eficiensy to use ca oh in primary teeth

Chemically, calcium hydroxide is classified as a strong base with a high pH (approximately 12.5–12.8). Its main properties come from the ionic dissociation of Ca2+ and OH) ions and their effect on vital tissues, generating the induction of hard-tissue deposition and being antibacterial. Although some studies have confirmed its efficacy against endodontic bacteria, other studies have questioned it effectiveness. The effectiveness of Ca(OH)2 against bacterial biofilms is uncertain and needs to be further elucidated. It seems that the combinations of Ca(OH)2 with camphorated paramonochlorophenol or CHX have the potential to be used as effective intracanal medicaments for cases in which fungal infection is suspected. Ca(OH)2 inactivates endotoxin, in vitro and in vivo, and appears currently the only clinically effective medicament for inactivation of endotoxin. The inhibitory effect of dentine, hydroxyapatite and remnants of necrotic pulp tissue as well as inflammatory exudate on the antibacterial potential of Ca(OH)2 has been demonstrated. Synergistic effect between Ca(OH)2 and NaOCl as well as between Ca(OH)2 and CHX has been demonstrated. Six-months-to-oneyear contact between Ca(OH)2 and dentine results in reduced flexural strength and lower fracture resistance of dentine. Diffusion of hydroxyl ions through dentine depends on the diameter of dentinal tubules (cervical versus apical), smear layer removal (patency of dentinal tubules) and period of medication. Removing efficacy of Ca(OH)2 paste from the root canal system seems to be

improved by using patency file, combining EDTA and NaOCl with hand instrumentation and the type of vehicle used. In addition, ultrasonic methods are more efficient in removing Ca(OH)2 remnants than passive irrigation. Ca(OH)2 paste is well tolerated by bone and dental pulp tissues. However, its effect on the periodontal tissue is controversial. The biocompatibility of Ca(OH)2-based sealers is controversial and because of their solubility, they do not fulfil all the criteria of an ideal sealer. Furthermore, their antibacterial activity is variable, and their cytotoxicity appears to be milder than for other groups of sealers. Ca(OH)2 is a suitable material for pulp capping and pulpotomy. However, its solubility in fluids is a problem that requires a good coronal seal. Ca(OH)2 has been the material of choice to create a calcified barrier in non-vital open-apex teeth. However, MTA apical barrier technique may replace it. Ca(OH)2 has been successfully used to manage perforations, horizontal root fracture and root resorption.

high alkaline pH of CaH can actually result in stimulation of progenitor cells (pre-odontoclasts) to form odontoclasts or not, also requires to be investigated.

but the main evidence base is CaOH is contraindicated in primary tooth