Many authors recommend the use for dentin reparation, but there are divergences when they talk about, if the Ca(OH)2 only form dentin in contact with the injured pulp or it can induce the formation of dentin too when it is placed in deep cavities near the pulp chamber.
Thank you in advance and best regards.
Hello again Manuel,
Calcium hydroxide works wonders during endodontic therapy. Well, it has been used for decades successfully specially for direct pulp capping and has very good anti bacterial properties primarily because of its alkaline pH.
As far as indirect pulp capping is concerned, some authors recommend its use and state that it stimulates the odontoblasts and some state that it has no such use. Well in literature, I guess most recommend that all the soft dentin must be removed before placement of calcium hydroxide. We must ensure that there is no bacterial contamination in such cases and calcium hydroxide does the job. In fact, cement provides good bactericidal effect on the remaining bacteria and some authors state that it may encourage the formation of secondary dentine. However; controversy still exists.
Once I accidentally did perforation of the furcation area of a lower molar and the intense pain of the patient was only controlled after I placed non-setting calcium hydroxide before going for MTA placement. It works wonders !
Wish you all the best !
and yes, here is something good with many citations ... this might answer your query better.
http://www.aapd.org/assets/1/25/falster3-02.pdf
Querido Dr el criterio del uso del Ca(OH)2 es por la estimulación de la fosfatasa alcalina para formar dentina, independiente del sitio en la dentina que se aplique.
Le dejo algunos artículos que explican más amplio al proceso.
Saludos
http://online.liebertpub.com/doi/abs/10.1089/ten.tea.2009.0054
http://www.sciencedirect.com/science/article/pii/S1079210403001550
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2591.1990.tb00108.x/abstract
Article Review of calcium hydroxide
Querido Dr el criterio del uso del Ca(OH)2 es por la estimulación de la fosfatasa alcalina para formar dentina, independiente del sitio en la dentina que se aplique.
Le dejo algunos artículos que explican más amplio al proceso.
Saludos
http://online.liebertpub.com/doi/abs/10.1089/ten.tea.2009.0054
http://www.sciencedirect.com/science/article/pii/S1079210403001550
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2591.1990.tb00108.x/abstract
Article Review of calcium hydroxide
Querido Dr el criterio del uso del Ca(OH)2 es por la estimulación de la fosfatasa alcalina para formar dentina, independiente del sitio en la dentina que se aplique.
Le dejo algunos artículos que explican más amplio al proceso.
Saludos
http://online.liebertpub.com/doi/abs/10.1089/ten.tea.2009.0054
http://www.sciencedirect.com/science/article/pii/S1079210403001550
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2591.1990.tb00108.x/abstract
Article Review of calcium hydroxide
The properties of Ca(OH)2 as indutor of dentin, does not necessary to be in contact with odontoblasts. As José Reys said, it induces the prodution of Alkaline Phostatase that stimules the prodution of hard tissue.
Tertiary dentin formation takes place only in favourable morphological and functional conditions, represented by presence of odontoblasts and undifferentiated mesenchymal cells which are responsible for dentinogenetic function. The formation rate and histological aspect of tertiary dentin is influenced by material used. Beneath the region of necrosis, cells of underlying pulp tissue differentiate into odontoblasts and elaborate dentin matrix... Researches have shown tertiary dentin formation with calcium hydroxide even in indirect pulp capping but with MTA in case of indirect pulp capping the histological evaluation revealed secondary dentin formation... So it is material dependent and also depends on the age of the patient till the pulp cells are adequately available . Please refer to article by M Monea 2014- histological evaluation of indirect pulp capping procedures...in European Scientific Journal.
eujournal.org>esj>article
Hello, if I get you right the question is "or it can induce the formation of dentin too when it is placed in deep cavities near the pulp chamber." ??
Well I guess it's wide accepted that CaOH is usually resorbed quite fast ... leaving a void space at the Indirect pulp capping interface, probably " recovered" but mechanically seen the weak point for future restoration.
Moreover the availables CaOH products are generally ranged in the lowest resistance groups of all restorative materials... therefore it is generally advised to place a more resistant protective base over the CaOH-capping layer.
Further CaOH anti-bacterial action is time-limited ( pH-related) and it has been largely reported as often providing uncomplete bridging...!
IMO for indirect pulp-capping, as far as the atraumatic decay excavation is respected, there no benefits to place CaOH, a thick mix of ZOP-cement base can better provides long term antibacterial protection and mechanical resistance.... faster and cheaper!
Additional benefits: one step etched &bonded + composite or delayed restoration according to the pulp-outcome and needs.
I'm using copper-salt added ZOP, daily from 8 yrs, with amazing results even in hopeless cases of extreme deep decay lesions..... so far the only problem is that ZOP is generally rejected because it's not an hi-tech material and because of the boring manual mixing procedure.... simply rated as "old school" !!
Who can tells what is wrong when healthy sound dentin is often to be found under a ZOP cemented PFM- crown ( even after more than 20 years) compared with the unfortunately very common "soft & sick" dentin structure of a similar PFM luted with Resin cement and or with Composite Core-build-up ??
In Vivo clinical long-term observations are far more instructive than many in vitro marketing - driven short -time speculations....
Sorry if I may hurt someone's faith in sharing my " adverse reaction " opinion.
Best regards
Hello, if I get you right the question is "or it can induce the formation of dentin too when it is placed in deep cavities near the pulp chamber." ??
Well I guess it's wide accepted that CaOH is usually resorbed quite fast ... leaving a void space at the Indirect pulp capping interface, probably " recovered" but mechanically seen the weak point for future restoration.
Moreover the availables CaOH products are generally ranged in the lowest resistance groups of all restorative materials... therefore it is generally advised to place a more resistant protective base over the CaOH-capping layer.
Further CaOH anti-bacterial action is time-limited ( pH-related) and it has been largely reported as often providing uncomplete bridging...!
IMO for indirect pulp-capping, as far as the atraumatic decay excavation is respected, there no benefits to place CaOH, a thick mix of ZOP-cement base can better provides long term antibacterial protection and mechanical resistance.... faster and cheaper!
Additional benefits: one step etched &bonded + composite or delayed restoration according to the pulp-outcome and needs.
I'm using copper-salt added ZOP, daily from 8 yrs, with amazing results even in hopeless cases of extreme deep decay lesions..... so far the only problem is that ZOP is generally rejected because it's not an hi-tech material and because of the boring manual mixing procedure.... simply rated as "old school" !!
Who can tells what is wrong when healthy sound dentin is often to be found under a ZOP cemented PFM- crown ( even after more than 20 years) compared with the unfortunately very common "soft & sick" dentin structure of a similar PFM luted with Resin cement and or with Composite Core-build-up ??
In Vivo clinical long-term observations are far more instructive than many in vitro marketing - driven short -time speculations....
Sorry if I may hurt someone's faith in sharing my " adverse reaction " opinion.
Best regards
Hello, if I get you right the question is "or it can induce the formation of dentin too when it is placed in deep cavities near the pulp chamber." ??
Well I guess it's wide accepted that CaOH is usually resorbed quite fast ... leaving a void space at the Indirect pulp capping interface, probably " recovered" but mechanically seen the weak point for future restoration.
Moreover the availables CaOH products are generally ranged in the lowest resistance groups of all restorative materials... therefore it is generally advised to place a more resistant protective base over the CaOH-capping layer.
Further CaOH anti-bacterial action is time-limited ( pH-related) and it has been largely reported as often providing uncomplete bridging...!
IMO for indirect pulp-capping, as far as the atraumatic decay excavation is respected, there no benefits to place CaOH, a thick mix of ZOP-cement base can better provides long term antibacterial protection and mechanical resistance.... faster and cheaper!
Additional benefits: one step etched &bonded + composite or delayed restoration according to the pulp-outcome and needs.
I'm using copper-salt added ZOP, daily from 8 yrs, with amazing results even in hopeless cases of extreme deep decay lesions..... so far the only problem is that ZOP is generally rejected because it's not an hi-tech material and because of the boring manual mixing procedure.... simply rated as "old school" !!
Who can tells what is wrong when healthy sound dentin is often to be found under a ZOP cemented PFM- crown ( even after more than 20 years) compared with the unfortunately very common "soft & sick" dentin structure of a similar PFM luted with Resin cement and or with Composite Core-build-up ??
In Vivo clinical long-term observations are far more instructive than many in vitro marketing - driven short -time speculations....
Sorry if I may hurt someone's faith in sharing my " adverse reaction " opinion.
Best regards
Hello, if I get you right the question is "or it can induce the formation of dentin too when it is placed in deep cavities near the pulp chamber." ??
Well I guess it's wide accepted that CaOH is usually resorbed quite fast ... leaving a void space at the Indirect pulp capping interface, probably " recovered" but mechanically seen the weak point for future restoration.
Moreover the availables CaOH products are generally ranged in the lowest resistance groups of all restorative materials... therefore it is generally advised to place a more resistant protective base over the CaOH-capping layer.
Further CaOH anti-bacterial action is time-limited ( pH-related) and it has been largely reported as often providing uncomplete bridging...!
IMO for indirect pulp-capping, as far as the atraumatic decay excavation is respected, there no benefits to place CaOH, a thick mix of ZOP-cement base can better provides long term antibacterial protection and mechanical resistance.... faster and cheaper!
Additional benefits: one step etched &bonded + composite or delayed restoration according to the pulp-outcome and needs.
I'm using copper-salt added ZOP, daily from 8 yrs, with amazing results even in hopeless cases of extreme deep decay lesions..... so far the only problem is that ZOP is generally rejected because it's not an hi-tech material and because of the boring manual mixing procedure.... simply rated as "old school" !!
Who can tells what is wrong when healthy sound dentin is often to be found under a ZOP cemented PFM- crown ( even after more than 20 years) compared with the unfortunately very common "soft & sick" dentin structure of a similar PFM luted with Resin cement and or with Composite Core-build-up ??
In Vivo clinical long-term observations are far more instructive than many in vitro marketing - driven short -time speculations....
Sorry if I may hurt someone's faith in sharing my " adverse reaction " opinion.
Best regards
Dear alain
Calcium Hydroxide (CH) is extensively used for hard tissue formation. The hard tissue formation may be required at a place where pulp has exposed or in deep cavities where pulp has not exposed. Its mode of action to form hard tissue is described as under:
CH dissociates into its constituents ions as Ca and Hydroxyl ions when it comes in contact with aqueous fluids from vital tooth tissues. In exposed pulp situation, it causes coagulative necrosis which converts underlying undiferentiated cells to odntoblasts. The odontonblast deposit the reparative dentin. In deep cavities without pulp exposure, dissociation of Hydroxyl ion helps in strong antibacterial activity and Ca is deposited to protect the underlying pulp.
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