Some studies that suggest that alkaline materials may degrade the strength of dentine, while other studies have shown little deleterious effects. As the effects of SH are time- and concentration-dependent, it is advisable to use higher concentrations of SH when pulp tissue is present in the canal as determined by a diagnosis of pulpitis. For teeth with a diagnosis of necrosis, and for pulpless or previously root filled teeth, there is no requirement for the tissue-dissolving capabilities of SH. In terms of the use of CH and MTA, the long-term dressing of immature teeth does not weaken teeth, since more recent and better designed studies show no weakening of teeth over time, unlike what was seen in earlier in vitro studies which had experimental design problems. This highlights the difficulty of translating the findings of in vitro studies into clinical practice

Most of the times Endodontic infections are due to bacterial inhabitation. Bacteria tend to release various endotoxins, which will cause the acidic environment and bone degradation due to increased osteoclastic activity. Especially, where the pulpal infections affect the periradicular tissues the activity is more severe. So, highly alkaline materials are adivsed to be used to decrease the osteoclastic activation, inactivate the bacteria and its contents and also promote the favourable environment for healing. So, most Endodontic materials are formulated to be alkaline.