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CALCIUM HYDROXIDE CEMENT

CALCIUM HYDROXIDE CEMENT. 1930 – Herman used Calcium hydroxide in vital pulp exposure. CLASSIFICATION & TYPES. Setting materials used for lining or as base in cavities or as root canal sealers. Strong effect Dycal, Medium effect Life, Renew, Reolit No effect MPC, Hydrex.

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CALCIUM HYDROXIDE CEMENT

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  1. CALCIUM HYDROXIDE CEMENT

  2. 1930 – Herman used Calcium hydroxide in vital pulp exposure.

  3. CLASSIFICATION & TYPES • Setting materials used for lining or as base in cavities or as root canal sealers. Strong effect Dycal, Medium effect Life, Renew, Reolit No effect MPC, Hydrex

  4. Non setting materials used for dressing root canals. • Analar calcium hydroxide, Pulp dent, Hypocal, Proviplast

  5. classified according to the mode of delivery • Dry powdered calcium hydroxide e.g., Analar calcium hydroxide • available as a dry powder • can be used by mixing it with either distilled water, saline, glycerine, local anaesthetic solution, camphorated monochlorophenol.

  6. Single paste system e.g., Life, Prisma VLC – dycal • available as single paste • can be used directly. Prisma VLC dycal utilizes light for the polymerization of the material to set.

  7. Two paste system e.g., Dycal, Hydrex • reaction between calcium and zinc ions and a salicylate chelating agent. • accelerated by presence of H2O.

  8. Root canal sealer. e.g., Sealapex, calcibiotic root canal sealer (CRCS), Apexit, Vitapex, Imbiseal. • the setting time is increased by replacing calcium hydroxide with calcium oxide to allow adequate time for the gutta percha root filling to be condensed. • Liquids e.g., Pulpdent cavity liner, Hydroxyline • aqueous suspensions of calcium hydroxide. • Used as liners.

  9. COMPOSITION Chemically activated calcium hydroxide Base • Glycol salicylate – 40% • Calcium sulphate – 30% • Calcium tungstate or Barium sulphate – 16% • Titanium oxide – 14% Catalyst • Calcium hydroxide – 50% • Zinc oxide – 10% • Zinc stearate – 0.5% • Ethylene toluene sulfonamide – 39.5%

  10. Light activated Calcium hydroxide • Calcium hydroxide • Barium sulphate • UDMA resin • Camphorquinone

  11. PROPERTIES • Compressive strength 7mins – 7.6mPa 24hrs – 8.3mPa • Tensile strength – 1.0mPa • Solubility – 0.4-7.8% • pH – 9.2- 11.7 • Setting time – 2.5 – 5.5mts

  12. Setting mechanism of calcium hydroxide containing materials There are two basic setting mechanisms • Calcium hydroxide reacts with salicylate to form a chelate i.e., amorphous calcium disalicylate. • Resin is activated by light in the wavelength range of 400 – 500nm – Single paste system.

  13. CHEMISTRY • alkaline in nature and has a slightly bitter taste • very slightly soluble in H2O and insoluble in alcohol.

  14. On contact with air it absorbs carbon dioxide, forming carbonate and thereby losing its effectiveness • stored in proper containers that have a tight seal • should be put into an amber colored bottle

  15. MODE OF THERAPEUTIC ACTION • Calcium hydroxide induced mineralization Acc to Binnie 1937 & Mitchell, Shamwalker 1958, -unique potential to induce mineralization

  16. The mechanism by which calcium hydroxide initiates the reparative process is unclear. • rise in pH as a result of hydroxyl ions may initiate or favor mineralization. (Mitchell and Shamwalker 1958). • may act as a local buffer against the acidic reactions produced by inflammatory process (Heitersay, 1975).

  17. material exerts mitogenic & osteogenic effect, the high pH combined with the availability of calcium & hydroxyl ions having an effect on enzymatic pathways and hence mineralization (Torneck et al 1982). • High pH may also activate alkaline phosphatase activity which is postulated to play an important role in hard tissue formation (Messer 1976)

  18. DENTIN BRIDGE • Dentinal bridge is a repair tissue that forms across the pulpal wound.. The repair material appears to be the product of odontoblasts and connective tissue cells. The barrier may not always be complete (Holand et al., 1979)

  19. Two different reaction patterns • Calcium hydroxide mixed with water or saline( pH 12.5) necrosis of any soft tissue contact with including dental pulp.

  20. differentiation of odontoblast like cells subjacent to the necrotic layer is observed and in 20-30 days a dentinal bridge will form under ideal conditions (Mjor et al., Quintessence international 2002).

  21. MANIPULATIVE TECHNIQUES • Dry powder application – • Insufflation –, calcium hydroxide is sprinkled gently over the pulp. • Amalgam carrier with plastic tip – Dry calcium hydroxide powder can be mixed with liquid vehicle into a thick paste

  22. Liquids – • should be applied to a dry cavity • multiple coatings to have an uninterrupted layer. • disintegrate in the saliva, they should be applied only up to the DEJ and not up to the cavosurface margin.

  23. Non setting pastes- • with metallic/plastic instrument • Pastes with greater flow could be used with lentulospirals. • Paste should be spread evenly on the shank and spiral filler is inserted into the canal and wiped around the canal walls

  24. Injection technique – • loaded into the Messings gun, • appropriate sized nozzle and plugger are chosen • Filling the entire canal is accomplished by compressing the paste while slowly withdrawing the needle until it is filled to cervical level. Use cotton pellet and then compress the paste slightly.

  25. chemically activatedcalcium hydroxide pastes • supplied as two paste system. • base paste is usually white in color • catalyst paste is light brown. • Equal pastes are dispersed out on a paper pad and mixed to uniform creamy consistency.

  26. Light activated calcium hydroxide • set only when activated by light.

  27. USES OF CALCIUM HYDROXIDE • As a liner • applied below the restoration in dentin only. • thickness of 2-5μm. Disadvantage colour, which is white and opaque and can be seen through transparent restoration

  28. The three main functions are • Minimizing marginal leakage • Neutralizing acids • Occluding exposed D tubules for pulp protection

  29. As a sub base • Thermal diffusivity is low for calcium hydroxide. • Minimal thickness required for thermal insulation is estimated to be 0.75mm

  30. As an indirect pulp capping agent • dentin nearest to the pulp tissue is left and calcium hydroxide is placed over it and tooth is restored. • Alkaline nature of calcium hydroxide is likely to neutralize the acids formed in carious dentin to prevent further progress of caries.

  31. Direct pulp capping • Undertaken to maintain the vitality of the exposed pulp

  32. intracanal medicament • current intracanal dressing of choice is calcium hydroxide • cannot be categorized as a conventional antiseptic but it does kill bacteria in root canal space

  33. Calcium hydroxide as a sealer • calcium hydroxide must be dissociated into calcium and hydroxyl ions. • an endodontic sealer based on calcium hydroxide must dissolve and the solid consequently lose content.

  34. may dissolve leaving obturation voids. This would ruin the function of sealer because it could disintegrate in the tissue. • have poor cohesive strength.

  35. Weeping canals • Calcium hydroxide is widely used in weeping canals to reduce the seepage of apical fluids into the canal so as to allow placement of satisfactory root filling.

  36. THANK U

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