Calcium hydroxide, a widely used intracanal medicament, is known to exert an antimicrobial effect and to degrade bacterial-derived lipopolysaccharides. However, little is known about the effect of Ca(OH)(2) on endogenous inflammatory mediators such as interleukin-1 alpha (IL-1 alpha), tumor necrosis factor-alpha (TNF-alpha), and calcitonin gene-related peptide (CGRP). This is an important gap in knowledge because these inflammatory mediators play an important role in mediating the pathogenesis of periradicular periodontitis. We tested the hypothesis that Ca(OH)(2) denatures IL-1 alpha, TNF-alpha, and CGRP. Human IL-1 alpha (0.125 ng/mL), TNF-alpha (0.2 ng/mL), and CGRP (0.25 ng/mL) were incubated with Ca(OH)(2) (0.035 mg/mL) for 1-7 days. At the end of the incubation period, the pH of the samples was neutralized, and the concentrations of the mediators were measured by immunoassays. Data were analyzed with one-way analysis of variance and Bonferroni multiple comparison tests. The results indicate that Ca(OH)(2) denatures IL-1 alpha, TNF-alpha, and CGRP by 50%-100% during the testing periods (P < .001). We concluded that denaturation of these proinflammatory mediators is a potential mechanism by which Ca(OH)(2) contributes to the resolution of periradicular periodontitis.
"This could be attributed to the continuous release of hydroxyl and calcium ions with the continuous ionic dissociation of the tested calcium hydroxide formulations and its antiinflammatory action. These findings were in agreement with the results of a previous study (Khan et al., 2008) and in disagreement with another study (Filho et al., 2002) which concluded that all calcium formulations causing an inflammatory response. "
"Several studies have demonstrated that after placement of calcium hydroxide in the root canal system, the hydroxyl ions diffuse through the dentinal tubules to the outer surface of the root.43–44 On the basis of these reports, it is possible that calcium hydroxide exerts an immunomodulatory effect by local denaturation of inflammatory mediators, possibly via alkaline hydrolysis of amide bonds45 or denaturation of some proinflammatory mediators.46 "
[Show abstract][Hide abstract] ABSTRACT: To develop a mature biofilm of Enterococcus faecalis inside the root canal system and to test its susceptibility to some antimicrobial medications in vitro.
Single rooted premolars were mechanically enlarged, sterilized, and then infected with a clinical isolate of E. faecalis. Biofilm formation and maturation was monitored using SEM. Biofilm bacteria were exposed to Amoxicillin+clavulanate, Ciprofloxacin, Clindamycin, Doxycycline, and calcium hydroxide as intracanal medications for 1 week. Finally bacterial samples were collected, and colony-forming units were enumerated.
SEM examination confirmed the formation of a mature biofilm at the end of the incubation period. All the chemotherapeutic agents used were significantly better than Calcium hydroxide in elimination of biofilm bacteria. The antimicrobial effect of Amoxicillin + clavulanate, Ciprofloxacin and Clindamycin was significantly better than Doxycycline (P=.05). However the difference in the antimicrobial effectiveness among them was statistically non-significant (P=.05).
The method used for bacterial biofilm development and maturation is reliable and can be used to assess the anti bacterial potential of endodontic materials. Also, the local application of antibacterial agents can be beneficial in resistant cases of apical periodontitis but only after careful culture and sensitivity testing to choose the appropriate agent for the existing flora.
"Furthermore, calcium hydroxide has favorable effects on the healing of periradicular lesion by increasing the pH of the periapical environment and by providing calcium ion for the repair process . Also, calcium hydroxide has denaturating effect on proinflammatory mediators such as IL1 and TNF . "
[Show abstract][Hide abstract] ABSTRACT: Dens invagination (DI) is a developmental abnormality of teeth which frequently results in a complex internal anatomy of the root canal system. DI type 3 is an anomaly characterized by infolding of enamel and dentin extending into the root apex. This may present difficulties when forming a diagnosis and treatment plan. Many treatment modalities have been presented in case reports for DI type 3, but there is insufficient evidence to recommend a therapy. This case report presents the successful nonsurgical root canal treatment of a maxillary canine with an open apex DI type 3, necrotic pulp, and an associated large periradicular lesion.
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