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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 12  »  Periapical lesions accidentally filled with calcium hydroxide
Periapical lesions accidentally filled with calcium hydroxide
Discussion - References.

It has been demonstrated that treatment with calcium hydroxide as an interim dressing in the presence of large and chronic periapical lesions can create an environment more favourable to healing and encourage osseous repair (Cvek 1972, Heithersay 1975, Vernieks & Messer 1978, Sahli 1988, Caliskan & Sen 1996). Nonetheless, despite the acknowledgement of calcium hydroxide as one of the most effective antimicrobial dressings during endodontic therapy, its antibacterial activity remains controversial and it is not clear whether the benefits of this substance are based solely upon superior antibacterial activity (Siqueira & Lopes 1999). Extension of the material beyond the apex has, therefore, been advocated by some to benefit from:
  1. anti-inflammatory activity, neutralization of acid products, activation of the alkaline phosphatase and antibacterial action (Souza et al. 1989);
  2. destruction of the epithelium thereby allowing the connective tissue invagination into the lesion (Sahli 1988).
The present evaluation was undertaken after we encountered an alkaline soft tissue burn due to a severe overextension into the periradicular tissues (De Bruyne et al. 2000). In order to evaluate the effect of known excessive overextensions of calcium hydroxide (half and more of the lesion filled) on the healing and periradicular repair of large periapical lesions, the clinical records of the patients attending our clinic with apical periodontitis during the last 10 years were consulted. Of the 11 case histories found with calcium hydroxide overextensions, nine were associated with clinical symptoms of swelling and pain lasting for at least 2–4 days after calcium hydroxide placement. Despite these flare-ups, all cases showed successful periradicular repair. Repair was associated with complete resorption of the extruded paste and ultimate periapical healing in more than half of the cases in the present study. In five cases, however, complete resorption of the paste (Reogan-Rapid) did not occur, although the periradicular and peri-extrusion radiolucency disappeared. A possible explanation for the complete resorption of Calxyl paste may be that the paste does not contain barium sulphate (which is added to calcium hydroxide pastes to improve radiopacity), whereas Reogan-Rapid does (Fava & Saunders 1999). Furthermore, a general finding was that in the present cases of extensive calcium hydroxide overextension, repair took more than 6 months to be complete. This finding confirms the findings of Vernieks & Messer (1978) who suggested that extrusion of calcium hydroxide beyond the apex may be a cause for the lack of early healing of periapical lesions. In this respect, there remains contradiction with other investigators who have advocated that direct contact between calcium hydroxide and periapical tissues is beneficial for osseoinductive reasons (Ghose et al. 1987, Rotstein et al. 1990). Finally, the present data confirm our previous conclusion on damage of the gingival and mucosal tissues induced by alkaline burn (De Bruyne et al. 2000), that as long as there is no intimate and prolonged contact of calcium hydroxide paste with soft tissues, reactions remain mild and are of transient nature.


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