Elsevier

Journal of Endodontics

Volume 35, Issue 4, April 2009, Pages 475-480
Journal of Endodontics

Review Article
Calcium Hydroxide–Based Root Canal Sealers: A Review

https://doi.org/10.1016/j.joen.2008.11.026Get rights and content

Abstract

The aim of this review was to consider laboratory experiments and clinical studies of calcium hydroxide–based root canal sealers. An extensive search of the endodontic literature was made to identify publications related to calcium hydroxide–based root canal sealers. The articles were assessed for the outcome of laboratory and clinical studies on their biological properties and physical characteristics. Comparative studies with other sealers were also considered. Several studies were evaluated covering different properties of calcium hydroxide–based sealers including physical properties, biocompatibility, leakage, adhesion, solubility, antibacterial properties, and periapical healing effect. Calcium hydroxide–based root canal sealers have a variety of physical and biological properties. Comparative studies reveal their mild cytotoxicity, but their antibacterial effects are variable. Further research is required to establish the tissue healing properties of calcium hydroxide in root canal sealers.

Section snippets

Leakage

The rationale for the addition of calcium hydroxide to root canal sealers is from observations of bases and liners containing the material and their antibacterial and tissue repair abilities. This is exerted via the leaching of calcium and hydroxyl ions to surrounding tissues 16, 17, 18, 19. The role of root canal sealers is to fill gaps; therefore, solubility, leakage, and adhesion are prime concerns. Accordingly, sealers should be insoluble and not disintegrate in fluids. Even though calcium

The Effect of Calcium Hydroxide on Periapical Tissue Healing

Ideal periapical healing after root canal treatment features bone regeneration, resumption of an intact periodontal ligament space, and the deposition of cementum around the root apex.

Calcium hydroxide is effective in the formation of calcific bridges when applied to exposed pulpal tissue (16). When calcium hydroxide comes in contact with water, it releases calcium ions during ionic dissociation. The quantity of free calcium ions determines its potential to induce mineralized tissue (41). Free

The Antimicrobial Effect

The incorporation of antibacterial components in root canal sealers may be an important factor in preventing the regrowth of residual bacteria and controlling bacterial re-entry into the root canal system. The antibacterial effect of calcium hydroxide is based on its ability to release hydroxyl ions and to raise pH 10, 11. The pH of calcium hydroxide paste has been shown to be as high as 12.5 when used for intracanal medicament purposes (11). In an experimental study, the pH of distilled water

Biocompatibility

Root canal sealers and filling materials may be exposed to the periradicular tissue at the apical and lateral foraminae so superior tissue tolerance to sealer is required to minimize local and systemic side effects. The cytotoxicity of sealers has been measured in vitro by cell culture or in vivo in animal studies. Several studies have compared the cytotoxic effects of calcium hydroxide–containing root canal sealers with the other types.

Cell culture tests using either human periodontal ligament

Flow

An acceptable flow within the working time is important for any root canal sealer in order to reach and seal the apical foramen and lateral dentinal wall irregularities. Flow depends on particle size, shear rate, temperature, and time from mixing. It can be measured with either a rheometer or from the diameter of the film of sealer between two glass plates under load (3). Pitt Ford et al (84) reported significant differences in flow between Apexit and Tubliseal EWT, the former being superior in

Conclusion

This review of calcium hydroxide–based root canal sealers shows that these materials do not fulfil all the criteria described by Grossman (5). Most studies are laboratory based or in animal models, which may differ from the clinical situation. The antibacterial effects of calcium hydroxide in sealers are variable. Cytotoxicity appears to be milder than for other groups of sealers. Solubility is a concern, but leakage cannot be linked directly to solubility, with studies reporting the potential

References (100)

  • F. Ozata et al.

    A comparative study of apical leakage of Apexit, Ketac-Endo and Diaket root canal sealers

    J Endod

    (1999)
  • I. Miletic et al.

    Apical leakage of five root canal sealers after one year of storage

    J Endod

    (2002)
  • A. Yucel et al.

    Bacterial penetration after obturation with four different root canal sealers

    J Endod

    (2006)
  • I. Soares et al.

    Periapical tissue response to two calcium hydroxide containing endodontic sealers

    J Endod

    (1990)
  • T. Kawakami et al.

    Fate of 45-labeled calcium hydroxide in a root canal filling paste embedded in rat subcutaneous tissues

    J Endod

    (1987)
  • B. Gettleman et al.

    Adhesion of sealer cements to dentin with and without the smear layer

    J Endod

    (1991)
  • K. Lee et al.

    Adhesion of endodontic sealers to dentin and gutta-percha

    J Endod

    (2002)
  • S. Das

    Effect of certain dental materials on human pulp in tissue culture

    Oral Surg Oral Med Oral Pathol

    (1981)
  • M. Tagger et al.

    Release of calcium and hydroxyl ions from set endodontic sealers containing calcium hydroxide

    J Endod

    (1988)
  • C. Yesilsoy et al.

    A comprehensive tissue toxicity evaluation of established and newer root canal sealers

    Oral Surg Oral Med Oral Pathol

    (1988)
  • R. Holland et al.

    Ability of a new calcium hydroxide root canal filling material to induce hard tissue formation

    J Endod

    (1985)
  • T.M.T. Waltimo et al.

    Clinical performance of 3 endodontic sealers

    Oral Surg Oral Med Oral Pathol Oral Radiol Endod

    (2001)
  • S. Sari et al.

    Sucess rate of Sealapex in root canal treatment for primary teeth: 3-year follow-up

    Oral Surg Oral Med Oral Pathol Oral Radiol Endod

    (2008)
  • T. Gordon et al.

    Influence on pH level of two calcium hydroxide root canal sealers in vitro

    Oral Surg Oral Med Oral Pathol

    (1986)
  • I. Heling et al.

    The antimicrobial effect within dentinal tubules of four root canal sealers

    J Endod

    (1996)
  • Z. Al-Khatib et al.

    The antimicrobial effect of various endodontic sealers

    Oral Surg Oral Med Oral Pathol

    (1990)
  • R. Barkhordar et al.

    Evaluation of antimicrobial activity in vitro of ten root canal sealers on Streptococcus sanguis and Streptococcus mutans

    Oral Surg Oral Med Oral Pathol

    (1989)
  • M. Leonardo et al.

    In vitro evaluation of antimicrobial activity of sealers and pastes used in endodontics

    J Endod

    (2000)
  • A. Mickel et al.

    Antimicrobial activity of endodontic sealers on Enterococcus faecalis

    J Endod

    (2003)
  • K. Markowitz et al.

    Biologic properties of eugenol and zinc oxide-eugenol

    Oral Surg Oral Med Oral Pathol

    (1992)
  • R. Esberard et al.

    pH changes at the surface of root dentin when using root canal sealers containing calcium hydroxide

    J Endod

    (1996)
  • L. Vajrabhaya et al.

    Comparison between Sulphodamine B dye staining and 51Cr-release method in cytotoxicity assay of endodontic sealers

    J Endod

    (1997)
  • O. Zmener et al.

    Biocompatibility of two calcium hydroxide based endodontic sealers: a quantitative study in the subcutaneous connective tissue of the rat

    J Endod

    (1988)
  • A. Mohammad et al.

    Scanning x-ray microanalysis of root canal sealers

    Oral Surg Oral Med Oral Pathol

    (1979)
  • A. Serper et al.

    Comparative neurotoxic effects of root canal filling materials on rat sciatic nerve

    J Endod

    (1998)
  • N. Allan et al.

    Setting times for endodontic sealers under clinical usage and in vitro condition

    J Endod

    (2001)
  • R. Caicedo et al.

    The properties of endodontic sealer cements

    J Endod

    (1988)
  • T. van der Burgt et al.

    Staining patterns in teeth discolored by endodontic sealers

    J Endod

    (1986)
  • M. Davis et al.

    Sealer distribution in coronal dentin

    J Endod

    (2002)
  • J. Parsons et al.

    In vitro longitudinal assessment of coronal discoloration from endodontic selaers

    J Endod

    (2001)
  • J. Kim et al.

    In vitro study of the biocompatibility of newly developed calcium phosphate-based root canal sealers

    J Endod

    (2004)
  • M. Fridland et al.

    MTA solubility: a long-term study

    J Endod

    (2005)
  • M. Torabinejad et al.

    Physical and chemical properties of a new root-end filling material

    J Endod

    (1995)
  • H.W. Roberts et al.

    Mineral trioxide aggregate material use in endodontic treatment: a review of the literature

    Dent Mater

    (2008)
  • R. Fidel et al.

    Adhesion of calcium hydroxide containing root canal sealers

    Braz Dent J

    (1994)
  • D. Ørstavik

    Materials used for root canal obturation: technical, biological and clinical testing

    Endod Topics

    (2005)
  • D. Ørstavik et al.

    Clinical performance of three endodontic sealers

    Endod Dent Traumatol

    (1987)
  • L. Grossman

    Obturation of root canal

  • J. Ingle et al.

    Obturation of the radicular space

  • L. Hendra

    Biocalex—a new approach to endodontia dependent upon biological principles and chemical action only

    J Br Endod Soc

    (1970)

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