Calcium hydroxide There is almost universal agreement that when an intervisit dressing is required, calcium hydroxide is the material of choice, and this is discussed in Part 9. There is far less agreement as to whether such dressings are indicated. Singlevisit endodontics the shaping, cleaning and obturation of the root canals in one appointment remains controversial. Most endodontists would agree that when the tooth under treatment is not infected, for example when performing elective endodontics or treating large exposures of vital pulps, completing treatment in a single visit is advisable. However, Sj gren et al. showed a significant increase in prognosis when infected root canals were dressed with calcium hydroxide for one week before obturation.
Gutmann has suggested that this effect was only apparent because their research employed 1% sodium hypochlorite, whereas the use of a full strength solution would preclude the need for such a dressing.
The wise practitioner would consider which approach best suits his or her style of practice.
Calcium hydroxide is applied with a spiral paste filler (noting the caution given at Part 5, Fig. 20), or a fine-tipped syringe may be used as seen in Figure 14. Care should always be taken not to extrude the material beyond the apical constriction. If this happens, inflammation may result which could take several days to subside. Calcium hydroxide containing points are available from which it is postulated that ions will dissociate into the fluid in the root canal, and which may be better controlled in apical length. However, research supporting this has not yet been reported in the endodontic literature.
A recent addition to the range of intracanal dressing available is the mixture Vitapex, shown at Figure 15. As well as calcium hydroxide, the material contains iodoform. It may be indicated for deep-seated infections of the root canal, such as the upper canine, shown in Part 2, Figure 1, which had resulted in an extra-oral sinus beneath the patient s eye. This closed and the tooth healed following one week s dressing. Extreme care is needed to ensure that this viscous dressing has been fully removed from the canal walls before obturation.