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2. INTRODUCTION
 Intracanal medicaments have
traditionally been integral to root
canal treatment.
 Calcium hydroxide is highly
recommended and widely accepted.
 Complete removal of calcium
hydroxide is difficult (Guignes et al
1991, Margelos et al 1997, Lambrianidis
1999, kim & kim 2002 ).
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3. AIM
This study was conducted to determine the
influence of the calcium hydroxide intracanal
medication on the apical sealing ability of root canal
fillings with zinc oxide - eugenol sealer and AH plus
sealer.
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4. MATERIALS & METHODS
30 extracted human mandibular premolars.
Access cavity prepared, a 10 size K-file introduced
into the canals.
Working length determined 1mm short of apical
foramen.
Coronal 1/3rd flared with size 4-2 gates Glidden
drills.
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5. Root canals prepared and enlarged using K-files up
to size 40 master apical file.
Proprietary root canal conditioning agent Glyde
(Dentsply) and 3% sodium hypochlorite (Vensons India)
used and a final rinse with distilled water.
Calcium hydroxide paste made by mixing calcium
oxide powder (Dental products of India Ltd.,) with distilled
water (Powder to Liquid ratio 1:1).
Canals dried with paper points .
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6. Teeth randomly divided into two groups
Group I
(Experimental Group – 20 teeth) - Calcium hydroxide
placed in the canal.
Group II
(Control Group – 10 teeth) - No medication placed.
The access cavities of all teeth in Group I (Exp. Group)
sealed with cotton and cavit & stored at 37°C and 100%
relative humidity for 7 days.
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7. Intracanal medication removed after 7 days with
K-files of sizes upto master apical file size with
copious irrigation with distilled water.
After the canals were dried with paper points, teeth
from each group subdivided into two subgroups.
Then all the canals obturated using cold lateral
condensation method.
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8. Sub-Group A (10teeth) : All the
teeth obturated using gutta-percha
and zinc oxide eugenol sealer (Dental
Group I Products of India Ltd.,)
(Exp. Group)
Sub-Group B (10teeth) : All the teeth
obturated using gutta-percha and AH
plus sealer (Dentsply ;Maillefer;USA.)
Sub-Group C (5 teeth) : All the teeth
obturated using gutta-percha and
zinc oxide eugenol sealer (Dental
Group II Products of India Ltd.,)
(Control Group)
Sub-Group D (5 teeth) : All the teeth
obturated using gutta-percha and AH
plus sealer (Dentsply ;Maillefer;USA.)
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9. DYE LEAKAGE TEST
Access cavities filled with glass-ionomer cement
(Ketac-molar, 3M ESPE) .
All specimens, coated with nail varnish except 1mm
around the apex.
Apical 3-mm of each root dipped in India ink (Camelin
Ltd., Mumbai) and incubated at 37°C and 100%
humidity for 14 days.
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10. EVALUATION OF APICAL LEAKAGE
All the specimens sectioned horizontally at 1, 2, 3, 4
& 5mm from the root apex with a universal tool
milling machine (Deckel, Germany) .
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11. Linear measurements of apical leakage recorded with
a stereomicroscope (Nikon SMZ – U, Japan, 20X Mag) to
evaluate the dye penetration depth.
The number of specimens with leakage
was counted at each section level.
Statistical analysis performed using chi-squared test.
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12. RESULTS
Number of specimens with leakage at each level
LEVEL FROM THE APEX
GROUPS NO (MM)
1 2 3 4 5
Sub-Group A -
(Ca(OH)2 + ZnOE 10 8 6 4 3 1
Group I
(Exp. Sealer)
Group) Sub-Group B -
(Ca(OH)2 + AH Plus 10 2 1 1 0 0
Sealer)
Sub-Group C - A
Group II 5 3 2 0 0 0
(ZnOE Sealer)
(Control
Group) Sub-Group D - B (AH
5 1 0 0 0 0
Plus Sealer)
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13.  Specimens in Sub-Group A (Exp.Grp.) showed
significantly more dye leakage (P<0.001) than Sub-Group
B (Exp. Grp.).
5MM LEVEL SPECIMEN 5MM LEVEL SPECIMEN
FROM GROUP A FROM GROUP B
 Specimens in Sub-Group A (Exp.Grp.) had
significant dye leakage (P<0.001) than the
control group.
2MM LEVEL SPECIMEN FROM GROUP A
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14.  Specimens in Sub-Group B (Exp.Grp.) showed
more dye leakage at 1,2 & 3mm level than Sub-Group
D (Control Group). But not to a statistically significant
level.
3MM LEVEL SPECIMEN 3MM LEVEL SPECIMEN
FROM GROUP B FROM GROUP D
 In the control group at 1mm and 2mm level
specimens obturated with zinc oxide eugenol sealer
showed more dye leakage than
AH plus group.
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2MM LEVEL SPECIMEN FROM GROUP C
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15. DISCUSSION
Calcium hydroxide medicated root canals obturated
using zinc oxide eugenol sealers showed more apical
leakage.
 Calcium hydroxide+eugenol compound =
calcium eugenolate.
 Interaction between calcium hydroxide and zinc
oxide eugenol sealers produce a rapid setting
reaction.
 Calcium hydroxide medicated root canals obturated
using AH plus sealer showed less leakage than all
groups, except control group: sub-group D (less
significant). www.indiandentalacademy.co
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16.  calcium hydroxide remnants, especially
at the apical region may adversely affect
the long term prognosis of root canal
therapy.
Future research has to be done to reduce
side effects and optimize the benefits of
calcium hydroxide.
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17. CONCLUSION
Under the condition of this study,
calcium hydroxide intra canal medication
increased apical leakage of root canal fillings
with both ZOE and AH Plus Cement Sealers.
However, canals obturated with ZOE
sealer had more leakage.
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18. ACKNOWLEDGEMENT
Dr. Arathi G, Professor,
Dr Lakshmi Balaji , Reader,
Dr Mathan Rajan , Sr Lecturer,
Dept. of Conservative Dentistry & Endodontics,
Sri Ramachandra Dental College,
Chennai.
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