Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

Calcium hydroxide
Calcium hydroxide has many of the properties of an ideal medica-
ment. A non-setting paste of calcium hydroxide may either be made
by mixing a powder form and sterile water, or purchased as a 
commercial product. It has the following properties:
• Strongly alkaline
• Antimicrobial and antibacterial
• Has low solubility
• Controls seepage of inflammatory exudates
• Induces calcific barrier formation
Iodine compounds
Most organisms are susceptible to calcium hydroxide, but this 
material is not always effective in teeth of complex root morphology
in which complete filling of lateral canals cannot be guaranteed. In
addition, some organisms, and particularly those implicated in re-
treatment cases, such as Enterococcus faecalis, are resistant to calcium
hydroxide. They are, however, susceptible to iodine-containing com-
pounds such as iodine potassium iodide. The presence of a smear
layer inhibits penetration, hence the rationale for removal of the
smear layer before placement of the inter-appointment medicament.
Iodine-containing compounds have good penetration effects, and 
will diffuse into dentinal tubules and lateral canals, but they are 
also short-lasting. It is therefore considered that a mixture of calcium
hydroxide and 5% iodine potassium iodide is an appropriate inter-
appointment medicament in re-treatment cases.
Steroid–antibiotic compounds
Commercial combinations of a steroid with an antibiotic are avail-
able and are used by some practitioners to alleviate the symptoms of
an acute or terminal pulpitis. The steroid component suppresses the
inflammatory response while the antibiotic addresses the microbial
infection. However, such products should not be used as an altern-
ative to meticulous cleaning and shaping procedures.
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Chapter 3
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Principles of endodontics