INVESTIGACIÓN CLÍNICA CASO n°13 DIFUSIÓN APICAL DEL HIDRÓXIDO DE CALCIO EN UN ESTUDIO IN VITRO LIZETT CASTELLANOS COSANO MASTER O.I.A Y PACIENTES ESPECIALES

INTRODUCCIÓN Resolución de la lesión periapical Bacterias causan lesión periapical Tratamiento Endodóncico Resolución de la lesión periapical INTRODUCCIÓN Consequently, the bacteria responsible for the failure of endodontic therapy may be those colonizing the periapical tissues and external surface of the root, where nonsurgical endodontic therapy cannot affect them. Failure of the lesion to resolve may therefore be due not to inadequate intraradicular endodontic therapy, but rather to an inability to address the extraradicular cause of the disease. Nevertheless, endodontic treatment of teeth with periapical lesions is less successful than treatment of teeth with no lesion present (1). Because bacteria are the cause of periapical disease (2), it is logical that failure to eradicate these bacteria may cause persistence of the lesion.

CaOH2 ELEVADO pH Formación tejidos duros Liberación de iones hidroxilo Hidroliza la parte lipídica de los LPS bacterianos Elevación del pH local Curación del tejido periodontal Formación tejidos duros Puente dentinario

Eficiencia y eficacia del Ca(OH)2 Elevación del pH del tejido Rapidez de la difusión CA(OH)2 IS ABLE TO MAINTAIN AN INCREASED TISSUE PH OVER A LONG TIME BECAUSE OF THE SLOW RELEASE OF HYDROXYL IONS .

Recently, researchers have found that Enterococcus faecalis, the most commonly isolated bacterial species in failed root canal procedures, appears to have the ability to remain viable in dentinal tubules, where Ca(OH)2 may not reach them despite extended exposure time. Because Ca(OH)2 kills by the effect of hydroxyl ions, its efficacy depends on the availability of those ions in solution, which in turn depends on the vehicle in which the Ca(OH)2 is carried. This relation has been demonstrated by the variable effectiveness of Ca(OH)2- containing mixtures against this bacterium. Analogously, the effectiveness of Ca(OH)2-containing mixtures against microorganisms in the periapical tissues should depend on the efficiency with which the intracanal medicament is able to diffuse from the root canal. HIDROXILO

OBJETIVOS The purpose of this study was to evaluate the apical diffusion of three Ca(OH)2 medicaments: (1) a Ca(OH)2 and methylcellulose preparation (PD); (2) a 10% aqueous suspension of Ca(OH)2 in distilled water; and (3) a thick mixture of Ca(OH)2 in distilled water with a viscosity similar to that of PD, through four apical aperture sizes, Using simulated root canals in an in vitro agar model.

MATERIAL Y MÉTODOS

95 ml filter-sterilized distilled water (dH2O 120 pipetas en representación de dientes unirradiculares con formación completa del ápice Ca(OH)2 and methylcellulose preparation Pulpdent (PD) 10 pipetas con una preparación final de 15 10 pipetas con una preparación final de 25 10 pipetas con una preparación final de 40 10 pipetas con una preparación final de 80 a 10% Ca(OH)2 suspension (10 g of USP Ca(OH)2 in 100 ml distilled water) 91% Ca(OH)2 paste (5 g USP Ca(OH)2 in 5.5 ml distilled water) Agar solutions, 100 ml 95 ml filter-sterilized distilled water (dH2O and 1.5 g Bacto Agar for a 1.5% final concentration Were sterilized for 20 minutes at 120°C, then placed into a 50°C water bath to prevent the agar from congealing.

RESULTADOS

No color, pH, or Ca ion change from the reserved broth specimen was noted for any negative control specimen. Mediciones del pH

10% disolution Ca(OH)2 MEDICIÓN DE IONES Ca 2++ Ca(OH)2 and PD DIFUSIÓN IONES Ca 2++ Paste Ca(OH)2 Ca(OH)2 and PD 10% disolution Ca(OH)2

MAYOR [ Ca ] Y AUMENTO del pH MAYOR APERTURA (40 y 80) MAYOR [ Ca ] Y AUMENTO del pH