Effect of Various Intracanal Calcium Hydroxide Dressing Materials on pH Changes in Simulated External Root Resorption Defects

Objectives: To evaluate the effect of placement of different CH dressing materials in the root canals on pH changes in simulated external root resorption defects.

Methods: Seventy-five extracted single rooted teeth were decoronated to the length of 14mm. Root canals were prepared with peeso reamers. An external defect of 0.7mm depth and 1.4mm in diameter were made on the root surface, 5 mm from the apex and then assigned into 5 groups with 15 teeth in each group. Group 1: CH+distilled water, Group 2: CH paste, Group 3: Biodentine, Group 4: CH+2% chlorhexidine gel+Zinc oxide, Group 5: Distilled water. The materials were placed in the assigned groups and pH was measured with a microelectrode at 30 minutes, 24 hours, 7 days, 14 days, 21 days, 28 days and 3 months respectively.

Results: Results revealed significant differences in the pH between the groups at all time intervals (p0.05). Group 1 samples showed highest pH at all time intervals when compared with other groups.

Conclusions: Calcium hydroxide and distilled water group maintained high pH at different time intervals in comparison with other groups followed by Biodentine group, calcium hydroxide paste and 2% CHX gel+CH+ZnO in the descending order and the pH could not be sustained by any of the material at the end of 3 months time interval.

References

1. Nopnakeepongsa W, Jantarat J, Surarit R, Smutkeeree A. Assessment of root dentin pH changes in primary and permanent molars with different types of calcium hydroxide intracanal medication. Pediatr Dent J. 2019;29(1):23-9.

2. Kazemipoor M, Tabrizizadeh M, Dastani M, Hakimian R. The effect of retreatment procedure on the pH changes at the surface of root dentin using two different calcium hydroxide pastes. J Conserv Dent. 2012;15(4):346-50.

3. Andreasen J, Jensen J, Steno S, Christensen A. Relationship between calcium hydroxide pH levels in the root canals and periodontal healing after replantation of avulsed teeth. Endod Topics. 2006;14:93-101.

4. Abbott PV. Prevention and management of external inflammatory resorption following trauma to teeth. Aust Dent J. 2016;61(S1):82-94.

5. Chamberlain TM, Kirkpatrick TC, Rutledge RE. pH changes in external root surface cavities after calcium hydroxide is placed at 1, 3 and 5 mm short of the radiographic apex. Dent Traumatol. 2009;25(5):470-4.

6. Lima TFR, Ascendino JF, Cavalcante IO, D´assunção FLC, Salazar-Silva JR, Silva EJNLD et al. Influence of chlorhexidine and zinc oxide in calcium hydroxide pastes on pH changes in external root surface. Braz Oral Res. 2019;33:e005. doi: 10.1590/1807-3107bor-2019.vol33.0005.

7. Heward S, Sedgley CM. Effects of intracanal mineral trioxide aggregate and calcium hydroxide during four weeks on pH changes in simulated root surface resorption defects: an in vitro study using matched pairs of human teeth. J Endod. 2011;37(1):40-4.

8. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review—part I: chemical, physical, and antibacterial properties. J Endod. 2010;36(1):16-27.

9. Sarkar NK, Caicedo R, Ritwik P, Moiseyeva R, Kawashima I. Physicochemical basis of the biologic properties of mineral trioxide aggregate. J Endod. 2005;31(2):97-100.

10. Sumer M, Muglali M, Bodrumlu E, Guvenc T. Reactions of connective tissue to amalgam, intermediate restorative material, mineral trioxide aggregate, and mineral trioxide aggregate mixed with chlorhexidine. J Endod. 2006;32(11):1094-6.

11. Hansen SW, Marshall JG, Sedgley CM. Comparison of intracanal endosequence root repair material and ProRoot MTA to induce pH changes in simulated root resorption defects over 4 weeks in matched pairs of human teeth. J Endod. 2011;37(4):502-6.

12. Malkondu Ö, KarapinarKazandağ M, Kazazoğlu E. A review on biodentine, a contemporary dentine replacement and repair material. Biomed Res Int. 2014;160951. doi: 10.1155/2014/160951.

13. Soares AJ, Lima TF, Nagata JY, Gomes BP, Zaia AA, SouzaFilho F. Intracanal dressing paste composed by calcium hydroxide, chlorhexidine and zinc oxide for the treatment of immature and mature traumatized teeth. Braz J Oral Sci. 2014;13(1):6-11.

14. Forghani M, Mashhoor H, Rouhani A, Jafarzadeh H. Comparison of pH changes induced by calcium enriched mixture and those of calcium hydroxide in simulated root resorption defects. J Endod. 2014;40(12):2070-3.

15. Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J. 2007;52(1):64-82.

16. Angkasuvan V, Panichuttra A, Nawachinda M, Ratisoontorn C. Evaluation of pH and calcium ion release at the simulated external root resorption cavities of teeth obturated with bioceramic sealer. Clin Exp Dent Res. 2022;8(4):900-5.

17. Nerwich A, Figdor D, Messer HH. pH changes in root dentin over a 4-week period following root canal dressing with calcium hydroxide. J Endod. 1993;19(6):302-6.

18. Aguiar AS, Guerreiro-Tanomaru JM, Faria G, Leonardo RT, Tanomaru-Filho M. Antimicrobial activity and ph of calcium hydroxide and zinc oxide nanoparticles intracanal medication and association with chlorhexidine. J Contemp Dent Pract 2015;16(8):624-9.

19. Safavi KE, Nakayama TA. Influence of mixing vehicle on dissociation of calcium hydroxide in solution. J Endod. 2000;26(11):649-51.

20. Tsesis I, Lin S, Weiss EI, Fuss Z. Dentinal pH changes following electrophoretically activated calcium hydroxide ions in the root canal space of bovine teeth. Dent Traumatol. 2005;21(3):146-9.

Kumari R, Yeluri R, Kanani H, Hule S. Effect of Various Intracanal Calcium Hydroxide Dressing Materials on pH Changes in Simulated External Root Resorption Defects: Original articles. Oral Sci Rep [Internet]. 2025 Dec 17 [cited 2025 Dec 17];47(1):46-56. Available from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=529

Kumari, R., Yeluri, R., Kanani, H. & Hule, S. (2025). Effect of Various Intracanal Calcium Hydroxide Dressing Materials on pH Changes in Simulated External Root Resorption Defects. Oral Sci Rep, 47(1), 46-56. Retrieved from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=529

Kumari, R., Ramakrishna Yeluri,Harikishan Kanani and Shepali Hule. 2025. "Effect of Various Intracanal Calcium Hydroxide Dressing Materials on pH Changes in Simulated External Root Resorption Defects." Oral Sci Rep, 47(1), 46-56. https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=529

Kumari, R. et al. 2025. 'Effect of Various Intracanal Calcium Hydroxide Dressing Materials on pH Changes in Simulated External Root Resorption Defects', Oral Sci Rep, 47(1), 46-56. Retrieved from https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=529

Kumari, R., Yeluri, R., Kanani, H. and Hule, S. "Effect of Various Intracanal Calcium Hydroxide Dressing Materials on pH Changes in Simulated External Root Resorption Defects", Oral Sci Rep, vol.47, no. 1, pp. 46-56, Dec. 2025.

Kumari, R., Yeluri, R., Kanani, H., et al. "Effect of Various Intracanal Calcium Hydroxide Dressing Materials on pH Changes in Simulated External Root Resorption Defects." Oral Sci Rep, vol.47, no. 1, Dec. 2025, pp. 46-56, https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=529