Calcium hydroxide is one of the most studied and widely used biomaterials in pediatric dentistry for preserving both primary and immature permanent teeth.
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✅ Introduction
In pediatric dentistry, preserving primary teeth and immature permanent teeth is crucial for chewing, aesthetics, and normal occlusal development. Calcium hydroxide has been considered the gold standard for pulp therapy for decades, although in recent years it has been compared with modern biomaterials such as mineral trioxide aggregate (MTA) and biodentine.
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° High pH (12.5): strong antibacterial effect.
° Induces reparative dentinogenesis.
° Neutralizes bacterial toxins.
° Good biocompatibility.
✅ Clinical Applications in Pediatric Dentistry
° Direct pulp capping: recommended for small pulp exposures.
° Indirect pulp capping: for deep carious lesions at risk of pulp exposure.
° Pulpotomy: preferred treatment in primary molars with reversible pulpitis.
° Apexification: promotes apical barrier formation in immature necrotic teeth.
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Studies report success rates above 80% in indirect pulp capping and apexification. However, its limited mechanical strength and solubility have led researchers to explore alternative biomaterials with improved longevity.
📊 Comparative Table: Benefits of Calcium Hydroxide in Pediatric Dentistry
| Aspect | Advantages | Limitations |
|---|---|---|
| Antibacterial Effect | Eliminates bacteria due to its high pH | Efficacy decreases over time |
| Dentinogenesis | Promotes dentin bridge formation | Bridges may be irregular with microleakage |
| Biocompatibility | Well tolerated by pulp and tissues | Low mechanical resistance |
| Accessibility | Affordable and widely available | Less durable than modern biomaterials |
💬 Discussion
Calcium hydroxide remains a valid option in pediatric dentistry, particularly in clinical settings where modern biomaterials are not accessible due to their high cost. Although MTA and biodentine show superior physical and biological performance, calcium hydroxide continues to be highly valued for its antimicrobial properties and affordability. Its main limitation is solubility, which may compromise long-term treatment success.
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Calcium hydroxide has been, and continues to be, a cornerstone in pediatric pulp therapy due to its ability to maintain pulp vitality and stimulate dentin formation. While modern biomaterials provide better long-term results, calcium hydroxide remains fundamental in clinical practice and dental education.
📝 References
✔ American Academy of Pediatric Dentistry. (2023). Pulp therapy for primary and immature permanent teeth. Reference Manual, 45(6), 384-392.
✔ Schwendicke, F., Brouwer, F., Schwendicke, A., & Paris, S. (2016). Different materials for direct pulp capping: systematic review and meta-analysis and trial sequential analysis. Journal of Dentistry, 48, 1–15. https://doi.org/10.1016/j.jdent.2016.03.002
✔ Fuks, A. B., Peretz, B., & Eidelman, E. (2021). Pulpotomy in primary teeth—New insights and future directions. Pediatric Dentistry, 43(6), 393–400.
✔ Parirokh, M., & Torabinejad, M. (2010). Mineral trioxide aggregate: A comprehensive literature review—Part I: Chemical, physical, and antibacterial properties. Journal of Endodontics, 36(1), 16–27. https://doi.org/10.1016/j.joen.2009.09.006
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