✅ Abstract
The combination of calcium hydroxide and iodoform paste has become a cornerstone in pediatric endodontics, especially in the pulpectomy of primary teeth.
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✅ Introduction
Pulpectomy is a vital endodontic procedure in primary teeth aimed at preserving function and maintaining arch integrity until natural exfoliation. Selecting the ideal obturating material is crucial for long-term success. Calcium hydroxide/iodoform paste, commonly known as Vitapex® or Metapex®, has gained popularity due to its antimicrobial properties, ease of application, and safe resorption pattern.
The paste provides a biologically compatible and resorbable obturation medium that supports periapical healing while avoiding interference with the eruption of permanent successors.
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The calcium hydroxide/iodoform paste is a premixed, radiopaque material containing:
▪️ Calcium hydroxide (Ca(OH)₂): Provides alkaline pH (~12.5) and induces hard tissue formation.
▪️ Iodoform (CHI₃): Offers broad-spectrum antimicrobial activity and enhances radiopacity.
▪️ Silicone oil or vehicles: Improve flow and handling properties, ensuring complete canal filling.
The paste is supplied in syringes or capsules, allowing controlled placement into root canals of primary teeth with resorbing roots.
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Calcium hydroxide dissociates into calcium and hydroxyl ions, creating an alkaline environment that promotes bacterial destruction, enzymatic inhibition, and dentin bridge formation. Iodoform, on the other hand, releases iodine, which has potent antiseptic and deodorizing properties, reducing anaerobic bacterial load.
Together, these components result in:
▪️ Antibacterial and anti-inflammatory effects.
▪️ Induction of periapical tissue repair and osteogenic potential.
▪️ Gradual resorption synchronized with the natural resorption of primary tooth roots.
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▪️ Excellent antimicrobial action against endodontic pathogens (Enterococcus faecalis, Streptococcus spp.).
▪️ Radiopacity allows clear postoperative radiographic evaluation.
▪️ Biocompatibility minimizes periapical irritation and promotes healing.
▪️ Controlled resorption, preventing overfilling complications.
▪️ Ease of application using syringe delivery systems.
▪️ High success rate in pulpectomized primary teeth.
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Comparative studies show that calcium hydroxide/iodoform paste demonstrates higher clinical and radiographic success rates than traditional zinc oxide–eugenol (ZOE) paste due to its resorbable and antimicrobial characteristics. However, clinicians should monitor potential premature resorption, which might lead to underfilling before the complete exfoliation of the tooth.
Recent evidence (Cehreli et al., 2022; Mohammadi et al., 2023) indicates that bioactive materials like calcium hydroxide–iodoform promote faster periapical healing and lower reinfection risk, aligning with modern minimally invasive endodontic principles in pediatric patients.
✍️ Conclusion
Calcium hydroxide/iodoform paste remains one of the most reliable obturation materials for pulpectomies in primary teeth, combining antimicrobial efficacy, biocompatibility, and resorption compatibility. Ongoing research continues to support its use as the gold standard for obturation in pediatric endodontics.
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▪️ Use Ca(OH)₂/iodoform paste for infected primary teeth with periapical involvement.
▪️ Ensure adequate canal debridement before obturation to enhance success.
▪️ Avoid excessive extrusion beyond the apex.
▪️ Evaluate radiographically at 3–6-month intervals to monitor healing and resorption.
▪️ Prefer newer formulations (e.g., Vitapex®, Metapex®) for predictable clinical handling.
📊 Comparative Table: Calcium Hydroxide/Iodoform Paste vs Other Root Canal Fillers
| Material | Advantages | Limitations |
|---|---|---|
| Calcium Hydroxide/Iodoform Paste (Vitapex®, Metapex®) | Antibacterial, biocompatible, easy to use, resorbs with root | May resorb faster than physiological root resorption |
| Zinc Oxide–Eugenol (ZOE) | Good sealing ability, widely available | Non-resorbable, may irritate periapical tissues, interferes with permanent eruption |
| Calcium Hydroxide–CMCP Paste | Strong antimicrobial activity | Potential toxicity and delayed healing |
| Iodoform Alone | Antiseptic, radiopaque | Limited hard tissue induction, low stability |
| Endoflas® | Antimicrobial, partial resorption behavior, good sealing | Contains eugenol; may cause persistent inflammation |
✔ American Academy of Pediatric Dentistry (AAPD). (2024). Guideline on Pulp Therapy for Primary and Immature Permanent Teeth. Retrieved from https://www.aapd.org
✔ Cehreli, S. B., Unverdi, E., & Aktoren, O. (2022). Clinical and radiographic comparison of calcium hydroxide/iodoform paste and zinc oxide–eugenol as root canal filling materials in primary teeth. International Journal of Paediatric Dentistry, 32(3), 408–415. https://doi.org/10.1111/ipd.12958
✔ Mohammadi, Z., Dummer, P. M. H., & Shalavi, S. (2023). Properties and applications of calcium hydroxide in endodontics and pediatric dentistry. European Archives of Paediatric Dentistry, 24(2), 231–240. https://doi.org/10.1007/s40368-022-00702-2
✔ Musale, P. K., & Mujawar, S. A. (2021). Comparative evaluation of resorbable obturating materials in primary teeth: A clinical study. Journal of Clinical Pediatric Dentistry, 45(5), 292–298. https://doi.org/10.17796/1053-4628-45.5.3
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