The effect of the renewal of calcium hydroxide paste on the apexification and periapical healing of teeth with incomplete root formation

Aim To evaluate the influence of renewing calcium hydroxide paste on apexification and periapical healing of teeth in dogs with incomplete root formation and previously contaminated canals. Methodology Forty premolars from four 6-month-old dogs were used. After access to the root canals and complete removal of the pulp, the canal systems remained exposed to the oral environment for 2 weeks. Canal preparation was then carried out using Hedstroem files, under irrigation with 1% sodium hypochlorite, 1 mm short of the radiographic apex. After drying, the canals of one premolar in each dog were left empty (group 4-control), and those of the other nine teeth in each animal were filled with a calcium hydroxide-propylene glycol paste. All teeth were restored with reinforced zinc oxide cement (IRM) or IRM and amalgam (group 4). The paste was renewed and the teeth restored again 1 week later. Then, the nine teeth in each animal were divided into three experimental groups: group 1 - paste not changed; group 2 - paste renewed every 4 weeks for 5 months; and group 3 - paste renewed after 3 months had elapsed. The teeth were restored with IRM and amalgam (groups 1 and 3) or IRM (group 2). The animals were killed 5 months later, and blocks of the teeth and surrounding tissues were submitted to histological processing. The sections were studied to evaluate six parameters: apical calcified tissue barrier, inflammatory reaction, bone and root resorption, paste extrusion and microorganisms. Results of experimental groups were analysed by Kruskal-Wallis nonparametric tests and by the test of proportions. The critical value of statistical significance was 5%. Results Significant differences (P < 0.05) were found in relation to the presence of bone resorption and paste in the periradicular area, the formation of a calcified tissue barrier at the apex, and the intensity of the apical inflammatory reaction. Bone resorption was more evident in group 1 (medicament not changed), and the presence of paste in the periodontal tissues was more common in groups 2 and 3. Renewal of the paste reduced the intensity of the inflammatory reaction (groups 2 and 3), but the formation of apical calcified tissue was more noticeable in the teeth where the paste had not been renewed. Conclusions Replacement of calcium hydroxide paste was not necessary for apexification to occur, however, it did reduce significantly the intensity of the inflammatory process. Monthly renewal of calcium hydroxide paste reduced significantly the occurrence of apexification.