LAUSR

INTRODUCTION The aims of this retrospective, cohort-case series was two-fold: 1) to evaluate the outcomes of teeth with necrotic pulps and apical periodontitis using long-term calcium hydroxide. Healing was assessed via the periapical index (PAI) system; and 2) to explore the possible association of fractures in relation to calcium hydroxide exposure long term. METHODS A total of 242 cases diagnosed with pulpal necrosis and apical periodontitis were treated with long-term calcium hydroxide using a standardized protocol. Injectable and powdered Ca(OH)2 were placed sequentially in the root canal system. All cases were re-evaluated within a three-month period until radiographic healing was observed. Clinical and radiographic evaluations were performed annually. Pre- and post-operative periapical radiographs were evaluated using the periapical index (PAI) system. RESULTS Of the 242 cases, 219 participants completed their treatment with annual follow-up. The average calcium hydroxide time was 5.4 months with a range of 1-12 months. Overall, by the latest follow-up visit, 90.0% (197/219) were classified as "healed". The overall mean pre-op and post-op PAI scores were 4.07 (± 0.80) and 1.76 (± 0.70), respectively. Kappa statistics showed an almost perfect agreement for inter-rater (k = 0.91) and intra-rater (k=0.95) reproducibility for both examiners. CONCLUSIONS Within the limitations of this study, the use of long-term calcium hydroxide in the treatment of teeth with necrotic pulps and apical periodontitis resulted in a predictable high outcome. There was no association observed between long-term calcium hydroxide use and the incidence of fractures during this study. Calcium hydroxide is a suitable material of choice as an inter-appointment dressing for teeth diagnosed with pulpal necrosis and apical periodontitis.