It is the most recommended pulpotomy medicament for pulpally involved vital young permanent tooth with incomplete apices.
It is acceptable because it promoted reparative dentin bridge formation and thus pulp vitality is maintained.
Histologically pulp tissue adjacent to calcium hydroxide was first necrotised by the high pH of calcium hydroxide. This necrosis was accompanied by the acute inflammatory changes in the underlying tissue. After 4 weeks a new odontoblastic layer and eventually a bridge of dentin developed.
Three histologic zones under calcium hydroxide in 4-9 days:
1. Coagulation necrosis
2.Deep staining areas with varied osteodentin
3.Relatively normal pulp tissue, slightly hyperemic, underlying an odontoblastic layer.
Internal resorption may result from overstimulation of the primary pulp by the highly alkaline calcium hydroxide. This alkaline induced overstimulation could cause metaplasia within the pulp tissue, leading to formation of odontoclasts. Also undetected microleakage could allow large numbers of bacteria to overwhelm the pulp and nullify the beneficial effects of calcium hydroxide.
Calcium hydroxide incorporated in a methylcellulose base such as pulpdent, showed earlier and more consistent bridging.
At present calcium hydroxide pulpotomy technique cannot be generally recommended for primary teeth.
But it is the recommended agent for carious and traumatic exposures in young permanent teeth, particularly with incomplete closure
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