Ultrasonic agitation reduces the time of calcium hydroxide antimicrobial effect and enhances its penetrability.

OBJECTIVES: The objective of the present work was to evaluate the ultrasonic agitation, time and vehicle (propylene glycol or distilled water) on the antimicrobial potential and penetrability of calcium hydroxide pastes on infected dentin by means of Confocal Laser Scanning Microscopy (CLSM) and microbiological culture (MC). MATERIALS AND METHODS: Dentin specimens were infected with Enterococcus faecalis using a new contamination protocol of 5 days. The specimens were divided into eight groups and dressed with the pastes for 7 or 15 days: G1) calcium hydroxide (CH) + propylene glycol (prop)/7 days (d), G2) CH + prop/7d + ultrasonic agitation (U), G3) CH + distilled water (dw)/7d, G4) CH + dw/7d + U, G5) CH + prop/15d, G6) CH + prop/15d + U, G7) CH + dw/15d, G8) CH + dw/15d + U. The ultrasonic activation was made for 1 min in both directions with a plain point insert. After medications removal, the images obtained by CLSM showed the viable (green) and dead (red) bacteria with Live and Dead dye. By the MC, the dentinal wall debris obtained by burs were collected for colony counts. For the penetration test, the Rodamine B dye was added to the CH pastes and analyzed by CLSM. RESULTS: The 7 and 15-days CH + prop+U pastes performed better antimicrobial efficacy, followed by the CH + dw+U/15d paste. CONCLUSIONS: All pastes demonstrated better penetration and antimicrobial activity against E. faecalis when agitated with ultrasound, even in periods of up to seven days. The propylene glycol vehicle showed better results. CLINICAL RELEVANCE: Agitation of the dressing that remains for less time inside the root canal can optimize the decontamination of endodontic treatment.

Synthesis and characterization of a new dimethacrylate monomer based on 5,50-bis(4-hydroxylphenyl)-hexahydro-4,7-methanoindan for root canal sealer application.

In this study, a new dimethacrylate monomer 5,5'-bis[4-(2'-hydroxy-3'-methacryloyloxy-propoxy)-phenyl]-hexahydro-4,7-methan-oindan (5,5'-BHMPHM) with molecular weight of 640 and large molecular volume was designed and synthesized. The structure of monomer 5,5'-BHMPHM was confirmed by FT-IR, 1H-NMR and elemental analysis. Degree of double bond conversion, volume shrinkage, contact angle, water sorption and solubility, diffusion coefficient value, flexure strength and modulus of 5,5'-BHMPHM/tri(ethylene glycol) dimethacrylate (TEGDMA) based resin were measured. 2,2-bis[4-(2'-hydroxy-3'-methacryloyloxy-propoxy)-phenyl]-propane(Bis-GMA)/TEGDMA based resin was used as reference. The result illustrated that the double bond conversion, polymerization shrinkage, and diffusion coefficient value of 5,5'-BHMPHM/TEGDMA based resin were significantly lower than that of Bis-GMA/TEGDMA based resin (P<0.05). Water sorption, solubility, flexure strength and modulus of 5,5'-BHMPHM/TEGDMA based resin were higher than that of Bis-GMA/TEGDMA based resin (P<0.05). There was no statistical difference between 5,5'-BHMPHM/TEGDMA based resin and Bis-GMA/TEGDMA based resin in contact angle (P>0.05).

Human phase I in vitro liver metabolism of two bisphenolic diglycidyl ethers BADGE and BFDGE.

Root canal sealers are commonly used to endodontically treat teeth with periapical infections. Some root canal sealers based on epoxy resin contain bisphenol A diglycidyl ether (BADGE) and bisphenol F diglycidyl ether (BFDGE). The presence of these chemicals is of concern due to the close contact to the blood stream at the apex and the long setting times of up to 24 h. These chemicals, or any of their degradation products or metabolites, can then exert their toxic effects before being excreted. This study aimed to identify the phase I in vitro biotransformation products of BADGE and BFDGE using human liver microsomes. During incubation with microsomal fractions, the epoxides were rapidly hydrolysed in a NADPH independent manner resulting in the formation of BADGE.2H2O and BFDGE.2H2O. Further, oxidative reactions, such as hydroxylation and carboxylation, generated other BADGE metabolites, such as BADGE.2H2O-OH and BADGE.H2O.COOH, respectively. For BFDGE, further oxidation of BFDGE.2H2O led to the newly reported carboxylic acid, BFDGE.H2O.COOH. In total, three specific metabolites have been identified which can serve in future human biomonitoring studies of BADGE and BFDGE.

The synergistic effects of SrF2 nanoparticles, YSZ nanoparticles, and poly-ε-l-lysin on physicomechanical, ion release, and antibacterial-cellular behavior of the flowable dental composites.

Resin-based pit-and-fissure sealants (flowable resin composites) were formulated using bisphenol-A-glycerolatedimethacrylate (Bis-GMA)-triethylene glycol dimethacrylate-(TEGDMA)-diurethanedimethacrylate (UDMA) mixed monomers and multiple fillers, including synthetic strontium fluoride (SrF2) nanoparticles as a fluoride-releasing and antibacterial agent, yttria-stabilized zirconia (YSZ) nanoparticles as an auxiliary filler, and poly-ε-l-lysin (ε-PL) as an auxiliary antibacterial agent. Based on the physical, mechanical and initial antibacterial properties, the formulated nano-sealant containing 5 wt% SrF2, 5 wt% YSZ and 0.5 wt% ε-PL was selected as the optimal specimen and examined for ion release and cytotoxicity. The results showed an average release rate of 0.87 µg·cm-2·day-1 in the aqueous medium (pH 6.9) and 1.58 µg·cm-2·day-1 in acidic medium (pH 4.0). The maximum cytotoxicity of 20% toward human bone marrow mesenchymal stem cells (hMSCs) was observed according to the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) cytotoxicity assay and acridine orange staining test. A synergy between SrF2 nanoparticles and ε-PL exhibited a better antibacterial activity in terms of colony reduction compared to the other samples. However, the inclusion of SrF2 and ε-PL caused mechanically weakening of the sealants that was partly compensated by incorporation of YSZ nanoparticles (up to 10 wt%).

In vitro pharmacodynamic activities of root canal sealers on Enterococcus faecalis.

AIM: The aim of this study was to evaluate the antimicrobial efficiency of different root canal sealers on Enterococcus faecalis (E. Faecalis) at different time intervals. METHODS AND MATERIALS: All sealers used were mixed according to the manufacturers' instructions then 75 mg of each sealer was added to different sterile tubes and evaluated at 20 minutes, 24 hours, 7 days, and 30 days. A time-kill assay (TKA) was used to determine the antimicrobial efficiency of the sealers. RESULTS: AH Plus and MCS were found to be bactericidal at 20 minutes and 24 hours, but only MCS was bactericidal at the seventh and thirtieth days. Epiphany and Sealapex were found to be bacteriostatic at the seventh and thirtieth days but indifferent at 20 minutes and 24-hours. MCS and AH Plus were both found to be bactericidal in freshly mixed samples, but only MCS was bactericidal at longer time periods. Epiphany Sealer and Sealapex were found to be bacteriostatic at longer time periods but indifferent at 20 minutes and 24 hours. CONCLUSION: The antibacterial effect of MCS was greater than the other sealers evaluated. CLINICAL SIGNIFICANCE: Sealers containing eugenol and epoxy resin might be preferable due to their antibacterial effect.

Bond strength and solubility of a novel polydimethylsiloxane-gutta-percha calcium silicate-containing root canal sealer.

BACKGROUND: Endodontic sealers are essential for sealing gutta-percha to the dentin walls. They help to ensure that the canal remains free of microorganisms which might lead to infection. In order to perform their intended function, the sealers should properly adhere to the dentin walls and remain insoluble when set in the canal. OBJECTIVES: The purpose of this study was to evaluate the bond strength and solubility of a novel polydimethylsiloxane-gutta-percha calcium silicate-containing root canal sealer (GuttaFlow® bioseal) and compare it with the zinc oxide and eugenol sealer (Zical®). MATERIAL AND METHODS: The endodontic sealers used in this study were GuttaFlow bioseal and Zical. The bond strength was assessed using push-out bond strength test in 3 root segments: coronal, middle and apical. The solubility was tested according to the American National Standards Institute / American Dental Association (ANSI/ADA) specification No. 57 at 3 different time intervals: 1, 7 and 14 days. RESULTS: The push-out bond strength in all root segments was significantly higher in Zical compared to GuttaFlow bioseal. The solubility was significantly higher on day 1 and 7 in Zical compared to GuttaFlow bioseal, and on day 14, the difference between them was not significant. CONCLUSIONS: Within the limitations of this study, the endodontic sealer GuttaFlow bioseal showed low bond strength values compared to Zical. The solubility of the set GuttaFlow bioseal and Zical were both within the recommended ANSI/ADA levels.

Addition of phosphates and chlorhexidine to resin-modified MTA materials.

To evaluate the properties of experimental mineral trioxide aggregate (MTA) resin-modified materials for root-end filling procedures, varying their compositions regarding the addition of hydroxiapatite (HA) or dicalcium phosphate dihydrate, with or without chlorhexidine digluconate. White MTA (Angelus, Londrina, Brazil) was used as a reference material. Degree of conversion (DC) was evaluated by Fourier transformed infrared (FTIr) spectroscopy (n = 5). Flowability (n = 3) and radiopacity (n = 3) were evaluated following ISO 6876:2001 methods. For splitting tensile strength analysis, cylindrical samples (n = 10) were subjected to compressive load using a universal testing machine (Instron Corporation, Norwood, MA). Water sorption and solubility tests were performed according to ISO 4049:2009 methods. Calcium ion release and pH analysis (n = 10) were evaluated using a pH meter (Orion, Watsonville, CA). Cytotoxicity (n = 8) of materials extracts was evaluated as cell viability percentage. Statistical analysis was performed using Kolmogorov-Smirnov for normal distribution and data was subjected to one-way ANOVA and Tukey test (α = 0.05). Addition of chlorhexidine digluconate reduced DC mean values for experimental materials (<50%). White MTA demonstrated lower flowability (5.3 mm) and higher radiopacity (9.8 mm Al), splitting tensile strength (9.1 MPa), solubility (8.2 µg/mm3 ), calcium ion release (~26.5 ppm), cytotoxicity (55.2%), and pH mean values (10.8), when compared to experimental materials. All groups demonstrated a decrease in calcium release (<85%) and pH (<13%). Formulation containing HA demonstrated similar pH values after 28 days when compared to white MTA. Evaluated experimental resin-modified MTA based materials without chlorhexidine digluconate showed satisfactory results for all physico-chemical properties tested and cytotoxicity. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2195-2201, 2019.

Sealer penetration and adaptation in root canals with the butterfly effect.

The butterfly effect is a phenomenon seen in some roots and is related to density of dentinal tubules. The aim was to investigate penetration depth and adaptation quality of root canal sealers and ProRoot MTA into bucco-lingual and mesio-distal aspects of roots with and without the effect. One hundred and twenty teeth were decoronated at the cemento-enamel junction. Canals were prepared and assigned to obturation groups: gutta-percha with a sealer (AH Plus, EndoREZ, Kerr Pulp Canal Sealer, MTA Fillapex) or ProRoot MTA alone (each containing 10 butterfly and 10 non-butterfly roots). Root sectioning yielded coronal and middle samples. Confocal laser scanning and scanning electron microscopy were used to assess penetration and adaptation. Teeth with the effect had greater mean penetration bucco-lingually (766 µm) than mesio-distally (184 µm, P = 0.003). Coronal sections had greater penetration (430 µm) compared with middle (247 µm, P = 0.006). In conclusion, greater penetration in roots with the effect may improve treatment outcomes.

Susceptibility of a polycaprolactone-based root canal filling material to degradation. Evidence of biodegradation from a simulated field test.

PURPOSE: To examine if Resilon, a polycaprolactone-based root filling material, was susceptible to microbial biodegradation by using a simulated field test that consisted of incubating the material in wet dental sludge under mesophilic and aerobic conditions. METHODS: Pressed disks prepared from Resilon, polycaprolactone (positive control) and gutta-percha (negative control) were incubated in wet dental sludge for up to 4 months and examined for topographical changes using scanning electron microscopy. RESULTS: Gutta-percha exhibited minimal changes in surface integrity, while polycaprolactone and Resilon exhibited severe surface pitting and erosion. In the latter, disappearance of the polymer matrix was accompanied by exposure of mineral and bioactive glass fillers. Bacteria and hyphae-like structures were present on the disk surfaces.

Effect of Different Irrigation Systems on Sealer Penetration into Dentinal Tubules.

INTRODUCTION: Different irrigation systems have been developed to improve the efficacy and distribution of the irrigants. The aim of this study was to compare the effect of conventional endodontic needle irrigation with other irrigant delivery and/or agitation systems on sealer penetration into dentinal tubules. METHODS: Fifty single-rooted teeth with round-shaped root canals were distributed in 5 homogeneous groups characterized by the different cleansing system used: conventional endodontic needle irrigation, EndoActivator, Irrisafe, Self-Adjusting File, and EndoVac. After instrumentation, all teeth were filled by Thermafil obturators and rhodamine B dye labeled TopSeal sealer. Teeth were transversally sectioned at 2-, 5-, and 7-mm levels from the apex and observed under confocal laser scanning microscope. Maximum, mean, and percentage of sealer penetration inside tubules around the root canal were measured. Moreover, the integrity of the sealer layer perimeter was evaluated. RESULTS: No significant differences both in mean (p > .05) and in maximum penetration depth (p > .05) were observed among groups, whereas both parameters showed an increased trend within each group from the 2- to the 7-mm level from apex. Similarly, the percentage of penetration around the root canal wall did not differ among groups (p > .05) and showed an increasing trend within each group from the apical to the coronal portion of the canal. CONCLUSIONS: Sealer penetration into dentinal tubules is not affected by the irrigant delivery and/or agitation systems studied. Thermafil with TopSeal technique achieves complete sealer perimeter integrity in all groups.

Cytotoxicity and Antimicrobial Effects of a New Fast-Set MTA.

Purpose. To compare the biocompatibility and antimicrobial effectiveness of the new Fast-Set MTA (FS-MTA) with ProRoot MTA (RS-MTA). Methods. The agar overlay method with neutral red dye was used. L929 mouse fibroblast cells were cultured. The liquid and oil extracts and solid test material were placed on the agar overlay, four samples for each material. Phenol was used as the positive control and cottonseed oil and MEM extracts were used as negative controls. Cytotoxicity was examined by measuring the zones of decolorization and evaluating cell lysis under an inverted microscope using the established criteria after 24 and 48 hours. The antimicrobial test was performed using the Kirby-Bauer disk-diffusion method against S. mutans, E. faecalis, F. nucleatum, P. gingivalis, and P. intermedia. The size of the zone of inhibition was measured in millimeters. Results. There was no zone of decolorization seen under or around the test materials for FS-MTA and RS-MTA at 24 and 48 hours. The antimicrobial test demonstrated no inhibitory effect of FS-MTA or RS-MTA on any bacterial species after 24 and 48 hours. Conclusions. There was no cytotoxicity or bacterial inhibition observed by the new Fast-Set MTA when compared to the ProRoot MTA after setting.

Treatment-dependent calcium diffusion from two sealers through radicular dentine.

This study examined how root canal irrigation with sodium hypochlorite and citric acid affected calcium diffusion, using a calcium hydroxide-based sealer and a zinc oxide eugenol-based sealer with little calcium hydroxide. Sixty-eight single-rooted, freshly extracted teeth were decrowned to 14 mm, instrumented using a crown down technique, and divided into two groups: the experimental group (irrigated with 5.25% NaOCl followed by 10% citric acid) and the control (irrigated with 5.25% NaOCl only). Both groups were divided into two subgroups, depending on the type of sealers used in obturation with gutta-percha. Coronal and apical openings were sealed and teeth were placed in water (37 degrees C). Spectrophotometry was used to measure the amount of calcium released in water through radicular dentin. For each sealer, the calcium diffused from the experimental group was significantly higher than that of the control group (p < 0.05).

[Diffusion of hydroxyl ions from calcium hydroxide in the dentinal tubules]. / Etude de la diffusion des ions OH- de l'hydroxyde de calcium dans les tubuli dentinaires.

The aim of this study was to compare hydroxyl ions diffusion from various calcium hydroxide forms: Hycal (1), Roeko points (2) and aqueous suspension placed in the pulpar chamber (3) or in the root canal (4). These experiments were conducted with bovine incisors in order to obtain quantitative evaluation. 540 lateral cavities, deep and superficial, were created in root dentin to measure the hydroxyl ions diffusion with a color indicator, the Blue epsilon With Hycal and aqueous suspension the diffusion of the OH- is obtained in the superficial cavities situated in the coronal part at 14 days (1 = 72%; 3 = 44%; 4 = 100%, (n=18)). In the apical part of the canal this phenomenon is never complete at 21 days (1 = 17%; 3 = 22%; 4 = 17%, (n=18)). No diffusion was observed with the Roeko points (the first generation).

Dentinal Tubule Penetration of Tricalcium Silicate Sealers.

INTRODUCTION: The treatments for which mineral trioxide aggregate (MTA)-based materials can be used in dentistry are expanding. Smaller particle size and easier handling properties have allowed the advent of tricalcium silicate sealers including EndoSequence BC Sealer (Brasseler USA, Savannah, GA), QuickSet2 (Avalon Biomed, Bradenton, FL), NeoMTA Plus (Avalon Biomed), and MTA Fillapex (Angelus, Londrina, Brazil). The objective of this study was to measure the tubule penetration with these sealers using continuous wave (CW) and single-cone (SC) obturation techniques. METHODS: Eighty single-rooted teeth were randomly divided into 8 groups of 10 and obturated with 1 of the previously mentioned sealers mixed with trace amounts of rhodamine using either the CW or SC technique. Teeth were sectioned at 1 mm and 5 mm from the apex and examined under a confocal laser microscope. The percentage of sealer penetration and the maximum sealer penetration were measured. RESULTS: The tricalcium silicate sealers penetrated tubules as deep as 2000 µm (2 mm). The percentage of sealer penetration was much higher 5 mm from the apex, with many specimens having 100% penetration for both SC and warm vertical techniques. MTA Fillapex, a resin-based sealer with less than 20% MTA particles, had significantly greater tubule penetration with a warm vertical technique versus the SC technique at the 1-mm level. CONCLUSIONS: Within the limitations of this study, the CW and SC techniques produced similar tubule penetration at both the 1-mm and the 5-mm level with the tricalcium silicate sealers BC Sealer, QuickSet2, and NeoMTA Plus.

Depth of penetration and appearance of Grossman sealer in the dentinal tubules: an in vivo study.

Five teeth extracted after chemomechanical preparation (group A) and 11 extracted 1 to 7 yr after endodontic treatment (group B) were selected for this study. A 1% NaOCl was used for irrigations and a lateral condensation technique with a Grossman-type sealer was used for obturation. The teeth were fractured and prepared for and viewed by a scanning electron microscope equipped with an electron dispersive spectrometer. All root canal walls of group A were covered with a thick smear layer. Sealer, either rod-like or granular in appearance and barium free, was present in the majority of the dentinal tubules of group B usually at a distance up to 200 microns from the root canal walls; in two cases up to 900 microns. Sealer was found deepest in the middle third of the root. The smear layer did not stop sealer from entering the dentinal tubules. The differences in the depth of penetration or in the appearance of the sealer cannot be attributed to the different time periods the teeth remained in the arch after endodontic treatment.

Ca2+ diffusion through dentin of Ca(OH)2 associated with seven different vehicles.

This investigation measured the diffusion of Ca2+ through dentin by using Ca(OH)2 associated with various vehicles. After mechanical preparation and removal of smear layer, 41 human premolar teeth were stored individually in flasks containing 800 ml of ultra-pure deionized water for 2855 h. The Ca2+ concentration was measured by atomic absorption spectrophotometry as a function of time. These measurements were divided into two phases: dissolution, to check the loss of Ca2+ from the tooth structure itself, for which all canals were kept empty and open in the absence of medication for 1168 h, and diffusion, in which the specimens were divided into 10 groups (3 control groups: group 1 = water control, group 2 = sealing control, and group 3 = open canal dissolution control; 7 experimental groups in which the whose canals were filled with Ca(OH)2 paste associated with the following vehicles: group 4 = saline; group 5 = polyethylene glycol (Calen); group 6 = glycerin and camphorated parachlorophenol group 7 = camphorated paramonochlorophenol; group 8 = glycerin; group 9 = glycerin and tricresol formaldehyde (TCF); and group 10 = anesthetic solution. This phase lasted 1687 h. A total of 1058 measurements of Ca2+ were made. Regression analysis was used for statistical evaluation. We concluded that diffusion occurred differently for each group: the medications used in the root canals interacted with the dentinal structure or among themselves; the medication coated the dentinal tubule, facilitating the diffusion of Ca2+ into the external part of the root.

Sealer distribution in coronal dentin.

A major cause of tooth discoloration is sealer remnants in the pulp chamber after root canal treatment. The purpose of this study was to assess coronal distribution and color changes of four commonly used sealers placed in the pulp chamber after 2 yr. Fifty extracted premolars were cross-sectioned in the coronal third of the root. The chamber contents were removed, and instrumentation was via the canal; then freshly mixed sealer was placed in each chamber. Sealers evaluated were: AH 26, Kerr Pulp Canal Sealer, Roth 801, and Sealapex. The apical access was sealed with white sticky wax, and the tooth was maintained in a moist environment at 37 degrees C for 2 yr. Teeth were split longitudinally, and digital images of the exposed dentin were made, scrambled, and evaluated blindly by trained evaluators for color changes and for presence of sealer in dentin. There was no measurable penetration of sealer into dentin for all groups and no dentin discoloration occurred. The sealers displayed marked discoloration. At 2 yr, the sealers discolored and remained confined primarily to the pulp chamber.

Experimental study of the biocompatibility of four root canal sealers and their influence on the zinc and calcium content of several tissues.

Four root canal sealers (AH-26, Roth 811, CRCS, and Sealapex) were tested for tissue biocompatibility in rat connective tissue. Each sealer was placed in Teflon tubes and implanted subcutaneously in Wistar-Furth rats. The implants were removed after 7, 14, and 21 days, fixed, and histologically prepared for microscopical evaluation. Brain, liver, kidneys, and uterus were removed from the animals killed at the first experimental period (7 days) and analyzed for zinc and calcium concentration by flame atomic absorption spectrophotometry. In total, 100 specimens were examined. At the seventh day, the most irritant material was seen to be AH-26, but this inflammatory reaction decreased with time. Roth 811 and Sealapex caused moderate-to-severe inflammatory reaction, whereas CRCS caused mild to moderate. CRCS and Roth 811 induced redistribution of zinc, whereas AH-26 induced changes in calcium content in some organs.

pH changes at the surface of root dentin when using root canal sealers containing calcium hydroxide.

The purpose of this study was to investigate long-term pH changes in cavities prepared in root surface dentin of extracted teeth after obturation of the root canal with gutta-percha and a variety of sealers containing calcium hydroxide. After cleaning and shaping, root canals in 50 recently extracted, human single-rooted teeth were divided into five groups. Each of four groups was obturated with gutta-percha and either Sealapex, Sealer 26, Apexit, or CRCS, all of which contain calcium hydroxide. The remaining group served as the control and was not obturated with gutta-percha or sealer. Cavities were prepared in the facial surface of the roots in the cervical and middle regions. The pH was measured in these dentinal cavities at the initiation of the experiment, and 3, 7, 14, 21, 28, 45, 60, 90, and 120 days after obturation. Results indicate that the pH at the surface of the root does not become alkaline when calcium hydroxide cements are used as root canal sealers. Regardless of the sealer used, the observed pattern of pH change was not different from that seen in the control group of roots that were not treated with sealer. It is concluded that calcium hydroxide-containing cements, although suitable for use as root canal sealants, do not produce an alkaline pH at the root surface. If such a pH change is related to treatment of root resorption, these sealants do not contribute to this treatment.

Changes in pH at the dentin surface in roots obturated with calcium hydroxide pastes.

The purpose of this study was to determine the pH, after defined periods of time, in cavities prepared in the facial surface of the cervical, middle, and apical regions of roots obturated with calcium hydroxide pastes. Root canal instrumentation was performed on 40 recently extracted, single-rooted human teeth. Cavities 1.5 mm in diameter and 0.75 mm in depth were prepared in the cervical, middle, and apical regions of the facial surface of each root. Teeth were randomly divided into four groups. One group was left unobturated and served as a control. The three remaining groups were obturated with either aqueous calcium hydroxide, calcium hydroxide mixed with camphorated monochlorophenol. or Pulpdent pastes. Access cavities and apical foramina were closed with Cavit. Each tooth was stored individually in a vial containing unbuffered isotonic saline. pH at the surface was measured in the cervical, middle, and apical cavities at 0 and 3, 7, 14, 21, 28, 45, 60, 90, and 120 days. Results indicate that hydroxyl ions derived from calcium hydroxide pastes diffused through root dentin at all regions over the experimental period of 120 days. The pattern of pH change at the tooth surface was similar in all regions of the root, regardless of the type of calcium hydroxide paste used. This was a rapid rise in pH from a control value of pH 7.6, to greater than pH 9.5 by 3 days, followed by a small decline to pH 9.0 over the next 18 days, before finally rising and remaining at, or above pH 10.0 for the remainder of the experimental period. Pulpdent paste in the apical region was the only exception in this pattern, producing a pH rise nearly one full unit below the other pastes, pH 9.3. These results indicate that, for all pastes tested, a high pH is maintained at the root surface for at least 120 days.