AvueCal - Premixed Calcium Hydroxide with Barium Sulphate.
Calcium hydroxide (Ca(OH)2) has been widely used in endodontics as an intracanal medicament to eliminate the remaining microorganisms after chemomechanical preparation.
Calcium hydroxide has been used by dentists in the clinical practice for over a century. In 1920, Herman introduced calcium hydroxide to dentistry as a pulp-capping material but today it is used widely in the field of endodontics.
Avuecal is widely used ;due to its
advantages such as:
• Initially bactericidal effect then bacteriostatic.
• Promotes healing and repair.
• High pH stimulates fibroblasts.
• Stops internal resorption.
• Neutralizes low pH of acids.
• Inexpensive and easy to used
Antimicrobial Effect of AvueCal
The release of hydroxyl ions in an aqueous environment is essential for the activation of calcium hydroxide against microbes. These ions reacted intensively with several biomolecules due to their highly oxidant free radicals.
As this reactivity is unspecified, the free radicals most likely gathered at the sites of generation. Hydroxyl ions have fatal effects on bacterial cells. They may damage the cytoplasmic membrane of bacteria, denature their proteins, or damage the DNA.
Used as disinfecting dressing
cation of calcium h
ydroxide paste at intervals of at least 7 days
e to eliminate and/or reduce the tot
al number of bacte
ria surviving even
The Effect of calcium hydroxide on pro-Inflammatory cytokines was studied and concluded that it leads to denaturation of these pro-inflammatory mediators such as interleukin-1 α (IL-1α), tumor necrosis factor α(TNF α) and calcitonin gene-related peptide (CGRP) that is a potential mechanism by which calcium hydroxide contributes to the resolution of periradicular periodontitis.
Intracanal medicament in Weeping Canal
Weeping canal is a canal from which constant clear or reddish exudation is appeared.
This exudate is associated with a large apical radiolucency. The tooth is difficult to treat as when opened, exudate stops but it again reappears in next appointment.
Signs and symptoms varies from symptomless to tenderness to percussion and palpation. Obturation of canals with exudates is contraindicated.
For such teeth, application of calcium hydroxide in the canal after drying with sterile
absorbent paper points is helpful. This is because of its high alkalinity, which changes
the acidic pH of periapical tissues to a more basic environment.
Two other mechanisms have also been proposed:
1) build up bone in the lesion due to the calcifying potential of calcium hydroxide and
2) the residual chronically inflamed tissue is cauterized by the caustic action of calcium hydroxide.
It has many advantages in this treatment modality such as stimulation of hard tissue formation, easy preparation, rapid resorption when extruded into the periodontium and healing enhancement of damaged periodontal tissues, we can use Avuecal or Avuepex or MTA/Bioceramics for the perforation management
Role in Root Resorption
Root resorption can be classified into internal, external or root-ended resorption based.
on the site of origin, and can affect the cementum and/or dentine of the root. Since calcium hydroxide has alkaline pH, it actively influences the local environment around a resorptive area by reducing osteoclast activity and stimulating repair.
The alkaline cal
cium hydroxide neutralizes the acidic environment which exists in the region
tion, reversing the reac
tion and thus stimulating
hard tissue format
ion. The diffusion of hydroxyl ions released by calcium hydroxide through the dentinal tubules that directly communicate with periodontal space would increase the pH of periodontal space from 6.0 to 7.4 - 9.6. To treat an internal resorption, the canal and resorption lacuna are
filled with calcium hydroxide paste.
The resorptive defect should be filled with calcium hydroxide at 3-month intervals until it reveals hard tissue formation, confirmed by both direct examination through the access cavity and radiograph. After establishment of physical barrier, the defect can be compacted with Gutta-percha.
AvueCal is made up of Calcium Hydroxide, Barium Sulphate & Excipients.
Syringe type for easy delivery of the paste into the canal
Excellent antibacterial property
can be used as Cavity liner under the restoration
High ph making it bactericidal to disinfect the canal efficiently