The effect of calcium hydroxide on the steroid component of Ledermix^® and Odontopaste^®

Abstract

AimTo investigate the chemical interaction of calcium hydroxide with the corticosteroid triamcinolone acetonide in Ledermix® Paste and in Odontopaste®, a new steroid/antibiotic paste.MethodologyValidated methods were developed to analyse the interaction of calcium hydroxide in two forms, Pulpdent® Paste and calcium hydroxide powder, with triamcinolone acetonide within Odontopaste® and Ledermix® Paste. High-performance liquid chromatography (HPLC) was used to analyse the mixed samples of the pastes and calcium hydroxide. The concentration of triamcinolone acetonide within the pastes was determined over 0, 2, 6, 24 and 72-h time-points. All tests with the HPLC involved the testing of the standard with triplicate injections alongside the samples. All samples were tested in duplicate with each injected twice; therefore, four tests were performed for each investigation. Linearity, precision and specificity of the testing procedures and apparatus were validated. Descriptive statistics are provided.ResultsIn both pastes, there was a marked rapid destruction of the triamcinolone acetonide steroid upon mixing with calcium hydroxide. Odontopaste® suffered a lower rate of destruction of the triamcinolone acetonide component than Ledermix® Paste, but both pastes showed very similar degrees of steroid destruction after 72 h. When using calcium hydroxide powder with Ledermix® Paste, the triamcinolone was destroyed entirely and immediately.ConclusionThe addition of calcium hydroxide to Odontopaste® or Ledermix® Paste results in the rapid destruction of the steroid.

In vitro assessment of the tooth staining potential of endodontic materials in a bovine tooth model

“…However, Ledermix, the best‐known representative of corticosteroid‐antibiotic root canal dressings, has been reported in several investigations to cause severe tooth discoloration . Odontopaste, which uses clindamycin as a substitute for the stain‐inducing tetracycline component, was released to the market in 2008 as a non‐staining alternative to Ledermix . In the present study, Odontopaste did not show significant staining compared to the negative control after 12 months.…”

Allergic reaction to the tetracycline component of Ledermix paste: a case report

“…Adding Pulpdent paste caused a loss of the corticosteroid (triamcinolone acetonide) from 81% immediately after mixing to 96% after 72 h (Athanassiadis et al . (), and the authors raised concerns regarding the effect and understanding of the chemistry of the hybrid paste, the drug interactions and the breakdown products.…”

Analgesic Effect of Odontopaste and a Compound Intracanal Medicament Between Root Canal Therapy Appointments

“…Although Odontopaste itself has about 0.5% calcium hydroxide in its combination, mixing of additional calcium hydroxide in a 50:50 combination with Odontopaste is not recommended. Athanassiadis et al observed rapid loss of steroid when Odontopaste or Ledermix was mixed with calcium hydroxide powder, although the overall destruction of steroid in Odontopaste was less (11). …”