Products - Multi-Cal™ - Clinical Procedure


Treatments with TempCanal, Multi-Cal or Pulpdent Paste

Root Canal Therapy

Pulpdent Paste, TempCanal and Multi-Cal are used in endocontics for all the following clinical situations outlined by Dr. G.S. Heithersay:

calcium hydroxide chart
1. Exudation control; 2. Large periapical lesions; 3. Antibacterial dressing; 4. Temporary root filling; 5. Apical inflammatory resorption; 6. Inflammatory resorption following trauma; 7. Apical internal resorption; 8. Internal-external root resorption; 9. Perforations; 10. Transverse root fractures; 11. Incompletely developed pulpless teeth

Heithersay GS. Calcium hydroxide in the treatment of pulpless teeth with associated pathology. J Brit Endo Society 1975;8(2):74-93.

Treatment of Abscessed Teeth

Four months after an auto accident in which the patient’s chin hit the steering wheel, the patient presented with loose and painful lower central incisors. We immediately performed root canals and placed TempCanal in the canals to stimulate healing.

Abscessed TeethFig1,2,3,&4
Fig. 1: Radiograph showing abscessed teeth with considerable bone loss.
Fig. 2: Six months after root canals and treatment with TempCanal, radiograph shows bone filling in and healing occurring. 
Fig. 3: One year follow up shows healing and obturation with Pulpdent Root Canal Sealer.
Fig. 4: Radiograph taken nine years after final filling shows long term success.

Treatment of Periapical Lesion and Internal Resorption

The patient presented with considerable discomfort and extreme sensitivity to hot, cold and percussion.

Periapical Lesion1,2,3&4
Fig. 1: Diagnostic radiograph shows internal resorption and periapical lesion of the maxillary left lateral. TempCanal was placed at this visit (not shown).
Fig. 2: Radiograph taken 3 months later shows TempCanal in place and periapical healing occurring.
Fig. 3: Radiograph taken after 13 months shows the root canal obturated with Pulpdent Root Canal Sealer using the Pulpdent Pressure Syringe. Note the slight extrusion of sealer beyond the apex and the internal resorption space obturated with sealer.
Fig. 4: Radiograph taken after 19 months shows internal resorption controlled and periapical lesion healed. Note lamina dura. Also shows a portion of the root canal sealer removed and the entire tooth reinforced with Pulpdent HardCord dual cure composite restorative using DenTASTIC as the bonding adhesive.

Treatment of Persistent Periapical Lesion

The Patient had been under treatment for 4 years for a persistent periapical lesion with constant drainage of his left central incisor. Retrograde surgery for removal of the cyst was scheduled. As a temporary measure before surgery, the pulp was removed and TempCanal was placed in the canal. The maxillary left lateral also tested non-vital and was endodontically treated and obturated with Pulpdent Root Canal Sealer at the same visit.

 Persistent Periapical Lesion1,2,3&4
Fig. 1: Radiograph shows periapical lesion involving the maxillary left central and lateral incisors.
Fig. 2: Six weeks following the placement of TempCanal, radiograph shows trabeculation occurring in the periapical area. The surgical procedure was postponed, the TempCanal dressing was changed, and the case was followed until healing of the periapical lesion occurred.
Fig. 3: One year follow up shows healing without surgery and final obturation with Pulpdent Root Canal Sealer using the Pressure Syringe technique.

Hard Tissue Formation

This patient lost his maxillary left central incisor due to a traumatic injury.

Hard Tissue
Fig. 1: Radiograph shows external root resorption on the mesial aspect of the maxillary right central incisor. The root canal was filled with TempCanal to promote healing.
Fig. 2: Radiograph taken 3 months later shows remineralization of the mesial aspect of the tooth.

Treatment of Avulsed Tooth

This child presented with avulsed left central and traumatized right central incisors. Two weeks after replantation and splinting, the pulps were removed and Pulpdent Paste was placed in the root canals. The case was followed regularly for 12 months, and the Pulpdent Paste was changed at each visit. After one year, the root canals were obturated with Pulpdent Root Canal Sealer using the Pressure Syringe technique.

Avulsed Tooth
Fig. 1: Photo shows child with avulsed left central and traumatized right central incisor.
Fig. 2: Radiograph taken two weeks following replantation shows replanted tooth, open apices and bone loss. At this visit the root canals were negotiated and Pulpdent Paste was placed as a dressing to stimulate healing and discourage traumatic rejection (not shown).
Fig. 3: Radiograph taken one year after treatment shows Pulpdent Paste in the root canals, apexification and bone fill.

Dentin Bridge Formation

Case 1

This histological section stained with H & E shows new dentin bridge formation two months following pulpal curettage and treatment with Pulpdent Paste.

Dentin-Bridge_Case1 G1-45


Case 2

The patient presented in pain with fractured upper central incisors and exposed pulps. Pulpotomies were performed using Pulpdent Paste as the pulpal dressing, which was sealed in place with zinc phosphate cement. Composite restorations were placed using pins for retention. One year after the pulpotomies, the patient returned for more esthetic composite restorations.

A radiograph taken after one-year shows two new dense dentin bridges with composites held in place with pins.

Dentin Bridge_Case2
Fig. 1; This is a rare photograph of the new dentin bridges after removal of the composite, pins and zinc phosphate cement.
Fig. 2: Multi-Cal can also be used for dentin bridge formation in direct pulp capping, pulpal curettage and vital calcium hydroxide pulpotomy procedures.