Efficacy of five irrigation techniques in removing calcium hydroxide from simulated S-shaped root canals

Abstract

Background/purpose Calcium hydroxide [Ca(OH) 2 ], a wildly used intracanal medicament, should be completely removed from the root canal before obturation to avoid negative effects on the treatment. This study evaluated the effectiveness of conventional needle irrigation (CNI), passive ultrasonic activation (PUI), photon-induced photoacoustic streaming (PIPS), XP-endo Finisher (XP) and EDDY for the removal of Ca(OH) 2 from S-shaped root canal. Materials and methods Eighty-four S-shaped root canals in resin blocks were prepared using Protaper Gold up to size #25/0.08 and filled with Ca(OH) 2 . Five groups were established according to the removal techniques (n = 16): CNI, PUI, PIPS, XP and EDDY group. The positive and negative control group (n = 2) were also established. Sodium hypochlorite 3% was used as the irrigant. Digital radiographs were used to measure the remaining Ca(OH) 2 . Statistical analysis of the data was performed by using the Kruskal–Wallis test, followed by Dunn's post hoc test with Bonferroni correction ( α = 0.05). Results All the tested techniques completely removed Ca(OH) 2 from the straight portion and coronal curve of the S-shaped root canal in 100% of cases. Regarding the apical curve, PUI, EDDY, PIPS and XP removed significantly more Ca(OH) 2 than CNI ( P < 0.05), with no significant differences among these four groups ( P > 0.05). The complete clearance of Ca(OH) 2 from the apical curve was observed in 75%, 62.5%, 56.3%, 43.8% and 0% of cases of PUI, EDDY, PIPS, XP and CNI group, respectively. Conclusion Irrigant activation enhanced Ca(OH) 2 removal from the apical region of the S-shaped root canal. CNI was significantly less effective than all activation techniques.

Removal of Calcium Hydroxide Intracanal Medicament With Four Different Techniques (A Cone Beam Computed Tomography in Vitro Study)

“…The efficiency of removal from the coronal and middle thirds could be attributed to the larger diameter in these areas, exposing dentin to a higher volume of irrigants and making Ca(OH)2 removal easier. This was in accordance with the findings of Shi et al (26). On the other hand, EDDY sonic activation was reported by Donnermeyer et al (6) to achieve the best results in the apical third.…”

Comparative evaluation of efficacy of different irrigation devices in removal of calcium hydroxide in teeth with simulated internal resorption cavities – An in vitro study

“…As consistent with previous research, results from this study also indicated that none of the proposed techniques removed 100% of CH from artificial IRR cavities. [ 1 2 7 8 9 14 19 20 21 ] Although to facilitate scoring without bias, cavities were made by no. 2 round diamond bur to standardize dimensions, location of resorption cavities, and quantity of medicament used.…”

“…Based on the results of this study [ Figure 3 ], PUI and XP-endo were able to remove complete CH in 55% of specimens, where IRR cavities were free of any debris which was significantly higher than EA (25%) and EI (5%). Several authors explained that during PUI, acoustic microstreaming and cavitation can cause a streaming pattern within the root canal from apical to coronal, which removes CH more effectively[ 1 2 6 7 8 9 11 14 19 20 21 ] as compared with sonic (EA) and syringe delivery (EI) system. Therefore, similar to previous studies,[ 1 2 6 7 8 9 ] this study also concluded that PUI possesses a great aptitude for clearing remote areas.…”

“…XP-endo showed superior performance in removal of CH, double antibiotic paste, smear layer, debris, or biofilm from a curved root canal in previous studies. [ 20 ] On the other hand, Wigler et al . [ 21 ] reported that manufacturer claims of the file reaching irregularities of root canal anatomy were not fulfilled due to 1-min operation time which was not sufficient for irrigant activation.…”

The efficacy of EndoActivator, passive ultrasonic irrigation, and Ultra X in removing calcium hydroxide from root canals: an in-vitro study

“…On the other hand, most ultrasonic devices which are used for passive ultrasonic irrigation (PUI) operate at 25–30 kHz [ 21 ]. As the gold standard of irrigant activation [ 22 ], PUI transmits the acoustic energy from an oscillating file or smooth wire to an irrigation solution in the root canals [ 23 ]. Compared with the traditional methods of root canal irrigation, the classic PUI devices have effectively improved root canal disinfection through the generation of cavitation and acoustic transmission [ 24 – 26 ].…”