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

Abstract

BACKGROUND: Calcium hydroxide (Ca(OH)2) is the most currently used intracanal medicament. Its remnants within the root canal have been found to negatively impact the final obturation. Accordingly, its complete removal is critical. OBJECTIVES: This study aimed to compare the removal of Ca(OH)2 paste from root canals using passive ultrasonic irrigation, EDDY sonic activation, Roeko canal brush and manual filing, using cone beam computed tomography (CBCT) for evaluation. METHODS: Forty single canaled extracted human teeth were prepared using ProTaper Next files (X3) and filled with Ca(OH)2 paste. The teeth were assigned randomly to four groups of 10, based on the method of Ca(OH)2 removal: Group A: Passive ultrasonic irrigation (PUI), Group B: EDDY sonic activation, Group C: Roeko canal brush and Group D: manual filing (Control group). Samples were scanned with CBCT and the intracanal Ca(OH)2 volume was measured pre and post retrieval. Statistical analysis was performed using Kruskal Wallis test followed by Bonferroni correction, with a level of significance set at P value of 0.05. RESULTS: Complete removal of intracanal Ca(OH)2 was not achieved by any of the tested techniques. However, PUI and EDDY removed a mean of (99.89% ± 0.19) and (99.86% ±0.34) of the intracanal paste, respectively, with no statistically significant difference between them. The apical third demonstrated the largest volume of residual paste. There was a statistically significant difference when PUI and EDDY were compared to the control group (p <0.0001). CONCLUSION: PUI and EDDY are the most effective methods in removing intracanal calcium hydroxide.