Effectiveness of different intracanal irrigation techniques in removing intracanal paste medicaments

Evaluation of different irrigation activation techniques for the removal of various medicaments from a simulated internal resorption cavity: an in vitro study

OBJECTIVES

This study aimed to assess the efficacy of different activation techniques in removing calcium hydroxide (Ultracal XS), Ledermix, and Bio-C Temp from simulated internal root resorption (IRR) cavities.

MATERIALS AND METHODS

108 single-rooted maxillary incisors were prepared using Reciproc R50 files. Simulated IRR cavities, 2 mm in diameter and located 8 mm from the apex, were created. Ultracal XS, Ledermix, and Bio-C Temp were applied to the samples, grouped by irrigation activation techniques: Standard Needle Irrigation (SNI), EDDY, Passive Ultrasonic Irrigation (PUI), and XP-endo Finisher (XPF). Medicament removal efficacy was evaluated using a standardized scoring system. Statistical analysis was performed using the Kruskal-Wallis test.

RESULTS

XPF and PUI were more effective than SNI in medicament removal across the groups, with no significant difference. EDDY showed no significant difference than other groups. Ledermix was more effectively removed in all activation groups compared to Bio-C Temp. The XPF was superior in removing Ultracal XS compared to Bio-C Temp. However, none of the groups achieved complete medicament removal.

CONCLUSIONS

XPF and PUI techniques enhance medicament removal efficacy. Bio-C Temp was more difficult to remove from the IRR cavities than other medicaments.

CLINICAL RELEVANCE

Bio-C Temp could be removed from the canals less effectively compared to calcium hydroxide and Ledermix. Among the tested irrigation activation methods, XPF and PUI were found to be more effective at removing the tested medicaments.

Comparative Analysis of AH Plus Bond Strength to Root Canal Dentin and Adhesive Interface Quality after Calcium Hydroxide Removal using Different Irrigation Protocols

INTRODUCTION

To evaluate the push-out bond strength (POBS) of AH Plus sealer to root dentin and the adhesive interface quality after calcium hydroxide (Ca(OH)2) intracanal dressing removal with different final irrigation protocols.

METHOD

After root canal instrumentation and irrigation, 40 root canals were filled with Ca(OH)2 and sealed. After 14 days, the specimens were randomly distributed according to the irrigation protocols for Ca(OH)2 removal (n = 10): GH2O (control) - distilled water; GNaOCl - 1% NaOCl; GEDTA - 17% EDTA; GEDTA + NaOCl - 17% EDTA + 1% NaOCl. The root canals were filled with AH Plus sealer and gutta-percha. After 7 days, the roots were sectioned into dentin slices and submitted to POBS test and analysis of the adhesive interface under scanning electron microscope. The POBS data were statistically evaluated (analysis of variance and Tukey test). The Kruskal-Wallis and Mann-Whitney tests were used to analyze the adhesive interface (α = 0.05).

RESULTS

GH2O, GNaOCl, and GEDTA + NaOCl had similar POBS values, with higher values on the apical third, in comparison with other thirds (P < .05). A homogeneous and free-of-gaps adhesive interface was observed for GH2O, GNaOCl, and GEDTA + NaOCl, with difference between GH2O and GEDTA (P < .05). GH2O and GEDTA + NaOCl presented higher sealer tags formation (P < .05).

CONCLUSION

The final rinse with EDTA for Ca(OH)2 dressing removal had a negative effect on the POBS of the filling material to root dentin. The use of EDTA followed by NaOCl had results similar to the distilled water, providing uniform and free-of-gaps adhesive interface, and a higher number of sealer tags.

Efficacy of Laser-Activated Irrigation and Conventional Techniques in Calcium Hydroxide Removal from Simulated Internal Resorption Cavities: Micro-CT Study

Objective: This study aimed to evaluate the effectiveness of different irrigant-activation techniques for eliminating calcium hydroxide from an internal root canal resorption cavity by using microcomputed tomography (micro-CT). Background: Several techniques and irrigants are inadequate for the complete removal of calcium hydroxide from an internal root resorption cavity. Recently, a few studies have investigated the effectiveness of various methods, but there has been no micro-CT study that compares the effectiveness of photon-induced photoacoustic streaming (PIPS) and shock wave enhanced emission photoacoustic streaming (SWEEPS) techniques. Methods: Seventy single-canal mandibular premolar teeth were selected and divided into seven groups (n = 10) according to the techniques to be used: syringe irrigation (SI), passive ultrasonic irrigation (PUI), EndoActivator (EA), XP-Endo finisher file (XP), Er,Cr:YSGG laser-activated irrigation, PIPS, and SWEEPS. The root canals were instrumented using a rotary system and divided vertically. Internal resorption cavities were created and standardized through diamond burs. Calcium hydroxide was placed into the root canal space. All specimens were evaluated using micro-CT in two different periods. The initial and residual calcium hydroxide volumes in the simulated cavities were calculated. Data were analyzed using a Kruskal-Wallis H test. Results: SWEEPS and PIPS were significantly more effective than EA, Er,Cr:YSGG, PUI, XP, and SI (p < 0.05). There was no significant difference between the SWEEPS and PIPS groups (p > 0.05). SI and XP showed the least effective activity (p < 0.05). Conclusions: The SWEEPS and PIPS techniques were superior to the EA, Er,Cr:YSGG, PUI, XP, and SI techniques. None of the techniques used entirely removed the calcium hydroxide from the resorption cavities.

In Vitro Development of a New Sponge-Based Delivery System for Intracanal Antimicrobial Administration in Endodontic Treatment

This study aimed to evaluate the in vitro performance of collagen-based sponges as a drug delivery system for intracanal antimicrobial administration. Four groups of loaded collagen-based sponges (A, 0.3% w/v amoxicillin trihydrate: potassium clavulanate (4:1); B, 0.03% w/v chlorhexidine gluconate [CHX]; C, 0.3% w/v amoxicillin trihydrate: potassium clavulanate (4:1) and 0.03% w/v CHX; D, 1% w/v amoxicillin trihydrate: potassium clavulanate (4:1) and 0.03% w/v CHX) were designed. Release kinetics were tested in vitro on cultures in Petri dishes, and the effect on bacterial biofilms was studied ex vivo on 114 extracted human single-rooted teeth. Biofilm formation was tested by scanning electron microscopy (SEM). Collagen sponges containing amoxicillin and chlorhexidine showed a time-sustained antimicrobial effect in vitro and were also able to destroy mature biofilms ex vivo. This datum was validated by means of SEM-based study of E. faecalis and S. aureus biofilms.

Evaluation of different irrigation solutions and activation methods on removing calcium hydroxide

Background/purpose

Dual Rinse HEDP is a soft chelator which can be used simultaneously with sodium hypochlorite (NaOCl). The aim of this study is to evaluate the efficacy of Dual Rinse HEDP with different irrigation systems on removing calcium hydroxide [Ca(OH)₂].

Materials and methods

Eighty maxillary central incisor teeth were shaped and a standard groove on the apical third of the root canal surface was prepared. The root canals were filled with Ca(OH)₂. Samples were divided into two groups according to the solution and these two groups were divided into three subgroups based on the activation technique. In group 1 (n = 10) Ca(OH)₂ was removed using conventional irrigation with NaOCl whereas in group 2 (n = 10) conventional irrigation with NaOCl - Dual Rinse HEDP mixture was used. Group 3 (n = 15) and group 4 (n = 15) received sonic activation with the same irrigants as groups 1 and 2 respectively. In group 5 (n = 15) passive ultrasonic irrigation (PUI) was used with NaOCl while in group 6 (n = 15) the irrigant was the mixture. The amount of remaining Ca(OH)₂ in the artificial grooves were evaluated under a light microscope.

Results

None of the procedures managed to completely remove the Ca(OH)₂ from artificial grooves. There was no significant difference between the groups (p = 0.053). The scores were significantly lower in PUI group compared to the other techniques between NaOCl groups (p = 0.021).

Conclusion

Dual Rinse HEDP does not make a difference on elimination of Ca(OH)₂. PUI is more efficient than both methods when NaOCl solution is used.

The effect of intracanal medicaments used in Endodontics on the dislocation resistance of two calcium silicate-based filling materials

Background

Intracanal medicaments can be used in various endodontic conditions including multiple visit endodontics after trauma or in regenerative endodontics. These medicaments should be removed from the root canal before the placement of the filling or repair material. The aim of the present study was to evaluate the effect of prior calcium hydroxide (Ca(OH)₂) and modified triple antibiotic paste (mTAP) placement on the push-out bond strength of TotalFill BC fast set putty (BC fast set putty) to root dentin when compared to mineral trioxide aggregate (MTA).

Methods

The root canals of 45 extracted mandibular premolars were prepared to a standardized internal diameter (1.5 mm). The specimens were randomly assigned to 3 groups according to the intracanal medicament used: mTAP (a mixture of metronidazole, ciprofloxacin, and cefaclor), Ca(OH)₂, and no intracanal medicament. After 1 week, the medicaments were removed, and the middle third of the roots were cut into two transverse sections (2.0 ± 0.05) (n = 90 slices). Thereafter, the specimens were divided into two subgroups (n = 45 each): MTA or BC putty. After 1 week, the push-out test was performed and failure mode was evaluated. The data were statistically analyzed using two-way ANOVA and Tukey’s post hoc.

Results

The application of the intracanal medicament did not significantly affect the bond strength of BC putty (p > .05). For MTA, the prior application of Ca(OH)₂ or mTAP significantly decreased the dislocation resistance (p < .05). Specimens in the MTA subgroups showed an almost equal number of cohesive and mixed types of failure while the majority of the specimens in the BC putty subgroups revealed the cohesive type.

Conclusions

Ca(OH)₂ and mTAP promoted lower bond strength of MTA to root dentin compared to the control group. However, the BC fast set putty bond strength to dentin was not affected by prior medication with Ca(OH)₂ or mTAP.

Comparison of Two Different Methods in the Removal of Oil-Based Calcium Hydroxide From Root Canal System: A Triple-Blinded Randomised Clinical Trial

OBJECTIVE

To compare the effectiveness of rotary master apical file (RMAF) with ultrasonic activation of endodontic file (UAF) in the removal of silicon oil-based calcium hydroxide (SOBCH) from the canal.

METHODS

Ethical review committee approval and informed consent was obtained. 60 cases with necrotic teeth in which silicon oil-based intracanal medicament (Metapex) was to be placed were randomised in one of the two groups using sealed envelopes containing assignment codes for medicament removal: RMAF and UAF group. After standard protocol of coronal access, cleaning and shaping, silicon oil-based SOBCH was placed using a Lentulo spiral. A periapical radiograph was taken after SOBCH placement to check for adequate adaptation. On 7th day, after instrumentation and medicament removal according to respective group, a second radiograph was taken to evaluate the effectiveness. Effectiveness was calculated using a graded scale in which 0 and 1 are effective and 2 and 3 are ineffective cleaning. Teeth were statistically analyzed using the Mann Whitney U and Chi-square test.

RESULTS

There was no statistically significant difference in the removal effectiveness of group RMAF and Group UAF at coronal (P=0.74) middle (P=0.71) and apical third (P=0.68). According to the graded score both techniques were equally effective in cleaning at all thirds of canal (RMAF=Apical: 1.09+-0.70, Middle: 0.61+-0.80, Coronal: 0.33+-0.48 and UAC=Apical: 1.00+-0.77, Middle: 0.52+-0.74, Coronal: 0.28+-0.46). Effectiveness of SOBCH removal using the two methods was not statistically significant between maxillary and mandibular teeth (P=0.35).

CONCLUSION

Both the removal methods, Ultrasonic activation of file and Rotary master apical file, for SOBCH were equally effective in all the thirds of canal. And none of the techniques were able to completely remove the SOBCH. Effectiveness of SOBCH removal using the two methods was not statistically different between maxillary and mandibular teeth. (EEJ-2020-07-183).

Evaluation of the evidence of effectiveness of ultrasonic activated irrigation for root canal treatment

Data sources Cochrane Library, Embase, LILACS, PubMed, SciELO, Scopus databases, endodontic journals and textbooks. Study selection Two independent reviewers screened the titles, abstracts and/or full-text of the both clinical or in vitro studies that used ultrasonic irrigant activation for management of teeth needing root canal therapy. Results The study included three clinical studies and 45 in vitro studies. The study reported no evidence of any benefit of ultrasonic activation over needle irrigation in improving the healing rate of apical periodontitis. While the study reported that the evidence for disinfection of the root canal was inconclusive it did show evidence of the efficacy of ultrasonic irrigation over needle irrigation when removal of pulp tissue remnants and hard tissue debris was assessed. Conclusion The study reported that it was essential that there should be more research into the antimicrobial effect on healing in periapical periodontitis when teeth are treated using ultrasonic activation.

The Effect of Submucosal Injection of Corticosteroids on Pain Perception and Quality of Life after Root Canal Treatment of Teeth with Irreversible Pulpitis: A Randomized Clinical Trial

INTRODUCTION

The aim of the present investigation was to study the effect of local infiltration of corticosteroids on postoperative pain and quality of life (QOL) in teeth with irreversible pulpitis after 1-visit endodontic treatment.

METHODS

In this double-blind randomized clinical trial, 242 healthy patients with irreversible pulpitis undergoing 1-visit endodontic treatment were included. Forty-five patients were lost during the follow-up, and the remaining 197 patients were followed for 7 days (67 patients in the placebo group, 66 in the long-acting betamethasone group, and 64 in the dexamethasone group). The patients marked their level of pain and QOL before treatment and at 6-, 12-, 24-, 48-, and 72-hour and 7-day postoperative intervals using a questionnaire. Freidman and Kruskal-Wallis tests were used for statistical analysis. P ≤ .05 was considered significant.

RESULTS

The pain was more severe in the placebo group compared with the other groups at all time intervals. A significant increase was observed in pain severity after 12 hours in all 3 groups. In general, the pain was less severe in the dexamethasone group compared with the betamethasone group at 6-, 12-, and 24-hour intervals. The pain severity was similar in both groups at 48 hours, and it was less severe in the long-acting betamethasone group compared with the dexamethasone group after 72 hours and 7 days. There were no significant differences in the betamethasone and dexamethasone groups in pain intensity between males and females. Moreover, overall pain perception was higher in the mandible than in the maxilla. There was an inverse and significant relationship between pain severity and QOL.

CONCLUSIONS

Infiltration of long-acting betamethasone and dexamethasone resulted in decreased postoperative pain experience. Dexamethasone was more effective in alleviating pain within the first 24-hour period after treatment. Infiltration of long-acting betamethasone and dexamethasone exhibited the same efficacy in 48 hours. The efficacy of long-acting betamethasone in pain relief lasted for 7 days. The QOL in the 2 groups receiving corticosteroids was higher than that in the placebo group.

An in vitro study on the efficacy of removing calcium hydroxide from curved root canal systems in root canal therapy

To compare the efficacy of various irrigants (citric acid, ethylenediaminetetraacetic acid (EDTA) and NaOCl) and techniques in removing Ca(OH)₂ in two types of curved root canal systems, simulated root canals with specific curvatures were used to investigate the effects of different irrigants and instruments on Ca(OH)₂ removal. The optimal methods were verified on extracted human teeth. Simulated root canals were assigned to one of two groups based on the irrigation solution: 10% citric acid or 2.5% NaOCl. Each group was divided into four subgroups according to the technique used to remove Ca(OH)₂. The percentage of Ca(OH)₂ removal in different sections of root canals was calculated. On the basis of the results obtained for the simulated canals, 10% citric acid and 17% EDTA were applied to remove Ca(OH)₂ from the extracted human teeth with curved root canal systems. The teeth were scanned by micro computed tomography to calculate the percentage of Ca(OH)₂ removal in the canals. In simulated root canals, we found that 10% citric acid removed more Ca(OH)₂ than 2.5% NaOCl in the 0–1 mm group from the apex level (P<0.05). Ultrasonic and EndoActivator activation significantly removed more Ca(OH)₂ than a size 30 K file in the apical third (P<0.05). However, there were no significant differences in any sections of the canals for 10% citric acid or 17% EDTA in removing Ca(OH)₂ in extracted human teeth. We concluded that it was effective to remove residual Ca(OH)₂ using the decalcifying solution with EndoActivator or Passive Ultrasonic Irrigation in a curved root canal system. A protocol for Ca(OH)₂ removal was provided based on the conclusions of this study and the methods recommended in previous studies.

Comparison of different techniques for removal of calcium hydroxide from straight root canals: an in vitro study

To compare four different techniques for removal of calcium hydroxide from straight root canals. The present study used the design suggested by Lee et al. (Int Endod J 37:607-612, 32) and van der Sluis et al. (Int Endod J 40:52-57, 17). One-hundred and ten extracted human teeth with straight root canals were prepared to ISO-size 50 and split longitudinally. Two lateral grooves were prepared, filled with calcium hydroxide and the root halves reassembled in a muffle. Calcium hydroxide was removed using one of five techniques: (1) passive ultrasonic irrigation, (2) hydrodynamic irrigation using RinsEndo^®, (3) sonic irrigation using the EndoActivator^®, (4) motor-driven plastic brush (CanalBrush™), and (5) manual irrigation with a syringe as the control group. Distilled water was used as irrigant. Cleanliness of the grooves was scored under a microscope with 40× magnification. For intraindividual reproducibility and interrater agreement, Cohens Kappa was calculated. Results of scoring were analyzed using a non-parametric test. Post hoc pairwise comparisons were used for irrigation techniques (α = 0.05). Passive ultrasonic irrigation performed significantly better than all other groups in the apical groove. Significant differences were found between RinsEndo and CanalBrush (P = 0.01855) and CanalBrush and syringe irrigation (P = 0.00021). In the coronal groove, passive ultrasonic irrigation performed significantly superior and hand irrigation performed significantly worse than all other groups. A statistically significant interaction was shown between irrigation technique and localization of the groove (P = 0.01358). The coronal grooves showed more remaining calcium hydroxide than the apical grooves. Complete removal of calcium hydroxide from the root canal could not be achieved with any of the techniques investigated. The highest degree of cleanliness resulted from the use of passive ultrasonic irrigation.

Removal of calcium hydroxide from Weine Type II systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study

Objective

This study compared the effectiveness of Er:YAG laser-activated irrigation (PIPS), passive ultrasonic irrigation (PUI) with EndoUltra and standard needle irrigation (SNI) in the removal of calcium hydroxide [Ca(OH)2] from the mesial roots of Weine Type II mandibular molars.

Material and Methods

Thirty mandibular molars were screened by µCT for the presence of mesial roots with complex intra-canal anatomy and a common apical foramen. The teeth were enlarged to a standardized 25/.06 preparation and filled with Ca(OH)2 paste. Specimens were divided into three groups (n=10) according to the technique used for Ca(OH)2 removal: PIPS, at 15 Hz and 20 mJ using a 9 mm long, 600 µm diameter tip; PUI using a 15/.02 tip; and SNI (30 Ga. side-vented needle). Equal volumes of 8.25% NaOCl and 17% EDTA were used in all groups. µCT was used to measure the initial amount of Ca(OH)2 present and to assess the residual volume of Ca(OH)2 following each irrigation protocol. Data were analyzed using Tukey HSD and Kruskal-Wallis tests (α=5%).

Results

The mean volume of Ca(OH)2 before removal was significantly higher in the coronal third than in the middle and apical third (p<0.001). Ca(OH)2 was similarly removed from the coronal and middle thirds with the three methods used (p>0.05). PIPS (median 0%; IQR: 0-0) showed significant higher Ca(OH)2 removal in the apical third than PUI (median 100%, IQR: 85-100) and SNI (median 47%; IQR: 16-72) (p<0.001).

Conclusions

PIPS laser-activation was more effective for the removal of Ca(OH)2 from mesial roots of mandibular molars with Weine Type II canal configurations than PUI with EndoUltra and SNI.

Comparison of the Effectiveness of Different Techniques for Supportive Removal of Root Canal Filling Material

Objective:

To compare the cleanliness of oval cross-sectioned root canals after using different supportive techniques for removal of root canal filling material as part of retreatment process.

Methods:

One hundred mandibular canine teeth with flat oval cross-sectioned canals were instrumented up to #40.06 and obturated using the warm vertical compaction technique. Removal of the gutta-percha and sealer was performed using the D-RaCe nickel-titanium retreatment instruments. The roots were randomly divided into four groups of 25 teeth, and the activation processes were applied: XP-endo Finisher (XP), EndoActivator (EA) and IrrıSafe (IS). Conventional needle irrigation (CI) was used as the control group. The teeth were sectioned, and digital images were captured. The photographs were analysed using AutoCAD software regarding the area of residual root filling. Kruskal–Wallis and post hoc Dunn’s tests were performed for statistical analysis.

Results:

There was significantly less gutta-percha and sealer remnant in the XP group than in the other groups (P<0.05). The CI group contained significantly more gutta-percha and sealer remnant than the other groups (P<0.05). The apical third of the CI group had significantly more residual gutta-percha and sealer when compared to that of the other groups (P<0.05).

Conclusion:

Within the limitations of this study, the amount of gutta-percha and sealer in the XP group was lower than that in the EA, IS, and CI groups.

Effect of double antibiotic and calcium hydroxide pastes on dislodgement resistance of an epoxy resin-based and two calcium silicate-based root canal sealers

OBJECTIVES

The purpose of the present study was to determine the dislodgement resistance of AH Plus, MTA Fillapex, and Total Fill BC sealer to root canal dentin walls following placement of calcium hydroxide (CH) or double antibiotic paste (DAP) medicaments.

MATERIALS AND METHODS

Root canals of 90 single-rooted human mandibular premolar teeth were instrumented with Reciproc rotary instruments to a size R50. The teeth were randomly divided into two experimental groups: those receiving an intracanal medicament with either CH or DAP and a control group (n = 30). After 3 weeks, the medicaments were removed by irrigation with 5 mL of 2.5 % NaOCl, 5 mL 17 % EDTA, and 5 mL distilled water under sonic agitation. Each group was then subdivided into three subgroups (n = 10), and the canals were filled with either AH Plus, MTA Fillapex, or Total Fill BC sealer. After 1 week, a push-out test was applied to the specimens and the results were analyzed using one-way analysis of variance (ANOVA) and post hoc Tamhane's tests.

RESULTS

Regardless of the type of intracanal medicament used, Total Fill BC Sealer and MTA Fillapex showed the highest and lowest bond strength, respectively (P < 0.05). The use or absence of medicaments did not significantly affect the dislodgment resistance of root canal fillings (P > 0.05). Prior CH placement improved dislodgement resistance of all sealers without statistical difference (P > 0.05). Adhesive failure between core and sealer was the most frequent failure mode.

CONCLUSIONS

Prior application of CH or DAP did not significantly affect the adhesion of the AH Plus, MTA Fillapex, and Total Fill BC Sealers.

CLINICAL RELEVANCE

There is a little information about the influence of antibiotic medicaments on the bond strength of root canal sealer. These findings suggest that the use of DAP does not affect the adhesion strength of AH Plus, MTA Fillapex, and Total Fill BC Sealers.