Effectiveness of four different techniques in removing intracanal medicament from the root canals: An in vitro study

Efficacy of various techniques in calcium silicate-based intracanal medicament removal: a micro-CT analysis

The purpose of this study was to evaluate the efficacy of different techniques in removing calcium silicate intracanal medicament (Bio-C Temp). Forty human single-canaled premolars were randomly distributed into five groups (n = 8). All root canals were instrumented, then filled with Bio-C Temp. Following 1-week incubation, the intra-canal medicament was removed using one of five techniques according to tooth group: conventional syringe irrigation, Endo Activator, passive ultrasonic irrigation (PUI), ProTaper Universal F3 and XP-endo Finisher (XPF). Micro-CT scanning was performed before and after removal of Bio-C Temp. All techniques significantly reduced the volume of Bio-C Temp (p < 0.001) without reaching complete elimination. The percentage of Bio-C Temp removed was significantly higher in the XPF group (98.2%) compared to conventional syringe irrigation (70.6%), the Endo Activator (75.7%), and the ProTaper Universal (76.6%). There was no significant difference between the XPF and PUI (95.1%) groups. None of the removal techniques were able to completely remove Bio-C Temp from the root canal. However, XPF was the most effective method, but was not statistically significant when compared to PUI. Clinical Relevance: This study demonstrated that both XPF and PUI outperform conventional irrigation in removing Bio-C Temp intracanal medicament.

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

Background

This study aimed to compare the efficacy of EndoActivator, passive ultrasonic irrigation, and Ultra X in removing calcium hydroxide from the artificial grooves in root canal walls.

Methods

The root canals of 50 extracted human maxillary incisors were instrumented by using the ProTaper rotary system up to #F4 (size 40/0.06 ProTaper) and the teeth were split longitudinally. Lateral grooves were created in the apical and coronal parts of one half and the middle part of the other half. Calcium hydroxide paste was applied to the grooves and the root halves were reassembled. After seven days, the calcium hydroxide was removed from the canal by using one of the EndoActivator, passive ultrasonic irrigation, and Ultra X devices; one group went without irrigation (control group). The CH remnants in the grooves were scored at 20× magnification. The data were analyzed by using the Kruskal–Wallis, Dunn’s post hoc, and Friedman tests. P < 0.05 was considered to be statistically significant.

Results

No statistically significant difference existed among the experimental groups at the coronal and middle grooves (P > 0.05). However, Ultra X was significantly more effective than passive ultrasonic irrigation at the apical grooves (P = 0.023).

Conclusion

Within the limitations of this study, Ultra X can be reported to remove the calcium hydroxide from the apical third more efficiently than passive ultrasonic irrigation.

Do Calcium Chelators Play a Role in the Removal of Calcium Hydroxide From Root Canals? A Systematic Review of Laboratory Studies

OBJECTIVE

To identify whether root canal irrigants with calcium chelation ability play a role in the removal of calcium hydroxide (CH) from the root canals when compared to non-chelators.

METHODS

The protocol is registered in the Open Science Framework registry (doi 10.17605/OSF.IO/CHG2Q). PubMed, Scopus, Embase, Cochrane Library, ProQuest, Google Scholar, Science direct and open grey databases were searched until March 2021. Laboratory studies comparing the effectiveness of calcium chelators in the removal of CH with non-chelators delivered using needle irrigation, irrigation agitation or instrumentation techniques were included. The quality of included studies was appraised using a modified Joanna Briggs Institute critical appraisal checklist for a randomised clinical trial. Two independent reviewers were involved in study selection, data extraction, appraising the quality of studies. Any disagreements were resolved by a third reviewer.

RESULTS

The current review included 17 studies, with 16 being of "moderate" quality and one of "low" quality. Due to methodological differences within the included studies, quantitative analysis was not performed. Laboratory studies were only included in the current review because no clinical study exists on this topic. Evidence from the review indicates that calcium chelators are superior to non-chelators in the removal of CH when used with needle irrigation, passive ultrasonic irrigation and instrumentation techniques.

CONCLUSION

Calcium chelators are superior in the removal of CH from the root canal system over non-chelators.

Effect of Calcium Hydroxide and Nano Calcium Hydroxide on Push-out Bond Strength of Epoxy Resin Sealer to Root Canal Dentin

Introduction

The goal of this paper was to determine the impact of calcium hydroxide (CH) and nano-calcium hydroxide (NCH) on the push-out bond strength of an epoxy resin-based sealer.

Materials and Methods

A total of 48 mandibular premolars were decoronated in vitro and instrumented by a ProTaper rotary system up to F4. The specimens then were randomly allocated into 3 groups (n=16). The two intervention groups were treated with either CH or NCH and one control group which did not receive any intracanal medicament. After one week of medicament placement, the specimens were irrigated by 10 mL 17% EDTA, followed by 10 mL 2.5% NaOCl and an ultimate flushing by 5 mL sterile saline. The samples were obturated using AH-Plus Jet sealer and gutta-percha by lateral condensation technique. Push-out test was done by a universal test machine to evaluate the bond strength among the sealer and the root canal dentin. Repeated measurement analysis followed by Tukey's HSD and Bonferroni post-hoc tests were used for data analysis.

Results

The control group showed a higher push-out bond strength in comparison to the specimens in the CH and NCH groups (P<0.05). In spite of the greater push-out bond strength of the samples treated with NCH in comparison to those in CH group, no statistically notable difference was found among them (P>0.05). Additionally, irrespective of the kind of medicament, the bonding at the apical level of the root canal was stronger compared to the coronal third (P<0.001).

Conclusion

According to the present in vitro study, application of CH and NCH resulted in a significant reduction of the bond strength between the epoxy resin-based sealer and dentinal walls. Although, application of these medicaments resulted in reduction of bonding of epoxy resin-based sealers root canal dentin significantly.

Removal efficacy of propolis/calcium hydroxide medicaments from the root canal

Objective:

To compare the removal efficacy of propolis and calcium hydroxide medicaments from the root canal using manual irrigation with sodium hypochlorite.

Methods:

A randomized controlled trial was conducted at the Department of Restorative Dentistry and Endodontics, College of Dentistry, King Faisal University for two months. Thirty single-rooted upper or lower permanent anterior teeth with sound root and closed apex were selected. After cleaning and shaping of canal by protaper rotary, teeth were randomly divided into two groups. In group “A,” propolis paste was placed while calcium hydroxide was placed inside root canals in group “B,” followed by temporary restoration. After seven days, intracanal medicament was removed using 25 # K file and irrigated canal by 5 ml of 3.0% sodium hypochlorite. A final irrigation of 2-ml of 17% EDTA for three minutes followed by 1-ml of normal saline was performed. A diamond disc was used to cut the crowns of the teeth from cemento-enamel junction and divide the roots into two halves. These sectioned halves were then observed under a stereomicroscope at 7X magnification and analyzed using Adobe Photoshop. Magnetic lasso tool was used to calculate the percentage of residual medicament in the canals by comparing the pixel proportion of the medicament with the total pixel proportion of the canal. Paired t-test was used to see the difference in the number of remaining remnants between propolis and calcium hydroxide. A p-value of less than 0.5 was considered statistically significant.

Results:

A statistically significant difference (p-value < 0.001) was observed in the percentage of remaining remnants between propolis (23.22%) and calcium hydroxide (38.58%) after thorough irrigation with sodium hypochlorite.

Conclusion:

Propolis is superior to calcium hydroxide in terms of their removal potency from the root canal after thorough irrigation with sodium hypochlorite.

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).

An in vitro evaluation of various irrigation techniques for the removal of double antibiotic paste from root canal surfaces

Objective

The aim of this study was to investigate the effectiveness of conventional syringe irrigations, passive ultrasonic irrigation (PUI), Vibringe, CanalBrush, XP-endo Finisher, and laser-activated irrigation (LAI) systems in removing double antibiotic paste (DAP) from root canals.

Material and Methods

One hundred five extracted single-rooted teeth were instrumented. The roots were split longitudinally. Three standard grooves were created and covered with DAP. The roots were distributed into seven groups: Group 1, beveled needle irrigation; Group 2, double side-vented needle irrigation; Group 3, CanalBrush; Group 4, XP-endo Finisher; Group 5, Vibringe; Group 6, PUI; Group 7, LAI. The amount of remaining DAP was scored under a stereomicroscope.

Results

Group 4, Group 6, and Group 7 removed significantly more DAP than the other protocols in the coronal region. Group 7 was more efficient in the middle region; however, no significant difference was found between Group 7 and Group 6. No differences were found between groups in the apical region either, except for the comparisons between groups 7 and 2, and groups 2 and 3.

Conclusions

None of the investigated protocols were able to completely remove the DAP from the grooves. The Vibringe and XP-endo Finisher systems showed results similar to those of conventional needle irrigation.

Comparison of different agitation methods for the removal of calcium hydroxide from the root canal: Scanning electron microscopy study

Aim:

This ex vivo study compared the efficiency of different irrigations systems to remove calcium hydroxide from root canal walls, especially from the apical third by using scanning electron microscopy (SEM).

Materials and Methods:

Eighty-four single-rooted teeth were divided into 4 groups of 20 teeth each, according to different irrigation protocols using a 30-gauge slot-tipped needle, ultrasonic irrigation system, erbium-doped yttrium aluminum garnet laser (Er: YAG) laser, and EndoVac system. The rest 4 teeth were used as control groups (2 positive and 2 negative control groups). After coronal access, all teeth were instrumented by Protaper Next rotary files (Dentsply-Maillefer, Ballaigues, Switzerland) up to size X3, followed an irrigation protocol and filled with pure calcium hydroxide powder mixed with saline. Teeth were stored in an incubator for 7 days, and then, calcium hydroxide was removed using 3 techniques: Manually (Group 1), by ultrasonic irrigation (Group 2), by laser Er: YAG and x-pulse tip (Group 3), and by EndoVac system (Group 4). The teeth of control groups were instrumented as the experimental groups; no removal technique was applied in positive group, whereas in negative one, the root canals were left empty. Teeth were sectioned longitudinally and observed under SEM Results were statistically analyzed with the Kruskal–Wallis Test and Mann–Whitney Test.

Results:

The results showed a significant difference between laser and the other three groups in coronal and middle root third, but no statistic difference in apical third.

Conclusion:

Laser improved the removal of calcium hydroxide in comparison with conventional techniques.