An in vitro comparison of irrigation using photon-initiated photoacoustic streaming, ultrasonic, sonic and needle techniques in removing calcium hydroxide.

Abstract

To evaluate the effect of various techniques including photon-initiated photoacoustic streaming (PIPS), ultrasonic, sonic and needle irrigation on the removal of calcium hydroxide [Ca(OH)2 ] from artificial grooves created in root canals. The root canals of 48 extracted single-rooted teeth with straight canals were prepared using ProTaper rotary instruments up to size 40. After the specimens had been split longitudinally, a standardized groove was prepared in the apical part of one segment that was filled with Ca(OH)2 powder mixed with distilled water. Each tooth was reassembled and the apices closed with wax. The specimens were irrigated for 60s with one of the following techniques: needle irrigation using 17% EDTA, PIPS with 17% EDTA, ultrasonic irrigation using 17% EDTA and sonic irrigation (EndoActivator) using 17% EDTA. The root segments were then disassembled, and the amount of remaining Ca(OH)2 evaluated under a stereomicroscope at 25× magnification. A pixel count of Ca(OH)2 remaining on the artificially created grooves was recorded as a percentage of the overall groove surface. The data were evaluated statistically using one-way analysis of variance and the least significant difference post hoc tests at 95% confidence level (P=0.05). Photon-initiated photoacoustic streaming was superior in removing Ca(OH)2 as compared to needle irrigation (P<0.001), sonic irrigation (P<0.001) and ultrasonic irrigation (P=0.046). Photon-initiated photoacoustic streaming provided complete removal of Ca(OH)2 from artificial grooves in straight root canals. Ultrasonic irrigation enhanced the Ca(OH)2 removal capacity of irrigating solution but did not provide complete removal from artificial grooves.