Abstract
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.
Highlights
Overwhelming evidence indicates that microorganisms have a fundamental role in the pathogenesis of periradicular diseases.[1]To eliminate the remaining microbes after root canal preparation and to prevent an interappointment reinfection of the root canal system, intracanal medications are recommended.[2]
Calcium hydroxide [Ca(OH)2] has been widely used as an intracanal medication owing to its good antibacterial properties and biocompatibility.[2]
The percentages of Ca(OH)[2] removal in simulated root canals are shown in Table 2 and Table 3 and Figure 2
Summary
Overwhelming evidence indicates that microorganisms have a fundamental role in the pathogenesis of periradicular diseases.[1]To eliminate the remaining microbes after root canal preparation and to prevent an interappointment reinfection of the root canal system, intracanal medications are recommended.[2]. The antibacterial effect of Ca(OH)[2] is most effective after direct contact with microorganisms.[2,6] it is important to obtain a compact and homogenous filling of Ca(OH)[2] in the entire root canal system.[6] Before obturation, Ca(OH)[2] should be completely removed from the root canal system to avoid any possible negative influence on treatment. Residual Ca(OH)[2] might lead to apical leakage[7] and reduced sealer adaptation,[8] and might interact with zinc oxide eugenol[9] and decrease the dentin bond strength.[10] any Ca (OH)[2] that is placed in the root canal system as an intracanal medication must be completely removed before root canal obturation
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