Abstract
The goal of this study was to evaluate the efficacy of the Self-Adjusting File (SAF) and ProTaper for removing calcium hydroxide [Ca(OH)2] from root canals. Thirty-six human mandibular incisors were instrumented with the ProTaper system up to instrument F2 and filled with a Ca(OH)2-based dressing. After 7 days, specimens were distributed in two groups (n=15) according to the method of Ca(OH)2 removal. Group I (SAF) was irrigated with 5 mL of NaOCl and SAF was used for 30 seconds under constant irrigation with 5 mL of NaOCl using the Vatea irrigation device, followed by irrigation with 3 mL of EDTA and 5 mL of NaOCl. Group II (ProTaper) was irrigated with 5 mL of NaOCl, the F2 instrument was used for 30 seconds, followed by irrigation with 5 mL of NaOCl, 3 mL of EDTA, and 5 mL of NaOCl. In 3 teeth Ca(OH)2 was not removed (positive control) and in 3 teeth canals were not filled with Ca(OH)2 (negative control). Teeth were sectioned and prepared for the scanning electron microscopy. The amounts of residual Ca(OH)2 were evaluated in the middle and apical thirds using a 5-score system. None of the techniques completely removed the Ca(OH)2 dressing. No difference was observed between SAF and ProTaper in removing Ca(OH)2 in the middle (P=0.11) and the apical (P=0.23) thirds. The SAF system showed similar efficacy to rotary instrument for removal of Ca(OH)2 from mandibular incisor root canals.
Highlights
The use of calcium hydroxide [Ca(OH)2] as intracanal dressing has been recommended WR LQGXFH DSH[L¿FDWLRQ WR FRQWURO LQWHUQDO DQG H[WHUQDO LQÀDPPDWRU\ URRW UHDEVRUSWLRQ DQG LQ the treatment of necrotic teeth with periapical lesions[2,6,7,17]
Failing to completely remove the dressing may interfere with the seal, adhesion, and penetration of endodontic sealers[4,5,14], adversely affecting the clinical performance of the sealer and possibly the long-term prognosis of root canal therapy[14]
Biomechanical preparation of the root canals was performed using ProTaper Universal rotary system (Dentsply Maillefer) from S1 to F2 driven at 250 rpm with 1.6 N/cm of torque using an electric engine (X-Smart; Dentsply Maillefer) under irrigation with 2.5% NaOCl
Summary
The use of calcium hydroxide [Ca(OH)2] as intracanal dressing has been recommended WR LQGXFH DSH[L¿FDWLRQ WR FRQWURO LQWHUQDO DQG H[WHUQDO LQÀDPPDWRU\ URRW UHDEVRUSWLRQ DQG LQ the treatment of necrotic teeth with periapical lesions[2,6,7,17]. The most commonly described method for Ca(OH)[2] removal is the use of a master apical ¿OH DW ZRUNLQJ OHQJWK FRPELQHG ZLWK WKH XVH of sodium hypochlorite (NaOCl) irrigation and EDTA3,13,20,21,23. Rotary instruments[11,12], sonically or ultrasonically-activated tips[3,24], and devices such as the CanalBrush[22] in conjunction with irrigation have been recommended. None of these methods, have been able to completely remove Ca(OH)[2] from the root canal, especially in the apical third[3,11]. Its thin compressible walls are made of a nickel-titanium mesh, allowing its shape to adapt to root canal’s along the crosssection, as well as longitudinally. The SAF will three-dimensionally conform to canals with circular or oval cross-section, allowing maintenance of the original canal shape.
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