Removal Of Calcium Hydroxide Research Articles

Effect of various calcium hydroxide removal protocols on the dislodgement resistance of biodentine in an experimental apexification model

Background/purposeResidual calcium hydroxide (CH) in the root canal dentine walls may influence the adhesion of tricalcium silicate-based materials. The aim of this study is to evaluate the effect of various CH removal protocols on the dislodgement resistance of biodentine from simulated immature root canals in an experimental apexification model. Materials and methodsCH was applied to 120 simulated immature root canals. The samples were divided into 12 experimental groups (n = 10) according to the applied irrigation protocols used for the removal of CH: Group 1: Sodium hypochlorite (NaOCl), Conventional needle irrigation (CNI); Group 2: NaOCl, EndoActivator; Group 3: NaOCl, XP-endo Finisher; Group 4: NaOCl- Ethylenediaminetetraacetic acid (EDTA), CNI; Group 5: NaOCl-EDTA, EndoActivator; Group 6: NaOCl-EDTA, XP-Endo Finisher; Group 7: NaOCl+etidronic acid (HEBP), CNI; Group 8: NaOCl+HEBP, EndoActivator; Group 9: NaOCl+HEBP, XP-endo Finisher; Group 10: NaOCl- Peracetic acid (PAA), CNI; Group 11: NaOCl-PAA, EndoActivator; Group 12: NaOCl-PAA, XP-endo Finisher; Control Group: CH was not applied. Biodentine was placed at the apical thirds of 130 immature root canals. Vertical loading was applied to biodentine fillings inside the dentin discs. Maximum force to dislodge the material was statistically analyzed with ANOVA. ResultsThe control, NaOCl+HEBP (CNI, EndoActivator, XP-endo Finisher) and NaOCl-PAA (EndoActivator, XP-endo Finisher) groups exhibited the lowest dislodgement resistance values (p < 0.001). When used CNI, irrigation with NaOCl+HEBP resulted in lower resistance to dislodgement of biodentine compared to NaOCl, and NaOCl-EDTA (p < 0.001). ConclusionAdhesion of apical barrier materials to root canal dentine can be influenced by the irrigation protocols used for CH removal.

Analysis of the ability of XP Clean and easy clean files to remove Calcium Hydroxide paste from simulated internal tooth resorptions

Aim: This study compared the ability of instruments XP Clean and Easy Clean to remove the calcium hydroxide paste from simulated internal root resorptions. Methodology: Thirty freshly extracted human lower incisors were sectioned through the long axis after biomechanical preparation with ProTaper files. On each half, a defect simulating an internal resorption was fabricated on the middle root canal third using a round bur. One week after insertion of calcium hydroxide paste, the teeth were divided into three groups according to the technique employed: G1-Conventional irrigation; G2-XP Clean and G3-Easy Clean. Each instrument was used in three cycles of 20 seconds, followed by renewal with 2 ml of irrigant. Thereafter, the specimens were analyzed on a stereoscopic magnifying glass to analyze the removal of dressing material. Results: Similar performance was observed for both methods employed, even though the rates of absence of removal were higher for the group Easy Clean compared to the group XP Clean. Conclusions: The XP Clean presented better results in removing the calcium hydroxide paste compared to Easy Clean, with statistically significant difference.

Effect of tip insertion depth and irradiation parameters on the efficacy of cleaning calcium hydroxide from simulated lateral canals using Er:YAG laser- or ultrasonic-activated irrigation

Background/purposeLaser-activated root canal irrigation (LAI) with an Er:YAG laser is considered more effective than other irrigation methods, whereas the effectiveness of LAI in cleaning lateral canals far from the laser tip remains unclear. This study aimed to compare the efficacy of removing calcium hydroxide [Ca(OH)2] paste from lateral canals using LAI or ultrasonic-activated irrigation (UAI), and to examine the effect of tip insertion depth and laser irradiation parameters on cleaning efficacy. Materials and methodsRadiopaque Ca(OH)2 paste (Calcipex II) was injected into lateral canals 6 mm from the root apex in 192 J-shaped simulated root canal models. LAI (Erwin AdvErl; 30 or 70 mJ; 10 or 20 pulses per second; laser tip R200T or R600T) and UAI (ENAC SE10; output setting: 3) were performed 3 times for 20 s. The laser tip was placed at 8–0 mm coronal to the lateral canal location. The volume of Ca(OH)2 paste before and after the experiment was measured using micro-CT (SMX-100CT). ResultsThe Ca(OH)2 removal rate by LAI was significantly higher than UAI at all tip insertion depths. Ca(OH)2 removal rate in LAI was significantly lower at the 8 mm position compared with other positions (P < 0.05). When the tip insertion depth was fixed at this position, Ca(OH)2 removal rate increased significantly when pulse energy and tip diameter were increased (P < 0.05). ConclusionLAI removed Ca(OH)2 paste from lateral canals away from the tip more effectively than UAI. Increasing the pulse energy and tip diameter improved the removal efficiency.

Final Endodontic Irrigation with 70% Ethanol Enhanced Calcium Hydroxide Removal from the Apical Third

IntroductionThe purpose of this study was to evaluate the cleanliness of root canal walls and dentinal tubules after attempting to remove the calcium hydroxide dressing with different irrigant solutions and the use of nonactivated irrigation or passive ultrasonic irrigation (PUI). MethodsAfter root canal instrumentation, 80 single-rooted teeth were filled with calcium hydroxide mixed with propylene glycol and 0.1% rhodamine B dye and inserted into canals with a Lentulo spiral. The calcium hydroxide dressing was initially removed with 10 mL saline solution and reinstrumentation with the master apical file. Then, the samples were randomly assigned into 8 experimental groups (n = 10) according to the irrigant solution with or without PUI: 2.5% sodium hypochlorite, 17% ethylenediaminetetraacetic acid + 1.25% sodium lauryl ether sulfate (EDTA-T), 37% phosphoric acid, or 70% ethanol. A final flush with 5 mL saline solution was performed. The percentage of clean root canal walls and the depth of clean dentinal tubules were measured with images of confocal laser scanning microscopy. The groups were compared using the 2-way analysis of variance test with the Bonferroni post hoc test for depth analysis and the Kruskal-Wallis with Dunn post hoc test for the perimeter analysis. ResultsIrrigation with 70% ethanol presented a significantly higher percentage of clean root canal walls and a higher depth of clean dentinal tubules when compared with irrigation with 2.5% sodium hypochlorite and 17% EDTA-T for both irrigation methods (P < .05). No differences were observed between nonactivated irrigation or PUI protocols (P > .05). ConclusionsSeventy percent ethanol enhanced calcium hydroxide removal from the apical root third compared with 2.5% sodium hypochlorite or 17% EDTA-T.

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

Background/purposeDual 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 methodsEighty 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. ResultsNone 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). ConclusionDual 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.

Investigation of a Calcium Hydroxide Overflowing From Root Apex during Calcium Hydroxide Removal

Calcium hydroxide has been widely used as intracanal medicament recently. However, removing calcium hydroxide accumulated in the apical foramen was difficult, and there is a risk of overflowing outside of the apical foramen during removing procedure. In this study, we investigated (1) the status of overflow from root apex foramen in each removal method using hand file or ultrasonic scaler, (2) possibility of reducing overflow in combination with citric acid solution or EDTA solution. Twenty-four maxillary premolar artificial teeth were performed root canal enlargement using K-fail until No.25 or No.30 size of thickness in each 12 teeth. After finishing root canal enlargement, calcium hydroxide was filled within root canal apex completely. Then calcium hydroxide was removed using ultrasonic scaler or hand file. Furthermore purified water, citric acid solution or EDTA solution was prepared as auxiliary agents respectively. After removing calcium hydroxide from each root canal was finished, the condition of calcium hydroxide overflowing from root apex was observed using stereomicroscope. Calcium hydroxide in the root canal was sufficiently removed from root canals in the groups using ultrasonic scaler. However slighted calcium hydroxide was remained around root apex in the groups using hand file. Overflow of calcium hydroxide to outside around root apex was observed both using ultrasonic scaler and hand file. The tendency of calcium hydroxide overflowing was higher in the case of using ultrasonic scaler than using hand file. In the groups of using hand file, no significant difference was observed for the different size of root canal enlargement, however overflow of calcium hydroxide was clearly higher in 30 size of root canal enlargement using ultrasonic scaler. The use of citric acid solution and EDTA solution as auxiliary agents showed that overflow of calcium hydroxide was decreased compared without using them. In particular, the decrease of overflowing was more clearly using citric acid solution than using EDTA solution. It is recommended that using hand file on removal apex areas of calcium hydroxide to reduce amount of overflowing and improve the removal efficiency. Moreover reducing the risk of calcium hydroxide overflowing are expected using citric acid solution or EDTA solution.

Efficacy of Endoactivator, CanalBrush, and passive ultrasonic irrigation in the removal of calcium hydroxide paste with iodoform and p-chlorophenol from root canals.

We evaluated and compared EndoActivator, CanalBrush, and passive ultrasonic irrigation (PUI) in the removal of calcium hydroxide and calcium hydroxide with iodoform and p-chlorophenol paste (Calcipast Forte) from artificial standardized grooves in the apical third of root canals. A total of 34 mandibular premolars were prepared and then split longitudinally. A standardized groove was prepared in the apical part of both segments. The grooves were filled with either calcium hydroxide or Calcipast Forte, and the segments were reassembled. CanalBrush, EndoActivator, or PUI were used. The amount of remaining medicament was evaluated using a four-grade scoring system. None of the irrigation methods could completely remove the pastes from the grooves. More Calcipast Forte paste was detected compared with calcium hydroxide (P < 0.01). PUI was the least effective method in removing Calcipast Forte. It was more difficult to remove Calcipast Forte than a water-based calcium hydroxide paste.

Comparison of two different methods in the removal of oil based calcium hydroxide from root canal system: A triple blinded randomized 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.

The Comparison of Different Irrigation Systems to Remove Calcium Hydroxide from the Root Canal: A Systematic Review and Meta-Analysis

Objective: To examine the effect of a variety of irrigation systems on the removal of root canal Ca (OH)2 residues through meta-analysis and systematic review. Material and Methods: A search of relevant articles was systematically performed on databases of Medline, PubMed, Cochrane Library, Embase, ISI, and Google Scholar published from 2013 to 2019. Electronic title management was carried out by EndNote X9 software. Searches were based on the main keywords of “Irrigation Systems”, “Calcium Hydroxide”,” Root Canal”, “Self-adjusting File OR SAF”, “Conventional Irrigation”, “EndoVac System”, “Ultrasonic Irrigation” and “YAG Laser”. Results: The studies investigated were found to lack any standardization concerning the irrigation method used or the measurement of outcomes; for instance, different studies used 5 or 10 mL of 2.5% NaOCl, or 5 mL of 5.25% NaOCl, or 0.5 mL, 3 mL and 10 mL of 17% EDTA. Conclusion: The effective techniques for the removal of root canal Ca(OH)2 were PUI, and SAF approaches.

The Effectiveness of Different Final Irrigation Protocols for Removal of Calcium Hydroxide Intracanal Medication from Root Canal

Abstract Calcium hydroxide is the most used intracanalar medicament between apointments. It shoud be properly removed before root canal filling because its remnants could compromise the sealing of root obturation. The aim of this study was to compare the effectiveness of two type of irrigation solutions, EDTA and SmearClear in the removal of calcium hydroxide from root canals. Materials and method: twenty human single rooted teeth were prepared using ProTaper Universal instrumentation till F2, .06 taper. The canals were filled with Ca(OH)2 and after 7 days the Ca(OH)2 was removed using 3 rinses of 5 ml 15% EDTA and 5 ml 5.25% NaOCl alternately (group 1; n=10) or 3 rinses of 5 ml Smear Clear (SybronEndo) and 5 ml 5.25% NaOCl alternately (group 2; n=10). Results: On the final radiographs the best result was found in group 2 where the cleanliness of the total surface of the root canal wall when SmearClear was used obtained better results comparative to NaOCl – 15% EDTA (91.34% to 71.69%). Conclusions: under the limitation of this study, SmearClear was superior in removing Ca(OH)2 material compared to NaOCl and 15% EDTA irrigation solution.

Effectiveness of five instruments when removing calcium hydroxide paste from simulated internal root resorption cavities in extracted maxillary central incisors.

To evaluate the effectiveness of five instruments used for irrigant agitation during the removal of calcium hydroxide [Ca(OH)2 ] paste in simulated internal root resorption (IRR) cavities created in extracted maxillary central incisors. Seventy maxillary central incisors with a single canal were selected. The canals were accessed and instrumented with Reciproc R50, then the roots were split in the bucco-lingual direction and the halves separated. Simulated IRR cavities were created, in both halves of the roots, 5mm from the apex with a spherical bur. The specimens were reconstructed with cyanoacrylate glue and allocated into seven groups: negative control - no treatment; positive control - filled with Ca(OH)2 without performing any irrigation protocol; the other groups were divided according to the instrument used for irrigant agitation, namely: Ultrasonic, EndoActivator® , EDDY® , XP-endo® Finisher and XP-endo® Shaper. The specimens were cleaved and analysed using optical microscopy and scanning electron microscopy, to compare the Ca(OH)2 remnants between them. Then, theIRR cavities created by the burs were cleaned and subjected to a protocol of demineralization with 20% nitric acid, the roots reconstructed, and the irrigant agitation methods, as well as the microscopic analysis was repeated. Analysis of the images of Ca(OH)2 remaining in the simulated IRR cavities after irrigation was performed by two calibrated examiners based on a previously established scoring system. The data were statistically compared by Kruskal-Wallis test, Mann-Whitney U-test and Wilcoxon tests, with the significance level set at 5%. There was a significant difference in the effectiveness of the instruments in relation to the cavity creation method (bur vs. bur/acid) and evaluation method (optical microscopy and scanning electron microscopy) (P<0.05). The XP-endo® Finisher and EDDY® groups were associated with significantly more effective removal of Ca(OH)2 when the IRR cavities were created using the acid protocol and analysed by scanning electron microscopy. None of the instruments tested were able to completely remove the Ca(OH)2 pastefrom the simulated IRR cavities; however, the EDDY® and XP-endo® Finisher removed more Ca(OH)2 in the bur/acid cavity creation method analysed by scanning electron microscopy.

Efficacy of Different Irrigation Systems Used to Remove Calcium Hydroxide from the Root Canal

Introduction: The present study aimed to compare the cleaning efficacy of passive ultrasonic irrigation (PUI), self-adjusting file (SAF), EndoVac, and conventional syringe irrigation (CSI) techniques on Ca(OH)2 removal from the root canal. Methods: This study was conducted on the mesial roots of 36 human mandibular molar teeth. After 1 month, the Ca(OH)2 was removed from the experimental groups using four different irrigation techniques (SAF, PUI, EndoVac, and CSI). The inner surfaces of the canals were examined using a stereomicroscope at 30x magnification. The assessment of remaining Ca(OH)2 medicament in the grooves was performed by three calibrated dentists using a scoring system ranged 0-3. Results: None of the groups showed complete Ca(OH)2 removal from the root canals. The PUI technique removed significantly more Ca(OH)2 from all root canals, compared to EndoVac and CSI techniques (P<0.05). In the apical third, SAF group results were significantly better than the CSI group results (P<0.05). In the middle third, the SAF technique led to significantly better results in the removal of Ca(OH)2, compared to the techniques used in other groups (P<0.05).Conclusion: Currently, there is no irrigation system that can completely remove Ca(OH)2 from the root canal in endodontics. Regarding the removal of Ca(OH)2 from root canals, the PUI technique was significantly better than EndoVac and CSI techniques. In addition, the SAF technique showed significant efficacy in the middle third of the root canals.

Análise da remoção do hidróxido de cálcio de canais radiculares bovinos com diferentes técnicas através da microscopia eletrônica de varredura

Objetivo: Avaliar a eficácia da remoção de Ca (OH)2 do canal radicular, comparando o uso de limas manuais, Easy Clean e irrigação ultrassônica passiva (IUP). Método: Trinta dentes incisivos bovinos foram utilizados neste estudo. Os canais radiculares foram preparados e as amostras foram divididas aleatoriamente em 3 grupos de acordo com a técnica utilizada para a remoção do Ca(OH)2 (n = 10): G1: limas manuais; G2: lima Easy Clean; G3: IUP. Após quinze dias, os espécimes foram seccionados e processados para observação dos terços médio e apical utilizando microscopia eletrônica de varredura (MEV). Um avaliador cego e calibrado atribuiu escores a cada espécime. Os dados obtidos foram submetidos ao teste de Kruskal-Wallys, seguido do teste de Dunn. Resultados: Não houve diferença significativa na remoção do Ca(OH)2 entre a lima manual e a Easy Clean e entre Easy Clean e IUP. A técnica de IUP removeu significativamente mais Ca(OH)2 quando comparado com o grupo lima manual. Nenhuma das técnicas testadas removeu completamente o Ca(OH)2 das paredes do canal radicular. Conclusão: Independentemente da técnica utilizada, nenhum dos protocolos testados removeu completamente o Ca(OH)2 do canal radicular. Entretanto, a irrigação ultrassônica passiva foi mais eficaz do que o grupo das limas manuais.

Comparison of Calcium Hydroxide Removal Activity of New Sonic System Vibringe and Different Irrigation Systems

Seventy single-rooted human mandibular premolar teeth were used for this study. The samples were prepared with the ProTaper rotary system up to F4 and filled with calcium hydroxide. One week later, Calcium hydroxide was removed from the root canals with the several irrigation methods as follows: Vibringe (Group 1), EndoVac (Group 2), conventional needle irrigations (Group 3), passive ultrasonic (Group 4). The roots were split longitudinally and evaluated at magnifications ranging from x50 to x1000. Statistical Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests.

Velocity and wall shear stress of 18% EDTA irrigation solution flow in the removal of Ca(OH)2 with computational fluid dynamic analysis

Introduction: Ethylene Diamine Tetra Acetic Acid (EDTA) 18% irrigation solution is one of the chelating agents that able to remove calcium hydroxide (Ca(OH)2) from the root canal wall. Failure of root canal treatment can be caused by the presence of residual calcium hydroxide in the root canal wall, thus blocking the bond between the medication and root canal filling material with the root canal wall. This study was aimed to observe the EDTA 18% flow in removing the Ca(OH)2 using CFD analysis. Methods: This research was descriptive. Cleanliness of the root canal wall from Ca(OH)2 medicament using EDTA 18% irrigation was analysed using the CFD method with test specimens in the form of resin blocks made according to the characteristics of the root canal. The irrigation needle used was side-vented with a position of 3 mm from the apical tooth. Stage analysis of root canal geometry was performed using Computational Fluid Dynamics (CFD) analysis to observe the characteristics of irrigation solutions in root canals in 3D. Results: The streamlined characteristics of EDTA 18% irrigation solution showed a unique behaviour due to the features of the side-vent shaped irrigation needle. Irrigation flow in the crown area of the inlet (side-vented irrigation needle) showed low velocity so that the fluid flow when exiting the inlet was more towards the apical than the outlet (root canal orifice). Conclusion: Velocity and wall shear stress of EDTA 18% showed the results validation conformity between experimental and CFD, that the maximum velocity of EDTA 18% is 19 ms-1 and EDTA 18% wall shear stress is 1.56 KPa for calcium hydroxide removal observed from the CFD study. Keywords: Computational fluid dynamics, EDTA 18%, calcium hydroxide (Ca(OH)2), velocity, wall shear stress

Removal of Calcium Hydroxide from Artificial Grooves in Straight Root Canals: Sonic Activation Using EDDY Versus Passive Ultrasonic Irrigation and XPendo Finisher

IntroductionThe aim of the present study was to compare sonic activation using EDDY (VDW, Munich, Germany), passive ultrasonic irrigation (PUI), and mechanical activation using the XPendo Finisher (FKG Dentaire, La Chaux-des-Fonds, Switzerland) for the removal of calcium hydroxide from artificial grooves in straight root canals. MethodsThe root canals of 90 human maxillary incisors with straight root canals were prepared using Mtwo files (VDW) up to size 40/.04, and the teeth were split longitudinally. A lateral groove in the apical or coronal part was prepared in each root half and filled with calcium hydroxide, and the root halves were reassembled. Five groups were established according to the removal techniques: group A, the XPendo Finisher; group B, EDDY; group C, PUI; group D, manual irrigation with a syringe; and group E, no irrigation (the control group). The activation procedures were performed for 30 seconds with 3 mL sodium hypochlorite 3% as the irrigant. The cleanliness of the grooves was scored under 10× magnification. The median of scoring was analyzed using the Kruskal-Wallis test (P = .05). ResultsAll activation techniques were significantly more effective in the removal of calcium hydroxide than manual irrigation (P < .05). Regarding the apical groove, EDDY and PUI were significantly more effective in the removal of calcium hydroxide than the XPendo Finisher (P < .05). No difference was found for the coronal groove (P > .05). ConclusionsEDDY and PUI were significantly more effective in the removal of calcium hydroxide than the XPendo Finisher regarding the apical region. Manual irrigation was significantly less effective than all activation techniques.

Efficacy of XP-Endo finisher in removal of calcium hydroxide from root canal system: A systematic review

Calcium hydroxide (CH) is widely used as an intracanal medicament between appointments to increase the number of canals free from bacteria. However, the remnant CH hinders the penetration of disinfectants and sealers into dentinal tubules and compromises the seal of the canal filling. Therefore, residual CH must be removed before permanent root canal obturation is completed. To analyze the efficacy of XP-endo finisher on the removal of CH medicament from root canal system. English language articles were retrieved from electronic biomedical journal databases. PubMed, Google Scholar, and ResearchGate were used to complete the search for all full-text articles available. The search was done till August 31, 2018. The last data search was conducted on September 1, 2018. All articles that were published in English were included. Only those articles that were published between January 1, 2011, and August 31, 2018, using XP-endo finisher were selected. The efficacy of XP-endo finisher on removal of CH medicament from root canal system. Total of 17 articles was identified through electronic database searching. After duplicate removal, and full-text reading, six articles qualified for qualitative synthesis in this systematic review. XP-endo finisher is proven to be more efficient in removing the CH medicament from root canal system.

Nonsurgical Management of Periapical Lesion with External Root Resorption Followed by Orthodontic Treatment in Maxillary Lateral Incisor

The aim of this case report is to discuss the radiological outcome of a nonsurgical management of periapical lesion with external resorption followed by orthodontic treatment of the maxillary lateral incisor. A 33-year-old female reported with missing tooth in the maxillary anterior region as a result of surgical extraction of maxillary left canine tooth. Patient was referred for intentional root canal treatment in 22 followed by fixed prosthesis. The radiograph revealed external resorption in 21 and 22. After preparation of the access cavity, the necrotic pulp was removed and the canal irrigated using 5.25% sodium hypochlorite solution. The canal was then dried and packed with calcium hydroxide for 6 weeks. After removal of calcium hydroxide, canal was disinfected, dried and four millimetres of MTA orthograde filling was carried out. After 24 hrs, root canal was obturated with back fill using system B. At 1-3-6, month recall, the tooth was asymptomatic with no pain on percussion or palpation. Radiographic examination demonstrated continued thickening of root canal walls, root lengthening and apical closure.

Removal efficacy of various calcium hydroxide/chlorhexidine medicaments from the root canal with the aid of biological microscope

Aim: An in vitro study was conducted to comparatively evaluate the two techniques – hand instrumentation and ultrasonic file irrigation for removal of various calcium hydroxide (Ca[OH]2)/chlorhexidine containing medicaments from the root canal by using Biological microscope and Digital Camera. Materials and Methods: Sixty-four human single-rooted teeth with straight canals were used. Root canal preparation was performed using Pro-taper Universal for Hand use (Dentsply Maillefer, Ballaigues Switzerland). Teeth were randomly divided into three Groups A, B, and C of 21 teeth each, the remaining tooth remained untouched and served as a negative control. Teeth of Group A were filled with Ca(OH)2 mixed with saline. Teeth of Group B were filled with Ca(OH)2 mixed with 0.2% chlorhexidine gel. Teeth of Group C were filled with Ca(OH)2 mixed with 0.12% chlorhexidine solution. Teeth were stored at 37°C and 100% relative humidity for 7 days. Then Ca(OH)2 was removed using two techniques: hand instrumentation and ultrasonic file irrigation in both groups. Teeth were sectioned longitudinally and observed under Biological microscope and Digital Camera. Results were statistically analyzed with the Mann–Whitney and Kruskal–Wallis test. Results: The results showed a significant difference between hand instrumentation and ultrasonic file irrigation in cervical and middle third, but no statistic difference in apical third. Conclusion: None of the techniques used in this study removed the inter-appointment root canal medicaments completely.

Efficacy of Removal of Calcium Hydroxide Medicament from Root Canals by Endoactivator and Endovac Irrigation Techniques: A Systematic Review of In vitro Studies.

Introduction:The aim of this systematic review was to systematically evaluate and summarize the outcomes of in vitro studies comparing Endoactivator irrigation and Endovac irrigation techniques for removing calcium hydroxide (Ca[OH]2) medicament from the root canals.Materials and Methods:The research question was developed according to the population, intervention, comparison, and outcome strategy. A computerized literature search was conducted in Medline, PubMed, Google Scholar, and Embase. A hand search of the reference lists of identified articles was performed to separate relevant articles. Two reviewers critically assessed the studies that fulfilled the inclusion criteria and processed. Evaluation of the risk of bias of the studies was performed independently by the two reviewers.Results:After study selection, 61 were assessed for eligibility. Of these, 13 met the inclusion criteria and were included in the systematic review. Since significant heterogeneity was found in the methodologies, it was not possible to conduct a meta-analysis.Conclusions:On the basis of available evidence, we determined that Endoactivator irrigation technique showed better performance in removing Ca(OH)2 intracanal medicaments from middle third and coronal third area of the root canals and Endovac irrigation technique showed better performance from the apical third area of the root canals. Due to the limitations, small sample sizes, and low number of included studies, further research is needed to confirm our results.