Effectiveness of the Severel Irrigation Techniques for Removal of Calcium Hydroxide-based Intracanal Medication from an Artificial Standardized Groove in the Apical Root Canal

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Background/aim: This study was aimed to evaluate the efficacy of
removal of calcium hydroxide [Ca(OH)2] with the apical negative
pressure irrigation system (EndoVac), passive ultrasonic irrigation
(PUI), and needle irrigation using sodium hypochlorite (NaOCl).
Materials and methods: The root canals of 30 freshly extracted
human mandibular premolars were used in this study. Each root
canal was prepared with nickel titanium rotary instruments. Each
root was split longitudinally through the canal. In one-half, a
standardized groove was cut in the canal wall 2–6 mm from the
apex, and filled with Ca(OH)2 paste. The roots were reassembled
with plastic bracelets. Three techniques were used for Ca(OH)2
removal: Group 1, irrigation using the EndoVac irrigation system;
Group 2, PUI; Group 3, needle irrigation; all used a total of 10 mL
of 5% NaOCl as the irrigant. The amount of residual Ca(OH)2 in
the groove was scored in accordance with previously reported
criteria. The data were analyzed with the Kruskal–Wallis and
Mann–Whitney U tests. The level of significance was set at p<
Results: No technique removed all Ca(OH)2. There were no
significant differences between Groups 1 and 2, and Groups 1 and
3 (p< 0.05). There was significant difference between Groups 2 and
3 (p> 0.05).
Conclusions: PUI was more effective in removing Ca(OH)2 paste
from artificial root canal grooves, but the efficacy of PUI did not
differ significantly from that of the EndoVac irrigation system.


Calcium hydroxide, EndoVac system, needle irrigation, passive ultrasonic irrigation, scanning electron microscopy

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Mohammadi Z, Abbott PV. Antimicrobial substativity of root canal irrigants and medicaments: a review. Aust Endod J 2009;35:131-9.

Siqueira JF, Jr., Rocas IN. Clinical implications and microbiology of bacterial persistence after treatment procedures. J Endod 2008;34:1291-301 e1293.

Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J 2007;52(1 Suppl):64-82.

Abbott PV. Medicaments: aids to success in endodontics. Part 1. A review of the literature. Aust Dent J 1990;35:438-48.

Mohammadi Z, Dummer PM. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J 2011;44:697-30.

Tanomaru JM, Leonardo MR, Tanomaru Filho M, et al. Effect of different irrigation solutions and calcium hydroxide on bacterial LPS. Int Endod J 2003;36:733-9.

Lima RK, Guerreiro-Tanomaru JM, Faria-Junior NB, et al. Effectiveness of calcium hydroxide-based intracanal medicaments against Enterococcus faecalis. Int Endod J 2012;45:311-6.

Hosoya N, Kurayama H, Iino F, et al. Effects of calcium hydroxide on physical and sealing properties of canal sealers. Int Endod J 2004;37:178-84.

Calt S, Serper A. Dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide. J Endod 1999;25:431-3.

Barbizam JV, Trope M, Teixeira EC, et al. Effect of calcium hydroxide intracanal dressing on the bond strength of a resin-based endodontic sealer. Braz Dent J 2008;19:224-7.

Kim SK, Kim YO. Influence of calcium hydroxide intracanal medication on apical seal. Int Endod J 2002;35:623-8.

De Faria-Junior NB, Keine KC, So MV, et al. Residues of calcium hydroxide-based intracanal medication associated with different vehicles: A scanning electron microscopy evaluation. Microsc Res Tech 2012;75:898-907.

Tasdemir T, Celik D, Er K, et al. Efficacy of several techniques for the removal of calcium hydroxide medicament from root canals. Int Endod J 2011;44:505-9.

Wiseman A, Cox TC, Paranjpe A, et al. Efficacy of sonic and ultrasonic activation for removal of calcium hydroxide from mesial canals of mandibular molars: a microtomographic study. J Endod 2011;37:235-8.

Kenee DM, Allemang JD, Johnson JD, et al. A quantitative assessment of efficacy of various calcium hydroxide removal techniques. J Endod 2006;32:563-5.

van der Sluis LW, Wu MK, Wesselink PR. The evaluation of removal of calcium hydroxide paste from an artificial standardized groove in the apical root canal using different irrigation methodologies. Int Endod J 2007;40:52-7.

Ricucci D, Langeland K. Incomplete calcium hydroxide removal from the root canal: a case report. Int Endod J 1997;30:418-21.

Wu MK, R’Oris A, Barkis D, et al. Prevalence and extent of long oval canals in the apical third. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:739-43.

Lee SJ, Wu MK, Wesselink PR. The efficacy of ultrasonic irrigation to remove artificially placed dentine debris from different-sized simulated plastic root canals. Int Endod J 2004;37:607-12.

van der Sluis LW, Versluis M, Wu MK, et al. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J 2007;40:415-26.

Krell KV, Johnson RJ, Madison S. Irrigation patterns during ultrasonic canal instrumentation. Part I. K-type files. J Endod 1988;14:65-8.

Saber Sel D, Hashem AA. Efficacy of different final irrigation activation techniques on smear layer removal. J Endod 2011;37:1272-5.

Schoeffel GJ. The EndoVac method of endodontic irrigation, part 2—efficacy Dent Today 2008;27:82, 84, 86-87.

Balvedi RP, Versiani MA, Manna FF, et al. A comparison of two techniques for the removal of calcium hydroxide from root canals. Int Endod J 2010;43:763-8.

Pawar R, Alqaied A, Safavi K, et al. Influence of an apical negative pressure irrigation system on bacterial elimination during endodontic therapy: a prospective randomized clinical study. J Endod 2012;38:1177-81.

Lambrianidis T, Margelos J, Beltes P. Removal efficiency of calcium hydroxide dressing from the root canal. J Endod 1999;25:85-8.

Lambrianidis T, Kosti E, Boutsioukis C, et al. Removal efficacy of various calcium hydroxide/chlorhexidine medicaments from the root canal. Int Endod J 2006;39:55-61.

Salgado RJ, Moura-Netto C, Yamazaki AK, et al. Comparison of different irrigants on calcium hydroxide medication removal: microscopic cleanliness evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:580-4.

Shin SJ, Kim HK, Jung IY, et al. Comparison of the cleaning efficacy of a new apical negative pressure irrigating system with conventional irrigation needles in the root canals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:479-84.

Nielsen BA, Craig Baumgartner J. Comparison of the EndoVac system to needle irrigation of root canals. J Endod 2007;33:611-5.

Jiang LM, Verhaagen B, Versluis M, et al. The influence of the ultrasonic intensity on the cleaning efficacy of passive ultrasonic irrigation. J Endod 2011;37:688-92.

Desai P, Himel V. Comparative safety of various intracanal irrigation systems. J Endod 2009;35:545-9.

Baker NA, Eleazer PD, Averbach RE, et al. Scanning electron microscopic study of the efficacy of various irrigating solutions. J Endod 1975;1:127-35.

Sedgley CM, Nagel AC, Hall D, et al. Influence of irrigant needle depth in removing bioluminescent bacteria inoculated into instrumented root canals using real-time imaging in vitro. Int Endod J 2005;38:97-104.

Brunson M, Heilborn C, Johnson DJ, et al. Effect of apical preparation size and preparation taper on irrigant volume delivered by using negative pressure irrigation system. J Endod 2010;36:721-4.