The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 9 ( September, 2021 ) > List of Articles


In Vitro Assessment of Intracanal Calcium Hydroxide Removal Using Various Irrigation Systems: An SEM Study

Pavithra K Ramanna, Deesha Kumari, Piyali Poddar, Maitri Shah, Arti Dixit

Keywords : Calcium hydroxide, Irrigation systems, Root canal, Scanning electron microscope

Citation Information : Ramanna PK, Kumari D, Poddar P, Shah M, Dixit A. In Vitro Assessment of Intracanal Calcium Hydroxide Removal Using Various Irrigation Systems: An SEM Study. J Contemp Dent Pract 2021; 22 (9):1003-1007.

DOI: 10.5005/jp-journals-10024-3142

License: CC BY-NC 4.0

Published Online: 06-01-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Aim: The aim of this research was to assess the effectiveness of three different irrigation systems in elimination of calcium hydroxide [Ca(OH)2]from root canals. Materials and methods: This in vitro research included ninety recently extracted mandibular premolar teeth with a solitary root. The sample teeth were subjected to disinfection employing sodium hypochlorite at 5.25%. The root canal preparation was performed followed by placement of premixed Ca(OH)2 within every canal. The sample teeth were then randomly allocated into one of the three experimental groups (each comprising 30 samples) as follows: Group 1, NaviTip FX irrigation system; group 2, Vibringe sonic irrigation system; and group 3, EndoVac apical negative pressure irrigation system. Following the preparation, each of the sample teeth was examined beneath a scanning electron microscope (SEM) at a magnification of 1000×. Results: An intragroup comparative analysis revealed that the highest Ca(OH)2 elimination was seen at middle third (0.82 ± 0.09, 0.30 ± 0.11) in NaviTip FX irrigation system and Vibringe sonic irrigation system, respectively. Higher Ca(OH)2 was eliminated at the apical third (0.26 ± 0.02) by the EndoVac irrigation system. At coronal third, maximum Ca(OH)2 removal was seen in EndoVac irrigation system (0.49 ± 0.03). A statistically significant difference was noted amid Vibringe sonic irrigation and EndoVac irrigation systems. The intergroup evaluation of Ca(OH)2 elimination at coronal, middle, and apical third showed a statistically significant difference between NaviTip FX irrigation and Vibringe sonic irrigation as well as between NaviTip FX irrigation and EndoVac irrigation at a p value of 0.001. The difference between EndoVac irrigation and Vibringe sonic irrigation was not statistically significant. Conclusion: Amid the limitations of this research, this research concludes that none among the irrigation methods employed could totally eliminate the Ca(OH)2 off the root canals. Nevertheless, EndoVac apical negative pressure irrigation has slightly superior potential in eliminating Ca(OH)2 from the root canals in comparison with Vibringe sonic irrigation as well as the NaviTip FX irrigation system. Clinical significance: Even though the Ca(OH)2 is largely suggested as medicament, its elimination at the point of canal obturation is likewise significant and complex as any remaining portion may avoid sealer diffusion inside the dentinal tubules, consequently substantially escalating the apical leakage of endodontically treated teeth.

  1. Narita H, Itoh S, Imazato S, et al. An explanation of the mineralization mechanism in osteoblasts induced by calcium hydroxide. Acta Biomater 2010;6(2):586–590. DOI: 10.1016/j.actbio.2009.08.005.
  2. Nandini S, Velmurugan N, Kandaswamy D. Removal efficiency of calcium hydroxide intracanal medicament with two calcium chelators: volumetric analysis using spiral CT, an in vitro study. J Endod 2006;32(11):1097–1101. DOI: 10.1016/j.joen.2006.06.005.
  3. Bhuyan AC, Seal M, Pendharkar K. Effectiveness of four different techniques in removing intracanal medicament from the root canals: an in vitro study. Contemp Clin Dent 2015;6(3):309–312. DOI: 10.4103/0976-237X.161860.
  4. 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(1):55–61. DOI: 10.1111/j.1365-2591. 2005.01049.x.
  5. Bramante CM, Pinheiro BC, Garcia RB, et al. Efficacy of the NaviTip FX irrigation needle in removing calcium hydroxide from root canal. J Clin Exp Dent 2012;4(4):e226–e229. DOI: 10.4317/jced.50857.
  6. Aricioglu B, Hatipoglu O. Comparison of calcium hydroxide removal activity of new sonic system vibringe and different irrigation systems. Int J Oral Dent Health 2019;5(2):1–6. DOI: 10.23937/2469-5734/1510092.
  7. Gupta R, Sharma H, Kumari RA, et al. Effectiveness of two techniques in removal of calcium hydroxide medicament from root canals: an in vitro assessment. J Clin Diagn Res 2018;12(7):ZC53-ZC55. DOI: 10.7860/JCDR/2018/36025.11807.
  8. Böttcher DE, Hirai VH, Da Silva Neto UX, et al. Effect of calcium hydroxide dressing on the long-term sealing ability of two different endodontic sealers: an in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110(3):386–389. DOI: 10.1016/j.tripleo.2010.05.007.
  9. Ballal N, Kumar S, Laxmikanth H, et al. Comparative evaluation of different chelators in removal of calcium hydroxide preparations from root canals. Aust Dent J 2012;57(3):344-348. DOI: 10.1111/j.1834-7819.2012.01710.x.
  10. Kuga MC, Tanomaru-Filho M, Faria G, et al. Calcium hydroxide intracanal dressing removal with different rotary instruments and irrigating solutions: ascanning electron microscopy study. Braz Dent J 2010;21(4):310–314. DOI: 10.1590/s0103-64402010000400004.
  11. 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(4):580–584. DOI: 10.1016/j.tripleo.2008.12.008.
  12. Margelos J, Eliades G, Verdelis C, et al. Interaction of calcium hydroxide with zinc oxide-eugenol type sealers: apotential clinical problem. J Endod 1997;23(1):43–48. DOI: 10.1016/S0099-2399(97)80206-3.
  13. Türker SA, Koçak MM, Koçak S, et al. Comparison of calcium hydroxide removal by self-adjusting file, EndoVac, and Canal Brush agitation techniques: an in vitro study. J Conserv Dent 2013;16(5):439–443. DOI: 10.4103/0972-0707.117523.
  14. Ahmetoglu F, Keles A, Simsek N. Effectiveness of the several irrigation techniques for removal of calcium hydroxide-based intracanal medication from an artificial standardized groove in the apical root canal. Marmara Dent J 2013;2:53–56. DOI: 10.12990/MDJ.201317509.
  15. Yücel AÇ, Gürel M, Güler E, et al. Comparison of final irrigation techniques in removal of calcium hydroxide. Aust Endod J. 2013;39(3):116–121. DOI: 10.1111/j.1747-4477.2011.00326.x.
  16. Schoeffel GJ. The EndoVac method of endodontic irrigation, Part 3: system components and their interaction. Dent Today 2008;27(8):108–111.
  17. Jiang LM, Verhaagen B, Versluis M, et al. Evaluation of a sonic device designed to activate irrigant in the root canal. J Endod 2010;36(8):143–146. DOI: 10.1016/j.joen.2009.06.009.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.