Boosting Root-Canal Cleanliness: A Stereomicroscopic Study of Calcium Hydroxide Removal with a Gentlefile Finisher Brush and EDTA
-
Mohammad Ali Ketabi
,
Nafiseh Golshahi
,
Babak Farzane
,
Ali Hassanzade Salmasi
,
Mohammad Mahdi Kiafar
,
Mohammad Naseri
Abstract
Objectives: Calcium hydroxide (CH) remnants in root canals can compromise root canal sealing, highlighting the need for effective removal techniques. This study assessed the efficacy of Gentlefile Finisher Brush (GB), in combination with ethylenediaminetetraacetic acid (EDTA), for CH removal by stereomicroscopic evaluation.
Materials and Methods: This in vitro study evaluated CH removal from 66 extracted single-rooted mandibular incisors. After canal preparation with ProTaper up to F2 and CH application, the specimens were incubated for 10 days and randomly divided into six groups on the basis of the irrigation method and instrument used: master apical file (MAF) or GB with saline or 17% EDTA (n=15 each) and positive and negative control groups (n=3 each). The CH was removed accordingly, and the teeth were longitudinally sectioned. The residual CH was quantified under a stereomicroscope at ×10 magnification using Digimizer software to compare the efficacy of different protocols. Data were analyzed using ANOVA and Tukey’s test (alpha=0.05).
Results: The combination of GB with 17% EDTA resulted in the lowest residual CH (8.30%±6.29%) significantly outperforming all other protocols (P<0.05). MAF with saline resulted in the highest residue (52.27%±19.24%). The Tukey’s post-hoc test confirmed that both the GB methods were significantly more effective than their MAF counterparts (P<0.05), while no significant difference was observed between the two MAF-based methods (P>0.05).
Conclusion: GB with 17% EDTA demonstrated superior efficacy in removing CH from root canals. These results highlight the importance of combining chelating irrigation with dynamic mechanical agitation to optimize intracanal cleanliness.
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2. Balvedi RP, Versiani MA, Manna FF, Biffi JC. A comparison of two techniques for the removal of calcium hydroxide from root canals. Int Endod J. 2010 Sep;43(9):763–8.
3. Tasdemir T, Celik D, Er K, Yildirim T, Ceyhanli KT, Yesilyurt C. Efficacy of several techniques for the removal of calcium hydroxide medicament from root canals. Int Endod J. 2011 Jun;44(6):505–9.
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7. Zorzin J, Wiessner J, Wiessner T, Lohbauer U, Petschelt A, Ebert J. Removal of radioactively marked calcium hydroxide from the root canal: Influence of volume of irrigation and activation. J Endod. 2016 Apr;42(4):637–40.
8. González Gratz GA, Iriarte Guerra MF, Alarcón Goldenberg PE. Efficacy of irrigation techniques in removing calcium hydroxide: a literature review. Odontoestomatología. 2022;24(39).
9. Rossi-Fedele G, Rodig T. Effectiveness of root canal irrigation and dressing for the treatment of apical periodontitis: A systematic review and meta-analysis of clinical trials. Int Endod J. 2023 Oct;56 Suppl 3:422–35.
10. Kuga MC, Tanomaru-Filho M, Faria G, So MV, Galletti T, Bavello JR. Calcium hydroxide intracanal dressing removal with different rotary instruments and irrigating solutions: a scanning electron microscopy study. Braz Dent J. 2010;21(4):310–4.
11. Rodig T, Hirschleb M, Zapf A, Hulsmann M. Comparison of ultrasonic irrigation and RinsEndo for the removal of calcium hydroxide and Ledermix paste from root canals. Int Endod J. 2011 Dec;44(12):1155–61.
12. Alturaiki S, Lamphon H, Edrees H, Ahlquist M. Efficacy of 3 different irrigation systems on removal of calcium hydroxide from the root canal: a scanning electron microscopic study. J Endod. 2015 Jan;41(1):97–101.
13. Kourti E, Pantelidou O. Comparison of different agitation methods for the removal of calcium hydroxide from the root canal: Scanning electron microscopy study. J Conserv Dent. 2017 Nov–Dec;20(6):439–44.
14. Gokturk H, Ozkocak I, Buyukgebiz F, Demir O. Effectiveness of various irrigation protocols for the removal of calcium hydroxide from artificial standardized grooves. J Appl Oral Sci. 2017 May–Jun;25(3):290–8.
15. Chawla A, Kumar V. Evaluating the efficacy of different techniques and irrigation solutions for removal of calcium hydroxide from the root canal system: A scanning electron microscope study. J Conserv Dent. 2018 Jul–Aug;21(4):394–400.
16. Keskin C, Keles A, Sariyilmaz O. Efficacy of glycolic acid for the removal of calcium hydroxide from simulated internal Resorption cavities. Clin Oral Investig. 2021 Jul;25(7):4407–13.
17. Holland R, Murata SS, Barbosa HG, Garlipp O, de Souza V, Dezan Junior E. Apical seal of root canals with gutta-percha points with calcium hydroxide. Braz Dent J. 2004;15(1):26–9.
18. Suciu I, Dimitriu B, Perlea P, Amza O, Jivoinovici R, Suciu I, et al. The consequences of remaining calcium hydroxide in the root canal. Romanian Journal of Stomatology. 2016 03/31;62(1):15–8.
19. Raghu R, Pradeep G, Shetty A, Gautham PM, Puneetha PG, Reddy TVS. Retrievability of calcium hydroxide intracanal medicament with three calcium chelators, ethylenediaminetetraacetic acid, citric acid, and chitosan from root canals: An in vitro cone beam computed tomography volumetric analysis. J Conserv Dent. 2017 Jan–Feb;20(1):25–9.
20. Macedo RG, Verhaagen B, Wesselink PR, Versluis M, van der Sluis LW. Influence of refreshment/activation cycles and temperature rise on the reaction rate of sodium hypochlorite with bovine dentine during ultrasonic activated irrigation. Int Endod J. 2014 Feb;47(2):147–54.
21. Zhou J, Liu T, Guo L. Effectiveness of XP-Endo Finisher and passive ultrasonic irrigation on intracanal medicament removal from root canals: a systematic review and meta-analysis. BMC Oral Health. 2021 Jun;21(1):294.
22. Suresh N, Varghese A, Sundar S, Nagendrababu V, Velmurugan N. Do calcium chelators play a role in the removal of calcium hydroxide from root canals? A systematic review of laboratory studies. Eur Endod J. 2022 Mar;7(1):11–9.
23. Rodig T, Vogel S, Zapf A, Hulsmann M. Efficacy of different irrigants in the removal of calcium hydroxide from root canals. Int Endod J. 2010 Jun;43(6):519–27.
24. Hamdan R, Michetti J, Pinchon D, Diemer F, Georgelin-Gurgel M. The XP-Endo Finisher for the removal of calcium hydroxide paste from root canals and from the apical third. J Clin Exp Dent. 2017 Jul;9(7):e855–60.
25. Azimian S, Bakhtiar H, Azimi S, Esnaashari E. In vitro effect of XP-Endo finisher on the amount of residual debris and smear layer on the root canal walls. Dent Res J (Isfahan). 2019 May–Jun;16(3):179–84.
26. Koprowicz A, Koprowicz P. Efficacy of finisher files in the removal of calcium hydroxide paste from the root canal system–preliminary results. J Med Sci. 2021 Jun;90(2):e499.
27. Deonizio M, Sydney G, Batista A, Estrela C. Root canal filling with calcium hydroxide paste using Lentulo spiral at different speeds. Dental Press Endod. 2011;1(1):58–63.
28. Bhalla V, Chockattu S. Intracanal delivery of calcium hydroxide: A literature review. Saudi Endod J. 2021 Jan;11(1):1–6.
29. Simcock RM, Hicks ML. Delivery of calcium hydroxide: comparison of four filling techniques. J Endod. 2006 Jul;32(7):680–2.
2. Balvedi RP, Versiani MA, Manna FF, Biffi JC. A comparison of two techniques for the removal of calcium hydroxide from root canals. Int Endod J. 2010 Sep;43(9):763–8.
3. Tasdemir T, Celik D, Er K, Yildirim T, Ceyhanli KT, Yesilyurt C. Efficacy of several techniques for the removal of calcium hydroxide medicament from root canals. Int Endod J. 2011 Jun;44(6):505–9.
4. Wiseman A, Cox TC, Paranjpe A, Flake NM, Cohenca N, Johnson JD. Efficacy of sonic and ultrasonic activation for removal of calcium hydroxide from mesial canals of mandibular molars: a microtomographic study. J Endod. 2011 Feb;37(2):235–8.
5. Saatchi M, Shokraneh A, Navaei H, Maracy MR, Shojaei H. Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis. J Appl Oral Sci. 2014 Sep–Oct;22(5):356–65.
6. da Silva JM, Silveira A, Santos E, Prado L, Pessoa OF. Efficacy of sodium hypochlorite, ethylenediaminetetraacetic acid, citric acid and phosphoric acid in calcium hydroxide removal from the root canal: a microscopic cleanliness evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Dec;112(6):820–4.
7. Zorzin J, Wiessner J, Wiessner T, Lohbauer U, Petschelt A, Ebert J. Removal of radioactively marked calcium hydroxide from the root canal: Influence of volume of irrigation and activation. J Endod. 2016 Apr;42(4):637–40.
8. González Gratz GA, Iriarte Guerra MF, Alarcón Goldenberg PE. Efficacy of irrigation techniques in removing calcium hydroxide: a literature review. Odontoestomatología. 2022;24(39).
9. Rossi-Fedele G, Rodig T. Effectiveness of root canal irrigation and dressing for the treatment of apical periodontitis: A systematic review and meta-analysis of clinical trials. Int Endod J. 2023 Oct;56 Suppl 3:422–35.
10. Kuga MC, Tanomaru-Filho M, Faria G, So MV, Galletti T, Bavello JR. Calcium hydroxide intracanal dressing removal with different rotary instruments and irrigating solutions: a scanning electron microscopy study. Braz Dent J. 2010;21(4):310–4.
11. Rodig T, Hirschleb M, Zapf A, Hulsmann M. Comparison of ultrasonic irrigation and RinsEndo for the removal of calcium hydroxide and Ledermix paste from root canals. Int Endod J. 2011 Dec;44(12):1155–61.
12. Alturaiki S, Lamphon H, Edrees H, Ahlquist M. Efficacy of 3 different irrigation systems on removal of calcium hydroxide from the root canal: a scanning electron microscopic study. J Endod. 2015 Jan;41(1):97–101.
13. Kourti E, Pantelidou O. Comparison of different agitation methods for the removal of calcium hydroxide from the root canal: Scanning electron microscopy study. J Conserv Dent. 2017 Nov–Dec;20(6):439–44.
14. Gokturk H, Ozkocak I, Buyukgebiz F, Demir O. Effectiveness of various irrigation protocols for the removal of calcium hydroxide from artificial standardized grooves. J Appl Oral Sci. 2017 May–Jun;25(3):290–8.
15. Chawla A, Kumar V. Evaluating the efficacy of different techniques and irrigation solutions for removal of calcium hydroxide from the root canal system: A scanning electron microscope study. J Conserv Dent. 2018 Jul–Aug;21(4):394–400.
16. Keskin C, Keles A, Sariyilmaz O. Efficacy of glycolic acid for the removal of calcium hydroxide from simulated internal Resorption cavities. Clin Oral Investig. 2021 Jul;25(7):4407–13.
17. Holland R, Murata SS, Barbosa HG, Garlipp O, de Souza V, Dezan Junior E. Apical seal of root canals with gutta-percha points with calcium hydroxide. Braz Dent J. 2004;15(1):26–9.
18. Suciu I, Dimitriu B, Perlea P, Amza O, Jivoinovici R, Suciu I, et al. The consequences of remaining calcium hydroxide in the root canal. Romanian Journal of Stomatology. 2016 03/31;62(1):15–8.
19. Raghu R, Pradeep G, Shetty A, Gautham PM, Puneetha PG, Reddy TVS. Retrievability of calcium hydroxide intracanal medicament with three calcium chelators, ethylenediaminetetraacetic acid, citric acid, and chitosan from root canals: An in vitro cone beam computed tomography volumetric analysis. J Conserv Dent. 2017 Jan–Feb;20(1):25–9.
20. Macedo RG, Verhaagen B, Wesselink PR, Versluis M, van der Sluis LW. Influence of refreshment/activation cycles and temperature rise on the reaction rate of sodium hypochlorite with bovine dentine during ultrasonic activated irrigation. Int Endod J. 2014 Feb;47(2):147–54.
21. Zhou J, Liu T, Guo L. Effectiveness of XP-Endo Finisher and passive ultrasonic irrigation on intracanal medicament removal from root canals: a systematic review and meta-analysis. BMC Oral Health. 2021 Jun;21(1):294.
22. Suresh N, Varghese A, Sundar S, Nagendrababu V, Velmurugan N. Do calcium chelators play a role in the removal of calcium hydroxide from root canals? A systematic review of laboratory studies. Eur Endod J. 2022 Mar;7(1):11–9.
23. Rodig T, Vogel S, Zapf A, Hulsmann M. Efficacy of different irrigants in the removal of calcium hydroxide from root canals. Int Endod J. 2010 Jun;43(6):519–27.
24. Hamdan R, Michetti J, Pinchon D, Diemer F, Georgelin-Gurgel M. The XP-Endo Finisher for the removal of calcium hydroxide paste from root canals and from the apical third. J Clin Exp Dent. 2017 Jul;9(7):e855–60.
25. Azimian S, Bakhtiar H, Azimi S, Esnaashari E. In vitro effect of XP-Endo finisher on the amount of residual debris and smear layer on the root canal walls. Dent Res J (Isfahan). 2019 May–Jun;16(3):179–84.
26. Koprowicz A, Koprowicz P. Efficacy of finisher files in the removal of calcium hydroxide paste from the root canal system–preliminary results. J Med Sci. 2021 Jun;90(2):e499.
27. Deonizio M, Sydney G, Batista A, Estrela C. Root canal filling with calcium hydroxide paste using Lentulo spiral at different speeds. Dental Press Endod. 2011;1(1):58–63.
28. Bhalla V, Chockattu S. Intracanal delivery of calcium hydroxide: A literature review. Saudi Endod J. 2021 Jan;11(1):1–6.
29. Simcock RM, Hicks ML. Delivery of calcium hydroxide: comparison of four filling techniques. J Endod. 2006 Jul;32(7):680–2.
| Issue | Vol 23 (Continuously Published Article-Based) | |
| Section | Original Article | |
| Keywords | ||
| Calcium Hydroxide Dental Pulp Cavity Root Canal Preparation Root Canal Therapy | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ketabi MA, Golshahi N, Farzane B, Hassanzade Salmasi A, Kiafar MM, Naseri M. Boosting Root-Canal Cleanliness: A Stereomicroscopic Study of Calcium Hydroxide Removal with a Gentlefile Finisher Brush and EDTA. Front Dent. 2026;23.
