Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2016, vol. 22, issue 4
Subject Area: Dental Medicine
Pages: 1355-1359
DOI: 10.5272/jimab.2016224.1355
Published online: 28 October 2016

J of IMAB 2016 Oct-Dec;22(4):1355-1359
Elka N. Radeva Corresponding Autor, Desislava M. Tsanova,
Department of Conservative Dentistry, Faculty of Dental medicine, Medical University, Sofia, Bulgaria.

Introduction: Calcium hydroxide is widely used in the field of endodontics as a temporary root canal filling. This medicament significantly increases pH and optimizes the treatment outcome. Its total removal before final obturation is very important. Otherwise it could affect the hermetic filling and respectively the endodontic success.
Aim: To evaluate the most effective irrigation protocol of calcium hydroxide removal from root canals.
Materials and methods: In this study 36 single root canal teeth were observed. They were randomly divided into three groups (n=10 each group) according to the technique applied for calcium hydroxide removal - manual irrigation, irrigation and Revo-S rotary instrumentation; and passive ultrasonic irrigation, and a control group (n=6) – irrigation with distilled water only. After calcium hydroxide removals following the procedures above, teeth were separated longitudinally in a buccal-lingual direction and remnants of medicaments were observed in the apical, middle and coronal part of each tooth. Then all of the specimens were observed using scanning electron microscopy and evaluated by a specified scale. The results have undergone statistical analysis.
Results: In the case of calcium hydroxide in the apex and in the middle with highest average is Revo-S, followed by Ultrasonic and irrigation. In the coronal part the highest average belongs to Revo-S, irrigation and Ultrasonic. In all groups the highest average is represented by control group.
Conclusion: There is not a universal technique for removal of intracanal medicaments and applying more than one protocol is required.

Key words: calcium hydroxide, conventional irrigation, irrigation protocols, passive ultrasonic irrigation,

- Download FULL TEXT /PDF 1557 KB/
Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Radeva EN, Tsanova DM. Efficacy of different endodontic irrigation protocols in calcium hydroxide removal. J of IMAB. 2016 Oct-Dec;22(4):1355-1359. DOI: 10.5272/jimab.2016224.1355.

Correspondence to: Assoc. Prof. Elka Radeva, PhD. Department of Conservative Dentistry, Faculty of Dental Medicine, Medical University – Sofia; 1, G. Sofiyski Blvd., 1431 Sofia, Bulgaria; E-mail:

1. Basrani B, Tjaderhane L, Santos JM, Pascon E, Grad H, Lawrence HP, et al. Efficacy of chlorhexidine- and calcium hydroxide-containing medicaments against Enterococcus faecalis in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Nov;96(5):618-24. [PubMed]
2. Castagnola R, Lajolo C, Minciacchi I, Cretella G, Foti R, Marigo L, et al. Efficacy of three different irrigation techniques in the removal of smear layer and organic debris from root canal wall: a scanning electron microscope study. G Ital Endod. 2014 Nov;28(2):79–86. [CrossRef]
3. Contardo L, De Luca M, Bevilacqua L, Breschi L, Di Lenarda R. Influence of calcium hydroxide debris on the quality of endodontic apical seal. Minerva Stomatol. 2007 Oct;56(10):509-17. [PubMed]
4. Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J. 2007 Mar;52(1 Suppl):S64-82. [PubMed]
5. Farhad AR, Barekatain B, Allameh M, Narimani T. Evaluation of the antibacterial effect of calcium hydroxide in combination with three different vehicles: An in vitro study. Dent Res J (Isfahan). 2012 Mar;9(2):167-72. [PubMed]
6. Mohammadi Z, Shalavi S. Is chlorhexidine an ideal vehicle for calcium hydroxide? A microbiologic review. Iran Endod J. 2012 Summer;7(3):115-22. [PubMed]
7. Estrela C, Estrela CR, Hollanda AC, Decurcio Dde A, Pécora JD. Influence of iodoform on antimicrobial potential of calcium hydroxide. J Appl Oral Sci. 2006 Jan;14(1):33-7. [PubMed]
8. Kim D, Kim E. Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part I. In vitro studies. Restor Dent Endod. 2014 Nov;39(4):241–252. [CrossRef]
9. Oliveira LD, Leão MV, Carvalho CA, Camargo CH, Valera MC, Jorge AO, et al. In vitro effects of calcium hydroxide and polymyxin B on endotoxins in root canals. J Dent. 2005 Feb;33(2):107-14. [PubMed]
10. Lambrianidis T, Kosti E, Boutsioukis C, Mazinis M. Removal efficacy of various calcium hydroxide/chlorhexidine medicaments from the root canal. Int Endod J. 2006 Jan;39(1):55-61. [PubMed]
11. Andrabi SMUN, Kumar A, Zia A, Iftekhar H, Alam S, Siddiqui S. Effect of passive ultrasonic irrigation and manual dynamic irrigation on smear layer removal from root canals in a closed apex in vitro model. J Investig Clin Dent. 2014 Aug;5(3):188-193. [CrossRef]
12. van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007 Jun;40(6):415-26. [PubMed]
13. Barbizam JV, Trope M, Teixeira E, Tanomaru-Filho M, Teixeira FB. Effect of calcium hydroxide intracanal dressing on the bond strength of a resin-based endodontic sealer. Braz Dent J. 2008; 19(3):224-227. [PubMed] [CrossRef]
14. George S, Kishen A, Song KP. The role of environmental changes on monospecies biofilm formation on root canal wall by Enterococcus faecalis. J Endod. 2005 Dec;31(12):867-72. [PubMed]
15. Capar ID, Ozcan E, Arslan H, Ertas H, Aydinbelge HA. Effect of different final irrigation methods on the removal of calcium hydroxide from an artificial standardized groove in the apical third of root canals. J Endod. 2014 Mar;40(3):451-4. [PubMed]
16. Kanter V, Weldon E, Nair U, Varella C, Kanter K, Anusavice K, et al. A quantitative and qualitative analysis of ultrasonic versus sonic endodontic systems on canal cleanliness and obturation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Dec;112(6):809-13. [PubMed]
17. Khaord P, Amin A, Shah MB, Uthappa R, Raj N, Kachalia T, et al. Effectiveness of different irrigation techniques on smear layer removal in apical thirds of mesial root canals of permanent mandibular first molar: A scanning electron microscopic study. J Conserv Dent. 2015 Jul-Aug;18(4):321-326. [PubMed]
18. 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. [PubMed]
19. da Silva JM, Andrade Junior CV, Zaia AA, Pessoa OF. Microscopic cleanliness evaluation of the apical root canal after using calcium hydroxide mixed with chlorhexidine, propylene glycol, or antibiotic paste. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Feb;111(2):260-4. [PubMed]
20. 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. [PubMed]
21. Taşdemir T, Celik D, Er K, Yildirim T, Ceyhanli KT, Yeşilyurt C. Efficacy of several techniques for the removal of calcium hydroxide medicament from root canals. Int Endod J. 2011 Jun;44(6):505-9. [PubMed]
22. Vineeta N, Gupta S, Chandra A. Retrievabilty of calcium hydroxide intracanal medicament with Chitosan from root canals: An in vitro CBCT volumetric analysis. J Conserv Dent. 2014 Sep;17(5):454-7. [PubMed]
23. 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. [PubMed].

Received: 12 September 2016
Published online: 28 October 2016

back to Online Journal