Efficacy of different agitation methods to remove calcium hydroxide medicament from artificial grooves in root canals

The aim of this study; comparative analysis of the remaining calcium hydroxide medicament placed in artificial grooves were prepared in the apical half of the root canals after the use of 2 different groups of irrigation solutions (Sodium Hypochlorite + Ethylene Diamine Tetra Acetic Acid (EDTA), Etidronic Acid.) applied with 5 different irrigation methods (Self Adjusting File (SAF), IrriFlex, Passive Ultrasonic Irrigation (PUI), XP Endo Finisher, Conventional Needle Irrigation). In the study, 120 incisors and premolar teeth with a single root and single canal, adjusted to 14 mm in length were used. Shaping the root canals was done with ProTaper Universal. Roots were divided into two longitudinally and an artificial groove was prepared on the root canal wall and calcium hydroxide medicament was placed on 120 samples. The combined teeth were hermetically sealed after that. The teeth were first divided into 2 main groups as sodium hypochlorite + EDTA and etidronic acid. It was then divided into 5 separate subgroups as SAF, PUI, IrriFlex, XP Endo Finisher and Conventional Needle Irrigation (n=12). The total irrigation volume was determined as 10 ml and total activation time was determined as 2 minutes in the groups. In etidronic acid groups, 10 ml of etidronic acid was used and activated for 2 minutes. In the sodium hypochlorite + EDTA groups, first 5 ml of sodium hypochlorite was used and activated for 1 minute. Afterwards, 5 ml of EDTA was used and activated for 1 minute. After the activation techniques were applied, the samples were dried and divided into two again. Images were taken with the aid of a stereomicroscope at x24 magnification from the samples. Calcium hydroxide medicament remaining in the grooves was scored. The obtained values were compared by applying the Kruskal-Wallis and Man Whitney U test. As a result of statistical analysis, sodium hypochlorite + EDTA was found to be more effective in removing calcium hydroxide medicament than etidronic acid (p<0.05). Conventional needle irrigation was found to be less effective in removing calcium hydroxide medicament than other groups which are IrriFlex, PUI, SAF and XP Endo Finisher (p<0.005). There was no significant difference between the IrriFlex, PUI, SAF and XP Endo Finisher groups (p>0.005). According to the results of this study, although no method can completely remove the calcium hydroxide medicament, it was observed that the calcium hydroxide medicament in the grooves was cleaned in 4 samples (16.7%) in the XP Endo Finisher and PUI groups, and in 2 samples (8.3%) in the SAF group. Additional activation methods are required to effectively remove the calcium hydroxide medicament. It is recommended to use IrriFlex because it is easy to apply, low cost, does not require any additional device or equipment, and is as effective as other methods in our study.