An in vitro evaluation of various

irrigation techniques for the

removal of double antibiotic
paste from root canal surfaces

Dr. Tarun kumar

FDS, BHU
 AIM..

The aim of this study was to investigate the

effectiveness of conventional syringe irrigations,
passive ultrasonic irrigation (PUI), Vibringe,
CanalBrush, XP-endo Finisher, and laser-activated
irrigation (LAI) systems in removing double
antibiotic paste

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 • The main goal of root canal treatment is to
enlarge the root canal system and to eliminate
bacteria and its products from it.

• Chemomechanical is often selected as first

approach to achieve the goal of eliminating the
intracanal bacterial population.

• but none of the contemporary techniques can

completely clean the root canal system

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 • Calcium hydroxide (CH) is widely used as an
intracanal medicament between
appointments.

• CH is biocompatible, inhibits osteoclastic

activity, can dissolve organic tissue, and has
regenerative properties.
• Despite of these advantages CH is insufficient
in completely removing bacteria from root
canals.

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 • Triple antibiotic paste and or double antibiotic
paste (DAP) used as intracanal medicaments in
cases in which CH cannot alleviate the
symptoms.

Why we need complete removal..?

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 Remnants of medicaments prevent
penetration of sealers or cements into
the root canal dentin walls, as they act
as a physical barrier along the
sealer/dentin interface.

Furthermore, clinical concentrations of CH,

DAP, and
TAP can lead to a moderate inflammatory
reactions
in subcutaneous tissues and are cytotoxic to
human
dental pulp stem cells
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 • The most commonly used technique for the
removal of medicaments is recapitulation of the
root canal with master apical file at the working
length (WL) followed by copious irrigation with
ethylenediaminetetraacetic acid (EDTA) and
sodium hypochlorite (NaOCl).

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 Materials & methods..

Single vented needle Double vented needle

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 CanalBrush (Coltene/Whaledent GmbHCo.
KG, Langenau, Germany)

Xp endo- finisher, FKG, Switzerland)

VibringeVibringe B. V. Corp, Amsterdam, Netherlands

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 Passive ultrasonic irrigation
Er:YAG laser
(Kavo Key 3+, KaVo, Biberach, Germany)

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 • 150 single rooted human anterior teeth were
selected.
• All have Intact apex, and no signs of
internal/external resorption was there.
• teeth were shortened using a diamond disc
under water cooling, and each tooth was given
a measurment of 15mm W/L.
• Canals were prepared with reciproc files (VDW,
Munich, Germany) under controlled torque and
root canals were irrigated with 10 mL of 2.5%
NaOCl
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 • they were placed in Eppendorf vials filled with
silicon material

• After the impression material was fully set, the

roots were grooved with a diamond disk and
split longitudinally without damaging the
inner layer of dentine around the canal.

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 • A number 1S cavitron tip (Aceton, Merignac,
France) was modified to create standarized
grooves which were 3 mm in length, 0.5 mm in
depth, and 0.2 mm in width, and were located
2–5 mm from the apex for apical sections, 11-14
mm from the apex for coronal sections, and 7-
10 mm from the apex in the opposite part of the
middle section

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 • Each of root halves and grooves were
irrigated with 5 mL 17% EDTA for 60 sec. and
5 mL 2.5% NaOCl for 60 sec. Then, the teeth
were agitated with a tooth brush to remove
debris and the smear layer. The root canal was
dried with paper points.
• Equal amounts of ciprofloxacin and
metronidazole were mixed with distilled water
at a liquid/powder ratio of 1:3 based on the
formulations.
• Each of grooves were filled with DAP by a
spreader and lentunospiral, stereomicroscopy
was used to conferm that the grooves were
fully filled with DAP
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 • After this, specimens were randomly divided into
seven experimental groups (n=15).
• For the removal of DAP in all 7 groups, an R40
(VDW, germany) were used to obtain a space for
irrigation needles and instruments.

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 Results..
• Significant difference was found between
tooth regions in terms of paste removal, and
more residues were observed in the apical
region.
• No significant difference was found in the
groups for apical, middle, and coronal thirds
(p>05), except for the XP-endo Finisher (G4)
and PUI (G6) (p<05).
• No significant differences were found between
these groups in the coronal region (p>05).
• No significant differences were found between
LAI and PUI groups (p>05)
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 • Akçay, et al.2 (2014) investigated the effectiveness
of PIPS and an EndoActivator System in removing
DAP and TAP from root canal irregularities in the
coronal and apical parts of a root canal system.
• They reported that PIPS was superior for the
removal of DAP and TAP, regardless of the groove
location, when compared with the EndoActivator
and needle irrigation groups.

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 • Another study by Arslan, et al.4 (2014)
investigated the effectiveness of different
irrigants with or without ultrasonic activation in
removing TAP from simulated root canal
irregularities. They reported that PUI with 1%
NaOCl was superior to other irrigation
techniques in removing TAP.
• None of the investigated techniques were able
to completely remove DAP from the artificial
grooves.

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 • However, laser-activated irrigation and PUI may
be preferred for the removal of DAP. The
Vibringe and XP-endo Finisher systems gave
similar results to those of conventional needle
irrigation.

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 Refrences

1- Akcay M, Arslan H, Topcuoglu HS, Tuncay O. Effect of calcium hydroxide and

double and triple antibiotic pastes on the bond strength of epoxy resin-based
sealer to root canal dentin. J Endod. 2014;40(10):1663-7.
2- Akcay M, Arslan H, Yasa B, Kavrik F, Yasa E. Spectrophotometric analysis of
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revascularization. J Endod. 2014;40(6):845-8.
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Dent J. 2007;52(1 Suppl):S64-82.

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10- FKG swiss endo. XP-endo Finisher Documentation [Internet].
11- Gomes-Filho JE, Duarte PC, Oliveira CB, Watanabe S, Lodi CS,
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