Efficacy of Four Techniques for Removing Calcium Hydroxide from the Apical Third of Root Canals: An in Vitro Study
*Dr. Golam Sabbir
MS Fellow, Department of Conservative Dentistry and Endodontics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. golam.sabbir.93@gmail.com
Dr. Mohammad Ali Asgor Moral
Professor, Department of Conservative Dentistry and Endodontics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Dr. MSU Zaman
MD Fellow, Department of Dental Pharmacology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Dr. AKM Bashar
Professor, Department of Conservative Dentistry and Endodontics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Dr. Rozina Akter
Senior Research Officer, Public Health Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
*Dr. Mohammad Nurunnabi
Assistant Professor, Department of Community Medicine and Public Health, Sylhet Women’s Medical College, Sylhet, Bangladesh. nur.somch@gmail.com
Keywords: Calcium hydroxide removal, apical third, XP-endo Finisher, passive ultrasonic
agitation, Master Apical File, H-file, SEM evaluation.
Abstract
Background: Complete removal of calcium hydroxide [Ca(OH)₂] before obturation is critical for optimal sealer adaptation and long-term endodontic success. However, limited irrigant penetration and canal intricacy make cleaning the apical third difficult.
Objective: To assess the effectiveness of four commonly used techniques Passive Ultrasonic Agitation (PUA), Master Apical File (MAF), XP-endo Finisher, and H-file instrumentation in removing Ca(OH)₂ from the apical third of root canals.
Methods: This in vitro comparative cross-sectional study was conducted from October 2022 to September 2023 at BSMMU, Dhaka, in collaboration with BUET. A total 64 freshly extracted single-rooted mandibular premolars were purposively selected and randomly assigned to four groups (n=16). Canals were prepared, filled with Ca(OH)₂ paste, and stored for one week. Ca(OH)₂ was then removed using PUA (Group A), MAF (Group B), XP-endo Finisher (Group C), or H-file instrumentation (Group D). Residual Ca(OH)₂ in the apical third was evaluated via SEM (×300–×2000) and scored on a 5-point scale by two blinded examiners.
Results: XP-endo Finisher (Group C) yielded the lowest mean residue score (1.94±0.68), followed by Passive Ultrasonic Agitation (Group A) (2.88±1.09), indicating superior cleaning efficacy. Master Apical File (Group B) and H-file instrumentation (Group D) showed significantly higher residue scores (4.81±0.40 and 5.0±0.0), demonstrating limited effectiveness. Differences among groups were statistically significant (p<0.001). Post-hoc analysis confirmed that Groups A and C removed Ca(OH)₂ more effectively than Groups B and D, while no significant difference existed between Groups B and D.
Conclusion: XP-endo Finisher removed Ca(OH)₂ more effectively from the apical third than PUA, MAF and H-file instrumentation. Advanced irrigant activation techniques may enhance apical cleanliness and improve obturation quality.
Dinajpur Medical College Journal, 2026 Jan; 19 (1):103-110