Keywords
endodontics
techniques
efficacy
therapeutic irrigation
removal
calcium hydroxide
techniques
efficacy
therapeutic irrigation
removal
calcium hydroxide
How to Cite
Efficacy of irrigation techniques in the removal of calcium hydroxide: literature review. (2022). Odontoestomatología, 24(39), 1-16. https://doi.org/10.22592/ode2022n39e313
Abstract
Objective: To characterize based on a bibliographic review the irrigation techniques with the greatest efficacy in the removal of calcium hydroxide as intracanal medication.
Materials and methods: Bibliographic review carried out in the electronic databases PubMed, Scopus and Web of Science. 32 articles contained between the years 2015 and 2020 were selected.
Results: The most studied technique is ultrasonic irrigation, not achieving the highest levels of efficacy. Laser-activated irrigation was found to be the most efficacious in the removal of medication in three thirds of the canals. The most frequently used irrigants were sodium hypochlorite and ethylenediaminetetraacetic acid.
Conclusion: The most efficacious techniques are laser-activated irrigation, followed by passive ultrasonic irrigation. The evidence supports that sodium hypochlorite and ethylenediaminetetraacetic acid should be the irrigants used, both sequentially and not exclusively used.
References
1. 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.
2. Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent. 2016 Mar;10:144–7.
3. Fernandes R, Ricci R, Milanda MR, Weckwerth H, Bombarda F, Burgos J, Hungaro MA. Antimicrobial Activity and Physicochemical Properties of Calcium Hydroxide Pastes Used as Intracanal Medication. J Endod. 2016 Dec;42(12):1822-8.
4. Türker SA, Koçak MM, Koçak S, Sağlam BC. Comparison of calcium hydroxide removal by self‐adjusting file, EndoVac, and CanalBrush agitation techniques: An in vitro study. J Conserv Dent. 2013 Oct;16(5): 439‐43.
5. Saad AG, Saad AS, Saad AN, Nasser AN. Evaluation of calcium hydroxide removal using EndoActivator system: An in vitro study. J Endod. 2014 Feb;4(1):137.
6. Aydin MN, Buldur B. The effect of intracanal placement of various medicaments on the bond strength of three calcium silicate-based cements to root canal dentin. J Adhes Sci Technol. 2018 Aug;32(5):542-52.
7. Jamali S, Jabbari G, Mousavi E, Ahmadizadeh H, Khorram M, Jamee A. The Comparison of Different Irrigation Systems to Remove Calcium Hydroxide from the Root Canal: A Systematic Review and Meta-Analysis. Pesqui Bras Odontopediatria Clín Integr. 2020; 20 (1): 1-8.
8. Arslan H, Akcay M, Capar ID, Saygili G, Gok T, Ertas H. An in vitro comparison of irrigation using photon-initiated photoacoustic streaming, ultrasonic, sonic and needle techniques in removing calcium hydroxide. Int Endod J. 2015 Mar;48(3):246-51.
9. Kuştarcı A, Er K, Siso SH, Aydın H, Harorlı H, Arslan D, et al. Efficacy of Laser-Activated Irrigants in Calcium Hydroxide Removal from the Artificial Grooves in Root Canals: An Ex Vivo Study. Photomed Laser Surg. 2016 May;34(5):205-10.
10. 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):290-98.
11. Uygun AD, Gündoğdu EC, Arslan H, Ersoy I. Efficacy of XP-endo finisher and TRUShape 3D conforming file compared to conventional and ultrasonic irrigation in removing calcium hydroxide. Aust Endod J. 2017 Aug;43(2):89-93.
12. Wigler R, Dvir R, Weisman A, Matalon S, Kfir A. Efficacy of XP-endo finisher files in the removal of calcium hydroxide paste from artificial standardized grooves in the apical third of oval root canals. Int Endod J. 2017 Jul;50(7):700-5.
13. Kfir A, Blau-Venezia N, Goldberger T, Abramovitz I, Wigler R. Efficacy of self-adjusting file, XP-endo finisher and passive ultrasonic irrigation on the removal of calcium hydroxide paste from an artificial standardized groove. Aust Endod J. 2018 Apr;44(1):26-31.
14. Donnermeyer D, Wyrsch H, Bürklein S, Schäfer E. Removal of Calcium Hydroxide from Artificial Grooves in Straight Root Canals: Sonic Activation Using EDDY Versus Passive Ultrasonic Irrigation and XPendo Finisher. J Endod. 2019 Mar;45(3):322-26.
15. Harzivartyan S, Hazar A, Kartal N, Cimilli Z. Evaluation of different irrigation solutions and activation methods on removing calcium hydroxide. JDS. 2020 Sept; 15(3): 243-9.
16. Turkaydin D, Basturk FB, Goker S, Tarcin B, Berker YG, Ovecoglu HS. Efficacy of Endoactivator, CanalBrush, and passive ultrasonic irrigation in the removal of calcium hydroxide paste with iodoform and p-chlorophenol from root canals. Niger J Clin Pract. 2020 Sep;23(9):1237-42.
17. Phillips M, McClanahan S, Bowles W. A titration model for evaluating calcium hydroxide removal techniques. J Appl Oral Sci. 2015 Jan-Feb; 23(1): 94-0.
18. Romualdo FB, Fernandes NC, Lima BC, Moraes LJ, Rodrigues R. Effectiveness of NaviTip FX on Intracanal Calcium Hydroxide Removal. Int. J. Odontostomat. 2016 Apr;10(1):143-148.
19. Kirar DS,Jain P , Patni P. Comparison of different irrigation and agitation methods for the removal of two types of calcium hydroxide medicaments from the root canal wall: an in-vitro study. Clujul Med. Jun 2017;90(3):327-332.
20. Hamdan R, Michetti J, Pinchon D, Diemer F, Georgelin 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;9(7):855-60.
21. Agrawal P, Garg G, Bavabeedu S, Arora S, Moyin S, Punathil S. Evaluation of Intracanal Calcium Hydroxide Removal with Different Techniques: A Scanning Electron Microscope Study. J Contemp Dent Pract. 2018 Dec; 19(12):1464-9.
22. 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 Jun; 25(3): 290–8.
23. 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 Aug;21(4):394-400.
24. Tamil S, Andamuthu SA, Vaiyapuri R, Prasad AS, Jambai S, Chittrarasu MA. Comparative Evaluation of Intracanal Calcium Hydroxide Removal with Hand File, Rotary File, and Passive Ultrasonic Irrigation: An In Vitro Study.J Pharm Bioallied Sci. 2019 May; 11(2): 442–5.
25. Falakaloğlu S, Adıgüzel Ö, Meryem Kara M, Özata M. Efficacy of Different Irrigation Systems Used to Remove Calcium Hydroxide from the Root Canal. J Dent Mater Tech. 2019 Jun; 8(3):121-8.
26. Gupta R, Sharma H, Kumari RA, Prakash AC, Rai N, Jain L. Effectiveness of Two Techniques in Removal of Calcium Hydroxide Medicament from Root Canals: An in-vitro Assessment. Research. JCDR 2018 Jul; 12(7):53-5.
27. Vega-Marcich M, Araya P, Herman S, Jofré B, Chaple-Gil AM, Fernández E, et al. Remoción de hidróxido de calcio del canal radicular con irrigación manual, sónica y ultrasónica. Rev Cubana Inv Bioméd. 2020;39(3):1-16.
28. Ma J, Shen Y, Yang Y, Gao Y, Wan P, Gan Y, et al. In vitro study of calcium hydroxide removal from mandibular molar root canals. J Endod. 2015 Apr; 41(4):553-8.
29. Ma JZ, Shen Y, Al-Ashaw AJ, Khaleel HY, Yang Y, Wang ZJ, et al. Micro-computed tomography evaluation of the removal of calcium hydroxide medicament from C-shaped root canals of mandibular second molars. Int Endod J. 2015 Apr;48(4):333-41.
30. Silva LJ, Pessoa OF, Teixeira MB, Gouveia CH, Braga RR. Micro-CT evaluation of calcium hydroxide removal through passive ultrasonic irrigation associated with or without an additional instrument. Int Endod J. 2015 Aug;48(8):768-73.
31. Li D, Jiang S, Yin X, Chang JW, Ke J, Zhang C. Efficacy of Needle, Ultrasonic, and Endoactivator Irrigation and Photon-Induced Photoacoustic Streaming in Removing Calcium Hydroxide from the Main Canal and Isthmus: An In Vitro Micro-Computed Tomography and Scanning Electron Microscopy Study. Photomed Laser Surg. 2015 Jun;33(6):330-7.
32. Lloyd A, Navarrete G, Marchesan MA, Clement D. Removal of calcium hydroxide from Weine Type II systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study. J Appl Oral Sci. 2016 Nov-Dec;24(6):543-48.
33. Kumar P, de Ataide IN, Fernandes M, Lambor R. A cone-beam computed tomography assessment of the efficacy of different irrigation devices for removal of silicone oil-based calcium hydroxide from root canal system. J Conserv Dent. 2017 Mar-Apr;20(2):68-71.
34. Neelakantan P, Sriraman P, Gutmann JL. Removal of calcium hydroxide intracanal medicament by different irrigants and irrigating techniques: a cone beam computed tomography analysis. Gen Dent. 2017 Nov-Dec;65(6):45-9.
35. Acharya N, Poudel D, Chakradhar A. A Comparative Evaluation of Removal of Intracanal Calcium Hydroxide with Endoactivator System and Mechanical Instrumentation with K File, Using Two Irrigating Solutions: an in Vitro Study. Kathmandu Univ Med J. 2018 Jan.-Mar;16(61):74-7.
36. de Oliveira RL, Guerisoli DMZ, Duque JA, Alcalde MP, Onoda HK, Domingues FHF, et al. Computed microtomography evaluation of calcium hydroxide-based root canal dressing removal from oval root canals by different methods of irrigation. Microsc Res Tech. 2019 Mar;82(3):232-237.
37.Murwakani NS, Usman M, Djauharie RAHN, Marissa C. Comparison of sonic and ultrasonic activation for removal of calcium hydroxide from root canals - A micro-CT study. J. int. dent. med. res. 2019 Jan;12(1):123-128.
38.Denna J, Shafie LA, Alsofi L, Al-Habib M, AlShwaimi E. Efficacy of the Rotary Instrument XP-Endo Finisher in the Removal of Calcium Hydroxide Intracanal Medicament in Combination with Different Irrigation Techniques: A Microtomographic Study. Materials (Basel). 2020 May;13(10):2222.
39.Masudi S, Azhar L, Raja R, Khursheed M. Removal Efficiency of Calcium Hydroxide Intracanal Medicament Using Two Irrigation Solutions. Int Medical J. 2014 Feb; 21(1): 106-9.
40. Parikh M, Kishan K, Solanki N, Parikh M, Savaliya K, Bindu VH, et al. Efficacy of removal of calcium hydroxide medicament from root canals by endoactivator and endovac irrigation techniques: A Systematic review of in vitro studies. Contemp Clin Dent. 2019;10:135-42.
41. Murwakani NS, Usman M, Djauharie RAHN, Marissa C. Comparison of sonic and ultrasonic activation for removal of calcium hydroxide from root canals - A micro-CT study. J. int. dent. med. res. 2019 Jan;12(1):123-128.
42.Raghu R, Pradeep G, Shetty A, Gautham P, Puneetha P, Satyanarayana TV. 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): 25–29.
43. Uzunoglu E, Eymirli A, Uyanik MÖ, Çalt S, Nagas E. Calcium hydroxide dressing residues after different removal techniques affect the accuracy of root-ZX apex locator. Restor Dent Endod. 2015 Feb;40(1):44–9.
44. Ahmetoglu F, Keles A, Simsek N. Effectiveness of the several irrigation techniques for removal of calcium hydroxide‐based intracanal medication from an artificial standardized groove in the apical root canal. Marmara Dent J. 2013 Jan;2: 53-6.
45. Azim AA, Aksel H, Margaret Jefferson M, Huang GT. Comparison of sodium hypochlorite extrusion by five irrigation systems using an artificial root socket model and a quantitative chemical method. Clin Oral Investig. 2018 Mar;22(2):1055-1061.
46. Vangala A, Doshi SR, Aparadh A, Hegde V. Apical Extrusion of Sodium Hypochlorite using Various Mechanical Activators. World J Dent. 2016;7(3):146-49.
47. Ahamed AA, Raj JD. Negative pressure irrigation system: a review. J. Pharm. Res. 2019 Jun;13(1):8-14.
48. Laky M, Volmer M, Arslan M, Agis H, Moritz A, Cvikl B. Efficacy and Safety of Photon Induced Photoacoustic Streaming for Removal of Calcium Hydroxide in Endodontic Treatment. Biomed Res. Int. 2018 Apr:1-6.
2. Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent. 2016 Mar;10:144–7.
3. Fernandes R, Ricci R, Milanda MR, Weckwerth H, Bombarda F, Burgos J, Hungaro MA. Antimicrobial Activity and Physicochemical Properties of Calcium Hydroxide Pastes Used as Intracanal Medication. J Endod. 2016 Dec;42(12):1822-8.
4. Türker SA, Koçak MM, Koçak S, Sağlam BC. Comparison of calcium hydroxide removal by self‐adjusting file, EndoVac, and CanalBrush agitation techniques: An in vitro study. J Conserv Dent. 2013 Oct;16(5): 439‐43.
5. Saad AG, Saad AS, Saad AN, Nasser AN. Evaluation of calcium hydroxide removal using EndoActivator system: An in vitro study. J Endod. 2014 Feb;4(1):137.
6. Aydin MN, Buldur B. The effect of intracanal placement of various medicaments on the bond strength of three calcium silicate-based cements to root canal dentin. J Adhes Sci Technol. 2018 Aug;32(5):542-52.
7. Jamali S, Jabbari G, Mousavi E, Ahmadizadeh H, Khorram M, Jamee A. The Comparison of Different Irrigation Systems to Remove Calcium Hydroxide from the Root Canal: A Systematic Review and Meta-Analysis. Pesqui Bras Odontopediatria Clín Integr. 2020; 20 (1): 1-8.
8. Arslan H, Akcay M, Capar ID, Saygili G, Gok T, Ertas H. An in vitro comparison of irrigation using photon-initiated photoacoustic streaming, ultrasonic, sonic and needle techniques in removing calcium hydroxide. Int Endod J. 2015 Mar;48(3):246-51.
9. Kuştarcı A, Er K, Siso SH, Aydın H, Harorlı H, Arslan D, et al. Efficacy of Laser-Activated Irrigants in Calcium Hydroxide Removal from the Artificial Grooves in Root Canals: An Ex Vivo Study. Photomed Laser Surg. 2016 May;34(5):205-10.
10. 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):290-98.
11. Uygun AD, Gündoğdu EC, Arslan H, Ersoy I. Efficacy of XP-endo finisher and TRUShape 3D conforming file compared to conventional and ultrasonic irrigation in removing calcium hydroxide. Aust Endod J. 2017 Aug;43(2):89-93.
12. Wigler R, Dvir R, Weisman A, Matalon S, Kfir A. Efficacy of XP-endo finisher files in the removal of calcium hydroxide paste from artificial standardized grooves in the apical third of oval root canals. Int Endod J. 2017 Jul;50(7):700-5.
13. Kfir A, Blau-Venezia N, Goldberger T, Abramovitz I, Wigler R. Efficacy of self-adjusting file, XP-endo finisher and passive ultrasonic irrigation on the removal of calcium hydroxide paste from an artificial standardized groove. Aust Endod J. 2018 Apr;44(1):26-31.
14. Donnermeyer D, Wyrsch H, Bürklein S, Schäfer E. Removal of Calcium Hydroxide from Artificial Grooves in Straight Root Canals: Sonic Activation Using EDDY Versus Passive Ultrasonic Irrigation and XPendo Finisher. J Endod. 2019 Mar;45(3):322-26.
15. Harzivartyan S, Hazar A, Kartal N, Cimilli Z. Evaluation of different irrigation solutions and activation methods on removing calcium hydroxide. JDS. 2020 Sept; 15(3): 243-9.
16. Turkaydin D, Basturk FB, Goker S, Tarcin B, Berker YG, Ovecoglu HS. Efficacy of Endoactivator, CanalBrush, and passive ultrasonic irrigation in the removal of calcium hydroxide paste with iodoform and p-chlorophenol from root canals. Niger J Clin Pract. 2020 Sep;23(9):1237-42.
17. Phillips M, McClanahan S, Bowles W. A titration model for evaluating calcium hydroxide removal techniques. J Appl Oral Sci. 2015 Jan-Feb; 23(1): 94-0.
18. Romualdo FB, Fernandes NC, Lima BC, Moraes LJ, Rodrigues R. Effectiveness of NaviTip FX on Intracanal Calcium Hydroxide Removal. Int. J. Odontostomat. 2016 Apr;10(1):143-148.
19. Kirar DS,Jain P , Patni P. Comparison of different irrigation and agitation methods for the removal of two types of calcium hydroxide medicaments from the root canal wall: an in-vitro study. Clujul Med. Jun 2017;90(3):327-332.
20. Hamdan R, Michetti J, Pinchon D, Diemer F, Georgelin 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;9(7):855-60.
21. Agrawal P, Garg G, Bavabeedu S, Arora S, Moyin S, Punathil S. Evaluation of Intracanal Calcium Hydroxide Removal with Different Techniques: A Scanning Electron Microscope Study. J Contemp Dent Pract. 2018 Dec; 19(12):1464-9.
22. 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 Jun; 25(3): 290–8.
23. 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 Aug;21(4):394-400.
24. Tamil S, Andamuthu SA, Vaiyapuri R, Prasad AS, Jambai S, Chittrarasu MA. Comparative Evaluation of Intracanal Calcium Hydroxide Removal with Hand File, Rotary File, and Passive Ultrasonic Irrigation: An In Vitro Study.J Pharm Bioallied Sci. 2019 May; 11(2): 442–5.
25. Falakaloğlu S, Adıgüzel Ö, Meryem Kara M, Özata M. Efficacy of Different Irrigation Systems Used to Remove Calcium Hydroxide from the Root Canal. J Dent Mater Tech. 2019 Jun; 8(3):121-8.
26. Gupta R, Sharma H, Kumari RA, Prakash AC, Rai N, Jain L. Effectiveness of Two Techniques in Removal of Calcium Hydroxide Medicament from Root Canals: An in-vitro Assessment. Research. JCDR 2018 Jul; 12(7):53-5.
27. Vega-Marcich M, Araya P, Herman S, Jofré B, Chaple-Gil AM, Fernández E, et al. Remoción de hidróxido de calcio del canal radicular con irrigación manual, sónica y ultrasónica. Rev Cubana Inv Bioméd. 2020;39(3):1-16.
28. Ma J, Shen Y, Yang Y, Gao Y, Wan P, Gan Y, et al. In vitro study of calcium hydroxide removal from mandibular molar root canals. J Endod. 2015 Apr; 41(4):553-8.
29. Ma JZ, Shen Y, Al-Ashaw AJ, Khaleel HY, Yang Y, Wang ZJ, et al. Micro-computed tomography evaluation of the removal of calcium hydroxide medicament from C-shaped root canals of mandibular second molars. Int Endod J. 2015 Apr;48(4):333-41.
30. Silva LJ, Pessoa OF, Teixeira MB, Gouveia CH, Braga RR. Micro-CT evaluation of calcium hydroxide removal through passive ultrasonic irrigation associated with or without an additional instrument. Int Endod J. 2015 Aug;48(8):768-73.
31. Li D, Jiang S, Yin X, Chang JW, Ke J, Zhang C. Efficacy of Needle, Ultrasonic, and Endoactivator Irrigation and Photon-Induced Photoacoustic Streaming in Removing Calcium Hydroxide from the Main Canal and Isthmus: An In Vitro Micro-Computed Tomography and Scanning Electron Microscopy Study. Photomed Laser Surg. 2015 Jun;33(6):330-7.
32. Lloyd A, Navarrete G, Marchesan MA, Clement D. Removal of calcium hydroxide from Weine Type II systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study. J Appl Oral Sci. 2016 Nov-Dec;24(6):543-48.
33. Kumar P, de Ataide IN, Fernandes M, Lambor R. A cone-beam computed tomography assessment of the efficacy of different irrigation devices for removal of silicone oil-based calcium hydroxide from root canal system. J Conserv Dent. 2017 Mar-Apr;20(2):68-71.
34. Neelakantan P, Sriraman P, Gutmann JL. Removal of calcium hydroxide intracanal medicament by different irrigants and irrigating techniques: a cone beam computed tomography analysis. Gen Dent. 2017 Nov-Dec;65(6):45-9.
35. Acharya N, Poudel D, Chakradhar A. A Comparative Evaluation of Removal of Intracanal Calcium Hydroxide with Endoactivator System and Mechanical Instrumentation with K File, Using Two Irrigating Solutions: an in Vitro Study. Kathmandu Univ Med J. 2018 Jan.-Mar;16(61):74-7.
36. de Oliveira RL, Guerisoli DMZ, Duque JA, Alcalde MP, Onoda HK, Domingues FHF, et al. Computed microtomography evaluation of calcium hydroxide-based root canal dressing removal from oval root canals by different methods of irrigation. Microsc Res Tech. 2019 Mar;82(3):232-237.
37.Murwakani NS, Usman M, Djauharie RAHN, Marissa C. Comparison of sonic and ultrasonic activation for removal of calcium hydroxide from root canals - A micro-CT study. J. int. dent. med. res. 2019 Jan;12(1):123-128.
38.Denna J, Shafie LA, Alsofi L, Al-Habib M, AlShwaimi E. Efficacy of the Rotary Instrument XP-Endo Finisher in the Removal of Calcium Hydroxide Intracanal Medicament in Combination with Different Irrigation Techniques: A Microtomographic Study. Materials (Basel). 2020 May;13(10):2222.
39.Masudi S, Azhar L, Raja R, Khursheed M. Removal Efficiency of Calcium Hydroxide Intracanal Medicament Using Two Irrigation Solutions. Int Medical J. 2014 Feb; 21(1): 106-9.
40. Parikh M, Kishan K, Solanki N, Parikh M, Savaliya K, Bindu VH, et al. Efficacy of removal of calcium hydroxide medicament from root canals by endoactivator and endovac irrigation techniques: A Systematic review of in vitro studies. Contemp Clin Dent. 2019;10:135-42.
41. Murwakani NS, Usman M, Djauharie RAHN, Marissa C. Comparison of sonic and ultrasonic activation for removal of calcium hydroxide from root canals - A micro-CT study. J. int. dent. med. res. 2019 Jan;12(1):123-128.
42.Raghu R, Pradeep G, Shetty A, Gautham P, Puneetha P, Satyanarayana TV. 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): 25–29.
43. Uzunoglu E, Eymirli A, Uyanik MÖ, Çalt S, Nagas E. Calcium hydroxide dressing residues after different removal techniques affect the accuracy of root-ZX apex locator. Restor Dent Endod. 2015 Feb;40(1):44–9.
44. Ahmetoglu F, Keles A, Simsek N. Effectiveness of the several irrigation techniques for removal of calcium hydroxide‐based intracanal medication from an artificial standardized groove in the apical root canal. Marmara Dent J. 2013 Jan;2: 53-6.
45. Azim AA, Aksel H, Margaret Jefferson M, Huang GT. Comparison of sodium hypochlorite extrusion by five irrigation systems using an artificial root socket model and a quantitative chemical method. Clin Oral Investig. 2018 Mar;22(2):1055-1061.
46. Vangala A, Doshi SR, Aparadh A, Hegde V. Apical Extrusion of Sodium Hypochlorite using Various Mechanical Activators. World J Dent. 2016;7(3):146-49.
47. Ahamed AA, Raj JD. Negative pressure irrigation system: a review. J. Pharm. Res. 2019 Jun;13(1):8-14.
48. Laky M, Volmer M, Arslan M, Agis H, Moritz A, Cvikl B. Efficacy and Safety of Photon Induced Photoacoustic Streaming for Removal of Calcium Hydroxide in Endodontic Treatment. Biomed Res. Int. 2018 Apr:1-6.