Usage of intracanal medicaments is a routine procedure in root canal treatment. Calcium Hydroxide (Ca(OH)2) is one of the most popular intracanal materials that has been reported to work efficaciously in decreasing the microbial load and thereby increasing the prognosis of the treatment. However, the mechanism of accurate placement of the material is often a challenge for the practitioner. This study compared the efficacy of five different delivery methods for placement of Ca(OH)2 medicament into the root canal and its evaluation using CBCT (Cone Beam Computed Tomography). 100 extracted human single-rooted teeth were decoronated to standardize the root length and were subsequently prepared with Protaper Gold endodontic rotary files in a sequential manner. After cleaning and shaping the roots were divided into five groups based on five delivery techniques of Ca(OH)2 paste (Ultracal XS) based on group 1: Hand K files; group 2: rotary lentulospirals; group 3: EndoActivator; group 4: Ultrasonic Tip and group 5: NaviTips. Two parameters including the volume of voids and apical limit of the root canal fillings were observed under CBCT and analyzed statistically using One Way ANOVA and Bonferroni test. The void volume percentage was lowest in the Ultrasonic Tip group followed by the EndoActivator group, K file group, Navitip group, and Lentulospiral Group respectively (p <0.05). Similarly, apical limit filling measurement was closest to the apex in the Ultrasonic group followed by Endoactivatorgroup, Navitip group, Lentulospiral group, and K file group respectively (p<0.01). In conclusion, none of the 5 delivery methods could completely fill the root canal system, nor could these material systems reach the apex, although superior compaction of calcium hydroxide and the best apical limit filling was observed in the Ultrasonic Tip group. This finding may indeed help clinicians for better usage and placement of Ca(OH)2 intracanally and more studies and development regarding the same can be assessed in the future.

1.
Siqueira JF
Jr
,
Rocas
IN
.
Optimizing single-visit disinfection with supplementary approaches: a quest for predictability
.
Aust Endod J.
2011
;
37
:
92
8
.
2.
Vera
J
,
Siqueira JF
Jr
,
Ricucci
D
,
Loghin
S
,
Fernandez
N
,
Flores
B.
One-versus two-visit endodontic treatment of teeth with apical periodontitis: a histobacteriologic study
.
J Endod.
2012
;
38
:
1040
52
.
3.
Ricucci
D
,
Russo
J
,
Rutberg
M
,
Burleson
JA
,
Spangberg
LS
.
A prospective cohort study of endodontic treatments of 1,369 root canals: results after 5 years
.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2011
;
112
:
825
42
.
4.
Mohammadi
Z
,
Dummer
PM
.
Properties and applications of cal¬cium hydroxide in endodontics and dental traumatology
.
Int Endod J.
2011
;
44
:
697
730
.
5.
Estrela
C
,
Mamede
Neto
I,
Lopes
HP
,
Estrela
CR
,
Pecora
JD
.
Root canal filling with calcium hydroxide using different techniques
.
Braz Dent J.
2002
;
13
:
53
6
.
6.
Deveaux
E
,
Dufour
D
,
Boniface
B.
Five methods of calcium hydroxide intracanal placement: an in vitro evaluation
.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2000
;
89
:
349
55
.
7.
Oztan
MD
,
Akman
A
,
Dalat
D.
Intracanal placement of calcium hydroxide: a comparison of two different mixtures and carriers
.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2002
;
94
:
93
7
.
8.
Blank-Goncalves
LM
,
Nabeshima
CK
,
Martins
GH
,
Machado
ME
.
Qualitative analysis of the removal of the smear layer in the apical third of curved roots: conventional irrigation versus activation systems
.
J Endod.
2011
;
37
:
1268
71
.
9.
Ruddle
CJ
.
Endodontic advancements: game-changing technologies
.
Dent Today.
2009
;
28
:
82
4
.
10.
Galvão
T
,
Camargo
B
,
Armada
L
,
Alves
F.
Efficacy of three methods for inserting calcium hydroxide-based paste in root canals
.
Journal of clinical and experimental dentistry. 2017
;
9
(
6):762
.
11.
Kitikuson
P
,
Srisuwan
T.
Attachment Ability of Human Apical Papilla Cells to Root Dentin Surfaces Treated with Either 3Mix or Calcium Hydroxide
.
J Endod.
2016
;
42
:
89
94
.
12.
Silveira
AM
,
Lopes
HP
,
Siqueira JF
Jr
,
Macedo
SB
,
Consolaro
A.
Periradicular repair after two-visit endodontic treatment using two different intracanal medications compared to single-visit endodontic treatment
.
Braz Dent J.
2007
;
18
:
299
304
.
13.
Baugh
D
,
Wallace
J.
The role of apical instrumentation in root canal treatment: a review of the literature
.
Journal of endodontics.
2005
;
31
(
5
):
333
40
.
14.
Holland
R
,
Otoboni Filho
JA
,
de Souza
V
,
Nery
MJ
,
Bernabe
PF
,
Dezan E
Jr
.
A comparison of one versus two appointment endodontic therapy in dogs teeth with apical periodontitis
.
J Endod.
2003
;
29
:
121
4
.
15.
Siqueira JF
Jr
,
Lopes
HP
.
Mechanisms of antimicrobial activity of calcium hydroxide: a critical review
.
Int Endod J.
1999
;
32
:
361
9
.
16.
Smutkeeree
A
,
Phajongviriyatorn
P
,
Komoltri
C
,
Jantarat
J.
Calcium hydroxide medication in primary molars using different preparations and placement techniques: an in vitro study
.
European Archives of Paediatric Dentistry.
2015
;
16
(
4
):
313
8
.
17.
Mozo
S
,
Llena
C
,
Forner
L.
Review of ultrasonic irrigation in endodontics: increasing action of irrigating solutions
.
Med Oral Patol Oral Cir Bucal.
2012
;
17
(
3
):
e512
e516
. Published 2012 May 1. doi:
18.
Mancini
M
,
Cerroni
L
,
Iorio
L
,
Armellin
E
,
Conte
G
,
Cianconi
L.
Smear layer removal and canal cleanliness using different irrigation systems (EndoActivator, EndoVac, and passive ultrasonic irrigation): field emission scanning electron microscopic evaluation in an in vitro study
.
J Endod.
2013
;
39
(
11
):
1456
60
.
19.
Peters
CI
,
Koka
RS
,
Highsmith
S
,
Peters
OA
.
Calcium hydroxide dressings using different preparation and application modes: density and dissolution by simulated tissue pressure
.
Int Endod J.
2005
;
38
(
12
):
889
95
.
20.
Sethi
P
,
Tiwari
R
,
Das
M
,
Singh
MP
,
Agarwal
M
,
Ravikumar
AJ
.
two dimensional versus three dimensional imaging in endodontics-an updated
.
system.
2016
Oct 20;10:11.
21.
William C.
Scarfe
,
Allan
G.
Farman What is Cone-Beam CT and How Does it Work?
Dent Clin N Am.
2008
;
52
;
707
730
.
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