A confocal laser scanning microscopic analysis of efficacy of different activated irrigants in the removal of calcium hydroxide medicament and subsequent penetrability of Bio-C sealer - An in vitro study

Aim: The aim of the study was to investigate the efficacy of different irrigants activated by pro-agitator tip system (PATS) Vario on the removal of calcium hydroxide medicament and subsequent penetration depth of Bio-C sealer.

Materials and methods: Fifty single-rooted mandibular premolars were selected. Access cavities were prepared; biomechanical preparation was done. Metapex that had been combined with rhodamine B dye was used to fill each sample. All the samples were divided into five groups (n = 10) - Group I: chitosan-citrate, Group II: intracanal heated sodium hypochlorite (NaOCl), Group III: phytic acid, Group IV: SmearClear, and Group V: saline. All samples were obturated using gutta-percha and Bio-C sealer (combined with fluorescein dye). Later, all samples were sectioned at 3, 6, and 9 mm from the apex and observed under a confocal microscope for residual Ca(OH)₂ and sealer penetration into dentinal tubules.

Results: The saline group exhibited the least amount of sealer penetration and high residual Ca(OH)₂, both of which were statistically significant (P ≤ 0.05).

Conclusion: The use of PATS Vario for irrigant activation enhanced the calcium hydroxide removal efficacy and penetration of Bio-C sealer into dentinal tubules. The elimination of calcium hydroxide and sealer penetration, from the apical region of the tooth, can be accelerated by intracanal heating of NaOCl.