Evaluation of Double and Triple Antibiotic Paste Removal Efficiency of Various Irrigation Protocols

Abstract

Objective: Aim of this study was to compare the double (DAP) and triple (TAP) antibiotic paste removal efficiency of conventional syringe irrigation (CSI), EndoActivator (EA), passive ultrasonic irrigation (PUI) and XP-endo finisher (XPF) from simulated immature root canals.

Materials and Methods: A total of 180 extracted mandibular canine roots were used. The apical 2 mm of the roots were removed, and Unicore drills were penetrated through the apical to the coronal direction approximately 1 mm to simulate an immature apex. Canals were prepared up to size 40 by using the Mtwo system. Roots were split longitudinally and then temporarily reassembled. The samples were randomly divided into 2 main groups as DAP and TAP. Five specimens for each main group were kept as negative control group. Then the pastes were placed with lentulo spiral. After 1 week five specimens for each main group were kept as positive control group. Then the remaining specimens in DAP and TAP groups were further assigned to 4 subgroups according to the removal technique (group 1: CSI; group 2: EA; group 3: PUI, group 4: XPF). The root halves were examined under a stereomicroscope at 10x magnification. Kruskal-Wallis H and Mann-Whitney U tests were used for statistical analyses.

Results: TAP and DAP were more effectively removed by XPF and PUI compared to CSI and EA (p<0.05). XPF and PUI DAP/TAP removal effectiveness was statistically similar (p>0.05). Moreover, CSI and EA showed similar effectiveness for both paste groups (p>0.05). Regarding the type of antibiotic paste, no significant difference between TAP and DAP was found (p>0.05).

Conclusion: The tested irrigation systems could not completely remove either TAP or DAP. The use of PUI or the XPF was more effective compared to the use of the EA and CSI.