Comparative Evaluation of Removal of Calcium Silicate Based Intracanal Medicament Using Different Irrigation Activation Techniques – An In-Vitro CBCT Volumetric Analysis

Purpose This study aimed to compare the efficacy of four techniques—conventional side-vented needle irrigation (CSI), XP-Endo Finisher (XPF), passive ultrasonic irrigation (PUI), and laser-assisted irrigation (LAI)—in removing Bio-C Temp, a bioceramic intracanal medicament, from straight root canals. The research sought to optimize intracanal medicament (ICM) removal protocols to improve root canal treatment outcomes. Method Forty extracted single-rooted teeth with standardized lengths were prepared and filled with Bio-C Temp. After seven days, ICM removal was attempted using the four techniques. Cone-beam computed tomography (CBCT) was employed to measure the residual ICM volume pre- and post-removal. Statistical analyses were conducted using t-tests, ANOVA, and Tukey’s post-hoc tests to evaluate differences between the groups. Results All techniques significantly reduced the amount of Bio-C Temp in root canals, but none achieved complete elimination. PUI demonstrated the highest efficacy, with minimal residual medicament, followed closely by LAI and XPF. CSI exhibited significantly higher residual ICM levels compared to the other methods (p < 0.001). Statistical analysis revealed no significant differences between PUI, LAI, and XPF in terms of effectiveness. Conclusion The findings underscore the importance of advanced activation techniques in ICM removal. PUI proved to be the most effective, followed by LAI and XPF, while CSI was the least efficient. These results highlight the need for incorporating advanced irrigation techniques to enhance root canal cleanliness, improving treatment success rates.