Calcium hydroxide removal from the root canal by photon induced photoacoustic streaming (PIPS) compared to needle irrigation\nand irrigation using sonic activation was investigated. Additionally, safety issues regarding apical extrusion were addressed. In\nendodontic treatment temporary intracanal medication like calcium hydroxide should be completely removed for long term\nsuccess. For analysis, 60 artificial teeth were prepared, filled with calcium hydroxide, and divided into four groups. The teeth\nwere assigned to needle irrigation, irrigation using a sonic device, PIPS with a lower energy setting (10 mJ, 15Hz), or PIPS with\na higher energy setting (25 mJ/40Hz). For comparison the weight of each tooth was measured before and after calcium hydroxide\nincorporation, as well as after removing calcium hydroxide using the four different methods. Regarding safety issues another 24\nsampleswere filled with stained calcium hydroxide and embedded in 0.4% agarose gel. Color changes in the agarose gel due to apical\nextrusion were digitally analysed using Photoshop. No significant differences were found for calcium hydroxide removal between\nthe two laser groups. Sonic assisted removal and needle irrigation resulted in significant less calcium hydroxide removal than both\nlaser groups, with significantly more calcium hydroxide removal in the ultrasonic group than in the needle irrigation group. For\napical extrusion the higher laser (25 mJ/40Hz) group resulted in significant higher color changes of the periapical gel than all other\ngroups. PIPS with the setting of 10 mJ/15Hz achieved almost complete removal of calcium hydroxide without increasing apical\nextrusion of the irrigation solution.
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