الفهرس 
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Abstract
The present study aimed to assess and compare the effects of the XP-endo Finisher (XPF), passive ultrasonic irrigation (PUI), and traditional syringe irrigation with side vented needle (SVN) after the removal of calcium hydroxide (Ca(OH)2) and double antibiotic paste (DAP) intra-canal medications on canal wall cleanliness and the amount of apically extruded debris in-vitro, as well as postoperative pain in-vivo.
For the in-vitro Study, ninety-six extracted single-rooted mandibular premolars with single straight root canals were used. After decronation, all canals were prepared using ProTaper Next NiTi files up to X4 file. After dryness, depending on the type of intracanal medications used teeth were allocated randomly into 2 groups (n=48); group A (Ca(OH)2) and group B (DAP) then incubated at 37 C and 100% humidity. After one week, samples in each group were randomly assigned to 3 subgroups (n=16) according to the method used for medicament removal; XPF, PUI and SVN. All techniques were used according to the manufacturer’s instructions with NaOCL and EDTA as an irrigant. For cleanliness, roots were split longitudinally and imaged using a 10X stereomicroscope to evaluate the residual medicament with image J software program followed by categorizing into a 4-grade scoring system. Debris extruded during the removal procedure were collected into pre-weighed Eppendorf tubes then left to dry in an incubator at 37°C for 7 days. The amount of extruded debris was assessed with an analytical balance and calculated by subtracting the initial weight from the final weight of the tube. All data were statistically analyzed using Kruskal-Wallis and Dunn’s test.
In the in-vivo study, seventy-two patients with necrotic single-rooted mandibular premolars were included, after confirming the diagnosis clinically and radiographically, mechanical preparation was done with ProTaper Next files up to X4 file. Patients were randomly assigned into two equal groups (n=36) according to ICMs used then after 7 days, were assigned randomly again into three equal subgroups (n=12) according to the removal methods. The pain was assessed using a modified visual analogue scale (VAS) postoperatively in the second visit, after 4, 12, 24, 48, 72 and 96 hours. The incident of analgesics intake and swelling were recorded for each patient. After 5 days, standard endodontic treatment was completed with lateral compaction technique with resin-based sealer for obturation. Data were statistically analyzed using the Kruskal Wallis test followed by multiple Mann Whitney U test with Bonferroni correction. Intragroup comparisons were done using Freidman’s test followed by Dunn’s post hoc test.
Results showed that in-vitro, canal cleanliness, both medicaments showed that the amount of remaining debris was significantly lower in the XPF and PUI compared with SVN (P-value < 0.001). Between XPF and PUI groups, there were no statistically significant differences (P> .05). On the other hand, debris extrusion was recorded for all groups without significant difference between them (P-value 0.237). In-Vivo, regarding the technique used for removal of intracanal medication, in both groups, SVN showed the highest significant pain score followed by PUI while XPF showed the lowest mean value at 4,12,24 and 48 hours. While no significant difference was obtained between them at 72 and 96 hours. In all groups, pain severity was significantly high at 12 hours then reduced gradually as the time increased. No significant difference regarding the incidence of analgesics intake was reported. As well as, none of the patients reported the occurrence of postoperative swelling.
Within the limitations of both experimental and clinical conditions of the current study, it could be concluded that;
After the removal of medicaments with various activation techniques, neither canal cleanliness, apically extruded debris, nor postoperative pain were affected by the type of medication used.
All tested techniques were inadequate for the complete removal of intracanal medications from the root canal system.
XPF and PUI were effective in the removal of both Ca(OH)2 and DAP intracanal medications concerning better canal cleanliness and a lower risk of apically extruded debris.
During the removal of intracanal medications, the risk of extrusion beyond the apex was increased by the use of conventional irrigation even with the closed-end needle.
In the removal of intracanal medication, XPF is an effective activation technique for controlling and reducing the severity of postoperative pain, as well as reducing analgesic intake.