A CONE-BEAM COMPUTED TOMOGRAPHY ASSESSMENT OF THE EFFICACY OF XP-ENDO FINISHER, LASER ASSISTED AND PASSIVE ULTRASONIC IRRIGATION TECHNIQUES ON REMOVAL OF TWO DIFFERENT INTRACANAL MEDICAMENTS – AN IN-VITRO STUDY

Abstract

Objectives: To compare the efficacy of laser-activated irrigation (LAI), passive ultrasonic irrigation (PUI), and XP-Endo Finisher (XPF) in removing Nitrofurantoin and modified triple antibiotic paste (MTAP) from root canals using cone-beam computed tomography (CBCT) volumetric analysis. Methods: Sixty extracted intact, caries-free, single-rooted mandibular first premolars were prepared and randomly allocated into six experimental groups (n=10), according to the irrigation activation technique and intracanal medicament used. Following medicament placement, removal was performed using LAI, PUI, or XPF. CBCT scans were obtained before and after medicament removal, and the residual medicament volume was assessed separately in the coronal, middle, and apical thirds. Intergroup differences were evaluated using one-way analysis of variance followed by Tukey post-hoc testing, while pre- and post-removal volumes were compared using paired t-tests. Results: All groups demonstrated a significant reduction in intracanal medicament volume following the removal procedures (p<0.001). LAI groups demonstrated significantly lower residual volumes than the PUI and XPF groups in the coronal, middle, and apical thirds (p<0.001). In the coronal third, residual volumes were 0.477 ± 0.208 mm³ and 0.493 ± 0.206 mm³ for the two LAI groups, compared with 1.395–1.558 mm³ for the other groups. A similar trend was observed in the middle and apical thirds. The overall reduction in total canal volume was also greater in the LAI groups, with mean reductions of 6.661 mm³ and 6.560 mm³, respectively. Conclusions: LAI demonstrated superior intracanal medicament removal compared with PUI and XPF, irrespective of the medicament used. The advantage of LAI was evident throughout the coronal, middle, and apical regions. Clinical Relevance: Laser-activated irrigation may provide more effective removal of intracanal medicaments before obturation and may enhance canal cleanliness, particularly in anatomically challenging regions such as the apical third.