Effectiveness of Post-Endodontic Access-Cavity Cleaning Techniques: A Randomized Clinical Study.

Abstract

Introduction: This randomized clinical study aimed to evaluate the efficacy of different post-endodontic access cavity cleaning techniques in removing residual epoxy resin-based sealer from the pulp chamber floor following root canal obturation.

Materials and methods: Seventy patients requiring root canal treatment in maxillary first molars were randomly assigned into seven groups (n=10) according to the cleaning protocol: dry cotton pellet, ethanol-saturated cotton pellet (5 sec), ethanol-saturated cotton pellet (clinically acceptable cleanliness), ethanol-saturated cotton pellet + air polishing, ethanol-saturated microbrush (5 sec), ethanol-saturated microbrush (clinically acceptable cleanliness) and air abrasion. After obturation with gutta-percha and AH Plus sealer, standardized macro photographs were taken before and after cleaning procedures. The sealer-covered area (SCA) was calculated using Adobe Photoshop based on pixel analysis. Statistical analyses included the Shapiro-Wilk, Paired samples t, Kruskal-Wallis and Mann-Whitney U tests. A p-value of < 0.05 was considered statistically significant.

Results: All cleaning protocols significantly reduced SCA values compared to baseline (p < 0.05). The highest SCA reductions were observed in the air abrasion (96.1%), ethanol-saturated microbrush (clinically acceptable cleanliness) (93.9%), ethanol-saturated cotton pellet + air polishing (92.8%) groups, with no significant differences among them (p > 0.05). These groups showed significantly higher cleaning efficacy compared to the ethanol-saturated microbrush (5 sec) (36.1%), dry cotton pellet (26.4%) and the ethanol-saturated cotton pellet (5 sec) (17.7%) groups (p < 0.05).

Conclusions: Among the evaluated methods, air abrasion, ethanol-saturated microbrush (clinically acceptable cleanliness), ethanol-saturated cotton pellet + air polishing and ethanol-saturated cotton pellet (clinically acceptable cleanliness) demonstrated superior effectiveness in removing residual sealer from the access cavity. Although no statistically significant differences were observed, aplication of microbrush and mechanically assisted cleaning techniques, including air polishing and air abrasion, emerged as the most reliable and effective cleaning strategies for clinical practice.