Aim of this study is to find which among the given agents orange oil, eucalyptus oil and10% citric acid is better to remove silicone - oil based and aqueous based calcium hydroxide. Present study was performed on 60 human mandibular premolars extracted for orthodontic purpose. After  decoronation of the crown instrumentation was done with sequential ProTaper Universal rotary  files  using crown down technique up to F4 on all specimen. Teeth were divided into two groups of 30 teeth each randomly. Half no of teeth filled with vitapex and half with ultracalXs. Vitapex and ultracalXs in teeth were retrieved with 10% citric acid, orange oil and eucalyptus oil along with passive ultrasonic agitation. Volumetric analysis was performed using CBCT

The results of the present study demonstrated that none of the agents tested were able to remove the oil based CH completely even though used along with passive ultrasonic activation. However aqueous CH was almost completely removed by all the three solvents used along with passive ultrasonic irrigation.   The present study showed, citric acid to remove oil based CH better than orange oil and eucalyptus oil. Eucalyptus oil and orange oil were found to have comparable removal efficacy as that of 10% citric acid in removing both aqueous and oil based calcium hydroxide in this study. It is concluded that the efficacy of eucalyptus oil and orange oil were comparable with 10% citric acid in removing both aqueous and silicon oil based calcium hydroxide intra canal medicament. As 10% citric acid can produces dentinal erosion, orange oil and eucalyptus oil along with passive ultrasonic activations can be considered as an effective alternative to citric acid

Keywords: Citric acid, ultra calXs, vitapex, orange oil, eucalyptus oil, ultrasonics, CBCT, CH (calcium hydroxide)

1. Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 1965; 20:340–349.
2. Moller AJR, Fabricius L, Dahlen G, Ohman AE, Heyden G. Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys. Scand J Dent Res 1981; 89: 475–484.
3. Peters OA. Current challenges and concepts in the preparation of root canal systems: a J Endod 2004 Aug; 30(8): 559-567.
4. Endo MS, Ferraz CC, Zaia AA, Almeida JF, Gomes BP. Quantitative and qualitative analysis of microorganisms in root-filled teeth with persistent infection: Monitoring of the endodontic retreatment. Eur J Dent 2013;7:302-9
5. Stamos DE, Sadeghi EM, Haasch GC, Gerstein H. An in vitro comparison study to quantitate the debridement ability of hand, sonic and ultrasonic instrumentation. J Endod 1987; 13:434–440.
6. Nair PN, Henry S, Cano V, Vera J. Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after ‘one visit’ endodontic treatment. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2005;99: 231–252.
7. Siqueira JF Jr., Lopes HP. Mechanisms of antimicrobial activity of calcium hydroxide: A critical review. IntEndod J 1999;32:361-9
8. Hasselgren G, Olsson B, Cvek M. Effects of calcium hydroxide and sodium hypochlorite on the dissolution of necrotic porcine muscle tissue. J Endod 1988;14: 125–127.
9. Safavi KE, Nichols FC. Effect of calcium hydroxide on bacterial lipopolysaccharide. J Endod 1993; 19:76–78.
10. Safavi KE, Nichols FC. Alteration of biologic properties of bacterial lipopolysaccharides by calcium hydroxide treatment. J Endod 1993;20:127–129.
11. Robert GH, Liewehr FR, Buxton TB, McPherson JC 3rd. Apical diffusion of calcium hydroxide in an in vitro model. J Endod 2005;31:57–60
12. Fava LR, Saunders WP. Calcium hydroxide pastes: Classification and clinical indications. IntEndod J 1999;32: 257‑82.
13. Vineeta N, Gupta S, Chandra A. Retrievabilty of calcium hydroxide intracanal medicament with chitosan from root canals: An in vitro CBCT volumetric analysis. J Conserv Dent 2014;17:454-7.
14. Margelos J, Eliades G, Verdelis C, Palaghias G. Interaction of calcium hydroxide with zinc oxide-eugenol type sealers: a potential clinical problem. J Endod 1997;23:43-8
15. Erdemir A, Ari H, Gungunes H, Belli S. Effect of medications for root canal treatment on bonding to root canal dentin. J Endod 2004;30:113–116
16. Barbizam JV, Trope M, Teixeira EC, Tanumaru-Filho M, Teixeira FB. Effect of calcium hydroxide intracanal dressing on the bond strength of a resin-based endodontic sealer. Braz Dent J 2008;19:224–227
17. Kim SK, Kim YO. Influence of calcium hydroxide intracanal medication on apical seal. IntEndod J 2002; 35:623– 628.
18. Lambrianidis T,Kosti E, Boutsioukis C, MazinisM. Removal efficacy of various calcium hydroxide/chlorhexidine medicaments from the root canal. IntEndod J 2006;39:55–61
19. Tasdemir T, Celik D, Er K, Yildirim T, Ceyhanli KT, Yesilyurt C. Efficacy of several techniques for the removal of calcium hydroxide medicament from root canals. IntEndod J 2011;44:505–509.
20. Nandini S, Velmurugan N, Kandaswamy D. Removal efficiency of calcium hydroxide intracanal medicament with two calcium chelators: volumetric analysis using spiral CT, an in vitro study. J Endod 2006;32:1097–1101.
21. Rodig T, Vogel S, Zapf A, Hulsmann M. Efficacy of different irrigants in the removal of calcium hydroxide from root canals. IntEndod J 2010;43:519–527.
22. Arslan H, Gok T, Saygili G, Altintop H, Akcay M, Capar ID. Evaluation of effectiveness of various irrigating solutions on removal of calcium hydroxide mixed with 2% chlorhexidine gel and detection of orange-brown precipitate after removal. J Endod 2014;40:1820–1823.
23. Kustarci, K. Er, S. H. Siso et al., “Efficacy of laser-activated irrigants in calcium hydroxide removal from the artificial grooves in root canals: an ex vivo study,” Photomedicine and Laser Surgery. 2016;vol.34,no.5:pp.205–210,
24. van der Sluis LW, Wu MK, Wesselink PR. The evaluation of removal of calcium hydroxide paste from an artificial standardized groove in the apical root canal using different irrigation methodologies. IntEndod J 2007;40:52-7
25. Kenee DM, Allemang JD, Johnson JD, Hellstein J, Nichol BK. A. Quantitative assessment of efficacy of various calcium hydroxide removal techniques. J Endod 2006;32:563-5.
26. Raghu R, Pradeep G, Shetty A, Gautham PM, Puneetha PG, Reddy TVS. Retrievability of calcium hydroxide intracanal medicament with three calcium chelators, ethylenediaminetetraacetic acid, citric acid, and chitosan from root canals: An in vitro cone beam computed tomography volumetric analysis. Journal of Conservative Dentistry. 2017;20(1):25-29
27. Jessamine Ng Lee, Cheolmin Park, and George M. Whitesides. Solvent Compatibility of Poly (dimethylsiloxane)-Based Microfluidic Devices. Analytical Chemistry , December 1, 2 0 03;Vol.75(23):6544-6554
28. Hansen MG. Relative efficiency of solvents used in endodontics. J Endod 1998; 24:38-40. 13.
29. Kfir A, Rosenberg E, Tamse A, Tsesis I. Can epoxy resin based endodontic sealers be softened within 1-2 min? An in vitro study with chloroform and xylene. EndodPract Today 2012;6:189-94.
30. Duncan HF, Chong BS. Removal of root filling materials: Root filling removal. Endod Topics 2008;19:33-5
31. Mohammadi, Z. and Dummer, P.M.H. Properties and Applications of Calcium Hydroxide in Endodontics and Dental Traumatology. L’institut d ’Etudes Judiciaires. 2011; 44: 697-730
32. Rohit Pannu, Vikas Berwal. Calcium Hydroxide in Dentistry: A Review.Journal of Applied Dental and Medical Sciences.2017; 3(3):24-31
33. Lambrianidis T, Margelos J, Beltes P. Removal efficiency of calcium hydroxide dressing from the root canal. J Endod. 1999;25:85-8
34. Deepak BS, Sherin JC, Mallikarjun Goud K.removal of intracanal medicaments – a review. ujmds 2015; 03 (03): page 14-22
35. Hosoya N, Kurayama H, Iino F, Arai T. Effects of calcium hydroxide on physical and sealing properties of canal sealers. IntEndod J 2004;37:178-84
36. Wiseman A, Cox TC, Paranjpe A, et al. Efficacy of sonic and ultrasonic activation for removal of calcium hydroxide from mesial canals of mandibular molars: a microtomographic study. J Endod. 2011;37:235-8.
37. -J. Lee, M.-K. Wu2& P. R. Wesselink. The effectiveness of syringe irrigation and ultrasonics to remove debris from simulated irregularities within prepared root canal walls.International Endodontic Journal.2004; 37:672–678,
38. Silicones, Ullmann's Encycl HH Moretto, M Schulze, G Wagner - Ind. Chem, 2000;32: 675-712
39. Yadav HK, Yadav RK, Chandra A, Thakkar RR. The effectiveness of eucalyptus oil, orange oil, and xylene in dissolving different endodontic sealers. J Conserv Dent 2016;19:332-7.
40. Simone Maria Galvão de Sousa, Thelma Lopes Silva.Demineralization effect of EDTA, EGTA, CDTA and citric acid on root dentin: a comparative study.Braz Oral Res 2005;19(3):188-92
41. McInnes-Ledoux P,  Cleaton-Jones  PE,  Austin    The pulpal  response  to dilute citric  acid  smear  removers. J Oral Rehabil 1985;12:215-28.
42. Yamaguchi M,  Yoshida  K,  Suzuki  R,  Nakamura  Root canal irrigation with citric acid solution.  J  Endod 1996;22:27-9
43. Scelza MF, Teixeira AM, Scelza P. Decalcifying effect of EDTA-T, 10% citric acid, and 17% EDTA on root canal dentin.Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2003;95:234236.
44. Sherin Jose Chockattu, B. S. Deepak1, K. Mallikarjun Goud. Comparison of efficiency of ethylenediaminetetraacetic acid, citric acid, and etidronate in the removal of calcium hydroxide intracanal medicament using scanning electron microscopic analysis: An in‑vitro study, Journal of Conservative Dentistry , January-February 2017 ;Volume 20   Issue 1  :6-11 
45. Wiseman A, Cox TC, Paranjpe A, et al. Efficacy of sonic and ultrasonic activation for removal of calcium hydroxide from mesial canals of mandibular molars: a microtomographic study. J Endod. 2011;37:235-8.
46. Milton Carlos KUGA Mário Tanomaru-Filho Gisele Faria Marcus Vinicius Reis SÓ2 Tiago Galletti José Roberto Sampaio Bavello .Calcium Hydroxide Intracanal Dressing Removal with Different Rotary Instruments and Irrigating Solutions: A Scanning Electron Microscopy Study. Brazi dent journal.2010;21(4):310-314
47. Kumar P, De Ataide Id, Fernandes M, Lambor R. A cone-beam computed tomography assessment of the efficacy of different irrigation devices for removal of silicone oil-based calcium hydroxide from root canal system. J Conserv Dent 2017;20:68-71
48. Martos J, Gastal MT, Sommer L, Lund RG, Del Pino FA, Osinaga PW. Dissolving efficacy of organic solvents on root canal sealers. Clin Oral Investig 2006;10:50-4.
49. Martos J, Bassotto AP, González-Rodríguez MP, Ferrer-Luque CM. Dissolving efficacy of eucalyptus and orange oil, xylol and chloroform solvents on different root canal sealers. IntEndod J 2011;44:1024-8.
50. Schäfer E, Zandbiglari T. A comparison of the effectiveness of chloroform and eucalyptus oil in dissolving root canal sealers. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2002;93:611-6.
51. Emre Bayram, Dilekdalat, Melike Bayram. Solubility evaluation of different rootcanal sealing materials. The journal of contemporary dental practice, Feb 2015;16(2):96-100
52. Tsuda H, Ohshima Y, Nomoto H, Fujita K, Matsuda E, Iigo M, et al. Cancer prevention by natural compounds. Drug Metab Pharmacokinet 2004;19:245-63
53. Zaccaro Scelza MF, Lima Oliveira LR, Carvalho FB, CôrteRealFaria S. In vitro evaluation of macrophage viability after incubation in orange oil, eucalyptol, and chloroform. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2006 Sep;102(3): e24-e27.
54. Magadha’s BS, Johann JE, Lund RG, Martos J, Del Pine FA. Dissolving efficacy of some organic solvents on gutta-percha. Bras Oral Res 2007;21:303-7.
55. Elemis AU, Redeemer A, Belli S. Effect of EDTA and citric acid solutions on the microhardness and the roughness of human root canal dentin. J Endod 2005; 31:107-10
56. Silva PV, Guides DFC, Naked FV, Pechora JD, CruzFilho AM. Chitosan: a new solution for removal of smear layer after root canal instrumentation. IntEndod J 2013; 46:332-8.
57. Pimenta JA, Zaparolli D, Pécora JD, Cruz-Filho AM. Chitosan: effect of a new chelating agent on the microhardness of root dentin. Braz Dent J 2012; 23:212-21.
58. Sonali Taneja, Manju Kumari, Surbhi Anand.Effect of QMix, peracetic acid and ethylene diamine tetraacetic acid on calcium loss and microhardness of root dentine.Journal of Conservative Dentistry  Mar-Apr 2014 ;  Vol 17  Issue 2:155-158

Dr Princy B P

Post graduate, Department of Conservative Dentistry and Endodontics Srisankara Dental College, Varkala