Citric Acid Irrigation Protocols for Bioceramic Sealers for Root Canal Retreatments

Objective: Root canals treated with bioceramic sealers that need retreatment present a clinical challenge. The presented study assessed 20% citric acid (with and without activation) in removing bioceramic sealer remnants. Material and Methods: Thirty extracted human lower premolars teeth were obturated with gutta-percha using bioceramic sealer, and have been split into three groups, each consisting of ten teeth: (1) 20% citric acid without activation, (2) 20% citric acid with ultrasonic activation, and (3) control group utilizing ProTaper Universal retreatment files exclusively. A scanning electron microscope (SEM) was used to investigate the remaining sealer remnants at the coronal, middle and apical thirds. The percentage of the uncleaned canal areas was determined quantitatively with the use of ImageJ software. Results: One-Way ANOVA had shown a significant difference between groups (p less than 0.001). At 64.8% ± 3.1, the control group had the greatest mean residual debris. While ultrasonic activation further improved cleaning efficacy (44.0% 2.6), irrigation with citric acid greatly reduced remnants (50.8% 4.9). Applying ultrasonic activation had the biggest cleaning impact in the apical third. In the apical third, the lowest debris was observed in the activation group (41.1% ± 0.9) vs. 45.3% (citric alone) and 65.7% (control). In the middle third, respective values were 44.1%, 51.5%, and 64.1%. In the coronal third, results were 64.8%, 55.5%, and 64.5%, respectively. Conclusion: According to our results, citric acid irrigation significantly enhances the removal of bioceramic sealer remnants from root canal walls, particularly when combined with ultrasonic activation. Compared to mechanical retreatment alone, the combination of chemical irrigation and activation resulted in a greater reduction of residual material. Citric acid significantly enhances the removal of bioceramic sealer remnants, particularly in the middle and apical thirds. Ultrasonic activation further improves efficacy, with the apical third showing the most notable improvement (41.1% vs. 65.7% in control). This protocol demonstrates a clinically effective and practical approach to improving the efficiency of endodontic retreatment procedures.