Effectiveness of SWEEPS, XP-endo finisher and passive ultrasonic irrigation in calcium hydroxide removal: A micro-computed tomography study

PURPOSE: This study sought to evaluate the effectiveness of Shock Wave Enhanced Emission Photoacoustic Streaming (SWEEPS), XP-endo Finisher (XPF), Passive Ultrasonic Irrigation (PUI), and Conventional Syringe Irrigation (CSI) in the removal of calcium hydroxide (CH) from the mesial root canals of mandibular molars, utilizing micro-computed tomography (micro-CT). METHODS: Forty mesial roots of mandibular molars were pair-matched according to canal morphology based on pre-operative micro-CT analysis and randomly assigned to four groups (n = 10). Following standardized canal preparation, CH was placed and stored for two weeks before removal using the assigned irrigation protocols. Micro-CT scans were obtained before and after CH removal, and the remaining CH volumes in the apical, middle, coronal, and total canal regions were quantitatively analyzed. RESULTS: All methods significantly reduced CH volume compared with baseline at all root levels (p < 0.05). CSI demonstrated significantly lower CH removal in the coronal and middle thirds compared with the other groups and was less effective than XPF and SWEEPS in the apical region (p < 0.05). SWEEPS and XPF demonstrated markedly superior CH elimination compared to PUI in the apical third (p < 0.05). CONCLUSION: Although complete CH removal was not achieved with any technique, SWEEPS and XPF demonstrated relatively higher removal effectiveness. This in vitro study demonstrated that sophisticated irrigation activation strategies, including SWEEPS and XP-endo Finisher, improved the elimination of calcium hydroxide from intricate root canal systems.