ReviewJournal of clinical and experimental dentistry2026
Calcium hydroxide removal using ultrasonic-activated acetic acid versus ultrasonic-activated sodium hypochlorite: A randomized ex vivo study with dual microscopy evaluation.
Review in Journal of clinical and experimental dentistry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
7 authors.
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Abstract
Background: Incomplete calcium hydroxide (Ca(OH)2) removal represents a significant clinical challenge that compromises endodontic obturation quality by interfering with sealer penetration and poteatouso@unicartagena.edu.contially leading to treatment failure. Despite advances in irrigation techniques, the complete elimination of Ca(OH)2 remains difficult, particularly in anatomically complex regions. Acetic acid (AA), a weak organic acid with demonstrated antimicrobial properties, has been proposed as a cost-effective alternative to sodium hypochlorite (NaOCl) for dissolving alkaline residues due to its acidic pH and superior theoretical capacity for acid-base neutralization reactions. This study aimed to compare the calcium hydroxide removal efficacy of ultrasonic-activated 5% acetic acid versus ultrasonic-activated 5.25% sodium hypochlorite across different root canal thirds using dual microscopy evaluation. Material and Methods: Thirty-eight single-rooted premolars were instrumented, medicated with calcium hydroxide for 7 days, and randomly allocated to ultrasonic-activated 5% acetic acid or ultrasonic-activated 5.25% sodium hypochlorite (n=19/group). Removal capacity was evaluated using stereomicroscopy and scanning electron microscopy across coronal, middle, and apical thirds. Data were analyzed using the Mann-Whitney U test and multivariate logistic regression (=0.05). Results: In the middle third, ultrasonic-activated acetic acid achieved superior removal (52.7% excellent/good vs 15.8%; p=0.017; OR=6.00, 95%CI:1.40-25.85) with adequate power (1-=0.82). Multivariate regression confirmed irrigant type as an independent predictor (adjusted OR=4.23, p=0.026) with significant irrigant×third interaction (p=0.041). No differences were observed in coronal (p=0.150) or apical thirds (p=0.820). Conclusions: Ultrasonic-activated acetic acid demonstrated superior calcium hydroxide removal in the middle third compared to ultrasonic-activated sodium hypochlorite. Acetic acid represents an accessible, cost-effective alternative for intracanal medicament removal.
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