Influence of activation systems on the removal and apical extrusion of a bioceramic intracanal medicament in immature teeth: an in vitro study

Purpose This study aimed to evaluate the effects of passive ultrasonic irrigation (PUI) and sonic activation (SA) on apical extrusion and the removal efficacy of bioceramic (BC), and calcium hydroxide (CH) based intracanal materials in simulated open-apex teeth. Materials and Methods Thirty-two extracted mandibular canines were prepared according to ISO #140, and an open-apex condition was created by apical resection. Specimens were randomly assigned to bioceramic (Bio-C Temp) and CH (DiaPaste) intracanal medication groups and subdivided among PUI or SA methods (n = 8). Extruded intracanal medicament was collected in pre-weighed tubes, and residual medicament was scored under a microscope. Residual intracanal medicament was evaluated using a four-grade scoring system. Normality was assessed using the Shapiro–Wilk test; group comparisons were performed with the Kruskal–Wallis test and Dunn’s posthoc test, with significance set at p<0.05. Results Apical Extrusion values were as follows: Group BC-PUI = 0.048 mg, Group BC-SA = 0.036 mg, Group CH-PUI = 0.052 mg, and Group CH-SA = 0.049 mg. No significant difference was observed in apical extrusion among the groups (p = 0.265). Median residual scores were Group BC-PUI = 0.5, Group BC-SA = 3, Group CH-PUI = 0.5 and Group CH-SA = 1. PUI resulted in significantly lower residual medicament scores than SA (p = 0.002). Conclusion Bio-C Temp demonstrated superior removal and apical extrusion characteristics were comparable to CH. These findings support its potential as a reliable alternative to CH.