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Saiz-Pardo-Pinos AJ, Manzano-Moreno FJ, Muñoz-Soto E, González-Rodríguez MP, Romero-Olid N, Olmedo-Gaya MV. Analysis of the Prognostic Factors That Influence the Outcome of Periapical Surgery, including Biomimetic Membranes for Tissue Regeneration: A Review. Biomimetics (Basel) 2024; 9:258. [PMID: 38786468 PMCID: PMC11117633 DOI: 10.3390/biomimetics9050258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
The objective of this study was to analyze the prognostic factors that influence the outcome of periapical surgery. A systematic search of the literature was carried out using PubMed and Scopus databases between January 2000 and December 2023 with no language limitations. The PICO question of the present systematic review was: What prognostic factors may influence the outcome of periapical surgery? The most relevant randomized controlled clinical trials (RCTs), prospective clinical trials, retrospective studies, and meta-analyses (n = 44) were selected from 134 articles. The reviewed literature evidenced that bone-lesion healing could significantly be improved by the absence of deep periodontal pockets (>4 mm), localization in anterior teeth, the absence of pain and/or preoperative symptoms, a size of bone lesion < 5 mm, the use of ultrasound, the correct placement of retrograde filling material, and the use of different biomimetic membranes for guided tissue regeneration (GTR). Some preoperative and intraoperative factors could significantly improve the prognosis of periapical surgery. However, these results were not conclusive, and further high-quality research is required.
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Affiliation(s)
| | - Francisco J. Manzano-Moreno
- Department of Stomatology, School of Dentistry, University of Granada, 18071 Granada, Spain; (M.P.G.-R.); (N.R.-O.); (M.V.O.-G.)
| | - Esther Muñoz-Soto
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, 18071 Granada, Spain;
| | - María Paloma González-Rodríguez
- Department of Stomatology, School of Dentistry, University of Granada, 18071 Granada, Spain; (M.P.G.-R.); (N.R.-O.); (M.V.O.-G.)
| | - Nuria Romero-Olid
- Department of Stomatology, School of Dentistry, University of Granada, 18071 Granada, Spain; (M.P.G.-R.); (N.R.-O.); (M.V.O.-G.)
| | - María Victoria Olmedo-Gaya
- Department of Stomatology, School of Dentistry, University of Granada, 18071 Granada, Spain; (M.P.G.-R.); (N.R.-O.); (M.V.O.-G.)
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Li H, Guo Z, Li C, Ma X, Wang Y, Zhou X, Johnson TM, Huang D. Materials for retrograde filling in root canal therapy. Cochrane Database Syst Rev 2021; 10:CD005517. [PMID: 34647617 PMCID: PMC8515509 DOI: 10.1002/14651858.cd005517.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Root canal therapy is a sequence of treatments involving root canal cleaning, shaping, decontamination, and obturation. It is conventionally performed through a hole drilled into the crown of the affected tooth, namely orthograde root canal therapy. When it fails, retrograde filling, which seals the root canal from the root apex, is a good alternative. Many materials are used for retrograde filling. Since none meets all the criteria an ideal material should possess, selecting the most efficacious material is of utmost importance. This is an update of a Cochrane Review first published in 2016. OBJECTIVES To determine the effects of different materials used for retrograde filling in children and adults for whom retrograde filling is necessary in order to save the tooth. SEARCH METHODS An Information Specialist searched five bibliographic databases up to 21 April 2021 and used additional search methods to identify published, unpublished, and ongoing studies. We also searched four databases in the Chinese language. SELECTION CRITERIA We selected randomised controlled trials (RCTs) that compared different retrograde filling materials, with the reported success rate that was assessed by clinical or radiological methods for which the follow-up period was at least 12 months. DATA COLLECTION AND ANALYSIS Records were screened in duplicate by independent screeners. Two review authors extracted data independently and in duplicate. Original trial authors were contacted for any missing information. Two review authors independently assessed the risk of bias of the included studies. We followed Cochrane's statistical guidelines and assessed the certainty of the evidence using GRADE. MAIN RESULTS We included eight studies, all at high risk of bias, involving 1399 participants with 1471 teeth, published between 1995 and 2019, and six comparisons of retrograde filling materials. - Mineral trioxide aggregate (MTA) versus intermediate restorative material (IRM): there may be little to no effect of MTA compared to IRM on success rate at one year, but the evidence is very uncertain (risk ratio (RR) 1.09, 95% confidence interval (CI) 0.97 to 1.22; I2 = 0%; 2 studies; 222 teeth; very low-certainty evidence). - MTA versus super ethoxybenzoic acid (Super-EBA): there may be little to no effect of MTA compared to Super-EBA on success rate at one year, but the evidence is very uncertain (RR 1.03, 95% CI 0.96 to 1.10; 1 study; 192 teeth; very low-certainty evidence). - Super-EBA versus IRM: the evidence is very uncertain about the effect of Super-EBA compared with IRM on success rate at 1 year, with results indicating Super-EBA may reduce or have no effect on success rate (RR 0.90, 95% CI 0.80 to 1.01; 1 study; 194 teeth; very low-certainty evidence). - Dentine-bonded resin composite versus glass ionomer cement: compared to glass ionomer cement, dentine-bonded resin composite may increase the success rate of the treatment at 1 year, but the evidence is very uncertain (RR 2.39, 95% CI 1.60 to 3.59; 1 study; 122 teeth; very low-certainty evidence). Same result was obtained when considering the root as unit of analysis at one year (RR 1.59, 95% CI 1.20 to 2.09; 1 study; 127 roots; very low-certainty evidence). - Glass ionomer cement versus amalgam: the evidence is very uncertain about the effect of glass ionomer cement compared with amalgam on success rate at one year, with results indicating glass ionomer cement may reduce or have no effect on success rate (RR 0.98, 95% CI 0.86 to 1.12; 1 study; 105 teeth; very low-certainty evidence). - MTA versus root repair material (RRM): there may be little to no effect of MTA compared to RRM on success rate at one year, but the evidence is very uncertain (RR 1.00, 95% CI 0.94 to 1.07; I2 = 0%; 2 studies; 278 teeth; very low-certainty evidence). Adverse events were not assessed by any of the included studies. AUTHORS' CONCLUSIONS Based on the present limited evidence, there is insufficient evidence to draw any conclusion as to the benefits of any one material over another for retrograde filling in root canal therapy. We conclude that more high-quality RCTs are required.
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Affiliation(s)
- Honglin Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhiyong Guo
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiangyu Ma
- Department of Endodontics, State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
- Department of Endodontics, Mianyang Hospital of TCM, Mianyang, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Trevor M Johnson
- Faculty of General Dental Practice (UK), RCS England, London, UK
| | - Dingming Huang
- Department of Endodontics, State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
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Abou ElReash A, Hamama H, Comisi JC, Zaeneldin A, Xiaoli X. The effect of retrograde material type and surgical techniques on the success rate of surgical endodontic retreatment: systematic review of prospective randomized clinical trials. BMC Oral Health 2021; 21:375. [PMID: 34303365 PMCID: PMC8306275 DOI: 10.1186/s12903-021-01731-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Endodontic surgical procedures, when performed, require retrograde filling materials that are biocompatible, non-toxic, non-irritant, dimensionally stable, and ideally promote bone formation. Precise evaluation of retrograde filling materials in clinical trials is necessary to give holistic view for properties of material and potential outcome from its use. The purpose of this review is to evaluate the effect of retrograde material type and surgical techniques on the success rate of surgical endodontic retreatment. Methods An electronic search was performed in the time frame between 1st of January 2000 to 1st of September 2020 using database. Sources Web of Science, PubMed and redundant hand searches through their references. Seven inclusion–exclusion criteria were set for the selection and identification of relevant articles. Risk of bias was conducted for the included studies. Results Nine randomized clinical trials (RCTs) fulfilled the inclusion criteria for this systematic review. The outcome of this review revealed that none of the reviewed trials totally-fulfilled CONSORT 2010 criteria. Conclusions In light of the outcome of this review, there is no enough evidence to support the superiority of certain retrograde filling material or surgical technique over another in the success rate of surgical endodontics retreatment. The variety of methodologies and strategies, such as patient selection, the method of treatment and study analysis, led to doubtful credibility of the obtained clinical evidence. Further prospective randomized controlled clinical trials evaluating the specific effect of the various used materials are needed.
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Affiliation(s)
- Ashraf Abou ElReash
- Department of Endodontic, Xiangya School of Stomatology, Central South University, Xiangya Road No 72. Kaifu, Changsha, 410078, Hunan Province, China
| | - Hamdi Hamama
- Department of Operative Dentistry, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - John C Comisi
- Department of Oral Rehabilitation, Medical University of South Carolina, James B. Edwards College of Dental Medicine, Charleston, SC, USA
| | - Ahmed Zaeneldin
- Restorative Dental Sciences Department, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Xie Xiaoli
- Department of Endodontic, Xiangya School of Stomatology, Central South University, Xiangya Road No 72. Kaifu, Changsha, 410078, Hunan Province, China.
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Outcome of Endodontic Surgery: A Meta-analysis of the Literature-Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root-end Filling Materials. J Endod 2018; 44:923-931. [PMID: 29681480 DOI: 10.1016/j.joen.2018.02.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of the present study was to investigate the influence of root-end preparation and filling material on endodontic surgery outcome. A systematic review and meta-analysis was conducted to determine the outcome of resin-based endodontic surgery (RES, the use of high-magnification preparation of a shallow and concave root-end cavity and bonded resin-based root-end filling material) versus endodontic microsurgery (EMS, the use of high-magnification ultrasonic root-end preparation and root-end filling with SuperEBA [Keystone Industries, Gibbstown, NJ], IRM [Dentsply Sirona, York, PA], mineral trioxide aggregate [MTA], or other calcium silicate cements). METHODS An exhaustive literature search was conducted to identify prognostic studies on the outcome of root-end surgery. Human studies conducted from 1966 to the end of December 2016 in 5 different languages (ie, English, French, German, Italian, and Spanish) were searched in 4 electronic databases (ie, Medline, Embase, PubMed, and Cochrane Library). Relevant review articles on the subject were scrutinized for cross-references. In addition, 5 dental and medical journals (Journal of Endodontics; International Endodontic Journal; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics; Journal of Oral and Maxillofacial Surgery; and International Journal of Oral and Maxillofacial Surgery) were hand checked dating back to 1975. All abstracts were screened by 3 independent reviewers (H.B., M.K., and F.S.). Strict inclusion-exclusion criteria were defined to identify relevant articles. Raw data were extracted from the full-text review of these selected articles independently by each of the 3 reviewers. In case of disagreement, an agreement was reached by discussion, and qualifying articles were assigned to group RES. For EMS, the same search strategy was performed for the time frame October 2009 to December 2016, whereas up to October 2009 the data were obtained from a previous systematic review with identical criteria and search strategy. Weighted pooled success rates and a relative risk assessment between RES and EMS were calculated. To make a comparison between groups, a random effects model was used. RESULTS Sixty-eight articles were eligible for full-text review. Of these, per strict inclusion exclusion criteria, 14 studies qualified, 3 for RES (n = 862) and 11 for EMS (n = 915). Weighted pooled success rates for RES were 82.20% (95% confidence interval [CI], 0.7965-0.8476) and 94.42% for EMS (95% CI, 0.9295-0.9590). This difference was statistically significant (P < .0005). CONCLUSIONS The probability for success for EMS proved to be significantly greater than the probability for success for RES, providing best available evidence on the influence of cavity preparation with ultrasonic tips and/or SuperEBA (Keystone Industries, Gibbstown, NJ), IRM (Dentsply Sirona, York, PA), MTA, or silicate cements as root-end filling material instead of a shallow cavity preparation and placement of a resin-based material. Additional large-scale randomized clinical trials are needed to assess other predictors of outcome.
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Ma X, Li C, Jia L, Wang Y, Liu W, Zhou X, Johnson TM, Huang D. Materials for retrograde filling in root canal therapy. Cochrane Database Syst Rev 2016; 12:CD005517. [PMID: 27991646 PMCID: PMC6463971 DOI: 10.1002/14651858.cd005517.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Root canal therapy is a sequence of treatments involving root canal cleaning, shaping, decontamination and obturation. It is conventionally performed through a hole drilled into the crown of the affected tooth, namely orthograde root canal therapy. For teeth that cannot be treated with orthograde root canal therapy, or for which it has failed, retrograde root filling, which seals the root canal from the root apex, is a good alternative. Many materials, such as amalgam, zinc oxide eugenol and mineral trioxide aggregate (MTA), are generally used. Since none meets all the criteria an ideal material should possess, selecting the most efficacious material is of utmost importance. OBJECTIVES To determine the effects of different materials used for retrograde filling in children and adults for whom retrograde filling is necessary in order to save the tooth. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 13 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 13 September 2016); MEDLINE Ovid (1946 to 13 September 2016); Embase Ovid (1980 to 13 September 2016); LILACS BIREME Virtual Health Library (1982 to 13 September 2016); and OpenSIGLE (1980 to 2005). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We also searched Chinese BioMedical Literature Database (in Chinese, 1978 to 20 September 2016); VIP (in Chinese, 1989 to 20 September 2016); China National Knowledge Infrastructure (in Chinese, 1994 to 20 September 2016); and Sciencepaper Online (in Chinese, to 20 September 2016). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) only that compared different retrograde filling materials, with reported success rate that was assessed by clinical or radiological methods for which the follow-up period was at least 12 months. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently and in duplicate. Original trial authors were contacted for any missing information. Two review authors independently carried out risk of bias assessments for each eligible study following Cochrane methodological guidelines. MAIN RESULTS We included six studies (916 participants with 988 teeth) reported in English. All the studies had high risk of bias. The six studies examined five different comparisons, including MTA versus intermediate restorative material (IRM), MTA versus super ethoxybenzoic acid cement (Super-EBA), Super-EBA versus IRM, dentine-bonded resin composite versus glass ionomer cement and glass ionomer cement versus amalgam. There was therefore little pooling of data and very little evidence for each comparison.There is weak evidence of little or no difference between MTA and IRM at the first year of follow-up (risk ratio (RR) 1.09; 95% confidence interval (CI): 0.97 to 1.22; 222 teeth; quality of evidence: low). Insufficient evidence of a difference between MTA and IRM on success rate at the second year of follow-up (RR 1.06; 95% CI: 0.89 to 1.25; 86 teeth, 86 participants; quality of evidence: very low). All the other outcomes were based on a single study. There is insufficient evidence of any difference between MTA and Super-EBA at the one-year follow-up (RR 1.03; 95% CI: 0.96 to 1.10; 192 teeth, 192 participants; quality of evidence: very low), and only weak evidence indicating there might be a small increase in success rate at the one-year follow-up in favour of IRM compared to Super-EBA (RR 0.90; 95% CI: 0.80 to 1.01; 194 teeth; quality of evidence: very low). There was also insufficient and weak evidence to show that dentine-bonded resin composite might be a better choice for increasing retrograde filling success rate compared to glass ionomer cement at the one-year follow-up (RR 2.39; 95% CI: 1.60 to 3.59; 122 teeth, 122 participants; quality of evidence: very low). And there was insufficient evidence of a difference between glass ionomer cement and amalgam at both the one-year (RR 0.98; 95% CI: 0.86 to 1.12; 105 teeth; quality of evidence: very low) and five-year follow-ups (RR 1.00; 95% CI: 0.84 to 1.20; 82 teeth; quality of evidence: very low).None of these studies reported an adverse event. AUTHORS' CONCLUSIONS Based on the present limited evidence, there is insufficient evidence to draw any conclusion as to the benefits of any one material over another. We conclude that more high-quality RCTs are required.
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Affiliation(s)
- Xiangyu Ma
- Mianyang Hospital of TCMDepartment of EndodonticsFucheng RoadMianyangSichuanChina621000
- West China College of Stomatology, Sichuan UniversityDepartment of Endodontics, State Key Laboratory of Oral DiseasesNo. 14, Section 3, Ren Min Nan RoadChengduSichuanChina610041
| | - Chunjie Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Liuhe Jia
- West China College of Stomatology, Sichuan UniversityDepartment of Endodontics, State Key Laboratory of Oral DiseasesNo. 14, Section 3, Ren Min Nan RoadChengduSichuanChina610041
- Beijing Jishuitan HospitalDepartment of DentistryNo 31, Xinjiekou East Street, Xicheng DistrictBeijingChina100035
| | - Yan Wang
- West China Hospital of Stomatology, Sichuan UniversityDepartment of Pediatric Dentistry, State Key Laboratory of Oral DiseasesNo. 14, Section 3, Renmin South RoadChengduSichuanChina610041
| | - Wenwen Liu
- School and Hospital of Stomatology, Peking UniversityDepartment of VIP Dental Service & Geriatric DentistryBeijingChina
- West China College of Stomatology, Sichuan UniversityDepartment of Oral Implantology, State Key Laboratory of Oral DiseasesNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Xuedong Zhou
- West China College of Stomatology, Sichuan UniversityDepartment of Endodontics, State Key Laboratory of Oral DiseasesNo. 14, Section 3, Ren Min Nan RoadChengduSichuanChina610041
| | - Trevor M Johnson
- RCS EnglandFaculty of General Dental Practice (UK)35‐43 Lincoln's Inn FieldsLondonUKWC2A 3PE
| | - Dingming Huang
- West China College of Stomatology, Sichuan UniversityDepartment of Endodontics, State Key Laboratory of Oral DiseasesNo. 14, Section 3, Ren Min Nan RoadChengduSichuanChina610041
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Abstract
Surgical endodontic therapy (apical surgery) is a treatment alternative aimed at removing periapical inflammatory tissue followed by apical resection and retro-filling of the root canal. These procedures are performed through a trans-osseous approach. Terminology pertinent to this article include: apical (periapical) curettage – a surgical procedure to remove diseased tissue from the alveolar bone in the apical region of a pulpless tooth; apical cyst – a cyst in bone at the apex of a pulpless tooth. It is believed that such cysts arise after the death of the pulp from noxious physical, chemical, or bacterial stimulation of epithelial rests of Malassez; apicoectomy (apical resection) – amputation of the apical portion of the root and removal of soft tissue in the bone; epithelial rests of Malassez – cords, strands, or clusters of ectodermal cells in the periodontal ligament (or sometimes alveolar bone) derived from remnants of Hertwig's epithelial root sheath. These cells frequently begin proliferating when inflammation occurs in the periodontal ligament and are believed to be responsible for the genesis of the epithelial lining of apical cysts.
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Tsesis I, Rosen E, Taschieri S, Telishevsky Strauss Y, Ceresoli V, Del Fabbro M. Outcomes of Surgical Endodontic Treatment Performed by a Modern Technique: An Updated Meta-analysis of the Literature. J Endod 2013; 39:332-9. [PMID: 23402503 DOI: 10.1016/j.joen.2012.11.044] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/21/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
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Tsesis I, Faivishevsky V, Kfir A, Rosen E. Outcome of Surgical Endodontic Treatment Performed by a Modern Technique: A Meta-analysis of Literature. J Endod 2009; 35:1505-11. [DOI: 10.1016/j.joen.2009.07.025] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 07/22/2009] [Accepted: 07/27/2009] [Indexed: 02/08/2023]
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COHN STEVENA. Treatment choices for negative outcomes with non-surgical root canal treatment: non-surgical retreatment vs. surgical retreatment vs. implants. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1601-1546.2005.00163.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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CHONG BUNSAN, PITT FORD THOMASR. Root-end filling materials: rationale and tissue response. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1601-1546.2005.00164.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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