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Monteiro TM, Cortes-Cid VO, Marceliano-Alves MFV, Campello AF, Bastos LF, Lopes RT, Siqueira JF, Alves FRF. Intracanal removal and apical extrusion of filling material after retreatment using rotary or reciprocating instruments: A new approach using human cadavers. Int Endod J 2024; 57:100-107. [PMID: 37886883 DOI: 10.1111/iej.13990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
AIM This study compared intracanal removal of filling as well as the frequency and volume of extruded material after retreatment with either HyFlex or Reciproc instruments in mandibular teeth from cadavers. METHODOLOGY The root canals of 14 pairs of contralateral single-rooted teeth in mandibles of cadavers were instrumented with Reciproc R40 and filled using lateral compaction. The mandibles were scanned in a micro-computed tomographic (micro-CT) device before and after retreatment procedures. The contralateral teeth were assigned to two groups (n = 14) according to the retreatment protocol using either HyFlex or Reciproc instrument systems. In the HyFlex group, the HyFlex Remover instrument was worked 3 mm short of the working length (WL), followed by HyFlex CM 40.04 and 50.04 at the WL. In the Reciproc group, the R50 instrument was worked up at the coronal two thirds, followed by two more cycles until the WL was reached. Pre- and post-operative micro-CT images were analysed for extrusion and intracanal removal of filling material. RESULTS After retreatment, extrusion of filling material occurred in 11 (78%) and 14 (100%) teeth from HyFlex and Reciproc groups respectively (p > .05). A similar volume of extruded material was observed after retreatment with both systems (p > .05). A significant decrease in the intracanal filling volume was verified after retreatment with both tested systems (p < .05). However, residual filling material was found in all root canals, regardless of the system. The amount of filling material removed (HyFlex = 80.8%; Reciproc = 65.9%) and the operation time was similar between systems (p > .05). CONCLUSIONS A high frequency of filling material extrusion was observed after retreatment with the two systems in a cadaver model, with no significant difference between them. Both protocols obtained similar efficacy in filling material removal procedures, although none completely cleaned the canals.
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Affiliation(s)
- Thamyres M Monteiro
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Duque de Caxias, Brazil
| | - Victor O Cortes-Cid
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Duque de Caxias, Brazil
| | | | - Andrea F Campello
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Duque de Caxias, Brazil
- Department of Endodontics, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Brazil
| | - Luan F Bastos
- Department of Nuclear Energy, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Ricardo T Lopes
- Department of Nuclear Energy, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - José F Siqueira
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Duque de Caxias, Brazil
- Department of Endodontics, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Brazil
| | - Flávio R F Alves
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Duque de Caxias, Brazil
- Department of Endodontics, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Brazil
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Sevgi U, Johnsen GF, Hussain B, Piasecki L, Nogueira LP, Haugen HJ. Morphometric micro-CT study of contralateral mandibular incisors. Clin Oral Investig 2023; 28:20. [PMID: 38147175 PMCID: PMC10751267 DOI: 10.1007/s00784-023-05419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES This study aimed to determine the degree of similarity and symmetry in the anatomy of contralateral mandibular incisors. Three-dimensional (3D) models of extracted teeth were obtained from microtomography (micro-CT) scans. Qualitative and quantitative assessments of the morphology and comparison of contralateral pairs were made. The null hypothesis was that contralateral mandibular incisors could not be considered identical in simple morphometric measurements. METHODS Sixty pairs of mandibular incisors were extracted from 30 patients and scanned with micro-CT. Virtual models of the cemento-enamel junction to the root apex were rendered. Parameters such as length, canal width, dentinal thicknesses, tortuosity, centerline length, accessory canals, root canal configurations, and root canal orifice cross-sections were used to compare the teeth. Width and thickness comparisons between paired teeth in the same individual were made by paired t-test (Wilcoxon signed-rank test for variables not normally distributed). An online randomization tool generated randomized pairs (independent of the individual/patient). Subsequently, an unpaired t-test (or Mann-Whitney U test for non-normally distributed parameters) and a correlation analysis were conducted. Canal configurations were classified according to preexisting classification schemes. The number and location of accessory canals and apical foramina were registered and compared. RESULTS Utilizing advanced imaging techniques and quantitative analyses, our study establishes that contralateral mandibular incisors exhibit a remarkable degree of symmetry in multiple morphological parameters, including length, canal width, and dentinal thicknesses. The apical third showed a high degree of inter-variability for the contralateral pairs. The rigorous statistical analysis of the normalized parameters by Z-score showed no statistically significant differences between the contralateral mandibular incisors. Comparisons between central and lateral teeth revealed differences in root length but no significant disparity in the distribution of accessory canals. Central teeth, on average, were longer, while accessory canals were distributed relatively evenly between central and lateral teeth. CONCLUSIONS The findings of this study further establish the significant similarities between contralateral mandibular incisors, reinforcing their suitability as a reliable substrate for root canal comparison studies. CLINICAL RELEVANCE The absence of statistically significant differences between contralateral pairs in normalized parameters underscores their potential as a reliable reference point for root canal comparison studies in clinical dentistry. Furthermore, our findings emphasize the importance of individualized treatment planning, considering the natural symmetry in mandibular incisors to enhance clinical decision-making. This research contributes valuable insights to the field of endodontics, offering a standardized approach to sample selection and enriching the understanding of dental anatomy.
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Affiliation(s)
- Usame Sevgi
- DF Dental Group, Istanbul, Turkey
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Gaute Floer Johnsen
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Tanngarden AS, Sørumsand, Norway
| | - Badra Hussain
- Oral Research Laboratory Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lucila Piasecki
- Department of Periodontics and Endodontics, University at Buffalo, Buffalo, NY, USA
| | - Liebert Parreiras Nogueira
- Oral Research Laboratory Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Håvard Jostein Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway.
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Johnsen GF, Haugen H, Nogueira LP, Sevgi U, Jimenez AM, DeLuca JT, Mancuso R, Piasecki L. Assessment of the Root Canal Similarity in Contralateral Mandibular Incisors. Int Dent J 2022; 73:71-78. [PMID: 35691729 PMCID: PMC9875282 DOI: 10.1016/j.identj.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The purpose of this study was to determine the degree of similarity between contralateral mandibular incisors utilising 3-dimensional (3D) models obtained from micro-computed tomographic (micro-CT) scans of extracted human teeth. The null hypothesis was that contralateral mandibular incisors do not exhibit matching symmetry. METHODS Sixty pairs (n = 120) of extracted mandibular incisors were obtained from 30 patients and scanned with micro-CT with a voxel size of 15.0 μm. 3D virtual models of the pulpal cavities were rendered. Geometric morphometric deviation analysis was performed after mirroring, automatic alignment, and co-registration of the models of contralateral teeth root mean square (RMS) errors were calculated. The quantitative analysis of the 3D models included 6 different geometric parameters. Data sets were examined with a 2-sample Kolmogorov-Smirnov test. Post hoc retrospective power analysis was performed to find statistical power (α = 0.05). RESULTS Contralateral pairs had a narrower distribution in deviation than random pairs. Also, contralateral pairs showed a statistically higher similarity coefficient (5 out of 6 geometric parameters) compared to random pairs (P < .001); no difference was found when comparing central to lateral pairs or between Vertucci type I configurations compared to non-type I. RMS errors had significantly lower Contralateral premolars (CPs) values than random pairs (P < .001). CONCLUSIONS A high degree of similarity was demonstrated for pairing contralateral mandibular incisors using 3D models. The similarity between contralateral central and lateral incisors suggests that when screened and matched, these 4 teeth might be used in endodontic research where similar root canal anatomy is crucial.
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Affiliation(s)
- Gaute Floer Johnsen
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Håvard Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway,Department of Biomaterials, Institute for Clinical Dentistry, University of Oslo, PO Box 1109 Blindern, NO-0317 Oslo, Norway
| | - Liebert Parreiras Nogueira
- Oral Research Laboratory, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Usame Sevgi
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ashley Mae Jimenez
- Department of Periodontics & Endodontics, University at Buffalo, Buffalo, New York, USA
| | - Joseph T. DeLuca
- Department of Periodontics & Endodontics, University at Buffalo, Buffalo, New York, USA
| | - Ryan Mancuso
- Department of Periodontics & Endodontics, University at Buffalo, Buffalo, New York, USA
| | - Lucila Piasecki
- Department of Periodontics & Endodontics, University at Buffalo, Buffalo, New York, USA
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De-Deus G, Souza EM, Silva EJNL, Belladonna FG, Simões-Carvalho M, Moreira Cavalcante D, Versiani MA. A critical analysis of research methods and experimental models to study root canal fillings. Int Endod J 2022; 55 Suppl 2:384-445. [PMID: 35226760 DOI: 10.1111/iej.13713] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
Canal filling materials and techniques have been one of the most studied topics in Endodontics. A simple search using the mesh term "root canal filling" in PubMed revealed more than 11,000 articles, an impressive number that is much higher than "root canal disinfection" (5,544 articles) or even the popular "root canal preparation" (8,527 articles). The overriding importance attributed to root filling procedures is not merely intuitive. It derived from the appealing relevance given by the appearance of the white lines in common radiographs grounded on retrospective clinical data that had identified the quality of a root filling as one of the major causes of treatment failure (lack of healing). Since the publication of the Washington study, impressive efforts have been made for the release of new materials and techniques, as well as, for the development of a plethora of laboratory methods to assess the quality of root filling procedures. This narrative review aims to address and discuss the most relevant laboratory methods to assess the root canal filling. Since filling quality improvements have not translated into higher success rates, as reported in longitudinal clinical studies, more than to deliver a simple methodology-based review, this paper aims to present an in-depth critical view on the assessment of laboratory methods used to study the filling materials and techniques. Recent data indicate that the long-term dimensional stability/degradation over time of endodontic sealers plays a central role in the treatment outcome. In this context, laboratory methods should be developed focusing on predicting, at least to some degree, the long-term clinical behaviour of root canal fillings, rather than simply ranking different materials or techniques.
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Affiliation(s)
- Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão
| | - Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | | | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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5
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Hülsmann M. A critical appraisal of research methods and experimental models for studies on root canal preparation. Int Endod J 2021; 55 Suppl 1:95-118. [PMID: 34800299 DOI: 10.1111/iej.13665] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/17/2021] [Indexed: 01/02/2023]
Abstract
It is the aim of this review to present a critical overview and summary on the contemporary possibilities, limitations and challenges of research related to root canal preparation. Frequently used research tools and contemporary research designs will be presented and discussed critically focussing on shortcomings and benefits with special regard to clinical relevance and scientific evidence. A plethora of experimental set-ups for assessing the shaping of root canals have been described in the endodontic literature using a considerable number of techniques and instruments. Nevertheless, it can be stated that scientific evidence demonstrating the clinical impact of many investigated topics is questionable or even missing. Instead of technical, radiographic and geometrical parameters, further research should focus on biological aspects and clinical evidence of the impact of root canal preparation on the outcome of root canal treatment.
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Affiliation(s)
- Michael Hülsmann
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
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Hildebrand T, Nogueira L, Sunde PT, Ørstavik D, Glasmacher B, Haugen HJ. Contrast-enhanced nano-CT reveals soft dental tissues and cellular layers. Int Endod J 2021; 54:1275-1288. [PMID: 33829522 DOI: 10.1111/iej.13527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 04/05/2021] [Indexed: 02/01/2023]
Abstract
AIM To introduce a methodology designed to simultaneously visualize dental ultrastructures, including cellular and soft tissue components, by utilizing phosphotungstic acid (PTA) as a contrast-enhancement agent. METHODOLOGY Sound third molars were collected from healthy human adults and fixed in 4% buffered paraformaldehyde. To evaluate the impact of PTA in concentrations of 0.3%, 0.7% and 1% on dental soft and hard tissues for CT imaging, cementum and dentine-pulp sections were cut, dehydrated and stained with immersion periods of 12, 24 h, 2 days or 5 days. The samples were scanned in a high-resolution nano-CT device using pixel sizes down to 0.5 µm to examine both the cementum and pulpal regions. RESULTS Dental cementum and periodontium as well as odontoblasts and predentine were made visible through PTA staining in high-resolution three-dimensional nano-CT scans. Different segments of the tooth required different staining protocols. The thickness of the cementum could be computed over the length of the tooth once it was made visible by the PTA-enhanced contrast, and the attached soft tissue components of the interior of the tooth could be shown on the dentine-pulp interface in greater detail. Three-dimensional illustrations allowed a histology-like visualization of the sections in all orientations with a single scan and easy sample preparation. The segmentation of the sigmoidal dentinal tubules and the surrounding dentine allowed a three-dimensional investigation and quantitative of the dentine composition, such as the tubular lumen or the ratio of the tubular lumen area to the dentinal surface. CONCLUSION The staining protocol made it possible to visualize hard tissues along with cellular layers and soft tissues in teeth using a laboratory-based nano-CT technique. The protocol depended on both tissue type and size. This methodology offers enhanced possibilities for the concomitant visualization of soft and hard dental tissues.
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Affiliation(s)
- T Hildebrand
- Institute for Multiphase Processes, Leibniz University Hannover, Hannover, Germany.,Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - L Nogueira
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - P T Sunde
- Department of Endodontics, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - D Ørstavik
- Department of Endodontics, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - B Glasmacher
- Institute for Multiphase Processes, Leibniz University Hannover, Hannover, Germany
| | - H J Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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7
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Tavares SJO, Gomes CC, Marceliano-Alves MF, Guimarães LC, Provenzano JC, Amoroso-Silva P, Machado AG, Siqueira JF, Alves FRF. Supplementing filling material removal with XP-Endo Finisher R or R1-Clearsonic ultrasonic insert during retreatment of oval canals from contralateral teeth. AUST ENDOD J 2020; 47:188-194. [PMID: 33030235 DOI: 10.1111/aej.12451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/13/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
This study compared the efficacy of XP-Endo Finisher R and R1-Clearsonic insert in removing filling material remnants from oval canals. Twelve pairs of contralateral premolars were treated and subsequently retreated with Reciproc 50. A supplementary procedure with XP-Endo Finisher R or R1-Clearsonic was performed. Micro-computed tomography was used to quantify the filling material volume in the full canal and apical segment lengths. Intragroup analyses revealed significant reduction of filling material after both procedures, not only in the full canal but also in the apical segment (P < 0.05). The amount of filling material removed with XP-Endo Finisher R and R1-Clearsonic was 47.9% and 52.2% in the apical segment (P > 0.05), and 82.1% and 64.6% in the full canal (P < 0.05). None of the instruments was effective in completely removing the filling material from the apical canal, but better results were obtained with XP-Endo Finisher R in the total canal length.
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Affiliation(s)
- Sandro J O Tavares
- Faculty of Dentistry, Department of Endodontics, Federal Fluminense University, Nova Friburgo, RJ, Brazil
| | - Cinthya C Gomes
- Faculty of Dentistry, Department of Endodontics, Federal Fluminense University, Nova Friburgo, RJ, Brazil
| | | | - Ludmila C Guimarães
- Faculty of Dentistry, Department of Endodontics, Federal Fluminense University, Nova Friburgo, RJ, Brazil
| | - José C Provenzano
- Faculty of Dentistry, Department of Endodontics, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - Pablo Amoroso-Silva
- PostGraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Duque de Caxias, RJ, Brazil
| | - André G Machado
- Faculty of Dentistry, Department of Endodontics, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - José F Siqueira
- Faculty of Dentistry, Department of Endodontics, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil.,PostGraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Duque de Caxias, RJ, Brazil
| | - Flávio R F Alves
- Faculty of Dentistry, Department of Endodontics, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil.,PostGraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Duque de Caxias, RJ, Brazil
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De‐Deus G, Simões‐Carvalho M, Belladonna FG, Versiani MA, Silva EJNL, Cavalcante DM, Souza EM, Johnsen GF, Haugen HJ, Paciornik S. Creation of well‐balanced experimental groups for comparative endodontic laboratory studies: a new proposal based on micro‐CT and
in silico
methods. Int Endod J 2020; 53:974-985. [DOI: 10.1111/iej.13288] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- G. De‐Deus
- Department of Endodontics Universidade Federal Fluminense NiteróiBrazil
| | | | - F. G. Belladonna
- Department of Endodontics Universidade Federal Fluminense NiteróiBrazil
| | - M. A. Versiani
- Department of Endodontics Universidade Federal Fluminense NiteróiBrazil
| | - E. J. N. L. Silva
- Department of Endodontics Grande Rio University Duque de Caxias Brazil
| | - D. M. Cavalcante
- Department of Endodontics Universidade Federal Fluminense NiteróiBrazil
| | - E. M. Souza
- Department of Dentistry II Federal University of Maranhão São Luís Brazil
| | - G. F. Johnsen
- Department of Biomaterial Faculty of Dentistry University of Oslo Oslo Norway
| | - H. J. Haugen
- Department of Biomaterial Faculty of Dentistry University of Oslo Oslo Norway
| | - S. Paciornik
- Department of Chemical and Materials Engineering Pontifícia Universidade Católica do Rio de Janeiro Rio de Janeiro Brazil
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PradeepKumar AR, Shemesh H, Archana D, Versiani MA, Sousa-Neto MD, Leoni GB, Silva-Sousa YT, Kishen A. Root Canal Preparation Does Not Induce Dentinal Microcracks In Vivo. J Endod 2019; 45:1258-1264. [DOI: 10.1016/j.joen.2019.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 01/05/2023]
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