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Barazy R, Alafif H, Achour H, Al-Aloul A, Alsayed Tolibah Y. Can antimicrobial photodynamic therapy serve as an effective adjunct protocol for disinfecting the necrotic root canal system? A randomized controlled study. BDJ Open 2024; 10:53. [PMID: 38902230 PMCID: PMC11190140 DOI: 10.1038/s41405-024-00239-y] [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: 03/06/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Bacterial infection plays an important role in persistent periapical lesions and inadequate disinfection of root canals is considered the biggest factor responsible for endodontic treatment failure. Antimicrobial Photodynamic Therapy (aPDT) has become the latest choice to eradicate microorganisms in root canals. OBJECTIVE This study aims to evaluate the effectiveness of Antimicrobial Photodynamic Therapy (aPDT) in bacterial count reduction compared to Passive Ultrasonic Activation (PUI) and Ca(OH)2 dressings. MATERIALS AND METHODS Forty-five anterior single canal teeth with medium-sized periapical lesions (2-5 mm) were divided into three groups according to the disinfecting technique (each group consists of 15 canals with 1:1:1 allocation ratio): Group A: Ca(OH)2 dressing. Group B: Passive Ultrasonic Activation (PUI). Group C: Antimicrobial Photodynamic Therapy (aPDT). Direct bacterial viable count method was used to count the colonies forming units (CFU) before and after the disinfecting and the bacterial count reduction was estimated, the statistical analysis was performed at a 95% confidence level using the Chi-square and Mann-Whitney U test. RESULTS aPDT showed no statistically significant difference when compared to passive ultrasonic irrigation (P > 0.05) but showed higher and more promising results when compared to Ca(OH)2 dressings (P < 0.05). CONCLUSIONS aPDT has the ability and effectiveness as a disinfecting technique in necrotic and infected root canals. CLINICAL SIGNIFICANCE OF THE STUDY The results of this clinical trial provide that aPDT can be considered an adjunct method for root canal disinfection with the same effectiveness as passive ultrasonic irrigation.
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Affiliation(s)
- Remy Barazy
- Department of Endodontics, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
| | - Hisham Alafif
- Department of Endodontics, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
| | - Hassan Achour
- Department of Endodontics, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
| | - Ahmad Al-Aloul
- Department of Endodontics, Faculty of Dentistry, Al-Sham Private University, Damascus, Syrian Arab Republic
| | - Yasser Alsayed Tolibah
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic.
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2
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Aminsobhani M, Hashemi N, Hamidzadeh F, Sarraf P. Broken Instrument Removal Methods with a Minireview of the Literature. Case Rep Dent 2024; 2024:9665987. [PMID: 38919975 PMCID: PMC11196850 DOI: 10.1155/2024/9665987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/24/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
Instrument fracture in the root canal system is an unpleasant incident that may occur during root canal treatment. Comprehensive cleaning of the root canal system is often impossible in the presence of a broken instrument. Therefore, it is often imperative to remove the broken fragment from the root canal system. To date, various methods have been proposed for the removal of broken instruments from the root canal system. However, no consensus has been reached on a safe technique with a high success rate for broken instrument removal. This case series reports six cases of successful removal of broken instruments using different methods including the ultrasonic, tube-and-glue, tube-and-wire, tube-and-internal shaft, and the forceps techniques and also provides a brief review of the relevant literature.
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Affiliation(s)
- Mohsen Aminsobhani
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
- School of DentistryAJA University of Medical Sciences, Tehran, Iran
| | - Nasim Hashemi
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hamidzadeh
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
| | - Pegah Sarraf
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
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Liu H, Shen Y. Two-year follow-up of a mandibular second premolar with a fractured irrigation needle extending beyond the apex: A case report. J Dent Sci 2024; 19:1237-1238. [PMID: 38618113 PMCID: PMC11010695 DOI: 10.1016/j.jds.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/11/2024] [Indexed: 04/16/2024] Open
Affiliation(s)
- He Liu
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
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4
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Ma H, Liu H, Shen Y. A microscopic and ultrasonic approach to manage separated files and calcified root canals in the first mandibular molar. Asian J Surg 2024; 47:1437-1438. [PMID: 38036351 DOI: 10.1016/j.asjsur.2023.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Haifeng Ma
- Department of Stomatology, Affiliated Hospital of Jining Medical University, Jining, China
| | - He Liu
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada.
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
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5
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Lin J, Wang C, Wang X, Chen F, Zhang W, Sun H, Yan F, Pan Y, Zhu D, Yang Q, Ge S, Sun Y, Wang K, Zhang Y, Xian M, Zheng M, Mo A, Xu X, Wang H, Zhou X, Zhang L. Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment. Int J Oral Sci 2024; 16:11. [PMID: 38302479 PMCID: PMC10834456 DOI: 10.1038/s41368-024-00278-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
ABSTARCT Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multi-disciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.
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Affiliation(s)
- Jiang Lin
- Department of Stomatology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Xiangdong Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Faming Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi' an, China
| | - Wei Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
| | - Hongchen Sun
- Department of Oral &Maxillofacial Pathology, School and Hospital of Stomatology, Jilin University, Jilin, China
| | - Fuhua Yan
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yaping Pan
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Dongdong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qintai Yang
- Department of Otolaryngology, Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaohua Ge
- Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration, Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Yao Sun
- Department of Implantology, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Kuiji Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Mu Xian
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Zheng
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Anchun Mo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanguo Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
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6
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Liu H, Shen Y. Microsurgical removal of an invisible fractured endodontic instrument from a mandibular first molar. J Dent Sci 2024; 19:724-725. [PMID: 38303829 PMCID: PMC10829631 DOI: 10.1016/j.jds.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/09/2023] [Indexed: 02/03/2024] Open
Affiliation(s)
- He Liu
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
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7
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Chandak M, Agrawal P, Mankar N, Sarangi S, Bhopatkar J. Navigating Separated Instrument Retrieval: A Case Report. Cureus 2023; 15:e50559. [PMID: 38222183 PMCID: PMC10787944 DOI: 10.7759/cureus.50559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Instrument separation during endodontic therapy is a complication occurring in 2% to 6% of cases. Focusing on the Masserann technique, the study presents a success rate of 55% in retrieving separated instruments. The technique's effectiveness is demonstrated through a case involving retrieving an instrument from the mandibular first premolar. The technique utilizes various tools, including trephine burs and an extractor, providing a reliable means to dislodge tightly wedged fragments. Despite limitations in specific tooth types and the necessity for frequent radiographic monitoring, the Masserann kit proves effective and underscores the importance of attempting retrieval before considering surgical interventions. The presented case exemplifies the technique's clinical applicability and positive outcomes in intricate scenarios, emphasizing its significance in endodontic practice.
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Affiliation(s)
- Manoj Chandak
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Paridhi Agrawal
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikhil Mankar
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swayangprabha Sarangi
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jay Bhopatkar
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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8
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Zarekar M, Satpute A, Zarekar M. Endodontic Retreatment of a Maxillary First Molar With Orthograde Retrieval of a Separated File by a Combination of Ultrasonic and File Braiding Techniques: A Case Report. Cureus 2023; 15:e50140. [PMID: 38186462 PMCID: PMC10771575 DOI: 10.7759/cureus.50140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
The persistence of apical periodontitis after endodontic therapy can be attributed to biological causes or when the treatment approaches have proven insufficient in completely eradicating the intra-radicular infection. This case report describes the endodontic retreatment of a maxillary molar in which file separation occurred during the cleaning and shaping procedure. The separated file was successfully retrieved utilizing a combination of ultrasonic and braiding techniques. The field of ultrasonics has undergone a thorough investigation and has been demonstrated to be a conservative technique with minimal radicular dentin trephination. The braiding technique is also a conservative method that involves the use of several braided H-files to apply a gripping force, facilitating the extraction of foreign bodies. The utilization of this methodology has been documented in the endodontic academic literature.
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Affiliation(s)
- Mohit Zarekar
- Paedodontics & Preventive Dentistry, Private Practice, Ahmednagar, IND
| | - Apurva Satpute
- Conservative Dentistry and Endodontics, Government Dental College & Hospital, Aurangabad, Aurangabad, IND
| | - Mohini Zarekar
- Institute of Tropical Medicine, Charité - Universitätsmedizin Berlin, Berlin, DEU
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9
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Ahmed HMA, El-Karim I, Duncan HF, Krastl G, Galler K. Implications of root, pulp chamber, and canal anatomy on pulpotomy and revitalization procedures. Clin Oral Investig 2023; 27:6357-6369. [PMID: 37870593 DOI: 10.1007/s00784-023-05284-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures. METHODS This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures. RESULTS Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up. CONCLUSIONS Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups. CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.
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Affiliation(s)
- Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Ikhlas El-Karim
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Henry F Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental, Traumatology University Hospital of Würzburg Pleicherwall, 2, 97070, Würzburg, Germany
| | - Kerstin Galler
- Department of Restorative Dentistry and Periodontology, University Hospital Erlangen, Erlangen, Germany
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Lakshmaiah D, Raj Kumar J, Sakthi N, Karunakaran J, Vishwanath S. The Management of Fractured Dental Instruments: A Case Series. Cureus 2023; 15:e49132. [PMID: 38130569 PMCID: PMC10733118 DOI: 10.7759/cureus.49132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
The most common problem faced by dentists during root canal therapy is instrument separation. Instrument separation leads to the inefficient biomechanical preparation of the canals, which can affect the outcome of the root canal-treated tooth. Hence, bypassing the fractured instrument or removal can be accounted as a viable choice to maintain the structural integrity of the tooth. This article illustrates a case series wherein the fractured instrument was managed successfully with the use of conservative techniques.
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Affiliation(s)
- Deepika Lakshmaiah
- Department of Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Jwaalaa Raj Kumar
- Department of Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Nikesh Sakthi
- Department of Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Janani Karunakaran
- Department of Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Sankar Vishwanath
- Department of Conservative Dentistry and Endodontics, KSR Institute of Dental Science and Research, Tiruchengode, IND
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11
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Zanza A, Reda R, Testarelli L. Endodontic Orthograde Retreatments: Challenges and Solutions. Clin Cosmet Investig Dent 2023; 15:245-265. [PMID: 37899987 PMCID: PMC10612510 DOI: 10.2147/ccide.s397835] [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: 05/03/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023] Open
Abstract
Endodontic orthograde retreatments are considered one of the possible treatment options in case of post-treatment diseases considering the promising results present in the literature. Despite this, a plethora of articles have been published on this topic, and drawing conclusions could be challenging. For this reason, this review aims to summarize the crucial points on each aspect of non-surgical endodontic retreatments, discussing and comparing the current protocols, techniques, materials, and indications. Taking into consideration data from the literature, in terms of diagnosis, CBCT should be considered the first choice, since it can thoroughly affect the diagnosis and treatment plan. Regarding the procedural phases, some conclusions can be drawn: when present, coronal restoration materials such as crowns, partial prostheses, post, and core should be removed; the use of magnification devices, ultrasonic instruments, and an in-depth interpretation of radiographic images with both 2D and 3D images are strongly recommended during the orifice location; additional protocols such as irrigants activation, ultrasonic cleaning, and rotary or reciprocating instrumentation of treated canals are strongly recommended for filling materials removal and to achieve a high-quality chemo-mechanical disinfection; perforations should be treated as soon as possible, and the material of choice to treat them is the MTA or other calcium-silicate-based repair materials; the presence of ledges does not intrinsically reduce the success rate of RCRts if properly managed; in case of instrument fragments, their removal should be considered as the first treatment option, however many variables should be considered to select the proper technique or consider the option of bypassing.
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Affiliation(s)
- Alessio Zanza
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Rodolfo Reda
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Testarelli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
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12
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Abbara MT, Akil S, Hamadah O, Achour H, Mahayni G, Tolibah YA. The effect of the irrigant activation protocol on postoperative pain in maxillary incisors with asymptomatic apical periodontitis: A three-arm randomized clinical trial. Clin Exp Dent Res 2023; 9:868-878. [PMID: 37786913 PMCID: PMC10582227 DOI: 10.1002/cre2.786] [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: 06/26/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/04/2023] Open
Abstract
OBJECTIVES This study aimed to compare the effects of three irrigation activation systems (IAS) on postoperative pain (PP) in activating three final irrigants: sodium hypochlorite 5.25%, ethylenediaminetetraacetic acid 17%, and chlorhexidine 2%. MATERIALS AND METHODS This parallel randomized clinical trial included referred patients with asymptomatic large-sized apical lesion incisors. A standard method was followed in the canal cleaning and shaping for all included patients in the study. Then, the patients were randomly assigned (1:1 allocation) into three groups: G1 (n = 20) with passive ultrasonic irrigation activation; G2 (n = 20) with XP-Endo Finisher file activation; and G3 (n = 20) with diode laser (810 nm) activation. PP was estimated in all groups using a visual analog scale after 1, 3, 7, and 14 days of treatment. Comparisons between the groups were made using the Kruskal-Wallis test, whereas the Mann-Whitney U test was used in the pairwise comparisons. RESULTS Sixty patients were followed-up in this trial. There were significant differences between the groups in terms of PP After 1, 3, and 7 days of treatment (p = 0.002, p = 0.017, and p = 0.006, respectively). On the first day of treatment, G3 showed the lowest PP compared with G1 and G2 (p = 0.007 and p = 0.001, respectively). On the third day of treatment, G3 showed less PP compared with G2 (p = 0.005). On the seventh day of treatment, G2 showed the highest PP compared with G1 and G3 (p = 0.012 and p = 0.003, respectively). CONCLUSIONS The XP-Endo Finisher file caused the highest PP level especially in the next day and 3 days of the treatment, whereas the diode laser had the lowest PP level during the first week of treatment. It is noteworthy that PP disappeared completely after 2 weeks of treatment with all three IASs. TRIAL REGISTRATION The trial was registered in the ISRCTN registry (Trial ID: SRCTN99457940).
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Affiliation(s)
| | - Samar Akil
- Department of Endodontics, Faculty of DentistryDamascus UniversityDamascusSyria
| | - Omer Hamadah
- Department of Oral Medicine, Faculty of DentistryDamascus UniversityDamascusSyria
| | - Hassan Achour
- Department of Endodontics, Faculty of DentistryDamascus UniversityDamascusSyria
| | - Ghina Mahayni
- Faculty of DentistryAl‐Sham Private UniversityDamascusSyria
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13
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Karim MH, Faraj BM. Comparative Evaluation of a Dynamic Navigation System versus a Three-dimensional Microscope in Retrieving Separated Endodontic Files: An In Vitro Study. J Endod 2023; 49:1191-1198. [PMID: 37393950 DOI: 10.1016/j.joen.2023.06.014] [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: 05/14/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION This study aimed to compare the effectiveness of a dynamic navigation system and a three-dimensional microscope in retrieving broken rotary Nickel-Titanium files when using trepan burs and the extractor system. MATERIALS AND METHODS Thirty maxillary first bicuspids with 60 separate roots were split into 2 comparable groups based on a comprehensive cone beam computed tomography analysis of the root length and curvature. After standardized access opening, glide paths, and patency attainment with the K file (sizes 10 and 15), the teeth were arranged on 3D models (three per quadrant, six per model). Subsequently, controlled-memory heat-treated Nickel-Titanium rotary files (#25/0.04) were notched 4 mm from the tips and fractured at the apical third of the roots. The C-FR1 Endo file removal system was employed under both guidance to retrieve the fragments, and the success rate, canal aberration, treatment time, and volumetric changes were measured. The statistical analysis was performed using IBM SPSS software at a significance level of 0.05. RESULTS The microscope-guided group had a higher success rate than the dynamic navigation system guidance, but the difference was insignificant (P > .05). In addition, the microscope-guided drills resulted in a substantially lower proportion of canal aberration, shorter time to retrieve the fragments and less change in the root canal volume (P < .05). CONCLUSION Although dynamically guided trephining with the extractor can retrieve separated instruments, it is inferior to three-dimensional microscope guidance regarding treatment time, procedural errors, and volume change.
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Affiliation(s)
- Mohammed H Karim
- Conservative Department, University of Sulaimani, College of Dentistry, Iraq.
| | - Bestoon M Faraj
- Conservative Department, University of Sulaimani, College of Dentistry, Iraq
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Umre U, Sedani S, Nikhade PP, Mishra A, Bansod A. The Good Old Masserann Technique for the Retrieval of a Separated Instrument: An Endodontic Challenge. Cureus 2023; 15:e45811. [PMID: 37876388 PMCID: PMC10591272 DOI: 10.7759/cureus.45811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
Instrument separation is one of the most upsetting endodontic errors, and it can occur at any time during root canal surgery. A broken file causes a metallic restriction in the root canal and makes it difficult to clean and shape the instrument effectively, thereby making the prognosis questionable. Hence, such a fragment should be properly retrieved when it becomes difficult to bypass it. A variety of techniques and tools are utilized for instrument recovery; however, most of them are expensive, difficult to master, and technique-sensitive. One such tool for orthograde removal of intracanal metallic obstacles is the Masserann kit. We discuss a case involving file removal from the maxillary premolar by using the Masserann technique.
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Affiliation(s)
- Utkarsh Umre
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shweta Sedani
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pradnya P Nikhade
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abeer Mishra
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akansha Bansod
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Coaguila-Llerena H, Lazo-Quezada G, Teves A, Zevallos-Chávez M, Faria G. Removal of separated instruments from unfavourable locations: Case reports using the HBW ultrasonic ring or a surgical approach. AUST ENDOD J 2023; 49:358-364. [PMID: 35932460 DOI: 10.1111/aej.12673] [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: 01/07/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/05/2023]
Abstract
Two patients were admitted to the dental clinic to evaluate two right mandibular first molars (both FDI no. 46). In Case 1, there was an accidental instrument separation, which was thought to have been bypassed; however, the instrument was located beyond the apical foramen, in the alveolar bone. The 1-week follow-up revealed that the fragment was close to the inferior alveolar nerve, thus allowing surgical removal to be performed. In Case 2, two separated instruments located in the apical third of the mesiobuccal and mesiolingual canals were removed using the HBW ultrasonic ring coupled to ISO 10 and 15 hand instruments. The 3-month and 1-year follow-ups (Case 1), and the 2-year and 3-year follow-ups (Case 2) showed a favourable evolution in both cases. It can be concluded that both the surgical approach and the HBW ultrasonic ring are viable options for the removal of separated instruments in unfavourable locations.
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Affiliation(s)
- Hernán Coaguila-Llerena
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University - UNESP, Araraquara, Brazil
| | | | - Abel Teves
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo - USP, Bauru, Brazil
| | - Marco Zevallos-Chávez
- Department of Endodontics, Catholic University of Santa Maria - UCSM, Arequipa, Peru
| | - Gisele Faria
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University - UNESP, Araraquara, Brazil
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Malentacca A, Zaccheo F, Rupe C, Lajolo C. Endodontic Clinical Outcome after Separated Instrument Removal Using a Spinal Needle Technique: A Retrospective Study of Thirty Years of Clinical Experience. J Endod 2023; 49:980-989. [PMID: 37422250 DOI: 10.1016/j.joen.2023.06.007] [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: 03/16/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Current methods for the removal of separated endodontic instruments (RSI) are not predictable. METHODS The primary outcome of this retrospective study was to assess the clinical and radiographic success (CRS) of teeth in case of RSI after a 5-year follow-up. Secondary outcomes were to evaluate (1) the effectiveness in RSI and (2) the risk of root fracture after RSI. The study protocol was registered at ClinicalTrials.gov (ID: NCT05128266). The patients were treated by the same endodontist between January 1991 and December 2019. The RSI was performed under the operative microscope as follows: first, the dentine surrounding the coronal part of the broken instrument was selectively removed by using a small ultrasonic tip to loosen the fragment; then, a modified spinal needle was used to catch and remove the instrument. The 1-, 3-, 5-, and >5-year CRS were recorded. Logistic regression analysis was performed to determine independent predictors of failure (ie, tooth number, type of root canal, shape of the root canal, type of broken instrument, apicocoronal level of the separated instrument, presence of periapical lesions, and root perforations). RESULTS A total of 158 teeth were included in this study. Finally, 131 instruments underwent RSI (82.9%). RSI was an independent predictor of CRS after 1-year of treatment (odds ratio: 58.3; 95% confidence interval: 27.42-95.73, P < .05). At the 5-year follow-up, only 10 of 131 teeth (7.6%) failed. All failures were caused by root fracture (10/10) (χ2 test, P < .05). Separated instruments located in the apical third of the root were more difficult to remove (13/49 cases, 26.5%; χ2 test, P < .05). CONCLUSIONS The proposed technique can achieve excellent effectiveness in RSI, can achieve a high CRS rate when a periapical lesion is present, is not associated to a significant increase in root fracture incidence, and should be performed with the help of an operative microscope.
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Affiliation(s)
| | | | - Cosimo Rupe
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli-IRCCS", Rome, Italy.
| | - Carlo Lajolo
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli-IRCCS", Rome, Italy
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17
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Altorisy A, Ahmad MZ. Assessing Confidence Levels in Endodontic Procedures Among Senior Undergraduate Dental Students at Qassim University, Saudi Arabia: A Cross-Sectional Observational Study. Cureus 2023; 15:e43649. [PMID: 37719548 PMCID: PMC10505051 DOI: 10.7759/cureus.43649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Background This study aimed to determine the confidence of senior dental students in Qassim University's undergraduate dentistry program in Saudi Arabia regarding their capacity to perform endodontic procedures. The study's objective was to pinpoint areas of weakness and offer suggestions for potential improvement of endodontic and clinical training for dental students. Methodology Using anonymous survey forms, 120 senior dental students were surveyed. Students' self-reported levels of confidence in performing various endodontic procedures, such as periapical radiographs, rubber dam placement, endodontically treated tooth restoration, anesthesia, broken instrument removal, and endodontic retreatment, were studied in this survey. A Likert-style rating scale of 1 to 5 was used in the survey, with 1 denoting high confidence and 5 denoting low confidence. Results The majority of senior dental students at Qassim University reported high levels of confidence in taking periapical radiographs, with 64.04% indicating a high level of confidence. The second most assured field was rubber dam installation, with 47.6% of students expressing high levels of assurance. Confidence levels were noticeably lower during more difficult procedures such as endodontic retreatment and the removal of broken instruments. While 12% of students expressed high confidence in endodontic retreatment, only 3.46% of students expressed high confidence in removing broken instruments. According to Pearson's correlation (r = 0.352, p = 0.001), there was a significant and favorable correlation between competency level and confidence in performing various endodontic procedure-related steps. Conclusions The study's findings suggest that senior dentistry students at Qassim University might benefit from additional training and assistance in some endodontic treatment areas. The lack of confidence displayed during more challenging procedures, such as the removal of broken instruments and endodontic retreatment, demonstrates the need for additional training and supervision in such cases. The results of this study may be useful for educators in other dental colleges who wish to consider developing new teaching techniques, utilizing simulators and digital learning tools, and increasing opportunities for hands-on training and supervision to improve dental students' self-confidence and skills.
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Affiliation(s)
- Abdullah Altorisy
- Restorative Dentistry, Qassim University College of Dentistry in Ar Rass, Al Rass, SAU
| | - Muhammad Zubair Ahmad
- Restorative Dentistry, Qassim University College of Dentistry in Ar Rass, Al Rass, SAU
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Grande NM, Castagnola R, Minciacchi I, Marigo L, Plotino G. A review of the latest developments in rotary NiTi technology and root canal preparation. Aust Dent J 2023; 68 Suppl 1:S24-S38. [PMID: 37960998 DOI: 10.1111/adj.12998] [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] [Accepted: 10/18/2023] [Indexed: 11/15/2023]
Abstract
The introduction of nickel-titanium (NiTi) mechanical instruments dramatically changed clinical endodontics over the last few decades. Before NiTi, it was necessary to use more instruments to create an ideal root canal shape, and many approaches, sequences and techniques were developed over the years. Recently, NiTi endodontic instruments have undergone a series of changes brought about by modifications in design, surface treatments, and thermal treatments to improve their root canal preparation outcomes and reduce associated canal preparation risks during root canal treatment. Heat treatment is one of the most fundamental approaches to improving the fatigue resistance and flexibility of NiTi endodontic instruments. In addition, new kinematics have been developed to offer greater safety and efficiency. This narrative review describes the general properties and manufacturing of NiTi instruments, and the mechanical system evolution of NiTi instruments.
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Affiliation(s)
- N M Grande
- Dipartimento di Testa-Collo e organi di senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Castagnola
- Dipartimento di Testa-Collo e organi di senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - L Marigo
- Dipartimento di Testa-Collo e organi di senso, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Odontoiatria Generale e Ortodonzia, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo. Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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Jovanović-Medojević M, Dragičević A, Milanović I, Matija L, Živković S. Opto-magnetic imaging spectroscopy in analyzing rotary NiTi endodontic instruments. J Mech Behav Biomed Mater 2023; 141:105789. [PMID: 36989872 DOI: 10.1016/j.jmbbm.2023.105789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 03/28/2023]
Abstract
Intra-canal fracture of rotary NiTi instruments occurs due to torsional stress, cyclic fatigue, or a combination of these two factors. Broken instruments are a serious obstacle to shaping, cleaning, and filling of the root canal and can adversely affect the outcome of endodontic therapy. The aim of this study was to examine the magnetic properties and ultrastructural changes of new, used, and fractured NiTi instruments using opto-magnetic imaging spectroscopy (OMIS). The study included three sets of different types of rotary instruments: MTwo (VDW, Munich, Germany), Pro Taper Universal (Dentsply Maillefer, Ballaigues, Switzerland), and BioRace (FKG DENTAIRE Swiss Dental Products, Le Crêt-du-Locle Switzerland). Root canal shaping was performed on root canals with different curvatures, and after intra-canal fracture, instruments of the same type (new, used, and fractured) were analyzed using OMIS at the Faculty of Mechanical Engineering, University of Belgrade. The obtained results showed a coincidence of peak localization for the used instruments that did not suffer a fracture, as well as for new, unused instruments of all examined groups. Additionally, there was a coincidence of peak intensities for new and fractured instruments in all groups. The specific treatment of electropolishing of the active surface of BioRace instruments caused a completely different electromagnetic response compared to conventional NiTi sets of tested instruments. New, unused BioRace instruments had the most pronounced positive (5.6078 n.a.u. x1000) and negative (-8.5218 n.a.u. x1000) intensity values. The analysis of NiTi instruments using opto-magnetic imaging spectroscopy indicated changes in the magnetic properties after their instrumentation.
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Affiliation(s)
- Milica Jovanović-Medojević
- University of Belgrade, School of Dental Medicine, Department for Restorative Dentistry and Endodontics, Rankeova 4, 11000, Belgrade, Serbia.
| | - Aleksandra Dragičević
- University of Belgrade, Faculty of Mechanical Engineering, Department for Biomedical Engineering, Kraljice Marije 16, 11120, Belgrade, Serbia.
| | - Ivana Milanović
- University of Belgrade, School of Dental Medicine, Department for Restorative Dentistry and Endodontics, Rankeova 4, 11000, Belgrade, Serbia.
| | - Lidija Matija
- University of Belgrade, Faculty of Mechanical Engineering, Department for Biomedical Engineering, Kraljice Marije 16, 11120, Belgrade, Serbia.
| | - Slavoljub Živković
- University of Belgrade, School of Dental Medicine, Department for Restorative Dentistry and Endodontics, Rankeova 4, 11000, Belgrade, Serbia.
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