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Silva EJNL, Alcalde MP, Martins JNR, Vieira VTL, Vivan RR, Duarte MAH, Belladonna FG, Braz-Fernandes FM, Versiani MA. To flat or not to flat? Exploring the impact of flat-side design on rotary instruments using a comprehensive multimethod investigation. Int Endod J 2023; 56:1301-1315. [PMID: 37594701 DOI: 10.1111/iej.13960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023]
Abstract
AIM To assess the influence of a flat-side design on the geometry, metallurgy, mechanical performance and shaping ability of a novel nickel-titanium rotary instrument. METHODOLOGY Sixty-five new 25-mm flat-side rotary instruments (size 25, taper 0.04) and their nonflat-side prototypes (n = 65) were assessed for major deformations and examined regarding macroscopic and microscopic design, determination of nickel and titanium elements ratio, measurement of phase transformation temperature and evaluation of mechanical performance parameters including time/cycles to fracture, maximum torque, angle of rotation, maximum bending and buckling strengths and cutting ability. Additionally, unprepared canal areas, volume of hard tissue debris and percentage reduction of dentine thickness were calculated for each tested instrument after preparing mesial canals of mandibular molars (n = 12), using micro-CT imaging. Statistical analyses were performed using the U-Mann-Whitney test and independent Student t-test (α = 5%). RESULTS The number of spirals (n = 8) and blade direction (clockwise) were similar between both flat and nonflat instruments, whilst the helical angles were equivalent (⁓25°). Flat-instruments showed inconsistencies in the homogeneity of the gold colour on the flat-side surface, blade discontinuity, and incomplete and variable S-shaped cross-sections. The titanium-to-nickel ratios were equivalent, but significant differences in the R-phase finish and austenitic start phase transformation temperatures were observed between the flat and nonflat-side instruments. The flat-side instruments demonstrated superior cutting ability compared to the nonflat instruments, as well as, significantly lower values for time to fracture, rotation to fracture and maximum torque to fracture (p < .001). No statistical difference was observed between tested instruments regarding angle of rotation (p = .437), maximum bending (p = .152) and buckling load (p = .411). Preparation protocols using flat and nonflat instruments did not show any statistically significant differences (p > .05). All flat-side instruments exhibited deformation after shaping procedures. CONCLUSIONS The flat-side instrument showcased enhanced cutting ability compared to its nonflat counterpart. However, it exhibited inferior performance in terms of time, rotation and maximum torque to fracture, along with distinct phase transformation temperatures. No differences were observed in the titanium-to-nickel ratios, angle of rotation, maximum bending, buckling load, preparation time, percentage of untouched canal walls, volume of hard tissue debris and percentage reduction of dentine thickness.
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Affiliation(s)
- Emmanuel J N L Silva
- Department of Endodontics, Fluminense Federal University, Rio de Janeiro, Brazil
- Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Endodontics, Grande Rio University, Rio de Janeiro, Brazil
| | - Murilo P Alcalde
- Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Jorge N R Martins
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - Victor T L Vieira
- Department of Endodontics, Grande Rio University, Rio de Janeiro, Brazil
| | - Rodrigo R Vivan
- Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marco A H Duarte
- Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Felipe G Belladonna
- Department of Endodontics, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Francisco Manuel Braz-Fernandes
- CENIMAT/I3N, Department of Materials Science, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
| | - Marco A Versiani
- Dental Specialty Center, Brazilian Military Police, Minas Gerais, Brazil
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Silva EJNL, Pinto KP, Belladonna FG, Ferreira CMA, Versiani MA, De-Deus G. Success rate of permanent teeth pulpotomy using bioactive materials: A systematic review and meta-analysis of randomized clinical trials. Int Endod J 2023; 56:1024-1041. [PMID: 37254176 DOI: 10.1111/iej.13939] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The results of vital pulp treatments in permanent teeth have been encouraging. Currently, pulpotomy treatment for permanent teeth primarily utilizes mineral trioxide aggregate (MTA) as the dressing material, followed by calcium hydroxide. While other calcium-silicate-based cements have been suggested for pulpotomy, there is a limited number of studies evaluating their long-term effectiveness. OBJECTIVES The objective of this systematic review and meta-analysis was to evaluate the success rate of pulpotomies performed on permanent teeth, comparing the use of ProRoot MTA with that of calcium hydroxide and other bioceramic materials. METHODS A comprehensive search was conducted in several electronic databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase and Science Direct until December 2022. The search was guided by PICOS criteria, including only randomized clinical trials (RCTs) that evaluated the success rate of pulpotomy treatments in permanent teeth using ProRoot MTA in comparison to calcium hydroxide and other bioceramic materials. The quality of the included studies was assessed using the RoB-2 tool to evaluate the risk of bias, and relevant data were extracted and analysed in RevMan software 5.3 using fixed-effect models. The GRADE tool was used to determine the overall quality of evidence. RESULTS The initial search retrieved 1072 studies and, after eliminating duplicates, 677 studies were screened and 28 studies were considered for eligibility. In the final selection process, 16 studies were included in the systematic review, with 10 being determined as having a high risk of bias. Pulpotomy showed an overall mean success rate of 92% after 1 year. The meta-analysis indicated a significantly higher success rate for pulpotomies utilizing MTA in comparison with calcium hydroxide, while no significant difference was seen between MTA and calcium-enriched mixture (CEM) or Biodentine. The GRADE assessment revealed an overall low level of evidence for the included studies. DISCUSSION Most randomized controlled trials exhibited a significant absence of control over confounding factors. CONCLUSIONS This systematic review and meta-analysis demonstrate that pulpotomy is a highly effective treatment for managing permanent teeth. The results indicate that the success rate of pulpotomy using ProRoot MTA is significantly higher than when using calcium hydroxide. However, the certainty of evidence supporting these findings is low, and there is a need for well-designed RCTs to assess the long-term outcomes of pulpotomy using newer bioceramic materials. REGISTRATION This systematic review was registered in the PROSPERO database (registration number CRD42023393970).
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Affiliation(s)
- Emmanuel J N L Silva
- Department of Endodontics, Fluminense Federal University, Rio de Janeiro, Brazil
- Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Endodontics, Grande Rio University, Rio de Janeiro, Brazil
| | - Karem P Pinto
- Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe G Belladonna
- Department of Endodontics, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Claudio M A Ferreira
- Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marco A Versiani
- Dental Specialty Center, Brazilian Military Police, Minas Gerais, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Rio de Janeiro, Brazil
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Moreira EJL, Silva EJNL, Belladonna FG, Maciel AC, Vieira VTL, De-Deus G. Mechanical performance of original; yellowish and blueish ProFile instruments: isolating heat-treatment as a variable. Braz Dent J 2022; 33:47-53. [PMID: 36043568 DOI: 10.1590/0103-6440202204978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
The present study aimed to perform two different heat-treatments in an austenitic NiTi ProFile instrument and to compare the mechanical performance of original and heat-treated instruments. Heat treatment of ProFile (tip size 25 and 0.06 taper) instruments were carried out in a furnace in argon atmosphere using a heating rate of 10° C/min. After reaching the programmed temperatures of 450 ºC or 500 ºC the system remained at a constant temperature for 10 minutes; followed by cooling in water at room temperature. Afterwards; the three groups (n=30 per group) of instruments were compared regarding their cyclic fatigue (n=10 per group); bending (n=10 per group); and buckling resistance (n=10 per group). After cyclic fatigue tests; a scanning electron microscope was used to analyze the fracture surfaces and observe the fracture mode. Statistical analysis was performed using One-way ANOVA and Student-Newman-Keuls test; with an alpha type error set at 0.05. Yellowish and blueish coloration was observed in the ProFile instruments after 450 ºC or 500 ºC heat treatments; respectively. Conventional ProFile instruments showed the lower cyclic fatigue; and the higher bending and buckling resistance (P<0.05). In contrast; yellowish ProFile instruments (heat treated at 500° C) showed the higher cyclic fatigue; and the lower bending and buckling resistance (P>0.05). It can be concluded that the different heat treatments performed on ProFile instruments increased its cyclic fatigue resistance and improved the flexibility and buckling resistance.
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Affiliation(s)
- Edson J L Moreira
- Department of Endodontics; Fluminense Federal University (UFF); Niterói; RJ; Brazil
| | - Emmanuel J N L Silva
- Department of Endodontics; Fluminense Federal University (UFF); Niterói; RJ; Brazil
| | - Felipe G Belladonna
- Department of Endodontics; Fluminense Federal University (UFF); Niterói; RJ; Brazil
| | - Ana Carolina Maciel
- Department of Endodontics; Fluminense Federal University (UFF); Niterói; RJ; Brazil
| | - Victor T L Vieira
- Department of Endodontics; Fluminense Federal University (UFF); Niterói; RJ; Brazil
| | - Gustavo De-Deus
- Department of Endodontics; Fluminense Federal University (UFF); Niterói; RJ; Brazil
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De-Deus G, Santos GO, Monteiro IZ, Cavalcante DM, Simões-Carvalho M, Belladonna FG, Silva EJNL, Souza EM, Licha R, Zogheib C, Versiani MA. Micro-CT assessment of gap-containing areas along the gutta-percha-sealer interface in oval-shaped canals. Int Endod J 2022; 55:795-807. [PMID: 35383977 DOI: 10.1111/iej.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
AIM To assess the interfacial adaptation (gap-containing areas) of two root canal sealers (EndoSequence BC Sealer and AH Plus) to a conventional gutta-percha (GP) cone (GP-sealer interface) in oval-shaped canals filled using the single cone technique. METHODOLOGY Sixteen teeth with oval-shaped canals were selected, scanned in a micro-computed tomographic device, and pair-matched according to the volume, aspect ratio and configuration of root canals. Root canals were then sequentially prepared with WaveOne Gold Primary and Large instruments, followed by filling with WaveOne Large GP points associated with either the premixed calcium-silicate EndoSequence BC Sealer or the epoxy resin-based AH Plus sealer (n = 8 per group) using the single cone technique. After 7 days stored in phosphate-buffered saline solution at 37°C, the specimens were rescanned and the reconstructed images segmented in order to differentiate the filling materials (sealer and GP cone) to the dentine. A total of 453 cross-sectional slices were assessed and categorized according to the presence or absence of gaps at the GP-sealer interface. Mann-Whitney U-test verified the differences between groups and were considered significant at alpha = 5%. RESULTS Gaps were non-homogenously distributed in two-dimensional axial cross-section images and none of the specimens showed completely gap-free areas along the entire GP-sealer interface. Root canals filled with EndoSequence BC Sealer and AH Plus displayed 171 (37.75%) and 136 (30.02%) slices with gaps in the GP-sealer interface and these frequencies were statistically significant (p = .000). CONCLUSIONS Although none of the specimens had a gap-free area along the entire GP-sealer interface, oval canals filled with AH Plus showed less gaps than the ones filled with EndoSequence BC Sealer.
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Affiliation(s)
- Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil
| | - Gustavo O Santos
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil
| | | | | | | | | | | | - Erick M Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Brazil
| | - Raphael Licha
- Department of Endodontics, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Carla Zogheib
- Department of Endodontics, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Marco A Versiani
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil
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De-Deus G, Oliveira DS, Cavalcante DM, Simões-Carvalho M, Belladonna FG, Antunes LS, Souza EM, Silva EJNL, Versiani MA. Methodological proposal for evaluation of adhesion of root canal sealers to gutta-percha. Int Endod J 2021; 54:1653-1658. [PMID: 33977555 DOI: 10.1111/iej.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/21/2022]
Abstract
AIM To compare the bond strength of an epoxy resin-based sealer and two calcium silicate-based sealers (CSS) to gutta-percha discs using a new method. METHODOLOGY Round discs of gutta-percha (n = 60), measuring 10 mm in diameter and 2 mm in thickness, were placed on a glass plate and a drop of each sealer (AH Plus, EndoSequence BC Sealer and EndoSeal MTA) was placed on their surface. Another identical disc was placed onto the first one and a standardized weight (0.0981 N) applied over them using a specially developed apparatus. Ten samples prepared for each sealer were submitted to a microshear bond strength test accomplished by a specially designed set-up coupled to a universal testing machine. The Kruskal-Wallis test followed by a post hoc procedure was used to compare groups considering the preliminary analysis of the raw data had indicated the nonadherence to a Gaussian distribution (Shapiro-Wilk, p < .05). Alpha error was set at 5%. RESULTS Overall, no premature failure occurred. All sealers had some degree of adhesiveness to gutta-percha discs but with a significant difference amongst them (Kruskal-Wallis, p = .019). The epoxy resin-based sealer (AH Plus) had significantly higher median shear bond strength values (1.43 MPa; 1.40-1.83) compared to EndoSeal MTA (0.53 MPa; 0.46-0.73) (p = .021) and EndoSequence BC Sealer (0.45 MPa; 0.34-0.46) (p = .023), whilst the lowest median value was observed with EndoSequence BC Sealer (0.45 MPa; 0.34-0.46) (p < .05). CONCLUSIONS CSS sealers had weaker bonding to gutta-percha when compared to the epoxy resin-based AH Plus sealer. The proposed methodology is an innovative and reproducible method for testing the bond strength of root canal sealers to gutta-percha.
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Affiliation(s)
- Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Diogo S Oliveira
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Daniele M Cavalcante
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Felipe G Belladonna
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Leandro S Antunes
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Erick M Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Emmanuel J N L Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Marco A Versiani
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Miguéns-Vila R, Martín-Biedma B, De-Deus G, Belladonna FG, Peña-López A, Castelo-Baz P. Micro-computed Tomographic Evaluation of Dentinal Microcracks after Preparation of Curved Root Canals with ProTaper Gold, WaveOne Gold, and ProTaper Next Instruments. J Endod 2020; 47:309-314. [PMID: 33096193 DOI: 10.1016/j.joen.2020.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the influence of rotary (ProTaper Next [PTN; Dentsply Maillefer, Ballaigues, Switzerland] and ProTaper Gold [PTG, Dentsply Maillefer]) and reciprocating (WaveOne Gold [WOG, Dentsply Maillefer]) systems in dentinal microcrack generation after the preparation of curved root canals using micro-computed tomographic analysis. METHODS Twenty-four human mandibular molars with curved roots were scanned in a micro-computed tomographic device using an isotropic resolution of 6.78 μm and randomly assigned into 1 of 3 experimental groups (n = 8) according to the root canal instrumentation system used (PTN, PTG, or WOG). Then, the root canals were prepared up to PTN X2, PTG F2, and WOG Primary instruments in the PTN, PTG, and WOG groups, respectively. After canal preparation, each specimen was scanned again. Pre- and postoperative cross-sectional images of the roots (N = 35,304) were analyzed to identify the presence of dentinal microcracks. RESULTS Overall, 26% of the images presented dentinal defects (n = 9188). Dentinal microcracks were observed in 24.6%, 26%, and 27.4% of the postinstrumentation images from the PTN, PTG, and WOG groups, respectively. However, all of these dentinal microcracks were already present in the corresponding preoperative images. No new microcracks were generated after the preparation of curved root canals of mandibular molars using the aforementioned systems. CONCLUSIONS Root canal instrumentation with PTN, PTG, and WOG systems did not induce the formation of new dentinal microcracks.
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Affiliation(s)
- Ramón Miguéns-Vila
- University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain.
| | | | - Gustavo De-Deus
- Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | | | | | - Pablo Castelo-Baz
- University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
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De-Deus G, Belladonna FG, Cavalcante DM, Simões-Carvalho M, Silva EJNL, Carvalhal JCA, Zamolyi RQ, Lopes RT, Versiani MA, Dummer PMH, Zehnder M. Contrast-enhanced micro-CT to assess dental pulp tissue debridement in root canals of extracted teeth: a series of cascading experiments towards method validation. Int Endod J 2020; 54:279-293. [PMID: 32920829 DOI: 10.1111/iej.13408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/15/2022]
Abstract
AIM To validate a new method for the evaluation of pulp tissue debridement in the root canals of extracted teeth using an impregnation protocol involving potassium triiodide, a radiocontrast solution known as Lugol's, combined with micro-computed tomographic (micro-CT) imaging. METHODOLOGY The impact of NaOCl on the radiopacity of Lugol's solution was assessed using a two-fold dilution series of Lugol in distilled water and 5.25% NaOCl, which were then pipetted into transparent dishes and radiographed. To verify the influence of Lugol on the proteolytic effect of NaOCl, a dissolution test was performed using fresh bovine meat. Ten slices did not undergo any tissue processing, whilst twenty slices were fixed in formaldehyde for 24 h. After that, 10 of them were immersed in Lugol for another 24 h. Then, all specimens were placed in NaOCl and the time required for a complete tissue dissolution was recorded. For the last experiments (histological validation and micro-CT assessment), 8 extracted mandibular premolars with formerly vital pulps were immersed in buffered formalin, scanned in a micro-CT device, accessed, immersed in Lugol for 7 days and scanned again. Then, the root canals of 5 teeth were prepared and scanned, and the volume of remaining pulp tissue identified and quantified, whilst 3 teeth were histologically processed. The same specimens were subjected to histological assessment, and the images of the histologic sections were registered with the corresponding micro-CT images to verify whether the pulp tissue in the histological sections matched its counterpart in the Lugol-impregnated tissues identified in the micro-CT slices. RESULTS There was no discernible effect on radiopacity when NaOCl was mixed with Lugol's solution. Tissue processing did not affect the time required for the complete dissolution of fresh bovine meat. Histological evaluation revealed a correlation between micro-CT and histological images confirming the identification of Lugol-impregnated pulp tissue in micro-CT images. CONCLUSIONS The radiocontrast Lugol's solution was unaffected by NaOCl and did not interfere with its soft tissue dissolution capability. The impregnation protocol using Lugol's solution allowed the visualization of pulp tissue on the micro-CT images and the identification of pulp remnants after chemical-mechanical canal procedures.
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Affiliation(s)
- G De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - F G Belladonna
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - D M Cavalcante
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - M Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - E J N L Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Department of Endodontics, Grande Rio University, Duque de Caxias, Rio de Janeiro, Brazil
| | - J C A Carvalhal
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - R Q Zamolyi
- Bonsucesso Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - R T Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M A Versiani
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - M Zehnder
- Division of Endodontology, Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
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Silva EJNL, Pinto KP, Ferreira CM, Belladonna FG, De-Deus G, Dummer PMH, Versiani MA. Current status on minimal access cavity preparations: a critical analysis and a proposal for a universal nomenclature. Int Endod J 2020; 53:1618-1635. [PMID: 32854167 DOI: 10.1111/iej.13391] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022]
Abstract
In the last decade, several access cavity designs involveing minimal removal of tooth tissue have been described for gaining entry to pulp chambers during root canal treatment. The premise behind this concept assumes that maximum preservation of as much of the pulp chamber roof as possible during access preparation would maintain the fracture resistance of teeth following root canal treatment. However, the smaller the access cavity, the more difficult it may be to visualize and debride the pulp chamber as well as locate, shape, clean and fill the canals. At the same time, a small access cavity may increase the risk of iatrogenic complications as a result of poor visibility, which may have an impact on treatment outcome. This study aimed to critically analyse the literature on minimal access cavity preparations, propose new nomenclature based on self-explanatory abbreviations and highlight the areas in which more research is required. The search was conducted without restrictions using specifics terms and descriptors in four databases. A complementary screening of the references within the selected studies, as well as a manual search in the highest impact journals in endodontics, namely International Endodontic Journal and Journal of Endodontics, was also performed. The initial search retrieved 1831 publications. The titles and abstracts of these papers were reviewed, and the full text of 94 studies was assessed. Finally, a total of 28 studies were identified as evaluating the influence of minimally invasive access cavity designs on the fracture resistance of teeth and on the different stages of root canal treatment (orifice location, canal shaping, canal cleaning, canal filling and retreatment). Overall, the studies had major methodological drawbacks and reported inadequate and/or inconclusive results on the utility of minimally invasive access preparations. Furthermore, they offered limited scientific evidence to support the use of minimally invasive access cavities to improve the outcome of root canal treatment and retreatment; they also provided little evidence that they preserved the fracture resistance of root filled teeth to a greater extent than traditional access cavity preparations. It was concluded that at present, there is a lack of supporting evidence for the introduction of minimally invasive access cavity preparation into routine clinical practice and/or training of undergraduate and postgraduate students.
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Affiliation(s)
- E J N L Silva
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil.,Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil.,Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - K P Pinto
- Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - C M Ferreira
- Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - F G Belladonna
- Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - G De-Deus
- Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - M A Versiani
- Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil
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Guerreiro MYR, Belladonna FG, Monteiro LPB, Lima CO, Silva EJNL, Brandão JMS. The influence of the addition of surfactants to sodium hypochlorite on the removal of hard tissue debris. Int Endod J 2020; 53:1131-1139. [PMID: 32294253 DOI: 10.1111/iej.13307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the effect of the addition of surfactants to sodium hypochlorite (NaOCl) on the removal of accumulated hard tissue debris (AHTD), before and after final irrigation with 17% EDTA, from mesial canals of mandibular molars through microcomputed tomographic (micro-CT) analysis. METHODOLOGY Thirty moderately curved mandibular mesial roots with Vertucci type II canal configuration were selected and scanned in a micro-CT device at an isotropic resolution of 22.9 μm. The specimens were assigned to three groups (n = 10) with respect to the root length, degree of curvature of the mesial root, volume and 3D anatomy of the root canals according to the irrigating solution used during root canal preparation: 2.5% NaOCl and 0.1% Benzalkonium Chloride, 2.5% NaOCl and 0.1% Tween 80 and 2.5% NaOCl without additives. The root canals were instrumented up to Reciproc R25 instrument. Then, the specimens were scanned again after canal preparation and after final irrigation with 17% EDTA, and the registered data sets were examined to evaluate the percentage of AHTD. For comparison between the different groups before and after using 17% EDTA, the Kruskal-Wallis test was used with a significance level of 5%. For comparison between the same groups before and after using 17% EDTA, the Wilcoxon test was used with a significance level of 5%. RESULTS None of the irrigant solutions tested was able to completely eliminate hard tissue debris from mesial canals of mandibular molars. There were no significant differences in the percentage of AHTD amongst the different irrigation solutions (P > 0.05). Final irrigation with 17% EDTA significantly reduced the percentage of AHTD (P < 0.05), without differences amongst the groups (P > 0.05). CONCLUSIONS The addition of surfactants to NaOCl did not affect the removal of AHTD from mesial canals of extracted mandibular molars. Final irrigation with 17% EDTA significantly improved AHTD removal.
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Affiliation(s)
- M Y R Guerreiro
- Department of Endodontics, Federal University of Pará, Belém, Brazil
| | - F G Belladonna
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil
| | - L P B Monteiro
- Department of Endodontics, Federal University of Pará, Belém, Brazil
| | - C O Lima
- Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - E J N L Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil.,Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Endodontics, Grande Rio University, Duque de Caxias, Brazil
| | - J M S Brandão
- Department of Endodontics, Federal University of Pará, Belém, Brazil
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10
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De-Deus G, Belladonna FG, Zuolo AS, Cavalcante DM, Carvalhal JCA, Simões-Carvalho M, Souza EM, Lopes RT, Silva EJNL. XP-endo Finisher R instrument optimizes the removal of root filling remnants in oval-shaped canals. Int Endod J 2019; 52:899-907. [PMID: 30663790 DOI: 10.1111/iej.13077] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/16/2019] [Indexed: 01/06/2023]
Abstract
AIM To evaluate the performance of XP-endo Finisher R instruments when removing root filling remnants from oval-shaped canals using microcomputed tomographic (micro-CT) imaging as the analytical tool. Passive ultrasonic irrigation (PUI) was used as a reference technique for comparison. METHODOLOGY Twenty mandibular incisors with oval-shaped canals were matched based on similar anatomic features of the canal (volume, aspect ratio and 3D configuration) after scanning procedures. The canals were prepared with Reciproc R25 instruments, filled with gutta-percha and AH Plus sealer using the single-cone technique and retreated up to a Reciproc R40 instrument. After retreatment procedures, the specimens were rescanned, and the homogeneity between the specimens, the oval-shaped anatomy and the remaining filling material were confirmed. The pair-matched samples were assigned to two experimental groups (n = 10), according to the supplementary approach used: XP-endo Finisher R or PUI. Each sample was scanned after each endodontic procedure. The volume of remaining root filling material was quantified before and after the use of each supplementary approach. This analysis was performed considering the total canal (Student t-test) and also by thirds (anova procedure followed by a Bonferroni correction). Data were analysed statistically with a significance level of 5%. RESULTS The volume of root filling material at baseline was similar between the groups (t-test, P = 0.787). XP-endo Finisher R removed significantly more root filling material compared to PUI (t-test, P = 0.015), as it removed a mean of ≅32% material compared to 12% for the PUI. There was no difference in the amount of root filling material removed in the root canal thirds after using both supplementary approaches (one-way anova, P = 0.07 for XP-endo Finisher R and P = 0.886 for PUI). CONCLUSIONS Both supplementary approaches significantly reduced the volume of remaining root filling material from oval-shaped canals. The XP-endo Finisher R instrument removed significantly more root filling material than PUI. None of the supplementary approaches was able to render oval-shaped canals completely free from remaining root filling material.
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Affiliation(s)
- G De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - F G Belladonna
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - A S Zuolo
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - D M Cavalcante
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - J C A Carvalhal
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - M Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - E M Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - R T Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - E J N L Silva
- Department of Endodontics, Grande Rio University, Duque de Caxias, Rio de Janeiro, Brazil
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11
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Souza EM, Quadros JDRP, Silva EJNL, De-Deus G, Belladonna FG, Maia-Filho EM. Volume and/or Time of NaOCl Influences the Fracture Strength of Endodontically Treated Bovine Teeth. Braz Dent J 2019; 30:31-35. [DOI: 10.1590/0103-6440201902076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022] Open
Abstract
Abstract The aim of this study was to evaluate whether amplifying the volume and/or time of contact of NaOCl affects the fracture strength of endodontically treated bovine teeth. Four bovine incisors from 10 animals were allocated into 4 groups using a split-mouth design. Root canals were instrumented using a sequence of 4 manual stainless steel files and irrigated with a 5.25% alkalized NaOCl solution. The total volume and time of irrigation, per sample, varied among the groups as following: standard volume and time of contact - 15 mL/11.5 min; volume raise - 30 mL/11.5 min; time of contact raise - 15 mL/19 min; and volume and time of contact raise - 30 mL/19 min. Samples were subjected to a fracture resistance assay. At p=0.05, two-way ANOVA statistically scrutinized the results. Effect size of NaOCl time of contact and volume were also calculated (η2). The variation in time (p=0.000), volume of irrigation (p=0.000) and the combination of both (p=0.038) negatively influenced the fracture resistance. Standard volume and time of irrigation showed the highest fracture strength while isolated increase in volume or time reduced in 25% and 37%, respectively, the fracture resistance; the simultaneous increase in volume and time of irrigation promoted a reduction of 47%. Effect size of NaOCl time of contact was superior (0.746) than the volume (0.564). Raising the volume and/or time of a 5.25% alkalized NaOCl solution reduces the fracture resistance of endodontically treated bovine teeth.
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12
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De-Deus G, Belladonna FG, Silva EJNL, Souza EM, Carvalhal JCA, Perez R, Lopes RT, Versiani MA. Micro-CT assessment of dentinal micro-cracks after root canal filling procedures. Int Endod J 2016; 50:895-901. [PMID: 27689844 DOI: 10.1111/iej.12706] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/27/2016] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the frequency of dentinal micro-cracks after root canal filling procedures with GuttaCore (GC), cold lateral compaction (CLC) and warm vertical compaction (WVC) techniques in mandibular molars using micro-computed tomographic analysis. METHODOLOGY Thirty mesial roots of mandibular molars, with a type II Vertucci's canal configuration, were prepared to working length with a Reciproc R40 instrument and randomly assigned to one of the three experimental groups (n = 10), according to the technique used for root filling: GC, CLC or WVC. The GC group was filled with a size 40 GC obturator, whilst CLC and WVC groups used conventional gutta-percha cones. AH Plus sealer was used in all groups. The specimens were scanned at an isotropic resolution of 14.25 μm before and after root canal preparation and after root filling. Then, all pre- and postoperative cross-sectional images of the roots (n = 41 660) were screened to identify the presence of dentinal defects. RESULTS Overall, 30.75% (n = 12 810) of the pre- + post-filling images displayed dentinal defects. In the GC, CLC and WVC groups, dentinal micro-cracks were observed in 18.68% (n = 2510), 15.99% (n = 2389) and 11.34% (n = 1506) of the cross-sectional images, respectively. All micro-cracks identified in the post-filling scans were also observed in the corresponding post-preparation images. CONCLUSION Root fillings in all techniques did not induce the development of new dentinal micro-cracks.
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Affiliation(s)
- G De-Deus
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - F G Belladonna
- Department of Endodontics, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - E J N L Silva
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - E M Souza
- Department of Dentistry II, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | - J C A Carvalhal
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - R Perez
- Department of Endodontics, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - R T Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - M A Versiani
- Department of Restorative Dentistry, Dental School of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
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13
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Prado MC, Gusman H, Belladonna FG, Prado M, Ormiga F. Effectiveness of three methods for evaluating root canal anatomy of mandibular incisors. J Oral Sci 2016; 58:347-51. [PMID: 27665973 DOI: 10.2334/josnusd.15-0730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This study compared the effectiveness of clinical observation, clinical microscopic observation, and tooth-clearing technique in determining the number of canals in mandibular incisors. Root canal ramifications were also analyzed. Using clinical and microscopic analyses, we determined the number of canal entrances in 277 mandibular incisors. In addition, tooth-clearing technique was used to determine the number of canals and frequency of ramifications in the samples. The kappa coefficient was used to compare the different methods with regard to frequency of canals. Most teeth had one canal entrance. The proportion of teeth with two canals was 23.5% by tooth-clearing analysis, 5.8% by clinical microscopy, and 1.1% by clinical analysis. A large number of samples had some type of ramification (40.1%), and most ramifications were present in teeth with two canals. The most frequent ramification was lateral canals (8.3%). Clinical microscopy improved identification of a second canal in mandibular incisors. However, it did not identify second canals in all teeth with two canals. (J Oral Sci 58, 347-351, 2016).
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Affiliation(s)
- Marina C Prado
- Proclin Department, School of Dentistry, Rio de Janeiro State University
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14
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Silva EJ, Perez R, Valentim RM, Belladonna FG, De-Deus GA, Lima IC, Neves AA. Dissolution, dislocation and dimensional changes of endodontic sealers after a solubility challenge: a micro-CT approach. Int Endod J 2016; 50:407-414. [PMID: 27000665 DOI: 10.1111/iej.12636] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/17/2016] [Indexed: 12/01/2022]
Abstract
AIM To evaluate, using a novel micro-CT approach, the solubility and dimensional changes of an MTA-based sealer inside the root canal system after a solubility challenge. The MTA-based material (MTA Fillapex) was compared to a gold standard epoxy-based endodontic sealer (AH Plus). METHODOLOGY Ten human mandibular premolars with a single canal were divided randomly into two groups (n = 5) according to the sealer used. The canals were instrumented using the Reciproc System (VDW) with a R40 file and filled with R40 gutta-percha cones and one of the sealers. The filled canals were immediately scanned in a micro-CT, and after that, the teeth were immersed in 20 mL phosphate-buffered saline (PBS) at 37 °C for 7 days, when they were removed and rescanned. Final image stacks were registered against the initial stacks and the numerical difference between the initial and final volume of the filling material was obtained. Calculations were performed to identify dimensional changes of the filling material. All image stacks were 3D rendered to disclose areas of dislocation of the filling material inside or outside the root canal. The Shapiro-Wilk's test revealed that data were normally distributed; thus, the Student's t-test was used to detect statistically significant changes, assuming a 5% α-error. RESULTS No significant changes were seen for the percentage volume of material lost after the solubility challenge for both AH Plus and MTA Fillapex groups (1.44% and 1.16%, respectively). A significant difference was, however, found for the volume of filling material which revealed dimensional changes after the solubility test (6.68% for MTA Fillapex and 1.09% for AH Plus). In fact, observation of 3D models disclosed that MTA Fillapex was associated with material extrusion through the foramen in all but one sample. In AH Plus filled samples, no material extrusion was detected. CONCLUSIONS Although the solubility of both sealers was similar using this novel micro-CT approach, MTA Fillapex was associated with significant dimensional changes related to material extrusion through the apex after PBS storage compared to AH Plus.
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Affiliation(s)
- E J Silva
- Escola de Ciências da Saúde, Universidade do Grande Rio, Rio de Janeiro, Brazil
| | - R Perez
- Corpo de Bombeiros Militar do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R M Valentim
- Escola de Ciências da Saúde, Universidade do Grande Rio, Rio de Janeiro, Brazil
| | - F G Belladonna
- Faculdade de Odontologia, Universidade Federal Fluminense, Niteroi, Brazil
| | - G A De-Deus
- Escola de Ciências da Saúde, Universidade do Grande Rio, Rio de Janeiro, Brazil
| | - I C Lima
- Laboratório de Instrumentação Nuclear, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - A A Neves
- Departamento de Odontopediatria e Ortodontia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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15
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Silva EJNL, Brito ME, Ferreira VD, Belladonna FG, Neves AA, Senna PM, De-Deus G. Cytotoxic effect of the debris apically extruded during three different retreatment procedures. J Oral Sci 2016; 58:211-7. [DOI: 10.2334/josnusd.15-0658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
| | - Mônica E. Brito
- Department of Endodontics, Health Sciences Center, Grande Rio University
| | - Vivian D. Ferreira
- Department of Endodontics, Health Sciences Center, Grande Rio University
| | | | - Aline A. Neves
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro
| | - Plinio M. Senna
- Department of Endodontics, Health Sciences Center, Grande Rio University
| | - Gustavo De-Deus
- Department of Endodontics, Health Sciences Center, Grande Rio University
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Silva EJNL, Carapiá MF, Lopes RM, Belladonna FG, Senna PM, Souza EM, De-Deus G. Comparison of apically extruded debris after large apical preparations by full-sequence rotary and single-file reciprocating systems. Int Endod J 2015; 49:700-5. [PMID: 26174577 DOI: 10.1111/iej.12503] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/07/2015] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the amount of apically extruded debris produced by ProTaper Universal (PTU), ProTaper Next (PTN), WaveOne (WO) and Reciproc (R) systems after large apical preparations. METHODOLOGY Sixty mandibular premolars with a single canal were selected and randomly assigned into 4 groups (n = 15) according to the system used for root canal preparation: PTU, PTN, WO and R groups. Canal preparations were performed up to size 40 in each group. Distilled water was used as an irrigant, and the apically extruded debris from each tooth was collected in pre-weighted glass vials and dried. The average weight of debris was assessed using a microbalance, and the data were analysed statistically using one-way analysis of variance and the post hoc Tukey multiple comparison test (α = 0.05). RESULTS The PTU system was associated with significantly more debris than the other systems (P < 0.05). No significant differences were found between PTN, WO and R systems (P > 0.05). CONCLUSIONS All systems were associated with apical debris extrusion when canals were prepared to a large apical size. The PTU system was associated with more debris extrusion.
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Affiliation(s)
- E J N L Silva
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Duque de Caxias, Rio de Janeiro, Brazil
| | - M F Carapiá
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Duque de Caxias, Rio de Janeiro, Brazil
| | - R M Lopes
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Duque de Caxias, Rio de Janeiro, Brazil
| | - F G Belladonna
- Department of Endodontics, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - P M Senna
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Duque de Caxias, Rio de Janeiro, Brazil
| | - E M Souza
- Department of Dentistry II, Federal University of Maranhão (UFMA), São Luís, Maranhão, Brazil
| | - G De-Deus
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Duque de Caxias, Rio de Janeiro, Brazil
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