Endodontide Kanal Tedavisinin Teknik Kalitesinin Değerlendirilme Kriterleri ve Prognoz Üzerine Etkisi
Özet
Endodontide kök kanal tedavisinin teknik kalitesinin değerlendirilmesinde kullanılan temel kriterler ve bu kriterlerin tedavi prognozu üzerindeki etkisi güncel literatür eşliğinde ele alınmıştır. Endodontik başarı; etkin kemomekanik preparasyon, 3 boyutlu sızdırmaz obturasyon ve nitelikli bir koronal restorasyonun birleşimine bağlıdır. İdeal radyografik dolgu sınırı, periapikal dokularla temasın en az olduğu apikal konstrüksiyon seviyesinde (radyografik apeksin 0-2 mm gerisinde) olmalıdır. Kanal dolgusunun, özellikle apikal 5 mm içerisinde boşluksuz (homojen) olması başarı olasılığını anlamlı derecede artırmaktadır. Düzenli bir koniklik, irrigasyon solüsyonlarının akışını ve materyal adaptasyonunu kolaylaştırsa da, prognoz üzerindeki doğrudan etkisi dolgu yoğunluğu kadar baskın değildir. Basamak oluşumu, perforasyon ve alet kırılması gibi prosedürel hatalar, dezenfeksiyonu engelleyerek özellikle nekrotik dişlerde başarısızlık riskini artırır. Ayrıca, MB2 gibi gözden kaçan ek kanalların varlığı, lezyon gelişim olasılığını artırmaktadır. Tedavi başarısının takibinde klinik semptomların yokluğu yeterli kabul edilmemelidir. PAI (Periapikal İndeks) ve 2D radyografinin yetersiz kaldığı vakalarda teşhis duyarlılığı yüksek olan CBCT kullanılabilir. Bu yönüyle teknik kalite kriterlerinin doğru değerlendirilmesi, hem klinik karar verme süreci hem de uzun dönem prognozun öngörülmesi açısından önemlidir.
The fundamental criteria used to evaluate the technical quality of root canal treatment in endodontics and their impact on treatment prognosis are discussed in light of current literature. Endodontic success relies on effective chemomechanical preparation, three-dimensional hermetic obturation, and an adequate coronal restoration. The ideal radiographic extent of root canal filling should terminate at the apical constriction (0–2 mm short of the radiographic apex), where contact with periapical tissues is minimal.
The absence of voids within the root canal filling, particularly in the apical 5 mm, significantly increases the probability of treatment success. Although a uniform taper facilitates irrigation and material adaptation, its direct influence on prognosis is less pronounced than obturation density. Procedural errors such as ledge formation, perforation, and instrument separation may compromise disinfection and increase the risk of failure, especially in necrotic teeth. Missed additional canals, such as MB2, may also contribute to persistent infection and lesion development. In outcome evaluation, the absence of clinical symptoms alone is insufficient. When conventional radiography and the Periapical Index (PAI) are inadequate, the CBCT-based PESS index may provide higher diagnostic sensitivity. Accurate assessment of technical quality is therefore essential for clinical decision-making and long-term prognosis.
Referanslar
Endodontology, E.S.o., Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. International endodontic journal, 2006. 39(12): p. 921-930.
Ng, Y.L., et al., Outcome of primary root canal treatment: systematic review of the literature -- Part 2. Influence of clinical factors. Int Endod J, 2008. 41(1): p. 6-31.
Patel, S., et al., European Society of Endodontology position statement: Use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by. Int Endod J, 2019. 52(12): p. 1675-1678.
Moussa‐Badran, S., et al., Technical quality of root fillings performed by dental students at the dental teaching centre in Reims, France. International Endodontic Journal, 2008. 41(8): p. 679-684.
Renner, D., et al., Influence of pulp condition on the accuracy of an electronic foramen locator in posterior teeth: an in vivo study. Brazilian oral research, 2012. 26: p. 106-111.
Ricucci, D. and K. Langeland, Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J, 1998. 31(6): p. 394-409.
Polyzos, N.K., et al., Factors Affecting the Outcome of Non-Surgical Endodontic Treatments Performed by Undergraduate Students in a Greek Dental School. Eur Endod J, 2018. 3(2): p. 93-100.
Sjogren, U., et al., Factors affecting the long-term results of endodontic treatment. J Endod, 1990. 16(10): p. 498-504.
Jurič, R., et al., Factors associated with the outcome of root canal treatment-A cohort study conducted in a private practice. Int Endod J, 2024. 57(4): p. 377-393.
Park, D.M., W.H. Seok, and J.Y. Yoon, Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis. J Clin Med, 2024. 13(10).
Schilder, H., Cleaning and shaping the root canal. Dental clinics of north America, 1974. 18(2): p. 269-296.
Ng, Y.L., V. Mann, and K. Gulabivala, A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. International endodontic journal, 2011. 44(7): p. 583-609.
Hülsmann, M., Endodontide problemler: etiyoloji, tanı ve tedavi. 2014: Quintessence Yayıncılık.
Alhadainy, H.A., Root perforations: a review of literature. Oral surgery, oral medicine, oral pathology, 1994. 78(3): p. 368-374.
da Silva, P.Z., et al., Radiographic evaluation of root canal treatment performed by undergraduate students, part I; iatrogenic errors. Iranian endodontic journal, 2018. 13(1): p. 30.
Lambrianidis, T., Ledging and blockage of root canals during canal preparation: causes, recognition, prevention, management, and outcomes. Endodontic Topics, 2006. 15(1): p. 56-74.
Gulabivala, K. and Y.L. Ng, Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles. International Endodontic Journal, 2023. 56: p. 82-115.
Gillen, B.M., et al., Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis. J Endod, 2011. 37(7): p. 895-902.
Torabinejad, M., B. Ung, and J.D. Kettering, In vitro bacterial penetration of coronally unsealed endodontically treated teeth. Journal of endodontics, 1990. 16(12): p. 566-569.
Alaçam, T., Endodonti. 1990: Gazi Üniversitesi Basın Yayın Yüksek Okulu Basımevi.
Wong, R., Conventional endodontic failure and retreatment. Dental Clinics, 2004. 48(1): p. 265-289.
Kabak, Y. and P. Abbott, Prevalence of apical periodontitis and the quality of endodontic treatment in an adult Belarusian population. International endodontic journal, 2005. 38(4): p. 238-245.
Sunay, H., et al., Cross‐sectional evaluation of the periapical status and quality of root canal treatment in a selected population of urban Turkish adults. International Endodontic Journal, 2007. 40(2): p. 139-145.
Burry, J.C., et al., Outcomes of primary endodontic therapy provided by endodontic specialists compared with other providers. Journal of endodontics, 2016. 42(5): p. 702-705.
Rhodes, J.S., Advanced endodontics: clinical retreatment and surgery. 2005: CRC Press.
Burke, F., et al., Technical quality of root canal fillings performed in a dental school and the associated retention of root‐filled teeth: a clinical follow‐up study over a 5‐year period. Journal of oral rehabilitation, 2009. 36(7): p. 508-515.
Burns, L.E., et al., Outcomes of primary root canal therapy: An updated systematic review of longitudinal clinical studies published between 2003 and 2020. Int Endod J, 2022. 55(7): p. 714-731.
Lin, L.M., J.E. Skribner, and P. Gaengler, Factors associated with endodontic treatment failures. Journal of endodontics, 1992. 18(12): p. 625-627.
WU, M.K. and P.R. Wesselink, Timeliness and effectiveness in the surgical management of persistent post‐treatment periapical pathosis. Endodontic Topics, 2005. 11(1): p. 25-31.
Tabassum, S. and F.R. Khan, Failure of endodontic treatment: The usual suspects. European journal of dentistry, 2016. 10(01): p. 144-147.
Ricucci, D., L.M. Lin, and L.S. Spångberg, Wound healing of apical tissues after root canal therapy: a long-term clinical, radiographic, and histopathologic observation study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2009. 108(4): p. 609-621.
Orstavik, D., Essential endodontology: prevention and treatment of apical periodontitis. 2020: John Wiley & Sons.
Huumonen, S. and D. Ørstavik, Radiological aspects of apical periodontitis. Endodontic topics, 2002. 1(1): p. 3-25.
Ng, Y.L., et al., Outcome of primary root canal treatment: systematic review of the literature–part 1. Effects of study characteristics on probability of success. International endodontic journal, 2007. 40(12): p. 921-939.
Orstavik, D., K. Kerekes, and H.M. Eriksen, The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol, 1986. 2(1): p. 20-34.
Ørstavik, D., K. Kerekes, and H.M. Eriksen, The periapical index: a scoring system for radiographic assessment of apical periodontitis. Dental Traumatology, 1986. 2(1): p. 20-34.
Wu, M.K., H. Shemesh, and P. Wesselink, Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment. International endodontic journal, 2009. 42(8): p. 656-666.
Lofthag-Hansen, S., et al., Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2007. 103(1): p. 114-119.
Çıkman, A.Ş., et al., Evaluation of endodontically treated teeth and related apical periodontitis using periapical and endodontic status scale: Retrospective cone-beam computed tomography study. 2022.
Bender, I., S. Seltzer, and W. Soltanoff, Endodontic success—A reappraisal of criteria: Part I. Oral surgery, oral medicine, oral pathology, 1966. 22(6): p. 780-789.
Prada, I., et al., Influence of microbiology on endodontic failure. Literature review. Medicina oral, patologia oral y cirugia bucal, 2019. 24(3): p. e364.
De Moor, R., et al., Undergraduate curriculum guidelines for endodontology. International endodontic journal, 2013. 46(12): p. 1105-1114.
Nair, P., et al., Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after “one-visit” endodontic treatment. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2005. 99(2): p. 231-252.
Chandra, A., Discuss the factors that affect the outcome of endodontic treatment. Australian Endodontic Journal, 2009. 35(2): p. 98-107.
Kojima, K., et al., Success rate of endodontic treatment of teeth with vital and nonvital pulps. A meta-analysis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2004. 97(1): p. 95-99.
Schaeffer, M.A., R.R. White, and R.E. Walton, Determining the optimal obturation length: a meta-analysis of literature. Journal of endodontics, 2005. 31(4): p. 271-274.
Unal, G.C., et al., Quality of root canal fillings performed by undergraduate dental students. European Journal of Dentistry, 2011. 5(03): p. 324-330.
Ribeiro, D., et al., Technical quality of root canal treatment performed by undergraduate students using hand instrumentation: a meta‐analysis. International Endodontic Journal, 2018. 51(3): p. 269-283.
Chakravarthy, P.V.K. and J.R.K. Moorthy, Radiographic assessment of quality of root fillings performed by undergraduate students in a Malaysian Dental School. Saudi Endodontic Journal, 2013. 3(2): p. 77-81.
Karabucak, B., et al., Prevalence of Apical Periodontitis in Endodontically Treated Premolars and Molars with Untreated Canal: A Cone-beam Computed Tomography Study. J Endod, 2016. 42(4): p. 538-41.
Costa, F., et al., Association between missed canals and apical periodontitis. Int Endod J, 2019. 52(4): p. 400-406.
Lin, L.M., P.A. Rosenberg, and J. Lin, Do procedural errors cause endodontic treatment failure? The Journal of the American Dental Association, 2005. 136(2): p. 187-193.
Spili, P., P. Parashos, and H.H. Messer, The impact of instrument fracture on outcome of endodontic treatment. J Endod, 2005. 31(12): p. 845-50.
McGuigan, M.B., C. Louca, and H.F. Duncan, The impact of fractured endodontic instruments on treatment outcome. Br Dent J, 2013. 214(6): p. 285-9.
Ricucci, D. and J.F. Siqueira Jr, Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. Journal of endodontics, 2010. 36(8): p. 1277-1288.
Sen, B., B. Piskin, and T. Demirci, Observation of bacteria and fungi in infected root canals and dentinal tubules by SEM. Dental Traumatology, 1995. 11(1): p. 6-9.
Oguntebi, B., Dentine tubule infection and endodontic therapy implications. International Endodontic Journal, 1994. 27(4): p. 218-222.
Baugh, D. and J. Wallace, The role of apical instrumentation in root canal treatment: a review of the literature. Journal of endodontics, 2005. 31(5): p. 333-340.
Yared, G.M. and F.E.B. Dagher, Influence of apical enlargement on bacterial infection during treatment of apical periodontitis. Journal of endodontics, 1994. 20(11): p. 535-537.
Card, S.J., et al., The effectiveness of increased apical enlargement in reducing intracanal bacteria. Journal of Endodontics, 2002. 28(11): p. 779-783.
Aminoshariae, A. and J. Kulild, Master apical file size–smaller or larger: a systematic review of healing outcomes. International Endodontic Journal, 2015. 48(7): p. 639-647.
Referanslar
Endodontology, E.S.o., Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. International endodontic journal, 2006. 39(12): p. 921-930.
Ng, Y.L., et al., Outcome of primary root canal treatment: systematic review of the literature -- Part 2. Influence of clinical factors. Int Endod J, 2008. 41(1): p. 6-31.
Patel, S., et al., European Society of Endodontology position statement: Use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by. Int Endod J, 2019. 52(12): p. 1675-1678.
Moussa‐Badran, S., et al., Technical quality of root fillings performed by dental students at the dental teaching centre in Reims, France. International Endodontic Journal, 2008. 41(8): p. 679-684.
Renner, D., et al., Influence of pulp condition on the accuracy of an electronic foramen locator in posterior teeth: an in vivo study. Brazilian oral research, 2012. 26: p. 106-111.
Ricucci, D. and K. Langeland, Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J, 1998. 31(6): p. 394-409.
Polyzos, N.K., et al., Factors Affecting the Outcome of Non-Surgical Endodontic Treatments Performed by Undergraduate Students in a Greek Dental School. Eur Endod J, 2018. 3(2): p. 93-100.
Sjogren, U., et al., Factors affecting the long-term results of endodontic treatment. J Endod, 1990. 16(10): p. 498-504.
Jurič, R., et al., Factors associated with the outcome of root canal treatment-A cohort study conducted in a private practice. Int Endod J, 2024. 57(4): p. 377-393.
Park, D.M., W.H. Seok, and J.Y. Yoon, Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis. J Clin Med, 2024. 13(10).
Schilder, H., Cleaning and shaping the root canal. Dental clinics of north America, 1974. 18(2): p. 269-296.
Ng, Y.L., V. Mann, and K. Gulabivala, A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. International endodontic journal, 2011. 44(7): p. 583-609.
Hülsmann, M., Endodontide problemler: etiyoloji, tanı ve tedavi. 2014: Quintessence Yayıncılık.
Alhadainy, H.A., Root perforations: a review of literature. Oral surgery, oral medicine, oral pathology, 1994. 78(3): p. 368-374.
da Silva, P.Z., et al., Radiographic evaluation of root canal treatment performed by undergraduate students, part I; iatrogenic errors. Iranian endodontic journal, 2018. 13(1): p. 30.
Lambrianidis, T., Ledging and blockage of root canals during canal preparation: causes, recognition, prevention, management, and outcomes. Endodontic Topics, 2006. 15(1): p. 56-74.
Gulabivala, K. and Y.L. Ng, Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles. International Endodontic Journal, 2023. 56: p. 82-115.
Gillen, B.M., et al., Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis. J Endod, 2011. 37(7): p. 895-902.
Torabinejad, M., B. Ung, and J.D. Kettering, In vitro bacterial penetration of coronally unsealed endodontically treated teeth. Journal of endodontics, 1990. 16(12): p. 566-569.
Alaçam, T., Endodonti. 1990: Gazi Üniversitesi Basın Yayın Yüksek Okulu Basımevi.
Wong, R., Conventional endodontic failure and retreatment. Dental Clinics, 2004. 48(1): p. 265-289.
Kabak, Y. and P. Abbott, Prevalence of apical periodontitis and the quality of endodontic treatment in an adult Belarusian population. International endodontic journal, 2005. 38(4): p. 238-245.
Sunay, H., et al., Cross‐sectional evaluation of the periapical status and quality of root canal treatment in a selected population of urban Turkish adults. International Endodontic Journal, 2007. 40(2): p. 139-145.
Burry, J.C., et al., Outcomes of primary endodontic therapy provided by endodontic specialists compared with other providers. Journal of endodontics, 2016. 42(5): p. 702-705.
Rhodes, J.S., Advanced endodontics: clinical retreatment and surgery. 2005: CRC Press.
Burke, F., et al., Technical quality of root canal fillings performed in a dental school and the associated retention of root‐filled teeth: a clinical follow‐up study over a 5‐year period. Journal of oral rehabilitation, 2009. 36(7): p. 508-515.
Burns, L.E., et al., Outcomes of primary root canal therapy: An updated systematic review of longitudinal clinical studies published between 2003 and 2020. Int Endod J, 2022. 55(7): p. 714-731.
Lin, L.M., J.E. Skribner, and P. Gaengler, Factors associated with endodontic treatment failures. Journal of endodontics, 1992. 18(12): p. 625-627.
WU, M.K. and P.R. Wesselink, Timeliness and effectiveness in the surgical management of persistent post‐treatment periapical pathosis. Endodontic Topics, 2005. 11(1): p. 25-31.
Tabassum, S. and F.R. Khan, Failure of endodontic treatment: The usual suspects. European journal of dentistry, 2016. 10(01): p. 144-147.
Ricucci, D., L.M. Lin, and L.S. Spångberg, Wound healing of apical tissues after root canal therapy: a long-term clinical, radiographic, and histopathologic observation study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2009. 108(4): p. 609-621.
Orstavik, D., Essential endodontology: prevention and treatment of apical periodontitis. 2020: John Wiley & Sons.
Huumonen, S. and D. Ørstavik, Radiological aspects of apical periodontitis. Endodontic topics, 2002. 1(1): p. 3-25.
Ng, Y.L., et al., Outcome of primary root canal treatment: systematic review of the literature–part 1. Effects of study characteristics on probability of success. International endodontic journal, 2007. 40(12): p. 921-939.
Orstavik, D., K. Kerekes, and H.M. Eriksen, The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol, 1986. 2(1): p. 20-34.
Ørstavik, D., K. Kerekes, and H.M. Eriksen, The periapical index: a scoring system for radiographic assessment of apical periodontitis. Dental Traumatology, 1986. 2(1): p. 20-34.
Wu, M.K., H. Shemesh, and P. Wesselink, Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment. International endodontic journal, 2009. 42(8): p. 656-666.
Lofthag-Hansen, S., et al., Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2007. 103(1): p. 114-119.
Çıkman, A.Ş., et al., Evaluation of endodontically treated teeth and related apical periodontitis using periapical and endodontic status scale: Retrospective cone-beam computed tomography study. 2022.
Bender, I., S. Seltzer, and W. Soltanoff, Endodontic success—A reappraisal of criteria: Part I. Oral surgery, oral medicine, oral pathology, 1966. 22(6): p. 780-789.
Prada, I., et al., Influence of microbiology on endodontic failure. Literature review. Medicina oral, patologia oral y cirugia bucal, 2019. 24(3): p. e364.
De Moor, R., et al., Undergraduate curriculum guidelines for endodontology. International endodontic journal, 2013. 46(12): p. 1105-1114.
Nair, P., et al., Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after “one-visit” endodontic treatment. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2005. 99(2): p. 231-252.
Chandra, A., Discuss the factors that affect the outcome of endodontic treatment. Australian Endodontic Journal, 2009. 35(2): p. 98-107.
Kojima, K., et al., Success rate of endodontic treatment of teeth with vital and nonvital pulps. A meta-analysis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2004. 97(1): p. 95-99.
Schaeffer, M.A., R.R. White, and R.E. Walton, Determining the optimal obturation length: a meta-analysis of literature. Journal of endodontics, 2005. 31(4): p. 271-274.
Unal, G.C., et al., Quality of root canal fillings performed by undergraduate dental students. European Journal of Dentistry, 2011. 5(03): p. 324-330.
Ribeiro, D., et al., Technical quality of root canal treatment performed by undergraduate students using hand instrumentation: a meta‐analysis. International Endodontic Journal, 2018. 51(3): p. 269-283.
Chakravarthy, P.V.K. and J.R.K. Moorthy, Radiographic assessment of quality of root fillings performed by undergraduate students in a Malaysian Dental School. Saudi Endodontic Journal, 2013. 3(2): p. 77-81.
Karabucak, B., et al., Prevalence of Apical Periodontitis in Endodontically Treated Premolars and Molars with Untreated Canal: A Cone-beam Computed Tomography Study. J Endod, 2016. 42(4): p. 538-41.
Costa, F., et al., Association between missed canals and apical periodontitis. Int Endod J, 2019. 52(4): p. 400-406.
Lin, L.M., P.A. Rosenberg, and J. Lin, Do procedural errors cause endodontic treatment failure? The Journal of the American Dental Association, 2005. 136(2): p. 187-193.
Spili, P., P. Parashos, and H.H. Messer, The impact of instrument fracture on outcome of endodontic treatment. J Endod, 2005. 31(12): p. 845-50.
McGuigan, M.B., C. Louca, and H.F. Duncan, The impact of fractured endodontic instruments on treatment outcome. Br Dent J, 2013. 214(6): p. 285-9.
Ricucci, D. and J.F. Siqueira Jr, Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. Journal of endodontics, 2010. 36(8): p. 1277-1288.
Sen, B., B. Piskin, and T. Demirci, Observation of bacteria and fungi in infected root canals and dentinal tubules by SEM. Dental Traumatology, 1995. 11(1): p. 6-9.
Oguntebi, B., Dentine tubule infection and endodontic therapy implications. International Endodontic Journal, 1994. 27(4): p. 218-222.
Baugh, D. and J. Wallace, The role of apical instrumentation in root canal treatment: a review of the literature. Journal of endodontics, 2005. 31(5): p. 333-340.
Yared, G.M. and F.E.B. Dagher, Influence of apical enlargement on bacterial infection during treatment of apical periodontitis. Journal of endodontics, 1994. 20(11): p. 535-537.
Card, S.J., et al., The effectiveness of increased apical enlargement in reducing intracanal bacteria. Journal of Endodontics, 2002. 28(11): p. 779-783.
Aminoshariae, A. and J. Kulild, Master apical file size–smaller or larger: a systematic review of healing outcomes. International Endodontic Journal, 2015. 48(7): p. 639-647.
