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ORIGINAL ARTICLE
Year : 2014  |  Volume : 32  |  Issue : 4  |  Page : 286-291
 

Evaluation of canal transportation and centering ability of K 3 (0.02%) and K 3 (0.04%) with hand K files in primary teeth using spiral computed tomography


1 Department of Pedodontics, SRM Dental College, SRM University, Tamil nadu, India
2 Professor and Head, Department of Pedodontics, Adhiparasakthi Dental college and Hospital, Melmaruvathur, Tamil nadu, India
3 Professor, Specialist Paedodontist, Department of Paedodontia, Dr. Sunny Medical Centre, United Arab Emirates
4 Department of Pedodontics, Sri Ramachandra University, Chennai, Tamil Nadu, India

Date of Web Publication17-Sep-2014

Correspondence Address:
Haridoss Selvakumar
AG1 Guru Royal Palace, Rayala Nagar First Main Road, Ramapuram, Chennai - 600 089, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.140943

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   Abstract 

Background: One of the objectives of root canal preparation is to clean and shape the root canal system while maintaining the original configuration. Therefore, it is important to keep the instruments centered to provide a correct enlargement, without excessive weakening of the root structure. Aim: The aim of the study was to compare canal transportation and centering ability of K 3 (0.02% taper) and K 3 (0.04% taper) with stainless steel hand K files in primary teeth using a spiral computed tomography (SCT) scan. Materials and Methods: A total of 75 extracted mandibular primary second molars was collected. Canals were divided randomly into three groups of 25 teeth each. Group I: K 3 files (0.02% taper), Group II: K 3 (0.04% taper), and Group III: Stainless steel hand K files. Three regions from apical, mid-root, and coronal levels of the canal were recorded. All the teeth were scanned before and after instrumentation by using SCT. Results: K 3 (0.02% taper) showed less canal transportation and a better centering ratio than K 3 (0.04% taper) and stainless steel hand K files. Statistical Analysis: The mean values were compared between different study groups and the P-value was calculated by using Kruskal-Wallis one-way ANOVA. The Mann-Whitney U-test followed by the Bonferroni correction method was employed to identify the significant groups at the 5% level. Conclusion: K 3 (0.02% taper) shaped root canals without significant shaping errors when compared to K 3 (0.04% taper) and stainless steel hand K files in primary teeth.


Keywords: Canal transportation, centering ability, primary teeth


How to cite this article:
Selvakumar H, Anandhan V, Thomas E, Swaminathan K, Vijayakumar R. Evaluation of canal transportation and centering ability of K 3 (0.02%) and K 3 (0.04%) with hand K files in primary teeth using spiral computed tomography . J Indian Soc Pedod Prev Dent 2014;32:286-91

How to cite this URL:
Selvakumar H, Anandhan V, Thomas E, Swaminathan K, Vijayakumar R. Evaluation of canal transportation and centering ability of K 3 (0.02%) and K 3 (0.04%) with hand K files in primary teeth using spiral computed tomography . J Indian Soc Pedod Prev Dent [serial online] 2014 [cited 2019 Nov 15];32:286-91. Available from: http://www.jisppd.com/text.asp?2014/32/4/286/140943



   Introduction Top


Pulp therapy is a treatment procedure to preserve the tooth thereby maintaining the arch integrity and preventing loss of space caused due to the early removal of the infected primary tooth. All stages of endodontic treatment in primary teeth must be based on biologic principles, especially root canal cleaning, disinfection, and shaping. [1] One of the primary objectives of root canal preparation during application of debriding instruments is maintaining the root canal curvature with centering ability and without or less canal transportation.

Until 1960, root canal instruments were produced of carbon steel, which is now replaced by stainless steel alloys. [2] Stainless steel files create aberrations, probably as a result of the inherent stiffness of stainless steel, which is compounded by the instrument design and canal shape. [3] Various studies have shown that the incidence of transportation and straightening of the root canal is common with the use of stainless steel files. [4] Later nickel titanium (NiTi) files were developed, which had properties of shape memory and super elasticity. The advent of NiTi rotary instrumentation has revolutionized root canal treatment by reducing procedural errors such as transportation associated with the use of stainless steel files. [5]

Curvatures and irregularities of root canal walls of deciduous teeth can be cleaned efficiently with nickel-titanium instruments with clockwise rotation resulting in removal of pulp tissue, dentin, and necrotic residues from the canals similar to manual filing. [6] Their ability to rotate on their own axes in the root canal without any risk or damage to the original anatomy is very important. [7]

Tachibana and Matsumoto evaluated the applicability of computed tomography (CT) imaging in endodontics in 1989. The use of CT to evaluate the quality of root canal preparation has been reported to provide better results than other methods such as radiographic imaging, cross-sectioning, and longitudinal cleavage. [8]

The ribbon-shaped morphology of primary teeth is a major concern in applying protocols for permanent teeth to primary molars. It may lead to lateral perforation on the inner root surface, especially in curved molar roots. The dentin in primary tooth is softer and less dense than that of permanent tooth, and roots are shorter, thinner, and more curved, often with undetectable root resorption. [9] All of these factors play an essential role in canal preparation of primary tooth compared with permanent tooth.

Little is known about the canal centering ability and canal transportation in a deciduous pulpectomy with K 3 rotary files and hand files. The aim of this study was to evaluate canal transportation and centering ability of K 3 (0.02% taper) and K 3 (0.04% taper) with conventional stainless steel hand K files using spiral computed tomography (SCT).


   Materials and Methods Top


Selection of teeth

Seventy-five extracted human mandibular primary second molars with minimum of second/third of its root length were collected and stored in formalin. Any attached soft tissue and calculus were removed with an ultrasonic scaler. The storage and handling of teeth were performed as per Occupational Safety and Health Administration guidelines and regulations. Standard access cavities were made for all the teeth. The distal root canal for all the teeth were negotiated by number 10 handheld stainless steel file. The distal root of primary mandibular second molar was selected, because they generally have a curved, large, single root canal with a uniform canal outline and relatively less intracanal ramifications compared with the mesial roots. [1] The working length of the canal was determined by observing the tip of the file protruding through the apical foramen and subtracting 1 mm from the recorded length.

Specimen preparation

The 75 teeth were randomly divided into three experimental groups containing 25 teeth each. The group I was instrumented with K 3 Rotary NiTi Endodontic File (SybronEndo) (0.02% taper) with Anthogyr at 250 rpm. The files were advanced while rotating slowly toward the apex and withdrawn as soon as the working length was reached, rotating until the file appeared outside the canal. Instrumentation was done up to the 35 size file. Group II was instrumented with K 3 Rotary NiTi Endodontic File (SybronEndo) (0.04% taper) with Anthogyr at 250 rpm. The files were advanced while rotating slowly toward the apex and withdrawn as soon as the working length was reached, rotating until the file appeared outside the canal. Instrumentation was done up to the 25 size file. In Group III the canals were instrumented with stainless steel K files with a quarter-turn pull and was instrumented manually up to 35 size file. There is no consensus on what size of instrumentation should be used. Some studies suggest that instrumentation should be halted at size 30, [10] whereas others recommend shaping up to size 35 or 40. [11]

For all groups after the use of each file, canals were irrigated with 3 mL of a 5.25% NaOCl solution. Lubrication was obtained using Glyde (Dentsply, Maillefer) during instrumentation, and after instrumentation, 1 mL of 17% ethylenediaminetetraacetic acid was used for 1 min followed by a final flush of 3 mL of NaOCl. Each instrument was changed after five canals. All irrigation procedures were delivered with a 27 gauge needle.

Specimen scanning

The root canal shape before and after instrumentation were scanned using a lightspeed plus CT scanner (GE Electricals, Milwaukee, USA). The teeth were mounted horizontally on a modeling wax sheet and viewed both cross sectionally and longitudinally with a constant thickness of 0.65 mm per slice and a constant spiral or a table speed of 0.75 and 120 KVP.

Image analysis

An imaginary line was drawn connecting the cementoenamel junction mesiodistally in the centermost slice of the longitudinal section and this was used as reference, and cross-sectional slices were made till the apex of the tooth. [11] The third slice from the imaginary line was taken in assessing the coronal section. The midcoronal area was determined according to the number of slices from the reference line to the apex, and the centermost cross-sectional slice was taken as mid-coronal section. The third slice from the apical end of the tooth was taken as apical section [Figure 1]. To standardize the procedure, four reference points were taken on the CT image of the coronal, midcoronal, and apical slices. They were taken on the outer walls of the distal root as buccal (A), lingual (B), mesial (C), and distal (D) points. A line was drawn connecting the outer wall of the buccal reference point to the outer wall of the lingual reference point, and another line was drawn connecting the outer wall of the mesial reference point to the outer wall of the distal reference point [Figure 2].
Figure 1: Schematic representation of the reference lines taken for the coronal, midcoronal, and apical region

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Figure 2: A schematic view of references used for calculation of canal transportation and canal centering ratio

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Evaluation of canal transportation

The extent and direction of canal transportation were determined by measuring the greatest distance between the edge of each instrumented canal and the corresponding edge of uninstrumented canal. The formula developed by Gambill et al. was used for the transportation calculation: (X1 - X2 ) - (Y1 - Y2 ). [12] X1 is the shortest distance from the outside of the canal to the periphery of the uninstrumented canal. Y1 is the shortest distance from the inside of the root to the periphery of the uninstrumented canal. X2 is the shortest distance from the outside of the root to the periphery of the instrumented canal. Y2 is the shortest distance from the inside of the root to the periphery of the instrumented canal. If the result obtained from this calculation using the above-mentioned formula is 0, then it indicates that there is no canal transportation.

Evaluation of centering ability

The mean centering ratio is a measure of the ability of the instrument to stay centered in the canal; the smaller the ratio, the better the instrument remained centered in the canal. The formula developed by Gambill et al. was used for the centering ratio calculation: (X1 - X2 )/(Y1 - Y2 ). [12] If the two numbers, i.e. (X1 - X2 ) and (Y1 - Y2 ) were not equal, then the lower figure was considered as the numerator of the ratio. A result of one obtained from the formula indicated perfect canal centering.

Statistical analysis

The mean and standard deviation for canal transportation and canal centering ability were estimated from the sample from each study group. The mean values were compared between different study groups, and the P-value was calculated by using Kruskal-Wallis one-way ANOVA. The Mann-Whitney U-test followed by the Bonferroni correction method was employed to identify the significant groups at the 5% level.


   Results Top


Comparison between groups for canal transportation

In the coronal region, the mean canal transportation in Group I (0.08 ± 0.14) is significantly less than Group III (0.25 ± 0.12) and Group II (0.19 ± 0.12) (P < 0.05). Furthermore, the mean canal transportation in Group II (0.19 ± 0.12) is significantly lesser than Group III (0.25 ± 0.12) [Figure 3].
Figure 3: Representative SCT scanning image of coronal region. (a) Preinstrumentation scan image: Group I. (b) Postinstrumentation scan image: Group I. (c) Preinstrumentation scan image: Group II. (d) Postinstrumentation scan image: Group II. (e) Preinstrumentation scan image: Group III. (f) Postinstrumentation scan image: Group III

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In the midcoronal region, the mean canal transportation in Group I (0.05 ± 0.07) is significantly less than Group III (0.09 ± 0.08) (P < 0.05). However, there is no significant difference between the mean canal transportation values of Group III (0.09 ± 0.08) and Group II (0.09 ± 0.09) [Figure 4].
Figure 4: Representative SCT scanning image of the midcoronal region. (a) Preinstrumentation scan image: Group I. (b) Postinstrumentation scan image: Group I. (c) Preinstrumentation scan image Group II. (d) Postinstrumentation scan image: Group II. (e) Preinstrumentation scan image: Group III. (f) Postinstrumentation scan image: Group III

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In the apical region, the mean canal transportation in Group I (0.08 ± 0.10) is significantly less than Group III (0.20 ± 0.16) and Group II (0.15 ± 0.04) (P < 0.05). Furthermore, the mean transportation in Group II (0.15 ± 0.04) is significantly less than Group III (0.20 ± 0.16) (P < 0.05) [Figure 5] and [Table 1].
Table 1: Comparison of mean canal transportation among different study groups

Click here to view
{Figure 5}

Comparison between groups for the centering ratio

In the coronal region, Group II (0.76 ± 0.30) had a significantly better centering ratio than Group I (0.46 ± 0.28) and Group III (0.45 ± 0.16) (P < 0.05). There is no significant difference between Group I (0.46 ± 0.28) and Group III (0.45 ± 0.16).

In the midcoronal region, Group I (0.91± 0.16) had a significantly better centering ratio than Group II (0.71 ± 0.20) and Group III (0.24 ± 0.04) (P < 0.05). However, in comparison Group II (0.71 ± 0.20) had a significantly better centering ratio than Group III (0.24 ± 0.04) (P < 0.05).

In the apical region, Group I (1.00 ± 0.22) showed a significantly better centering ratio than both Group II (0.62 ± 0.20) and Group III (0.36 ± 0.10) (P < 0.05). While Group II (0.62 ± 0.20) had a significantly better centering ratio than Group III (0.36 ± 0.10) (P < 0.05) [Table 2].
Table 2: Comparison of mean canal centering
ability among different study groups


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   Discussion Top


The goal of endodontic treatment in primary teeth is to control the pathogen bacteria in the root canal system of the necrotic teeth. [13] The two aims of root canal instrumentation are as follows:

  1. to clean and shape the root canal system and
  2. to allow the placement of a hermetic filling.


The ability to enlarge a canal without deviation from the original curvature is a primary objective in the endodontic teeth. [7]

Numerous investigations have shown that the preparation of curved root canals with stainless steel instruments frequently results in undesirable aberrations such as elbows, zips, and danger zones. [15] The introduction of Ni Ti rotary instruments has not only enabled easier and faster instrumentation of the root canal system, but also has provided consistent, predictable and reproducible shaping with considerably less iatrogenic damage. [16] The Ni-Ti alloys files are composed of 56% Ni and 44%Ti, which present a low elasticity modulus, high resilience, corrosion resistance, super elasticity, and shape's thermal memory. [17] Ni-Ti alloys have been found to be two to three times more elastic than similarly manufactured stainless steel files. This property may allow Ni-Ti files to negotiate curved canals with less lateral stress but do not allow the precurving of Ni-Ti files. [18] K 3 (SybronEndo) is a third-generation NiTi rotary instrument, features an asymmetrical design with a slightly positive rake angle for optimum cutting efficiency and unparalleled debris removal. Peripheral Blade Relief was designed to reduce friction, and it also helps to control the depth of the cut. This aids in protecting the instrument from over-engagement and separation. The noncutting tip of the K 3 instrument helps us to follow the canal path while minimizing the risk of ledging, zipping, and perforation. This feature also aids in minimizing canal transportation. The third radial land feature allows the operator to have more control by centering and stabilizing the instrument while rotating and facilitate smoother operation. They are 4 mm shorter than their competitors, yet the working (fluted) length is the same. [19]

Various methods have been used to compare the canal shape before and after preparation to investigate the efficiency of instruments and techniques developed for root canal preparation. The use of CT to evaluate the quality of root canal preparation has been reported to provide better results than other methods such as radiographic imaging, cross-sectioning, and longitudinal cleavage. Good results have been reported in-vitro and in-vivo with C-shaped canals. [20] In spite of its high cost and difficult sensitivity, CT is well indicated as a methodological resource in the research line. [21] Owing to the above-mentioned advantages, SCT was used in our study to assess the canals before and after instrumentation.

In this study, a comparison between rotary K 3 (0.02% taper), K 3 (0.04% taper) files, and hand stainless steel K files was performed to evaluate the canal transportation and centering ratio. For stainless steel K files, more canal transportation and less centering ability were seen when compared with the other two rotary files because of its stiffness and by the cutting efficiency. [22] Schafer and Schlingemann reported that K 3 instruments resulted in significantly less canal transportation and better canal centering ability than K flexofiles. [23] Canoglu et al. by using rotary and stainless steel hand file (K-file/Maillefer) in primary molar roots observed no significant difference in canal transportation and found that both the instruments maintain the canal centeric throughout all three regions (coronal, midcoronal, and apical). [1] Yoshimine et al. found that K3 NiTi files showed no indication of deviation, especially on the inner side of the curve region. [24]

NiTi files have been manufactured with a unique process that controls the material's memory, making the files extremely flexible. [25] This increases the ability of the file to follow the anatomy of the canal very closely and reduces the risk of transportation. Several previous studies reported the canal centering ability and canal transportation of K 3 Ni-Ti rotary systems in permanent teeth. [23],[24],[26],[27],[28] No data are available regarding the canal transportation and centering ability of K 3 file in deciduous teeth, and further research is recommended to evaluate the effectiveness in primary teeth.


   Conclusion Top


Ni-Ti systems having less cross-sectional area and more flexibility like K 3 instruments should be used for canals with more complex curvature. [23] Under the conditions of this study, K 3 NiTi rotary (0.02% taper) instrument showed less canal transportation and a better canal centering ratio than K 3 (0.04% taper) and stainless steel K files. Hence, K 3 (0.02% taper) might considered as safer rotary systems in deciduous dentition. The lack of studies regarding canal transportation and the canal centering ratio in the primary teeth, and the results obtained in this study highlight the importance of more research to develop safer procedure for the treatment of deciduous teeth. The main advantage of K 3 rotary files are 4 mm shorter than other Ni-Ti rotary files, this factor is clinically significant in the pediatric dentistry, because it allows reducing the patient's fatigue.


   Acknowledgment Top


we would like to thank Dr. Joseph Reuben, MDS for his help.

 
   References Top

1.Canoglu H, Tekcicek MU, Cehreli ZC. Comparison of conventional, rotary, and ultrasonic preparation, different final irrigation regimens, and 2 se-alers in primary molar root canal therapy. Pediatr Dent 2006;28:518-23.  Back to cited text no. 1
    
2.Nagaratna PJ, Shashikiran ND, Subbareddy VV. In vitro comparison of NiTi rotary instruments and stainless steel hand instruments in root canal preparations of primary and permanent molar. J Indian Soc Pedod Prev Dent 2006;24:186-91.  Back to cited text no. 2
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3.Musani I, Goyal V, Singh A, Bhat C. Evaluation and comparison of biological cleaning efficacy of two endofiles and irrigants as judged by microbial quantification in primary teeth: An in vivo study. Int J Clin Pediatr Dent 2009;2:15-22.   Back to cited text no. 3
    
4.Schäfer E. Effects of four instrumentation techniques on curved canals: A comparison study. J Endod 1996;22:685-9.  Back to cited text no. 4
    
5.Iqbal MK, Maggiore F, Suh B, Edwards KR, Kang J, Kim S. Comparison of apical transportation in four Ni-Ti rotary instrumentation techniques. J Endod 2003;29:587-91.  Back to cited text no. 5
    
6.Silva LA, Leonardo MR, Nelson-Filho P, Tanomaru JM. Comparison of rotary and manual instrumentation techniques on cleaning capacity and instrumentation time in deciduous molars. J Dent Child (Chic) 2004;71:45-7.  Back to cited text no. 6
    
7.Crespo S, Cortes O, Garcia C, Perez L. Comparison between rotary and manual instrumentation in primary teeth. J Clin Pediatr Dent 2008;32:295-8.  Back to cited text no. 7
    
8.Tachibana H, Matsumoto K. Applicability of X-ray computerized tomography in endodontics. Endod Dent Traumatol 1990;6:16-20.  Back to cited text no. 8
    
9.Kuo C, Wang Y, Chang H, Huang G, Lin C, Li U, et al. Application of Ni-Ti rotary files for pulpectomy in primary molars. J Dent Sci 2006;1:10-5.  Back to cited text no. 9
    
10.Llewelyn DR; Faculty of Dental Surgery, Royal College of Surgeons. UK national clinical guidelines in paediatric dentistry. The pulp treatment of the primary dentition. Int J Paediatr Dent 2000;10:248-52.  Back to cited text no. 10
    
11.Camp JH, Fuks AB. Pediatric endodontics: Endodotic treatment for the primary and young permanent dentition. In: Cohen S, Burns RC, editors. Pathways of the Pulp. St. Louis: Mosby; 2006. p. 633-71.  Back to cited text no. 11
    
12.Reuben J, Velmurugan N, Kandaswamy D. The evaluation of root canal morphology of the mandibular first molar in an Indian population using spiral computed tomography scan: An in-vitro study. J Endod 2008;34:212-5.  Back to cited text no. 12
    
13.Gambill JM, Alder M, del Rio CE. Comparison of nickel-titanium and stainless steel hand-file instrumentation using computed tomography. J Endod 1996;22:369-75.  Back to cited text no. 13
    
14.Ballesio I, Campanella V, Gallusi G, Marzo G. Chemical and pharmacological shaping of necrotic primary teeth. Eur J Paediatr Dent 2002;3:133-138.  Back to cited text no. 14
    
15.Hülsmann M, Schade M, Schäfers F. A comparative study of root canal preparation with HERO 642 and Quantec SC rotary Ni-Ti instruments. Int Endod J 2001;34:538-46.  Back to cited text no. 15
    
16.Mahran AH, AboEl-Fotouh MM. Comparison of effects of ProTaper, HeroShaper, and Gates Glidden Burs on cervical dentin thickness and root canal volume by using multislice computed tomography. J Endod 2008;34:1219-22.   Back to cited text no. 16
    
17.Pruett JP, Clement DJ, Carnes DL Jr. Cyclic fatigue testing of nickel-titanium endodontic instruments. J Endod 1997;23:77-85.  Back to cited text no. 17
    
18.Taºdemir T, Aydemir H, Inan U, Unal O. Canal preparation with Hero 642 rotary Ni-Ti instruments compared with stainless steel hand K-file assessed using computed tomography. Int Endod J 2005;38:402-8.  Back to cited text no. 18
    
19.Gambarini G. The K3 rotary nickel-titanium instrument system. Endod Top 2005;10:179-82.  Back to cited text no. 19
    
20.Hartmann MS, Barletta FB, Camargo Fontanella VR, Vanni JR. Canal transportation after root canal instrumentation: A comparative study with computed tomography. J Endod 2007;33:962-5.  Back to cited text no. 20
    
21.Limongi O, de Albuquerque DS, Baratto Filho F, Vanni JR, de Oliveira EP, Barletta FB. In vitro comparative study of manual and mechanical rotary instrumentation of root canals using computed tomography. Braz Dent J 2007;18:289-93.  Back to cited text no. 21
    
22.Lam TV, Lewis DJ, Atkins DR, Macfarlane RH, Clarkson RM, Whitehead MG, et al. Changes in root canal morphology in simulated curved canals over-instrumented with a variety of stainless steel and nickel titanium files. Aust Dent J 1999;44:12-9.   Back to cited text no. 22
    
23.Schäfer E, Schlingemann R. Efficiency of rotary nickel-titanium K3 instruments compared with stainless steel hand K-Flexofile. Part 2. Cleaning effectiveness and shaping ability in severely curved root canals of extracted teeth. Int Endod J 2003;36:208-17.  Back to cited text no. 23
    
24.Yoshimine Y, Ono M, Akamine A. The shaping effects of three nickel-titanium rotary instruments in simulated S-shaped canals. J Endod 2005;31:373-5.   Back to cited text no. 24
    
25.Shen Y, Zhou HM, Zheng YF, Peng B, Haapasalo M. Current challenges and concepts of the thermomechanical treatment of nickel-titanium instruments. J Endod 2013;39:163-72.   Back to cited text no. 25
    
26.Al-Sudani D, Al-Shahrani S. A comparison of the canal centering ability of ProFile, K3, and RaCe Nickel Titanium rotary systems. J Endod 2006;32:1198-201.  Back to cited text no. 26
    
27.Guelzow A, Stamm O, Martus P, Kielbassa AM. Comparative study of six rotary nickel-titanium systems and hand instrumentation for root canal preparation. Int Endod J 2005;38:743-52.  Back to cited text no. 27
    
28.Jodway B, HülsmannM. A comparative study of root canal preparation with NiTi-TEE and K3 rotary Ni-Ti instruments. Int Endod J 2006;39:71-80.  Back to cited text no. 28
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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