[Downloaded free from http://www.jcd.org.in on Monday, November 16, 2015, IP: 117.233.3.

155]

Original Article

Dentinal defects before and after rotary root canal

instrumentation with three different obturation
techniques and two obturating materials
Ponnuswamy Kumaran, Elangovan Sivapriya, Jamuna Indhramohan, Velayutham Gopikrishna, K Subramani
Savadamoorthi, Angambakkam Rajasekharan Pradeepkumar
Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India

Abstract
Aim: To evaluate the role of rotary root canal instrumentation followed by obturation with three different techniques and two
different materials on the incidence of dentinal defects.
Materials and Methods: One hundred and sixty mandibular premolars were divided into eight groups (n = 20). Group I
was left untreated and served as control. The other seven groups were prepared with profile rotary instruments till #40.06
taper. After preparation, group II was left unfilled, groups III, IV, and V were obturated with Gutta-percha and AH Plus sealer
using passive technique, lateral compaction and warm vertical compaction, respectively. Groups VI, VII, and VIII were
obturated with Resilon and Realseal sealer using passive technique, lateral compaction, and warm vertical compaction,
respectively. Roots were then sectioned at 3, 6, and 9 mm from the apex and inspected under a stereomicroscope (50)
for dentinal defects. Chi-square test was performed to compare the incidence of dentinal defects between the groups (P
< 0.05).
Results: The unprepared control group had no dentinal defects. The instrumentation group (group II) and the obturation group
(groups III-VIII) showed significantly more defects than the uninstrumented control group (group I) (P < 0.001). There was no
significant difference between the root canal obturating techniques (group III-VIII) when compared with the instrumentation
group (group II). On inter group comparison among the obturation groups the number of defects after lateral compaction with
Gutta-percha (group IV) was significantly larger than passive Gutta-percha obturation (group III) (P < 0.05).
Conclusions: The results suggest that root canal instrumentation significantly influenced the incidence of dentinal defects or
fracture. Dentinal defects were more significantly attributed to the role of root canal instrumentation rather than the type of
obturation technique or material. Lateral compaction with Gutta-percha significantly produces more defects than passive
Gutta-percha obturation.
Key words: Dentin defects; obturation techniques; resilon; real seal; root canal instrumentation; vertical root fracture

INTRODUCTION
Vertical root fracture (VRF) is defined as a complete or
incomplete fracture initiated from the root at any level,
usually directed bucco-lingually.[1] It is a catastrophic
complication during or after root canal treatment[2]
presenting a significant clinical problem, which is difficult
to diagnose and treat.[3] It is also well known that most
vertically fractured teeth, with no history of trauma have
been root filled.[2]
It is generally accepted that the strength of an endodontically
treated tooth is directly related to the amount of remaining

sound tooth structure.[4] However, preparation procedures

and obturation techniques could also damage root dentin
resulting in fracture or craze lines.[5]
A crack or craze line can propagate into VRF if the tooth is
subjected to repeated stress. There is evidence that VRFs
are probably caused by the formation and propagation
of smaller, less pronounced defects, and not by the force
practiced during preparation or obturation.[6]
Lateral compaction of Gutta-percha is widely used to fill
the root canal system and was previously reported to be
Access this article online

Address for correspondence:

Quick Response Code:

Dr. A. R. Pradeepkumar, No. 10, Nowroji Road, Chetpet,

Chennai - 600 031, Tamil Nadu, India.
E-mail: arpradeep@vsnl.com

Website:
www.jcd.org.in

Date of submission : 17.07.2013

Review completed : 07.09.2013
Date of acceptance : 08.10.2013

DOI:
10.4103/0972-0707.120968

522

Journal of Conservative Dentistry | Nov-Dec 2013 | Vol 16 | Issue 6

[Downloaded free from http://www.jcd.org.in on Monday, November 16, 2015, IP: 117.233.3.155]

Kumaran, et al.: Dentinal defects caused by shaping and obturation techniques

associated with an increased risk of VRF.[2] Spreader design

and applied forces were suggested as contributing factors
to the appearance of VRF.[3]
The potential for VRF is also present with warm vertical
compaction[7] as the forces used may be equal to the forces
of lateral compaction.
Techniques where no compaction forces (passive obturation)
were used have been proposed and shown to produce an
apical seal similar to that of lateral compaction when used
in conjunction with dimensionally stable sealers.[8]
As an alternative to Gutta-percha, adhesive dental materials
like Resilon are now available that may offer an opportunity
to reinforce the root filled tooth through the use of bonded
sealers in the root canal system.[9]
So far, no study has compared the effect of obturation with
Gutta-percha and Resilon with three different obturation
techniques in the formation of dentin defects. In the
present study, the aim was to evaluate the incidence of
defects in root dentine before and after rotary root canal
instrumentation (ProFiles) and three different obturation
techniques (passive, lateral, and warm vertical compaction)
using two obturating materials (Gutta-percha and Resilon).

MATERIALS AND METHODS

One hundred and sixty single rooted mandibular premolar
teeth[10] extracted atraumatically for periodontal reasons
were collected. Teeth with external cracks or defects, deep
caries, with previous restorations, immature apices, and
teeth with more than one canal were excluded. The teeth
were placed in 0.5% sodium hypochlorite for half an hour,
ultrasonically cleaned and stored in purified filtered water.[11]
The root surfaces were observed under 7.5 magnification
in a stereomicroscope using an external light source to
exclude cracks. All the teeth were decoronated using a
diamond disc in a micromotor under water spray leaving
a root length of approximately 13+/- 1 mm.[12] The roots
were divided into eight groups (n = 20).

Group I
It served as control where no instrumentation and
obturation procedures were done.

Group II
Shaping and cleaning was standardized for Groups II, III, IV,
V, VI, VII, and VIII.

Shaping and cleaning

Initial working length was determined with a #10 K-File
(Dentsply Maillefer, Ballaigues, Switzerland) inserted into the
root canal until the tip of the file was observed at the apical

foramen. Final working length was established by decreasing

the file length by 1 mm from the initial working length. To
avoid dehydration all the roots were kept in distilled water
throughout the experimental procedure. All samples were
hand instrumented to ISO #20 K file (Dentsply-Maillefer
Ballaigues, Switzerland), and then prepared to #40/.06 taper
with ProFile instruments (Dentsply-Maillefer, Ballaigues,
Switzerland). Initially the coronal third of the root canals
were prepared by Orifice Shaper. Canal preparation was
done in a crown down sequence with ProFile instruments
40/.06, 35/.06, 30/.06, 40/.04, and 35/.04 to resistance and
then with 35/.06 and 40/.06 to working length.[13]
Canal patency was maintained by using #10 file reaching
to working length and irrigation was done with 2% sodium
hypochlorite after each change of instrument. Flushing
of the canal with normal saline was carried out after every
three instruments and a final rinse with 5 ml of 17% EDTA
SmearClear (SybronEndo) was done prior to the obturation. A
total of 12 ml of sodium hypochlorite and saline was employed
per tooth. The roots were surrounded in polyvinyl siloxane
(Aquasil, Dentsply DeTrey, Germany) during obturation.

Group III passive obturation gutta-percha +

AH plus sealer
A master Gutta-percha point #40 with 0.02 taper (DentsplyMaillefer, Ballaigues, Switzerland) was verified for tug back,
coated with epoxy AH Plus sealer (Dentsply DeTrey Gmbh,
Konstanz, Germany) and placed till the determined working
length. Additional #25 (0.02 taper) cones were placed to a
depth where resistance was met without use of a spreader.[14]

Group IV lateral compaction gutta-percha +

AH plus sealer
Master cone #40 Gutta-percha with 0.02 taper was coated
with AH Plus sealer to the estimated working length. Lateral
compaction was done with #25 stainless steel spreader with
a stopper placed at 1 mm short of working length initially,[15]
and the exerted force not exceeding 2 kg, which was
measured using a digital scale.[10] Additional cones of #20
(0.02 taper) (Dentsply-Maillefer, Ballaigues, Switzerland)
were used. An average of 7-8 cones were placed in each
canal.

Group V: Warm vertical compaction guttapercha + AH plus sealer

Master cone #40 Gutta-percha with 0.06 taper (DentsplyMaillefer, Ballaigues, Switzerland) coated with AH-Plus sealer
till determined working length and downpack was done by
continuous wave compaction with medium light plugger up to
5 mm short of working length with exerted force not exceeding
2 kg,which was measured using a digital scale[10] using
downpack instrument E and Q Plus heat source (Meta Biomed
Co. Ltd., Korea) with temperature set at 160C. The canal was
again coated with sealer, and backfilling was carried out with

Journal of Conservative Dentistry | Nov-Dec 2013 | Vol 16 | Issue 6

523

[Downloaded free from http://www.jcd.org.in on Monday, November 16, 2015, IP: 117.233.3.155]

Kumaran, et al.: Dentinal defects caused by shaping and obturation techniques

thermoplasticized Gutta-percha using E and Q plus gun (Meta

Biomed Co Ltd, Korea) with the temperature set at 160C.

Group VI: Passive obturation resilon + real seal

sealer

A. No defect
B. Fracture
C. All other defects

A. No defect

Teeth were obturated similar to group III with Resilon

and Real seal (SybronEndo, Orange, CA) according to
manufacturers instruction.

No defects is defined as root dentine devoid of any lines or

cracks where both the external surface of the root and the
internal root canal had no defects.

Group VII: Lateral compaction resilon + real

seal sealer

B. Fracture

Teeth were obturated similar to group IV with Resilon and

Real seal according to manufacturers instruction.

Group VIII: Warm vertical compaction resilon

+ real seal sealer
Teeth were obturated similar to group V with Resilon and
Real seal according to manufacturers instruction.

Fracture is defined as a line extending from the root canal

space to the outer surface of the root.

C. Other defects
Other defects is defined as all other craze lines observed
that did not reach the canal lumen or a partial crack
extending from the canal wall into the dentine without
reaching the outer surface of the root.

Statistical analysis

Storage of specimens
Roots were stored for a period of 1 week at 37C and 100%
humidity to allow the sealer to set.[16]

Examination of roots

Chi-square test was performed to compare the incidence of

fractures and other defects between the eight groups using
the SPSS/PC version 17.0. The level of significance was set
at P < 0.05.

All roots were sectioned horizontally at 3, 6, and 9 mm

from apex[17] with a slow-speed saw (Isomet, Buehler, Lake
Bluff, IL) under water cooling.

RESULTS

Sections were then viewed through a stereomicroscope

(Model Meiji Techno, EMT 52145) using an external light
source. Pictures were taken with a camera (Nikon) at a
magnification of 50 [Figure 1]. The root surfaces were
inspected and defects were noted.

No defects were found in the control group. Defects were

found in all test groups (groups II-VIII) and were statistically
significant than the unprepared control group (group I)
(P0.001). There was no statistically significant difference
between instrumentation group (group II) and obturation
groups and between obturation groups lateral compaction
Gutta-percha (group IV) was significant than the passive
Gutta-percha obturation (group III) (P < 0.05). Intragroup
comparison between the groups at coronal, middle,
and apical sections showed no statistically significant
difference.

Defects were classified as suggested by Wilcox et al.[5] and

categorized as follows:

Tables 1 and 2 summarizes the results.

DISCUSSION
a

Figure 1: Stereo microscopic sections (50): Arrows point

at dentinal defects. a) No Defects. b) Fractures. c) Multiple
Defects. d) Craze lines

524

Resistance to fracture is frequently measured to assess

the weakening of the root after different procedures. This
method applies an external force until the root fractures.[18] In
the current experiment, the influence of various procedures
were directly observed and no external forces were applied.
The sectioning method used in the current study allowed
the evaluation of the effect of root canal treatment
procedures on root dentine by direct inspection of the root
canal dentinal wall, observing not only root fracture but
also dentinal defects such as craze lines and incomplete
cracks, which predispose teeth to VRF.

Journal of Conservative Dentistry | Nov-Dec 2013 | Vol 16 | Issue 6

[Downloaded free from http://www.jcd.org.in on Monday, November 16, 2015, IP: 117.233.3.155]

Kumaran, et al.: Dentinal defects caused by shaping and obturation techniques

Table 1: Distribution of defects at three levels (Coronal, Middle, Apical) among the test groups
Gr-I Control
(n=20)
Defects
Coronal (3 mm)
Middle (6 mm)
Apical (9 mm)

0
0
0

Gr-II
(n=20)

Gr-III P (GP)* Gr-IV L (GP)* Gr-V WV (GP) * Gr-VI P (Res)* Gr-VII L (Res)* Gr-VIII WV
(n=20)
(n=20)
(n=20)
(n=20)
(n=20)
(Res)* (n=20)

No Defects No Defects No Defects No Defects No Defects No Defects No Defects No

Defects
Defects
Defects
Defects
Defects
Defects
Defects
Defects
20
0
0

3
3
4

17
17
16

3
4
2

17
16
18

8
7
4

12
13
16

5
3
4

15
17
16

3
4
3

17
16
17

8
6
2

12
14
18

6
6
5

14
14
15

I- Instrumentation, P (GP)- Passive (Gutta-percha), L (GP)- Lateral (Gutta-percha), WV (GP)- Warm vertical (Gutta-percha), P (Res)- Passive (Resilon), L (Res)- Lateral
(Resilon), WV (Res)- Warm Vertical (Resilon).

Table 2: Statistical analysis among tested groups at

three levels (Coronal, Middle, Apical)
Groups

Coronal Middle Apical P-Value

(9 mm) (6 mm) (3 mm) (<0.005)

Control
Instrumentation group

0
4

0
3

0
3

0.887

Passive obturation Gutta-percha

Lateral compaction Gutta-percha
Warm vertical compaction
Gutta-percha
Passive obturation Resilon
Lateral compaction Resilon
Warm vertical compaction
Resilon
Total

2
4
4

4
7
3

3
8
5

0.676
0.367
0.732

3
2
5

4
6
6

3
8
6

0.887
0.092
0.921

24

33

36

0.074

The roots were embedded in polyvinyl siloxane in an

attempt to mimic periodontal conditions that may change
the force distribution pattern around the tooth when
external forces are used in obturation.[10,19] However, the
actual clinical situation may be more complex.
Apical preparations were standardized with ProFile 40/.06
taper according to Singla et al.[13] who concluded that
ProFile 40/.06 taper instruments offered the advantage of
maximum debridement without significant reduction in
root fracture resistance.
In the current study, craze lines were not seen in unprepared
teeth (group I) proving that craze lines in the other groups
were caused by the preparation and obturation procedures.
There was a statistically significant increase in the incidence
of dentinal defects between the uninstrumented control
group (group I) and all the test groups.

uninstrumented control (group I). Topcuoglu et al.[20] assessed

the fracture resistance of three different obturation materials
namely Gutta-percha, BeeFill, and Thermafil and found no
significant difference among the three obturation techniques.
Shemesh et al.[10] assessed the effects of canal preparation
and passive obturation on the incidence of dentinal defects.
They found that lateral compaction of Gutta-percha produced
significantly more defects than passive obturation.
Our study is the first to compare the effect of Resilon
employed in three different techniques namely passive,
lateral, and warm vertical on the incidence of dentinal
defects. The results of our study indicate two important
clinical findings. The primary finding is that both the
obturation materials tested (Gutta-percha and Resilon) in
three different techniques (passive, lateral, warm vertical)
showed no significant difference in the incidence of dentinal
defects when compared with the instrumentation group
(group II). This is in concurrence with other studies that
show dentinal defects being primarily attributed to rotary
instruments rather than to the obturating techniques.[10,20]
The secondary finding of our study in relevance to the inter
group comparison among the obturation techniques and
materials shows that lateral compaction with Gutta-percha
created more dentinal defects than the passive obturation.
This is in concurrence with the study done by Shemesh
et al.[10] who showed that lateral compaction of Guttapercha results in significantly more dentinal defects than
Gutta-percha obturated with a passive technique.

Many of the defects did not connect with the pulp space, and
were located in places away from direct contact with intracanal
instruments, which is in accordance with a previous study by
Wilcox et al.,[5] who speculated that the stresses generated from
inside the root canal are transmitted through the root to the
surface where they overcome bonds holding dentine together.

Resilon is a thermoplastic synthetic polymer because of the

incorporation of polycaprolactone, a biodegradable aliphatic
polyester that has a low glass transition temperature of 62C.
It is bondable to methacrylate-based resins as it contains
dimethacrylate resins. This highly filled, radio-opaque root
filling material can couple to a variety of dentin adhesives
and resin type sealers, including Ephiphany (Pentron Clinical
Technologies, Wallinford, CT), Real Seal (SybronEndo,
Orange, CA), and Next (HeraeusKulzer, Armonk, NY).[21]

There was no statistically significant difference between

the instrumentation group (group II) and three different
obturation groups using either of the two obturating
materials (groups III-VIII). The results suggest that root
canal instrumentation alone (group II) significantly increases
the incidence of dentinal defects when compared with the

Primary components of Resilon are (1) Resilon core material

containing bioactive glass, Bismuth oxychloride, and Barium
sulfate. (2) Resin sealer is a dual cure, resin-based composite
sealer. The resin matrix is composed of bisphenol-Aglycidyldimethacrylate (BisGMA), Urethane dimethacrylate
(UDMA) and hydrophilic difunctional dimethacrylates. It

Journal of Conservative Dentistry | Nov-Dec 2013 | Vol 16 | Issue 6

525

[Downloaded free from http://www.jcd.org.in on Monday, November 16, 2015, IP: 117.233.3.155]

Kumaran, et al.: Dentinal defects caused by shaping and obturation techniques

contains fillers of calcium hydroxide, barium sulfate, barium

glass, and silica. (3) Self-etch primer that contains sulfonic acid
terminated fuctional monomer, 2-hydroxyethyl methacrylate
(HEMA), water, and a polymerization initiator. HEMA enhances
the bonding of resin to dentin.[22]
Studies have shown that the combined use of self etch
adhesives and methacrylate-based resin sealers with Resilon
are more resistant to bacterial leakage and root fracture.[23,24]
In a study by Baba et al.,[25] Resilon demonstrated higher
fracture resistance as compared with Gutta-percha when
lateral compaction was used while Sagsen et al.[12] and
Ribeiro et al.[18] showed no statistically significant difference
in terms of fracture resistance between teeth obturated with
Gutta-percha and Resilon. The results of our study show no
significant difference among the three obturation techniques
employed with Resilon on the incidence of dentinal defects.
The probable reason that the adhesive systems do not
influence dentinal defects could be due to the effect of oxygen
molecules present in dentine tubules on the polymerization
of the sealer/dentin interface. The low modulus of elasticity
of Resilon and Gutta-percha cones when compared with
dentin could play a role in this. Very high C-factor of root
canals during polymerization of resinous endodontic sealers
may also cause gaps along dentin/filling material interface.[18]

4.
5.
6.

7.
8.
9.
10.
11.
12.
13.

14.
15.
16.

Our results indicate that the instrumentation of root canals

can have a significant effect on dentin defect formation and
therefore on fracture resistance. However, it is not clear
whether all micro cracks would lead to VRF and this need to
be studied further.

17.

CONCLUSION

20.

Within the limitation of this in vitro study, we can conclude

that NiTi instrumentation induces the formation of dentinal
defects during canal preparation. Dentinal defects are
more significantly attributed to the role of root canal
instrumentation rather than the type of obturation technique
or material. Among the tested obturation techniques; lateral
compaction with Gutta-percha significantly produces more
defects than passive Gutta-percha obturation.

21.

ACKNOWLEDGEMENTS

25.

The authors wish to thank Dr. K. Kumanan and Dr. Palanisamy, Dept
of Animal Biotechnology, Madras Veterinary College for experimental
support and Dr. Ravanan for the statistical interpretation of the results.

REFERENCES
1.
2.
3.

Endodontics: Colleagues of excellence (AAE), 2008.

Meister F Jr, Lammel TJ, Gerstein H. Diagnosis and possible causes of
vertical root fractures. Oral Surg Oral Med Oral Pathol 1980;49:243-53.
Pitts DL, Natkin E. Diagnosis and treatment of vertical root fractures.
J Endod 1983;9:338-46.

526

18.
19.

22.

23.
24.

Wilcox LR, Roskelley C, Sutton T. The relationship of root canal

enlargement to finger-spreader induced vertical root fracture. J Endod
1997;23:533-4.
Williams C, Loushine RJ, Wellers RN, Pahley DH, Tay FR. A comparison
of cohesive strength and stiffness of Resilon ans gutta-percha. J Endod
2006;32:553-5.
Soros C, Zinelis S, Lambrianidis T, Palaghias G. Spreader load required
for vertical root fracture during lateral compaction ex vivo: Evaluation of
periodontal simulation and fracture load information. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2008;106:e64-70.
Blum JY, Machtou P, Micallef JP. Analysis of forces developed during
obturations. Wedging effect: Part II. J Endod 1998;24:223-8.
Dilek DM, Spangberg LS. Comparison of apical leakage in root canals
obturated with various gutta-percha techniques using a dye vacuum
tracing method. J Endod 1994;20:315-9.
Johnson ME, Stewart GP, Nielsen CJ, Hatton J. Evaluation of root
reinforcement of endodontically treated teeth. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2000;90:360-4.
Shemesh H, Wesselink PR, Wu MK. Incidence of dentinal defects after
root canal filling procedures. Int Endod J 2010;43:995-1000.
Strawn SE, White JM, Marshall GW, Gee L, Goodis HE, Marshall SJ.
Spectroscopic changes in human dentine exposed to various storage
solutions short term. J Dent 2006;24:417-23.
Sagsen B, Er O, Kahraman Y, Akdogan G. Resistance to fracture of roots
filled with three different techniques. Int Endod J 2007;40:31-5.
Singla M, Aggarwal V, Logani A, Shah N. Comparative evaluation
of rotary ProTaper, Profile, and conventional stepback technique on
reduction in Enterococcus faecalis colony-forming units and vertical root
fracture resistance of root canals. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2010;109:105-10.
Souza EM, Wu MK, Shemesh H, Bonetti-Filho I, Wesselink PR.
Comparability of the results of two leakage models. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2008;106:309-13.
Piskin B, Aydn B, Sarikanat M. The effect of spreader size on fracture
resistance of maxillary incisor roots. Int Endod J 2008;41:54-9.
Bier CA, Shemesh H, Tanomaru-Filho M, Wesselink PR, Kishen. A
Mechanisms and risk factors for fracture predilection in endodontically
treated teeth. Endod Topics 2006;13:57-83.
Shemesh H, Bier CA, Wu MK, Tanomaru-Filho M, Wesselink PR. The
effects of canal preparation and filling on the incidence of dentinal
defects. Int Endod J 2009;42:208-13.
Ribeiro FC, Souza-Gabriel AE, Marchesan MA, Alfredo E,
Silva-Sousa YT. Influence of different endodontic filling materials on root
fracture susceptibility. J Dent 2008;36:69-73.
Lertchirakarn V, Palamara JE, Messer HH. Patterns of vertical root
fracture: Factors affecting stress distribution in the root canal. J Endod
2003;29:523-8.
Topuolu HS, Arslan H, Kele A, Kseolu M. Fracture resistance of
roots filled with three different obturation techniques. Med Oral Patol
Oral Cir Bucal 2012;17:e528-32.
Gesi A, Raffaelli O, Goracci C, Pashley DH, Tay FR, Ferrari M. Interfacial
strength of Resilon and Gutta-Percha to intraradicular Dentin. J Endod
2005;31:809-13.
Shafer E, Zandbiglari T, Schafer J. Influence of resin based adhesive root
canal fillings on the resistance of fracture of endodotically treated roots:
An in vitro preliminary study. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2007;103:274-9.
Shipper G, rstavik D, Teixeira FB, Trope M. An evaluation of microbial
leakage in roots filled with a thermoplastic synthetic polymer-based root
canal filling material (Resilon). J Endod 2004;30:342-7.
Teixeira FB, Teixeira EC, Thompson JY, Trope M. Fracture resistance of
roots end- odontically treated with a new resin filling material. J Am Dent
Assoc 2004;135:646-52.
Baba SM, Grover SI, Tyagi V. Fracture resistance of teeth obturated
with Gutta percha and Resilon: An in vitro study. J Conserv Dent
2010;13:61-4.

How to cite this article: Kumaran P, Sivapriya E, Indhramohan J,

Gopikrishna V, Savadamoorthi KS, Pradeepkumar AR. Dentinal
defects before and after rotary root canal instrumentation with
three different obturation techniques and two obturating materials.
J Conserv Dent 2013;16:522-6.
Source of Support: Nil, Conflict of Interest: None declared.

Journal of Conservative Dentistry | Nov-Dec 2013 | Vol 16 | Issue 6