BASIC RESEARCH – TECHNOLOGY

€
Oznur Sarıyılmaz, DDS, MSc,*
Ru€ya Sessiz, DDS, MSc,† and The Impact of Coronal Flaring
Osman Sefa Kocaman, DDS‡
Files on Pericervical Dentin
Thickness in Mandibular
Molars

ABSTRACT
SIGNIFICANCE
Introduction: This study aimed to assess the influence of different coronal flaring files on
The use of coronal flaring files dentin removal in mandibular teeth using cone-beam computed tomographic (CBCT) images.
during root canal preparation Methods: CBCT images of 48 mandibular molar teeth were acquired and randomly divided
did not significantly affect into 2 main groups, with each main group further divided into 3 subgroups. In the first main
dentin removal in the furcation group, root canal preparation was performed using TruNatomy (Dentsply Sirona, Ballaigues,
area. The TruNatomy Switzerland), ProTaper Gold (Dentsply Sirona), and One Curve (Micro-Mega, Besancon,
instrument group France) files without the use of coronal flaring files. In the second main group, root canal
demonstrated greater preparation was performed using the same files with the use of coronal flaring files. After the
effectiveness in preserving completion of root canal preparation, a second set of CBCT images was obtained.
pericervical dentin compared Subsequently, the dentin removal and remaining critical dentin were assessed by measuring
with the other instrument at 4 distinct points below the furcation level. Data were compared between groups using the
groups. Mann-Whitney U and Kruskal-Wallis tests with alpha set at 5%. Results: The ProTaper Gold
files demonstrated higher dentin removal compared with the TruNatomy files. In the no-flaring
groups, the One Curve files exhibited greater dentin removal than the TruNatomy files at
specific levels. The use of coronal flaring files generally did not significantly impact dentin
removal, except for certain cases in the TruNatomy and ProTaper Gold groups.
Conclusions: The TruNatomy instrument group was more effective in preserving pericervical
dentin compared with the other instrument groups. Coronal flaring files can be confidently
used to preserve critical dentin during root canal treatment. (J Endod 2024;50:514–519.)

KEY WORDS
Cone-beam computed tomographic imaging; coronal flaring; dentin removal; mandibular
molars; pericervical dentin

Coronal flaring is the process of removing cervical dentin in the root canal orifice to create a straight
pathway for endodontic instruments to access the apical portion of the root canal1. This technique
From the *Faculty of Dentistry,
Departments of Endodontics, Çanakkale enables better control of instruments in the apical third without creating tension and facilitates accurate
Onsekiz Mart University, Çanakkale; determination of the working length2,3. The implementation of coronal flaring also enhances the
†
Faculty of Dentistry, Department of effectiveness of irrigation solutions in reaching the apical region and reduces the risk of infected debris
Dentomaxillofacial Radiology, Çanakkale being extruded through the apex4,5.
Onsekiz Mart University, Çanakkale; and
‡ Nevertheless, it should be noted that excessive coronal flaring carries the risk of perforation,
Ilgın Dr Vefa Tanir State Hospital, Turkish
Republic Ministry of Health, Konya particularly in the furcation area6. Conversely, using small tapered cervical preflaring can reduce stress in
€ the cervical region7. According to Clark and Khademi8, pericervical dentin refers to the region of a tooth
Address requests for reprints to Dr Oznur
Sarıyılmaz, Department of Endodontics, extending approximately 4 mm coronally and apically from the crestal bone level. They highlighted that the
Faculty of Dentistry, Çanakkale Onsekiz loss of pericervical dentin can lead to vertical root fractures, which significantly impact tooth survival8. To
Mart University, Çanakkale, Turkey. address this concern, the use of low tapered canal instruments has gained prominence as a minimally
E-mail address: oznursariyilmaz@yahoo. invasive approach to preserving pericervical dentin9.
com
0099-2399/$ - see front matter
The distal area of mesial roots in mandibular molars has concavity10. Abou-Rass et al11 described
this area as the “danger zone” because of its increased susceptibility to strip perforation during root canal
Copyright © 2024 American Association
of Endodontists.
shaping and post space preparation procedures. Numerous studies have examined the remaining dentin
https://doi.org/10.1016/ thickness after root canal preparation in the danger zone regions of mandibular molars12-15. There is a
j.joen.2024.01.008 substantial body of literature investigating the effectiveness of different coronal flaring files in dentin

514 Sarıyılmaz et al. JOE  Volume 50, Number 4, April 2024

removal in mandibular molar teeth12,15,16. included in this study after CBCT scans to The Preparation of Samples
However, there is currently a lack of specific ensure that each study group consisted of Flaring Groups
studies evaluating the efficacy of new file specimens with similar dentin thickness in the For the TN flaring group, the root canals were
systems with coronal flaring capabilities, such danger zone investigated in this study. prepared using TN instruments in the following
as TruNatomy (TN; Dentsply Sirona, A total of 96 mesial canals (including 48 sequence: the Orifice Modifier (20/0.8), Glider
Ballaigues, Switzerland) and ProTaper Gold mesiobuccal and 48 mesiolingual canals) of 48 file (17/0.2), and Prime file (26/0.4), as per the
(PG; Dentsply Sirona). Furthermore, there is a mandibular molar teeth with a similar length manufacturer’s instructions.
dearth of research on the effectiveness of the were used for the study. The teeth were For the OC flaring group, One Flare (25/
One Flare (Micro-Mega, Besancon, France) thoroughly cleaned of any hard or soft tissue 0.9), One G (Micro-Mega) (14/0.3), and OC
coronal flaring file, which is recommended for deposits using hand scalers, and then they (25/0.6) instruments were used respectively
use in conjunction with the One Curve (OC; were stored in a 5% formal saline solution. To according to the manufacturer’s instructions.
Micro-Mega) file. obtain a flat constant reference point for further For the PG flaring group, the files in the
The accuracy and reliability of linear root canal preparation and measurements, the PG file set were used in sequence as follows:
measurements on cone-beam computed crowns were removed, leaving approximately Sx (18/0.3), S1 (18/0.3), S2 (20/0.4), F1 (20/
tomographic (CBCT) images, which are taken 3 mm above the cementoenamel junction 0.7), and F2 (25/0.8).
without patient motion and metal artifacts, are using a water-cooled, diamond disc. The root
considered adequate17. Also, CBCT images canals were irrigated with 2.5% hypochlorite, No-Flaring Groups
have been reported as an adequate method and apical patency was achieved using a size For the TN no-flaring group, the root canals
for examining canal configuration and the 10 K-file. The working length was determined were prepared using TN instruments in the
isthmus before canal preparation, by subtracting 1 mm from the measured length following sequence: Glider (17/0.2) and Prime
demonstrating dentin bridge formation, and at the point where the file first emerges from (26/0.4) files without using the Orifice Modifier
detecting extruded filling material18-20. the apex. During this stage, samples deviating (20/0.8), as per the manufacturer’s instructions.
The aim of this study was to evaluate from the specified working length of For the OC no-flaring group, One G (14/
the effect of coronal flaring files on the 13 6 1 mm were replaced with spare teeth to 0.3) and OC (25/0.6) files were used respectively
amount of dentin removal in mandibular teeth standardize the groups. without using a coronal flaring file (One Flare).
on CBCT images. The null hypothesis of this The teeth were vertically mounted in For the PG no-flaring group, without
study was that the usage of coronal flaring dental pink wax and randomly divided into 6 using an SX file (18/0.3), other files in the PG file
files will not have any effect on the amount of groups. Then, CBCT imaging of the specimens set (ie, S1 [18/0.3], S2 [20/0.4], F1 [20/0.7],
dentin removal in the danger zone. The was performed using the same CBCT and F2 [25/0.8]) were used in sequence.
second hypothesis of the study was that equipment (NewTom 5G XL; QR Systems, All instruments were used by mounting
there will be no difference in terms of dentin Verona, Italy). The scanner parameters were as the VDW Gold Reciproc (VDW GmbH, Munich,
removal effectiveness among different file follows: an exposure time of 9 seconds, Germany) endomotor with torque and rotation
systems. operating at 110 kV(p), and an 8 ! 8 field of speed set as recommended by the
view. The CBCT unit provided 0.100-mm axial manufacturer. The activation process involved
cuts and image reconstruction with a high 3 in-and-out movements with an amplitude of
MATERIALS AND METHODS intensity of projection. The beam incidence 3–5 mm. To ensure standardization, root canal
The methodology of this study was approved was on the cervical portion of the device used preparation with coronal flaring files was
by the Çanakkale Onsekiz Mart University to fasten the specimens. The Digital Imaging performed up to 5 mm beyond the root canal
Ethical Committee of Clinical Research (2023/ and Communications in Medicine files were orifice. The entire root canal preparation was
01-07). The protocol of our study was analyzed using New Net Technologies (Naples, performed by a single operator. Root canal
performed in accordance with the guidelines FL) version 11.5 software on a desktop irrigation was carried out using a 30-G single-
outlined in the Declaration of Helsinki. The total computer running Windows 10 (Microsoft sided irrigation needle positioned 2 mm short
number of samples required for the study was Corp, Redmond, WA). of the working length. At each file change, the
determined based on data from a previous The dentin thickness of the danger zone canals were irrigated with 2 mL 2.5% sodium
study21 using the G*Power 3.1 software was measured at 1, 2, 3, and 4 mm below the hypochlorite solution. After completion of the
package (Heinrich Heine University, Dusseldorf, furcation level (Fig. 1A and B). preparation, a final irrigation was performed
Germany). The minimum required total sample
size was calculated as 48 (n 5 8) based on the F
test family, an effect size of 0.705, an alpha-type
error of 0.05, and power of 0.95.
Teeth that had any calcification in the
root canal system, crown-root fractures, caries,
or restorations were excluded from the study.
The inclusion criteria encompassed teeth with a
canal curvature ranging between 20 and 30
according to Schneider22 and mature roots.
Due to the potential for intracanal calcification
caused by restorations or caries, teeth with
intact root canal structure free from caries or
previous restorations were selected for this
study. Therefore, human teeth extracted for FIGURE 1 – (A ) Locations of dentin thickness measurements taken beneath the furcation level. (B ) Measurement of
periodontal and orthodontic reasons were dentin thickness on the mesial and distal aspects of the mesial root in mandibular molars.

JOE  Volume 50, Number 4, April 2024 Pericervical Dentin Thickness in Mandibular Molars 515
using 2 mL 17% EDTA, 2 mL 2.5% sodium flaring files within the OC file group at various impact the critical dentin thickness remaining in
hypochlorite, and 2 mL sterile saline solution. root levels did not have a significant impact on this particular area.
After the preparation, CBCT images the amount of dentin removed. However, the In this study, similar to other
were obtained, and dentin thicknesses were use of coronal flaring files at 1 mm and 2 mm investigations10,11, it was observed that the
measured at 1, 2, 3, and 4 mm below the below the furcation level in the PG file group mesial dentin thickness was consistently
furcation level. A 10% sample of the data was statistically increased the amount of removed higher than the distal dentin thickness at all
assessed by both the endodontist and the dentin. root levels. Therefore, to assess the dentin
radiologist to ensure calibration. All imaging The remaining dentin thickness was removal efficiency of coronal flaring files, the
studies were reviewed by a radiologist with divided into 3 categories: ,0.5 mm, 0.5– analysis focused on the distal canal,
5 years of experience. 1 mm, and .1 mm. Table 3 presents the specifically at 1, 2, 3, and 4 mm below the
percentages of dentin thickness remaining at furcation level. We chose to evaluate this
Statistical Analysis different furcation levels for files. In the TN area in our study because the remaining
Because it was observed through the Shapiro- group, the remaining dentin thickness at any dentin is more vulnerable in this region,
Wilk test that the data were not normally root level did not decrease below 0.5 mm. In necessitating caution during root canal
distributed, the Mann-Whitney U test was both the flaring and no-flaring groups of PG preparation.
used for pairwise comparisons between the and OC files, there were areas in which the Various techniques can be used to
flaring and no-flaring groups in terms of the remaining dentin thickness decreased to measure dentin thickness, including the
amount of dentin removed. A comparison of below 0.5 mm. sectioning method, radiographic comparison,
the file groups in terms of dentin removal was CBCT imaging, and micro–computed
conducted using the Kruskal-Wallis test with a tomographic (micro-CT) imaging12,25,26. The
DISCUSSION sectioning method provides accurate
95% confidence level.
Coronal flaring is an essential procedure in measurements but is not suitable for in vivo
root canal treatment, aiming to minimize use because it causes a loss of tooth hard
RESULTS
obstructions, optimize irrigation, and facilitate tissues27. Radiographic methods provide 2-
Table 1 presents the average dentin access to the apex2-5. Although providing dimensional imaging but lack information
thicknesses in the mesial and distal regions numerous benefits, it is crucial to exercise about dentin thickness in the buccolingual
before preparation in the mesial canals of caution during coronal flaring to prevent direction. Studies have shown that dentin
mandibular molars. In mandibular molar teeth, excessive enlargement, which could lead to thickness measured with radiographs tends to
the average dentin thickness in the mesial unfortunate incidents such as perforation or be thicker than the actual thickness of the
canals was found to be lower in the distal weakening of the furcal wall, especially in dentin28. Micro-CT imaging offers detailed
region compared with the mesial region at all mandibular molars6. Over the years, the ideal information about dentin thickness, canal
furcation levels. root canal shaping procedures have evolved, morphology, and curvatures at micrometer
Table 2 presents the median (minimum- with an emphasis on minimal invasive root intervals29. However, this technology has
maximum) values of dentin removal at different canal preparation to preserve pericervical limitations, including high costs, limited sample
furcation levels of mandibular molars for the file dentin9. This study aimed to compare the capacity, and its inability to be used in clinical
groups. There was a significant difference in TruNatomy system, introduced to the market settings.
the amount of dentin removal between all file with the concept of minimal invasive root Many previous studies have used CBCT
groups at all furcation levels. In the flaring canal preparation, including a coronal flaring images to measure dentin thickness before
group, PG files removed statistically more file, with other systems that also incorporate and after instrumentation13-15,30. In a study
dentin compared with TN files at all furcation coronal flaring files. Furthermore, this study that measured the minimum dentin thickness
levels. In the no-flaring groups, PG files aims to evaluate dentin removal effect of after instrumentation of mandibular
removed statistically more dentin than TN files different rotary systems, both with and second molars with C-shaped root canal
at furcation levels of 3 mm and 4 mm. In the without the use of a coronal flaring file, during anatomy, researchers reported that CBCT
no-flaring group, both PG and OC files the preparation of curved mandibular molar measurements provided accurate information
removed statistically more dentin compared root canals. about the minimum dentin thickness
with TN files at 1 and 2 mm below the furcation Abou-Rass et al11 defined the distal compared with micro-CT measurements31.
level. It was observed that the use of a coronal region of mesial roots in mandibular molars as Another study highlighted the potential of
flaring file only at 1 mm below the furcation level danger zones because of their susceptibility to CBCT imaging in measuring dentin thickness
in the TN file group increased the amount of strip perforation in 1980. Several studies have and aiding in clinical decision making,
removed dentin. The utilization of coronal evaluated the danger zone in a similar manner especially in cases involving instrument
to the study by Abou-Rass et al10,23. De Deus fractures32. In the current study, dentin
et al24 reported in their study that the danger thickness measurements before and after
TABLE 1 - The Average Dentin Thicknesses in the
zone can be located in the mesial region of the instrumentation were acquired using CBCT
Mesial Canal of Mandibular Molars
mesial canals of mandibular molars, with an images, which offer precise and reliable
incidence of 40%, and this region is measurements along with in vivo imaging
Mesial Distal
predominantly located vertically in the middle capabilities.
Furcation level Mean ± SD Mean ± SD
third of the root. In this study, dentin thickness Significant differences were observed in
1 mm 1.37 6 0.21 1.11 6 0.23 dentin removal among the TN, OC, and PG
was evaluated up to 4 mm below the furcation
2 mm 1.25 6 0.20 1.01 6 0.22
level. This decision was made because coronal systems in both the flaring and no-flaring
3 mm 1.16 6 0.20 0.94 6 0.21
4 mm 1.08 6 0.21 0.93 6 0.20 flaring instruments tend to remove more dentin groups. The PG files exhibited greater dentin
from the coronal third of the root because of removal at all root levels compared with the TN
SD, standard deviation. their wider tapers, which can significantly file group. In the no-flaring groups, specifically

516 Sarıyılmaz et al. JOE  Volume 50, Number 4, April 2024

TABLE 2 - The Median (Minimum-Maximum) Values of Dentin Removal in the Danger Zone for 3 Different File Groups

TruNatomy One Curve ProTaper Gold

Median Median Median
Furcation level Flaring (minimum-maximum) (minimum-maximum) (minimum-maximum) P value
1 mm Flaring 0.2 (0.1–0.3) Aa
0.25 (0–0.5) ABa
0.3 (0.2–0.6) Ba
,.05
No flaring 0.1 (0–0.2)Ab 0.25 (0–0.5)Ba 0.2 (0–0.6)Bb ,.05
P value ,.05 ..05 ,.05
2 mm Flaring 0.1 (0–0.4)Aa 0.2 (0–0.5)ABa 0.3 (0.1–0.5)Ba ,.05
No flaring 0 (0–0.2)Aa 0.2 (0–0.5)Ba 0.2 (0–0.6)Bb ,.05
P value ..05 ..05 ,.05
3 mm Flaring 0.1 (0–0.2)Aa 0.2 (0–0.3)ABa 0.3 (0–0.5)Ba ,.05
No flaring 0.1 (0–0.2)Aa 0.1 (0.1–0.3)ABa 0.15 (0–0.4)Ba ,.05
P value ..05 ..05 ..05
Flaring 0.1 (0–0.2)Aa 0.1 (0–0.2)ABa 0.1 (0–0.5)Ba ,.05
4 mm No flaring 0.1 (0–0.2)Aa 0.1 (0–0.3)ABa 0.1 (0–0.5)Ba ,.05
P value ..05 ..05 ..05

In rows, uppercase letters indicate significance between file groups, and lowercase letters in columns indicate significance between flaring groups.

at 1 and 2 mm below the root level, the OC files have a minimum of 1 mm of remaining thickness measurements in CBCT imaging
demonstrated higher dentin removal than the dentin35. A reduction in the remaining with additional studies.
TN file group. Our findings are consistent with dentin thickness to 0.5 mm during post
a study conducted by Silva et al26 that also preparation leads to decreased fracture
compared the amount of dentin removal in the resistance compared with having 1 mm of CONCLUSIONS
mesial and distal canals of lower molars using remaining dentin36. In our study, the TN Based on the evaluation of the remaining critical
the PG and TN systems. Similarly, in line with group showed no decrease in the remaining dentin thickness in this study, it is evident that
our results, Silva et al reported that in the dentin thickness below 0.5 mm at any root the TN instrument group is more effective in
mesial canals of mandibular molars, PG files level in both the flaring and no-flaring preserving pericervical dentin compared with
removed more dentin than the TN files at the subgroups. However, the OC and PG the other instrument groups. We recommend
coronal level. groups exhibited regions where dentin clinicians consider not only the taper and ISO
The amount of dentin that the files can thickness fell below 0.5 mm. number of the files but also the diameter of the
remove is more dependent on the diameter of Regarding the amount of removed file actively engaging in the preparation of the
the file in the preparation area rather than the dentin during root canal preparation, no root canal when selecting files in cases in which
apical diameter and taper of the files. The TN file significant differences were observed when the preservation of pericervical dentin is crucial.
system is produced using a 0.8-mm wire, in using coronal flaring files in all 3 file groups Furthermore, considering the benefits offered
contrast to the 1.2-mm wire used by many other except in the TN group at 1 mm below the by coronal flaring files, it can be confidently
file systems, with the aim of better preserving furcation level and in the PG group at 1 and concluded that these files can be safely used to
root dentin, as stated by the manufacturer33. 2 mm below the furcation level. These findings preserve the remaining critical dentin during
The results of this study also indicate that the TN suggest that the use of coronal flaring files is root canal preparation.
file system is more successful in preserving generally safe in terms of dentin removal,
pericervical dentin compared with the other file particularly in the furcation area.
systems tested regardless of whether the flaring The limitation of the study is that CBCT
ACKNOWLEDGMENTS
file is used or not. imaging may not be able to provide Supported by Çanakkale Onsekiz Mart
Dentin thickness less than 1.3 mm is measurements as detailed as micro-CT University Scientific Research Coordination
associated with a higher risk of vertical root imaging in assessing the remaining dentin €
Unit (project number: TLOAP-2023-4340).
fracture34. To prevent root fractures during thickness. It might be more beneficial to The authors deny any conflicts of
post preparation, it is recommended to support the accuracy of remaining dentin interest related to this study.

TABLE 3 - Critical Remaining Dentin Percentages with Different Files Groups at Different Root Levels

TruNatomy (%) One Curve (%) ProTaper Gold (%)

Remaining dentin 1 mm 2 mm 3 mm 4 mm 1 mm 2 mm 3 mm 4 mm 1 mm 2 mm 3 mm 4 mm
Flaring ,0.5 mm 0 0 0 0 18.8 18.8 18.8 0 6.3 18.8 25 25
0.5–1 mm 56.3 68.8 80 76.5 56.3 62.5 62.5 81.3 75 68.8 62.5 68.8
.1 mm 43.8 31.3 20 23.5 25 18.8 18.8 18.8 18.8 12.5 12.5 6.3
No-flaring ,0.5 mm 0 0 0 0 12.5 0 6.3 0 18.8 25 12.5 12.5
0.5–1 mm 31.3 43.8 62.5 68.8 50 75 87.5 93.8 50 48.8 56.3 56.3
.1 mm 68.8 56.3 37.5 31.3 37.5 25 6.3 6.3 31.3 31.3 31.3 31.3

JOE  Volume 50, Number 4, April 2024 Pericervical Dentin Thickness in Mandibular Molars 517
REFERENCES
1. Isom TL, Marshall JG, Baumgartner JC. Evaluation of root thickness in curved canals after flaring.
J Endod 1995;21:368–71.

2. Ibelli GS, Barroso JM, Capelli A, et al. Influence of cervical preflaring on apical file size
determination in maxillary lateral incisors. Braz Dent J 2007;18:102–6.

3. Davis RD, Marshall JG, Baumgartner JC. Effect of early coronal flaring on working length change
in curved canals using rotary nickel-titanium versus stainless steel instruments. J Endod
2002;28:438–42.

4. Leeb J. Canal orifice enlargement as related to biomechanical preparation. J Endod 1983;9:463–

70.
5. Topçuog € u
lu HS, Ust €n Y, Akpek F, et al. Effect of coronal flaring on apical extrusion of debris
during root canal instrumentation using single-file systems. Int Endod J 2016;49:884–9.

6. da Silva PB, Duarte SF, Alcalde MP, et al. Influence of cervical preflaring and root canal
preparation on the fracture resistance of endodontically treated teeth. BMC Oral Health
2020;20:111.

7. Yuan K, Niu C, Xie Q, et al. Comparative evaluation of the impact of minimally invasive preparation
vs. conventional straight-line preparation on tooth biomechanics: a finite element analysis. Eur J
Oral Sci 2016;124:591–6.

8. Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dent
Clin North Am 2010;54:249–73.
9. Gluskin AH, Peters CI, Peters OA. Minimally invasive endodontics: challenging prevailing
paradigms. Br Dent J 2014;216:347–53.
10. Berutti E, Fedon G. Thickness of cementum/dentin in mesial roots of mandibular first molars. J
Endod 1992;18:545–8.

11. Abou-Rass M, Frank AL, Glick DH. The anticurvature filing method to prepare the curved root
canal. J Am Dent Assoc 1980;101:792–4.

12. Akhlaghi NM, Bajgiran LM, Naghdi A, et al. The minimum residual root thickness after using
ProTaper, RaCe and Gates-Glidden drills: a cone beam computerized tomography study. Eur J
Dent 2015;9:228–33.
13. Sousa VC, Alencar AHG, Bueno MR, et al. Evaluation in the danger zone of mandibular molars
after root canal preparation using novel CBCT software. Braz Oral Res 2022:36–8.
14. Elnaghy AM, Elsaka SE. Evaluation of root canal transportation, centering ratio, and remaining
dentin thickness associated with protaper next instruments with and without glide path. J Endod
2014;40:2053–6.

15. Flores CB, Montagner F, Gomes BP, et al. Comparative assessment of the effects of Gates-
Glidden, Largo, LA-Axxess, and New Brazilian Drill CPdrill on coronal pre-enlargement: cone-
beam computed tomographic analysis. J Endod 2014;40:571–4.

16.  MV, et al. Effects of four instruments on coronal pre-

Sanfelice CM, da Costa FB, Reis So
enlargement by using cone beam computed tomography. J Endod 2010;36:858–61.

17. Fokas G, Vaughn VM, Scarfe WC, et al. Accuracy of linear measurements on CBCT images
related to presurgical implant treatment planning: A systematic review. Clin Oral Implants Res
2018;29(Suppl 16):393–415.

18. Gomes TC, Coelho JA, Pinheiro LR, et al. Influence of apical diameter on filling material extrusion
during retreatment - A Micro-CT and CBCT evaluation. Braz Dent J 2022;33:13–9.
19. Bui AH, Pham KV. Evaluation of reparative dentine bridge formation after direct pulp capping with
biodentine. J Int Soc Prev Community Dent 2021;11:77–82.

20. Lamira A, Mazzi-Chaves JF, Nicolielo LFP, et al. CBCT-based assessment of root canal
treatment using micro-CT reference images. Imaging Sci Dent 2022;52:245–58.

21. Chaudhary NR, Singh DJ, Somani R, et al. Comparative evaluation of efficiency of different file
systems in terms of remaining dentin thickness using cone-beam computed tomography: an
In vitro study. Contemp Clin Dent 2018;9:367–71.

22. Schneider SW. A comparison of canal preparations in straight and curved root canals. Oral Surg
Oral Med Oral Pathol 1971;32:271–5.
23. Zhou G, Leng D, Li M, et al. Root dentine thickness of danger zone in mesial roots of mandibular
first molars. BMC Oral Health 2020;20:43.

518 Sarıyılmaz et al. JOE  Volume 50, Number 4, April 2024

 24. De-Deus G, Rodrigues EA, Belladonna FG, et al. Anatomical danger zone reconsidered: a micro-
CT study on dentine thickness in mandibular molars. Int Endod J 2019;52:1501–7.

25. Espir CG, Nascimento CA, Guerreiro-Tanomaru JM, et al. Radiographic and micro-computed
tomography classification of root canal morphology and dentin thickness of mandibular incisors. J
Conserv Dent 2018;21:57–62.

26. Silva EJNL, Lima CO, Barbosa AFA, et al. The Impact of trunatomy and protaper gold instruments
on the preservation of the periradicular dentin and on the enlargement of the apical canal of
mandibular molars. J Endod 2022;48:650–8.

27. Pedicord D, elDeeb ME, Messer HH. Hand versus ultrasonic instrumentation: its effect on canal
shape and instrumentation time. J Endod 1986;12:375–81.
28. Patel S, Dawood A, Whaites E, et al. New dimensions in endodontic imaging: part 1. Conventional
and alternative radiographic systems. Int Endod J 2009;42:447–62.

29. Rhodes JS, Ford TR, Lynch JA, et al. Micro-computed tomography: a new tool for experimental
endodontology. Int Endod J 1999;32:165–70.

30. Kumar S, Naik NS, Vashisth P, et al. Comparative evaluation of hand, rotary and reciprocation
motion on dentin thickness and instrumentation time in primary anterior teeth using CBCT: An
observational study. J Clin Exp Dent 2023;15:e396–402.

31. n G, Chen B, et al. Root dentine thickness in C-shaped lower second molars
Martin G, Arce Brisso
after instrumentation: A CBCT and micro-CT study. Aust Endod J 2021;47:122–9.
32. Xu J, He J, Yang Q, et al. Accuracy of cone-beam computed tomography in measuring dentin
thickness and its potential of predicting the remaining dentin thickness after removing fractured
instruments. J Endod 2017;43:1522–7.
33. The TruNatomy Brochure. Ballaigues, Switzerland, Dentsply Sirona. https://assets.
dentsplysirona.com/flagship/en/explore/endodontics/brochure/trunatomy/END-TruNatomy-
Brochure.pdf. Accessed January 4, 2024.
34. Silva LR, de Lima KL, Santos AA, et al. Dentin thickness as a risk factor for vertical root fracture in
endodontically treated teeth: a case-control study. Clin Oral Investig 2021;25:1099–105.

35. Cheung W. A review of the management of endodontically treated teeth. Post, core and the final
restoration. J Am Dent Assoc 2005;136:611–9.

36. Farina AP, Weber AL, Severo Bde P, et al. Effect of length post and remaining root tissue on
fracture resistance of fibre posts relined with resin composite. J Oral Rehabil 2015;42:202–8.

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