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Properties of a modified quaternary ammonium silane formulation as a potential root canal irrigant in endodontics

Daood U, Parolia A, Matinlinna J, Yiu C, Ahmed HMA, Fawzy A

Dent Mater, 2020 12;36(12):e386-e402.
PMID: 33010944 DOI: 10.1016/j.dental.2020.09.008

OBJECTIVES: Evaluate a new modified quaternary ammonium silane irrigant solution for its antimicrobial, cytotoxic and mechanical properties of dentine substrate.
METHODS: Root canal preparation was performed using stainless steel K-files™ and F4 size protaper with irrigation protocols of 6% NaOCl + 2% CHX; 3.5% QIS; 2% QIS and sterile saline. Biofilms were prepared using E. faecalis adjusted and allowed to grow for 3 days, treated with irrigants, and allowed to grow for 7 days. AFM was performed and surface free energy calculated. MC3T3 cells were infected with endo irrigant treated E. faecalis biofilms. Raman spectroscopy of biofilms were performed after bacterial re-growth on root dentine and exposed to different irrigation protocols and collagen fibers analysed collagen fibers using TEM. Antimicrobial potency against E. faecalis biofilms and cytoxicity against 3T3 NIH cells were also. Resin penetration and MitoTracker green were also evaluated for sealer penetration and mitochondrial viability. Data were analysed using One-way ANOVA, principal component analysis and post-hoc Fisher's least-significant difference.
RESULTS: Elastic moduli were maintained amongst control (5.5 ± 0.9) and 3.5% QIS (4.4 ± 1.1) specimens with surface free energy higher in QIS specimens. MC3T3 cells showed reduced viability in 6%NaOCl+2%CHX specimens compared to QIS specimens. DNA/purine were expressed in increased intensities in control and 6% NaOCl + 2% CHX specimens with bands around 480-490 cm-1 reduced in QIS specimens. 3.5% QIS specimens showed intact collagen fibrillar network and predominantly dead bacterial cells in confocal microscopy. 3.5% QIS irrigant formed a thin crust-type surface layer with cytoplasmic extensions of 3T3NIH spread over root dentine. Experiments confirmed MitoTracker accumulation in 3.5% treated cells.
SIGNIFICANCE: Novel QIS root canal irrigant achieved optimum antimicrobial protection inside the root canals facilitating a toxic effect against the Enterococcus faecalis biofilm. Root dentine substrates exhibited optimum mechanical properties and there was viability of fibroblastic mitochondria.

Matched MeSH terms: Dentin
Quantification of secondary dentin formation based on the analysis of MDCT scans and dental OPGs in a contemporary Malaysian population

Hisham S, Abdullah N, Noor MHM, Franklin D

Leg Med (Tokyo), 2019 02;36:59-66.
PMID: 30415193 DOI: 10.1016/j.legalmed.2018.11.004
Matched MeSH terms: Dentin, Secondary/anatomy & histology
Fulltext Quaternary ammonium silane (k21) based intracanal medicament triggers biofilm destruction

Kok ESK, Lim XJ, Chew SX, Ong SF, See LY, Lim SH, et al.

BMC Oral Health, 2021 03 12;21(1):116.
PMID: 33711992 DOI: 10.1186/s12903-021-01470-x

BACKGROUND: Compare antimicrobial efficacy of a quarternary ammonium silane (QAS)/k21 as an intracanal medicament against E. faecalis and C. albicans biofilms formed on root dentin.
METHODOLOGY: Dentin blocks were sterilized and E. faecalis and C. albicans microbial colonies were counted for colony-forming-units against 2%k21, 2%CHX and Ca(OH)2 medicaments. Biofilm colonies after 7 days on dentin were analysed using confocal laser scanning microscopy with live/dead bacterial viability staining. TEM was done to study dentin collagen matrix. Dentin discs from 3rd day and 7th day well plate was used for Raman spectra and observed under fluorescent-microscope. Docking studies were carried out on MMP-2 S1 binding-domain with k21.
RESULTS: There was reduction of E. faecalis/C. albicans when k21, chlorhexidine and calcium hydroxide were used with highest percentage in 2%k21 treated specimens. 2%k21 showed dense and regular collagen network with intact cross-banding and decreased Raman intensity for 2%k21 on 3rd day. NaOCl + k21 showed least adherence, whereas saline groups showed highest adherence of E. faecalis and C. albicans to root-canal dentin. Alizarin red staining of hDPSCs revealed calcium deposition in all groups with significant difference seen amongst 2%k21 groups. MMP-2 ligand binding was seen accurately indicating possible target sites for k21 intervention.
CONCLUSION: 2%k21 can be considered as alternative intracanal medicament.

Matched MeSH terms: Dentin
Racial variations in the extent of tooth root translucency in ageing individuals

Whittaker DK, Bakri MM

Arch Oral Biol, 1996 Jan;41(1):15-9.
PMID: 8833585

One hundred and ninety-eight single-rooted teeth from individuals aged 21-90 yr of Caucasian, Malay, Chinese Malay and Indian Malay origin were studied. Single or serial longitudinal sections of extracted teeth were cut following dye imbibition of patent dentinal tubules. The extent of sclerosis of apical dentinal tubules was assessed and correlated with the age of the individual. Correlation with age was higher in the Caucasian than the Malay races and within the Malaysian racial groups correlation with age was highest in the Malays and lowest in the Chinese. It is concluded that factors other than age may be important in the formation of sclerotic apical dentine in teeth of different racial origin. The effect of racial origin should be considered when using sclerosis as a means of age determination in forensic cases.

Matched MeSH terms: Dentin/ultrastructure*; Dentin, Secondary/pathology
Remaining tooth structure associated with various preparation designs for the endodontically treated maxillary second premolar

Seow LL, Toh CG, Wilson NH

Eur J Prosthodont Restor Dent, 2005 Jun;13(2):57-64.
PMID: 16011232

Existing literature suggests a relationship between the amount of remaining tooth structure and the fracture resistance of the restored endodontically treated tooth. This study investigated the amount of tooth structure remaining following various tooth preparations used in the restoration of the endodontically treated maxillary second premolar. Illustrations of the maxillary second premolar in buccopalatal, mesiodistal and occlusal sections were drawn to scale. Outlines of various intra- and extracoronal preparations were superim-posed on the illustrations to reveal the amount of tooth tissue remaining in each case. Preparations for a ceramic inlay, inlay with palatal cusp coverage and onlay left 2.0-2.5mm of tooth structure buccally and palatally. Following preparation for a metal-ceramic crown, approximately 1.0mm of tooth structure remained buccally, and between 1.6mm-1.8mm palatally. Preparation for an all-ceramic crown was observed to leave 1.0mm-1.2mm of tooth structure surrounding what remained of the endodontic access cavity. It was concluded that decisions as to the type of definitive restoration to restore the endodontically treated maxillary second premolar may be influenced, amongst other factors, by information on the amount of tooth tissue remaining following preparation.

Matched MeSH terms: Dentin/pathology
Fulltext Scanning Electron Microscopic Examination of Root Canal Walls of Deciduous Molars with Necrotic Pulp

Rusmah, M.

Ann Dent, 1995;2(1):-.
MyJurnal

The root canal walls of twenty -five deciduous molar teeth with exposed and necrotic pulps were examined using thescanning electronmicroscope. Immediately after extraction, all teeth were fixed in Kamosky's solution. The coronal portion of the tooth was sectioned at about 2mm above the enamel cemental junction.The mesial and distal roots were separat~d and either split in the mesio-distal or bucco-lingual direction. All specimens were prepared for SEM. Obsevations showed that all roots were infected with organisms consisting of cocciand short rods. Some of the coccihad penetrated the dentine layer. However, the distribution of organisms is. not uniform throughout thecanals. Bacterialinvasion ismostinthecoronal region and reduces towards the apical region: Accompanying bacterial invasion is root canal walls deterioration. The odontoblastic processes are the first to deteriorate followed by the predentine layer.

Matched MeSH terms: Dentin
Sealing ability of various restorative materials as coronal barriers between endodontic appointments

Tapsir Z, Aly Ahmed HM, Luddin N, Husein A

J Contemp Dent Pract, 2013 Jan 1;14(1):47-50.
PMID: 23579892

To evaluate and compare the microleakage of various restorative materials used as coronal barriers between endodontic appointments.

Matched MeSH terms: Dentin/ultrastructure
Fulltext Shaping Ability of 2Shape and WaveOne Gold Files Using Cone-Beam Computed Tomography

Singh S, Mirdha N, Shilpa PH, Tiwari RVC, Abdul MSM, Sainudeen S

J Int Soc Prev Community Dent, 2019 06 07;9(3):245-249.
PMID: 31198696 DOI: 10.4103/jispcd.JISPCD_411_18

Aim and Objective: The aim of this study is to evaluate the apical transportation, centering ability, and volume of removed dentin of WaveOne Gold (WOG) and 2Shape with the use of cone-beam computed tomography.
Materials and Methods: Freshly extracted mandibular teeth with sample size of thirty were carefully chosen and instrumented using the 2Shape and WOG rotary files. Preoperative and postinstrumentation cone-beam computed tomographic scans were done to accomplish mesial and distal dentin walls' measurements and volume of removed dentin calculations, apical transportation, and centering ratio. Statistical analysis was performed and confirmed by independent t-test. Statistical significance was set at 5%.
Results: When shaping ability of 2Shape and WOG was evaluated, it was reported that there was no statistically significant differences noted among the groups in relation to the total volume of removed dentin, apical transportation, and centering ratio.
Conclusion: It can be concluded that 2Shape and WOG preserved the original canal anatomy well and did not eliminate excess dentin during shaping and cleaning. Rotary nickel-titanium files which work on the principle of rotary movement attained an outcome analogous to that of the rotary files working on reciprocating motion in relation to alteration in angle.

Matched MeSH terms: Dentin
Fulltext Shear bond strength of computer-aided design and computer-aided manufacturing feldspathic and nano resin ceramics blocks cemented with three different generations of resin cement

Ab-Ghani Z, Jaafar W, Foo SF, Ariffin Z, Mohamad D

J Conserv Dent, 2015 Sep-Oct;18(5):355-9.
PMID: 26430296 DOI: 10.4103/0972-0707.164028

To evaluate the shear bond strength between the dentin substrate and computer-aided design and computer-aided manufacturing feldspathic ceramic and nano resin ceramics blocks cemented with resin cement.

Matched MeSH terms: Dentin
Fulltext Silver Colloid Staining of Sclerotic and Non-sclerotic Dentine

Mohd. Bakri, M., Mohamed, N.H., Whittaker, D.A.

Ann Dent, 2003;10(1):-.
MyJurnal

Phosphophoryn, a higWyphosphorylated protein, is the most abundant protein among the non-collagenous protein of dentine. The staining of phosphophoryn can be done by using the silver colloid staining. In this paper, the staining effect of the silver colloid stain on both non-sclerotic and sclerotic dentine was investigated. Eight teeth from donors aged 14, 17, 22, 34, 55, 57, 60 and 65 were used for this experiment. The younger teeth were used to demonstrate normal root dentine while the older age teeth were used to demonstrate sclerotic root dentine at the apical region of the root. There was no staining of the normal root dentine as compared to sclerotic dentine when the silver colloid staining was used.

Matched MeSH terms: Dentin; Dentin, Secondary
Synergistic effects of VE-TPGS and riboflavin in crosslinking of dentine

Daood U, Matinlinna JP, Fawzy AS

Dent Mater, 2019 02;35(2):356-367.
PMID: 30528297 DOI: 10.1016/j.dental.2018.11.031

OBJECTIVE: Effect of d-alpha-tocopheryl poly(ethyleneglycol)-1000-succinate (VE-TPGS) with riboflavin-5'-phosphate solution on crosslinking of dentine collagen was investigated to analyze collagen's structural integrity.
METHODS: VE-TPGS was added to RF-solution, at RF/VE-TPGS (w/w) ratios of 0.125/0.250 and 0.125/0.500. Demineralized dentine beams were used (10wt.% phosphoric acid), rinsed using deionized-water and analysed using ELISA (Human MMP2 ELISA; Human CTSK/Cathepsin-K for MMP2 and Cathepsin K analysis). AFM of dentine collagen-fibrils structure was done before and after dentine specimens' placement in mineralization solution and tested after 14days in artificial saliva/collagenase (AS/Co) solution. The specimens were tested after 24h in mineralization solution for surface/bulk elastic modulus. Nano-indentation was carried out for each specimen on intertubular-dentine with lateral spacing of 400nm. Reduced elastic-modulus and nano-hardness were calculated and collagen content was determined using hydroxyproline-assay. Micro-Raman were performed. TEM was carried out to study structural variations of dentine-collagen in artificial-saliva (collagenase). Data were presented as mean±standard deviation and analyzed by SPSS v.15, by analysis of variance.
RESULTS: Synergetic effect of VE-TPGS was observed with RF through higher structural integrity of dentine collagen-fibrils shown by TEM/AFM. Superior surface/bulk mechanical stability was shown by nano-indentation/mechanical testing. Improvement in collagenase degradation resistance for hydroxyproline release was observed and lower endogenous-protease release of MMP-2/Cathepsin-K. Raman-analysis analysed chemical interactions between RF and collagen confirming structural-integrity of collagen fibrils after crosslinking. After 24h mineralization, AFM showed mineral depositions in close association with dentine-collagen fibrils with RF/VE-TPGS formulations.
SIGNIFICANCE: Potential synergetic effect of RF/VE-TPGS was observed by reflection of higher structural integrity and conformational-stability of dentine-collagen fibrils.

Matched MeSH terms: Dentin*
Fulltext Technique to repair iatrogenically-damaged roots during post canal preparation using resin composite and optic fibre posts

Lui, J.L.

Ann Dent, 2007;14(1):14-18.
MyJurnal

During post crown restoration, the preparation of the post canal can be fraught with difficulties resulting in widening, gouging and transportation of the post canal; sometimes with near root perforation. A technique is described to repair such iatrogenically damaged internal root canal walls using reinforcing resin composite and optic glass fibre posts. The root dentine, resin composite and glass fibres, having similar moduli of elasticity, will result in a repaired root with a ‘monolithic’ structure and possessing numerous desirable characteristics. This repair technique can easily be carried out in one sitting at the chairside thereby allowing the continued serviceability of the iatrogenically compromised root-filled tooth.

Matched MeSH terms: Dentin
Fulltext Teeth in osteogenesis imperfecta: a light microscopic study

Siar CH

Med J Malaysia, 1986 Jun;41(2):161-5.
PMID: 3821613

The light microscopic features of the dentine in three teeth from two cases of osteogenesis imperfecta (OJ) are presented. Results show that teeth in OJ distinctively have a more uniform and tubular mantle dentine, and a characteristic laminated circumpulpal dentine formed by distorted incremental bands alternating with parallel rows of interglobular dentine and interrupted by comet-shaped vascular canals. The study indicated that in the absence of overt OJ features, the changes in dentine alone are sufficiently characteristic to establish such a diagnosis.

Matched MeSH terms: Dentin/pathology*
Fulltext The Effectiveness of Remineralizing Agents on Dentinal Permeability

Berkathullah M, Farook MS, Mahmoud O

Biomed Res Int, 2018;2018:4072815.
PMID: 30276206 DOI: 10.1155/2018/4072815

The effectiveness of remineralizing agents in reducing dentine permeability by tubule occlusion using fluid filtration device functioning at 100 cmH2O (1.4 psi) pressure and SEM/EDX analysis were evaluated and compared. Seventy (n = 70) dentine discs of 1±0.2 mm width were prepared from sound permanent human molars. Fifty (n = 50) dentine discs were randomly divided into 5 groups (n = 10): Group 1: GC Tooth Mousse Plus (Recaldent GC Corporation Tokyo, Japan), Group 2: Clinpro™ White Varnish (3M ESPE, USA), Group 3: Duraphat® Varnish (Pharbil Waltrop GmbH, Germany), Group 4: Colgate Sensitive Pro-Relief™ dentifrice (Colgate Palmolive, Thailand), and Group 5: Biodentine™ (Septodont/UK). Dentine permeability was measured after treatment application at 10 minutes, artificial saliva immersion at 7 days, and citric acid challenge for 3 minutes. Data were analyzed by two-way repeated measures ANOVA. Dentine specimens (n = 20) were used for SEM/EDX analyses to obtain qualitative results on dentine morphology and surface deposits. Each treatment agent significantly reduced dentine permeability immediately after treatment application and created precipitates on treated dentine surfaces. All agents increased permeability values after 7 days of artificial saliva immersion except Clinpro White Varnish and Biodentine. Clinpro White Varnish exhibited significant resistance to acid challenge compared to others. Colgate Sensitive Pro-Relief dentifrice has a dual mechanism of action in reducing the dentine sensitivity.

Matched MeSH terms: Dentin Permeability*; Dentin Desensitizing Agents/pharmacology*
Fulltext The Role of Transient Receptor Potential (TRP) Channels in the Transduction of Dental Pain

Hossain MZ, Bakri MM, Yahya F, Ando H, Unno S, Kitagawa J

Int J Mol Sci, 2019 Jan 27;20(3).
PMID: 30691193 DOI: 10.3390/ijms20030526

Dental pain is a common health problem that negatively impacts the activities of daily living. Dentine hypersensitivity and pulpitis-associated pain are among the most common types of dental pain. Patients with these conditions feel pain upon exposure of the affected tooth to various external stimuli. However, the molecular mechanisms underlying dental pain, especially the transduction of external stimuli to electrical signals in the nerve, remain unclear. Numerous ion channels and receptors localized in the dental primary afferent neurons (DPAs) and odontoblasts have been implicated in the transduction of dental pain, and functional expression of various polymodal transient receptor potential (TRP) channels has been detected in DPAs and odontoblasts. External stimuli-induced dentinal tubular fluid movement can activate TRP channels on DPAs and odontoblasts. The odontoblasts can in turn activate the DPAs by paracrine signaling through ATP and glutamate release. In pulpitis, inflammatory mediators may sensitize the DPAs. They could also induce post-translational modifications of TRP channels, increase trafficking of these channels to nerve terminals, and increase the sensitivity of these channels to stimuli. Additionally, in caries-induced pulpitis, bacterial products can directly activate TRP channels on DPAs. In this review, we provide an overview of the TRP channels expressed in the various tooth structures, and we discuss their involvement in the development of dental pain.

Matched MeSH terms: Dentin Sensitivity/complications; Dentin Sensitivity/metabolism*
Fulltext The antibacterial efficacy of silver diamine fluoride (SDF) is not modulated by potassium iodide (KI) supplements: A study on in-situ plaque biofilms using viability real-time PCR with propidium monoazide

Abdullah N, Al Marzooq F, Mohamad S, Abd Rahman N, Rani KGA, Chi Ngo H, et al.

PLoS One, 2020;15(11):e0241519.
PMID: 33141868 DOI: 10.1371/journal.pone.0241519

Silver diamine fluoride (SDF) is commonly used to arrest caries lesions, especially in early childhood caries. Recently, it was suggested that SDF can be combined with potassium iodide (KI) to minimize the discoloration of demineralized dentine associated with SDF application. However, the antibacterial efficacy of SDF alone or combined with KI on in-situ biofilm is unknown. Hence, we compared the anti-plaque biofilm efficacy of two different commercially available SDF solutions, with or without KI, using an in-situ biofilm, analysed using viability real-time PCR with propidium monoazide (PMA). Appliance-borne in-situ biofilm samples (n = 90) were grown for a period of 6 h in five healthy subjects who repeated the experiment on three separate occasions, using a validated, novel, intraoral device. The relative anti-biofilm efficacy of two SDF formulations; 38.0% Topamine (SDFT) and 31.3%, Riva Star (SDFR), KI alone, and KI in combination with SDFR (SDFR+KI) was compared. The experiments were performed by applying an optimized volume of the agents onto the biofilm for 1min, mimicking the standard clinical procedure. Afterwards the viability of the residual biofilm bacteria was quantified using viability real-time PCR with PMA, then the percentage of viable from total bacteria was calculated. Both SDF formulations (SDFT and SDFR) exhibited potent antibacterial activities against the in-situ biofilm; however, there was non-significant difference in their efficacy. KI alone did not demonstrate any antibacterial effect, and there was non-significant difference in the antibacterial efficacy of SDF alone compared to SDF with KI, (SDFT v SDFR/KI). Thus, we conclude that the antibacterial efficacy of SDF against plaque biofilms is not modulated by KI supplements. Viability real-time PCR with PMA was successfully used to analyze the viability of naturally grown oral biofilm; thus, the same method can be used to test the antimicrobial effect of other agents on oral biofilms in future research.

Matched MeSH terms: Dentin
Fulltext The comparison between two irrigation regimens on the dentine wettability for an epoxy resin based sealer by measuring its contact angle formed to the irrigated dentine

Mohan RP, Pai AR

J Conserv Dent, 2015 Jul-Aug;18(4):275-8.
PMID: 26180409 DOI: 10.4103/0972-0707.159717

The aim was to assess the influence of two irrigation regimens having ethylenediaminetetraacetic acid (EDTA) and ethylenediaminetetraacetic acid with cetrimide (EDTAC) as final irrigants, respectively, on the dentine wettability for AH Plus sealer by comparing its contact angle formed to the irrigated dentine.

Matched MeSH terms: Dentin
The effect of filler content and processing variables on dimensional accuracy of experimental composite inlay material

Razak AA, Harrison A

J Prosthet Dent, 1997 Apr;77(4):353-8.
PMID: 9104710

Dimensional accuracy of a composite inlay restoration is important to ensure an accurate fit and to minimize cementation stresses.

Matched MeSH terms: Dentin-Bonding Agents/chemistry
Fulltext The effect of fluorosis on human teeth under light microscopy: A cross-sectional study

Ramesh M, Narasimhan M, Krishnan R, Aruna RM, Kuruvilla S

J Oral Maxillofac Pathol, 2017 Sep-Dec;21(3):345-350.
PMID: 29391706 DOI: 10.4103/jomfp.JOMFP_247_16

Background: Fluoride is needed for the normal development of bone and teeth; in high levels, it affects developing teeth and bone. Dental fluorosis (DF) is caused by ingestion of excess fluoride mainly through drinking water.

Aim: The present study aims to observe and understand the histological changes of fluorosed teeth under light microscope (LM).

Materials and Methods: Teeth which were indicated for extractions for orthodontic or periodontal problems were selected. Thirty extracted teeth were selected with varying degrees of DF based on modified Dean's fluorosis index. Ground sections of these teeth were prepared and the sections were studied under binocular LM. Photomicrographs were taken under high power objective using 15 megapixels Nikon camera.

Results and Conclusion: Qualitative histologic changes in different grades of fluorosed teeth were evaluated in enamel, dentin, cementum and between their junctions. Fluoride interacts with enamel in both mineral phases and organic macromolecules by strong ionic and hydrogen bonds resulting in incomplete crystal growth at prism peripheries. This presents as hypomineralization of enamel and dentin, increased interglobular dentin, increased secondary curvatures and changes in cementum such as diffuse cementodentinal junction and increased thickness of Tomes' granular layer. Changes in the structure of the teeth with Dean's index below 2 and teeth with Dean's index of 2 and above were compared using Chi-square test. P value was found to be highly significant being 0.00047. Many of the features of dental fluorosis seen in the present study under light microscope are comparable to those results studied under specialized microscopes.

Matched MeSH terms: Dentin
The existence of butterfly effect and its impact on the dentinal microhardness and crack formation after root canal instrumentation

Lin GSS, Ghani NRNA, Noorani TY

Odontology, 2021 Jul;109(3):672-678.
PMID: 33458795 DOI: 10.1007/s10266-021-00589-1

To compare the microhardness and crack formation in root dentine presented with butterfly effect in lower premolars. Sixty mature lower premolars were selected and divided into the control and experimental groups. Teeth in the experimental group were instrumented up to size 30/.04. The roots were cut horizontally into twelve parts of 1-mm-thick cross-section and were numbered accordingly. They were divided into coronal, middle, and apical root sections. Sections were then viewed under a microscope to determine the presence of butterfly effect and subsequently scored. 8 teeth from both control and experimental groups with the highest and lowest score were selected. Crack formation was inspected and classified into four different types of cracks. Microhardness test was performed using a Vickers hardness test. Higher frequency of butterfly effect was found in the apical root section and root dentine with butterfly effect were harder mesiodistally. The middle and apical root sections with butterfly effect were harder than the coronal section. No significant difference of dentine hardness between the control and experimental groups. Cracks only occurred in the experimental group and presented in buccolingual direction with a higher rate of Type 1 and Type 2 cracks. Prevalence of butterfly effect in lower premolars increased from coronal to apical with increased hardness mesiodistally. More buccolingual cracks were found in radicular dentine with butterfly effect and most of them exhibited Type 1 and Type 2 cracks. Roots of lower premolar with butterfly effect may be susceptible to a higher rate of vertical root fracture in buccolingual direction, especially after root canal treatment. Thus, special attention should be given not to overload instruments during root canal preparation.

Matched MeSH terms: Dentin

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