![]()
The How’s and Why’s of Root Filling Techniques - X-ray image of a tooth with visible root canal filling
# **The Rationale and Assessment of Root Canal Fillings**
**Why do we fill root canals?**
**Pre-operative**
2½ years later
**Why do we fill root canals?**
x **“The outcome of endodontic treatment**
**depends on how well the canals have**
**been cleaned and disinfected ...”**
Pre-operative
2½ years later
![]()
Radiographs showing a tooth pre-operative and 2½ years later.
> “The outcome of endodontic treatment depends on how well the canals have been cleaned and disinfected ...”
*Pre-operative*
*2½ years later*
**Why do we fill root canals?**
$$
\text{Consider - TWO aspects to endodontics}
$$
## **The Two Core Aspects of Endodontics**
**Why do we fill root canals?**
**Consider - TWO aspects to endodontics**
" **Treat the current / presenting problem**
. **Prevent future infection**
- **Treat the current / presenting problem**
- **Prevent future infection**
**Why do we fill root canals?**
‟ **Treat the current / presenting problem**
- i.e. Pulpitis / infected canal + apical periodontitis
### **1. Treating the Current/Presenting Problem**
- i.e. Pulpitis / infected canal + apical periodontitis
**Why do we fill root canals?**
$^\text{J}$ **Treat the current / presenting problem**
$\dot{\text{u}}$ i.e. **Pulpitis / infected canal + apical periodontitis**
q **Diagnosis**
q **Remove the cause**
(caries, cracks, restoration breakdown)
q **Remove pulp or infected debris**
q **Clean and disinfect canal**
q **Medicate** - anti-inflammatory
- anti-bacterial
q **Interim restoration**
The process involves:
- **Diagnosis**
- **Remove the cause** (caries, cracks, restoration breakdown)
- **Remove pulp or infected debris**
- **Clean and disinfect canal**
- **Medicate**
- anti-inflammatory
- anti-bacterial
- **Interim restoration**
Why do we fill root canals?
- Prevent future infection
↳ i.e. Infected canal → apical periodontitis
### **2. Preventing Future Infection**
- i.e. Infected canal → apical periodontitis
**Why do we fill root canals?**
* **Prevent future infection**
* i.e. Infected canal Û apical periodontitis
* **Root canal filling**
* **Coronal restoration**
* **Oral hygiene, diet, etc**
This is achieved through:
- **Root canal filling**
- **Coronal restoration**
- **Oral hygiene, diet, etc**
# **Why do we fill root canals?**
**Prevent future infection**
Ú HOW do RCF's help this?
    q **Are they anti-bacterial?**
        o Short term only - **?? Few days**
    q **Do they “seal” canals?**
        o Doubtful
        o **But much emphasis placed on this**
#### **How do Root Canal Fillings (RCFs) Prevent Future Infection?**
- **Are they anti-bacterial?**
- Short term only - **?? Few days**
- **Do they “seal” canals?**
- Doubtful
- **But much emphasis placed on this**
**Conditions Favourable for Bacterial Colonisation of Root Canals**
$\times$ **Space**
$\times$ **Co-colonising organisms**
$\times$ **Low oxygen tension**
$\times$ **Nutrients**
M **Pulp tissue remnants**
M **Necrotic debris**
M **Saliva**
M **Foods**
M **Inflammatory exudate, etc**
## **The Role of the Canal Environment**
### **Conditions Favourable for Bacterial Colonisation of Root Canals**
- **Space**
- **Co-colonising organisms**
- **Low oxygen tension**
- **Nutrients**
- Pulp tissue remnants
- Necrotic debris
- Saliva
- Foods
- Inflammatory exudate, etc
**Why do we fill root canals?**
Main function of a RCF is to *FILL* the canal space
- and thus make it less favourable for bacterial
colonisation to occur
**Conditions Favourable for Bacterial**
**Colonisation of Root Canals**
* Space
* Co-colonising organisms
* Low oxygen tension
* **Nutrients**
* Pulp tissue remnants
* Necrotic debris
* Saliva
* Foods
* Inflammatory exudate, etc
The main function of a RCF is to *FILL* the canal space and thus make it less favourable for bacterial colonisation to occur.
**Louis Pasteur**
x “Don’t worry about the bacteria …..
…. it is the environment in which
they live that is important”
> **Louis Pasteur**
>
> “Don’t worry about the bacteria ….. …. it is the environment in which they live that is important”
**How do we assess RCF's?**
× What makes a good RCF?
ᴹ **Clinically, we base our assessment**
**on the radiographic appearance**
![]()
Two dental radiographs showing root canal fillings.
## **Assessment of Root Canal Fillings (RCFs)**
### **What makes a good RCF?**
- Clinically, we base our assessment on the radiographic appearance.
![]()
Dental X-ray images, possibly of the anterior maxilla, showing teeth with posts and crowns.
**How do we assess RCF's?**
× What do radiographs tell us about RCF's?
![]()
Radiograph of a tooth with a root canal filling.
### **What do radiographs tell us about RCF's?**
![]()
Radiographic images of dental root canal fillings (RCF) showing variations in radiographic appearance and potential issues related to dental restorations
**How do we assess RCF's?**
* **What do radiographs tell us about RCF's?**
* **Only how radiopaque the root filling material is and where it has been placed !!**
=
1 yr later
![]()
Radiographs showing a comparison of a root canal filling at baseline and 1 year later.
- **Only how radiopaque the root filling material is and where it has been placed !!**
*1 yr later*
**How do we assess RCF's?**
**x ALSO: Radiographs do not indicate the degree of filling of the root canal <ins>SYSTEM</ins>**
Lower 2nd Premolar
(Dr Paul Fitz-Walter)
Lower 1st Molar - Mesial root
(J Endod 1986; 12: 354)
![]()
Microscopic image of a lower 2nd premolar and a diagram of lower 1st molar mesial root canals
- **ALSO: Radiographs do not indicate the degree of filling of the root canal <ins>SYSTEM</ins>**
*Lower 2nd Premolar (Dr Paul Fitz-Walter)*
*Lower 1st Molar - Mesial root (J Endod 1986; 12: 354)*
**Root Canal Fillings**
-v-
<div align="center">
| SEAL | -v- | FILL |
|---|---|---|
| **Block or prevent** | | **Obliterate the** |
| *entry into* and | | **canal space** |
| *exit out of* | | |
| **the canal space** | | |
</div>
**There is a DIFFERENCE !!**
## **"Seal" vs. "Fill": A Key Distinction**
<div align="center">
| SEAL | -v- | FILL |
|---|---|---|
| **Block or prevent** | | **Obliterate the** |
| *entry into* and | | **canal space** |
| *exit out of* | | |
| **the canal space** | | |
</div>
**There is a DIFFERENCE !!**
# **Aims of Root Canal Fillings**
| APICAL “SEAL” | CORONAL “SEAL” |
| :---: | :---: |
| | |
| **Keep** ***tissue fluids*** **out of the canal** | **Keep** ***bacteria*** **out of the canal** |
| ů **Supply nutrients** | ů **Stop re-infection** |
| | |
| **Stop** ***bacteria*** **& / or** ***endotoxins*** **reaching the periapical region** | **Keep** ***nutrients*** **out of the canal** |
| ů ***Apical periodontitis*** | ů **So bacteria can not survive** |
| | |
| **Need BOTH !!** | |
## **Aims of Root Canal Fillings**
| APICAL “SEAL” | CORONAL “SEAL” |
| :---: | :---: |
| **Keep** ***tissue fluids*** **out of the canal** | **Keep** ***bacteria*** **out of the canal** |
| - Supply nutrients | - Stop re-infection |
| **Stop** ***bacteria*** **& / or** ***endotoxins*** **reaching the periapical region** | **Keep** ***nutrients*** **out of the canal** |
| - *Apical periodontitis* | - So bacteria can not survive |
| **Need BOTH !!** | |
**How well do RCF’s seal canals?**
× **Apically ?**
× **Coronally ?**
× Is any **technique** better than others ?
× Is any **material** better than others ?
## **Evaluating the "Seal": Techniques and Materials**
- How well do RCF’s seal canals?
- **Apically ?**
- **Coronally ?**
- Is any **technique** better than others ?
- Is any **material** better than others ?
**Background**
One of the most commonly stated aims
of endodontic treatment is to obtain
an “apical seal”
### **Historical Background: The Focus on "Apical Seal"**
One of the most commonly stated aims of endodontic treatment is to obtain an “apical seal”.
**Background**
One of the most commonly stated aims
of endodontic treatment is to obtain
an “apical seal”
%
M **A “three-dimensional root filling”**
%
M **A “hermetic seal” (air -v- fluid?)**
This is also described as:
- A “three-dimensional root filling”
- A “hermetic seal” (air -v- fluid?)
Commonly used clinical techniques for root
canal fillings are largely based on early
research work concerning **“apical leakage”**
Commonly used clinical techniques for root canal fillings are largely based on early research work concerning **“apical leakage”**.
Commonly used clinical techniques for root
canal fillings are largely based on early
research work concerning **“apical leakage”**
**M Mainly passive dye penetration studies**
**M Some other techniques also used:**
**ú Electrochemical**
**ú Isotope penetration**
**ú Fluorometry**
**ú Spectrophotometry**
**ú Bacterial penetration**
- **Mainly passive dye penetration studies**
- **Some other techniques also used:**
- Electrochemical
- Isotope penetration
- Fluorometry
- Spectrophotometry
- Bacterial penetration
# **Apical Percolation**
x The "Washington Study" attributed 60% of failures to apical "percolation" - **BUT:**
* m **Apical percolation was not defined**
* m **Study was based on radiographic reviews**
* m **No evidence presented to support their claims about apical percolation**
* m **Apical percolation not actually tested**
* m **Study not controlled and not refereed**
### **Critique of Early Leakage Studies**
#### **Apical Percolation and The "Washington Study"**
The "Washington Study" attributed 60% of failures to apical "percolation" - **BUT:**
- Apical percolation was not defined
- Study was based on radiographic reviews
- No evidence presented to support their claims about apical percolation
- Apical percolation not actually tested
- Study not controlled and not refereed
**<font color="#4CC417">The “Washington Study”</font>**
* This study and other “leakage” studies formed the basis of many endodontic research projects for over 40 years
* Many refinements and recommendations for clinical techniques and materials were made as a result of these studies
* **<font color="#FFFF00">Most were either very poorly controlled experiments or had no controls at all**
* **<font color="#FF00FF">Typically “passive dye” studies**
<img src="An illustration of a laboratory apparatus used for leakage studies">
#### **The Legacy of the "Washington Study"**
- This study and other “leakage” studies formed the basis of many endodontic research projects for over 40 years.
- Many refinements and recommendations for clinical techniques and materials were made as a result of these studies.
- **Most were either very poorly controlled experiments or had no controls at all**
- **Typically “passive dye” studies**
# **Vacuum Test Methods**
M 1989 - Spångberg *et al*
M 1989 - Goldman *et al*
M 1991 - Oliver & Abbott
ú **Vacuum test methods must be used to remove the effects of entrapped air**
ú **Otherwise the study is unpredictable and the results are meaningless**
**The Effect of Entrapped Air**
![]()
A yellow straw inserted in a small jar containing a brown liquid, with a close-up showing trapped air in the straw indicated by a red arrow.
**The Effect of Entrapped Air**
![]()
A two panel image showing the effect of entrapped air in a tube submerged in liquid.
***Correlation between clinical success and apical dye penetration***
**Oliver CM, Abbott PV.**
**Int Endod J 2001; 34: 637-44.**
**Aims of the Study**
- To determine if there is a correlation between apical dye penetration and the clinical performance of root canal fillings
**Oliver & Abbott 2001**
**Methodology**
x **Extracted root-filled human teeth**
M **Clinical performance known**
M **No fractures / no previous apical surgery**
**Oliver & Abbott 2001**
**Methodology**
* **Extracted root-filled human teeth**
* Clinical performance known
* No fractures / no previous apical surgery
* **Endodontic treatment classified as**
**"favourable" or "unfavourable" - based on:**
* Clinical & radiographic signs / symptoms
* Patient comfort & function
* Reasons for extraction
**Oliver & Abbott 2001**
**Dye Penetration**
x All teeth placed in 2% methylene blue dye
Oliver & Abbott 2001
# **Dye Penetration**
<br>
* x All teeth placed in 2% methylene blue dye
* x Vacuum applied to teeth in dye
* M 660 mm Hg for 5 minutes
* M To remove entrapped air from any voids in the root fillings
<br>
**Oliver & Abbott 2001**
**Dye Penetration**
**x** All teeth placed in 2% methylene blue dye
**x** Vacuum applied to teeth in dye
M **660 mm Hg for 5 minutes**
M **To remove entrapped air from any voids in the root fillings**
**x** Then left passively in the dye for 7 days
**x** Dye penetration measured
Oliver & Abbott 2001
**Results**
x **Positive Controls**
* **ALL teeth had dye penetration throughout the entire canal - 100% of root length**
* **Indicates reliable experimental system to disclose all voids in canals/fillings**
Oliver & Abbott 2001
**Results**
x **Positive Controls**
M ALL teeth had dye penetration throughout the entire canal - 100% of root length
M Indicates reliable experimental system to disclose all voids in canals/fillings
x **Negative Controls**
M NO dye penetration into root canals
M Indicates varnish and wax coatings prevent dye penetration through the coated roots
Oliver & Abbott 2001
**Results**
x Mean linear dye penetration
M **Expressed as: % of root length**
Oliver & Abbott 2001
**Linear Measurement of Dye Penetration**
<table>
<thead>
<tr>
<td style="color: #ff0000;">**Endodontic Outcome**</td>
<td>No. of Canals</td>
<td>Mean % Root Length</td>
<td>S.D.</td>
<td>Range</td>
</tr>
</thead>
<tbody>
<tr>
<td>Favourable</td>
<td>82</td>
<td>48.37</td>
<td>33.97</td>
<td>0 - 100</td>
</tr>
<tr>
<td>Unfavourable</td>
<td>126</td>
<td>56.53</td>
<td>34.42</td>
<td>5.6 - 100</td>
</tr>
</tbody>
</table>
**Oliver & Abbott 2001**
**Examples - Linear Dye Penetration**
**Favourable Endodontic Outcome**
**Oliver & Abbott 2001**
![]()
Radiographs and sectioned teeth showing dye penetration.
**Examples - Linear Dye Penetration**
**Unfavourable Endodontic Outcome**
**Oliver & Abbott 2001**
![]()
An illustration showing x-rays of endodontically treated teeth and a tooth split to show dye penetration along the root filling.
**Volumetric Measurement of Dye Penetration**
| **Endodontic Outcome** | **No. of Canals** | **Mean (x $10^3$ ml)** | **S.D.** | **Range** |
| :--- | :--- | :--- | :--- | :--- |
| Favourable | 52 | **1.324** | **2.748** | 0 - **17.008** |
| Unfavourable | 66 | **2.200** | **2.431** | 0 - **17.861** |
**Oliver & Abbott 2001**
NB - Volume of a central incisor canal prepared to #40 file is approx. **29 x $10^3$ ml**
**Discussion**
x **Apical dye penetration** - **99.5% of the teeth**
x **Large standard deviations**
x **Wide “range” of dye penetration**
Š **These figures can affect statistical results**
x **Trends** show little difference between **favourable and unfavourable cases**
x **The technical quality of the root fillings was not a factor**
{
With both methods
}
**Oliver & Abbott 2001**
**Usefulness of Dye Penetration Tests**
$\times$ ALL root fillings show apical dye penetration
- ?? to what extent
$\times$ Usually test apical penetration (not coronal)
$\times$ Dye penetration - i.e. *fluid* - not the same as:
M **Coronal bacterial penetration**
M **Toxin escape** *FROM* **the canal**
$\times$ *Apical dye penetration tests - poor predictors*
*of endodontic treatment outcomes, and the*
*performance of RCF techniques & materials*
# **Technical Standard of RCF's**
* Some studies show higher rates of favourable outcomes with **“technically satisfactory”** RCF’s
* **Sjögren et al 1990**
<img src="https://i.imgur.com/83pQ8lA.png" alt="Diagram showing the results of RCF outcomes based on filling length (0-2 mm, >2 mm, and short fill). The outcomes are presented as fractions and percentages with p-values indicating statistical significance between groups." />
# **Technical Standard of RCF's**
× **Buckley & Spångberg - 1995**
***
M **Survey of endodontics in USA**
M **Cross-sectional study of radiographs**
× Full mouth survey - 14 PA's + 4 BW's
× 208 pt's - 5,272 teeth
***
Ú **290 teeth with RCF's**
Ú **42% were “technically unsatisfactory”**
× Based on radiographic assessment only
**Technical Standard of RCF's**
$ \times $ Buckley & Spångberg - 1995
| | Percentage | Condition |
| :---: | :---: | :---: |
| > 2 mm short: | $25.2\ \%$ | **had PA radiolucencies** |
| 0 - 2 mm: | $20.7\ \%$ | |
| Beyond apex: | $42.9\ \%$ | |
# Technical Standard of RCF's
**x** Buckley & Spångberg - 1995
| | Percentage | Condition |
| :--- | :--- | :--- |
| **M** > 2 mm short: | 25.2 % | \multirow{3}{*}{had PA radiolucencies} |
| **M** 0 - 2 mm: | 20.7 % | |
| **M** Beyond apex: | 42.9 % | |
| **Ù** | **“... poor quality root fillings were more strongly associated with periapical disease than higher quality root fillings”** | |
| **R** | **But this was NOT statistically significant** | |
# **Coronal Penetration of Bacteria**
X Many studies have demonstrated that various
bacteria can migrate along the entire length
of a root canal filling
M **Coronal** Ú **Apical**
<img src="Coronal_penetration_of_bacteria_diagram">Coronal penetration of bacteria diagram and labels showing Bacteria, RCF, and Broth</img>
**Coronal Penetration of Bacteria**
* Many studies have demonstrated that various bacteria can migrate along the entire length of a root canal filling
* **Coronal -> Apical**
* **Time for penetration varies**
* e.g. **2 days** 3 days
* 20 days 30 days
* 60 days 90 days
* etc.
**Diagram:**
A diagram illustrating the setup for studying penetration with labels: Bacteria, RCF (Root Canal Filling), and Broth. A large red arrow indicates the apical direction of penetration.
<img alt="Diagram illustrating the penetration of bacteria from coronal to apical through a root canal filling into a broth." />
- **Time for penetration varies**
- e.g. **2 days**, 3 days, 20 days, 30 days, 60 days, 90 days, etc.
# **Dentine - Pulp complex**
<p> </p>
**Dr. Hien Ngo**
![]()
Two images showing microscopic views of dentine/pulp complex
**Coronal Penetration of Bacteria**
x **Treatment outcome: Ray & Trope - Int Endod J 1995**
M **1,010 teeth assessed radiographically for:**
**Outcome & standard of RCF's and restorations**
#### **Key Study: Ray & Trope - Int Endod J 1995**
- **1,010 teeth assessed radiographically for:**
- Outcome & standard of RCF's and restorations
**Coronal Penetration of Bacteria**
**x Treatment outcome: Ray & Trope - Int Endod J 1995**
M 1,010 teeth assessed radiographically for:
**Outcome & standard of RCF's and restorations**
| RCF's: | **Restorations:** | |
|---|---|---|
| | **Good** | **Poor** |
| **Good** | 91.4 % | 44.1 % |
| **Poor** | 69.6 % | 18.1 % |
##### **Findings (Ray & Trope - 1995)**
*Percentage of cases with apical healing*
| RCF's: | **Restorations:** | |
|---|---|---|
| | **Good** | **Poor** |
| **Good** | 91.4 % | 44.1 % |
| **Poor** | 69.6 % | 18.1 % |
**Coronal Penetration of Bacteria**
**x** **Treatment outcome:** Ray & Trope - Int Endod J 1995
**M** **Concluded:**
> “... The quality of the coronal restoration
> was more important than the quality of
> the RCF for apical periodontal healing ...”
##### **Conclusion (Ray & Trope - 1995)**
> “... The quality of the coronal restoration was more important than the quality of the RCF for apical periodontal healing ...”
**Coronal Penetration of Bacteria**
$\times$ Example of coronal dye penetration
**Labial view**
**Proximal view**
![]()
Two sets of dental images showing periapical radiographs and corresponding gross views of extracted teeth, demonstrating dental material and dye penetration in labial and proximal views. Labels indicate "Labial view" and "Proximal view" for the respective image pairs.
*Example of coronal dye penetration*
![]()
Example of coronal dye penetration in sectioned teeth
**Root Canal Fillings**
**x** So … if:
**M** Apical dye penetration does not matter
**=** Total filling of the canal is not essential
**=** High technical standard is not essential
… why do we spend so much time and
effort doing high quality RCF’s ??
## **Revisiting the Purpose of RCFs**
So … if:
- Apical dye penetration does not matter
- Total filling of the canal is not essential
- High technical standard is not essential
… why do we spend so much time and effort doing high quality RCF’s ??
Root Canal Fillings
✗ Because … they:
➐ Fill most of the space
# **Root Canal Fillings**
<br>
× **Because … they:**
> ⇁ **Fill most of the space**
>
> ⇁ **Create an unfavourable environment**
> **for bacteria to survive in**
# **Root Canal Fillings**
***
X **Because ... they:**
***
7 **Fill most of the space**
7 **Create an unfavourable environment**
**for bacteria to survive in**
7 **Slow down the process of further**
**infection and apical periodontitis**
**Root Canal Fillings**
× **Because ... they:**
**7 Fill most of the space**
**7 Create an unfavourable environment**
**for bacteria to survive in**
**7 Slow down the process of further**
**infection and apical periodontitis**
**7 Give an indication of the overall technical**
**standard of the endodontic treatment**
**Because … they:**
- **Fill most of the space**
- **Create an unfavourable environment for bacteria to survive in**
- **Slow down the process of further infection and apical periodontitis**
- **Give an indication of the overall technical standard of the endodontic treatment**
**Why do we fill root canals?**
- **Prevent future infection**
- i.e. Another infected canal / apical periodontitis
- **Root canal filling**
- **Coronal restoration**
- **Oral hygiene, diet, etc**
### **The Realistic Role of RCFs in Preventing Future Infection**
- **Root canal filling**
- **Coronal restoration**
- **Oral hygiene, diet, etc**
**Why do we fill root canals?**
* **Prevent future infection**
* **BUT ..... Realistically .....**
* **RCF's only slow down the onset of apical periodontitis**
- **BUT ..... Realistically .....**
- **RCF's only slow down the onset of apical periodontitis**
**Why do we fill root canals?**
**Prevent future infection**
Ú BUT ..... Realistically .....
RCF's only slow down the onset of
apical periodontitis
The **“seal”** of the coronal restoration
is probably the most critical factor
- The **“seal”** of the coronal restoration is probably the most critical factor.
**Why do we fill root canals?**
**Prevent future infection**
- **BUT ….. Realistically …..**
- RCF’s only slow down the onset of apical periodontitis
- The “seal” of the coronal restoration is probably the most critical factor
- The RCF is not likely to have much effect on the outcome of the current treatment
- Only has a minor effect on how long the tooth may remain free of infection
- The RCF is not likely to have much effect on the outcome of the current treatment.
- Only has a minor effect on how long the tooth may remain free of infection.
**When should the canal be filled?**
$\times$ **When all of the following have occurred:**
$\hat{E}$ Canal preparation and cleaning completed
$\hat{E}$ There are no symptoms associated with the tooth
$\hat{E}$ The canals can be dried
$\hat{E}$ Mobility, percussion and palpation are normal
$\hat{E}$ The draining sinus has healed - *if present pre-op'ly*
$\hat{E}$ Swelling has resolved - *if present pre-op'ly*
$\hat{E}$ Evidence of healing - *if large lesion pre-op'ly*
## **Criteria for When to Fill the Canal**
The canal should be filled **when all of the following have occurred:**
- Canal preparation and cleaning completed
- There are no symptoms associated with the tooth
- The canals can be dried
- Mobility, percussion and palpation are normal
- The draining sinus has healed - *if present pre-op'ly*
- Swelling has resolved - *if present pre-op'ly*
- Evidence of healing - *if large lesion pre-op'ly*
[[Root fillings - 2018.pdf#page=1|Root fillings - 2018, p.1]]
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[[Root fillings - 2018.pdf#page=54|Root fillings - 2018, p.54]]
[[Root fillings - 2018.pdf#page=55|Root fillings - 2018, p.55]]
[[Root fillings - 2018.pdf#page=56|Root fillings - 2018, p.56]]
[[Root fillings - 2018.pdf#page=57|Root fillings - 2018, p.57]]
[[Root fillings - 2018.pdf#page=58|Root fillings - 2018, p.58]]
[[Root fillings - 2018.pdf#page=59|Root fillings - 2018, p.59]]
[[Root fillings - 2018.pdf#page=60|Root fillings - 2018, p.60]]
[[Root fillings - 2018.pdf#page=61|Root fillings - 2018, p.61]]
[[Root fillings - 2018.pdf#page=62|Root fillings - 2018, p.62]]
[[Root fillings - 2018.pdf#page=63|Root fillings - 2018, p.63]]
[[Root fillings - 2018.pdf#page=64|Root fillings - 2018, p.64]]
[[Root fillings - 2018.pdf#page=65|Root fillings - 2018, p.65]]
[[Root fillings - 2018.pdf#page=66|Root fillings - 2018, p.66]]
[[Root fillings - 2018.pdf#page=67|Root fillings - 2018, p.67]]
[[Root fillings - 2018.pdf#page=68|Root fillings - 2018, p.68]]
[[Root fillings - 2018.pdf#page=69|Root fillings - 2018, p.69]]