Dentinal Defects Research Articles

Dentin dysplasia type I-novel findings in deciduous and permanent teeth.

BackgroundDentin dysplasia type I (DD-I) is a rare autosomal dominant hereditary disorder which seriously affects the root development of teeth, causing spontaneous tooth loss (in teenagers). At present, the study of DD-I focuses on familial and phenotypic analyses and reports regarding the ultrastructural study of DD-I are few. The purpose of this study was to clarify and discuss the clinical, histopathological, and ultrastructural features of the dentin defects in DD-I. In addition, the study further explores the root development and provides clues for uncovering virulent genes associated with the disease.MethodsWe recruited 31 members of a four-generation Chinese family, including eleven with dentin defects. Four permanent teeth and four deciduous teeth were obtained from individuals affected by DD-I. At the same time, two caries-free like-numbered permanent teeth and deciduous teeth served as controls, respectively. Analyses of these teeth were carried out using stereomicroscopy, light microscopy, and scanning and transmission electron microscopy, respectively.ResultsSimilar to previous reports, extracted teeth showed typical histopathological and ultrastructural features of DD-I and teeth had short roots with obliterated pulp chambers. Furthermore, several novel discoveries were found in teeth affected by DD-I, including; (1) thinner dentin; (2) larger scalloped dentinoenamel junctions; (3) teardrop-shaped lacunae in the enamel; (4) rodless enamel and (5) irregular collagen fibers.ConclusionsThe results exhibited defined features of DD-I in the family and further confirmed that abnormal dentin structure affected both the deciduous and permanent dentitions. In addition, these findings may contribute to a better understanding of the pathogenesis of DD-I as well as aid in the subclassification of this disease.

Comparison of incidence of dentinal defects after root canal preparation with continuous rotation and reciprocating instrumentation

Biomechanical preparation is one of the most important steps in endodontic therapy. Rotary instrumentation has facilitated this step. Nowadays the market is flooded with different types of rotary instruments. The present study compared the root dentinal crack formation with continuous rotating versus reciprocating root canal preparation methods. One hundred and fifty freshly extracted teeth were used for the study. They were divided into 5 groups with 30 teeth in each group. Thirty teeth were kept under control group A and no root canal preparation was done for this group. Another 30 teeth were prepared with hand files which were kept under control group B. In the experimental groups (sample size, n=30 each) root canals were prepared with ProTaper, K3XF rotary system and WaveOne. Sectioning of these teeth was done at 3, 6 and 9mm from the apex and were evaluated for the presence of any defects. Root dentinal cracks were produced with each type of rotary instruments. Statistical analysis showed no significant difference in root dentinal crack formation between control groups and WaveOne system. There was statistically significant difference in root dentinal crack formation when the canals were prepared with ProTaper and K3XF rotary system. So it was concluded, that continuous rotating instruments could produce dentinal crack formation. Root canal instruments with reciprocating movement appear to be a better option than continuous rotation movement.

A Direct Electric Field-Aided Biomimetic Mineralization System for Inducing the Remineralization of Dentin Collagen Matrix.

This in vitro study aimed to accelerate the remineralization of a completely demineralized dentine collagen block in order to regenerate the dentinal microstructure of calcified collagen fibrils by a novel electric field-aided biomimetic mineralization system in the absence of non-collagenous proteins. Completely demineralized human dentine slices were prepared using ethylene diamine tetraacetic acid (EDTA) and treated with guanidine hydrochloride to extract the bound non-collagenous proteins. The completely demineralized dentine collagen blocks were then remineralized in a calcium chloride agarose hydrogel and a sodium hydrogen phosphate and fluoride agarose hydrogel. This process was accelerated by subjecting the hydrogels to electrophoresis at 20 mA for 4 and 12 h. X-ray diffraction (XRD), scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX), and transmission electron microscopy (TEM) were used to evaluate the resultant calcification of the dentin collagen matrix. SEM indicated that mineral particles were precipitated on the intertubular dentin collagen matrix; these densely packed crystals mimicked the structure of the original mineralized dentin. However, the dentinal tubules were not occluded by the mineral crystals. XRD and EDX both confirmed that the deposited crystals were fluorinated hydroxyapatite. TEM revealed the existence of intrafibrillar and interfibrillar mineralization of the collagen fibrils. A novel electric field-aided biomimetic mineralization system was successfully developed to remineralize a completely demineralized dentine collagen matrix in the absence of non-collagenous proteins. This study developed an accelerated biomimetic mineralization system which can be a potential protocol for the biomineralization of dentinal defects.

Endodontic instrumentation and root filling procedures: effect on mechanical integrity of dentin

Vertical root fractures are a major reason for extraction of endodontically treated teeth and teeth after root canal treatment are more prone to fracture compared to untreated teeth. One suggested reason for this difference is the destructive effects of some files and filling methods used during root canal treatment. However, most studies that investigated the effects of specific instrumentation and filling methodologies on the root canal walls are in vitro destructive experiments and a concern has lately been raised on the clinical relevancy of the results of these studies. Novel non‐destructive methodologies and a cadaver study recently tried to challenge the concept of dentinal defects caused by instrumentation alone. This article presents an overview of the various studies conducted on the effect of endodontic procedures on the appearance of dental defects and will critically examine the evidence in light of the relevant literature.

DSPP Is Essential for Normal Development of the Dental-Craniofacial Complex

The craniofacial skeleton is derived from both neural crest cells and mesodermal cells; however, the majority of the bone, cartilage, and connective tissue is derived from the neural crest. Dentin sialophosphoprotein (DSPP) is a precursor protein that is expressed by the connective tissues of the craniofacial skeleton, namely, bone and dentin with high expression levels in the dentin matrix. Gene ablation studies have shown severe dental defects in DSPP-null mutant mice. Therefore, to elucidate the role of DSPP on the developing dental-craniofacial complex, we evaluated phenotypic changes in the structure of intramembranous bone and dentin mineralization using 3 different age groups of DSPP-null and wild-type mice. Results from micro–computed tomographic, radiographic, and optical microscopic analyses showed defective dentin, alveolar and calvarial bones, and sutures during development. The impaired mineralization of the cranial bone correlated well with low expression levels of Runx2, Col1, and OPN identified using calvarial cells from DSPP-null and wild-type mice in an in vitro culture system. However, the upregulation of MMP9, MMP2, FN, and BSP was observed. Interestingly, the null mice also displayed low serum phosphate levels, while calcium levels remained unchanged. Alizarin red and von Kossa staining confirmed the dysfunction in the terminal differentiation of osteoblasts obtained from the developing calvaria of DSPP-null mice. Immunohistochemical analysis of the developing molars showed changes in Runx2, Gli1, Numb, and Notch expression in the dental pulp cells and odontoblasts of DSPP-null mice when compared with wild-type mice. Overall, these observations provide insight into the role of DSPP in the normal development of the calvaria, alveolar bone, and dentin-pulp complex.

Incidence of dentinal defects after preparation of severely curved root canals using the Reciproc single-file system with and without prior creation of a glide path.

To investigate the incidence of dentinal defects after preparation of severely curved root canals using the Reciproc single-file system with and without prior creation of a glide path. Mesial roots from extracted mandibular first molars were collected and scanned with CBCT to assess the morphology of the root canal systems. Three groups of 20 anatomically comparable specimens were generated. The control group was left unprepared, whilst the experimental groups were prepared with Reciproc R25 with and without a glide path (groups RG and R, respectively). Roots were then sectioned perpendicular to the long axis at 2, 4, 6, 8 and 10mm from the apex, and coloured photographs of the sections at 40× were obtained. Two blinded examiners registered the presence of dentinal defects twice at 2-week interval. Data were statistically analysed using the Fisher exact and Cochran's Q tests. No defects were observed in the control group. The overall incidence of dentinal defects was 26% in group R and 24% in group RG, with no significant differences between them (P>0.05). Dentinal defects occurred significantly more often in the middle and coronal thirds compared to the apical third of the canals (P<0.05). Prior preparation of a glide path had no impact on the incidence of dentinal defects when using Reciproc files.

The dentin phosphoprotein repeat region and inherited defects of dentin.

Nonsyndromic dentin defects classified as type II dentin dysplasia and types II and III dentinogenesis imperfecta are caused by mutations in DSPP (dentin sialophosphoprotein). Most reported disease-causing DSPP mutations occur within the repetitive DPP (dentin phosphoprotein) coding sequence. We characterized the DPP sequences of five probands with inherited dentin defects using single molecule real-time (SMRT) DNA sequencing. Eight of the 10 sequences matched previously reported DPP length haplotypes and two were novel. Alignment with known DPP sequences showed 32 indels arranged in 36 different patterns. Sixteen of the 32 indels were not represented in more than one haplotype. The 25 haplotypes with confirmed indels were aligned to generate a tree that describes how the length variations might have evolved. Some indels were independently generated in multiple lines. A previously reported disease-causing DSPP mutation in Family 1 was confirmed and its position clarified (c.3135delC; p.Ser1045Argfs*269). A novel frameshift mutation (c.3504_3508dup; p.Asp1170Alafs*146) caused the dentin defects in Family 2. A COL1A2 (c.2027G>A or p.Gly676Asp) missense mutation, discovered by whole-exome sequencing, caused the dentin defects in Family 3. We conclude that SMRT sequencing characterizes the DPP repeat region without cloning and can improve our understanding of normal and pathological length variations in DSPP alleles.

Dspp-independent Effects of Transgenic Trps1 Overexpression on Dentin Formation

The Trps1 transcription factor is highly expressed in dental mesenchyme and preodontoblasts, while in mature, secretory odontoblasts, it is expressed at low levels. Previously, we have shown that high Trps1 levels in mature odontoblasts impair their function in vitro and in vivo. Col1a1-Trps1 transgenic (Trps1-Tg) mice demonstrate defective dentin secretion and mineralization, which are associated with significantly decreased Dspp expression due to direct repression of the Dspp gene by Trps1. Here, by crossing Trps1-Tg and Col1a1-Dspp transgenic (Dspp-Tg) mice, we generated Col1a1-Trps1;Col1a1-Dspp double transgenic (double-Tg) mice in which Dspp was restored in odontoblasts overexpressing Trps1. Comparative micro–computed tomography analyses revealed partial correction of the dentin volume and no improvement of dentin mineralization in double transgenic mice in comparison with Trps1-Tg and wild-type (WT) mice. In addition, dentin of double-Tg mice has an irregular mineralization pattern characteristic for dentin in hypophosphatemic rickets. Consistent with this phenotype, decreased levels of Phex, Vdr, and Fam20c proteins are detected in both Trps1-Tg and double-Tg odontoblasts in comparison with WT and Dspp-Tg odontoblasts. This suggests that the Dspp-independent dentin mineralization defects in Trps1-Tg mice are a result of downregulation of a group of proteins critical for mineral deposition within the dentin matrix. In summary, by demonstrating that Trps1 functions as a repressor of later stages of dentinogenesis, we provide functional significance of the dynamic Trps1 expression pattern during dentinogenesis.

Micro–computed Tomographic Assessment on the Effect of ProTaper Next and Twisted File Adaptive Systems on Dentinal Cracks

IntroductionThe aim of the present study was to evaluate the frequency of dentinal microcracks observed after root canal preparation with ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland) and Twisted File Adaptive (TFA; SybronEndo, Orange, CA) systems through micro–computed tomographic analysis. MethodsTwenty moderately curved mesial roots of mandibular molars presenting a type II Vertucci canal configuration were randomly assigned to 2 experimental groups (n = 10) according to the system used for the root canal preparation: PTN or TFA systems. The specimens were scanned through high-resolution micro–computed tomographic imaging before and after root canal preparation. Afterward, pre- and postoperative cross-sectional images of the mesial roots (N = 25,820) were screened to identify the presence of dentinal defects. ResultsDentinal microcracks were observed in 38.72% (n = 5150) and 30.27% (n = 3790) of the cross-sectional images in the PTN and TFA groups, respectively. All dentinal defects identified in the postoperative scans were already present in the corresponding preoperative images. ConclusionsRoot canal preparation with PTN and TFA systems did not induce the formation of new dentinal microcracks.

Temporo-spatial requirement of Smad4 in dentin formation

The TGF-β/BMP family plays an important role in multiple stages of tooth development. TGF-β/BMP signaling is required for odontoblast differentiation and dentin formation; however, the precise molecular mechanisms underlying dentin formation remain unclear. To address the role of TGF-β/BMP signaling in dentin formation, we analyzed mice in which Smad4, a key intracellular mediator of TGF-β/BMP signaling, was subjected to tissue-specific ablation under the control of Dspp, OC, or Col1a1 promoters. Three independent Smad4 conditional knockout mice exhibited various dentin defects in the crowns and roots of their molars depending on the transactivator. In all mutant molars, crown dentin thickness was thinner than that of the control. In addition, impaired dentin was found in the cervical region and root furcation area. Although the initial differentiation of odontoblasts was normal, odontoblast polarity abruptly decreased and the expression of Col1a1, OC, and Dspp was reduced in the odontoblasts of mutant molars. In Dspp-Cre-mediated Smad4 disruption mice, primary dentin formation was slightly delayed, while secondary dentin formation was severely affected in the cervical region of the molars. These results indicate that TGF-β/BMP signaling is required for odontoblast maturation and dentin formation in a stage- and site-dependent manner.

Review of the dental implications of X-linked hypophosphataemic rickets (XLHR).

The aim of this article was to review the dental implications of X-linked hypophosphataemic rickets (XLHR) and to provide suggestions regarding the dental treatment of these patients. The following search items "x-linked hypophosphataemia, hypophosphataemic rickets, vitamin D-resistant rickets" were used for literature search. Only full-text articles were analysed and summarized to get an overview of the different treatments and outcomes of hypophosphataemic patients. Radiographically, very large pulp chambers with an abnormally high pulp volume/tooth volume ratio, suggesting taurodontism, are often evident. The affected teeth are characterised by a thin enamel layer and dentinal defects. The gender distribution of hypophosphataemic patients is almost equal, but postpubertary males seem to show a trend to develop more severe dental symptoms of the disease. Abscesses without any signs of dental caries or trauma are frequent findings. The most often affected teeth are incisors followed by molars and premolars. Treatment options include frequent dental examination, application of topical fluoride varnish and sealing of pits and fissures to prevent microbial invasion that may result in pulpitis and further endodontic complications. X-linked hypophosphataemic rickets is associated with marked structural alterations of dental hard tissues and the development of multiple abscesses and sinus tracts of dental origin. Therefore, profound knowledge of the various dental implications of XLHR is required to provide these patients with the best possible treatment options.

Enamel and dentin mineralization in familial hypophosphatemic rickets: a micro-CT study.

The aim of the present study was to analyse the mineralization pattern of enamel and dentin in patients affected by X-linked hypophosphatemic rickets (XLHR) using micro-CT (µCT), and to associate enamel and dentin mineralization in primary and permanent teeth with tooth position, gender and the presence/absence of this disease. 19 teeth were collected from 5 individuals from the same family, 1 non-affected by XLHR and 4 affected by XLHR. Gender, age, tooth position (anterior/posterior) and tooth type (deciduous/permanent) were recorded for each patient. Following collection, teeth were placed in 0.1% thymol solution until µCT scan. Projection images were reconstructed and analysed. A plot profile describing the greyscale distance relationship in µCT images was achieved through a line bisecting each tooth in a region with the presence of enamel and dentin. The enamel and dentin mineralization densities were measured and compared. Univariate ANOVA and post hoc Tukey tests were used for all comparisons. Teeth of all affected patients presented dentin with a different mineralization pattern compared with the teeth of healthy patients with dentin defects observed next to the pulp chambers. Highly significant differences were found for gray values between anterior and posterior teeth (p < 0.05), affected and non-affected (p < 0.05), as well as when position and disease status were considered (p < 0.05). In conclusion, the mineralization patterns of dentin differed when comparing teeth from patients with and without FHR, mainly next to pulp chambers where areas with porosity and consequently lower mineral density and dentin defects were found.

Evaluation of dentinal defect formation after root canal preparation with two reciprocating systems and hand instruments: an in vitro study

The purpose of this study was to evaluate the presence of dentinal defects after root canal preparation with hand instruments and two different reciprocating instruments. Sixty freshly extracted mandibular incisor teeth were selected for this in vitro study. On the basis of root length, mesiodistal and buccolingual dimensions, the teeth were allocated into three identical experimental groups (n = 15) and one control group (n = 15). The teeth in the control group were left unprepared. The other groups were: stainless steel hand instruments, WaveOne® Primary instruments and RECIPROC® R25 instruments. The reciprocating instruments were used with a reciprocating gentle in-and-out motion in a torque-limited electric motor at the appropriate preset mode. Horizontal sections were made 3, 6 and 9 mm from the apex. Samples were stained with methylene blue and viewed through a stereomicroscope. The presence of dentinal defects (fractures, incomplete cracks and craze lines) and their locations were investigated by two endodontists. These data were analysed statistically by Fisher's exact and chi-square tests. No defects were observed in the unprepared group. All instruments caused dentinal defects, with no significant differences between the instrument systems. All experimental groups demonstrated significantly more defects at the 3-mm level in comparison with the unprepared group (p = 0.032). At the other levels, there was no significant difference between the experimental groups and the control group. The use of hand or reciprocating instruments could induce the formation of dentinal defects during root canal preparation.

The Effect of Using RC Prep during Root Canal Preparation on the Incidence of Dentinal Defects

IntroductionThe purpose of this in vitro study was to evaluate the effect of using RC Prep (Well-Prep, Vericom Co, Anyang, Korea) during root canal preparation on the incidence of defects in root canal walls. MethodsOne hundred extracted mandibular incisors with single canals were randomly divided into 1 control group and 4 experimental groups (n = 20). The teeth in group 1 (control) were coronally flared with Gates Glidden drills (Mani, Japan), but no further preparation was made. All teeth in the experimental groups were first coronally flared with Gates Glidden drills and then prepared similarly by means of ProTaper instruments (Dentsply Maillefer, Ballaigues, Switzerland). The difference between the experimental groups was the following: in group 2, saline was used as an irrigation solution without the application of RC Prep; in group 3, teeth were irrigated with saline, and RC Prep was also applied to canals before the insertion of each file; in group 4, sodium hypochlorite (NaOCl) was used for irrigation without the application of RC Prep; and in group 5, both NaOCl and RC Prep were used. The apical root surface and horizontal sections 3, 6, and 9 mm from the apex were observed under a microscope. The presence of cracks was noted. The chi-square test and Fisher exact test were used for statistical analysis of differences between and among the groups. ResultsA significant difference was found between and among the 5 groups (P < .05). Group 4 (NaOCl), which had the highest number of cracked teeth, was significantly different from group 1 (control) (P < .05). RC Prep, with both saline and NaOCl, had no significant effect on the incidence of microcrack formation (P > .05). When data were pooled, regardless of whether RC Prep was used, there was a significant difference between saline (groups 2 + 3) and NaOCl (groups 4 + 5) (P < .05). ConclusionsRC Prep was unable to reduce the risk of dentinal defects. NaOCl caused more defects compared with saline.

Radicular dentinal defects incidence after using EDTA gel with different root canal instrumentation techniques

Objectives: The purpose of this study was to compare the incidence of dentinal defect formation after using EDTA gel during root canal preparations by three different instrumentation techniques. Materials and Methods: One hundred and forty maxillary central incisors were decoronated and roots were embedded in resin blocks. Twenty samples were left unprepared (Control group), and the remaining 120 samples were divided into three groups. Each group was divided equally into two subgroups according to the use of EDTA gel during root canal instrumentation. Roots were prepared with hand file (Group 1), ProTaper Universal (Group 2) and WaveOne (Group 3). Roots were sectioned 3, 6, and 9 mm from the apex, and the cut surface was observed microscopically and the presence of dentinal defects was checked. The differences between groups were analyzed using Fisher's exact test. Results: Unprepared roots did not show any dentinal defects. Dentinal defects were observed in all prepared roots. The difference between experimental groups and subgroups regarding the incidence of dentinal defects was not statistically significant. Conclusion: Canal preparation using hand or rotary files created radicular dentinal defects. The use of EDTA gel during root canal preparation did not reduce the incidence of dentinal defects.

Comparison of dentinal damage induced by different nickel-titanium rotary instruments during canal preparation: An in vitro study.

Aim:To compare dentinal damage caused by hand and rotary nickel-titanium instruments using ProTaper, K3 Endo, and Easy RaCe systems after root canal preparation.Materials and Methods:One hundred and fifty freshly extracted mandibular premolars were randomly divided into five experimental groups of 30 teeth each and biomechanical preparation was done: Group 1 with unprepared teeth; Group 2 were prepared with hand files; Group 3 with ProTaper rotary instruments; Group 4 with K3 rotary; Group 5 with Easy RaCe rotary instruments. Then, roots were cut horizontally at 3, 6, and 9 mm from apex and were viewed under stereomicroscope. The presence of dentinal defects was noted.Statistical analysis:Groups were analyzed with the Chi-square test.Results:Significant difference was seen between groups. No defects were found in unprepared roots and those prepared with hand files. ProTaper, K3 rotary, and Easy RaCe preparations resulted in dentinal defects in 23.3%, 10%, and 16.7% of teeth, respectively. More defects were shown in coronal and middle sections, and no defect was seen in apical third.Conclusion:The present study revealed that use of rotary instruments could result in an increased chance for dentinal defects as compared to hand instrumentation.

Mechanical or cold lateral compaction: The incidence of dentinal defects

The incidence of dentinal defects may influence the outcome of root canal treatment. The aims of this study were to evaluate and compare the incidence of dentinal defects following root canal obturation with two different techniques. A total of 110 mesial roots of human mandibular first molars were selected. Twenty-seven roots were left unprepared as negative controls (NCs). The mesiobuccal canals of 83 roots were prepared using rotary instruments. Twenty-seven roots were left unobturated as positive controls (PCs). Twenty-eight roots were obturated with cold lateral compaction (CLC) technique and the others were obturated with mechanical lateral compaction (MLC) technique. In the CLC and MLC groups, spreader penetration depth was measured by an electromechanical testing machine in canals containing master Gutta-percha cones. After root canal obturation, all the roots were sectioned horizontally at four levels from the apex and evaluated under a stereomicroscope at a magnification of ×40. The presence of dentinal defects was noted. Data were analyzed using the Chi-square and t-tests. The number of defects was not significantly different between the CLC, MLC, and PC groups. The CLC, MLC, and PC groups had significantly more defects compared to the NC group. According to the results of this study, the MLC and CLC techniques were the same in producing dentinal defects.

Late morphological teeth changes in children after chemotherapy

Teeth changes after chemotherapy are of clinical importance, but no morphological studies were conducted on microscopic level. To assess morphological changes in teeth developing under chemotherapy. Twenty-nine adolescents aged 13-16 years that received chemotherapy at the age of 2-13 were included in the study. Teeth morphology was evaluated by means of clinical and radiological data as well as microscopy of extracted teeth (n=13). Thirty healthy children aged 13-16 and 8 teeth extracted for orthodontic reasons served as a control. Chemotherapy has arresting impact on teeth development confirmed by aplasia of germs when influenced on stages I-II (p=0.0001), preliminary apexogenesis resulting in shortened roots in teeth at the later stages of growth and development (p=0.01). Enamel and dentine defects usually located in cervical area are also a specific feature, while caries incidence was not higher when compared to control group. Children receiving chemotherapy have high risk of secondary teeth loss because of germs aplasia and extraction of severely decayed teeth. Early diagnostics helps to prevent secondary deformations of dental arches by prompt prosthetic rehabilitation. Root morphology changes should be considered by root canal treatment.

Stereomicroscopic evaluation of dentinal defects induced by new rotary system: "ProTaper NEXT".

Introduction:The objective of this study was to evaluate dentinal defects formed by new rotary system — Protaper next™ (PTN).Materials and Methods:Sixty single-rooted premolars were selected. All specimens were decoronated and divided into four groups, each group having 15 specimens. Group I specimens were prepared by Hand K-files (Mani), Group II with ProTaper Universal (PT; Dentsply Maillefer), Group III with Hero Shaper (HS; Micro-Mega, Besancon, France), and Group IV with PTN (Dentsply Maillefer). Roots of each specimen were sectioned at 3, 6, and 9mm from the apex and were then viewed under a stereomicroscope to evaluate presence or absence of dentinal defects.Results:In roots prepared with hand files (HFs) showed lowest percentage of dentinal defects (6.7%); whereas in roots prepared with PT, HS, and PTN it was 40, 66.7, and 26.7%, respectively. There was significant difference between the HS group and the PTN group (P < 0.05).Conclusion:All rotary files induced defects in root dentin, whereas the hand instruments induced minimal defects.

Periapical Microsurgery: The Effect of Root Dentinal Defects on Short- and Long-term Outcome

Periapical Microsurgery: The Effect of Root Dentinal Defects on Short- and Long-term Outcome