4/20/2017 Theanatomyoftherootapex:AreviewandclinicalconsiderationsinendodonticsAlothmaniOS,ChandlerNP,FriedlanderLTSaudiEndodJ

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Year:2013|Volume:3|Issue:1|Page:19
AlothmaniOS
Theanatomyoftherootapex:Areviewandclinicalconsiderationsinendodontics
ChandlerNP
FriedlanderLT
OsamaSAlothmani1,NicholasPChandler2,LaraTFriedlander2
1 DepartmentofConservativeDentistry,DivisionofEndodontics,FacultyofDentistry,KingAbdulaziz
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University,Jeddah,SaudiArabia Scholarfor
2 DepartmentofOralRehabilitation,SirJohnWalshResearchInstitute,UniversityofOtago,Dunedin,New
Zealand AlothmaniOS
ChandlerNP
DateofWebPublication 7Aug2013 FriedlanderLT

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apicalforamen
CorrespondenceAddress: cementodentinal
NicholasPChandler
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SchoolofDentistry,UniversityofOtago,P.O.Box647,Dunedin9054 endodontics
NewZealand radiographicapex

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DOI:10.4103/16585984.116273

Inthisarticle
Abstract
Abstract Introduction
Conclusion
Studiesontheanatomyoftherootapexareanareaofinteresttotheendodontisttheyhavereportedthat References
thepositionoftheapicalconstriction,apicalforamenandthecementodentinaljunctionvariesacrossthe ArticleTables
toothtypes.Theseanatomicalapicallandmarksareconsideredextensionlimitsforrootcanal
instrumentationandfilling.Achievinganoptimumworkinglengthisthoughtessentialforsuccessfulroot
ArticleAccessStatistics
canaltreatment,soadoptinganyoftheselandmarksisassociatedwithcertainrisksandbenefits.The
Viewed 10716
variabilityinthepositionoftheapicalconstrictionandapicalforamen,forexample,complicatestheir
Printed 107
clinicaldetection,whilethecementodentinaljunctionisahistologicallandmarkthatcannotbedetected
Emailed 3
clinically.Theradiographicapexdoesnotalwayscoincidewiththeanatomicapexofthetooth.Thepre
PDF
operativestatusofthepulpmustbeconsideredwhileobtainingtheworkinglength.Mostprognosticstudies 1439
Downloaded
agreethatextendingtherootfillingtowithin23mmoftheradiographicapexisassociatedwithfavorable
Comments [Add]
treatmentoutcomes.

Keywords:Apicalconstriction,apicalforamen,cementodentinaljunction,endodontics,radiographicapex

Howtocitethisarticle:
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4/20/2017 Theanatomyoftherootapex:AreviewandclinicalconsiderationsinendodonticsAlothmaniOS,ChandlerNP,FriedlanderLTSaudiEndodJ

AlothmaniOS,ChandlerNP,FriedlanderLT.Theanatomyoftherootapex:Areviewandclinical
considerationsinendodontics.SaudiEndodJ20133:19

HowtocitethisURL:
AlothmaniOS,ChandlerNP,FriedlanderLT.Theanatomyoftherootapex:Areviewandclinical
considerationsinendodontics.SaudiEndodJ[serialonline]2013[cited2017Apr20]3:19.Available
from:http://www.saudiendodj.com/text.asp?2013/3/1/1/116273

Introduction

Thesearchstrategyforthisreviewconsistedofacombinedelectronicandmanualsearchofreferences
publishedinEnglish.TheformerwascarriedoutusingMedlineviatheOvidinterfacetoNovember2012
usingthesearchterms:Apicalforamen,apicalconstriction,cementodentinaljunction,rootapex,anatomic
apex,radiographicapex,majordiameter,minordiameterandoutcomeofrootcanaltreatment.Thelatter
searchinvolvedacrosscheckoftheelectronicresultswithreviewarticlesandtextbookchapterstoidentify
allpossiblerelevantpublications.

Theterminalpartofatoothrootexhibitsfourdistinctlandmarkstheapicalconstriction(AC),apical
foramen(AF),rootsapex(anatomicandradiographic)andcementodentinaljunction(CDJ).[1]Whilethe
AFisthemainapicalopeningoftherootcanal,theACisdefinedastheapicalpartoftherootcanalwith
thenarrowestdiameter.Theanatomicapexdiffersfromtheradiographicapexinthattheformeristheroot
endasidentifiedmorphologicallyandthelatterisidentifiedradiographically.[2]TheCDJisthelineof
unionbetweendentinandcementumatwhichpulpaltissueendsandperiodontaltissuestarts.[3]

Theapicalconstriction

VariabilityinthepositionoftheACiswelldocumented.ThedistancebetweentheACandtheAFranged
between0.41.2mm,whileitsreportedlocationinrelationtotherootapexrangedbetween0.51.01mm
[Table1].TheACismostlylocatedeitherindentinorattheCDJlevelandlessfrequentlyincementum.[4]
Anotherstudyof50mandibularpremolars,reportedthattheACisalwaysfoundcoronaltotheCDJ.[10]
Hence,theACandCDJdonotalwayscoincide.
Table1:Thepositionoftheapicalconstriction

Clickheretoview

TheshapeoftheACinlongitudinalsectionshasfourpossibleconfigurationssingle,tapered,multi
constrictedandparallelthefirsttwowerethemostcommon.[7]FortyeightpercentofACshadthesingle
topographywhiletherestweretapered,multiconstrictedorparallel.[12]Arecentstudyevaluatedthe
morphologyoftheACinpalatalrootsofmaxillarymolarsusingmicrocomputedtomographyandreported
thattheACwaspresentin34%oftheroots.TheACwasconsideredpresentonlyifithadsingleortapered
morphologies.However,rootswithflaringorparallelshapeswereconsideredtolackanyconstriction.[13]

Inhorizontalsections,thelabiolingualdimensionofthecanalattheACwaslargerthanthemesiodistal
dimensionby0.05mm.[9]ThemostcommonshapeofrootcanalattheACwascircular,althoughovaland
irregularoutlineswerealsoseen.[5],[9]TheACofmaxillarycentralincisorsexhibitedanaverage0.165
mmslopewithonly10%representingaflatmorphology.[14]Outof93canals,41canalshadaslotlike
constrictionwhile52canalshadapointconstriction.[15]

Theapicalforamen

DeviationoftheAFfromtherootapexiscommon,withareportedfrequencyrangingfrom17100%
[Table2].Ontheotherhand,theaveragedistancebetweentheAFandtherootapexwasfoundtobeless
than1mm[Table3].
Table2:Frequencyofapicalforamendeviationfromtipofrootapex

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Table3:Distancebetweentheapicalforamenandtipofrootapex

Clickheretoview

AhigherfrequencyofAFdeviationhasbeenassociatedwithaginganddepositionofcementum.[4],[19],
[22]Deviationalsodifferedaccordingtotoothtype.Only15%ofmaxillarycentralincisorshadtheirAFat

adistanceofmorethan1mmfromtherootapex,[21],[33]butahigherfrequencyofAFdeviationin
posteriorteethhasbeenobserved.Thiswasattributedtomorecementumdepositionattheapicesof
posteriorteethasanadaptationtohigherocclusalloadsandcompensationforenamelattrition.[7],[23],[27]
Excludingmolars,theaverageAFdeviationformaxillaryandmandibularteethwassimilar.[18]Another
studyfoundthatAFdeviationinmandibularteethwasmorethanformaxillaryteeth.[27]However,another
studybythesamegroupfoundthattheoppositewastrue.[30]

Thecementodentinaljunction

Duringtoothdevelopment,cementumdepositionfollowsthatofdentin,resultinginalineofdelineation
separatingthetwotissuetypes.[34]Thelineofunionwasdifficulttorecognizehistologicallyand
consideredimaginary.[35]However,severallaterstudieshavereportedthemicroscopicappearanceofthe
CDJ.[4],[10],[22],[26],[33],[36],[37]Outof268teeth,only37teethdidnotdisplaytheCDJ,evenathigher
magnification.BothsidesoftheCDJendedatthesamelevelinonly53%ofayoungerteethgroupand
60%ofanolderteethgroup.[4]AnotherstudyreportedthatbothlevelsoftheCDJcoincidedinonly5%of
theteeth.TheleveloftheCDJattheleftsideofthecanalwasmorecoronalthanontherightside,andit
wasmorecoronalinmaxillarycaninesthaninmaxillaryincisors.[26]Histologicalexaminationof122
mandibularpremolarsrevealedthatneithersideoftheCDJcoincided.[38]Variabilityinthepositionofthe
CDJhasbeendocumented.TheCDJwascoronaltotheAFbyatleast0.3mmwhilethemaximumdistance
reportedbetweentheCDJandrootapexwas2.5mm[Table4].
Table4:Positionofthecementodentinaljunction

Clickheretoview

Importanceofachievingoptimumworkinglength

Theaimofrootcanaltreatment(RCT)istoresolveand/orpreventapicalperiodontitis.[39]Theassociation
betweenmicrobialinfectionoftherootcanalsystemandthedevelopmentofapicalperiodontitishasbeen
wellestablished.[40],[41]RCTusuallyinvolvesmechanicalinstrumentationoftherootcanalsystem
accompaniedbysodiumhypochlorite(NaOCl)irrigation.[42],[43],[44],[45],[46]Threedimensionalfillingof
therootcanalsystem[47]andtheprovisionofawellsealedcoronalrestorationareconcludingstepsof
treatment.[48]Managementofinfectedrootcanalsdiffersfromthosecontainingvital,inflamedtissue
becausetheyrequireadequatedisinfectionpriortorootfilling.Thisisgenerallyachievedbytheapplication
ofcalciumhydroxideasanintracanalmedicamentforatleastoneweek.[49]Invitalteeth,calcium
hydroxideisnotnecessarybecausetheradicularpartoftheinflamedvitalpulpremainsinfectionfreeas
longasitisvital.[50]Thelevelofrootcanalinstrumentationandfillingshouldallowcompletedebridement
andsealingoftherootcanalsystemwithoutviolatingthesurroundingtissueorleavingcriticalpartsofthe
apicalregionuncleanand/orunsealed.[51]

Consequencesofoverinstrumentation

Overinstrumentationinthiscontextimpliestheextensionofinstrumentsintotheperiapicaltissuebeyond
theboundariesoftherootcanalsystem.Endodonticinstrumentsshouldideallybekeptwithintherootcanal
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systemtominimizepostoperativediscomfort.[52]Overinstrumentationmayleadtodiscomfortasaresult
oftheacuteinflammatoryresponseelicitedfrommechanicaldamagetotheperiapicaltissue.Development
ofpainwilldependontheintensityoftheacuteinflammation,whichisinturnproportionaltotheextentof
tissuedamage.[53],[54]

Ininfectedcases,theperiapicalinflammatoryreactionmightbefurthercompoundedifover
instrumentationleadstotheextrusionofmicrobesandinfecteddebris.Ithasbeenshownthatextruded
dentinandcementumchips,possiblyinfected,provokevaryinginflammatoryresponsesintheperiapical
tissue.[55]Microscopic,cultureandmolecularmethodshavedisclosedmicrobesinapicalgranulomas.[56],
[57],[58],[59]Thesepathogensmaygainaccesstotheperiapicaltissuethroughoverinstrumentation,with
ActinomycesisraeliiandPropionibacteriumpropionicum,knownfortheirabilitiesinestablishingextra
radicularinfections.[60]

Overinstrumentationalsopromotesoverfilling[61]whichcanresultinmechanicalandtemporary
chemicalirritationoftheperiapicaltissue.[50]Inahistologicalstudy,allsixoverfilledcasesshowedsevere
inflammatoryreactionsintheperiapicalregionbutnoneofthepatientsexperiencedpain.[62]Furthermore,
overfillingwasassociatedwithcontaminationoftheapicalareaandpossibleforeignbodyreaction.[63]

Consequencesofunderinstrumentation

Underinstrumentationreferstocleaningandshapingtherootcanaltoalevelshorterthandesired,leaving
regionsoftheapicalpartofthecanalwithoutproperdebridement.

Achievingoptimuminstrumentationdepthmightbemorecriticalduringthetreatmentofinfectedcanals
thanwhenmanagingvitalinflamedpulps.[64]Thelikelihoodofanunfavorableoutcomeofrootfilledteeth
withinaccessibleACswas5.3timeshigherthanwheninstrumentationcouldbeextendedtothelevelofthe
AC.Thepresenceofapreoperativeradiolucencyrelatedtotheteethoftheformergroupincreasedthe
chancesofanunfavorableoutcomeby3.4fold.[65]Underinstrumentationmayleadtolossofworking
lengthandaccumulationofinfecteddebrisapically.[50]Buildupofapicaldebrisshouldbeprevented
althoughitisyettobeproventhatitimpairsorpreventshealing.[51]

Optimalworkinglength

Thereisgeneralagreementthatmaintaininginstrumentationandrootfillingwithintherootcanalisdesired.
[51],[66],[67]Severalapicalreferencepointshavebeensuggestedasthefurthestapicalextensionfor

instrumentationandrootfilling.TheseincludetheCDJ,AF,ACandtheradiographicapex.Siqueira[50]
suggestedthatthepreoperativestatusofthepulpshouldalsobetakenintoconsiderationduringworking
lengthdetermination.

CDJastheidealapicalterminationpoint

TheCDJistheidealterminationpointforRCT.[68],[69]Sealingtherootcanalsystematthispointwould
theoretically,preventmicrobialescapeintoperiapicaltissuesandblockentryoftissuefluidsintothecanal
space.[3],[34]However,theCDJisahistologicalpointthatcannotbelocatedclinicallyanditsappearance
variesfromtoothtotooth.[4],[10],[26],[33],[35],[36],[62],[66],[70],[71],[72]Moreover,SaadandAlYahya[38]
demonstratedthattheCDJofsometeethwerelocatedinsidetherootcanal.Suchfindingsprecludethe
adoptionoftheCDJasanendpointforrootcanaltreatmentprocedures.

AFastheidealapicalterminationpoint

CleaningandfillingtherootcanaltotheAFhasbeenproposed.[35],[70]TheAFisareliableapical
landmark[73]andlimitingcleaningandshapingshortoftheAFguaranteesthattheentireprocedureis
performedinsidetherootcanalregardlessofthepositionorexistenceoftheAC.[51]Nonetheless,accurate
locationoftheAFisonlypossiblehistologically.[33]Periapicalradiographsfrequentlyfailedtoidentifythe
positionofbuccallyorlinguallydeviatedAFs.[18],[23],[74]ThepositionoftheAFwasreportedtoaffect
theaccuracyofelectronicapexlocators.[29],[75]Inflammatoryrootresorptionassociatedwithinfected
canalsmighteliminatetheAF.[1]TheAFis,therefore,notareliablereferencepointforworkinglength
determination.[26],[51]

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Ithasbeensuggestedtoextendrootcanalinstrumentationto1mmshortoftheradiographicapex,which
wouldensurecloserproximitytopositionoftheAF.[21]However,continuouscementumdepositionalters
thepositionoftheradiographicapextotheAF.[76]Meanwhile,dependingonasubjectivelevelshortofthe
radiographicapextowhichdisinfectionandrootfillingareextendedtodonotnecessarilyguaranteethatthe
entirecanalistreatedanddoesnotabsolutelypreventoverinstrumentation.[1],[23],[50]

ACastheidealapicalterminationpoint

TheACwouldrepresentthesmallestapicaldimensionpossibleforrootcanalinstrumentation.[5]
Terminationatthispointwouldresultintheleastamountoftissuedamageandconsequently,minimal
repairwouldbeneeded.[62]ThequalityguidelinesoftheEuropeanSocietyofEndodontology(2006)
recommendthatworkinglengthdeterminationshouldbeascloseaspossibletotheAC.[77]Inaddition,the
divergentshapeofthecanalapicaltotheACwouldbedifficulttoadequatelycleanandseal.[4],[5],[36]The
mostfavorablehistologicalresponseattheperiapicalregionwasseenwheninstrumentationandfilling
endedattheleveloftheAC.[62]Sjgrenetal.,[78]concludedthatinstrumentationtotheACresultedin
90%healingininfectedteeth.However,themethodofidentifyingtheACwasnotclearandmanyteeth
wereprepared1mmshortoftheradiographicapexiftheAFcouldnotbeidentifiedradiographically.Teeth
whereinstrumentationcouldbeextendedtotheleveloftheACwerefoundtohavebettertreatment
outcomesthanthoseinwhichtheACcouldnotbenegotiated.[76]Kuttler[4]recommendedthatallroot
canalproceduresshouldterminate0.5mmshortoftheAF,asthispointisconsideredtobethenearestto
theAC.ToremainclosetotheAC,arangeof0.51.5mmshortoftheradiographicapexwasrecommended
asanappropriateworkinglengthdependingonthespecificrootbeingtreated.[24]

AdoptingtheACasanapicallandmarkhasseverallimitationsasrestrictinginstrumentationtothisposition
risksleavingdiseasedtissueapicaltotheAC.[79]Moreover,theACcouldnotbehistologicallyidentified
inmanyteeth.[13],[80]Inflammatoryprocessesassociatedwithanecroticpulpmayleadtorootresorption
andconsequently,lossoftheAC.[1]WhentheACwasabsentorpoorlydevelopedtheEndocater(Hygenic
Corp,Akron,OH,USA),asinglefrequencyimpedancebasedelectronicapexlocator,gavereadings
beyondtheapex.[8]Nonetheless,theaccuracyoftheRootZX(J.MoritaCorp,Osaka,Japan),an
impedanceratiobasedapexlocator,wasnotinfluencedbyrootresorptionanditwasabletodetectthe
narrowestpartofthecanalswithinregionswithresorptionlacunae.[81],[82]

AttemptingtoconfinerootcanalprocedurestotheleveloftheACisfurthercomplicatedbythevariability
ofitspositionandtopography.[5],[7],[9],[11],[13],[51]Clinically,settingtheworkinglength1mmshortofthe
radiographicapexmaypositionthefileexactlyattheACin22%,35%and11%ofanteriors,premolarsand
molars,respectively.[83]Unfortunately,continuouscementumdepositionalterstherelationofthe
radiographicapextotheAC.[76]Thisimpliesthattheuseofasingle'average'distancetolocatetheACis
unreliableandunrealistic.[10],[24],[66]The'unevenness'oftheACindicatesthatusingitasanapicalend
pointwouldresultinaworkinglengththatislongandshortatthesametime.[14]

RicucciandLangeland[62]advocatedtheneedforgoodanatomicalknowledge,carefulinterpretationofa
preoperativeradiographaccompaniedwithtactilesensationandvisualizationofbleedingonthetipsof
instrumentstoaidlocationoftheAC.FurtherstudiesareneededtoclarifythesuitabilityoftheACasthe
terminationpointforcleaningandshaping.[10],[84]

RadiographicapexastheidealapicalterminationpointSchilder[47],[52]recommendedextending
instrumentationandrootfillingtotheleveloftheradiographicapex,presumablytoincludeallapical
ramificationsinthedisinfectionandrootfillingprocedures.However,completeinstrumentationandfilling
oflateralcanalswaspracticallyimpossible.[85]Simon[1]suggestedinstrumentationtotheradiographic
apexandthensteppingbacktocreateanapicalstopfortherootfilling.Nolongtermresultsareavailableto
supportthisconcept.

Adoptingtheradiographicapexasareferencepointwouldresultinunderoroverinstrumentationbecause
theAFisusuallynotlocatedattheradiographicapex.[79],[28]Whenthefilewasinsertedtothelevelof
radiographicapexinvitro,50%oftheteethhadfilesextendingbeyondtheAF.[69]Filesterminatingatthe
radiographicapexinvivohadactuallyextendedbeyondtheAFinmostcases.[86]

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Apicallimitofinstrumentationandrootfillingforvitalteeth

Preservationoftheapicalpulptissuehasbeenrecommendedtoachieveabetteroutcomeinvitalimmature
permanentteeth.Thisvitaltissuehasbeenconsideredessentialforapicalclosurebynewlydepositedhard
tissueafterRCT.[51],[66],[87],[88]Insupportofthepreservationoftheapicalvitalpulpareprognostic
studiesindicatingthatthemaintenanceoftheapical23mmofvitalpulpprovidesfavorableresultsandthat
bothoverinstrumentationandoverfillingintheseteethhasanegativeimpactontreatmentoutcomes.[64],
[78],[87],[89],[90],[92]However,thevitalityoftheresidualapicalpulptissuewasnotalwaysmaintained.[93]

AsreviewedbySiqueira,[50]thecurrentevidenceindicatesthatthepreservationofthepulpstumpisnot
essentialforapicalintegrity.

Apicallimitofinstrumentationandrootfillingforinfectedteeth

Whiletheapical3mmisthemostcritical,[1]theentireinfectedrootcanalshouldbedisinfected
thoroughly.[50],[88]Microorganismslocatedattheapicalpartofthecanalhavebetteraccessibilityto
periapicaltissue.Thiswouldallowthemtoacquirenutritionandexertharmfuleffectsonthesurrounding
structures.[54]Theapicalpartsofinfectedrootcanalsexhibitingperiapicallesionswillharborabundant
bacteria.[94],[95],[96],[97],[98]Bacteriahavebeendetectedattheleveloftheapicalforamen[59]and
persistedinareasinaccessibletoinstrumentationintheapicalpartofrootsaftersinglevisittreatment.[99]
Nonetheless,bacterialprofilesoftheapicalpartofinfectedcanalsshowedadiversityofmicroorganisms
similartothecoronalpart.[100]Hence,thewholerootcanalmustbedisinfectedtotheleveloftheAF
becausebacteriaareabletocolonizetheentirecanalandthrive,especiallyapically.

TheeffectofoverinstrumentationontheoutcomeofRCTininfectedteethisyettobefullyexplored.
Overinstrumentationreducedthehealingrateofinfectedrootcanals.[92],[101]Evenwhenthelevelof
instrumentationwaslimitedtotheapexlevel,ahigherfrequencyofapicalperiodontitiswasobservedon
followup.[102]Theprognosisofinfectedrootcanalswasreportedtobeimprovedwhentheywere
instrumentedclosetotheirapices.[64],[65],[78]

Manystudiesconcludedthatterminatingtherootfillingwithin23mmoftheradiographicapexresultsin
thebestlongtermprognosisandoverfillingorunderfillingadverselyaffectedtheoutcome.[64],[78],[90],
[91],[92],[101],[102],[103],[104]Ontheotherhand,ithasbeensuggestedthattheextentofrootfillingdoesnot

influencetheapicalstatusofinfectedrootcanals.[105],[106],[107]Overfilledteethshowedsignsofapical
healingatlongerfollowupperiodsbecausetheextrudedmaterialdelays,butdoesnotprevent,healing.
[108]Insupportofthisfindingisthatresorptionofexcesssealerwasevidentwithlongerfollowup

observations.[109],[110]

Itmustbekeptinmindthatthelevelsofinstrumentationandrootfillingarerelatedfactorsandthatmost
commonlytherootcanalwillbefilledtothelevelitisinstrumentedto.Thus,separatingtheeffectofboth
factorsmightnotbepossible.Nevertheless,itseemsthattheybothexertasignificantinfluenceonthe
outcomeoftreatment,regardlessofthepreoperativepulpstatusofthetooth.[111]

Apicallimitofinstrumentationandrootfillingfornonsurgicalretreatmentcases

Overinstrumentationreducedthehealingrateofconventionalnonsurgicalretreatmentcasesandledto
developmentofnewapicallesions.[112]Overfillingwasfoundtoresultinlowerhealingratesof
conventionalnonsurgicalretreatmentcases.[112],[113]Thiswasincontrasttothefindingsreportedin
otherstudies,inwhichtheoutcomeofconventionalnonsurgicalretreatmentwasnotinfluencedbythe
extentoftherootfilling.[78],[114]Infact,Sjgrenetal.[78]identifiedthequalityofrootfillingtobemore
importantforachievingoptimumresultsafterconventionalnonsurgicalretreatment.Analyzingtheresults
oftheTorontostudyshowedthattheextentoftherootfillingsignificantlyaffectedthetreatmentoutcome
inthePhasesIandIIstudies.[115]WhenthesamplesizewasalmostdoubledinPhasesIIIandIV,this
factorwaseliminated.[116]Othersdemonstratedthatoverfilledretreatedteethmayshowsignsofapical
healingwhenthefollowupperiodwasextended.[117]

Conclusion

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TheapicalpartoftherootincludesseverallandmarksincludingtheAC,AFandCDJ.Adoptinganyof
theselandmarksasanapicallimitofinstrumentationandrootfillinghasitsadvantagesanddisadvantages.
Attaininganoptimumworkinglengthisaprerequisiteforfavorablerootcanaltreatmentoutcome.
VariabilityinthepositionsoftheAC,AFandCDJcomplicatestheirclinicaldetection.Theapicallimitof
instrumentationandrootfillingcoulddifferaccordingtothepreoperativestatusofthepulp.Rootcanal
treatmentoutcomestudiesreportedthatextendingtherootfillingtowithin23mmfromtheradiographic
apexisstronglyassociatedwithfavorableprognosis.

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Tables

[Table1],[Table2],[Table3],[Table4]

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4/20/2017 Theanatomyoftherootapex:AreviewandclinicalconsiderationsinendodonticsAlothmaniOS,ChandlerNP,FriedlanderLTSaudiEndodJ

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