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Balto K – This review illustrates the current lack of published or ongoing RCT, and the lack of availability of high–level evidence dealing with clinically relevant outcomes, for the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment. Future RCT might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis not only on clinically relevant but also patient–centred outcomes.

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