Abstract
The present study used microcomputed tomography (micro-CT) images to assess the prevalence, number, and location of apical ramifications (ARs) in the root canals of different dental groups in a Brazilian population. Three hundred and sixty-seven extracted human teeth, totaling 475 roots, were scanned by micro-CT at 19.6 µm spatial resolution. The obtained images were evaluated by two observers in consensus, and a descriptive analysis was performed to verify the prevalence, number, and location of ARs in each dental group. Chi-square test was used to compare the prevalence of ARs in different types of roots, and one-way analysis of variance compared the number of ARs in the apical 1 mm, 2 mm, and 3 mm of the root. Significance level was established at 5% (α=0.05). ARs were present in 253 (53.3%) of the 475 roots evaluated. A total of 607 ARs were detected, with the vast majority (530) located at one and two millimeters from the main foramen. The highest prevalence of ARs was observed in maxillary canines (65%); maxillary premolars - single-rooted (83.3%), buccal root (80%), and palatine root (73.3%); mandibular premolars (64.2%); mesiobuccal root of maxillary molars (76.6%); and mesial root of mandibular molars (66.6%). For the Brazilian population, most of the ARs are located in the apical 1 and 2 mm of the root, with greater prevalence in the posterior teeth and maxillary canines. These findings suggest the need for additional attention while planning endodontic treatments, including strategies to effectively clean and fill the apical region.
Highlights
Knowledge about the anatomical complexities of the root canals is highly associated with a successful endodontic therapy, due to the influence of such complexities on diagnosis, planning and clinical conduct [1,2]
apical ramifications (ARs) connect the main canal to the periodontal ligament and, as they are unlikely to be cleaned with conventional instrumentation and irrigation, biofilms may grow and cause periapical diseases [5,6]
Data Collection The study sample was composed of 367 extracted human teeth: 42 mandibular incisors, 58 maxillary incisors, 47 mandibular canines, 35 maxillary canines, 53 mandibular premolars, 69 maxillary premolars, 33 mandibular molars and 30 maxillary molars
Summary
Knowledge about the anatomical complexities of the root canals is highly associated with a successful endodontic therapy, due to the influence of such complexities on diagnosis, planning and clinical conduct [1,2]. Knowledge about the prevalence of irregularities in the apical region of different groups of teeth may guide the need for more specific procedures such as correct determination of the working length, agitation of irrigating solutions, and filling of ARs using an adequate obturation technique, in order to prevent an inflammatory response or treatment failure [7,8]. Considering the impact of root canal anatomy on endodontic therapy, several studies using different evaluation methods, such as histology, clearing technique, scanning electron microscopy, cone beam computed tomography and microcomputed tomography (micro-CT), have been performed [4,9,10]. The aim in this study was to assess the prevalence, number, and location of apical ramifications in the root canals of different dental groups of a Brazilian population, using micro-CT images
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