Abstract
Introduction. Mandibular premolars have been reported with complex anatomical aberrations, making them one of the most difficult teeth to manage endodontically. Methodology. An exhaustive search was undertaken to identify associated anatomic studies of mandibular premolars through MEDLINE/PubMed database using keywords, and a systematic review of the relevant articles was performed. Chi-square test with Yates correction was performed to assess the statistical significance of any anatomic variations between ethnicities and within populations of the same ethnicity. Documented case reports of variations in mandibular premolar anatomy were also identified and reviewed. Results. Thirty-six anatomic studies were analyzed which included 12,752 first premolars and nineteen studies assessing 6646 second premolars. A significant variation in the number of roots, root canals, and apical foramen was observed between Caucasian, Indian, Mongoloid, and Middle Eastern ethnicities.The most common anatomic variation was C-shaped canals in mandibular first premolars with highest incidence in Mongoloid populations (upto 24%) while dens invaginatus was the most common developmental anomaly. Conclusions. A systematic review of mandibular premolars based on ethnicity and geographic clusters offered enhanced analysis of the prevalence of number of roots and canals, their canal configuration, and other related anatomy.
Highlights
Mandibular premolars have been reported with complex anatomical aberrations, making them one of the most difficult teeth to manage endodontically
The pulp space is divided into two parts: the pulp chamber, which is usually described as that portion within the crown, and the pulp canal or root canal, which lies within the confines of the root
An exhaustive search was undertaken through MEDLINE/PubMed database to identify published literature related to the root anatomy and root canal morphology of the permanent mandibular premolars by using key words “root canal anatomy,” “root canal morphology,” “mandibular premolars,” “mandibular first premolar,” and “mandibular second premolar,” alone or in combination
Summary
Mandibular premolars have been reported with complex anatomical aberrations, making them one of the most difficult teeth to manage endodontically. A significant variation in the number of roots, root canals, and apical foramen was observed between Caucasian, Indian, Mongoloid, and Middle Eastern ethnicities.The most common anatomic variation was C-shaped canals in mandibular first premolars with highest incidence in Mongoloid populations (upto 24%) while dens invaginatus was the most common developmental anomaly. Other canal complexities are present and exit the root as one, two, or more apical canals (Types II–VIII) [2] This could be better understood through an insight into the development of root formation. If two or three tongues of epithelium grow towards each other from this collar to bridge the gap and fuse, two or three diaphragms evolving independently from each other will form They will either remain fused, forming fused roots, or single roots with multiple canals, or separated, forming distinct roots in multirooted teeth [3]
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