Accessory Canals Research Articles

The dentary of Protolipterna ellipsodontoides: description, taxonomy, and palaeobiology

ABSTRACT Protolipterna ellipsodontoides is a small bunodont South American native ungulate, generally considered an early litoptern, exclusively found in the Palaeogene Itaboraí Basin. Its dentition is well known; however, its mandibular morphology was only known by fragmentary materials. Here, we describe the first complete mandible of this species. A micro-CT scan reveals the first case of alveolus resorption in this putative early litoptern. Two accessory canals on the retromolar region are also described. Canals on the retromolar region are documented for other mammalian orders; however, this represents the first description of this feature for the Protolipternidae. Unlike more advanced litopterns, this species lacks specialisations related to strict herbivory, and its dental and mandibular morphology suggests an omnivore habit. A comparison with the mandible of another Itaboraian protolipternid, Miguelsoria parayirunhor, indicates the presence of different dietary specialisations. Body mass estimations for both species are also provided.

Evaluation of hard tissue characteristics and calcifications in pulp tissue of hypomineralized permanent molars using micro-computed tomography

ObjectivesTo determine and compare pulp volume, dentin mineral density, presence of microcracks, pulp stones, and accessory canals, as well as their localizations in root regions for hypomineralized and healthy teeth. DesignThis study included 60 extracted permanent molar teeth, categorized into hypomineralized and healthy groups (n = 30 each). The hypomineralized group comprised molar teeth with limited white, yellow, or brown opacities, post-eruptive breakdown, or extensive restoration or crown damage. The healthy group included caries-free molar teeth without these characteristics. Using 3D micro-computed tomography images pulp volume, dentin mineral density, and the presence and locations of microcracks, pulp stones, and accessory canals were determined for each group. Statistical analyses were conducted using Independent T-test and Chi-square test, with significance set at p < 0.05. ResultsThere was no statistically significant difference between the groups regarding pulp volume and microcracks (p ≥ 0.05). The number of accessory canals was significantly greater in the cervical (p = 0.011; p < 0.05) and middle (p = 0.010; p < 0.05) regions of the hypomineralized teeth than healthy teeth. Dentin mineral density was statistically higher in the apical, middle, and cervical root regions (p < 0.001; p < 0.05); however, the number of pulp stones was found to be greater in the cervical regions of healthy teeth compared with those with hypomineralization (p = 0.026; p < 0.05). ConclusionThere were lower dentin mineral density measurements, a decreased number of pulp stones in the cervical region, and a greater number of accessory canals in the middle and cervical regions of hypomineralized teeth compared with healthy teeth.

Anatomy and function of the canalis sinuosus and its injury prevention and treatment strategies in implant surgery

The canalis sinuosus, a canal containing the anterior superior alveolar nerve bundle, originates from the infraorbital canal and extends along the maxillary sinus and nasal cavity edges to the anterior maxilla. It was once regarded as an anatomical variation. However, with the widespread application of cone beam computed tomography (CBCT), the detection rate of canalis sinuosus in the population has increased. The canalis sinuosus exhibits diverse courses, branching into multiple accessory canals and terminating at the nasal floor or the anterior tooth region, with the majority traversing the palatal side of the central incisor. The anterior superior alveolar nerve bundle within the canalis sinuosus not only innervates and nourishes the maxillary anterior teeth and the corresponding soft tissues, and the maxillary sinus mucosa, but also relates to the nasal septum, lateral nasal wall, and parts of the palatal mucosa. To minimize surgical complications, strategies for preventing and treating canalis sinuosus injuries need to be investigated. Preoperatively, CBCT is used to identify the canalis sinuosus and to virtually design implant placement at a distance of more than 2 mm from the canalis sinuosus. Intraoperatively, assessing bleeding and patient comfort, complemented by precision surgical techniques such as the use of implant surgical guide plates. Postoperatively, CBCT is used to examine the relationship between the implant and the canalis sinuosus, and treatment of canalis sinuosus injuries can be tailored based on the patient's symptoms. This review summarizes the detection of canalis sinuosus in the population, its anatomical characteristics, and the physiological functions in the anterior maxilla, and discusses strategies for avoiding canalis sinuosus injuries during implant surgery, thereby enhancing clinical awareness and providing references for clinical decision-making.

Evaluation of canalis sinuosus and accessory canal morphology by cone-beam computed tomography.

To evaluate canalis sinuosus (CS) and accessory canalis sinuosus (AC) morphology and their relationship with the impacted canine on cone-beam computed tomography (CBCT) images. The diameter and location of the CS, its distance from the nasal cavity (NC-CS), its distance from the buccal cortical plate (BC-CS), and its distance from the alveolar ridge crest (AR-CS) were evaluated on 1000 CBCT scans. The prevalence and termination of AC and the presence of impacted canines were also evaluated. CS was detected in 89 (8.9%) of 1000 CBCTs. The mean CS diameter was found as 1.34 ± 0.53mm. No statistically significant difference was found between gender, age, direction, and CS presence and diameter. CS was most frequently seen in regions 11 (23.6%) and 13 (23.6%). The average NC-CS, BC-CS, and AR-CS length was 6.14, 6.06 and 4.35mm, respectively. AC was detected in 22 patients (24.71%). There was no statistically significant difference between the presence of AC and gender, age, CS diameter, NC-CS, BC-CS, and AR-CS distance. BC-CS length and AR-CS length were statistically significantly higher in patients with impacted canines. It should be kept in mind that the CS diameter, NC-CS, BC-CS, and AR-CS distance may increase in the presence of an impacted canine and the integrity of the neurovascular structure should be preserved. The fact that the CS is often localized in the palatial region requires a detailed evaluation of the anterior maxillary region with three-dimensional imaging methods.

Prevalence and topography of bifid and trifid mandibular canal in Turkish Western Anatolia Population: evaluation of the inferior alveolar canal with CBCT.

Various anatomical variations of the inferior alveolar canal increase the incidence of surgical complications; Therefore, this study aimed to evaluate the frequency and configuration of bifid and trifid mandibular canals using cone beam computed tomography (CBCT) in the Turkish subpopulation. The inferior alveolar canal was evaluated on 1014 hemi-mandibles in the CBCT (I-CAT 3D Imaging System) images of 513 patients. The frequency and configuration of the bifid and trifid mandibular canal (MC) were examined. The relationship between bifid MC configuration and dental status and age groups was analyzed. The distance of the accessory canal to the buccal and lingual walls and the alveolar crest was measured. The diameter of the main canal and accessory canal was measured and its relationship with dental status and age groups was evaluated. Bifid MC was found in 266 hemi-mandibles (24.7%) and 212 (41.3%) of 513 patients. The most common type of bifid MC was the retromolar canal (87 sides), followed by the forward canal without confluence (41; 4%) and the dental canal (34; 3.4%). 10 of the dental canals were opening to the 1st molar, 14 of the 2nd molars, and 10 of the 3rd molars. The number of retromolar foramina was 1 on 56 sides, 2 on 15 sides, and 3 on 4 sides. Forward canal without confluence was more common in edentulous patients than in dentulous patients, while the dental canal was more common in dentulous patients. The main canal diameter was 3.53 ± 0.97mm and the bifid MC diameter was 1.82 ± 0.70mm. Distance of the bifid MC to the lingual wall was higher in the > 64years group than in the 18-39years group (p = 0.022). Distance of the bifid MC to the alveolar crest was lower in the > 64years group compared to the 18-39years group and 40-64years group (p = 0.015). The main canal diameter was higher in the 40-64years group than in the 18-39years group (p = 0.012). Bifid MC has a high prevalence, occurring in almost one in two patients. Dental and retromolar types, which are close to the teeth, are more common, and this increases the possibility of complications. CBCT is the most accurate imaging technique used to detect and define these variations.

Anatomical Factors of the Anterior and Posterior Maxilla Affecting Immediate Implant Placement Based on Cone Beam Computed Tomography Analysis: A Narrative Review.

The aim of this narrative review was to provide insights into the influence of the morphological characteristics of the anatomical structures of the upper jaw based on cone beam computed tomography (CBCT) analysis on the immediate implant placement in this region. To conduct this research, we used many electronic databases, and the resulting papers were chosen and analyzed. From the clinical point of view, the region of the anterior maxilla is specific and can be difficult for immediate implant placement. Anatomical structures in the anterior maxilla, such as the nasopalatine canal and accessory canals, may limit and influence the implant therapy outcome. In addition to the aforementioned region, immediate implant placement in the posterior maxilla may be challenging for clinicians, especially in prosthetic-driven immediate implant placement procedures. Data presented within the recently published materials summarize the investigations performed in order to achieve more reliable indicators that may make more accurate decisions for clinicians. The possibility for immediate implant placement may be affected by the NPC shape in the anterior maxilla, while the presence of ACs may increase the incidence of immediate implant placement complications. The variations in IRS characteristics may be considered important criteria for choosing the implant properties required for successful immediate implant placement.

Root canal morphology of permanent mandibular anterior teeth in a Pakistani population: A cone beam computed tomography assessment.

To investigate the incidence of accessory canals and the variation in root canal morphology of permanent mandibular incisors and canines in Pakistani population using Cone Beam Computed Tomography (CBCT). A cross-sectional study was conducted in University College of Dentistry, The University of Lahore, Pakistan after getting institutional ethical permission from January 2020 to September 2022. The data included records of 111 patients consisting of 444 permanent mandibular incisors and 222 permanent mandibular canines. Accessory root, root canals and Vertucci canal configuration for each tooth was recorded. Data analysis was done using SPSS v20. Descriptive statistics were calculated for each anatomical parameter. Chi-square test was applied to determine association of gender with the presence of accessory roots and root canals. Among the 111 records evaluated, 48.6% were males and 51.4% were females. No accessory root was found in the central and lateral incisors. However, an accessory root was found in 4.9% of the canines. The incidence of accessory canals in the central incisors, lateral incisors and canines was 18.9%, 25.2% and 10.4% respectively. The most common canal configuration in teeth with accessory canals was Type-III, followed by Type-II and Type-V. None of the central or lateral incisor showed accessory root while it was detected in 4.9% canines. The frequency of accessory root canal was found to be 18.9%, 25.2% and 10.4% in central incisors, lateral incisors and canines respectively. The most common canal configuration was Type-I, followed by Type-III and Type-II. Type-V, VI and VII were less common.

Anatomical Variations of the Canalis Sinuosus: A CBCT Study

Objective: Canalis sinuosus (CS) is a bony canal separated from the infraorbital nerve containing the anterior superior alveolar vessel-nerve bundle. This study aimed to assess the anatomical variations of the canalis sinuosus from cone-beam computed tomography (CBCT) images. Methods: CBCT images of 568 patients (328 females and 240 males; aged between 18 and 81 years old) were evaluated retrospectively. Axial, sagittal, coronal, and cross-sectional images with 0.5 mm slice thicknesses were used to evaluate the presence of CS and associated accessory canal (AC). Results: Bilateral CS was detected in the entire sample (n=568, 100%). A total of 340 ACs were detected, including at least one AC in 41.9% of the patients. The median value of AC diameter was calculated as 0.89 mm both for females and males. ACs were found in 135 females and in 103 males. One up to five ACs were found per patient. However, the majority of the patients had one AC. ACs were mostly located at tooth region 11 (17.9%) and tooth region 12 (16.4%). Only 59.71% of ACs had a radiographically observed foramen. Conclusion: In conclusion, all patients had CS and ACs were in nearly half of the patients. Knowledge about these structures aid to correct radiographic diagnosis of these canals and minimize the risk of complications during surgical procedures.

Prevalence and Anatomical Characteristics of Bifid and Trifid Mandibular Canals: A Computer Tomography Analysis.

To assess the prevalence and configuration of bifid (BMC) and trifid (TMC) mandibular canals using computed tomography (CT), describing the anatomical characteristics of the accessory canals, especially of the retromolar type. CT scans of 123 patients were analysed. BMCs were identified and the patterns of bifurcation were classified, including trifid canals. The width of accessory canals was measured. Retromolar canals were further classified according to their course and morphology, while their position and width were evaluated using linear measurements on CT images. The majority of patients (53.6%) presented at least one BMC or TMC. 36.2% of mandibular canals were bifid, while 4.5% were trifid. The forward canals (12.6%) and retromolar canals (10.2%) were the most common among BMCs. In relation to the retromolar canals, 60% were vertical and 40% curved, with a mean width of 1.03 ± 0.28mm. BMCs and TMCs are common 3D radiographic findings, so that they should be considered as anatomical variations, not anomalies. Preoperative CT or CBCT evaluation should aid in identifying these variations and analysing their position and course in surgical planning.

Bacterial adhesion and microleakage of restorative materials for sealing accessory canals in implant prosthesis.

The level of bacterial adhesion and bacterial microleakage in four different materials utilised to seal the access passage of screw retained implant supported prosthesis (SRIP) is of interest to dentists. Four distinct categories were created from the samples on the basis of restorative materials used for sealing access passage in SRIP. Guttapercha and light cured acrylic resin were found to have comparatively low bacterial adhesion and bacterial microleakage in sealing accessory canals in screw retained implant supported prosthesis.

Identification of Middle Mesial Canal in Mandibular Molars Using Five Different Techniques: An In vitro Study.

The purpose of the study was to find out the incidence of the middle mesial canal in mandibular molars by using five different techniques. A total of 150 extracted human mandibular first molars were selected, and cone beam computed tomography (CBCT) images were taken. Then, conventional access cavities were made, followed by troughing under dental loupes (3X), and were also examined under a dental operating microscope (DOM) (6X). Incidence of intermediate canals was noted from all these stages. Later, these teeth underwent a clearing method procedure, and incidence was noted from this stage and compared. The overall diagnostic accuracy of CBCT (9 mm) had 97.48%, and evaluation under DOM had an overall accuracy of 97.33%. The least accuracy was found with the naked eye (92.67%). This study advocates the usage of newer methods like CBCT and DOM to find out and negotiate these accessory canals.

Obturarea canalelor laterale la premolarul secund maxilar – prezentare a două cazuri clinice

The lateral canals are communication pathways between the main endodontic canal and the periodontal space. In case of pulpal pathosis, it is very important to seal the main canal together with lateral and accessory canals, because that means a premise for the rapid healing of apical pe­rio­dontitis. Endodontic obturation method of warm ver­ti­cal condensation most commonly seals the lateral and ac­ces­sory canals as well. The radiographic examination can show the presence and the correct filling of these little ra­mi­fi­ca­tions.

Micro-computed tomographic analysis of the morphology of maxillary lateral incisors

ObjectiveThis study aimed to investigate the morphology of maxillary lateral incisors (MxLI) using micro-computed tomography (micro-CT).Materials and methodsThe root canal configurations (RCC) of maxillary lateral incisors (MxLI) of a mixed Swiss-German population were examined using micro-CT, 3D imaging, and a 4-digit system code indicating the main root canal from coronal to apical thirds and the main foramina number.ResultsThe most frequently observed RCC of MxLI were 1-1-1/1 (Vertucci I/Ve I, 80.0%), 1-1-2/2 (Ve V, 7.3%), 1-2-1/1 (Ve III, 6.4%), 2-1-1/1 (Ve II, 1.8%), and 1-1-1/2 (1.8%)(n = 110). Three additional RCC were observed less frequently (0.9%). The MxLI showed one physiological foramen in 89.1%, two in 9.1%, and seldom three (1.8%). Most accessory canals were identified in the apical third of a root (20.0%), and no accessory canals in 72.7% of the samples.ConclusionsDetailed information on the internal morphology of MxLI of a Swiss-German population is given. The most frequently observed RCC of MxLI is 1-1-1/1 (Ve I). However, accessory canals may occur in all apical thirds, and 20% of all teeth investigated showed a challenging RCC for clinical treatment.Clinical relevanceThis study offers clinicians comprehensive data on MxLI morphology, emphasizing the significance of understanding varied RCC and accessory canal presence for improving root canal treatment outcomes. Over 25% of teeth exhibited complex RCC or accessory canals, influencing decisions during root canal treatment.

Exploring the Interface: A Case Series on Endoperio Lesions.

Endoperiodontal lesion is a result of pathological/inflammatory connections between pulpal and periodontal tissues via open structures like apical foramina, dentinal tubules, and lateral accessory canals. This case series deals with endoperio lesions in which regenerative treatment is performed post-root canal treatment (RCT). Post 6 months, results suggested uneventful healing with gain in clinical attachment level.

Reliability of Three-Dimensional Micro-Computed Tomography Root Canal Analysis Using Drishti Software: A Pilot Study

In recent years, micro-computed tomography (micro-CT) has become a promising tool for non-destructive imaging and the study of root canal morphology in endodontics. However, the reliability of such analyses heavily relies on the accuracy and consistency of the software used for image processing. Objective: This study aims to investigate the reliability of two different micro-CT voxel sizes using open-source three-dimensional (3D) software (Drishti v3.0) used to identify and quantify the Apical Foramen (AF) and Apical Constriction (AC) in mandibular premolars. Methods: Eight mandibular premolars were divided into two groups, with four samples in each group. Samples were scanned using a ZEISS X-Radia 520 Micro-CT system with two different voxel sizes of 23 µm (Group A) and 17 µm (Group B), respectively. The micro-CT data were reconstructed and transferred to Drishti Software, and individual image rendering was performed to visualize the images for data analysis. The position and measurement of AF and AC to the anatomical apex were measured individually and independently by single operators. Results: The reliability of the measurements assessed using Intraclass Correlation Coefficients (ICCs) between two voxel sizes was excellent and on par with previous research. This pilot study suggested that results for voxel sizes of 23 µm and 17 µm were comparable. Both voxel size 3D images demonstrated excellent and high-quality visualization of the root canal configuration, lateral and accessory canals, apical deltas, major AF, and AC. Conclusion: It is feasible and reliable to visualize and analyze 3D micro-CT images using open-source software (Drishti v3.0). Both voxel sizes of 23 µm and 17 µm are recommended for use in root canal study.

Influence of root shape on canal complexity at the mandibular molar apical surgical resection level: A micro-CT study

ObjectivesThis study aimed to investigate the relationship between the aspect ratios of mandibular molar roots at the apical 3-mm level and their root canal complexity. DesignThis study used micro-CT imaging to analyze 163 two-rooted mandibular molars. The aspect ratios of the roots at the apical 3-mm level were categorized as "< 2.75" or "≥ 2.75" (mesial) and "< 1.75" or "≥ 1.75" (distal). A two-dimensional (2D) analysis focused on four apical axial cross-section levels to determine the presence of main and accessory canals and isthmus. Additionally, a three-dimensional (3D) assessment of the apical 4-mm of both roots examined main and accessory canals, apical foramina, apical deltas, and middle mesial canals. ResultsMesial roots with aspect ratios ≥ 2.75 showed a higher number of main canals at all levels compared to those with aspect ratios < 2.75 at the 3-mm level. Additionally, the ≥ 2.75 group exhibited more accessory canals and a higher average number of accessory canals. The 3D assessment confirmed significantly more accessory canals and apical foramina in the ≥ 2.75 group. The prevalence of roots with apical deltas was nearly double in the ≥ 2.75 group, and middle mesial canals were exclusively found in this group. In the distal root, the ≥ 1.75 group showed a significantly higher number of main canals at all axial levels. No significant differences were observed between groups in terms of accessory canals, apical foramina, or deltas. ConclusionsA higher root aspect ratio is related to higher anatomical complexity.

Root and canal morphology of the maxillary first molar: A micro-computed tomography-focused observation of literature with illustrative cases. Part 2: Internal root morphology

The complexity of root canal morphology can influence cleaning and shaping of the root canal system and, ultimately, treatment outcomes. Undiscovered root canal morphology can greatly reduce the prognosis of endodontic treatment due to the preservation of offending organisms and their by products. The maxillary first molar has been identified as one of the most challenging teeth to treat endodontically due to its complex internal anatomy, the presence of additional and accessory canals and intricate root canal configurations. This paper is the second of two that provide a micro computed tomography (micro-CT)-focused overview of available literature on various aspects of the root and canal morphology of the maxillary first permanent molar. The aim of this paper is to provide an overview of relevant aspects of the internal root morphology in different populations. The content is supported by illustrative micro-CT images and clinical cases or images.

Micro-CT and histological examination of accessory canals in 34 equine cheek teeth.

Accessory canals and apical deltas have been extensively studied in human dentistry. Their clinical role as a difficult to clean reservoir for bacteria during endodontic treatments has been well described. Many papers describe in detail the pulp anatomy of equine dentition but little attention has been given to their apical ramifications. The goal of this paper is to describe the presence and anatomy of these accessory canals and apical deltas in healthy equine cheek teeth and discuss their possible relevance in the light of equine endodontics. To accomplish this, 15 maxillary and 19 mandibular healthy cheek teeth were collected ranging from Triadan 06 s to 11 s with eruption ages from 4 to 9 years. Their root anatomy was documented in detail based on micro computed tomography images. A subset of 3 teeth also underwent histological examination. Accessory canals were found in all but two teeth examined. Up to 44 accessory canals per tooth have been found with locations ranging from the root furcation down to the apex of the root and with highly variable diameters. Apical deltas in different stages of development were found in 84% of the roots. The presence of accessory canals identified on microCT images could be confirmed using histological examination although some of them were obliterated by reparative dentin. Accessory canals can be found in most equine cheek teeth and add complexity to their endodontic anatomy. This could have important implications for their treatment in case of pulp pathology. In humans, failure to remove bacterial biofilm from such canals has been associated with failure of endodontic treatment. Research on diseased equine teeth is required to gain a better understanding of their clinical relevance in horses.

Diode laser to enhance irrigation of the root canal system: systematic literature review

The use of lasers in endodontics has revolutionized the dental field by offering a precise and less invasive option to treat pulp and periapical problems. This is why the importance of the diode laser in endodontics is recognized in order to potentiate the irrigation of the root canal system. The aim of this study was to interpret, by means of a systematic literature review, the use of the diode laser to enhance root canal irrigation in endodontics. Through a systematic review, 18 original articles related to the aforementioned topic were analyzed, which were obtained from the electronic search of the following databases: Springer, BioMed Central, Multidisciplinary Digital Publishing Institute, PubMed, Wiley Online Library. In addition. It was obtained as results that it is possible to reach areas such as lateral or accessory canals that may be inaccessible for traditional irrigation techniques, eliminating dentin debris, smear layer and other residues; however, despite its advantages it should be considered that the application of the diode laser should not replace conventional treatment, but should be considered as a possible complementary treatment. It is concluded that the application of the diode laser in endodontic therapy improves the efficiency of root canal system disinfection

Evaluation of the Accessory Canals of Canalis Sinuosus Via Cone Beam CT

Objective: Canalis sinuosus (CS) is a common anatomical variation in the anterior maxilla that originates from the infraorbital canal and carries the anterior superior alveolar nerve and vessels. This study aimed to examine the presence, frequency, and features of CS and its accessory canals (ACs) using cone beam computed tomography (CBCT) images.&#x0D; Methods: A total of 495 CBCT images were retrospectively analyzed in axial, sagittal, and coronal sections. Patient age and sex, presence or absence of CS, location as right, left, or bilateral if CS was present, and number of ACs were recorded. In addition, the end regions of the ACs were recorded as central incisor, central-lateral incisor, lateral incisor, lateral incisor-canine, and canine regions. All recorded data were statistically analyzed.&#x0D; Results: At least one CS was found in 54 (10.9%) of 495 CBCT images. CS(s) were bilateral in 26 (48.2%) cases and unilateral in 28 (51.8%; 25 on the left and 3 on the right side). The ACs of the CS predominantly terminated in the lateral incisor region (p =.025). The frequency of CS was not statistically different between males and females (p =.313).&#x0D; Conclusion: Accessory canals in the anterior maxilla are mostly associated with branches of the CS. In the current study, the prevalence of CS was 10.9%, and most of the CSs were opening in the lateral incisor region. Detection of accessory canals in the anterior maxilla and examination of this region with CBCT will prevent misdiagnoses and postoperative complications arising from damage to these structures.