Accessory Canals Research Articles

Incidence Of Accessory Canals In Maxillary Molars Under 25 Years Of Age And Its Association With Gender

The field of medicine is an ever changing science undergoing continuing tremendous development. A better understanding of art and science of endodontics have accelerated the introduction of various treatment modalities that has made the field flourish in the aspect of prognosis of different dental problems. Root canal treatment on a global basis has reported to be increasing as well, hence in this current scenario it is important for the clinician to have a thorough knowledge regarding the root canal anatomy and morphology for a successful treatment outcome. In this study we have attempted to assess and understand the influence of accessory canals in maxillary molars under 25 years of age and its influence on gender. The study was carried out in a university setting where the patient records were reviewed and analysed and a data of 86000 patients between June 2019 and March 2020 was collected and compiled, reviewed, tabulated, and exported to the Statistical Product and Service Solutions (SPSS) software for statistical analysis. A statistically significant data was not obtained from the study, but the data has remarkable clinical significance. Within the limitations of the study it has been found that 8% of the total entries analysed were indicated with accessory canals and a future extensive research involving a larger data will help in the diagnosis and treatment planning for the root canal of maxillary molars.

Endodontic approach to mandibular molars with accessory mesial canals: Case Series

Endodontic approach to mandibular molars with accessory mesial canals: Case Series

Mesiobuccal Root Canal Morphology of Maxillary First Molars in a Brazilian Sub-Population - A Micro-CT Study.

Objective:This study aimed to investigate the root canal system morphology of maxillary first molar mesiobuccal (MB) roots in a Brazilian sub-population using micro-computed tomography.Methods:Ninety-six MB roots were scanned with a micro-CT (Skyscan 1173, Bruker). Three-dimensional images were analyzed regarding the number of pulp chamber orifices, the number and classification of the canals, the presence of accessory canals in different thirds of the root as well as the number and type of apical foramina.Results:A single entrance orifice was found in 53.0% of the samples, two in 43.9% and only 3.1% had three orifices. The second mesiobuccal root canal (MB2) was present at some portion of the root in 87.5% of the specimens. A single apical foramen was present in 16.7%, two in 22.9%, and three or more foramina in 60.4% of the roots. Only 55.3% and 76.1% of the root canals could be arranged by Weine’s and Vertucci’s classifications, respectively.Conclusion:The number of orifices at the pulp chamber level could not work as a predictor of the MB2 presence. The most prevalent canal configuration was Weine type IV / Vertucci type V. The anatomical complexity of the MB root could not be entirely classified by the current most accepted classifications.

Observation of double mandibular canals and types of bifid canals in dry skulls

Background/Aim: The aim of the present study was to assess prevalence and morphologic mandibular canal variations in dry skulls. Material and Methods: Panoramic radiographs were obtained of 57 skulls among the academic collection at the University of Pittsburgh. Orthodontic wire was inserted through the mandibular canal as a reference point at panoramic images for localization of the course of the mandibular canal. Results: Double mandibular canals were present in 2 out of 57 skulls (3,5%); one of them was unilateral the other one was bilateral. Additionally, bifurcation of the mandibular canal and different types of configurations were assessed. In five of the specimens (8,8%) bifid canals were identified. Among them, one case (1,7%) was identified as a forward type. In one case additional canal (1,7%), was detected in the retromolar region, which joined the main canal. Three of the specimens (5,3%) showed accessory canal types. These were the canals that detached from the main canal and proceeded towards the molar teeth roots (dental type). All of these bifid canal types were unilateral. Conclusions: Our results depicted the anatomical variations of the mandibular canal. Dental practitioners should be aware of this underestimated but not a rare occurrence of mandibular canal variations in order to avoid complication during surgical procedures.

3-dimensional Analysis and Literature Review of the Root Canal Morphology and Physiological Foramen Geometry of 125 Mandibular Incisors by Means of Micro–Computed Tomography in a German Population

IntroductionThe aim of this study was to examine the root canal system morphology of mandibular incisors by means of micro–computed tomographic imaging. MethodsThe root canal configuration, physiological foramina, frequency of accessory and connecting canals, and the size and shape of the physiological foramina of 125 mandibular incisors were investigated by means of micro-CT and 3-dimensional imaging software. Root canal configuration of the coronal, middle, and apical thirds and the physiological foramina number are described by a 4-digit system code. ResultsThe most frequent root canal configurations were 1-1-1/1 (56%), 1-2-1/1 (17.6%), and 1-1-1/2 (10.4%); 9 additional different root canal configurations were observed. Single-rooted incisors showed in 80% 1, in 16% 2, and in 4% 3 physiological foramina, respectively. Accessory canals were found in only 13.6% of the investigated teeth. Connecting canals were observed in 36% of the sample, most often in root canal configurations 1-2-1/1 (12.8%) and 2-2-1/1 (7.2%). The morphologic dimensions of a total of 146 physiological foramina were measured. Their mean wide and narrow diameters were 0.24 mm (standard deviation = 0.1 mm) and 0.23 mm (standard deviation = 0.08 mm) when only 1 physiological foramen was present. The physiological foramen shapes observed were oval (56%), round (28.8%), and irregular (15.2%). ConclusionsThe study provides detailed information about the root canal morphology of anterior teeth in a German population. Within the limitations of the study, the authors recommend according to results obtained in this investigation a final physiological foramen preparation size of ISO 30-35; yet, such a decision should be carefully considered on an individual basis.

Assesment of accessory branches of canalis sinuosus on CBCT images.

Background The aim of this study is to describe the presence, to reveal the frequency and characteristics of accessory canals (ACs) of the canalis sinuosus (CS) by cone beam computed tomography (CBCT). Material and Methods A total of 326 CBCT examinations were scanned retrospectively. The anatomical views were evaluated on sagittal, axial, coronal and cross sectional imaging. The following parameters were recorded: age, sex, presence or absence of ACs, location in relation to the adjacent teeth and distance to the nasal cavity floor (NCF), alveolar ridge crest (ARC) and buccal cortical bone (BCB), and incisive canal. All the collected data were statistically analyzed. Results 113 patients (34,7%); presented ACs in total 214 foramina of the sample. There were no statistically significant changes in the presence of ACs regarding age groups excluding 80-89 years. But there is a statistically significant difference regarding the frequency of ACs and the gender. The prevalence for male patients was higher than female patients. Curved-shape configuration of CS prevalence is found as 69,15%. The prevalence of vertical tracing is 26,16% and Y-shape configuration of CS prevalence is 4,67%. Diameter of the foramens of the CS branches was 1.30 mm. The mean distance of the AC to the NCF, BCB, and ARC were found 13,83 mm, 6,60 mm and 5,32 mm, respectively. Conclusions In the anterior palatal region, ACs are mostly related to CS’s branches. So; knowing the course of CS branches in surgical planning and radiographic evaluations in this region is extremely important for preventing complications and avoiding misdiagnosis. Key words:Anterior superior alveolar nerve, canalis sinuosus, maxilla.

Comparative Evaluation of Antimicrobial Efficacy of Calcium Hydroxide, Chitosan, Chlorhexidine and Their Combinations Against Enterococcus Fecalis and Candida Albicans Using Quantitative Real Time Polymerase Chain Reaction – An In Vitro Study

Bacterial invasion of root canal system is crucial for the onset and maintenance of periapical diseases. Hence, one of the goals of the endodontic treatment is to kill micro-organisms in the root canal system. Although, biomechanical preparation and root canal shaping effictively reduces the microbiota, these procedures do not completely eliminate bacteria in the lateral and accessory root canals, isthmi, and apical deltas. Thus, intracanal medication between appointments is recommended to further reduce bacteria in the root canal system.

Application of a new system for classifying tooth, root and canal morphology in the primary dentition.

Knowledge of root and canal morphology is essential for the effective practice of root canal treatment. Paediatric endodontics aims to preserve fully functional primary teeth in the dental arch; however, pulpectomy procedures in bizarre and tortuous canals encased in roots programmed for physiologic resorption are unique challenges. A new coding system for classifying the roots and main canals (https://doi.org/10.1111/iej.12685), accessory canals (https://doi.org/10.1111/iej.12800) and developmental anomalies (https://doi.org/10.1111/iej.12867) has been introduced recently. This paper discusses challenges for describing root and canal morphology in primary teeth and describes the potential application of the new classification system for root canals in the primary dentition.

Evaluation of Root Canal Morphology and Root Apex Anatomy of Mandibular Premolars in an Iranian Population: an ex-vivo study

Objectives Adequate knowledge about canal anatomy is necessary for clinicians to prevent any damage to the periodontium. The aim of this study was to evaluate the canal and apical complexities of the mandibular first and second premolars in an Iranian population. Methods One-hundred mandibular first (n=50) and second (n=50) premolars were collected. After access cavity preparation, 2% methylene blue was injected into the canals, and they were sealed with Coltosol and nail varnish. Next, demineralization and clearing with 5% nitric acid and methyl salicylate were performed. Apical morphology including the presence of accessory canals, apical delta, anastomoses and canal configurations was evaluated under a stereomicroscope at x16 magnification. Descriptive statistics (including tables, central tendency and dispersion tests) were used for data analysis. Results The most prevalent form of canal type was Vertucci’s type I in first and second premolars. The mean distance between the apical foramen and anatomic apex, apical foramen and apical constriction, and apical constriction and anatomic apex was 0.3, 0.6 and 0.9 mm, respectively for the first premolars. These values were 0.3, 0.5 and 0.8 mm, respectively for the second premolars. Conclusion Although most mandibular premolars have one canal, using appropriate cleaning methods is imperative because of high prevalence of accessory canals, anastomoses and apical deltas. First premolars pose more challenges in this respect

Clinical Appearance of Lateral Incisive Canal

A 59-year-old patient was referred to dental clinic for immediate dental implantation in the area of upper central incisors due to severe periapical lesions which not subjected to endodontic retreatment and periapical surgery. Removal of central incisors and periapical lesions, dental implant placement were performed under local anesthesia with sedation. During the surgery a significant bleeding was noted from a unilateral accessory canal (asterisk). In our case, it exited at the palatal aspect of tooth 2.1; its foramen was of oval shape and measured 2.00 × 3.00 mm. In case of that canal`s location it terms lateral incisive canal. Other similar terms can also be applied to describe this rare anatomical structure: accessory canal of the anterior maxilla, lateral incisor canal, and neurovascular variation in anterior palate. Panel clearly demonstrates the axial intraoperative view after bone drilling (circle) (preparing a hole for second implant); implant analog (which is used for correct positioning of implant) inserted into socket of tooth 1.1 is indicated by triangle. Lateral incisors marked by numbers 1.2 and 2.2.

Endodontic Retreatment of a Maxillary Central Incisor with Two Root Canals in a Patient with Cleft Lip and Palate.

The failures in endodontic treatments are often related to anatomical variations. Some anatomical changes in anterior teeth occur in patients with cleft lip and palate. This paper aims to report the endodontic retreatment of a maxillary central incisor with two roots and two canals on a patient who presents cleft lip and palate. A male patient, 11-year-old, reported pain when chewing related to the left maxillary central incisor tooth (tooth 21) which featured a sinus tract after primary endodontic treatment. In periapical radiograph, it was observed an alteration on the anatomy of the root on the tooth 21, which featured a radiolucent area on the dental apex and had been properly endodontically treated. In cone-beam computed tomography (CBCT) images the presence of an accessory root in the palatal region was observed, that had not been prepared, or filled. Thus, the non-treated accessory canal was instrumented with the crown-down technique and filled with gutta-percha and endodontic sealer. After 1 year of follow-up, the patient presented the tooth with a normal masticatory function and no painful symptoms. Therefore, it can be concluded that the additional root canals may be present and the CBCT is an important tool to evaluate the internal root morphology. In cleft lip and palate patients, the root canals morphology should be carefully analyzed due to high prevalence of dental anomalies which may influence the success in endodontic treatment.

Micro–computed Tomographic Evaluation of the Prevalence, Distribution, and Morphologic Features of Accessory Canals in Chinese Permanent Teeth

IntroductionThe present study used high-resolution micro–computed tomographic imaging to investigate the prevalence, distribution, and morphologic features of accessory canals (ACs) in the Chinese population. MethodsScanning was performed on 1400 extracted permanent teeth using 15-μm resolution. The prevalence and distribution of the ACs in those teeth were analyzed. The number of ACs was calculated based on the following morphologic features: patent ACs without branching, obstructed ACs without branching, and branched ACs. Patent ACs were virtually segmented for measurements of their length and tortuosity. ResultsACs were identified in 735 teeth (401 upper and 334 lower teeth). The incidences of ACs in the mesiobuccal and mesial roots were higher in the upper and lower molars. Of the 1611 ACs detected, 1182 were patent ACs without branching, 291 were obstructed ACs without branching, and 138 were branched ACs. In those branched ACs, 114 were type 1-2, 20 were type 2-1, and 4 were type 1-2-1. Most ACs were located in the apical third of the canal space (86.5%), with a median length of 880.9 μm. The length of ACs in the apical third was significantly shorter than those in the middle and coronal thirds of the canal space (P < .05). ConclusionsFor the Chinese population, most ACs are located in the apical third, with lengths that are considerably shorter than those in the coronal and middle thirds of the canal space. Because ACs are more prevalent in premolars and molars, attention should be paid to their morphologic features during root canal treatment.

Cone Beam Computed Tomography in the Analysis of Endodontic Treatment of Teeth (in an Experiment)

Objective. To determine peculiarities when using microfocus cone beam computed tomography (micro-CBCT) and cone beam computed tomography (CBCT) to analyze the anatomy of the teeth and the quality of endodontic treatment.Material and methods. Micro-CBCT and CBCT were experimentally used to examine 8 extracted tooth preparations before and after endodontic root canal treatment using different types of filling material.Results. Micro-CBCT showed the high informative value of determining the type, nature, and quality of canal filling and diagnosed many cracks and accessory canals. According to the micro-CBCT findings, the tooth apexes were not filled; the lumen of the canals was unevenly and loosely filled with endodontic material; the passages of guttapercha points were well traced; the nature of the endodontic material was differentiated.Conclusion. Micro-CBCT opens up new opportunities in dentistry with tooth volume visualization, allowing the minor and low-contrast details of the anatomical structure of the teeth to be seen on the X-ray image.

Radicular cyst involving maxillary sinus: A report of rare case

A pathological cavity lined by epithelium containing either fluid or semifluid substance is termed as cyst. The cyst associated with the teeth is called as odontogenic cyst. The periapical cyst or Radicular cyst is one among the odontogenic cysts which is most prevalent and associated with a dead or non-vital tooth. The epicentre of these cysts is mostly the apices of the involved non-vital teeth, however they may also be found on the lateral aspects of the roots in relation to lateral accessory root canals. They are inflammatory in nature. Most of the radicular cysts are small in size, but sometimes it can extend to displace maxillary sinus. In this situation, careful examination with the use of computed tomography (CT) helps you to distinguish the pathology arising from maxillary sinus itself or is it odontogenic origin causing displacement of the sinus. This article is highlighting the importance of advanced diagnostic aids like computed tomography in managing a rare case of massive radicular cyst involving the maxillary sinus in 52 year female which was treated surgically. Keywords : Radicular cyst, Maxillary sinus, Computed tomography.

The neurovascular contents of a unilateral double mandibular canal: A case study

The occurrence of bifid mandibular canals is unusual but not rare. Previous reviews and case studies have described numerous types of bifid canals based on location, anatomy, and contents. Developmentally, ossification of the mandible begins at the region of the mental foramen and continues posteriorly, forming the mandibular canal around the neurovascular bundle within. This process explains the creation of multiple mandibular canals and the diversity of canal types previously recorded in the literature; the inferior alveolar nerve originates as three distinct bundles and may experience incomplete fusion, or the nerve and artery may be isolated during ossification. However, the presence of two distinct mandibular canals, each originating from its own mandibular foramen, is even more unusual. This case report describes a unilateral variant discovered during the dissection of a 92‐year‐old African American female. On the left side, the cadaver presents two distinct mandibular canals, each containing a branch of the maxillary artery and mandibular nerve, the third division of the trigeminal (CN V). The nerves within the two canals, the inferior alveolar nerve in the superior canal and the mental nerve in the inferior canal, were distinct from each other at the level of the posterior division of the mandibular nerve, within 1 cm of foramen ovale in the infratemporal region. This is the first description of such an occurrence, and emphasizes the need for identification of the contents of a bifid or accessory mandibular canal prior to invasive procedures.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Apical root canal anatomy in the mesiobuccal root of maxillary first molars: influence of root apical shape and prevalence of apical foramina - a micro-CT study.

To determine whether a relationship exists between the apical shape of roots and root canal system complexity by performing a micro-computed tomography analysis. One hundred extracted permanent maxillary first molars were scanned using a micro-computed tomography device at 19.6μm voxel size. Two groups of mesiobuccal roots were formed according to the root aspect ratio value in the apical 3-mm cross-sectional level ('<2 and≥2.00'). Data were recorded regarding the number and presence of accessory canals and their location, isthmus, presence of the mesiobuccal canal and dentine thickness. Depending on the analysed variable, Mann-Whitney U test and Z-test for proportions were used to compare groups. The significant level was set at 5%. Mesiobuccal roots with an aspect ratio≥2.00 at the apical 3-mm cross-sectional level had higher percentages of accessory canals, apical foramina and MB2 root canals in the apical 3mm. The vertical average distance from the accessory foramina and origin from the anatomic apex was 1.40 and 2.19mm, respectively. Overall, 21.8% of the accessory canals had their origin coronal to a 3-mm root resection line. There was no difference between the groups regarding dentine thickness. The shape of the apical 3mm of maxillary first molar mesiobuccal roots was a predictive factor for the presence of complex root canal systems. Roots with a lower aspect ratio had less complex apical anatomy.

Radicular Groove Accessory Canal Morphology in Mandibular First Premolars: Micro–computed Tomographic Study

IntroductionThe purpose of this study was to investigate the morphologic features of radicular groove accessory canals (RGACs) in mandibular first premolars and their relationship to root anatomy by micro–computed tomographic imaging. MethodsA total of 154 single-rooted mandibular first premolars with radicular grooves were selected. The teeth were scanned by micro–computed tomographic imaging, and the following parameters were recorded:(1) the presence of RGACs,(2) the origin of RGACs,(3) the position of the RGAC foramen in the groove in relation to root length,(4) the foramen diameter,(5) the type of groove present according to the Arizona State University dental anthropology scoring system (ASUDAS), and(6) the type of anatomy present according to Vertucci’s classification. The data were recorded and statistically analyzed using the chi-square test (P < .05). ResultsThe incidence of RGACs in the teeth was 49.9%. The average distance from the cementoenamel junction plane to the RGAC foramen was 8.83 ± 2.53 mm, and the majority of the RGAC foramina were located in the middle third. Regarding the severity of the groove, the presence of RGACs was significantly higher for groups ASUDAS 3 and 4 compared with ASUDAS 1 and 2 (85.7% and 14.3%, respectively). The presence of at least 1 RGAC was greatest for Vertucci type V (46%) and for more complex types (46%) when compared with Vertucci types I and III. ConclusionsMandibular first premolars with radicular grooves often present with RGACs. An association between the internal and external anatomy and the presence of RGACs was detected in this study.

A mandibular bone defect of uncertain significance: report of a paleopathological case.

Anatomical variations of the mandibular canal as well as the presence of accessory canals and foramina are common findings in the human mandible. Here, we present a previously unreported type of anatomical variation, consisting of a large full-thickness bone defect of the right mandibular ramus, observed in a young male unearthed from a mediaeval cemetery located in North-Eastern Italy. The defect was located very close to, yet not directly connected with, the mandibular canal. Awareness of the existence of deviations from the anatomical norm such as that we describe here is strategic to avoid diagnostic misinterpretations, minimise technical hitches, and prevent clinical complications during invasive procedures in the region of the mandible.

Evaluation of the efficacy of Er:YAG laser–activated irrigation in a simulated accessory canal

Aim: The aim of this study was to evaluate the effect of laser-activated irrigation (LAI) on the removal of debris-mimicking hydrogel from a simulated accessory canal. Materials and Methods: The simulated accessory canal was located 3 mm from the apex, perpendicular to the straight main canal. Gelatin hydrogel as a substitute of debris was used to fill the simulated accessory canal. The root canals were irrigated for 20 or 40 seconds by LAI using an erbium: yttrium aluminum garnet (Er:YAG) laser (30 mJ, 20 pps) or for 40 seconds by syringe irrigation (SI). During LAI, the cone-shaped tip of the laser was positioned stationary at 3 or 10 mm from the apex. Irrigation was performed using 5% NaOCl. The distance over which the hydrogel was removed from the accessory canal entrance was measured and compared between the irrigation procedures. Results: Using NaOCl as the irrigant, a significant increase was observed in the distance over which the hydrogel was removed by LAI compared with that by SI. A longer irradiation period with LAI resulted in significantly greater amount of hydrogel removal. There was no significant difference in hydrogel removal when the laser tip was positioned at 3 and 10 mm from the apex. Conclusion: Within the limitations of this in vitro model, LAI removed more hydrogel from the accessory canal than SI, when using NaOCl as the irrigant. Furthermore, the irradiation time influenced the cleaning efficacy, but the tip position did not.

Effect of Different Irrigating Solutions in the Removal of Smear Layer from the Root Canal

The purpose of this review is to assess the efficacy of different irrigating solutions in the removal of the smear layer from the root canal. Irrigating solutions are used in root canal treatment for the removal of the infected tissue which may still be present especially in the accessory canals. There are other uses for irrigating solutions like anti microbial property and lubrication. The removal of smear layer is vital for the adaptation of the obturation material to the root canal walls and the prevention of reinfection as some micro organisms penetrate deeper into the dentinal tubules. The most commonly used irrigating solution in day to day use are sodium hypochlorite and chlorhexidine gluconate which are said to have very good anti microbial efficacy but inefficiency in the removal of smear layer. This review focuses on the establishment of irrigants in the removal of smear layer and its use in routine procedures.