Apical Deltas Research Articles

Position and frequency of lateral canals in carnassial teeth of dogs

Carnassial teeth, as one of the most important teeth in dogs, are commonly affected by different types of injuries and pathological disorders, which require endodontic treatment. Lateral canals, which leave the main root canal, and apical deltas are present in the root canal system of dogs. These canals represent small branches that leave the main root canal at a sharp angle and terminate in a region of the periodontal ligament on the external root surface. In this study, 200 teeth were included, of which 100 were superior fourth premolars and 100 were inferior first molars. Lateral canals were present in a total of 30 roots of superior fourth premolar teeth, whereas in inferior first molars, these canals were found in 3% of roots. In superior fourth premolars, lateral canals were mostly present in the apical third, 86%, while 14% were present in the middle third of the root. In inferior first molars, lateral canals were found in 3% of the roots, 2% in the apical third and 1% in the middle third of the roots. The knowledge of the complex root canal morphology is essential for any endodontic treatment. Due to the presence and frequency of lateral canals, it is imperative to perform more thorough cleaning and instrumentation while performing endodontic treatment on superior fourth premolars compared to inferior first molars.

Microbial challenges and solutions in root canal therapy

Root canal therapy (RCT) faces significant challenges due to microbial invasion and biofilm formation within the root canal system. The intricate anatomy of root canals, including isthmuses, lateral canals, and apical deltas, provides a conducive environment for pathogenic microorganisms, complicating effective disinfection. Key pathogens such as Enterococcus faecalis and Candida albicans are highly resilient, capable of forming biofilms that protect them from antimicrobial agents and host defences. Current antimicrobial strategies in endodontics combine mechanical instrumentation with chemical disinfection. Mechanical debridement, though essential, often falls short of thoroughly cleaning the complex root canal anatomy. Sodium hypochlorite (NaOCl), the gold standard irrigant, exhibits broad-spectrum antimicrobial properties but struggles to penetrate biofilms and dentinal tubules fully. Adjunctive solutions like chlorhexidine (CHX) and ethylenediaminetetraacetic acid (EDTA) enhance the antimicrobial efficacy of NaOCl by providing prolonged action and removing the smear layer, respectively. Intracanal medicaments, such as calcium hydroxide (Ca(OH)2), are utilized to maintain antimicrobial activity between treatment sessions. Despite its high pH and effectiveness against a wide range of bacteria, Ca(OH)2 shows limited efficacy against biofilm-forming bacteria like Enterococcus faecalis. Innovations in irrigation techniques, such as passive ultrasonic irrigation (PUI) and laser-activated irrigation (LAI), have improved the delivery and activation of irrigants, enhancing their ability to disrupt biofilms and penetrate the root canal system. Nanoparticle-based irrigants and medicaments represent a promising advancement in endodontic disinfection. Their small size and large surface area allow for better penetration and interaction with bacterial cells, significantly reducing bacterial load in the root canal system. Combining traditional and advanced antimicrobial strategies is essential for overcoming the limitations of current methods and improving the success rates of endodontic therapy. Understanding the mechanisms of microbial invasion and biofilm formation, along with integrating emerging technologies, can lead to more effective disinfection protocols. This approach aims to enhance treatment outcomes and ultimately ensure the longevity of endodontically treated teeth.

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.

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.

Comparative Morphology of the Carnassial Teeth Root Canals in Mixed-Breed Dogs and German Shepherds.

Root canal treatment of carnassial teeth in dogs is a common endodontic technique which aims to re-establish or maintain the health of the periapical tissues. In total, 43 dogs were used in this study. Root canal morphology was evaluated in 86 superior fourth premolars and 86 inferior first molars. Apical delta was present in 247 roots, while obliteration of the root canal was found in 11 roots. The most common type of apical delta of the roots of superior fourth premolars was type II, with up to 10 apical ramifications, while type IIIA, with 10-20 apical ramifications, was most commonly present in the roots of inferior first molars. Considering that knowledge of the morphology of root canals is essential for a successful endodontic procedure, the aim of this study was to analyze and compare the morphology of root canals in the carnassial teeth of German shepherds and mixed-breed dogs. Apical resection for the purpose of endodontic therapy of the superior fourth premolar and the inferior first molar is indicated at a length of 4 to 6 mm from the anatomical tip of the roots, which would completely remove the apical delta of these two teeth.

Morphological study of pulp cavity anatomy of canine teeth in domestic cats using micro-computed tomography.

An understanding of the pulp cavity anatomy of individual teeth is essential for success during endodontic therapy. The objective of this study was to document pulp cavity anatomy and summarize numerical data of maxillary and mandibular canine teeth of domestic cats using micro-computed tomography (micro-CT). Thirty-nine canine teeth from eleven domestic cat cadaveric specimens were extracted and prepared for scanning. Segmentation of the pulp cavity was performed using the Avizo (v2022.2) software package. The morphological features of the pulp cavity including overall shape, configuration, presence of apical deltas and lateral canals was recorded. A quantitative analysis was performed on thirty-one teeth to explore associations between pulp cavity volume and length, apical delta length, maximum apical delta foramina number and cusp-to-tip length using a linear mixed model. Correlation between pertinent continuous variables was assessed using a Pearson's correlation test. Most pulp cavities exhibited varying curvature and ranged from a cylindrical configuration in the coronal third to an ovoid configuration in the middle to apical third. A ribbon-like flattened canal was observed in 6/31 teeth (19%). All canine teeth depicted an apical delta with various configurations except for two teeth that showed a single canal exiting at the apex. In 15/31 teeth (48%), the primary root canal within the apical delta could be clearly identified and in 16/31 (52%) the primary root canal was indiscernible. The results showed that the pulp cavities of maxillary canine teeth were significantly larger and longer and the cusp-to-tip length was longer, when compared to mandibular teeth. The apical delta length was negatively correlated to the volume of the pulp cavity. No specimens depicted lateral canals. This study revealed that the anatomy of the canine tooth pulp cavity in cats can vary considerably and should be a consideration when performing thorough debridement, shaping and obturation of the endodontic system.

Diagnostic value of cone beam computed tomography for root canal morphology assessment – a micro-CT based comparison

ObjectivesThe aim of this study was to assess cone beam computed tomography (CBCT) as a root canal anatomy diagnostic tool by comparison with micro-CT gold-standard.Materials and methods216 two-rooted mandibular molars were first scanned in a CBCT device (200 μm voxel size) and posteriorly in a micro-CT scanner (19.61 μm). The volumes were sequentially screened to classify main root canal anatomy according to Vertucci classification, and for the presence of lateral canals and apical deltas, in both mesial and distal roots.ResultsBoth methods revealed a higher prevalence of Vertucci Type II and IV in the mesial root, and Vertucci Type I in the distal root. The percentage of agreement for main root canal anatomy classification between CBCT and micro-CT scores was high (85.2%).ConclusionSensibility to detect both lateral canals and apical deltas with CBCT was low. These results attest to the fact that minor anatomical changes might be difficult to identify with CBCT imaging, hampering its diagnostic value.

Narrative literature review on the complexity of the internal anatomy of root canals

The intricate and highly variable nature of the internal anatomy of root canals poses significant challenges for effective endodontic treatments. The aim of the study was to interpret the complexity of the internal anatomy of root canals through a narrative literature review. This study adopted an exploratory methodology and was characterized by its observational and descriptive nature, analyzing information from a cross-sectional and retrospective perspective. An exhaustive evaluation of 25 articles was conducted on PubMed, Google Scholar, and Elsevier through ScienceDirect, from 2016 to 2023. This study revealed that a deep understanding of the internal root anatomy and its variations is essential for the success of endodontic treatments, highlighting the importance of advanced diagnostic techniques, such as Cone Beam Computed Tomography (CBCT), for identifying anomalies. It was found that anatomical variations, including C-shaped canals, lateral canals, and apical deltas, are more prevalent in posterior teeth. Moreover, anterior lower teeth rarely exhibit more than one root, with Vertucci type I classification predominating in their internal anatomy, which implies less complexity compared to posterior teeth. It concludes that success in endodontics critically depends on detailed knowledge of the internal root anatomy. The findings emphasize the need to apply precise diagnostic techniques and adapt treatment strategies to the specific anatomical complexity of each tooth, especially in those with more complex root configurations

A Cone-Beam Computed Tomographic Analysis of Mesiobuccal Root Canals of Maxillary First Molars.

The maxillary first molar is crucial for proper bite formation and jaw positioning in adulthood. The prevalence of dental caries in the study's sample population suggests it is a common candidate for endodontic therapy. Multiple studies have shown that the canal and root morphology of the maxillary first molar are abnormal. The distobuccal and palatal roots of 286 maxillary first molars were removed at the furcation. The mesiobuccal roots were then imaged using cone-beam computed tomography (CBCT) on all specimens. The specimens were analyzed in comparison with one another. The following factors were studied. The number and arrangement of canals, as described by Vertucci; the presence or absence of an isthmus, as described by Kim; the canal curvature angle, as measured by the Schneider method; characteristics such as calcified segments, lateral canals, and an apical delta.For the flow analysis, CBCT was utilized to examine the root channel architecture of 286 mesiobuccal (MB) permanent maxillary first molar. Type I canal arrangement was found in 51.6% of teeth, Type II in 33.3%, Type III in 4.6%, Type IV in 4.2%, Type V in 2.5%, and Type VII in 1.5%. Type I, II, III, and V isthmus were each present in 26%, 6.7%, 9.5%, and 10.2% of the samples, respectively. Teeth with MB1 canal angulations of 0-20 degrees, 21-40 degrees, and more than 40 degrees were found in 56, 188, and 41 teeth, respectively. From 0 to 20 degrees, 21 to 40 degrees, and more than 40 degrees, 15 teeth, 88 teeth, and 25 teeth, respectively, had angulations in their MB2 canals. Only 9.8% of the samples had lateral canals, while 16.1% had both accessory canals and apical deltas. There were 19 cases with calcified segments in the coronal third of the MB1 canal and 13 cases in the middle third. There were no calcifications at the distal end of the MB1 canal. Thirteen of the specimens showed calcification only in the most caudal third of the MB2 canal, whereas the middle and distal thirds were uncalcified. Utilizing a noninvasive approach, a CBCT scan has the capacity to provide valuable insights into the root canal configuration.

Multipopulation evaluation of the internal morphology of mandibular first premolars from different South American countries. A micro-computed tomography study

ObjectiveTo evaluate and compare several anatomical parameters of mandibular first premolars from individuals from different Latin American countries using micro-computed tomography. DesignFive hundred extracted mandibular first premolars from Brazilian, Argentinian, Chilean, Colombian, and Ecuadorian individuals were scanned using micro-computed tomography (n = 100 teeth/country). Root canal configurations were classified according to established parameters. Analyses also included: canal volume and surface area, structure model index, distances from the apical foramen to the root apex or the cementoenamel junction, major/minor apical canal diameters, canal orifice shape, and prevalence of ramifications. ResultsA single root was the most common anatomy in all countries (range, 97%−100%). Vertucci’s type-I canal was the most frequent configuration (range, 36%−66%), followed by C-shaped and type-V canals. The oval-shaped canal orifice was the most predominant in all countries (range, 34%−58%), followed by the circular shape (range, 16%−47%). C-shaped canals occurred in all subpopulations (range, 14%−26%), always associated with radicular grooves. Ranges for canal ramifications were as follows: accessory canals, 36%−73%; lateral canals, 4%−12%; and apical delta, 4%−14% of the teeth. Many anatomic parameters differed significantly between countries (P < .05). ConclusionsVertucci’s types-I and -V, and C-shaped canals were the most prevalent configurations in the subpopulations investigated. Accessory canals and several complex anatomies were found, with some significantly different frequencies between countries.

To Analyze the Mesiobuccal Root Canal of Maxillary First Molar using Cone Beam Computed Tomography: An Ex-vivo Study.

The purpose of this study was to use cone bar CT to investigate the root trench morphology of two-hundred mesiobuccal permanent first molars in the maxilla. The distobuccal and palatal roots were removed at the furcation in 250 maxillary first molars. The mesiobuccal roots were then imaged using cone beam computed tomography on all specimens. The specimens were analyzed and compared to one another." This study looked into the following factors. How Many Canals There Are and What Shape Those Canals Take Errors such as lateral canals, apical delta, calcified segments, and others. Vertucci's trench configuration, kinds I, II, III, IV, V, and VII, were seen in 30%, 20%, 5%, 6%, 7%, and 2.5% of the teeth, respectively. Calcified sections were found in the coronal third of the MB1 trench for eight of the samples, and in the central third for two of the samples. The MB1 trench did not have any calcifications at its very end. The coronal 33 percent of the MB2 trench was calcified in eight samples, but no calcifications were seen in the middle or upper thirds. Noninvasively and with little radiation, a cone beam CT scan can help you learn about your root canal setup.

Rare root canal morphology of maxillary second molars: A report of three cases

Key Clinical MessageEndodontists should be aware that some maxillary second molars can have more than three roots. If any unusual anatomical features are detected during dental radiography or endodontic procedures, it is necessary to conduct cone‐beam computed tomography (CBCT) scanning to prevent procedural mishaps.AbstractCBCT can provide three‐dimensional reconstructed images of the root canal system. With the help of CBCT, variations in tooth root number and root canal morphology, such as extra canals, apical ramifications, apical deltas, and lateral canals, can be identified. Knowledge of the variations is very important for the success of endodontic treatment. This report suggests that endodontists must not assume that a MSM has only three tooth roots, which is the most prevalent number.

Feasibility of photon-counting computed tomography as a novel imaging modality for challenging endodontic diagnostic tasks

Photon-counting computed tomography (PCCT) is an innovative technological advancement in relation to x-ray detectors which offers ultra-high-resolution images. The current study aimed to evaluate the visualization ability of PCCT compared to cone-beam computed tomographic (CBCT) devices for challenging endodontic diagnostic tasks. A reference image of an anthropomorphic phantom was acquired using an industrial micro-CT device. Thereafter, the phantom was scanned with three imaging devices, which included PCCT scanner (NAEOTOM Alpha) and two CBCT devices (3D Accuitomo 170 and NewTom VGi evo) having standard and high-resolution acquisition protocols. The diagnostic tasks involved visualizing fine endodontic structures (apical delta, narrow canal, and isthmus) and root cracks. Three experienced examiners assessed the images and were blinded to the PCCT and CBCT devices. Each image was rated according to a three-grade scale (appropriate, acceptable, or inappropriate) for the diagnostic tasks. In relation to fine endodontic structures grouped together, PCCT showed similar diagnostic performance compared to the reference image (p > 0.05). As for the CBCT devices, an excellent performance was only observed with the 3D Accuitomo 170 device at a high-resolution acquisition mode (p > 0.05). The visualization of root cracks was also better with 3D Accuitomo 170 compared to other devices (p < 0.05). Overall, PCCT and 3D Accuitomo 170 at a high-resolution setting showed similar performance for visualizing fine endodontic structures. In addition, the high-resolution CBCT protocol was superior for visualizing root cracks compared to both PCCT and other standard- and high-resolution CBCT protocols.

Image quality for visualization of cracks and fine endodontic structures using 10 CBCT devices with various scanning protocols and artefact conditions

The aim of this study was to evaluate CBCT exposure protocols and CBCT devices in terms of image quality for the detection of cracks and fine endodontic structures using 3 conditions of metallic artifacts. An anthropomorphic phantom containing teeth with cracks, isthmus, narrow canal, and apical delta was scanned using ten CBCT devices. A reference industrial CT image was used to detect and measure all structures. Three conditions were created: (1) metal-free, (2) ‘endo’ and (3) ‘implant’ with metallic objects placed next to the teeth of interest. For each condition, three protocols were selected: medium field of view (FOV) standard resolution, small FOV standard and high resolution. The results showed that only small FOV high-resolution metal-free images from two devices (A and H) were appropriate to visualize cracks. For fine structure identification, the best result was observed for small FOV high resolution. However, the visualization significantly worsened in the presence of metallic artefacts. The ability of CBCT images for visualizing cracks is restricted to certain CBCT devices. Once metallic artefacts are present, crack detection becomes unlikely. Overall, small FOV high-resolution protocols may allow detection of fine endodontic structures as long as there are no high-dense objects in the region of interest.

IMPACT OF THE PASSIVE/ACTIVE ULTRASONIC ACTIVATION ON THE ENDODONTIC IRRIGANTS EFFECTIVENESS - A REVIEW

Introduction: various irrigation devices and chemical solutions are being developed and improved nowadays for better penetration deep into the complex root canal system. Activation of irrigating solutions enhances the solution effectiveness. Evidence in the literature suggests that ultrasonic irrigation is much more effective in this respect than syringe irrigation alone. Passive ultrasonic irrigation (PUI) and/or ultrasonically activated irrigation (UAI): nowadays, the two terms, PUI and UAI, are interchangeable in the literature and represent the same technique. Literature data have shown that combining ultrasonically activated NaOCl with EDTA results in significantly greater removal of the smear layer. Conclusion: the use of ultrasonic activation of the irrigating solution after root canal preparation significantly improves the removal of debris from hard-to-reach areas such as isthmuses, lateral canals and the apical delta.

Comparative Evaluation of Antibacterial Efficacy of Two Bioceramic Root Canal Sealers Incorporated with Novel Silica Doped TiO2 Nanoparticles: An In-vitro Study

Introduction: The success of Root Canal Treatment (RCT), depends on the complete elimination of microorganisms in combination with complete root canal system closure. Complete elimination of bacteria cannot be done by cleaning and shaping alone from lateral canals, isthmuses, and apical deltas. Thus, root canal sealers with ideal physical, biological, and improved antimicrobial characteristics are thus, necessary to avoid reinfections. Aim: To evaluate the antibacterial efficacy of two Bioceramic (Bio-C) modified root canal sealers, using Silica Doped Titanium Dioxide Nanoparticles (SiTiO2 ), a unique, extremely effective antibacterial agent on root canal dentin infected with Enterococcus faecalis (E. faecalis). Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics in collaboration with the Department of Microbiology at Sree Sai Dental College and Research Institute, Andhra Pradesh, India. The study was done in August 2022. The antibacterial efficacy of the two Bio-C sealers was evaluated by counting Colony Forming Units (CFU) and the percentage of live bacteria by a confocal laser scanning microscope. A total of 60 middle thirds of single-rooted teeth incubated with E.faecalis were chosen. Gutta-percha (GP) was used to fill the canals along with sealers in all six groups (group I-VI), namely Mineral Trioxide Aggregate based (MTA Fillapex); MTA Fillapex+SiTiO2 NPs (1% wt); MTA Fillapex +2% wt SiTiO2 NPs; Bio-C; Bio-C+ 1% wt SiTiO2 NPs; Bio-C+ 2% wt SiTiO2 NPs respectively, and incubated for seven days, each tooth was divided into two halves longitudinally. Microbiological analysis was conducted on one half, and microscopic analysis on the other half. The six groups were compared using a one-way Analysis of Variance (ANOVA) and intergroup comparison with Tukey’s post-hoc tests. Results: The addition of SiTiO2 NPs to Bio-C and MTA Fillapex significantly reduced the bacteria, compared to an unmodified sealer (p-value&lt;0.001). MTA Fillapex with SiTiO2 NPs showed higher bacterial viability compared with Bio-C with SiTiO2 NPs. Conclusion: Loading endodontic sealers with SiTiO2 NPs has a material-dependent impact on the antibacterial properties, that could lower the frequency of secondary infections.

Clinical case: second mandibular premolar with three root canals

The effectiveness and success of endodontic treatment depends on the doctor's professionalism and knowledge of the anatomy and morphology of root canals. The equipment that is at the disposal of the dentist is also of great importance. At the moment, it is difficult to imagine the diagnosis of complex endodontic pathology without the use of cone-beam computed tomography. Diagnostic radiographs in different projections are important for getting an idea of the number of existing root canals, but do not always give a complete picture of the anatomy and morphology of root canals. Magnifying devices (binoculars and dental microscope) are also very helpful for competent treatment in modern dentistry in general and endodontics in particular. Premolars of the mandible are among the most difficult teeth for endodontic treatment due to a sufficient number of variations in internal morphology, the presence of additional root canals, apical deltas and lateral canals.

Pulp Regenerative Cell Therapy for Mature Molars: A Report of 2 Cases

Regenerative cell therapy using autologous dental pulp stem cells (DPSCs) in mature single-rooted teeth is a potential alternative to traditional endodontic treatment. However, there is no evidence supporting the use of DPSCs in multirooted teeth. This case report aimed to demonstrate the feasibility and outcomes of pulp regenerative cell therapy in mature multirooted molars, which typically have a higher prevalence of apical deltas. A 26-year-old male and a 29-year-old male were referred for the pulp regeneration of their maxillary molars. After access preparation and establishing apical patency, root canal preparation and disinfection were performed. Autologous DPSCs were isolated from extracted third molars, cultured according to the guidelines of good manufacturing practice, and transplanted into the prepared root canals with granulocyte colony-stimulating factor in atelocollagen. The access cavity was sealed with Biodentine and composite resin. Clinical evaluation during the follow-up period of 48 weeks and laboratory evaluation after 4 weeks revealed no adverse events or evidence of systemic toxicity. After 48 weeks, radiographs and cone-beam computed tomography showed no periapical radiolucency. The teeth showed a positive response to electric pulp testing in 4 weeks in both cases. The signal intensities on magnetic resonance imaging of the regenerated pulp tissue in the affected teeth were comparable to those of the normal pulp in adjacent teeth after 24 weeks. This report of 2 cases demonstrates the utility of DPSCs and the feasibility of pulp regenerative cell therapy in multirooted molars.

Three-dimensional evaluation of root canal morphology of maxillary first premolars: Micro–computed tomographic study

AimThe aim of this in vitro study was to investigate the root and root canal morphology of maxillary first premolar teeth in a Kuwaiti population using micro–computed tomography (μ- CT). Materials and methodsA total of 100 maxillary first premolars were scanned in a micro– computed tomographic device. The external anatomy (number of roots, distance from cementoenamel junction to apex, and presence of a palatal groove) and internal anatomy (number of canals and presence of apical deltas, lateral canals, and isthmi) of teeth were analyzed using descriptive analysis. ResultsThe number of roots was one root (57 %), two roots (41 %), and three roots (2 %). The longest and shortest roots measured 17.7 and 11.2 mm, respectively. The palatal groove was present in 63.4 % of the teeth. According to Vertucci’s classification, type IV configuration was the most prevalent (53 %), followed by type II. A new root canal configuration type (1–2–1–2–1) was detected. Apical deltas, lateral canals, and isthmi were present in 33 %, 48 %, and 21 % of teeth, respectively. ConclusionType IV canal configuration was the most common root canal configuration. A new root canal configuration type IX for (1–2–1–2–1) was proposed for Kuwaiti population. The μ-CT device could to be a better diagnostic tool for understanding the anatomy of the root canal system.