Canal Anatomy Research Articles

Evaluation of Variations in Root Canal Anatomy and Morphology of Permanent Maxillary Premolars among the Emirate Population using CBCT

Background: Many types of research have revealed that root canal anatomy differs by race and country based on various national populations, but no study has been conducted on the UAE population. Objectives: Identifying the most common morphology of the upper premolars in a group of local and non-local people in the UAE. Methods: Cone-beam computed tomography (CBCT) images of 215 intact maxillary premolars were analyzed. The Pearson Chi-squared test and the two samples t-test were applied. Results: Most of the maxillary first premolars were two-root formed (90%). Single-rooted teeth were less common (8%). Three-rooted maxillary first premolars represented a low frequency of 1.9%. Most of the maxillary second premolar teeth studied in this research (52%) had two roots. Almost all local and non-local populations had two canals for both first and second maxillary premolar. Only two maxillary first premolars (0.2%) had the three-canal morphology. The most frequent canal morphology in the maxillary first premolar group among local UAE and non-local was type V. The maxillary second premolar group among local UAE was type II (32%). In non-local UAE, type V (25%). In addition, six types of uncommon canal anatomic variants (types 1-2-3, 2-3-2, 3-2-1, 1-2-3-2, 2-1-2-1, and 3-2) were discovered in 3.7% of local UAE and 36.3% of non-local UAE. Conclusion: The results suggest a more quantitative approach to maxillary first and second premolar access cavity preparation in the UAE population to prevent errors and iatrogenic damage when identifying the canals.

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.

Management Of Mandibular Second Molar With Single Root And Single Canal Using Re-Treatment Procedure

The root canal anatomy of mandibular second molar teeth is known to be highly variable. Whilst the most frequently seen configuration is two mesial canals and one distal canal, other variations such as four canals, two canals, and C-shaped canal system do also exist. This case report describes the re-treatment of unusual root canal configuration of a mandibular second molar, with one canal in a single conical root, using the contemporary advancements in endodontics. Following clinical and radiographic examinations of the case, a diagnosis of symptomatic apical periodontitis of tooth #37 was established, and retreatment followed by composite build-up were planned. Clinicians should be aware of the different anatomic variants each tooth may exhibit. Furthermore, clinicians need to possess the proper knowledge and skills that allow them to utilize the diagnostic and therapeutic tools available at their disposal in order to optimize the quality of care provided to their patients.

Assessment of Root Anatomy and Variations of Third Mandibular Molars in the Population of Peshawar using Cone Beam Computed Tomography

Background: Third molars have root canal structure that is frequently incredibly complicated and highly varied. Greater heterogeneity in root patterns and canal shape has been linked to mandibular third molars. Aim: To assess the root and canal anatomy of mandibular third molar in the people of Peshawar using cone beam computed tomography. Study Design: Retrospective study. Place and Duration of Study: Khyber College of Dentistry and Rehman College of Dentistry, from 1st December 2020 to 31st January 2022. Methodology: One hundred and ninety five CBCT scans of third mandibular molars were examined and the data in regards to their root number, canal number, Vertucci’s classification, gender and age relation of morphology in mandibular third molars was statistically assessed. Results: Greater number of 3rdmandibular molars had two roots (89.7%) and two canals (67.7%). Most mesial roots had Vertucci Type I (61%), distal root had type I canals as well (92.8%) Conclusion: The current study concluded that mandibular third molars showed great variation in Root canal configuration. Majority had two roots and two canals per root. Keywords: Canal configuration, Vertucci’s classification, Mandibular third molars, Cone beam computed tomography (CBCT)

Root canal morphology of 1316 premolars from Brazilian individuals: an in vivo analysis using cone-beam computed tomography.

The aim of this study was to investigate the internal root canal anatomy of maxillary and mandibular premolars in a Brazilian subpopulation, in order to establish the prevalence of the different configurations proposed by Vertucci. Three hundred and ninety-eight cone-beam computed tomography scans were collected from a private imaging clinic database in Rio de Janeiro, including 217 maxillary and 226 mandibular scans. A total 1316 premolars (594 maxillary and 722 mandibular) were evaluated using an image viewer, and classified according to Vertucci. Two calibrated examiners determined the frequency of each morphological Type. A third examiner reviewed discordant cases. The Kappa test was applied to verify inter-rater agreement, and Fisher's Exact Test to verify gender-related differences. The most frequent root canal configurations of maxillary first and second premolars were Type IV (73.86%) and Type I (47.18%), respectively. Type I was the most prevalent in mandibular first and second premolars (80.59% and 95.86%, respectively). Only Types I and VIII presented a statistically significant difference between sexes. Type I was more frequent in females and Type VIII in males. A highly significant frequency of Type I was found in both mandibular first and second premolars, whereas the most frequent maxillary premolar root canal configuration was Type IV for first premolars and Type I for second premolars.

Comparative Evaluation of Root Canal Centering Ability of ProTaper, Mtwo, WaveOne, and Reciproc Using Cone-beam Computed Tomography: In Vitro Study

To compare the centering ability of rotating (ProTaper and Mtwo) and reciprocating (WaveOne and Reciproc) file systems using cone-beam computed tomography (CBCT). Eighty extracted human mandibular molars with curvature within 15-45° were selected and randomly divided into four groups (n = 20): group I (ProTaper), group II (Mtwo), group III (WaveOne), and group IV (Reciproc). The selected teeth were arranged in a template, and pre-instrumentation and post-instrumentation CBCT scans were taken using Kodak Carestream CS 9300 machine. The centering ability was measured in four planes namely, at furcation, 3 mm apical to furcation (coronal), 6 mm apical to furcation (middle), and 3 mm coronal to the apex (apical), wherein dentin thickness was measured from pre- and post-instrumentation CBCT scans and recorded for each canal (mesiobuccal and mesiolingual) separately and statistically analyzed. Mtwo and Reciproc remained better centered followed by WaveOne and least by ProTaper in different-level comparisons. In the mesiodistal dimension (MD) at the 3 mm, 6 mm, and 3 mm apical level, Mtwo and Reciproc showed better centering, meanwhile, in the buccolingual dimension, only in the 3 mm apical level, Mtwo and Reciproc remain better centered. A significant difference was seen between the group and type of canal. Mtwo and Reciproc showed better centered preparation than ProTaper and WaveOne. Significant differences were seen between the groups and types of canal. Root canal instrumentation should maintain the original canal anatomy. The proper enlargement keeping in mind the remaining strength in the tooth structure is essentially decided by how the selected instrument is centered. The alloy used for instrument manufacture and its design (taper, cross-section, and tip) will influence the centered preparation. The type of instrument and the instrumentation techniques should be chosen based on root canal anatomy.

Radiographic assessment of root canal morphology of mandibular central incisors using new classification system: A cross-sectional study.

Lack of basic knowledge about the external and internal anatomies of the root canal system and common variations in teeth may lead to various procedural errors or treatment failure. In this study, the root canal configurations of mandibular incisors and the symmetry of the contralateral incisors of Saudi Arabian subpopulations were analyzed and determined using cone beam computed tomography (CBCT). A retrospective evaluation of 700 patients was conducted, and 1260 fully developed permanent mandibular central incisors were assessed. The number of root canals was determined, and the internal root canal anatomies were categorized based on Ahmed et al.’s criteria. The CBCT images were independently evaluated by 2 trained dentists and an endodontist. The data were assessed using the chi-square and one-way analysis of variance tests. All the mandibular central incisors included in the study were single-rooted. According to Ahmed et al’s classification system, the most common classification (82.6%) was 1ManA1 (Vertucci type I), followed by 1ManA1-2-1 (Vertucci type III; 13%). Second canals were more frequently recorded in the male participants than in the female participants. The root canal configuration between contralateral incisors was largely symmetrical. Most of the mandibular incisors in the examined Saudi Arabian population had a single canal. Nevertheless, a substantial number of patients had a complex root morphology. Hence, CBCT can be utilized as a potential supplementary tool during root canal treatment.

Technical quality of endodontic obturation performed in a paediatric dental department.

Technical quality of endodontic obturation performed in a paediatric dental department.

Seçilen bir Türk popülasyonunda koni-ışınlı bilgisayarlı tomografi kullanılarak mandibular birinci ve ikinci premolarların kök kanal morfolojisi ve literatür taraması

Objectives: To investigate the root canal morphology of permanent mandibular premolars using cone-beam computed tomography (CBCT) in the selected population and to review previous studies regarding other selected Turkish subpopulations. Materials and Methods: The sample for this retrospective study included 1048 CBCT images of 672 females and 376 males representing 1613 mandibular first and 1461 second premolars. Pubmed and Google Scholar were used to search previous literature with selected keywords. Results: The incidence of single root in mandibular first and second premolars was 99.75% and 99.38%, respectively. Complex root canal anatomy was evident in the first premolars compared to second premolars and in males than females (p<0.05). Eight studies have previously evaluated the root canal anatomy of mandibular premolars of other Turkish subpopulations by clearing or CBCT images. The prevalence of 2 or more root canals was found between 5.80% - 39.50% in mandibular first premolars and 1.1% -29% in mandibular second premolars in these studies. Conclusions: More attention should be paid to the detection of additional canals during root canal treatment of mandibular premolars, especially in male patients. The symmetrical morphology of the premolars may guide the practitioners during the root canal treatment. Evaluation methods could affect the results regarding root canal anatomy.

Correlation between presence of radix entomolaris in mandibular first molars and C-shaped canals in mandibular second molars: a sample of CBCT scans in Taiwanese students

The anatomy of root canals is so complex that in many cases it is not sufficient to take an intraoral radiograph to diagnose the number and shape of root canals. Therefore, Cone Beam Computed Tomography (CBCT) facilitating diagnosis and treatment planning in endodontics is gaining more and more importance. Radix entomolaris is an extra root which is found in mandibular molars and located distolingually. C-shaped canal is most commonly found in mandibular second molars and can differ significantly in shape from the typical anatomy of lower molars. The aim of the study was to evaluate the correlation between presence of radix entomolaris in mandibular first molars and presence of C-shaped mandibular second molars in Taiwanese students based on CBCT scans. The material consisted of 19 CBCT examinations taken in the Department of Dental and Maxillofacial Radiodiagnostics of the … Among 19 CBCT examinations 5 cases of coexistence of additional root and C- shaped canals were found. Up to 80.0% of cases were bilateral. In the studied sample there was high coincidence of radix entomolaris in mandibular first molars and C-shaped mandibular second molars. Knowledge of this correlation will prevent diagnostic errors during endodontic and surgical treatment planning.

An Observational Study on Root Canal Morphology of Mandibular Incisors in a Dental College Hospital

INTRODUCTIONAdditional canals are frequent findings in radicular morphology of the mandibular incisors. Finding additional canals and their obturation significantly improve the prognosis of endodontic treatment. Cone Beam Computed Tomography (CBCT) best visualize all canals and their configurations. The study assessed root canal anatomy of mandibular incisors on CBCT images of the patients. MATERIAL AND METHODSAn observational cross-sectional study was carried during July-October 2021 on 42 CBCT images of the patients visiting Kantipur Dental College and Hospital. The samples were selected using convenience sampling presenting with bilateral mandibular central and lateral incisors. Root canals and their configurations were assessed on 168 teeth. The presence of unilateral or bilateral additional root canal was recorded and chi-square test was used to test its association with gender (p < 0.05). RESULTThe prevalence of additional canal was 27.4% in mandibular incisors. Bilateral symmetrical distribution of extra canal in mandibular central and lateral incisors were 36.3% and 41.6% respectively. There was a significant association between the presence of extra canal and gender in both central incisors (p-value 0.019) and lateral incisors (p-value 0.009). Type I canal configuration was most prevalent (72.6%) followed by Type III (22.6%). CONCLUSIONThe prevalence of double canals in mandibular incisors is 35% in male and 4% in female samples confirming the male predominance. Bilaterally symmetrical occurrence of double canal is evident up to 41%. CBCT evaluation helps in the visualization of missing root canals during endodontic therapy.

Impact of a Retained Instrument on Treatment Outcome: A Systematic Review

AbstractInstrument separation during endodontic therapy is a frequent accident with rotary instruments being more likely to separate than manual ones. There are various treatment options when the instrument separates in a canal depending on the location, complexity of the canal anatomy, and the operators' ability. The success of the tooth that has a retained fragment of instrument in the canal has been assessed in various studies but no clear conclusion has been drawn. The goal of this systematic review is to answer as many questions as possible. Does the retention of a separated instrument, compared with no retained separated instrument, result in a worse clinical outcome in adult patients who have received nonsurgical root canal treatment? Materials and Methodology The search was conducted with the boolean terms in various database following the PRISMA guidelines. The inclusion and exclusion criteria were set for the inclusion of the study for the systematic review. Results Out of the 330 articles that were obtained, 28 were duplicates. After screening for eligibility, only 7 articles were retrieved for full text. When inclusion and exclusion criteria were applied, none of the studies could be included. Conclusion There is still a lack of consensus on the treatment option for a separated instrument and there is no clear evidence to suggest whether the prognosis of the tooth with retained instrument is reduced or not.

Prevalence of C-Shaped Root Canal Systems in Mandibular Second Molars in Nepalese Population

Introduction: Detailed diagnosis, treatment planning, and successful endodontic treatment require an in-depth understanding of the root canal anatomy and its distinguishing features in various ethnic groups.Objective: The aim of this study was to study the C-shaped canal morphology of mandibular second molars in the Nepalese population by using clinical and radiographic analysis.Methods: This descriptive cross-sectional study will be designed and implemented using records from dental records from January 2017 to January 2021. Out of 4680 cases, 1800 cases were evaluated as samples based upon inclusion and exclusion criteria. The prevalence of C-shaped root canals according to age, sex, and quadrant was calculated. The morphology of C-shaped root canals was assessed on the basis of radiographic appearance and clinical examination records. Descriptive statistics were presented as numbers and percentages. The Chi-square test was used to check any association between variables. The level of significance was kept at 0.05.Results: The prevalence of C-shaped canals was 0.105%(n=162) in the second mandibular molar with the highest prevalence being in the young adult age group (18-25) and slightly higher in male cases than females. Unilateral cases (93.83%) of C-shaped were more prevalent than bilateral (6.17%). Group of age and site(unilateral/bilateral) variables were significantly associated with the prevalence of c-shaped canals.Conclusions: Knowing the anatomical variation and prevalence of the population we are treating is of utmost importance for a favorable outcome. In comparison to the prevalence of other Asian countries like China and Korea, the prevalence of C-shaped canals was comparatively less.

Nanoparticles in Endodontics Disinfection: State of the Art.

Endodontic-related diseases constitute the fourth most expensive pathologies in industrialized countries. Specifically, endodontics is the part of dentistry focused on treating disorders of the dental pulp and its consequences. In order to treat these problems, especially endodontic infections, dental barriers and complex root canal anatomy should be overcome. This constitutes an unmet medical need since the rate of successful disinfection with the currently marketed drugs is around 85%. Therefore, nanoparticles constitute a suitable alternative in order to deliver active compounds effectively to the target site, increasing their therapeutic efficacy. Therefore, in the present review, an overview of dental anatomy and the barriers that should be overcome for effective disinfection will be summarized. In addition, the versatility of nanoparticles for drug delivery and their specific uses in dentistry are comprehensively discussed. Finally, the latest findings, potential applications and state of the art nanoparticles with special emphasis on biodegradable nanoparticles used for endodontic disinfection are also reviewed.

A Three-Dimensional Analysis of Morphological Variations in Maxillary Second Molar in a North Indian Population Using Cone-Beam Computed Tomography.

Background: Cone beam computed tomography (CBCT) has evolved in the field of endodontics and has helped to diagnose and treat the case very easily and accurately. The researchers set out to pinpoint the exact placement of the roots and canals in the maxillary second molars of North Indians by analyzing CBCT pictures.Methods: In this study, in vivo CBCT was used to examine the maxillary second molars (n = 70) in detail. Both the number and configuration of root canals may be determined using Vertucci's categorization.Results: Most people had three roots in their second molars (85.7%). Most maxillary second molars that had three roots looked like they had three separate roots (81.7%). In the roots of 85.7% of maxillary second molars, one canal was found in the mesiobuccal roots, and 14.2% had an MB2 canal. All of the canals in the palatal, distobuccal root, and MB1 root were Type I. The Type II canal configuration was found in 11.7% of MB2 canals. Type IV canals were found in 5% of the MB2 canals. The number of maxillary second molars with MB2 was found to be the same for both men and women (P =0.11). The number of MB2 cases did not depend on where the teeth were or how old the person was (P=0.08 and 0.06, respectively). The fact that both second molars appeared at the same time was important (P<0.001).Conclusions: We report the occurrence of unusual morphologic abnormalities that affect only one root and have only been described in case reports. CBCT scans can help doctors better understand root canal anatomy and potentially enhancing endodontic management outcomes.

Comprehensive evaluation of root and root canal morphology of mandibular second molars in a Saudi subpopulation evaluated by cone-beam computed tomography

BackgroundThe study's goal was to use Cone Beam Computed Tomography (CBCT) to assess the root and root canal anatomy of mandibular second molars with C-shaped root canal configurations in residents of the Hail district. The impact of gender and side on the frequency of root canal morphology was considered.MethodsThe sample size for this study was 304 untreated mandibular second molars with completely developed roots on the right and left sides. Using CBCT on the teeth, the root form and canal morphology for each root are based on Vertucci's classification. The occurrence of canals in the shape of a C. The prevalence and resemblance of the left and right sides or men and females were investigated. The Chi-square test was performed to evaluate the findings.ResultsOf the 304 mandibular second molars studied, 286 teeth had two roots (94.1%), whilst 13 (4.3%) were C-shaped root canal systems. 77 molars (25.3%) had two canal orifices, 219 (72.0%) had three canal orifices, and six (2.0%) and one (0.3%) had four and five root canal orifices, respectively. Type IV was the most common for mesial root, accounting for 57.7% of the sample (n = 176). For distal root, the most common occurrence was type I, which occurred 282 times (96.60%). The most prevalent root canal morphology was the presence of two canals in the mesial root and one canal in the distal root of teeth with two distinct roots (variant 3). (69.4%). The overall prevalence of C-shaped root canal systems is (4.3%) (n = 13).ConclusionsThe patient's race is an undeniable factor that influences root canal anatomy. The root canal morphology of mandibular second molars revealed significant differences between Saudi subpopulations. The majority of mandibular second molars had two roots and three root canals. When treating these molars, the presence of a C-shaped root canal system must be taken into account.

Shaping ability of different NiTi rotary systems during the preparation of printed mandibular molars.

This study aimed to evaluate the shaping ability of XP-endo Shaper, TruNatomy and EdgeFile X3 during the preparation of resin-printed mandibular molar mesial root canals. Thirty-three resin-based mandibular mesial roots with two canals, obtained from extracted tooth cone-beam computed tomography (CBCT) image and printed on a three-dimensional (3D) printer, were divided into three experimental groups according to the different nickel-titanium (NiTi) systems used for root canal preparation. The specimens were scanned using CBCT imaging before and after root canal preparation. Then images were registered using a dedicated software and changes in the canal area, volume, untouched canal surface and the maximum and minimum dentine wall wear were calculated. The XP-endo Shaper instruments showed improved shaping ability with lower untouched root canal surface and better preservation of root canal anatomy during the preparation of resin-printed mandibular mesial root canals compared with TruNatomy and EdgeFile X3 systems.

3D-Printed Teeth in Endodontics: Why, How, Problems and Future-A Narrative Review.

Three-dimensional printing offers possibilities for the development of new models in endodontics. Numerous studies have used 3D-printed teeth; however, protocols for the standardization of studies still need to be developed. Another problem with 3D-printed teeth is the different areas of literature requested to understand the processes. This review aims to gather evidence about 3D-printed teeth on the following aspects: (1) why they are advantageous; (2) how they are manufactured; (3) problems they present; and (4) future research topics. Natural teeth are still the standard practice in ex vivo studies and pre-clinical courses, but they have several drawbacks. Printed teeth may overcome all limitations of natural teeth. Printing technology relies on 3D data and post-processing tools to form a 3D model, ultimately generating a prototype using 3D printers. The major concerns with 3D-printed teeth are the resin hardness and printing accuracy of the canal anatomy. Guidance is presented for future studies to solve the problems of 3D-printed teeth and develop well-established protocols, for the standardization of methods to be achieved. In the future, 3D-printed teeth have the possibility to become the gold standard in ex vivo studies and endodontic training.

Syndrome of venous compression neuropathy in patients with pelvic varicose veins

The study objective is to investigate the pathogenesis of the development of pelvic symptoms in patients with pelvic varicose veins.Materials and methods. From 2015 to 2022, 145 men with pelvic varicose veins were examined. The examination included questioning of patients using questionnaires (scales) and instrumental methods: 1) ultrasound examination of the scrotum with color Doppler mapping; 2) transrectal ultrasound examination of the prostate and veins of the periprostatic plexus; 3) magnetic resonance imaging of the inferior vena cava and pelvic vessels or computer (multispiral) tomography of the abdominal organs with contrast; 4) phlebography of the renocaval and ileocaval segments.Results. The variant anatomy of fibrous and fibro-osseous canals (tunnels) can explain the fact that with equally pronounced expansion of the pelvic veins, some patients have pelvic symptoms due to nerve compression, while the other part does not. This concept is supported by the fact that in those patients who had complaints of pain, dysuria and erectile dysfunction, after surgical treatment of pelvic varicose veins, in most cases they disappeared or decreased.Conclusion. Pain syndrome (56.6 % of cases), erectile dysfunction (51 % of cases) and dysuria (17.9 % of cases) were noted as clinical manifestations in patients with pelvic varicose veins. Analysis of data after examination and treatment of patients with pelvic varicose veins allowed us to identify “venous compression neuropathy syndrome” as a probable cause of the development of pelvic symptoms in patients with pelvic varicose veins. Depending on the level of localization of nerve compression by varicose veins, we proposed to distinguish three forms of this syndrome: 1) thoracic, 2) lumbar, and 3) sacral form.

Non surgical retreatment three rooted maxillary premolars: A case report

Effective and successful endodontic treatment requires dentists to have adequate information on the clinical variations in root canal anatomy. Maxillary premolars exhibit anatomical variations in the numbers of roots and canals, which pose a challenge during root canal therapy these variations must be considered for successful endodontic therapy. Herein, we illustrate the diagnosis and clinical management of previously endodontically treated three rooted maxillary premolars using Cone Beam Computed Tomography (CBCT).