Permanent Mandibular Molars Research Articles

Relationship of incidence of radix entomolaris and C-shaped canal in mandibular molars using CBCT: A multi-centre study.

This study aimed to evaluate the relationship of incidence between radix entomolaris (RE) in permanent mandibular first molars (FM) with C-shaped canal (CSC) in permanent mandibular second molars (SM). A total of 1015 cone-beam computed tomography (CBCT) images of permanent mandibular molars from Malaysian patients were collected retrospectively and analysed by researchers from seven dental schools in Malaysia trained in CBCT technology. The presence and absence of RE and CSC were scored as 'yes' or 'no'. The prevalence of FM with RE was 21.2% and SM with CSC was 37.9%. The co-occurrence of RE and CSC in the same quadrant was 6.5% (OR = 1.497, p = 0.014). Female, Chinese and samples from Eastern Peninsular Malaysia were associated with CSC in SM (p < 0.05). The increased appearance of CSC in SM when RE is present in FM makes it imperative for clinicians to be vigilant during examination and diagnosis to prevent potential endodontic mishaps.

Spontaneous space closure after extraction of permanent first molars in children and adolescents: a systematic review and meta-analysis.

Extraction of the permanent first molars is sometimes necessitated in children and adolescents due to deep carious lesions or developmental defects. To estimate the prevalence of spontaneous space closure after extraction of permanent first molars and identify factors associated with it. Unrestricted searches in five databases for human studies until February 2024. Longitudinal before-and-after (cohort) human studies assessing eruption of the permanent second molars and spontaneous space closure after extraction of the permanent first molar. Study selection, data extraction, and risk of bias assessment were performed in duplicate. Random-effects meta-analyses of average spontaneous space closure prevalences and odds ratios (OR) with their 95% confidence intervals (CI) were performed, followed by meta-regression/sensitivity/reporting biases' analyses and evaluation of our confidence in effect estimates. Sixteen reports pertaining to 15 studies (1 prospective /14 retrospective) were included covering 1159 patients (ages 5.5-15.0 years [mean 10.0 years]; 45% male on average) and 2310 permanent second molars. The prevalence of spontaneous space closure was higher in the maxilla (nine studies; 85.3%; 95% CI = 73.7%-92.3%) than the mandible (11 studies; 48.1%; 95% CI = 34.5%-62.0%) to a significant extent (nine studies; OR = 7.77; 95% CI = 4.99-12.11; P < 0.001). For both maxillary/mandibular second molars, Demirjian category E was associated with increased space closure odds than earlier/later stages (P < 0.05). Spontaneous space closure in the mandible was seen more often for patients ages 8-10 years (compared with older patients; three studies; OR = 3.32; 95% CI = 1.73-6.36; P < 0.001) and when the mandibular permanent third molar was present (four studies; OR = 2.28; 95% CI = 1.67-3.09; P = 0.003). Additional analyses failed to find any significant modifying factors. The quality of evidence was very low in all instances due to the inclusion of retrospective studies with methodological issues. Existing evidence indicates that spontaneous space closure in children and adolescents after extraction of the permanent first molar is seen more often in the maxilla than the mandible. Extraction of the permanent first molar at the Demirjian stage E of the second molar and presence of the lower permanent third molar is associated with increased odds of space closure, but uncertainty persists, due to methodological issues of existing studies. PROSPERO (CRD42023395371).

Comparative evaluation of different endodontic access cavity designs on canal transportation and centering ability using bondent platinum file system on mandibular molar – An in vitro cone-beam computed tomography study

ABSTRACT Aim: This study aimed to compare the effects of different endodontic access cavity designs on canal transportation (CT) and centering ability (CA) using the bondent platinum file system on mandibular molars, utilizing cone-beam computed tomography (CBCT). Methodology: Thirty extracted human permanent mandibular molars which fulfilled the inclusion criteria were divided into three groups, Group 1 (TEC): Traditional endodontic access cavity (control group), Group 2 (CEC): Conservative endodontic access cavity, and Group 3 (TrEC): Truss endodontic access cavity. The teeth were scanned using CBCT initially followed by random allocation into three groups. Root canals were prepared using Bondent platinum file system in mesiobuccal and mesiolingual canals using #25.06 file and in distal canal #30.06 file. Postpreparation, CBCT scans to assess CT and CA at 3 mm, 5 mm, and 7 mm from the apex. Data analysis was performed using a one-way analysis of variance and Tukey’s post hoc test. Results: Significant differences (P &lt; 0.01) in mean CT and CA were observed between Group 1 (TEC) and Groups 2 (CEC) and 3 (TrEC). Dentin removal was highest at 3 mm, followed by 5 mm and 7 mm. The distal canal showed the greatest dentin loss compared to other canals. Conclusion: Minimal access cavity designs (CEC and TrEC) demonstrated less CT and improved CA compared to the traditional access cavity design (TEC). Study limitations acknowledged that conservative access cavity designs result in less deviation (CT) and better centering of the prepared canals compared to the traditional approach (TEC). These results imply the potential benefits of adopting less invasive access cavity designs in endodontic practice to enhance treatment outcomes.

Management of preeruptive intracoronal radiolucency (PEIR): a case series with up to 8 years follow-up.

Preeruptive intracoronal radiolucency (PEIR) is a rare dental anomaly often incidentally detected during routine radiographic examinations. This condition manifests as a radiolucent lesion beneath the enamel-dentin junction of unerupted teeth, particularly in mandibular molars, posing diagnostic and management challenges due to its asymptomatic nature. The treatment of PEIR depends on the extent of the lesion and the degree of pulp involvement. Case series: This case series reports on four patients with progressive PEIR. In Cases 1 and 2, lesions were incidentally discovered in panoramic radiographs during orthodontic planning (mandibular permanent second molars), and additional surgical exposure to access the lesion was required as teeth were only partially erupted. Interestingly, in Case 3, the PEIR was not visible in earlier radiographs though the crown of the tooth was already mineralized (mandibular permanent second molar). For Case 4, the tooth presented with symptoms of reversible pulpitis (mandibular permanent first molar). All lesions were treated with indirect pulp capping using biocompat-ible material. The patients were followed up for a period of up to 8 years to evaluate treatment success. Indirect pulp capping and restorations were found to be successful in all four cases in the last follow-up: 1 year (Case 2), 1.4 years (Case 4), 1.5 years (Case 1), and 8 years (Case 3). Conclusion: This case series demonstrates the effectiveness of early intervention via surgical exposure and indirect pulp capping and restoration for managing severe cases of PEIR. However, further research with larger samples and long follow-up is necessary.

Efficacy of topical tranexamic acid soaked absorbable gelfoam in relieving post-extraction pain in warfarin patients: a randomized, triple-blinded, split-mouth, active-controlled clinical trial

BackgroundWarfarin patients who need dental extraction face the problem of bleeding and no sufficient hemostasis results in dry socket and postoperative pain. This study aimed to evaluate and compare the efficacy of the topical application of tranexamic acid-soaked absorbable Gelfoam (TXA-Gel) and saline-soaked absorbable Gelfoam (saline-Gel) in relieving postoperative pain following bilateral simple extraction of permanent mandibular molars in warfarin patients.MethodsThis was a randomized, triple-blinded, split-mouth, active-controlled clinical trial. It was performed at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Damascus University, between November 2021 and October 2023. 60 bilateral permanent mandibular molars, which were indicated for simple extraction in 30 warfarin patients randomly assigned into two groups according to the topical hemostatic agents after extraction used: Group 1: control group, saline-Gel (n = 30). Group 2: TXA-Gel (n = 30). A simple randomization method was performed by flipping a coin. The primary outcome measure was the visual analogue scale (VAS). The intensity of pain was evaluated at the baseline (t0), and on the 1st (t1), 2nd (t2), 3rd (t3), 4th (t4), 5th (t5), 6th (t6), and 7th (t7) days following extraction. The Kolmogorov–Smirnov test and the Mann-Whitney U test were performed. The level of significance was set at 0.05 (p < 0.05).ResultsThe mean vas scores was 4.17 ± 1.76 at t1 and decreased to 0.73 ± 0.78 at t7 in the TXA-Gel group. However, in the Gelfoam group, the mean vas scores was 4.83 ± 2.18 at t1 and decreased to 1.80 ± 1.00 at t7. The results of the Mann-Whitney U test showed that there was no statistically significant difference between the two groups at t1 (p = 0.236) and t2 (p = 0.155). However, there was a statistically significance difference at the rest time points (p < 0.05).ConclusionsTXA-Gel played a prominent role in alleviating post-extraction pain in warfarin patients.Trial registrationThe trail was retrospectively registered at the ISRCTN registry (ISRCTN71901901).

Endodontic management and outcome of non-surgical root canal treatment for radix entomolaris associated mandibular molar teeth: A scoping review of case reports

Radix entomolaris (RE) is an anatomical variant of the permanent mandibular molar (MM) with various complex anatomy. However, there is limited literature on the guideline on endodontic management of RE, resulting in unclear understanding on the endodontic treatment outcomes. Hence, this study aimed to map current case reports on endodontic treatment modalities, occurrence of endodontic mishaps, and outcome of MM associated with RE. A systematic search was performed in PubMed, Google Scholar, Scopus, Science Direct, PLOS, and Lilac databases for English articles published between 2000 and 2022 that met the inclusion criteria. The search yielded 1435 results; after screening was completed, only 58 articles were included in the study and critically appraised using JBI critical appraisal tool. Amongst the modifications made in endodontic management of RE were utilising angulated periapical radiograph supplemented with cone-beam computed tomography, extending the access cavity distolingually, and maintaining a small apical size of #25. There were 12% incidence of endodontic mishaps (separated instrument, ledge, missed canal, and extruded sealer) on RE. The success and survival rate of MM associated with RE were 58.7% and 40% respectively, at an average of 8.4 months. The basic management of MM with RE is similar to that of other MM. However, emphasis should be made on RE identification to prevent endodontic mishaps that can influence the endodontic treatment outcome.

Frequency of C-Shaped Root Canals in Permanent Mandibular Second Molars in a Sample of Pakistani Population using Cone Beam Computed Tomography

Frequency of C-Shaped Root Canals in Permanent Mandibular Second Molars in a Sample of Pakistani Population using Cone Beam Computed Tomography

Accuracy of Age Estimation Method Using Dental Radiographs of Permanent Mandibular Second Molars in a Southern Thailand Population

Age estimation is an important process for identifying individuals. In 2020, Duangto et al. estimated age by assessing dental development according to the method of Demirjian on permanent mandibular second molars using a panoramic radiograph. They also developed equations and tested their accuracy in a population of northern Thailand. However, several studies have shown that age estimation methods vary in suitability and accuracy depending on genetic and environmental factors within each population group. Therefore, this research aimed to test the accuracy of dental age estimation using the equations derived from panoramic radiographs of permanent mandibular second molars in a population of southern Thailand. A total of 224 radiographs of 112 males and 112 females aged 7–14 years were used for this study. The samples were categorized into eight groups (28 radiographs per group). The study identified tooth development in stages C–G that followed the Demirjian method and converted these stages into numerical values (3–7). The researchers tested these numerical values in the Duangto et al. equations. The findings revealed that age estimation using the Duangto et al. equations was not significantly different from chronological age. The accuracy had a margin of error not exceeding one year with 95% confidence intervals. In conclusion, the age estimation equations of Duangto et al. can accurately estimate the age of persons living in southern Thailand.

Two-year evaluation of a nano-hybrid and a bulk-fill resin composite: a randomized, double-blind split-mouth clinical study

ObjectivesThe aim of this study was to compare the 2-year clinical performance of a bulk-fill composite resin and a nano-hybrid-filled composite resin in 6-12-year-old children in a split-mouth design.Materials and methodsThis randomized, split-mouth, and double-blind study was conducted on 89 patients aged 6–12 years with caries on bilateral mandibular first molars. In a split-mouth design, restorations of mandibular permanent molars were completed with nano-hybrid organically modified ceramic (ORMOCER)-based bulk-fill composite resin Admira Fusion x-tra (Voco GmbH, Cuxhaven, Germany) and nano-hybrid composite Grandio (Voco, Cuxhaven, Germany). Futurabond U single dose (Voco, Cuxhaven, Germany) was used with selective enamel etching. The clinical success of the restorations was evaluated using USPHS and FDI criteria at 6, 12, and 24-month follow-up controls.ResultsIn the 2-year follow-up, all restorations were clinically acceptable. Grandio was significantly worse than Admira Fusion x-tra in terms of surface luster and superficial change (p < 0.05). Surface staining and color match scores increased in Admira Fusion x-tra compared with Grandio significantly (p < 0.05).ConclusionsAlthough both materials showed acceptable clinical performance over 2 years, a significant difference was observed between the surface luster, surface staining, marginal adaptation, and staining of the nano-hybrid composite placed with the incremental technique and the bulk-fill ORMOCER-based composite resin.Clinical relevanceAs an alternative to nano-hybrid composite resins, using bulk-fill restorative materials, which can be indicated in the proper case, may contribute to shortening treatment procedures and increasing patient and physician comfort, leading to clinical success.

Mandibulotomy Technique and Permanent Molar Injury After Mandibular Distraction Osteogenesis in Infants.

The risk that mandibular distraction osteogenesis (MDO) poses to the developing mandibular dentition is well-known; however, less is understood about how the choice of instrumentation used for mandibular osteotomy might affect the development of permanent molars. Retrospective chart review examining infants with micrognathia who underwent MDO from 2010 to 2018 at a single tertiary care children's hospital using external, multivector devices. The first and second permanent mandibular molars were radiographically examined years after surgery to determine whether osteotomy cutting techniques affect the risk of injury to the permanent dentition. Thirty-seven infants and children underwent MDO from 2010 to 2018. Follow-up dental radiographs were available for 17 patients; 6 patients were excluded based on the use of preoperative computed tomography, utilization of virtual surgical planning technology, use of buried internal distractors, or older age at the time of distraction surgery. This yielded a total of 11 patients who underwent MDO with external hardware without virtual surgical planning representing 22 osteotomies. Sixteen osteotomies were performed using a side-cutting burr and 6 with a piezoelectric saw. The median age at distraction surgery was 3 weeks. The rate of an abnormal permanent first or second mandibular molar finding per osteotomy was 88% (14/16) in the side-cutting group versus 17% (1/6) with the piezoelectric technique (P = 0.004). Mandibular distraction osteogenesis risks injury to the mandibular molars; however, this study suggests a significant risk reduction in molar injury if the piezoelectric device is utilized.

Geometric Morphometric Shape Analysis of Mandibular Post-Canine Dentition

Background: Genetic and epigenetic alterations have significant impacts on the morphology of permanent mandibular premolars and molars. Geometric morphometry is a powerful technique, which can be utilized to identify specific landmarks that exhibit variation and that are associated with ancestry and dimorphism. Methods: The geometric and anatomic landmarks of mandibular premolars and molars were extracted from 3D digital replicas of diagnostic dental casts prepared for model analysis (n = 160). Tooth shape analysis was conducted using various techniques, including Procrustes superimposition, Procrustes ANOVA, discriminant function analysis, and the regression of shape over the centroid size. Results: Procrustes ANOVA showed that centroid size was not significantly different between the two sexes, but shape was significantly different in the two-cusp-type second premolars (p = 0.0035) and in the first/second molars (p &lt; 0.001). The three-cusp type of the second premolars showed the highest degree of allometry, with 3.35%, followed by the mandibular second molars, with 3%, indicating that distal class types have a tendency to exhibit allometry. The distal and lingual components of the tooth showed more variability, and females tended to have sharper cusp configurations. Conclusions: This study shows how landmarks vary in permanent human post-canine dentition, a crucial finding for anatomic reconstruction and restorative dentistry. In particular, the molars and premolars of the mandible post-canine teeth are critical for achieving optimal masticatory efficiency and overall health. Additionally, a higher degree of allometry and the later formation of cusps correlate with greater shape variation, particularly on the distal and lingual sides. For precise restorative procedures, a thorough understanding of the anatomy of these teeth is required.

A Case of Surgical Treatment of Lower Molars in a Mesolithic Sample from a Cemetery on the Yuzhny Oleniy Ostrov, Karelia, Russia

Here, we present the earliest case of surgical treatment of mandibular permanent molars known in Northern Eurasia. It concerns an aged woman buried at a Mesolithic cemetery on the Yuzhny Oleniy Ostrov (Island) in Lake Onega, southern Karelia, 8250–8050 cal BP. Our objective was to reconstruct the technology of surgical intervention, and to diagnose and describe the underlying condition. To do this, we carried out an examination of teeth and bone tissues of the upper and lower jaws and a traceological analysis of identified lesions. As we found, in the last few months of her life, the woman underwent several dental operations, including the extraction of the lower left third molar and, in a stepwise fashion, of fragments of the distal part of crown and lingual part of the distal root of the lower right first molar. The first operation was successful—the woman survived for at least two months after it had been performed. The second operation was also successfully performed at least two months before death, likely immediately after the trauma. The mesial part of the crown was removed just before death. No ancient cases where fragments of an injured tooth were removed are known to us. The removal of the lower third molar can be compared only with the earliest previously known case, described in a sample from the Pucará de Tilcara fortress in Northern Argentina (15th–16th centuries AD). Indications for surgery partly coincide in both cases, and include complications of apical periodontitis and the development of osteomyelitis. However, the technology of surgery and its logistics are different.

The effect of calcium hydroxide and double antibiotic paste on radiographic outcomes and periapical MMP-8 levels in regenerative endodontic procedures: a randomized clinical trial.

The primary goal is to evaluate the effects of two different intracanal medicaments, calcium hydroxide [Ca(OH)2] and double antibiotic paste (DAP), on radiographic outcomes during regenerative endodontic procedures (REP) of immature permanent mandibular first molars with symptomatic irreversible pulpitis and symptomatic apical periodontitis (SIP/SAP). Additionally, the secondary goal was to evaluate MMP-8 levels during REP using two different intracanal medicaments. The study included 20 patients with immature mandibular first molars exhibiting SIP/SAP. Participants were randomly assigned into two groups based on the applied intracanal medicament. Ca(OH)2 (n=10) was prepared by mixing it with sterile distilled water, while the same amount of powdered metronidazole and ciprofloxacin were mixed and combined with sterile distilled water for DAP (n=10). MMP-8 in periapical samples were measured at baseline and on the 14th day using immunofluorometric assay. Image-J software with TurboReg plug-in was utilized to determine changes in root length, root width, radiographic root area (RRA) during the 12-month follow-up period. Data were analyzed by SPSS 25.0 (p<.05). Significant increase in MMP-8 on the 14th day compared to baseline in both groups (p<0.001). There was no significant difference between the two groups in terms of the increase in MMP-8 (p>0.05). Root length significantly increased in both groups (p=0.001), with Ca(OH)2 showing a greater increase (p=0.046). Root width and RRA increased similarly in both groups at 12th month. Both Ca(OH)2 and DAP applications resulted in a significant increase in periapical MMP-8 levels. Increase in radiographic root width and root area was similar between two groups, but Ca(OH)2 led to a significantly greater increase in root length. Further studies with larger sample sizes are necessary to validate our findings during REP of vital immature permanent mandibular molars. Clinical Trials database: NCT05581706.

Nonmetric Traits in Permanent Teeth as Clues to Ethnicity in Vidarbha Subpopulation to Aid Forensic Profiling: Pilot Study

Abstract Introduction: Nonmetric dental traits have a crucial role in ethnic classification of populations that help in forensic racial identification. Many studies have demonstrated the differences in the expression and frequency of dental traits between various ethnic groups for ancestry determination in the context of forensic dental anthropology. The present study is an attempt to assess the frequency and variation in nonmetric traits for establishing ethnicity in the Vidarbha subpopulation. Aim: The aim of the study was to assess the frequency and variation of nonmetric traits in permanent teeth for establishing ethnicity in the Vidarbha subpopulation. Materials and Methods: Participants of the Vidarbha subpopulation were selected by random sampling method. Molars, premolars, and incisors were evaluated for frequency of nonmetric traits, and variations were graded according to Dentoanthropological System of State University of Arizona criteria. Descriptive statistics, Chi-square test, and Student’s t-test were used for analysis of data. Results: The most common occlusal morphology in mandibular first and second molar was 5 cusp and 4 cusp, respectively, with the “+” groove pattern. Cusp 3 and cusp 4 were observed frequently in the maxillary molars. One lingual cusp was most commonly seen in mandibular premolars show while incisors showed faint shoveling. Conclusion: Our study concludes that nonmetric traits were present and showed variation in permanent maxillary and mandibular teeth among the Vidarbha subpopulation. Cusp 5 and Cusp 4 in first and second mandibular molars, respectively, groove pattern “+” and grade 1 protostylid were the most frequent grades observed in permanent mandibular molars. One lingual cusp was most commonly seen in mandibular premolars and faint shoveling was a notable feature in incisors of this population.

Root canal curvature influences uncontrolled removal of dentin and cleaning efficacy after ultrasonic activation.

This study evaluated the correlation between root canal curvature and the effects of ultrasonic irrigation in the following parameters: volume of uncontrolled dentin removal (UDRVol), maximum depth of dentin defects, removal of accumulated hard tissue debris (AHTD), and canal transportation in prepared curved root canals. Twenty-four human permanent mandibular molars were divided into two groups according to root canal curvature: moderate curvature (MC: mean 25°); and severe curvature (SC: mean 48°). The specimens were scanned using an X-ray microcomputed scanner (Skyscan 1172) before and after cleaning and shaping and after the final irrigation protocol with ultrasonic irrigation. There was a moderate correlation between the degree of root canal curvature and the volume of remaining AHTD (p<0.05) and between the degree of root canal curvature and maximum depth of defects due to uncontrolled removal of dentin (p<0.05). The teeth in the SC group had a greater maximum depth of defects on the dentin wall in the apical third than the teeth in the MC group (p <0.05). Both groups had a significant reduction of AHTD in all canal thirds, but the amount of remaining AHTD in the middle and apical thirds and the whole canal was significantly greater in the SC than in the MC group (p <0.05). Canal transportation was not influenced by the canal curvature in all thirds (p >0.05). This study concluded that root canal curvature affects significantly the uncontrolled removal of dentin and remaining AHTD volume after the final irrigation protocol with ultrasonic irrigation.

Case series on two-stage disinfection in regenerative endodontics on permanent mandibular molar with blunderbuss canal

Background: Revascularization is a promising approach as it promotes root end closure forming healthy, thick root dentin at the apex which provides clinical and radiographic success due to the elimination of bacteria and disinfection of the canal which gives a 100% sterile environment to receive SCAP. Aim: To examine the effect of a regenerative endodontic procedure on immature necrotic teeth with apical periodontitis Method: An 8-year-old medically fit boy was referred to the department with a lingering type of pain in the immature permanent mandibular first right molar. Bleeding was induced in the root canals at the third appointment. The blood clots (scaffolds) were covered with MTA, and the tooth was restored with a composite filling. Recall sessions were scheduled after one month and 3 months, when the tooth appeared asymptomatic clinically and radiographically, with considerable periapical healing. Conclusion: An immature multirooted tooth with necrotic pulps and periapical radiolucency was managed with evident clinical and radiographic success, wherein non-setting calcium hydroxide paste and triple antibiotic paste were used sequentially to guarantee complete canal disinfection.

Radix entomolaris and radix paramolaris: A cone-beam computed tomography study of permanent mandibular molars in a large sample from Slovenia

ObjectivesTo investigate the prevalence, unilateral/bilateral concurrency, and external morphology of permanent mandibular molars (PMMs) with radix entomolaris (RE) and radix paramolaris (RP) in a sample from Slovenia. DesignMedium field-of-view cone-beam computed tomography images of 1315 participants (681 males, 634 females) aged 13–90 years (mean age 45.5) were retrospectively examined. A total of 1363 first, 1824 second, and 1314 third PMMs were evaluated. The external morphology of the affected teeth was categorized according to Carlsen and Alexandersen’s classifications. ResultsThe individual-level RE frequencies in the first, second, and third PMMs were 1.6%, 1.9%, and 10.1%, respectively. The respective RP frequencies were 0%, 1.8%, and 3.2%. The first PMMs exclusively exhibited type A RE morphology, whereas in the second and third PMMs, types B and AC morphologies predominated. Bilateral concurrence rates were low (0–7.1%), with the exception of type A RE in first PMMs (62.5%). RE occurrences in the first and second PMMs were correlated (odds ratio = 70.2; 95% confidence interval 17.4 −282.7; P < 0.001). In concurrent cases, the second PMM followed its anterior neighbor in expressing type A morphology, and conversely, all affected second PMMs standing next to a two-rooted first PMM exhibited non-type A morphology. ConclusionsIn this sample, the first and second PMMs exhibited low supernumerary root frequencies comparable to those of other European samples. The third PMM was most often affected. The presence of RE on the first PMM increased the possibility of its presence on the adjacent second PMM and vice versa.

An atypical anatomy of permanent mandibular second molar with five roots.

Especially in molars that may have sometimes aberrant additional root canals, the complexity of tooth internal morphology in individual cases sometimes does not match to admitted classification rules and underlines the risk of missed anatomy during the endodontic management. To our knowledge, a permanent mandibular second molar with independent five roots, three mesial and two distal, each of them harboring a single canal, was not yet reported. Despite the treatment difficulties this tooth could be successfully approached by using dental operative microscope and cone-beam computed tomography (CBCT) with small field of view. Though CBCT is not a routine imagistic examination, in case of atypical tooth anatomy aiming to establish adequate diagnosis and treatment plan, the successful clinical outcome prevails over the irradiation dose.

Prevalence of Radix Entomolaris in Mandibular Permanent Molars Analyzed by Cone-Beam CT in the Saudi Population of Ha'il Province.

The present study aimed to examine the prevalence of radix entomolaris (RE) in the mandibular permanent molar within a specific sub-population in Saudi Arabia. A comprehensive analysis was conducted on 499 cone-beam computed tomography (CBCT) scans of a mandibular molar from a sample of Saudi patients aged between 18 and 65. The primary objective of this study was to investigate the anatomical characteristics of mandibular permanent molars, specifically focusing on the number of roots present. The chi-square test was employed to examine the relationship between various variables. In the case of mandibular first molars, it was observed that 95.3% of these molars exhibited a bifurcated root structure. In comparison, the remaining 4.7% displayed a triradicular configuration within the sample population under investigation. Although there were some variations, no significant differences in the number of roots were observed between males and females or left and right sides (p > 0.05). In the case of mandibular second molars, it was observed that 96.9% of them exhibited a bifurcated root structure, whereas 2.5% displayed a trifurcated root configuration, and a mere 0.6% possessed a single root. There were no statistically significant variations in the number of roots between males and females or left and right sides (p > 0.05). The identification of REwas observed in the mandibular molars. Moreover, the discovered RE roots were predominantly found in the mandibular first molar, displaying a tendency for bilateral occurrence in both male and female individuals.

Beyond Tradition: Non-surgical Endodontics and Vital Pulp Therapy as a Dynamic Combination.

Symptomatic irreversible pulpitis and apical periodontitis in mature permanent teeth present challenges in their management. Traditional treatment approaches, such as root canal therapy or tooth extraction, may compromise tooth structure and oral function. This review article explores the combination of non-surgical endodontic treatment and vital pulp therapy as an alternative approach for these conditions. The purpose is to examine this combined approach's effectiveness, benefits, challenges, and limitations. The objectives include reviewing the literature, evaluating clinical outcomes, discussing potential benefits, and providing recommendations for clinical practice. The combination approach aims to preserve tooth structure, promote healing, and reduce postoperative complications. The article discusses the rationale for combining the two techniques, presents evidence supporting their efficacy, and outlines the techniques and protocols involved. Clinical outcomes, case studies, potential challenges, and comparative analysis with traditional approaches are also explored. Future directions and research recommendations highlight areas for further investigation, innovations, and the development of clinical guidelines. In conclusion, the combination of non-surgical endodontic treatment and vital pulp therapy offers a valuable strategy for managing mature permanent mandibular molars with symptomatic irreversible pulpitis and apical periodontitis. Further research and advancements are needed to refine the treatment protocol and expand the evidence base, and clinicians should stay updated to provide optimal care and improve patient outcomes.