Root Canal Morphology Research Articles

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.

Analysis of apical third root canal morphology of the palatal root of maxillary first molar and its proximity to maxillary sinus: A cone-beam computed tomographic study

ABSTRACT Aims: The aim of this study was to assess the angulation of the apical exit from radiographic apex of palatal root of maxillary first molar, to measure the distance between radiographic apex and apical exit of palatal root of maxillary first molar and to measure the distance of apical exit of palatal root of maxillary first molar from maxillary sinus floor. Materials and Methods: A total of 118 untreated, well-developed maxillary first molars were selected on cone-beam computed tomography scans. Data were collected and viewed by invivo5 software. Descriptive statistical analysis was given as mean value. Results: Radiographic apex and apical exit did not coincide in the large number of samples. The palatal root of maxillary first molar was found to be in direct contact with the floor of maxillary sinus in maximum samples. Conclusion: Apical exit does not coincide with the radiographic apex in all the cases. The distance between radiographic apex and apical foramina or apical exit ranges from 0 to 1.43 mm. The apical exit or apical foramina are in direct contact with maxillary sinus floor in 75% cases.

Cone beam computed tomography evaluation of root canal morphology of maxillary premolars in North-West sub-population of Pakistan

Cone beam computed tomography evaluation of root canal morphology of maxillary premolars in North-West sub-population of Pakistan

Assessment of the canal anatomy of the premolar teeth in a selected Turkish population: a cone-beam computed tomography study

BackgroundTeeth may have additional roots and a different number of root canals. Overlooked root canals may cause endodontic failure. The aim of this study was to investigate the prevalence of root canals and the number of roots of premolars in a selected Turkish population.Materials and methodsA total of 2,570 teeth from 1,438 patients were evaluated. The cone-beam computed tomography scans of 1,055 maxillary and 1,515 mandibular premolars were examined.ResultsType IV root canal morphology was observed most frequently in maxillary first premolars (77%), and the rates of single and double channel formations were very similar (51% and 49%, respectively). Of the second maxillary premolars, 57.4% had Type I morphology, and 89.9% of the teeth were single-rooted, while 68.6% had a single root canal. The most common formation was Type I (85%) among mandibular first premolars, and a single root was observed in 95.6% of these teeth. In addition, 87% of the mandibular first premolars had a single root canal. The second mandibular premolars mostly had Type I (95.4%) formation, and 99.3% of the teeth were single-rooted, while 96.9% had a single root canal.ConclusionAccording to our findings, 51% of maxillary first premolars had a single root, 79.4% had two root canals, and 77% had Type IV (77%) formation. Maxillary second premolars mostly had Type I formation. In addition, a single root and single root canal formation were most common. Mandibular first premolars generally had a single root and single root canal formation, but 13% had two root canals, and 6.4% had Type V formation. More than 95% of mandibular second premolars had Type I formation.

Analysis of Root Canal Characteristics in Permanent Canine Teeth Among 270 Saudi Subjects: A Cone-Beam Computed Tomography Study.

BACKGROUND An understanding of root canal morphology is vital for successful endodontic treatment. However, variations in the root canal system of permanent canines, especially in relation to population-based diversity, are not well-documented. This study thus aimed to analyze the root canal numbers, configurations, and bilateral symmetry in 1080 permanent canine teeth among 270 Saudi individuals using cone-beam computed tomography (CBCT), contributing to the existing body of knowledge and aiding clinicians in devising effective treatment strategies. MATERIAL AND METHODS The CBCT images of 270 participants, encompassing 1080 canines (540 pairs of upper and lower canines), were scrutinized for root and canal counts. Canal configurations were assessed based on Ahmed's and Vertucci's classifications. Bilateral symmetry in these parameters was recorded and the data were statistically analyzed. RESULTS The study revealed variable prevalence of multiple roots and canals in maxillary and mandibular canines. Ahmed's and Vertucci's type I canal configuration was predominantly observed. Notably, significant bilateral symmetry was noted in root and canal numbers, and canal configurations. CONCLUSIONS The most common configuration of permanent canines was a single root and canal, usually adhering to Ahmed's and Vertucci's type I classification. Mandibular canines showed a higher incidence of two canals than two roots. The extent of bilateral symmetry, especially in mandibular canines, could provide valuable insights for better contralateral tooth treatment planning.

Anatomical complexities affecting root canal preparation: a narrative review.

A fundamental aspect of the Endodontic field is the knowledge of root canal anatomy. Using a variety of techniques, the internal and external anatomy of teeth have been extensively investigated throughout the past century. Recent improvements in three-dimensional computed tomography have enabled more detailed evaluations of root canal morphology in both clinical and laboratory settings. Essentially, researches have unveiled that the root canal constitutes a complex system, comprising not only the main root canal but also lateral components, including isthmuses, fins, accessory canals and apical ramifications. Undoubtedly, this intricate morphology poses a significant challenge when it comes to the process of shaping, cleaning and disinfecting the root canal system. This article aims to explore the anatomical aspects of the root canal system that impact the chemomechanical procedures.

Age-related changes in the morphology of the root canal system of mandibular first molars: a micro-CT study.

This study aimed to evaluate changes on root canal morphology in patients with different ages using micro-CT technology. Mandibular first molars (n = 150) were scanned at a pixel size of 13.68µm, categorized into 3 groups according to patient's age and analyzed regarding configuration, orifices, apical foramina, root length, canal volume, and surface area. Morphological 2D and 3D parameters were evaluated in distal roots with Type I configuration (n = 109) as well as the morphology of isthmuses Types I and III in 68 mesial roots. One-way ANOVA post hoc Tukey and Kruskal-Wallis tests were used for statistical analyses (α = 5%). A great variation in the canal configuration was found. No difference was observed in roots' length (p > 0.05). Canal volume reduced with age (p < 0.05), while surface area increased (p < 0.05) in patients ≤ 30years. There was no difference in canal/root length, area, and from foramen to the apex in distal roots with Type I configuration (p > 0.05), but 2D and 3D parameters significantly decreased with age (p < 0.05). Overall, the diameter of the isthmuses' roof reduced with age (p < 0.05). In patients ≥ 31years with Type III isthmus the distance from the isthmus floor to the foramen of the mesiolingual canal also decreased (p < 0.05). Overall, the internal morphology of the mesial roots of mandibular first molars was more affected by aging than distal canals. The most relevant tested parameter that significantly reduced in both roots was the volume of the root canal systems. A detailed evaluation of fine anatomical aspects of the root canal system of mandibular first molars of patients with different ages showed that the internal morphology of mesial roots is more affected by aging than distal canals.

Internal Morphological Variability of Mandibular Premolars in North Indian Population

Aims: The current study aims to investigate the root canal morphology of root canals of mandibular premolar teeth via cone-beam computed tomography (CBCT) among a sample of the north Indian population.&#x0D; Study Design: Retrospective observational study.&#x0D; Place and Duration of Study: Department of conservative dentistry and endodontics.&#x0D; Methodology: A total of 240 CBCT images were examined in the study. The Mandibular premolars were identified, and canal configurations were classified according to vertucci classification. Root canal configurations were investigated using a chi-square test.&#x0D; Results: Of the total 240 Mandibular premolars, vertucci type I was found in 86.66% in Mandibular first premolars followed by type v (8.33%) and type iv (5%). Vertucci type I was found in 96.6% in Mandibular second premolars followed by type v (1.66%), type iii (0.8%) and type viii (0.8%).&#x0D; Conclusion: The root morphology of Mandibular premolars in the north Indian population demonstrated a high degree of variability. However, the clinician should be aware about the possible anatomic variations of these teeth and their relationship with the adjacent anatomic structures while planning and performing endodontic, restorative, periodontal, and surgical procedures.

Root and Root Canal Morphology of Premolars in a Sample of the Lebanese Population: Clinical Considerations

Objectives: The aim of this study was to investigate the root anatomy of the maxillary and mandibular premolars among a sample of the Lebanese population and to explore their incidence by sex and the symmetry between the left and right sides. Materials and Methods: This retrospective analysis of 250 cone-beam computed tomography (CBCT) scans consisted of 960 maxillary and 972 mandibular premolars. Roots, canals, and morphology types were recorded. Vertucci’s classification was used to categorize the canal morphologies. Fisher’s exact and chi-square tests were applied (P≤.05). Results: The majority of maxillary first premolars had two roots (85.3%) with two canals (91.3%). Most of the maxillary second premolars showed one root (79.8%). Two-root canals (53.55%) were more common than one canal (44.2%). The three-root, three-canal morphology was rarely spotted in the maxillary first (0.4%) and second premolars (2.3%). The one-root (99.2%) and one-canal (84.5%) morphologies were most frequently located in the mandibular first and second premolars (100%, 88.6%), and two canals being less common (15.5%, 11.4%) correct same as before. The total prevalence of premolars with a complex root canal morphology was 62.4%, found in types II, III, and V to VIII. Men had significantly more roots and root canals in their maxillary first premolars than women (P≤.05). No significant differences were observed between the contralateral premolars (P&gt;.05). Conclusions: Premolars displayed wide variations in root and root canal morphology and symmetry between the contralateral premolars.

Evaluation of root and canal morphology of mandibular premolar amongst Saudi subpopulation using the new system of classification: a CBCT study

BackgroundThe clinician should have complete knowledge of the normal anatomy of the root as well as complexities in the root canal configuration for a better outcome, as missed or improper handling of the canal system can lead to the failure of an entire endodontic procedure. The present study aims to assess the morphology of roots and canals in permanent mandibular premolars in the Saudi subpopulation with a new classification system.MethodsThe present study includes 1230 mandibular premolars (645 first premolars and 585-second premolars) from 500 CBCT images of the patients, including retrospective data. iCAT scanner system (Imaging Sciences International, Hatfield, PA, USA) was used to obtain the images; scanning of 8 × 8 cm images was performed at 120 KVp and 5–7 mA with a voxel size of 0.2 mm. The new method of classification presented by Ahmed et al. 2017 was used to record and classify the root canal morphology, followed by recording the differences regarding the age and gender of the patients. Comparison of canal morphology in lower permanent premolars and its association with gender and age of the patients was done by Chi-square test/ Fisher exact test; the significance level was set at 5% (p ≤ 0.05).ResultsThe left mandibular 1st and 2nd premolars with one root were 47.31%, with two roots were 2.19%. However, three roots (0.24%) and C-shaped canals (0.24%) were reported only in the left mandibular 2nd premolar. The right mandibular 1st and 2nd premolars with one root were 47.56%, with two roots were 2.03%. The overall percentage of the number of roots and canals in the first and second premolars 1 PM 1 (88.38%), 2 PM 1 B 1 L 1 (3.5%), 2 PM B 1 L 1 (0.65%), 1 PM 1–2−1 (3.08%), 1 PM 1–2 (3.17%), 1 PM 1–2−1–2 (0.24%), 3 PMMB 1 DB 1 L1 (0.48%). However, the C-shaped canals (0.40%) were reported in right and left mandibular second premolars. No statistically significant difference was reported between mandibular premolars and gender. A statistically significant difference was reported between mandibular premolars and the age of the study subjects.ConclusionType I (1 TN 1) was the major root canal configuration in permanent mandibular premolars, which was higher among males. The CBCT imaging provides thorough details about the root canal morphology of lower premolars. These findings could support diagnosis, decision-making, and root canal treatment, for dental professionals.

Management of mandibular central incisor with two canals

The dentist lacks the necessary knowledge and understanding of root canal morphology or lacks the experience and ability to navigate the canal, they frequently fail to notice the presence of a canal and leave it untreated. This case report emphasize on necessary knowledge of tooth morphology a clinician should have to avoid endodontic failure in patients who have two canals in mandibular incisor.

Revisiting Premolars Using Cone-Beam Computed Tomography Analysis and Classifying Their Roots and Root Canal Morphology Using Newer Classification.

The objective is to compare the internal morphology of premolars while applyingthe Vertucci andrecent classification systemfor root canal variations in the Gujarat populationusing CBCT. A sample size of 537 CBCT images collected from various diagnostic centers in Gujarat was analyzed. The root canal morphology was then classifiedby using two methods - Ahmed et al. and Vertucci classification system. Fisher's exact test and Chi-square test were used for statistical analysis. All the premolars revealed a varied canal configuration. More than halfof maxillary first and 42% of maxillary second premolars were double rooted. Vertucci type IV classification was the most common infirst maxillary premolars and Type I and type IV were commonly seen in second premolars. According to the new system, the code 2N B1 P1 wascommonly seen for first maxillarypremolars. The majority of mandibular premolars were single rooted. Classification wise type I Vertucci and 1 N1 were themost common types observed. Premolars - both maxillary and mandibular - in this subpopulation had a wide range of root canal anatomical variations.Clinicians should be aware of this for a successful treatment outcome.The new system for classifying canal morphology describes the root and canal configurations in a more accurate and practical manner compared to the Vertucci classificationand hence can be used routinely.

Evaluation of Root Canal Morphology of Maxillary Second Premolars and Its Relation to Maxillary Sinus in a Saudi Arabian Population.

This study aimed to evaluate the root canal anatomy of maxillary second premolars, and its relation to the maxillary sinus in a Saudi Arabian population using cone-beam computed tomography. Records of 301 patients (602 Teeth) were obtained from a Cone-beam Computed Tomography Database of the College of Dentistry, Jazan University from February 2020 to January 2022. The number of roots, root canals, and the relationship between the root apices of maxillary second premolars and the floor of the maxillary sinuses were studied. The data was recorded, tabulated, and statistically analyzed. A majority of maxillary second premolars were single-rooted (78.74%), followed by double-rooted (20.76%) and three-rooted (0.5%). Two canals (59.1%) were seen in the majority of the examined teeth, followed by one canal (40.4%) and three canals (0.5%). The roots of the maxillary second premolars were predominantly (69.17%) outside the sinus. Nineteen percent of roots were in contact with the floor of the maxillary sinus with no significant difference between buccal and palatal roots, and around twelve percent (11.73%) of roots were inside the maxillary sinus. The root canal system morphology of maxillary second premolars showed a wide range of anatomical variations in the Saudi Arabian population with a predominance of single roots. Most of the roots were located outside the sinus followed by in contact and then inside the sinus. Three-rooted second premolars were exceedingly rare. The cognizance of maxillary second premolar root canal anatomy and its relation to maxillary sinus would be a valuable affirmation for dentists of different nationalities treating the Saudi Arabian population to ensure a successful endodontic treatment.

Endodontic challenges in the management of radix entomolaris: Case series

Endodontic treatment of Radix Entomolaris is challenging and requires a complete understanding of root canal system, and skills to manage the commonly occurring mishaps during the treatment. Therefore, comprehensive clinical &amp; radiographic interpretation is critical in identifying unusual root canal morphologies. The additional root variation in the mandibular molars may be present either mesio-bucally (Radix Paramolaris) or distolingually (Radix Entomolaris). This case series intends to discuss the diagnosis, endodontic challenges during file separation, and non-surgical endodontic management of two cases of Radix Entomolaris in the mandibular first molar.

Maxillary Canine with Rare Root Canal Morphology

Understanding root canal morphology is the main prerequisite for the clinician to carry out root canal therapy. The intricate structure of the root canals always creates challenges for the clinician during the cleaning and shaping procedure. Diversities in the canal morphology has to be thoroughly evaluated and studied using radiographs and also by the utilization of additional diagnostic aids before initiating the treatment procedure. This paper describes the management of maxillary canine with Vertucci type II canal configuration, a rare morphological occurrence.

Endodontic management of three rooted premolars with atypical root canal morphology: Case report

Anatomical variations in the root canal morphology is a commonly occurring phenomenon. Arriving at a precise diagnosis clinically and radio-graphically would lead us to appropriate treatment planning which is mandatory for successful outcome of the endodontic treatment. Maxillary and mandibular second premolars have intricate root canal anatomy. The incidence of three rooted premolars is very rare in Indian population, presence of additional roots would make the clinician’s job difficult and challenging. The following case report describes the endodontic and restorative management of maxillary and mandibular second premolar with atypical root canal anatomy being successfully treated with the help of magnification.

Evaluation of root canal morphology of mandibular central and lateral incisor in Mosul city by using CBCT

Background: Lower incisor endodontic treatment failures are primarily due to missing canals, notably the lingual canal. Aim: The incisors' root architecture and the number of canals of the mandibular would be evaluated using computed tomography using a cone beam (CBCT). Methods: 220 patients with age (18-75) years who visited Al Noor Dental Center in Mosul over the course of two years had their 780 central and lateral incisors of the jaw evaluated using 3D CBCT images. The classification of the Vertucci system was applied to determine how the root canal was shaped. Results: A comparison between the incisors of lateral and central canal shape using the Vertucci method, the number of central incisors with only one root was higher than the lateral incisors with the roots of the same number. Where it was found that the central incisors of the first type are 377 teeth, while the number of incisors Lateral 358, the number of incisors in the second type was 5 teeth, and the lateral 3 teeth. Conclusions: The root morphology of the sexes differs significantly. Various morphological alterations should be anticipated by the dental professional when undertaking endodontic treatment. To ascertain the morphological traits of the conductor's anterior tooth roots, additional research is required.

Calcium Silicate-Based Sealer Dentinal Tubule Penetration-A Systematic Review of In Vitro Studies.

The aim of this systematic review was to perform a qualitative synthesis of in vitro studies which evaluate and compare the penetration of calcium silicate-based sealers into dentinal tubules. A systematic advanced search was performed in Scopus, Embase, Medline (via PubMed), Web of Science, and Cochrane databases on the 1 December 2022. In vitro studies that compared the tubular penetration of at least two calcium silicate-based sealers in extracted human teeth were eligible. PRILE 2021 guidelines were used for the assessment of the risk of bias included studies. The search identified a total of 680 preliminary records, among which 12 studies were eligible for review. The most used methodology to evaluate sealer penetration was the use of a fluorochrome together with the tested sealers and the analysis of their penetration under confocal laser microscopy. Regarding the results of the included studies, calcium silicate-based sealers exhibit a favorable dentinal tubule penetration. Tubular penetration, however, can be affected by factors such as the irrigation protocol, sealer activation, the filling method used, and root canal morphology. EndoSequence BC Sealer showed the highest sealer penetration among the tested sealers. The influence of different fluorochromes on the results of dentinal tubule penetration studies should also be further explored. The in vitro nature of the included studies limits the applicability of the results into the clinical setting. Prospero registration: CRD42022383896.

Morphologic Variations and Gender Dimorphism in Mandibular First Premolar Root Canal Pattern: A CBCT Study in South Indian Population

Objective: The study aimed to evaluate the variations in the RCM of mandibular first premolars (MFP) in south Indians and also evaluated the gender dimorphism and contralateral symmetry of the pattern. Methods: 200 Cone Beam Computed Tomography (CBCT) images of MFP of patients above 18 years were analyzed for the root canal morphology after excluding the distorted images, endodontically treated tooth or fractured root. The teeth were carefully evaluated in cross-sectional, axial and coronal sections and the information regarding the number of roots and the type of root canal as per Vertucci’s classification. Interobserver and intraobserver reliability were also checked. Results: Single rooted teeth with Type I (73.01%) variation was the most prevalent pattern observed in the study population, which was followed by Type III (14.11%) and Type V (5.52%), respectively. Type IV and Type VIII variations were not found in our study. Conclusions: In both males and females, type I configuration was the most common pattern with symmetry in contralateral mandibular single-rooted first premolars.

Root and root canal morphology of permanent mandibular first and second molars in a Kuwaiti population: A retrospective cone-beam computed tomography study

AimEndodontic diseases typically affect the mandibular molars. Understanding the complex morphology of the root canal system and its variations is necessary for successful endodontic treatment. The aim of this study was to evaluate the morphology of roots and root canals of mandibular first and second permanent molar teeth in a Kuwaiti population using cone-beam computed tomography (CBCT). Materials and methodsCBCT images of 651 mandibular first and second molar teeth were obtained from specialist government dental centers. The age, sex, root canal configuration, and number and type of roots were recorded. The data were statistically analyzed. ResultsThe most common canal configuration in the mandibular first and second molars was type II (65.6% and 54.4%, respectively), with no significant difference seen between the sexes (p = 0.234). The canal configuration was significantly different between the mandibular first and second molars (p < 0.001). Most teeth had two roots (94.5%); split roots were common (92.6%) and the number thereof varied significantly. Radicular grooves were most common on the lingual side (4.9%). C-shaped canals were present in 43 (6.60%) teeth. Additionally, one tooth had a confluent middle mesial canal and nine (1.4%) had radix entomolaris. ConclusionMandibular molars in our Kuwaiti population typically had two split roots with type II and IV canal configurations. The prevalence rates of C-shaped canals, middle mesial canals, and radix entomolaris were remarkably low.