Root Canal Morphology Research Articles

Radix Entomolaris: A Case Report and Review of Literature

Understanding and awareness of unusual root canal morphologies in different teeth is extremely important for a dentist in order to achieve maximal beneficial effect to the patient. Any missed canal during endodontic treatment causes persistent infection around endodontically- treated tooth leading to unsuccessful outcome of root canal treatment. One of the altered tooth morphology is of the mandibular molars having additional root located either lingually (the radix entomolaris) or buccally (the radix paramolaris). Therefore, this case report discusses the endodontic treatment of mandibular first molar with a radix entomolaris.

Assessment of root and root canal morphology of mandibular premolars using cone beam computed tomography in a tertiary center of Nepal

Introduction: Mandibular premolars are considered an enigma in dentistry because of their variability in anatomical and morphological features making it difficult to treat endodontically. This study was conducted to determine the root and canal morphology of mandibular premolars in the Nepalese population by using cone beam computed tomography imaging. Methods: One hundred and thirty-four cone beam computed tomography images of the Nepalese population were collected by convenience sampling method from April 1 to August 31, 2022 in Bir Hospital, Kathmandu, Nepal. A total of 536 premolars (268 mandibular first premolars and 268 mandibular second premolars) were evaluated by two examiners (one endodontist and one oral radiologist). Canal configuration was classified according to Vertucci’s classification. Results: In mandibular premolar teeth, the majority had one root followed by two roots and fused roots. The most common configuration in mandibular premolars was Vertucci’s type I (83.88% and 96.65% in the first and second premolar respectively) followed by type V (9.89%) in the first premolar and type III (1.86%) in the second premolar. Vertucci’s type VII (0.37%), C-shaped configuration (1.46%), and an unusual configuration (0.37%) were observed in the first premolar. In mandibular first premolars, males showed more variation than females; while in second premolars, females showed more variation than males. Conclusions: Mandibular premolar teeth showed variation in root and canal morphology with one root and Vertucci’s type I in the majority of the cases.

CBCT Imaging of a Rare Case of Radix Entomolaris in Mandibular Second Molar

The presence of an additional supernumerary distolingual root in the mandibular molar is termed Radix Entomolaris (RE). It is common in the mandibular first molar, but its occurrence in the mandibular second molar is scarcely reported in the literature. Two-dimensional imaging can diagnose anatomical root canal variations when taken with different horizontal angulations. With the recent innovations in three-dimensional diagnostic imaging, cone beam computed tomography (CBCT) can aid in unfolding the complexities of the root canal system. Accurate diagnosis by CBCT leads to the success of endodontic treatment. A rare case of radix entomolaris in the mandibular second molar in an Indian female is reported here with three of its CBCT findings. Imaging in all three dimensions, oblique sections and volume rendering by CBCT proved to be of additional help to understand the complex anatomy and root canal morphology of the tooth.

Root and canal morphology of maxillary second molars in a Black South African subpopulation using cone-beam computed tomography and two classifications.

This study investigated the root and canal morphology of maxillary second molars in a Black South African population using high-resolution cone-beam computed tomography. In total, 386 maxillary second molar teeth were evaluated and described according to the classifications of Vertucci (with the additions of Sert and Bayirli), as well as Ahmed et al. Root number, fusions and canal morphology were recorded. Relationships between morphology, sex and age were assessed using Fisher's exact test (p < 0.05). Maxillary second molars were predominantly three-rooted (96.1%), with root fusion observed in 14%. No relationships between sex, age and canal morphology were found. Additional canals were observed in 67.4% of mesiobuccal roots. The Ahmed et al. classification provided a better overall description of the morphology. In this population, maxillary second molar teeth exhibited a diversity of root and canal morphology. Complex variations may render endodontic management more difficult and increase the possibility of missed anatomy.

Unraveling the enigma: A case report

The purpose of this case report is to emphasize the importance of cone-beam computed tomography (CBCT) and dental operating microscope for endodontic treatment on mandibular second premolar with three separate roots. In endodontics, the possible existence of extra canals must be considered before endodontic treatment is instituted. A wide morphological variation of the mandibular second premolar is known to exist. The incidence of a three-rooted mandibular second premolar is approximately 0.4%. A 43-year-old female patient was referred for endodontic treatment on the mandibular second premolar. IOPA revealed three roots, and hence for confirmation, a CBCT image was taken and root canal treatment was performed under an operating microscope for enhanced visualization. This case report describes the successful endodontic treatment of a mandibular second premolar with three separate roots and canals filled using gutta-percha and AH Plus. Clinical significance: Conventional endodontic treatment can be performed on a tooth with complex root canal morphology using an operating microscope.

Radiographical Evaluation of Root Canal Morphology of The Maxillary And Mandibular Premolar Teeth by Using Cone-beam Computed Tomography in Kurdistan Region, Iraq

Radiographical Evaluation of Root Canal Morphology of The Maxillary And Mandibular Premolar Teeth by Using Cone-beam Computed Tomography in Kurdistan Region, Iraq

Endodontic Management Of Mandibular First Molar With An Unusually 28 Mm Root – A Case Report

One of the most important aspects of endodontic therapy is determining the correct working length. Cleaning, shaping, and obturation cannot be done correctly unless the working length is properly established. As a result, an accurate root canal working length assessment is required for expected endodontic success. Endodontic literature heavily focuses on a plethora of root canal morphologies. However, none has come across a mandibular molar with a 28mm canal length or ever has been reported. To our knowledge, we present the successful endodontic management of the mandibular first molar with an unusually long root length and canal.

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.

Analysis of the mandibular molars root canals morphology. Study by computed tomography.

This study aimed to analyze the root and root canal morphology of mandibular first and second molars using CBCT images. A total of 2,400 mandibular molars exams were selected from 600 patients aged between 18 and 75 years. The number of roots, number of root canals, and root canal configuration according to the Vertucci classification were verified. Overall, 94.92% of mandibular first molars and 90.17% of mandibular second molars had two separate roots. Among the biradicular molars, the first molars showed a greater incidence of type IV canals in the mesial root and type I in the distal root. In the second molars, the most common canal form was type IV in the mesial root and type I in the distal root. In the triradicular molars, the type IV and type I configurations were the most common in the mesial root of the first molar and second molar, respectively. In both triradicular molars, there was a prevalence of type I canal in the distal and DL roots. Statistical analysis was performed at a significance level of 0.05. The number of roots was correlated with gender (Spearman test), and the canal's configuration with gender and bilaterality (Wilcoxon test). The subpopulation studied has a high incidence of bilateral symmetry and mandibular molars with two roots with two distinct mesial canals and one distal canal. The bilateral configuration is possible to estimate the number of canals, especially in images that are difficult to visualize, such as atresic canals.

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.

Root and root canal morphology of mandibular second permanent molars in the Gansu province population: A CBCT study.

To study the anatomical characteristics of the root and root canal system of the mandibular second molars in the population of Gansu province, and to provide theoretical and clinical references for improving the success rate of root canal therapy (RCT) of mandibular second molars. The number of roots and root canals, root canal type and pulp chamber height of mandibular second molars were determined by observing cone-beam computed tomography (CBCT) images of people living in Gansu. The most common type of mandibular second molars in the Gansu province population was a double root with three root canals (47.55%), followed by a C-shaped root (35.56%). There were more females than males with a C-shaped root (p< 0.05). The most common root canal subtype of the C-type root was C3 (13.91%). Most of the population (77.11%) had bilateral mandibular second molars with symmetrical root canal morphology. With an increase in age, the height of the pulp chamber decreased significantly. The incidence of root canal variation of the mandibular second molars is relatively high in the population of Gansu province. Preoperative examination with CBCT is essential for mandibular second molars that need RCT to avoid root canal treatment failure and decrease the occurrence of postoperative pain as much as possible.

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.

Assessment of the coronal root canal morphology of permanent maxillary first molars using digital 3D-reconstruction technology based on micro-computed tomography data

The design of minimally invasive access has become a hotspot. This study aimed to evaluate the coronal root canal morphology of permanent maxillary first molars to facilitate the design of endodontic access cavities for minimally invasive linear access. A selection of 91 permanent maxillary first molars was evaluated. Three-dimensional tooth models were reconstructed using micro-computed tomography data. Root canal prevalence and coronal root canal landmarks were recorded. The positional coordinates of landmarks in the horizontal plane and the angles and directions of coronal root canal curvature in the horizontal and axial planes were also assessed. The detection rates of the mesiobuccal (MB), distobuccal (DB), and palatal (P) canals were 100%, whereas that of the second mesiobuccal (MB2) canals was 68.1%. All landmarks were located near the central fossa. In the axial plane, the average angles of coronal root canal curvature were DB (27.05°)>MB (25.43°)>P (20.71°) in teeth with three canals, and MB2 (33.20°)>MB (29.61°)>DB (28.40°)>P (23.69°) in teeth with four canals. In the horizontal plane, the average angles were P (78.15°)>DB (42.34°)>MB (32.41°) in teeth with three canals, and P (81.26°)>DB (43.44°)>MB (41.22°)>MB2 (9.41°) in teeth with four canals. In maxillary first molars, coronal root canals tend to converge towards the occlusal surface. The results of this study could be applied to improve the precision of endodontic access cavity designs of minimally invasive access.

CBCT based study to analyze and classify root canal morphology of maxillary molars - A retrospective study.

The study aims to evaluate maxillary molars' root and root canal morphology among the Saudi population using Cone-Beam Computed Tomography scanning (CBCT). Retrospectively, the CBCT scans of 483 Saudi nationals were evaluated to identify the number of roots and root canals in maxillary first and second molars. The records were tabulated and classified according to Vertucci and a new system for root and canal classification given by Ahmed and Dummer. Fisher's exact test was used to analyze the data statistically. To check for symmetry, comparisons were made between all the maxillary first molars (MFM's) and maxillary second molars (MSM's) on opposing quadrants. Inter Observer variability was seen using Cohen's Kappa test. MFM's presented with three roots with Type II Vertucci canal configuration (VC) commonly seen among them. MSM's had more variations in the number of roots and canals, although three roots and Type I VC were predominantly seen. When comparing the two genders statistically significant difference was observed in both maxillary molars at a 5% level using Fisher's exact test. Three roots with four canals (3R4C) were predominantly observed in the MFM's (85.6%) and three roots with three canals (3R3C) identified in 51.95% were more common than 3R4C (43.55%) in MSM's. Both the maxillary molars bilaterally, exhibited a high percentage of symmetry in root and canal configurations. Identification of root canal morphology of molars would reduce the chances of root canal failures by making sure all canals are obturated. This study provides supplemental information about the root canals of maxillary molars in a Saudi Arabian subpopulation.

Evaluation of Root Canal Configuration of Maxillary and Mandibular First Molar by CBCT: A Retrospective Cross-Sectional Study.

Adequate knowledge of root canal morphology along with its probable variations is imperative to acquire successful endodontic treatment. This retrospective cross-sectional study aimed to investigate the root canal configuration of maxillary and mandibular first molar using Cone-Beam Computed Tomography (CBCT) among patients in Al-Ahsa region, Saudi Arabia. A total of 377 samples were included, out of which 123 CBCT (I-CAT Vision QTM) scans with intact all first permanent molars were selected in this study and scanned in sagittal, axial, and coronal views by using BlueSkyPlan software. The number of canals in each root and their configuration according to the Vertucci classification system was evaluated. Statistical analysis was analyzed using SPSS version 21 (IBM). Chi-square test was applied to evaluate the association of root canal morphology and mandibular and maxillary first molars with respect to gender. Out of 123 CBCT scans, 59 (48.0%) were males and 64 (52.0%) were females; the mean age was 26.95 ± 10.65 years. The mesiobuccal root of bilateral maxillary first molar had Type-I (87.0%) of Vertucci classification followed by Type-IV (9.8%). Additionally, all mesiobuccal roots (100%) of the left mandibular first molar had Type-I of Vertucci’s classification. A significant association has been observed between gender and a number of canals in bilateral maxillary first molars. Females showed a significantly higher prevalence of three-root canal configuration in maxillary first molars of both sides compared four canals found most commonly in males (p = 0.004). This study concluded that the majority of maxillary and mandibular permanent first molars had three roots and three canals with Type-I Vertucci’s classification in patients belonging to the Al-Ahsa region of the Saudi Arabia. It was also proved that gender is significantly associated with the number of canals in a bilateral maxillary molar.

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&amp;lt;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.

Effect of a bioactive glass-based root canal sealer on root fracture resistance ability

The root fracture resistance of endodontically treated teeth is decreased significantly, and it is more likely to fracture. This study aimed to evaluate the effect of a novel root canal sealer based on bioactive glass (BG) on root fracture resistance and explore its mechanism. The BG-based root canal sealer (BG Sealer) was prepared by mixing a kind of bioactive glass (10.8% P2O5, 54.2% SiO2, 35% CaO, mol.%, named PSC), zirconia (ZrO2) powder, sodium alginate (SA) and phosphate solution (PS). A pH meter was used to measure the pH of simulated body fluid (SBF) after immersion with BG Sealer at different time. After preparing the samples of BG sealer with a diameter of 4mm and a height of 6mm, the compressive strength was tested by a universal testing machine. The scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) were used to detect and analyze the mineral status of root canal systems filled with BG Sealer. The push out test was used to measure the push out bond strength of BG Sealer. The fracture resistance of root canals filled with BG Sealer was detected by the compressive loading test. Bioceramic root canal sealer iRoot SP was set as the control group. (1) Physicochemical properties: The pH value of SBF immersed with BG Sealer increased slightly up to 7.68, while the pH of SBF immersed with iRoot SP increased to 12.08. The compressive strength of the novel BG Sealer was 4.62±1.70MPa, which was lower than that of iRoot SP (P<0.05). (2) Mineralization: The hydroxyapatite layers were observed on the surface of BG Sealer and iRoot SP after being immersed in SBF for 4 weeks. BG Sealer and iRoot SP were both able to penetrate into the dentin tubules, duplicate the morphology of root canals well, and form a layer of hydroxyapatite. (3) Adhesion to dentin: There was no significant difference between the push out bond strength of the novel BG Sealer and iRoot SP (P>0.05). (4) Fracture resistance: After immersion in SBF for 4 weeks, the fracture resistance of roots filled with BG Sealer and iRoot SP was 454.16±155.39N and 445.50±164.73N, respectively, both of which were not statistically different from that of the roots unprepared and unfilled (394.07±62.12N)(P>0.05), whereas higher than that of the roots prepared and unfilled (235.36±83.80N)(P<0.05). The novel BG Sealer has good adhesion to the root dentin, can penetrate into the dentin tubules to generate minerals, and meanwhile can improve the fracture resistance of the roots after root canal treatment. It is expected to be a bioactive root canal sealer with good clinical application prospects.

Anatomical variations and bilateral symmetry of roots and root canal systems of mandibular first permanent molars in a Saudi Arabian population utilizing cone beam computed tomography

<h3>Objective</h3> To evaluate the anatomical variations of the roots and root canal systems and to determine the symmetry between right and left mandibular first permanent molars in a Saudi Arabian population using images derived from cone beam computed tomography (CBCT) scans. <h3>Methods</h3> CBCT scans (with exposure parameters 90 kVp, 5–8 mA, 17.5 s exposure time, and 0.25 mm voxel size with a 170 × 120 mm FOV) were retrieved from the database and axial, coronal, and sagittal sections of the mandibular first molars were examined. The number of roots, number of canals, and type of canal configuration based on Vertucci's classification were recorded. Bilateral symmetry between right and left sides of the same individuals and differences between genders were investigated. <h3>Results</h3> Out of 174 mandibular first molars, 97.1% were two rooted and 2.9% were three rooted (with a distolingual root). In regards to the number of canals, 73% had three, 25.3% had four and 1.7% had two root canals. In teeth with four root canals, 90.9% of the extra canals were in the distal root, while 9.1% were in the extra distolingual root. The most common canal configurations in the mesial and distal roots were type IV (64.9%) and type I (77%), respectively. Symmetrical analysis revealed 100% symmetry in number of roots and 56.4% in number of canals between right and left teeth in the same individual. <h3>Conclusion</h3> An extra root was seen in few cases of mandibular first molars of the studied population. A wide range of canal configurations was noted, with high prevalence of type IV in the mesial root and type I in the distal root. No associations between gender and root anatomy and canal morphology were discovered. Although high bilateral symmetry was found in numbers of roots, it varied with regards to numbers of canals and canal configurations in the same individuals. <b>Statement of Ethical Review</b> Human/Animal subjects were used and this study was approved by an institutional ethics panel

Diagnosis and treatment of a maxillary lateral incisor with two root canals. A case report.

Although endodontic treatment has shown high success rates, the factors involved in the failure cases are still being studied. In this sense, the complexity of interradicular anatomy may lead to inadequate instrumentation and the persistence of etiological factors related to apical periodontitis and endodontic failure. The present case report illustrates the occurrence, diagnosis and nonsurgical endodontic treatment of a maxillary lateral incisor with two canals. A 24-year-old Peruvian woman was referred complaining of darkening of the upper front tooth. After clinical examination, the patient was diagnosed with necrotic pulp and asymptomatic apical periodontitis. Still, radiographic examination revealed a disruption in the canal continuity, leading to a suspicion of unusual root canal morphology in the maxillary lateral incisor. By taking radiographs from different angles, according to the technique described by Clark, the presence of two independent canals was verified. Since most cases of endodontic failure are due to untreated canals, a predictable endodontic therapy must achieve the removal and neutralisation of etiologic factors related to periapical infiltration. The occurrence of additional root canals requires a correct interpretation of radiographic images to detect these variants and take the necessary considerations for proper endodontic treatment.