Roots Of Maxillary Second Molars Research Articles

FREQUENCY OF SECOND MESIOBUCCAL CANAL IN PERMANENT MAXILLARY SECOND MOLARS AT A TERTIARY CARE CENTRE OF NEPAL

Background: The success of endodontic treatment relies on the precise identification of root canals followed by cleaning, shaping, and obturating the canals. Mesiobuccal root of maxillary second molar teeth present wide variations with regard to the number and type of root canals. The complexity of the root canal varies widely in different ethnic groups. The study aimed to determine the prevalence of second mesiobuccal canal (MB2 canal) in maxillary second molar. Methods: A descriptive cross-sectional study was conducted at Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Bhairahawa. A total of 100 permanent maxillary second molar undergoing endodontic treatments were studied. After access cavity preparation ultrasonic tips and magnification loupes were used to open the subpulpal groove in a direction from first mesiobuccal (MB1) canal towards the palatal canal to locate the second mesiobuccal (MB2) canal. Radiovisiography (RVG) was taken to confirm the presence of MB2 canals. Results: MB2 canals were detected in 52 teeth out of 100 teeth that were studied. It was found that the younger adult (18-35 years) tends to have a higher proportion of MB2 canals (65.6%) as compared to the middle-aged elderly (36-55years) in whom it could be identified only 33.4% of the time. Conclusions: Based on this study, it can be concluded that the prevalence of MB2 canal in mesiobuccal root of the permanent maxillary second molar is high.

Quantitative Measurement of Buccal Cortical Bone Thickness in Infrazygomatic Crest Area at Different Alveolar Bone Heights and Insertion Angles of Infrazygomatic Crest Screws: A CBCT Study

Introduction Skeletal anchorage devices for the efficient orthodontic treatment mechanics can be placed at various interradicular and extraradicular sites intra orally. However, their placement in the infrazygomatic crest area can broaden the horizon of orthodontic treatment. The bone thickness in the infrazygomatic crest (IZC) area can vary at different heights and insertion angles during the placement of IZC screws between maxillary second premolar and second molar region. Aims and objectives The purpose of our study was to evaluate the variation in bone thickness in the IZC area at different insertion angles along the mesiobuccal root of maxillary first molar and at different heights from the crest of the alveolar bone in the apical direction between maxillary second premolar and second molar region using cone beam computed tomography, so as to determine the best possible site where the bone thickness will be maximum that will suit to a particular size of IZC screw. Materials and Methods CBCT images of 50 subjects were analyzed by a single observer, the bone thickness in the IZC area was measured and interpreted at different heights from the alveolar crest in the apical direction, that is, 5 mm, 7 mm, 9 mm, 11 mm at six regions between maxillary second premolar and second molar. Bone thickness was also measured at different insertion angles ranging from 55º to 75º to occlusal plane of permanent maxillary first molar along its mesiobuccal root. Results The bone thickness in the IZC area was 4.5 mm–3.5 mm, when it was measured at different angles ranging from 55º to 75º to the occlusal plane of maxillary first molar along its mesiobuccal root with maximum bone thickness at 75° with a mean ± SD of 4.56 ± 1.4. Statistically significant differences in bone thickness were found between maxillary first and second molar on both right and left sides at different heights with maximum bone thickness at 11 mm apical from the alveolar crest with a mean ± SD of 2.03 ± 0.76 and 1.91 ± 0.88, respectively, and along the mesial root of maxillary second molar on right and left sides at 11 mm apical from the alveolar crest with a mean ± SD of 2.12 ± 0.80 and 1.95 ± 0.75, respectively. Conclusions The best site and safe zone for miniscrew insertion in IZC area is at 7 mm to 9 mm distance from the alveolar crest apically along the mesial root of maxillary second molar and at an angle of 55°–75º to the occlusal plane of maxillary first molar, so as to ensure the adequate stability of the miniscrew and without causing any damage to the adjacent anatomical structures.

Oral characteristics in adult individuals with periodontal Ehlers-Danlos syndrome.

Periodontal Ehlers-Danlos syndrome (pEDS) is a monogenic type of Ehlers-Danlos syndrome characterized by periodontal destruction at a young age. The present study aimed to document the oral phenotype of pEDS based on prospective clinical investigations. Thirty-five adult individuals from 13 families with a clinically and genetically confirmed diagnosis of pEDS underwent a systematic oral assessment. Periodontitis stage 3 or 4 or edentulism due to periodontal destruction were diagnosed in 94% of the individuals. First permanent tooth loss was reported at the age of 21.5 years (median; range 13-43 years). Deep periodontal pockets were infrequent, with 94% measuring <4 mm. However, there was increased clinical attachment loss (CAL) averaging 8 mm (range 4-13 mm), and the probability of being edentate between the age of 35 and 44 years was 28-47% compared with less than 0.25% of the general population. Radiographic anomalous findings were only found in a portion of subjects and consisted of fused roots of maxillary second molars (81%), root hypoplasia (57%), taurodontism (26%) and tooth rotation of premolars (67%). As such, radiographic findings are not considered common characteristics of pEDS. Characteristic oral traits of pEDS in adults are severe CAL with shallow probing depths and marked gingival recession. This is complemented by a lack of attached gingiva. These indications need to be paralleled by genetic analyses to diagnose pEDS unambiguously.

Comparison of Infrazygomatic Crest Dimension Above Mesiobuccal Roots of Maxillary Molars in South Indian Subjects: A Retrospective Cone Beam Computed Tomography Study

Aim and Objective: The aim of the study was to compare the full-depth bone thickness and the cortical bone thickness in the infrazygomatic crest (IZC) region above the mesiobuccal (MB) root of maxillary first molar and second molar and thus find the ideal site for the placement of IZC screw. Materials and Methods: Pretreatment cone-beam computed tomography images of 30 orthodontic patients were collected and IZC bone thickness and cortical bone thickness were measured above the MB root of maxillary first and second molar at an angle of 70° to the molar occlusal plane. Measurements were done on both right and left sides. Independent sample t test was done to compare the bone thickness between the right and left sides and also to compare the bone thickness above the first and the second molar. Results: Mean bone thickness at the IZC region of 5.48 ± 2.2 mm and 7.78 ± 2.35 mm and a cortical bone thickness of 2.24 ± 0.46 mm and 2.13 ± 0.46 mm was obtained above the MB root of maxillary first molar and second molar, respectively. IZC bone thickness was significantly higher above the second molar than above the first molar ( P < .001), whereas there was no significant difference in the cortical bone thickness measured on both the sites ( P = .22). Conclusion: Significantly higher IZC bone thickness was noted above the MB root of the maxillary second molar, which may ensure better stability and safety of the miniscrew.

An assessment of morphological patterns and number of canals in mesiobuccal root of maxillary second molars in our patients: Analyzed by Cone Beam Computed Tomography

Objective: To assess the number of canals and morphological patterns of mesiobuccal root of maxillary second molars based on Vertucci’s classification analyzed by Cone Beam Computed Tomography (CBCT) scans in our patients. Study Design: Retrospective Cross sectional analytical study. Place and Duration: At Operative Dentistry Department, Islamic International Dental Hospital, Islamabad from 1st September 2020 to 1st January 2021. Methodology: Cone-beam computed tomography (CBCT) scans (PLANMECA, Finland) were used with image size 13 x 9cm (651 x 651 x 451 cm3), voxel size 200μm to include maxillary anatomy with 96 KV radiation dose, exposure time of 12.527 seconds and current of 9 MA. Slice thickness of 0.200mm was recorded. Axial, coronal and sagittal planes were used to evaluate root canal anatomy of maxillary second molars. Number of canals and morphological patterns as per Vertucci’s classification were recorded in mesiobuccal root of maxillary second molars. Results: Out of 200 cone-beam computed tomography (CBCT) scans, 316 maxillary second molars met the inclusion criteria. Mesiobuccal root of maxillary second molars having one canal were found in 78.48% and 2 canals in 21.52%. Maximum frequencies of canals in mesiobuccal root of maxillary second molars as per Vertucci’s Classification were found to have type I i.e. 78.5% followed by type IV in 16.5% and type II in 5%. Conclusion: Number of canals is variable for the mesiobuccal root of maxillary second molar. Single canal and Vertucci’s type I is the most common canal configuration type in mesiobuccal root of maxillary second molars. Significant difference was found between gender and Vertucci’s classification in mesiobuccal root. Keywords: Cone Beam Computed Tomography, Maxillary Second Molar, Root Canal Morphology

High percentage of mesiobuccal roots of maxillary second molars have a complicated configuration and morphology

High percentage of mesiobuccal roots of maxillary second molars have a complicated configuration and morphology

Anatomical relationship of maxillary posterior teeth with the sinus floor and buccal cortex.

This study aimed to evaluate the possibility of root fenestration or oroantral communication by evaluating the distance from root apex to the sinus floor and buccal cortex in maxillary posterior teeth using cone-beam computed tomography (CBCT) images. The study included 2182 roots of the maxillary posterior teeth from 219 patients after reviewing CBCT images of 462 patients according to the location of roots by two endodontists. The distances from each root apex to the maxillary sinus floor and buccal and palatal cortices were evaluated according to sex and age, and the mean values were compared by one-way analysis of variance and Mann-Whitney U-test. The distance between root apex and maxillary sinus floor was the greatest in maxillary first premolars and shortest in the mesio-buccal roots of maxillary second molars. The distances from root apex to the buccal and palatal cortical bones were significantly greater in male patients than those in female patients (P<0·05). The palatal roots of maxillary first molars exhibited the highest incidence as well as the greatest mean length (1·96mm) of protrusion into the maxillary sinus. The distance from root apex to the sinus floor was found to increase with age, except in case of maxillary second premolars. Understanding the relationship of maxillary posterior teeth with the sinus floor and buccal cortex could provide clinicians valuable information to help reduce iatrogenic damage.

Unusual location of second mesiobuccal orifice in maxillary second molar

Presence of second canal in mesiobuccal root of maxillary second molar is not uncommon but generally found closer to mesiobuccal orifice. This article reports a case of a maxillary second molar with an orifice of second mesiobuccal canal closer to palatal canal orifice.

Root canal morphology analysis of maxillary permanent first and second molars in a southeastern Turkish population using cone-beam computed tomography

Background/purposeThe aim of this retrospective study was to determine the root and canal morphology of the maxillary first and second molars in a Turkish subpopulation using cone-beam computed tomography (CBCT). Materials and methodsCBCT images of 417 women and 410 men aged 14–70 years were examined. A total of 1158 maxillary permanent first molars and 1305 maxillary permanent second molars were analyzed. The number of root canals and canal configurations were investigated and classified according to Vertucci's classification. The data were analyzed using Pearson's Chi-square test. ResultsIn both first and second maxillary molars, the presence of three roots was the most common occurrence. The prevalence of additional canals (type II, III, or greater) in mesiobuccal roots of maxillary first and second molars was approximately 62% and 37.5%, respectively. Type I canal configuration was the most prevalent in the distobuccal (99.6%) and palatal (99.8%) roots of maxillary first molars, and in the distobuccal (99.7%) and palatal (99.2%) roots of maxillary second molars. The incidence of the number of root canals and the configurations of maxillary first and second molars did not statistically differ with sex (P > 0.05). ConclusionThe high prevalence of additional canals in the mesiobuccal roots of maxillary first and second molars is noteworthy. CBCT is an effective method to study the external and internal morphology of dental tissues.

Root resection under the surgical field employed for extraction of impacted tooth and management of external resorption

This case report illustrates determination of prognosis and immediate resection carried out, before completing the endodontic therapy, during the surgery employed for managing a nonperiodontal problem. This case showed external pressure resorption in the distobuccal root of maxillary second molar caused by the impingement of impacted third molar. Extraction of third molar was decided when healing was not seen, despite initiating endodontic therapy in second molar. Following elevation of flap and extraction of third molar, the poor prognosis due to severe bone loss around the resorbed root was evident. But due to strategic value of second molar, it was found beneficial to employ resection. Therefore, immediate resection was carried out in the same surgical field before the completion of endodontic therapy. This prevented the need for another surgical entry with its associated trauma to carry out resection separately later. Resection followed by the completion of endodontic therapy and full crown assisted in salvaging the remaining functional portion of the tooth and prevented the occurrence of distal extension with its potential drawbacks.

Cervical Enamel Projections in Unusual Locations: A Case Report and Mini‐Review

Periodontitis is primarily a bacteria-induced disease that can be modified by tooth-related local factors. Cervical enamel projections (CEPs) are a common tooth anomaly that can act as contributing factors in the development of periodontitis. They are most commonly found at the buccal surfaces of mandibular molars. A 57-year-old female was referred to our clinic for treatment of chronic periodontitis. A clinical examination revealed moderate attachment loss that was localized to the palatal side of the maxillary second molars. The rest of the dentition was less affected, with a diagnosis of generalized slight chronic periodontitis. An initial non-surgical periodontal treatment was provided followed by apically positioned flap surgery in the maxillary right and left posterior areas. At the time of surgery, CEPs were found where the periodontium was most affected. Because surgical intervention exposed the CEPs, they were not removed. After the active therapy, which resulted in inflammation resolution and maintainable probing depths, the patient was placed on a 3-month recall for periodontal maintenance. CEPs were found in an unusual location on the palatal roots of maxillary second molars. The findings of this case report confirm the role of CEPs as a local contributing factor in localized chronic periodontitis.

Cervical enamel projections in unusual locations: A case report and mini-review.

Background: Periodontitis is primarily a bacteria-induced disease that can be modified by tooth-related local factors. Cervical enamel projections (CEPs) are a common tooth anomaly that can act as a contributing factor in the development of periodontitis. They are most commonly found at the buccal surfaces of mandibular molars. Methods: A 57-year-old female was referred to our clinic for treatment of chronic periodontitis. Clinical examination revealed moderate attachment loss that was localized to the palatal side of the maxillary secondary molars. The rest of the dentition was less affected, with a diagnosis of generalized slight chronic periodontitis. Initial non-surgical periodontal treatment was provided, followed by apically positioned flap surgery in the maxillary right and left posterior areas. At the time of surgery, CEPs were found where the periodontium was most affected. Results: Due to the fact that surgical intervention exposed the CEPs, they were not removed. After the active therapy, which resulted in inflammation resolution and maintainable probing depth, the patient was placed on a three-month recall for periodontal maintenance. Conclusions: This case report presents CEPs in an unusual location in the palatal roots of maxillary secondary molars. CEPs confirm their role as a local contributing factor in localized chronic periodontitis.