Root Trunk Research Articles

Investigation of the furcation morphology of permanent mandibular first molars by using micro-computed tomography

BackgroundTo investigate the anatomic features of the root furcation of permanent mandibular first molars.MethodsA total of 50 extracted mandibular first molars (25 two-rooted and 25 three-rooted) were collected and scanned using micro-computed tomography. The digital models of teeth and root canal systems were reconstructed three-dimensionally. The tooth models were displayed in parallel projection mode from buccal and distal views. Screenshots were captured and subsequently analyzed using Image-Pro Plus 6.0 software after calibration. The furcation angle, root trunk length, maximum depth and level of distal root concaves of mesial roots, and length of enamel projections were measured, and the furcation types (classified into type V, type U and type W) were detected. Statistical analysis was performed using the Shapiro-Wilk’s test, one-way analysis of variance, Student’s t-test and Chi-square test.ResultsThe mean furcation angle between the distobuccal (DB) and distolingual (DL) roots (in distal view) was the greatest (59.2°), whereas the furcation angle between the mesial and DL roots (in buccal view) was the smallest (25.4°) among the four furcation angles (all p < 0.05). Regarding the furcation types, bucco-lingual root trunk length, maximum depth and site of the distal root concavities, and enamel projection length, no significant differences were detected between the three- and two-rooted molar groups (all p > 0.05). The frequency of type V was the highest (54.0%), followed by type U (26.0%), and type W had the lowest occurrence rate (20.0%). The mean length of distal root trunk in the three-rooted mandibular molars was significantly greater than that of the buccal/lingual one (3.7 mm vs. 3.0 mm, p < 0.01). The maximum depth of the distal concavities of the mesial roots was on average 0.66 ± 0.19 mm, and the site was located at an average of 2.8 ± 1.3 mm below furcation. The mean length of buccal enamel projections was significantly longer than that of lingual ones (3.1 mm vs. 0.7 mm, p < 0.01).ConclusionsThe furcation anatomy of the mandibular first molar is complex, and the presence of the DL root may further complicate its topography. A thorough understanding of these anatomic features is essential for successful periodontal treatment.

Factors associated with furcation involvement and fixed prostheses: A cross-sectional study.

The study aims to explore the relationship between horizontal and vertical furcation involvement (FI) in teeth with or without a single unit fixed prosthesis (FP). Adult subjects presenting to the periodontics department requiring cone beam computed tomography (CBCT) analysis were recruited for this study. 79 patients, with a total of 200 teeth, were split into two groups based on the presence or absence of FP within the same patient. Our analysis considered patient-level factors like smoking, diabetes, and periodontal severity and tooth-level factors including root trunk length (RTL), probing depth (PD), periodontal supracrestal tissue height (STH), supracrestal tissue attachment (STH-PD), interproximal bone distance (IPBD) to the cementoenamel junction (CEJ) (control) or crown margin (Test), and the distance from the furcation to the CEJ (control) or crown margin (Test). Subsequently, we developed a predictive model for FI. The presence of a prosthesis had a significant association with FI, with an odds ratio (OR) of 12.8 (p < 0.001). Other factors significantly correlated with FI were periodontitis (OR = 10.9; p = 0.006), buccal furcation site (OR = 5.70; p < 0.001), and PD (OR = 1.90; p = 0.027). FP placement increased IPBD by 1.08mm (p < 0.001). The predictive model built for FI demonstrated a sensitivity of 92.9% and a specificity of 66.7%. Fixed prosthesis significantly influenced FI only in periodontitis patients. Factors such as periodontitis Stage, probing depth, and buccal site contribute to FI. The high sensitivity of the predictive model highlights the importance of considering these correlations during treatment planning. Comprehending FI factors is vital for devising customised treatment plans to halt disease progression and enhance outcomes of periodontal regenerative therapies.

Morphological study of distal furcation in mandibular first molars based on cone beam computed tomography images in Beijing population.

This retrospective study explored the incidence of independent distal-lingual root (DLR) in mandibular first molars and the morphologic features of distal furcations through cone beam computed tomography (CBCT) in Beijing population. A total of 401 CBCT images of both mandibular first molars existed were included. The sex of the patients, the incidence of DLR, the distal root trunk length (DRT), the locations of distal furcation entrance (DFE), and the separation angle of distal furcation (ADF) were recorded. The incidence rates of DLR were 33.2% on the subject level and 26.8% on the tooth level. The incidence of DLR was not different between genders but was higher on the right sides. The DRT values were 4.15 mm±1.02 mm. The ADF was 65.56°±11.56°. The DFE was located lingually, and 97.2% DFE was located more apically than buccal/lingual furcations. A high incidence of DLR was found in the Beijing population. The DRT was longer than buccal and lingual sites. The DFE was located lingually with a wide separation. Understanding the morphological features of distal furcation can help clinicians to make proper treatment plans.

Endodontic retreatment of a mesotaurodontic mandibular first molar with C-shaped configuration in a patient with multiple taurodonts: A case report and review of literature

Abstract Taurodontism is a dental anomaly characterized by an apical displacement of the pulp chamber floor, resulting in a large pulp chamber with short roots. It can be associated with certain syndromes and abnormalities, although it is common to occur as an isolated characteristic. This anomaly can occur along with other root canal system anomalies such as C-type configuration. The aim of this report is to present the successful endodontic management of a C-shaped mesotaurodontic mandibular molar and review the literature available on this matter. A 23-year-old Persian female was referred by her dental surgeon to complete the root canal treatment of her right mandibular first molar (#46). Clinical examination showed a temporized cavity with no response to pulpoperiapical tests or visible pocket depth while an elongated root trunk with slight periodontal ligament widening, incomplete obturation of the root canal system, and periapical radiolucency was evident on the intraoral radiograph. Cone-beam computed tomography (CBCT) revealed a taurodontic and type III C-shaped root canal configuration. With a diagnosis of previous treatment and asymptomatic apical periodontitis, the patient was scheduled for root canal retreatment. The same anomaly was discovered in other molar teeth on the panoramic radiograph taken before the primary treatment of tooth #46. At a 2-month follow-up session, the tooth was found asymptomatic clinically and radiographically. The past publications about the management of nonsyndromic taurodontic molars were also reviewed. The review of 29 similar articles showed that preoperative CBCT, magnification with illumination, along with active irrigation are helpful items in managing such cases.

Biometric analysis of furcation area of molar teeth and its relationship with instrumentation

The anatomy of furcation favours the bacterial retention and makes periodontal debridement as well as oral hygiene procedures difficult. Teeth that have lost attachment to a level of the furcation are said to have a furcal invasion or furcation involved.Involvement of furcation in a multi-rooted tooth poses a very different type of clinical situation in terms of establishment of diagnosis, determination of prognosis and of course planning the treatment modality.The present study was carried out on 200 selected extracted human first and second permanent molar teeth based on a predefined criteria. Teeth with prosthetic crowns, fused or fractured roots, those not fully developed, grossly carious or heavily restored at the cementoenamel junction (CEJ) were excluded from the study. The morphology of the root trunk was recorded by measuring various dimensions of the root trunk,including furcal angle and root trunk volume was calculated by using a custom made special apparatus. The furcation areas were debrided with different types of curettes in the market in order to see how best the instrument could be maneuvered in the furcation area. The data so obtained was statistically analysed using SPSS version 22. The highest root trunk volume and the longest root trunk length were found to be in the maxillary second molar. 48.60% furcations didn’t allow instrument engagementof furcation area with standard area specific curettes. The proposal of inclusion of root trunk length (mm) is suggested in addition to classification of FI to have assess prognosis and appropriate treatment for of the involved tooth.

Morphometric Measurements of Root Anatomic Areas of Maxillary First Premolar Teeth in a Representative Nepalese Population

Background The prognosis of furcation involved maxillary first premolar is typically guarded to poor. The presence of concavities in the root trunk and the positioning of the roots in the buccal and palatal regions of the teeth are responsible for its challenges during instrumentation and control plaque. We aimed to access the presence of concavities on the root surface as well as morphometric measurement of the root trunk dimensions in the maxillary first premolar teeth in Nepalese population.MethodsA cross-sectional quantitative study was conducted in the Department of Periodontics and Oral Implantology, College of Medical Sciences (CoMS). Extracted Maxillary first premolar teeth were evaluated for the number of roots, morphometric measurement of the root trunk, root divergence, and root length. The presence of concavities was recorded on the mesial and distal root surface at cervical, middle, and apical thirds of the root.ResultsThe overall mean root trunk length was less on the mesial aspect than on the distal aspect (6.39 ± 2.54 and 8.08 ± 3.48 respectively). The prevalence of root surface concavity on the cervical third at the mesial aspect (90 %) was found to be higher than in the distal aspect (15%) Conclusions Owing to the higher prevalence of root surface concavity on the cervical third of mesial aspect, use of mini-bladed curettes is recommended for the effective root surface debridement of the periodontally involved maxillary first premolar tooth. Patients with periodontally involved maxillary first premolar should be advised to use interdental brushes rather than dental floss.

The Root Complex in Posterior Teeth: A Direct Digital Analysis.

The aim of this morphometric study was to precisely determine the 3D characteristics of the root complex of the posterior dentition. Extracted and well-preserved permanent posterior teeth were included in this analysis and grouped based on tooth type and arch location. All teeth were digitally scanned. Morphologic and dimensional features of the root complex were assessed, including length and surface area of the root trunk and individual roots, width of root concavities (RC), and furcation entrance, when present. A total of 240 posterior teeth comprised the study sample. The root complex of multirooted maxillary first premolars presented with a long root trunk (10.49 mm), representing 65.52% of the surface area, and two short roots comprising the remaining 34.8% of the surface area. Root trunks of mandibular molars were an average of 0.8 mm shorter than their maxillary counterparts. Class III furcation involvement is expected in all maxillary and mandibular molars, as well as multirooted maxillary first premolars, after 4.80 mm and 10.49 mm of clinical attachment loss, respectively. RCs were a common finding among the evaluated dentitions. The root complex morphology varies among the maxillary and mandibular posterior dentition. RCs are highly prevalent in both maxillary and mandibular dentition. The findings derived from this study can be utilized in daily clinical practice for the adequate management of posterior dentition and serve as a reference for future investigations in dental anatomy and digital technology. Also, these findings can guide the industry into creating and redefining tools that adequately adapt to the anatomical characteristics and variations of the specific tooth type.

Effects of root trunk reverse growth simulation on the contents of active ingredients in cortices of Eucommia ulmoides and Magnolia officinalis

Effects of root trunk reverse growth simulation on the contents of active ingredients in cortices of Eucommia ulmoides and Magnolia officinalis

Deep Margin Elevation With Resin-modified Glass Ionomer in Posterior Adhesive Indirect Restorations Based on Biomimetic Principles: A Case Report

A ceramic onlay restoration is a more conservative treatment than full-coverage crowns for endodontically treated teeth (ETT); thus, it helps preserve the tooth structure. Deep margin elevation (DME) is a method to relocate subgingival margins into a more coronal position with resin-modified glass ionomer (RMGI) or direct composite resin before the cementation of the indirect restoration. A 33-year-old male was referred to restore two ETT (teeth N. 46 and 47) with extensive coronal defects extending subgingivally between two teeth. Tooth N. 47 could not undergo a crown lengthening (CL) procedure due to its short root trunk. DME with RMGI was done for both teeth before preparation for ceramic onlays. In this case, by following the principles of biomimetic dentistry, we aimed to restore the tooth defect with a material that bore all functional stresses, in addition to achieving esthetic. It seems that DME in combination with ceramic onlay restoration can be a conservative method to restore ETT in the posterior region. The goal of considering the principles of biomimetic dentistry is to maintain the function of teeth using a good bond to hard tissue that unifies the tooth and its restoration hence distributing the stresses through the tooth as a unit with near-normal functional, biological, and esthetic features.

Cover Crops as Reservoirs for Young Vine Decline Pathogens

Young vine decline (YVD) is a grapevine trunk disease (GTD) which results in stunted and delayed growth, reduced yield, root necrosis and eventually death of young vines. Given losses associated with root trunk disease, and increasing limits on chemical fungicides, there is a need for sustainable approaches to combat disease; (1) Cover cropping is a commonly used practice in agricultural systems and has potential to reduce disease in vineyards but there is a risk that cover crop species may act as a host for grapevine pathogens, increasing the risk of infection; (2) We tested 25 plant species commonly used in cover crops to assess their potential to act as a host for a Ilyonectria liriodendri, which is a causal agent of young vine decline. We inoculated greenhouse pots with a pathogeninc strain of Ilyonectria and assayed the roots for the presence of the pathogen; (3) Of the 25 cover crops tested, many of the species showed increased root abundance of Ilyonectria, compared to background levels. In particular phacelia (Phacelia tanacetifolia) and buckwheat (Fagopyrum esculentum) showed very high levels of root colonization. (4) This is the first study to our knowledge that highlights the potential of cover crops to soil borne fungal pathogens.

Diagnosis and Management of Furcation Lesions in Dogs - A Review.

The furcation is the anatomic area where the roots divide on a multirooted tooth. Periodontal disease causing alveolar bone loss can lead to furcation lesions of various stages. Once furcation involvement has occurred, the area can be more difficult to clean or treat due to the complex anatomy and morphology of furcations. Teeth with short root trunks, longer tooth roots, and roots with wide furcation entrance areas/degrees of separation and wide root divergence are considered better candidates for long term maintenance. Dog teeth possess many of these advantageous anatomic features compared to human teeth. Treatment options for teeth with furcation lesions include: closed debridement, open debridement, furcation plasty, tunneling, partial tooth or root resection, root separation (hemisection or trisection), regenerative therapies, or exodontia. There are many factors to consider in determining treatment options. The favorable and unfavorable characteristics for maintenance of teeth with furcation lesions are summarized. Home care and ongoing professional care are important aspects of periodontal disease control for any patient. Studies of systemic and local antibiotic therapies in human patients have not demonstrated reduction of furcation stages, and probiotic effects at furcation sites have not been specifically examined. Human review studies show that most molar teeth once deemed "hopeless" due to stage 3 furcation lesions can be maintained for at least 5 to 15 years with supportive periodontal therapy. Similar long term studies in dogs are needed to improve the evidence-based management of canine patients with furcation lesions.

Relationship Between Root Trunk Types and Periodontal Attachment Loss in Taiwanese’s Molars Affected with Class III Furcation Involvements

The purpose of the present study was to investigate the relationship between root trunk types (RTT) and periodontal attachment loss (PAL) on molars affected with Class III furcation involvement (FI). The extracted teeth (169) of maxillary (103) and mandibular (66) molars in individuals affected severe advanced periodontitis were diagnosed as molars with Class III FI and alveolar bone loss ≧70%. The clinical records include patient’s age, gender, degree of FIs and vertical dimensions of root trunk types (RTT), molar location, furcation site, and number of extracted molars. The assessments of the PAL and RTT of the extracted molars were taken under a stereomicroscope equipped with micrometer scale. Collected data were analysed using the chi-square test and one-way ANOVA. Results showed that significant relationships between PALs and 1) prevalence of molar location (p&lt;0.001); 2) RTTs (f=4.32, p&lt;0.05); 3) molar types; and 4) furcation surfaces (p&lt;0.05). It was concluded that the prevalence of the molar extraction affected with the Class III molar FI is associated with increasing length of root trunk and PAL.

Comparative Study of Two Ways to Measure Root Trunk Length to Assess the Possibility of Crown Lengthening in Molars: Measuring Parallel to the Root Surface vs Parallel to the Tooth Axis

The aim of this study was to compare root trunk measurements taken parallel to the tooth axis (TA) to those taken parallel to the root surface (RS) in order to assess the decision-making implications of each method on crown-lengthening surgery. A total of 672 root trunks were measured via CBCT in two planes: TA and RS. The possibility of performing crown lengthening in each clinical situation based on the distance from the cementoenamel junction (CEJ) to the crestal bone (CB) after ostectomy (CEJ-CB) was judged and compared between groups. When RS was used as a reference point, the proportions of cases that judged crown lengthening to be possible were 83.63%, 59.08%, and 39.18% for CEJ-CB values of 4, 5, and 6 mm, respectively. When TA was used instead, those proportions decreased by 3.87% to 7.29%. The lingual root trunk of the lower first molar (LFL) with a CEJ-CB of 4 to 5 mm emerged as the most problematic area; here, the difference between reference planes occurred with one out of every six teeth. Within the limits of this study, utilizing TA for surgical crown-lengthening treatment planning is not ideal because it may lead to extraction of many savable teeth.

Assessment of Mandibular Molar Root Morphology Using Cone‑Beam Computed Tomography in Periodontitis Patients From Eastern Province: A Cross-Sectional Study

BackgroundThe aim of this study was to assess the root morphology of mandibular molar teeth using cone‑beam computed tomography (CBCT) in patients with periodontal disease.MethodsIn total, 88 patients were included in this study (70 patients with periodontitis and 18 patients with non-periodontitis). This cross-sectional study involved CBCT images taken for patients who visited the dental clinic of Imam Abdulrahman Bin Faisal University (IAU) from January 2019 to March 2021. The following data were analyzed on the mandibular molars: root length, number of root canals, root trunk, distance between roots, accessory canals in the furcation area (ACF), bone loss, and furcation involvement.ResultsThe mesial root was longer than the distal root in the mandibular molars of periodontitis and non-periodontitis patients. A statistically significant difference was observed between non-periodontitis and periodontitis patients regarding the number of mesial root canals of the mandibular first molar; 70% had two root canals in non-periodontitis patients, compared with 86.1% in periodontitis patients (p = 0.04). First molars of non-periodontitis patients had significantly longer root trunks than periodontitis patients (4.65 ± 0.90 compared with 4.09 ± 1.02, p = 0.007). There was a statistically significant difference in bone loss between non-periodontitis and periodontitis patients (0% and 25% for first molars, and 2.8% and 23.6% for second molars, respectively). Accessory furcation canals were 2.9 % in second molars and 7.1 % in first molars in periodontitis patients, which were higher compared with non-periodontitis patients.ConclusionsThe first molar showed a longer root trunk in non-periodontitis patients than in periodontitis patients. The mean mesial and distal root lengths were also greater in the first than the second molar. Accessory canals in the furcation area were more observed in first molars than in second molars in periodontitis patients compared with non-periodontitis patients.

Supernumerary roots in maxillary deciduous canines: A rare anomaly with a long history

ObjectiveTo describe two maxillary deciduous bi-rooted canines, one archeological and one modern, and examine the possible etiology of this condition. DesignTwo cases of bi-rooted canines were described and compared to published examples. Both specimens were radiographed and measured and compared to one-rooted samples. The archeological specimen was scanned using CBCT to facilitate detailed examination of the deciduous teeth. The extracted modern tooth was embedded in epoxy resin and two coronal sections were cut, one through the crown and one through the roots and examined with a light microscope. ResultsThe bi-rooted canines were larger than the control samples. They showed none of the features commonly associated with gemination. The radiographs and scans showed that the canine roots in the archeological case diverged mesio-distally like the buccal roots in the adjacent first deciduous molar. In the clinical case, the root trunk was elongated mesio-distally and the furcation was located very close to the apex with a C-shaped root canal. ConclusionsBoth variants of the condition described above are rare in deciduous canines. They do not seem to be associated with fusion or gemination. However, as the teeth are relatively flattened bucco-lingually and we tentatively propose that this form results from spatial constraints during the early stages of crown development that have contributed to the development of additional roots. The megadont dimension of the recent bi-rooted deciduous canine may affect root development and the necessity of two mesio-distally located roots for anchorage in the maxilla.

Types and Dimensions of Molar Root Trunk Correlated with Molars Affected Class III Furcation Involvement in Taiwanese

Types and Dimensions of Molar Root Trunk Correlated with Molars Affected Class III Furcation Involvement in Taiwanese

Micro-tomographic analysis of the root trunk and pre-furcation area of the first mandibular molars.

This study analyzed the root trunk (RT) and the pre-furcation area (PFA) of mandibular first molars. Thirty lower first mandibular molars extracted due to advanced periodontal disease were evaluated in a high-energy spiral computerized micro-tomography. Two gutta-percha markings on the cementoenamel junction (CEJ) and at the furcation entrance (FE) at buccal and lingual surfaces served as reference points for measurements of RT length, and PFA width and depth, at the levels of CEJ, 1mm apical to CEJ, 2mm apical to CEJ, and at the FE. The mean RT length was 2.49mm at buccal and 3.18mm at lingual sides. The mean widths of the PFA at CEJ, at 1 and 2mm apical to CEJ, and at FE were 2.9, 3.4, 3.9 and 4.3mm, respectively, while the mean depths were 0.19, 0.32, 0.57 and 1.1mm, respectively. The PFA coincided with CEJ in 10 buccal and 10 lingual surfaces, representing 33.33% of the sample. There was a negative correlation between RT length and PFA dimensions. This study concludes that the RT length was smaller than previous studies. From the CEJ up to the furcation entrance, the PFA showed a progressive increase in width and depth. The coincidence of the PFA area beginning at the CEJ in 1/3, and the negative correlation between RT length and PFA dimensions may represent greater risk factor for the early development of furcation lesions.

Insights into the isotopic mismatch between bulk soil water and &amp;lt;i&amp;gt;Salix matsudana&amp;lt;/i&amp;gt; Koidz trunk water from root water stable isotope measurements

Abstract. Increasing numbers of field studies have detected isotopic mismatches between plant trunk water and its potential sources. However, the cause of these isotopic offsets is not clear, and it is uncertain whether they occur during root water uptake or during water transmission from root to trunk. Thus, we measured the specific isotopic composition (δ2H and δ18O) of each component (e.g. bulk soil water, mobile water, groundwater, trunk water and root water of Salix matsudana Koidz trees) in the soil–root–trunk continuum with a resolution of about 3 days. We report three main findings. First, we detected a clear separation between the isotopic compositions of mobile water and bulk soil water, but the distinction between mobile water and bulk soil water gradually decreased with increasing soil depth. Second, root water composition deviated from bulk soil water isotopic composition but overlapped with the composition derived for less mobile water. The maximum differences in δ2H and δ18O between bulk soil water and root water were −8.6 ‰ and −1.8 ‰, respectively. Third, trunk water was only isotopically similar to root water at 100–160 cm depths, and it remained stable during the experimental period, suggesting that the trees consistently used the stable deep water source. In conclusion, the isotopic offset between bulk soil water and trunk water of S. matsudana reflected an isotopic mismatch between root water and bulk soil water associated with the heterogeneity of the soil water. Our results illuminate relationships between the isotopic compositions of soil waters of various mobilities, root water and trunk water that may be useful for advancing our understanding of root water uptake and transport.

A new approach to root debridement: millimeter and furcation specific periodontal files

The most commonly used procedure for root surface debridement is mechanical scaling and root planing using hand instruments. Periodontal files are used as a part of treatment introduced in subgingivally pockets. The difficult lies in stablishing an analogy of this depth measurement to the probe by a PCP 12 and the corresponding input of this files at the same distance. The authors present new files, similar to Hirschfeld, have been modified with external marking at 12mm, allowing the Periodontist this analogy, and facilitating the process. On the other hand a specific small diameter PHenriques 6 and PHenriques 7 files, to instrument more easily this complex region. Consist of a series of 3 blades, and its sharp edges in 270 degrees around the active tip, reaching the root trunk, fornix and neighbor´s surfaces. They are extremely useful especially in Class III involvement and sharpening in the same way as conventional files.

Relationship between Molar Root Trunk Type and Molar Loss in Individuals with Class III Furcation Involvements: A Retrospective Study

Relationship between Molar Root Trunk Type and Molar Loss in Individuals with Class III Furcation Involvements: A Retrospective Study