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Ginjeira A, Neto F, Behdad S, Farinha I, Gonçalves N, Martins JNR, Pires M, Rito Pereira M, Vasconcelos I, Duarte I. Influence of root shape on canal complexity at the mandibular molar apical surgical resection level: A micro-CT study. Arch Oral Biol 2024; 164:105983. [PMID: 38718467 DOI: 10.1016/j.archoralbio.2024.105983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES This study aimed to investigate the relationship between the aspect ratios of mandibular molar roots at the apical 3-mm level and their root canal complexity. DESIGN This study used micro-CT imaging to analyze 163 two-rooted mandibular molars. The aspect ratios of the roots at the apical 3-mm level were categorized as "< 2.75" or "≥ 2.75" (mesial) and "< 1.75" or "≥ 1.75" (distal). A two-dimensional (2D) analysis focused on four apical axial cross-section levels to determine the presence of main and accessory canals and isthmus. Additionally, a three-dimensional (3D) assessment of the apical 4-mm of both roots examined main and accessory canals, apical foramina, apical deltas, and middle mesial canals. RESULTS Mesial roots with aspect ratios ≥ 2.75 showed a higher number of main canals at all levels compared to those with aspect ratios < 2.75 at the 3-mm level. Additionally, the ≥ 2.75 group exhibited more accessory canals and a higher average number of accessory canals. The 3D assessment confirmed significantly more accessory canals and apical foramina in the ≥ 2.75 group. The prevalence of roots with apical deltas was nearly double in the ≥ 2.75 group, and middle mesial canals were exclusively found in this group. In the distal root, the ≥ 1.75 group showed a significantly higher number of main canals at all axial levels. No significant differences were observed between groups in terms of accessory canals, apical foramina, or deltas. CONCLUSIONS A higher root aspect ratio is related to higher anatomical complexity.
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Affiliation(s)
- António Ginjeira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Filipa Neto
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Shirin Behdad
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Inês Farinha
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Nuno Gonçalves
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Jorge N R Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; LIBPhys-FCT UID/FIS/04559/2013 (https://doi.org/10.54499/UIDB/04559/2020), Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Mariana Pires
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal.
| | - Mário Rito Pereira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Isabel Vasconcelos
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; Center for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Rua de Portugal, 2430-028 Marinha Grande, Portugal
| | - Isabel Duarte
- TEMA - Centre for Mechanical Technology and Automation, Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal; LASI - Intelligent Systems Associate Laboratory, Guimarães, Portugal
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Al-Rammahi HM, Chai WL, Nabhan MS, Ahmed HMA. Root and canal anatomy of mandibular first molars using micro-computed tomography: a systematic review. BMC Oral Health 2023; 23:339. [PMID: 37248469 DOI: 10.1186/s12903-023-03036-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND A thorough understanding of root and canal anatomy is crucial for successful root canal treatment outcomes. This systematic review aims to explore the published micro-CT studies investigated the anatomy of root and canal system in permanent mandibular first molars. METHOD An electronic search was performed on Web of science, PubMed, and Scopus. Micro-CT journal studies investigated the root and canal anatomy of permanent double-rooted mandibular first molars were included. Data on study characteristics, objectives of interest, specifications of the studies, and micro-CT specifications were extracted. Risk of bias assessment (ROB) of the included studies was performed using Anatomical Quality Assessment (AQUA) tool. The extracted data were presented in tables and figures to present and synthesise the results. A meta-analysis was performed for the studies related to the prevalence of Vertucci's canal configurations, middle mesial canal (MMC) configurations, and Fan's isthmus types. RESULTS Amongst 1358 identified studies, thirty met the inclusion criteria. In terms of the objectives, the selected studies showed high anatomical variability in mandibular first molars. Twenty-two (73%), 25 (83%), and 12 (40%) of the studies reported the population/ethnicity, micro-CT specifications, and ethical approval, respectively. 28 (93%) studies did not disclose the method of sample size estimation. In only 6 (20%) of the studies, the authors had calibrated the assessment approaches. Mostly, a potential ROB was reported in domain 1 (objective(s) and subject characteristics) and domain 3 (methodology characterization). Whilst, low risk was reported in domains 2 (study design), 4 (descriptive anatomy), and 5 (reporting of results). The overall ROB was reported to be ''moderate'' in the vast majority of the studies (27/30). Meta-analysis results showed high levels of heterogeneity among the studies related to MMCs (I2 = 86%) and Fan's isthmus (I2 = 87%). As for the root canal configuration, pooled prevalence showed that Vertucci type IV and type I were the most prevalent in mesial and distal root canals, respectively. CONCLUSION Based on moderate risk of bias level of evidence, micro-CT studies have shown wide range of qualitative and quantitative data presentations of the roots and canals in mandibular first molars. Protocol and registration. The protocol of this systematic review was prospectively registered in the Open Science Framework database ( https://osf.io ) on 2022-06-20 with the registration number 10.17605/OSF.IO/EZP7K.
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Affiliation(s)
- Hasan M Al-Rammahi
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Conservative Dentistry, Faculty of Dentistry, University of Babylon, AL Hillah city, Iraq
| | - Wen Lin Chai
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohamed Shady Nabhan
- Department of Prosthetic Dentistry, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Hany M A Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Pawar AM, Singh S. The morphology of the pulp chamber floor of permanent mandibular first and second molars in an Indian subpopulation-a descriptive cross-sectional study employing Pawar and Singh classification. PeerJ 2022; 10:e14392. [PMID: 36518276 PMCID: PMC9744145 DOI: 10.7717/peerj.14392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Mandibular molars are multi-rooted teeth with a complex and strenuous root canal anatomy. Because there is relatively negligible literature describing the pulp chamber floor anatomy, predicting the exact anatomical layout and its variations is daunting. A thorough comprehension and knowledge of the same is required for efficacious endodontic treatment consequence. The purpose of this study was to characterise and ascertain the pulp chamber floor anatomy of permanent mandibular first (ManFMs) and second (ManSMs) molars in an Indian population. Methods On 2,134 extracted human mandibular first (ManFMs = 1,067) and second molars (ManSMs = 1,067), a descriptive cross-sectional investigation was executed. Cleaning and removal of hard and soft tissue debris were performed, followed by flattening the anatomical crown until the pupal architecture was uncovered. A stereomicroscope with a magnification of 4.5 magnification was used to investigate the pulpal anatomy. Statistical analysis was carried out using chi square test, with 95% confidence intervals and a p value of 0.05 considered statistically significant. Results The majority of the ManFMs showed presence of three canal orifices in 57.73%, followed by four orifices 31.31%, five orifices 8.81%, and six orifices 2.15%. For ManSMs, majorly three orifices were found in 39.83% specimens, followed by two orifices in 37.39%, four orifices in 16.31%, and single root canal orifice was observed in 6.47%. The mesio-buccal, mesio-lingual, disto-buccal, disto-lingual canal orifices exhibited round and oval shapes in both ManFMs and ManSMs. The shape was predominantly oval with a single distal canal orifice (84.25% ManFMs and 74.16% ManSMs). In ManSMs, among the single root canal orifice, 66.66% were round in shape and 33.34% were C-shaped. In ManSMs with two root canal orifices, mesially 79.44% exhibited oval and 20.56% round shape. Distally, 74.16% were oval and 25.84% were round. The shapes of the access cavities for ManFMs were rectangular in 46.67% and triangular in 53.33%. For the ManSMs, the access cavities were triangular in 39.83%, rectangular in 16.31% and non-classified (others) in 43.86% of specimen. In both ManFMs and ManSMs, the pulp chamber floor morphology was predominately Y shaped (57.73% and 39.83%) according to the Pawar and Singh classification© of pulp chamber floor anatomy. Conclusion Our study indicated that the orifices on the pulp chamber floor are arranged in a typical manner, supporting the proposed categorization. Furthermore, description of the anatomical patterns of the pulp chamber guides the clinicians in chair-side treatment decisions.
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Affiliation(s)
- Ajinkya M. Pawar
- Department of Conservative Dentistry and Endodontics, TPCT’s Dental College and Hospital, Navi Mumbai, Maharashtra, India,Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Shishir Singh
- Department of Conservative Dentistry and Endodontics, TPCT’s Dental College and Hospital, Navi Mumbai, Maharashtra, India
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Karobari MI, Arshad S, Noorani TY, Ahmed N, Basheer SN, Peeran SW, Marya A, Marya CM, Messina P, Scardina GA. Root and Root Canal Configuration Characterization Using Microcomputed Tomography: A Systematic Review. J Clin Med 2022; 11:jcm11092287. [PMID: 35566414 PMCID: PMC9099997 DOI: 10.3390/jcm11092287] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 02/06/2023] Open
Abstract
This systematic review’s objective was to conduct a complete analysis of the literature on the root canal morphology using advanced micro-computed tomography. The electronic web databases PubMed, Scopus, and Cochrane were examined for research papers concerning the chosen keywords, evaluating the root canal morphology using Micro-CT, published up to 2021. The articles were searched using MeSH keywords and searched digitally on four specialty journal websites. DARE2 extended (Database of Attributes of Reviews of Effects) was used to assess bias risk. The information was gathered from 18 published studies that strictly met the criteria for inclusion. In the included studies, a total of 6696 samples were studied. The studies were conducted on either maxillary (n-2222) or mandibular teeth (n-3760), permanent anteriors (n-625), and Third molars (n-89). To scan samples, a Scanco Medical machine in was used in 10 studies, Bruker Micro-CT in 34, and seven other machines were utilized in the rest. Bruker Micro-CT software from Kontich, Belgium, VG-Studio Max 2.2 software from Volume Graphics, Heidelberg, Germany, was the most commonly used software. The minimum Voxel size (resolution) adopted in the included studies was 11.6 µm. However, 60 µm was the maximum. Most studies classified the root canal morphology using Vertucci’s classification system (n-16) and the four-digit system (n-6).
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Affiliation(s)
- Mohmed Isaqali Karobari
- Conservative Dentistry Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia
- Department of Conservative Dentistry & Endodontics, Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences University, Chennai 600077, Tamil Nadu, India
- Correspondence: (M.I.K.); (T.Y.N.); (G.A.S.)
| | - Sohaib Arshad
- Periodontics Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
| | - Tahir Yusuf Noorani
- Conservative Dentistry Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia
- Correspondence: (M.I.K.); (T.Y.N.); (G.A.S.)
| | - Naveed Ahmed
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
| | - Syed Nahid Basheer
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia;
| | - Syed Wali Peeran
- Department of Periodontics, Armed Forces Hospital Jizan, Jazan 82722, Saudi Arabia;
| | - Anand Marya
- Department of Orthodontics, Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences University, Chennai 600077, Tamil Nadu, India;
| | - Charu Mohan Marya
- Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad 121002, Haryana, India;
| | - Pietro Messina
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90133 Palermo, Italy;
| | - Giuseppe Alessandro Scardina
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90133 Palermo, Italy;
- Correspondence: (M.I.K.); (T.Y.N.); (G.A.S.)
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Altan Şallı G, Egil E. Evaluation of mesial root canal configuration of mandibular first molars using micro-computed tomography. Imaging Sci Dent 2022; 51:383-388. [PMID: 34987998 PMCID: PMC8695466 DOI: 10.5624/isd.20210038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to evaluate the root canal morphology of mesial roots of mandibular first molars. Materials and Methods Forty extracted mandibular first molars were used in this study. The morphological examination of root canals was conducted in accordance with the Vertucci classification using micro-computed tomography (micro-CT). Any aberrant root canal configurations not included in the Vertucci classification were recorded, and their frequency was established using descriptive statistics. Intra-observer reliability was assessed using the Wilcoxon signed-rank test, while inter-observer reliability was assessed using the Cohen kappa test. Significance was evaluated at the P<0.05 level. Results The mesial roots of mandibular first molars had canal configurations of type I (15%), type II (7.5%), type III (25%), type IV (10%), type V (2.5%), type VI (7.5%), and type VII (7.5%). The images showed 10 (25%) additional configuration types that were not included in the Vertucci classification. These types were 1-3-2-3, 1-2-3-2-3, 2-3-1, 2-3, 1-2-3-1, 2-1-2-3, 3-2-1, 1-2-3-1, 2-3-2-3, and 1-2-1-2-1. The intra-observer differences were not statistically significant (P>0.05) and the kappa value for inter-observer agreement was found to be 0.957. Conclusion Frequent variations were detected in mesial roots of mandibular first molars. Clinicians should take into consideration the complex structure of the root canal morphology before commencing root canal treatment procedures to prevent iatrogenic complications. Micro-CT was a highly suitable method to provide accurate 3-dimensional visualizations of root canal morphology.
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Affiliation(s)
- Gülay Altan Şallı
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Beykent University, Istanbul, Turkey
| | - Edibe Egil
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Gelişim University, Istanbul, Turkey
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Hassan H, Zaher M, Rabie M. Root canal morphology and incidence of isthmus in the mesial root canal of the mandibular first molar using cone-beam computed tomography of two different scanning modes. SAUDI ENDODONTIC JOURNAL 2022. [DOI: 10.4103/sej.sej_54_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Barros de Oliveira ML, Junqueira RB, Kamburoğlu K, Eratam N, Çakmak EE, Sönmez G, Küçük Ö, Verner FS. Assessment of the Metal Artifact Reduction Tool for the Detection of Root Isthmus in Mandibular Molars with Intraradicular Posts in Cone-beam Computed Tomographic Scans. J Endod 2021; 47:1583-1591. [PMID: 34265325 DOI: 10.1016/j.joen.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/21/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This study evaluated the performance of the metal artifact reduction (MAR) tool in cone-beam computed tomographic scans using different fields of view (FOVs) in the detection of a root isthmus in mandibular molars with intraradicular posts. METHODS Twenty-eight teeth were scanned by micro-computed tomographic imaging (gold standard images). Thereafter, specimens were allocated into the following groups: gutta-percha (teeth without posts, n = 10), a prefabricated metal post (n = 9), and a fiberglass post (n = 9). Cone-beam computed tomographic scans were taken using 8 acquisition protocols, varying the size of the FOV (10 × 5.5 cm and 5 × 5.5 cm) and the MAR tool (disabled, low, normal, and high modes). A root isthmus was evaluated considering a 5-point scale. Data were analyzed considering a 5% significance level. RESULTS Intra- and interexaminer agreement varied from moderate to substantial. The frequency of correct diagnosis varied significantly in all groups regardless of the image acquisition protocol selected (P < .05). In the gutta-percha group, there was no difference in the accuracy, sensitivity, and specificity values between the tested protocols. In the metal and fiberglass post groups, the accuracy values were higher with the "disabled" and "low" modes of the MAR tool regardless of the FOV size. This was also observed for the sensitivity values in the metal post group (P < .05). CONCLUSIONS The size of the FOV did not affect the performance of the MAR tool in the diagnosis of a root isthmus in molars with intraradicular posts. Our findings suggest that the use of the tool in the "normal" and "high" modes is contraindicated for this purpose.
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Affiliation(s)
- Manuela Lima Barros de Oliveira
- Applied Health Sciences Post-Graduate Program, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Rafael Binato Junqueira
- Applied Health Sciences Post-Graduate Program, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil; Department of Dentistry, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Kıvanç Kamburoğlu
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey.
| | - Nejlan Eratam
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Esra Ece Çakmak
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Gül Sönmez
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Özlem Küçük
- Department of Nuclear Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Francielle Silvestre Verner
- Applied Health Sciences Post-Graduate Program, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil; Department of Dentistry, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
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Three-dimensional morphologic classifications and analysis of canal isthmuses in permanent molars. Surg Radiol Anat 2021; 43:1793-1799. [PMID: 34245350 DOI: 10.1007/s00276-021-02796-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the three-dimensional morphology of isthmuses in molars according to their boundary characteristics using micro-computed tomography (micro-CT). METHODS Micro-CT reconstructed images of 248 molars were evaluated. Isthmuses were classified into four types based on the boundary characteristics: isthmus with roof, isthmus with floor, band-shaped isthmus, and isthmus without boundary. The tooth and root with isthmuses, the number and location of the isthmuses in the root, and the canal configurations were recorded. The maximum of the major diameter of all canal cross-sections in one isthmus (dmax), the minor diameter of the canal in same cross-section (dmin), the distance between the dmax cross-section and apex (Dm-a), isthmus length (Li), and distance from the isthmus ending cross-section to apex (De-a) were measured and analysed with a significance threshold set to 5%. RESULTS Isthmuses were present in 75.4% specimens. The four types of isthmuses were found in various molars and roots. Their distribution in different root locations and canal configurations was significantly different. The dmax, dmin, Li, and De-a were analysed according to different molars and different isthmus types; their respective median values were 2.508 mm, 0.07 mm, 3.09 mm, and 3.96 mm. CONCLUSION The three-dimensional classification of isthmuses according to the boundary characteristics provides a comprehensive picture of the isthmus in molars. Their corresponding distributions in different molars, location in roots, and canal configurations will be helpful in predicting the type of isthmus based on the tooth position and canal configurations.
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Natanasabapathy V, Rajesh PS, Ashritha MCV, Mishra A, Namasivayam A, Kandaswamy D, Srinivasan MR. Root canal isthmi and interorifice distance in human permanent teeth of an Indian subpopulation using cone-beam computed tomography: A retrospective cross-sectional study. J Conserv Dent 2021; 23:563-570. [PMID: 34083910 PMCID: PMC8095684 DOI: 10.4103/jcd.jcd_576_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/04/2022] Open
Abstract
Objective: The aim of the study was to evaluate the prevalence of root canal isthmus (RCI) and measure the interorifice distance (IOD) between the root canals. Additionally to correlate IOD with the RCI in human permanent teeth using conebeam computed tomography (CBCT) in an Indian sub-population (Chennai). Materials and Methods: A total of 5881 teeth from 280 CBCT full mouth scans were analyzed. The presence or absence of complete and incomplete RCI of each tooth was identified using the map-reading strategy. IOD was calculated by measuring the distance between the center of each root canal orifice to that of the center of the adjacent orifice at the level of the cementoenamel junction using the axial and sagittal sections. Chi-square analysis and correlation statistics using Spearman's rank-order test was done (P < 0.05). Results: High prevalence of RCI was found in maxillary first premolars, mesial root of mandibular molars, and mesiobuccal root of maxillary first molars, while its prevalence was low in maxillary canines and mandibular premolars and absent in maxillary incisors. RCI was predominantly seen in the cervical and middle third of the root canal in all the teeth evaluated. A weak negative correlation was established between the IOD and RCI for maxillary premolars, whereas a weak positive correlation was seen in maxillary first molars and mandibular second molars. Conclusion: The prevalence of RCI was high in the posterior teeth in comparison to the anterior teeth in the present study. There was no strong correlation between IOD and RCI in all the teeth evaluated.
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Affiliation(s)
- Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Parashar Saumya Rajesh
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - M C V Ashritha
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Anisha Mishra
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ambalavanan Namasivayam
- Department of Periodontology and Oral Implantology, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Deivanayagam Kandaswamy
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Manali Ramakrishanan Srinivasan
- Department of Conservative Dentistry and Endodontics, Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India
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Keles A, Keskin C, Alqawasmi R, Gunduz K, Aydemir H. Diagnostic accuracy of endoscopy for the detection of isthmuses of mandibular molar teeth using micro-CT as reference. Eur Oral Res 2021; 55:34-38. [PMID: 33937760 PMCID: PMC8055258 DOI: 10.26650/eor.20210065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose: The aim of this study was to evaluate the efficacy of endoscopic visualisation
to detect the presence and type of isthmuses within the mesial root canals of
mandibular first molar teeth compared with micro-computed tomography (micro-
CT) images as reference. Materials and methods: Thirty-two mesial roots of mandibular first molars presenting isthmuses were
selected based on micro-CT scans. In all, 12 type I and 20 band-shaped isthmuses
were collected. The specimens were mounted in the posterior socket of dental
phantom manikin for endoscopic visualisation. The ability of endoscopes to visualize
the presence of isthmuses and distinguish the type of isthmuses was compared.
Micro-CT images of the specimens were used as references. Data were analyzed
using Fisher’s exact tests. Results: Sensitivity of endoscope to detect isthmuses were also calculated for each
isthmus type. In 37.5% of the samples, isthmus presence was correctly diagnosed
via orthograde endoscopic visualization. Type I istmuses were significantly more
detected than band-shaped isthmuses (P<0.05). Endoscope showed higher
sensitivity to detect type I isthmus than band-shaped isthmus. Conclusion: The endodontic endoscope could detect type I isthmuses more accurately than
band- shaped isthmuses.
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Affiliation(s)
- Ali Keles
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun,Turkey
| | - Cangul Keskin
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun,Turkey
| | - Rawan Alqawasmi
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun,Turkey
| | - Kaan Gunduz
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ondokuz Mayıs University, Samsun,Turkey
| | - Hikmet Aydemir
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun,Turkey
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11
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Keles A, Keskin C, Alqawasmi R, Aydemir H. Accuracy of an endoscope to detect root canal anastomoses in mandibular molar teeth: a comparative study with micro-computed tomography. Acta Odontol Scand 2020; 78:433-437. [PMID: 32141355 DOI: 10.1080/00016357.2020.1735515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The aim of this study was to investigate the accuracy of endoscopic visualization to detect root canal anastomoses at the coronal half of the mesial root canals of mandibular molars using micro-computed tomographic (micro-CT) images as reference.Material and methods: Seventy-four mesial roots of mandibular first molars with (n = 47) or without (n = 27) intercanal anastomosis were selected based on the micro-CT scans of 269 mandibular first molars at a pixel size of 10 µm. The specimens were mounted on the mannequins and their root canals were evaluated using dental operating microscope (DOM) and endoscope. The endoscopic probe was inserted into the main mesial root canals and 2 blinded observers evaluated the presence of a divergence point of anastomosis (where the branching occurs) as 'present' or 'absent'. The scorings were compared with the three-dimensional reconstructed images of the specimens and recorded as 'correct' or 'incorrect' evaluation. Degree of agreement between evaluators was assessed with Kappa test and the accuracy of endoscopic visualization according to the presence and location of anastomosis was compared using Fisher exact tests with a significance threshold at 5%.Results: High inter-examiner reliability was reported (0.91). None of the divergence points were identified using DOM whereas 11 divergence points were detected using endoscope, corresponding the 23.4% of the intercanal anastomoses. The endoscope also showed the absence of an intercanal anastomosis correctly in all of the specimens without an anastomosis. Detectability of a divergence point using endoscope was not affected by its location within the coronal half of root canal (p > .05).Conclusions: The endoscopes were able to visualize the divergence points of 23.4% of the intercanal anastomoses located at the coronal halves of root canals.
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Affiliation(s)
- Ali Keles
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Cangül Keskin
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Rawan Alqawasmi
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Hikmet Aydemir
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
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12
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Xu S, Dao J, Liu Z, Zhang Z, Lu Y, Zeng X. Cone-beam computed tomography investigation of middle mesial canals and isthmuses in mandibular first molars in a Chinese population. BMC Oral Health 2020; 20:135. [PMID: 32384929 PMCID: PMC7206827 DOI: 10.1186/s12903-020-01126-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/29/2020] [Indexed: 11/20/2022] Open
Abstract
Background While there is ample research into the anatomy of mandibular molars, little is known regarding isthmuses and middle mesial (MM) canals in Chinese populations. The goal of this study was to determine the prevalence of MM canals and isthmuses in the mesial root of mandibular first molars using Cone-beam Computed Tomography. Methods Cone-beam Computed Tomography images of 357 mature mandibular first molars were retrospectively analyzed. Presence of isthmuses and MM canals, and the length of isthmuses in the mesial root were recorded. Meanwhile, we also recorded possible correlated factors such as demographics, side of mandible, presence of separated distal-lingual roots. Results Of these 357 teeth, 209 showed evidence of either complete or partial communication in the mesial root. Of these, 11(3.1%) exhibited true MM canals while 198(55.5%) exhibited isthmuses. Sex or side of mandible was not correlated with the prevalence of isthmuses (P > 0.05). However, there was a significant association between the presence of a distal-lingual root and the prevalence of such communication (P < 0.001). The average length of isthmuses was 4.3 ± 3.1 mm. Conclusions We detected high rate of isthmuses and low rate of MM canals in mesial roots of mandibular first molars, which is important as such areas should be identified and cleaned during root canal treatment.
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Affiliation(s)
- Shuaimei Xu
- Department of Endodontics, Stomatological Hospital, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Junfeng Dao
- Department of Prosthodontics, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Zhongjun Liu
- Department of Endodontics, Stomatological Hospital, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Zhiyong Zhang
- Department of Oral and Maxillofacial Radiology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Yu Lu
- Department of Endodontics, Stomatological Hospital, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Xiongqun Zeng
- Department of Endodontics, Stomatological Hospital, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China.
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Al Shehadat S, Waheb S, Al Bayatti SW, Kheder W, Khalaf K, Murray CA. Cone Beam Computed Tomography Analysis of Root and Root Canal Morphology of First Permanent Lower Molars in a Middle East Subpopulation. J Int Soc Prev Community Dent 2019; 9:458-463. [PMID: 31620378 PMCID: PMC6792317 DOI: 10.4103/jispcd.jispcd_41_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/03/2019] [Indexed: 11/16/2022] Open
Abstract
Aim: The aim of this study was to investigate variations in the number of roots and root canals in first permanent lower molars (FPLMs) using cone beam computed tomography (CBCT). Materials and Methods: A total of 640 CBCT images were analyzed using SIDEXIS XG software version 2.62 (Sirona Dental Systems, Bensheim, Germany). The entire root anatomy of FPLMs was investigated in three dimensions and the number of roots, root canals, and the number of canals per root were recorded. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software, version 24, (IBM Corporation, USA) to determine the relationship between root anatomy and gender, age, or tooth location (right or left side). Results: The majority of FPLMs had two roots (96%), whereas the remaining 32 FPLMs (4%) had three roots. Almost two-thirds of the sample (62.7%) had three root canals, whereas only three cases (0.4%) of the FPLMs had six canals. When comparing bilateral differences in the distribution of root canals, it was determined that a quarter of FPLMs (24.1%) had an unequal number of canals. Moreover, there were differences in the number of additional canals between the mesial and distal roots with 17.5% of the former having three canals as compared with only 0.5% of the distal root. Interestingly, not more than one canal was observed in all additional root cases. No significant differences were observed in the number of canals between males and females or between right and left sides of the examined FPLMs (P > 0.05). Conclusion: Dental clinicians should be aware of the presence of an additional root in 4% of FPLMs, and about a quarter of the cases (27%) had an extra middle mesial canal in the mesial root, which was found to be more prevalent in middle age groups.
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Affiliation(s)
- Saaid Al Shehadat
- Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Saad Waheb
- Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Saad Wahbi Al Bayatti
- Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Waad Kheder
- Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Khaled Khalaf
- Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Colin A Murray
- Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Karunakaran JV, PremKumar MM, Aarthi G, Jayaprakash N, Kumar SS. Isthmus Incidence in Human Permanent Mandibular First Molars of a South Indian Population: A Cone-Beam Computerized Tomographic Study. J Pharm Bioallied Sci 2019; 11:S468-S473. [PMID: 31198389 PMCID: PMC6555315 DOI: 10.4103/jpbs.jpbs_80_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: This study aimed to analyze incidence of isthmus in human permanent mandibular first molar teeth using cone-beam computed tomographic imaging techniques in a South Indian population. Materials and Methods: Three hundred permanent mandibular first molar teeth were collected, cleaned, and stored in normal saline. They were divided into groups (GPs) I and II based on number of roots, and were further subdivided (right and left [RL] subgroups A and B for GP I; and RL subgroups C and D for GP-II). Samples were processed and isthmus incidence was evaluated by cone-beam tomography, compared, and statistically analyzed. Results: Overall in mandibular first molars, the isthmus incidence in mesial root was 97.2%, distal root was 39%, and distolingual root was 0%. There was no statistically significant difference between the right and left mandibular first molar teeth with regard to incidence of isthmus (P > 0.05). There was an incidence of type I (38.67%), type II (56.33%), type III (3%), and type IV (2%) isthmuses in mesial root and type I (12.33%), type II (16%), and type III (10.67%) in distal root. Conclusion: Incidence of isthmus was very high in the mesial root of the mandibular first molar and should be factored during nonsurgical and surgical endodontic treatment procedures to achieve successful treatment outcomes.
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Affiliation(s)
| | | | - Ganapathy Aarthi
- Department of Conservative Dentistry, Vinayaka Missions Sankarachariar Dental College, Salem Tamil Nadu, India
| | - Nachimuthu Jayaprakash
- Department of Conservative Dentistry, JKK Nattraja Dental College and Hospital, Komarapalayam, India
| | - Swaminathan Senthil Kumar
- Department of Conservative Dentistry, JKK Nattraja Dental College and Hospital, Komarapalayam, India
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