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

Rare Root Canal Configuration in a Second Maxillary Molar: A Case Report

Endodontic treatment is a routine procedure performed daily in dental practices. It requires a good knowledge of all the variations in the configurations of the root canal systems of different groups of teeth. A thorough analysis of all available imaging studies is necessary. Difficulties may arise in the analysis and treatment protocol for rare morphological features of the root canal system. A representative of these cases is the single-rooted upper second molar with one wide canal. The purpose of this article is to present a case with an unusual upper second molar morphology: a single wide root canal. Magnification and good anatomical understanding facilitated detection and treatment, preserving the tooth's function within the dentition.

Proximity of maxillary molar palatal roots to adjacent structures for endodontic microsurgery: a cone-beam computed tomography study

BACKGROUND

The surgical complexity associated with the palatal roots of maxillary molars was considerably elevated. Previous studies on the relationships between maxillary molar roots and the maxillary sinus or cortical plates have focused on individual root observation without considering the positional relationship between buccal and palatal roots or analysing the surgical pathway of maxillary molar palatal roots. This study aimed to investigate the relationship between maxillary molar palatal roots and adjacent anatomical structures to provide a reference for performing palatal roots endodontic microsurgery.

METHODS

Anatomical characteristics of the maxillary molar roots were determined using cone-beam computed tomography (CBCT) imaging data from 250 patients. The relationship between the root apex plane (RAP) and the maxillary sinus floor (MSF) was categorized into two types (Type I and Type II) based on whether the RAP was higher than the MSF or not. There were also two subclasses for Type I and Type II, which included Type I-a (RAP was lower than MSF), Type I-b (RAP and MSF were on the same plane), Type II-a (root apex protruded into the maxillary sinus) and Type II-b (root apex did not protrude into the maxillary sinus, but the RAP was higher than the MSF). Distances from the root apexes to the MSF and the cortical bone surface were measured.

RESULTS

Of 500 teeth, 1352 roots were evaluated. Buccal roots obstruction 3 mm from the palatal root apex were present in almost all maxillary molars. The proportion of Type II-b cases in the palatal roots of three-rooted maxillary molars was significantly higher than that in the mesiobuccal (MB) and distalbuccal (DB) roots (P < 0.01). The distance from the root apex to the MSF increased with age and was significantly longer in females than in males (P < 0.05). The average distance from the apexes of palatal roots to the buccal cortical plate was 10.12 mm for first molars and 10.53 mm for the second molars. When measured through the MB roots, the distance to the buccal cortical plate was significantly shorter than that through the DB roots in the first molars (P < 0.05); however, the opposite was observed in the second molars (P < 0.05).

CONCLUSIONS

For determining the relationship between maxillary molar palatal roots and adjacent structures, CBCT provides reliable information, which acts as the basis for performing endodontic microsurgery of the palatal roots. Understanding the relationship between the roots of the maxillary molar and neighbouring anatomical structures helps surgeons evaluate potential difficulties, select optimal strategies, and reduce complications.

CLINICAL TRIAL NUMBER

Not applicable.

Evaluation of root and root canal morphology of mandibular and maxillary canine teeth in Turkish subpopulation by cone beam computed tomography with using two classification systems

BACKGROUND

Knowledge of root and canal morphology is a prerequisite for effective nonsurgical and surgical endodontic treatments. The aim of this cone beam computed tomography (CBCT) study was to evaluate the root canal morphology of permanent canines in a Turkish subpopulation using two classification systems.

METHODS

A total of 2,000 canine teeth were examined. The number of roots was identified, and root canal configurations were classified according to Vertucci's classification and a new system for classifying root and canal morphology. Fisher's exact test was used for statistical analysis, and the level of significance was set at 0.05 (p = 0.05).

RESULTS

The canal configuration type I was the most common in all canines, while type III was the second most common. According to the new system, the code 1C1-1 was the most common, whilst 1C1 (A1) codes were the second most common for all canines. In this study, more than 10% morphology that did not fit the Vertucci classification was detected. In the categorization of accessory canals based on the new classification, the most common type in all canines was 1C1,1 (A1). Age had an effect only on the morphology of the left maxillary canine (p < 0.05).

CONCLUSION

Canines in the Turkish subpopulation showed a relatively high degree of variation in root and canal anatomical variations. Clinicians should be aware of where canals converge or diverge to avoid missing canals. The new system for classifying canal morphology describes root and canal configurations more accurately and practically compared to the Vertucci classification.

Critical analysis of a new system to classify root and canal morphology - A systematic review

A novel system to classify root and canal morphology was recently introduced (Ahmed et al. 2017). This systematic review aimed to answer the following research question: Does the Ahmed et al. system provide a more accurate and practical classification of root and canal anatomy compared to other classifications? A literature search was conducted in Google Scholar, Scopus and Wiley Online Library to identify the citation counts for the article entitled 'A new system for classifying root and root canal morphology; doi.org/10.1111/iej.12685'. After removal of duplicates and unrelated articles, 15 studies were included and analysed. All studies compared the Ahmed et al. system with the Vertucci classification. Results revealed that both systems were able to classify simple canal configurations in single-rooted anterior and premolar teeth, disto-buccal and palatal roots of maxillary molars. However, the Ahmed et al. system provided more accurate and comprehensive categorisations of single-rooted teeth with complex canal anatomy, multi-rooted maxillary and mandibular premolars and the mesio-buccal root of maxillary molars. Further evidence on the utility of the Ahmed et al. system is required using other diagnostic devices especially in molars.

Investigation of mandibular second molar root and canal morphology in a Black South African population using cone-beam computed tomography and two classification systems

PURPOSE

To investigate the root and canal morphology of mandibular second molars, including anatomical variations, in a Black South African population using two classification systems.

METHODS

Cone-beam computed tomography images of 386 teeth were evaluated. The number of roots and canal configurations were categorized using the classifications of Vertucci (with modifications by Sert and Bayirli) and Ahmed et al. (including the modified Melton classification). Relationships between variables were assessed using Fisher's exact test (P < 0.05).

RESULTS

Mandibular second molars were predominantly two-rooted (91.7%). The majority of teeth had three canals including Type IV mesial (41.2%) and Type I (75.1%) distal (Ahmed et al. configuration: 2MDM M2 D1). Three or more canals were present in almost one-fifth of mesial (n = 72/386, 18.6%) and a small number of distal (n = 21/386, 5.4%) roots. Males displayed additional canals more frequently in the distal root (P = 0.02). C-shaped anatomy was found in 5.7%. Among the C-shapes, the most common was Melton's Type III in the coronal (50%), middle (81%) and apical (72%) thirds.

CONCLUSION

In this population, mandibular second molar teeth exhibited diverse morphology, which would have clinical significance for endodontic practitioners. The Ahmed et al. classification provided a better description than the Vertucci classification.