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Bansal R, Hegde S, Astekar M. Morphology and prevalence of middle canals in the mandibular molars: A systematic review. J Oral Maxillofac Pathol 2018; 22:216-226. [PMID: 30158775 PMCID: PMC6097385 DOI: 10.4103/jomfp.jomfp_194_17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objectives: The purpose of this paper is to systematically review the various studies and case reports on the morphology and prevalence of middle canals in the mandibular molars. Methodology: Electronic databases such as MEDLINE, PubMed, EBSCOhost, ScienceDirect and various journals were screened to identify published literature till March 2017 and earlier for articles related to middle canals in the human permanent mandibular molars. Obtained articles were categorized as original researches, case reports and review articles. Well-defined review questions were developed using the patient population, intervention, comparison and outcome framework to summarize the objectives: “Does middle canal vary in morphology and anatomic location? What is the prevalence of middle canals in mandibular molars? Does ethnicity affect the prevalence of middle canals in mandibular molars?” Morphology was studied and prevalence rates were determined from the evaluation of data extracted from the articles. Results: The search strategy resulted in 87 articles, of which 36 were original research papers and 51 were case reports. The prevalence of middle canals in the various populations ranged from 0.26% to 53.8%. Middle canals were reported in Europeans, Asians, Africans and South and North American populations. The prevalence of middle mesial canal and middle distal canal in various races was reported as up to 53.8% and 10%, respectively. The orifice of middle canal exists below a dentinal projection in the groove between the two main canals. They were observed in fin, confluent and independent configuration. Out of these, confluent configuration was more prevalent. Conclusion: Middle canal varies in morphology and anatomic location. Ethnicity affects the prevalence of middle canals in the mandibular molars.
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Affiliation(s)
- Rashmi Bansal
- Department of Conservative and Endodontics, Faculty of Dentistry, Udaipur, Rajasthan, India.,Department of Pacific Academy of Higher Education and Research University, Udaipur, Rajasthan, India
| | - Sapna Hegde
- Department of Pedodontics and Preventive Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - Madhusudan Astekar
- Department of Oral Pathology and Microbiology, Institute of Dental Science, Bareilly, Uttar Pradesh, India
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Identification and Endodontic Management of Middle Mesial Canal in Mandibular Second Molar Using Cone Beam Computed Tomography. Case Rep Dent 2015; 2015:867976. [PMID: 26664763 PMCID: PMC4664793 DOI: 10.1155/2015/867976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/08/2015] [Accepted: 11/08/2015] [Indexed: 11/17/2022] Open
Abstract
Endodontic treatments are routinely done with the help of radiographs. However, radiographs represent only a two-dimensional image of an object. Failure to identify aberrant anatomy can lead to endodontic failure. This case report presents the use of three-dimensional imaging with cone beam computed tomography (CBCT) as an adjunct to digital radiography in identification and management of mandibular second molar with three mesial canals.
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Management of six root canals in mandibular first molar. Case Rep Med 2015; 2015:827070. [PMID: 25685156 PMCID: PMC4312998 DOI: 10.1155/2015/827070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/16/2014] [Indexed: 11/18/2022] Open
Abstract
Success in root canal treatment is achieved after thorough cleaning, shaping, and obturation of the root canal system. This clinical case describes conventional root canal treatment of an unusual mandibular first molar with six root canals. The prognosis for endodontic treatment in teeth with abnormal morphology is unfavorable if the clinician fails to recognize extra root canals.
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Hasan M, Umer F. Endodontic retreatment of a mandibular first molar with five root canal systems: an important clinical lesson. BMJ Case Rep 2014; 2014:bcr-2013-201402. [PMID: 24654237 DOI: 10.1136/bcr-2013-201402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The objective of root canal treatment is to perform complete debridement of the root canals and subsequent obturation to facilitate healing of periapical pathosis. However, this process becomes complicated with the presence of additional root canal systems. The purpose of the present article is to report successful non-surgical retreatment of a mandibular first molar with five canals. This case report discusses the clinical management of a previously root filled mandibular firstmolar with two missed canal systems; distolingual and an additional mesial canal known as the middle mesial canal. The post-treatment radiographs show successful obturation to length in all canals. The middle mesial canal was found to be associated with mesiolingual canal and categorised as confluent. The configuration of canals in the mesial root was type XV, based on the classification given by Sert and Bayirli. This case report highlights the importance of knowledge and its application in the management of abnormal anatomic variants which play a crucial role in the success of endodontic retreatment.
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Affiliation(s)
- Muhammad Hasan
- Operative Dentistry, Dental Section, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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Mohammadi Z, Shalavi S, Jafarzadeh H. Extra roots and root canals in premolar and molar teeth: review of an endodontic challenge. J Contemp Dent Pract 2013; 14:980-6. [PMID: 24685809 DOI: 10.5005/jp-journals-10024-1437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The main goal of endodontic treatment is healing of the periapical tissues which are gained by elimination of bacteria and their byproducts from the canal and prevention from reinfection. Understanding of root canal anatomy is an essential part in endodontic treatment. Anatomic forms and variations in special teeth should be well known, one of them is extra roots/ canals. Although possible aberrations of canal anatomy should be considered for all teeth, some teeth should be highlighted. This review addresses the prevalence, diagnosis (clinical and radiographic), and endodontic management of teeth with extra roots/canals.
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Affiliation(s)
- Zahed Mohammadi
- Iranian Center for Endodontic research (ICER), Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences Tehran, Iran
| | | | - Hamid Jafarzadeh
- Associate Professor, Dental Research Center, Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran, e-mail: and
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Ballullaya SV, Vemuri S, Kumar PR. Variable permanent mandibular first molar: Review of literature. J Conserv Dent 2013; 16:99-110. [PMID: 23716959 PMCID: PMC3659872 DOI: 10.4103/0972-0707.108176] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 08/15/2012] [Accepted: 08/23/2012] [Indexed: 11/16/2022] Open
Abstract
Introduction: The success of root canal therapy depends on the locations of all the canals, thourough debridement and proper sealing. At times the clinicians are challenged with variations in morphology of root canal. This review article attempts to list out all the variations of permanent mandibular first molar published so for in the literature. Materials and Methods: An exhaustive search was undertaken using PUBMED database to identify published literature from 1900 to 2010 relating to the root canal morphology of permanent first molar by using key words. The selected artcles were obtained and reviewed. Results: Total ninty seven articles were selected out of which 50 were original article and forty seven were case reports. The incidence of third canal in mesial root was 0.95% to 15%. The incidence of three rooted mandibular first molar was 3% to 33%. Only ninety cases reported with c-shape canal configuration. Incidence of Taurodintism without congenital disorder was very rare. Conclusion: The root canal treatment requires proper knowlegde of variations in root canal morphology in order to recognise, disinfect and seal all portal of exit. This can be accomplished with proper diagnosis using newer modes, modification in access preparation, use of operating microscope, enhanced methods of disinfecting and sealing of all canals.
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Affiliation(s)
- Srinidhi V Ballullaya
- Department of Conservative dentistry and Endodontics, St Joseph Dental College, Duggirala, Eluru, West Godavari District, India
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Three independent mesial canals in a mandibular molar: four-year followup of a case using cone beam computed tomography. Case Rep Dent 2013; 2013:891849. [PMID: 23662215 PMCID: PMC3639676 DOI: 10.1155/2013/891849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/24/2013] [Indexed: 11/17/2022] Open
Abstract
Endodontic treatment of mandibular molars is challenging because of variable root canal morphology. The nonsurgical endodontic management of a mandibular first molar presenting an independent middle mesial canal is reported. After coronal access, additional clinical inspection of the mesial canals' orifices and their interconnecting groove using an endodontic explorer and 4.5× loupes enabled the identification of the middle mesial canal orifice. All root canals were chemomechanically prepared and filled. The tooth was asymptomatic and functional after 4 years of followup. Cone beam computed tomography (CBCT) images revealed normal periapical status and three-dimensional (3D) anatomical aspects of the root canal system.
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Karunakaran JV, Shobana R, Kumar M, Kumar S, Mankar S. Management of middle mesial canal in mandibular second molar. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2012; 4:S161-4. [PMID: 23066241 PMCID: PMC3467889 DOI: 10.4103/0975-7406.100259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 01/02/2012] [Accepted: 01/26/2012] [Indexed: 11/10/2022] Open
Abstract
The primary objective of endodontic therapy is to achieve a three-dimensional obturation of the root canal space after adequate preparation of the canal space to remove the tissue debris, microorganisms, and their byproducts. Anatomical variations have frequently been encountered in endodontic practice and have to be adequately managed by the clinician. Missed roots and canals are a major reason for failure of therapy. Technological advances have given the clinician ample opportunity to identify and treat these aberrations successfully. The present report describes a left mandibular second permanent molar requiring root canal treatment, found to have three separate canals in the mesial root. This case demonstrates a rare anatomical configuration and emphasizes the need for the clinician to be aware of and look out for such variations and use adequate diagnostic methodologies prior to and during therapy to detect such variations. The possibility of additional canals, whenever in doubt, should be explored with the assistance of technologies such as those of magnification and illumination and various diagnostic aids. Operator experience has also shown to be a key factor in negotiation and management of these aberrant canal configurations.
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Affiliation(s)
- J V Karunakaran
- Department of Conservative Dentistry, JKKN Dental College, Komarapalayam, Tamil Nadu, India
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Deepalakshmi M, Karumaran CS, Miglani R, Indira R. Independent and confluent middle mesial root canals in mandibular first molars: a report of four cases. Case Rep Dent 2012; 2012:103125. [PMID: 22792497 PMCID: PMC3389654 DOI: 10.1155/2012/103125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 05/15/2012] [Indexed: 11/25/2022] Open
Abstract
Mandibular molars demonstrate considerable variations with respect to number of roots and root canals. The possibility of additional root canals should be considered even in teeth with a low frequency of abnormal root canal anatomy. This paper discusses the endodontic management of the rare anatomical complexity middle mesial canals in mandibular first molar and also serves to remind the clinicians that such anatomical variations should be taken into account during the endodontic treatment of the mandibular molars.
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Affiliation(s)
- Mohanavelu Deepalakshmi
- Department of Conservative Dentistry & Endodontics, Chettinad dental college, Chettinad Health City & Research Institute, Old Mahabalipuram Road, Kelambakkam 603103, Chennai, India
| | | | - Revathi Miglani
- Department of Conservative Dentistry & Endodontics, Ragas Dental College & Hospital, Uthandi 600119, Chennai, India
| | - Rajamani Indira
- Department of Conservative Dentistry & Endodontics, Ragas Dental College & Hospital, Uthandi 600119, Chennai, India
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Mushtaq M, Farooq R, Rashid A, Robbani I. Spiral computed tomographic evaluation and endodontic management of a mandibular first molar with three distal canals. J Conserv Dent 2011; 14:196-8. [PMID: 21814366 PMCID: PMC3146117 DOI: 10.4103/0972-0707.82602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/30/2011] [Accepted: 02/05/2011] [Indexed: 02/07/2023] Open
Abstract
The use of spiral computed tomography serves as a boon in endodontic diagnosis of complex anatomic variations. The present case demonstrates the spiral tomographic evaluation and endodontic management of a mandibular first molar with 5 canals (2 mesial and 3 distal canals), which is a very rare anatomic variant. Such anatomic variations should be taken into account in day to day endodontic practice to ensure a high degree of clinical success.
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Affiliation(s)
- Mubashir Mushtaq
- Department of Conservative Dentistry and Endodontics, Government Dental College, Srinagar, India
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Root Anatomy and Canal Configuration of the Permanent Mandibular First Molar: A Systematic Review. J Endod 2010; 36:1919-31. [DOI: 10.1016/j.joen.2010.08.055] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 08/26/2010] [Accepted: 08/28/2010] [Indexed: 12/20/2022]
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Faramarzi F, Fakri H, Javaheri HH. Endodontic treatment of a mandibular first molar with three mesial canals and broken instrument removal. AUST ENDOD J 2010; 36:39-41. [DOI: 10.1111/j.1747-4477.2009.00162.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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La SH, Jung DH, Kim EC, Min KS. Identification of Independent Middle Mesial Canal in Mandibular First Molar Using Cone-Beam Computed Tomography Imaging. J Endod 2010; 36:542-5. [DOI: 10.1016/j.joen.2009.11.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 11/07/2009] [Accepted: 11/12/2009] [Indexed: 11/17/2022]
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Kontakiotis EG, Tzanetakis GN. Four canals in the mesial root of a mandibular first molar. A case report under the operating microscope. AUST ENDOD J 2007; 33:84-8. [PMID: 17697250 DOI: 10.1111/j.1747-4477.2007.00068.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this era of microscope-assisted endodontics, finding variations in root canal system anatomy is not uncommon. Operating microscopes combined with careful clinical examination and radiographic interpretation can aid the clinician to successfully treat cases with such internal anatomy. The understanding of this view enables the possible location of additional canals in any tooth requiring endodontic treatment. The present clinical article demonstrates a rare anatomical complexity in the mesial root of a mandibular first molar. Four independent root canal orifices were found in this root by clinical detection with the aid of a dental operating microscope. This case shows that additional canals can be located in any root undergoing endodontic treatment and clinicians should always be aware of aberrant internal anatomy.
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Affiliation(s)
- Evangelos G Kontakiotis
- Department of Endodontics, Dental School, University of Athens, Anthron 2, Patisia, 11143 Athens, Greece.
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CANTATORE GIUSEPPE, BERUTTI ELIO, CASTELLUCCI ARNALDO. Missed anatomy: frequency and clinical impact. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1601-1546.2009.00240.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Torabinejad M, Kutsenko D, Machnick TK, Ismail A, Newton CW. Levels of Evidence for the Outcome of Nonsurgical Endodontic Treatment. J Endod 2005; 31:637-46. [PMID: 16123698 DOI: 10.1097/01.don.0000153593.64951.14] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The purpose of this systematic review was (a) to search for clinical articles pertaining to success and failure of nonsurgical root canal therapy, and (b) to assign levels of evidence to these studies. Electronic and manual searches were conducted to identify studies published between January 1966 and September 2004 with information on the success and failure of nonsurgical root canal therapy. Articles were reviewed and graded for strength of level of evidence (LOE) from one (highest level) to five (lowest level). This review resulted in the identification of 306 clinical studies related to this topic area. Six articles were randomized controlled trials (RCTs, LOE 1). This search also identified 12 low-quality RCTs (LOE 2), 14 cohort studies (LOE 2), five case-control and eight cross sectional studies (LOE 3), four low-quality cohort studies (LOE 4), and five low-quality case-control studies (LOE 4). The majority (73) of the often-quoted "success and failure" studies were case series (LOE 4). The rest of the articles were descriptive epidemiological studies (42), case reports (114), expert opinions (18), literature reviews (4), and one meta-analysis. Based on these findings, it appears that a few high-level studies have been published in the past four decades related to the success and failure of nonsurgical root canal therapy. The data generated by this search can be used in future studies to specifically answer questions and test hypotheses relevant to the outcome of nonsurgical root canal treatment.
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Affiliation(s)
- Mahmoud Torabinejad
- Department of Endodontics of the School of Dentistry, Loma Linda University, Loma Linda, California 92350, USA.
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Abstract
With the advent of magnification, either by loupes or microscope, the astute clinician must be aware of recent literature that states that the mandibular first molar has a 1-15% chance of a fifth canal. This is a case report accompanied by a review of the literature that shows the unusual anatomy of the mandibular first molar.
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Affiliation(s)
- Dean Baugh
- University of Pittsburgh School of Dental Medicine, Pennsylvania, USA
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