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Pertek Hatipoğlu F, Magat G, Karobari MI, Buchanan GD, Kopbayeva M, Taha N, Fernández-Grisales R, Bekjanova O, Luu P, Bürklein S, Mufadhal A, Petridis X, Mora MF, Sugumaran S, Allawi S, Ivica A, Lim WY, Fadag A, Jagtap R, Kulczyk T, Alfirjani S, Palma PJ, Hatipoğlu Ö. Multinational cross-sectional study and meta-analysis on radicular grooves, C-shaped canals, and taurodontism in mandibular first premolars across 20 countries. Sci Rep 2025; 15:17974. [PMID: 40410308 PMCID: PMC12102226 DOI: 10.1038/s41598-025-02666-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Accepted: 05/15/2025] [Indexed: 05/25/2025] Open
Abstract
The success of root canal therapy is fully predicated upon a complete understanding of root and canal morphology and all the anatomical variations that can complicate the endodontic treatment. Of these morphological variations, taurodontism, RGs, and C-shaped canals are of note due to their implications on diagnosis, treatment planning, and endodontic success. This study aimed to investigate the prevalence and regional variations of C-shaped canals, RGs, and taurodontism across 20 countries using CBCT imaging and meta-analytic methods. A multicenter, cross-sectional study analyzed CBCT datasets from 6,000 participants (12,000 teeth) distributed equally across 20 countries. Standardized evaluation arrangements were utilized to identify RGs (RG), taurodontism, and C-shaped canals with their prevalence stratified by region, gender, and age. Statistical analyses cover subgroup comparisons, correlation studies, and sensitivity analysis using Cramer's V. RGs had a pooled global prevalence of 20%, with high-rised rates in Africa. C-shaped canals reported a 10% global prevalence, mainly in Asia, On the Other hand taurodontism was lowest prevalent at 7%, with markable regional variability. Prominent bilateral symmetry was noticed for all features, and taurodontism showed the highest rate (98.33%). Important correlations existed among C-shaped canals, grooves, and taurodontism showing shared developmental pathways. The current study points out the significant prevalence, including anatomical variations of RGs, taurodontism, and C-shaped canals in mandibular 1st premolars, with substantial demographic and regional differences. The findings highlight the importance of perception of these features' morphological interrelationships along with bilateral symmetry to increase diagnostic accuracy, clinical outcomes, and treatment planning.
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Affiliation(s)
| | - Güldane Magat
- Department of Oral Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
| | - Mohmed Isaqali Karobari
- Department of Conservative Dentistry and Endodontics, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospital, Saveetha University, Chennai, 600077, Tamil Nadu, India
| | - Glynn Dale Buchanan
- Department of Odontology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Faculty of Medicine and Health, Sydney Dental School, The University of Sydney, Sydney, Australia
| | - Maira Kopbayeva
- School of Dentistry, Department of Therapeutics Dentistry. Almaty, Kazakh National Medical University named after S.D.Asfendiyarov, Almaty, Kazakhstan
| | - Nessrin Taha
- Department of Conservative Dentistry, Jordan University of Science and Technology Irbid, Irbid, Jordan
| | | | - Olga Bekjanova
- Faculty of Dentistry, Tashkent State Dental Institute, Tashkent, Uzbekistan
| | - Peter Luu
- Faculty of Medicine and Health, Sydney Dental School, The University of Sydney, Sydney, Australia
| | - Sebastian Bürklein
- Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Münster, Germany
| | - Abdulbaset Mufadhal
- Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, Sana'a University, Sana'a, Yemen
| | - Xenos Petridis
- Department of Endodontics, Section of Dental Pathology and Therapeutics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - María Fernanda Mora
- Endodontic department of Dentistry, Universidad Central del Ecuador Quito, Quito, Ecuador
| | - Surendar Sugumaran
- Department of cariology and comprehensive care Dentistry, NYU college of Dentistry, New York, USA
- Department of Conservative dentistry and Endodontics, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Saveetha University, Chennai, India
| | - Safaa Allawi
- Department of Endodontic and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Anja Ivica
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Wen Yi Lim
- Department of Restorative Dentistry, National Dental Centre, Singapore, Singapore
| | - Abdulrahman Fadag
- Endodontics Department, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Rohan Jagtap
- Division of Oral and Maxillofacial Radiology, Department of Care Planning and Restorative Sciences, University of Mississippi Medical Center School of Dentistry, Jackson, MI, 39216, USA
| | - Tomasz Kulczyk
- Dept.of Diagnostics, Poznan University of Medical Sciences, Poznan, Poland
| | - Suha Alfirjani
- Department of Conservative Dentistry and Endodontics, University of Benghazi, Benghazi, Libya
| | - Paulo J Palma
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ömer Hatipoğlu
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Department of Restorative Dentistry, Recep Tayyip Erdogan University, Rize, Turkey.
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Lin CY, Yu YY. Mandibular left first premolar with three roots and three canals: A case report. World J Clin Cases 2025; 13:100822. [PMID: 40330286 PMCID: PMC11736522 DOI: 10.12998/wjcc.v13.i13.100822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 11/29/2024] [Accepted: 12/20/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND The numbers of mandibular first premolar roots and root canals vary, and the incidence of three roots and three canals is 0.09%. CASE SUMMARY In this article, we review the root and root canal conditions for the mandibular first premolar and report the case of a mandibular left first premolar with three roots and three canals in a male patient, with suggestions for clinical diagnosis and treatment. The patient was referred by an orthodontist for the extraction of the tooth. Preoperative cone-beam computed tomography examination revealed that it had three roots. Under local anesthesia, the extraction socket was carefully expanded, and the tooth was successfully removed intact using forceps. The procedure was uneventful, with no root fractures, postoperative bleeding, or sensory abnormality observed. CONCLUSION The mandibular first premolar is characterized by multiple roots and canal variations that can increase the difficulty of treatment.
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Affiliation(s)
- Cheng-Yi Lin
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Yue-Yuan Yu
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
- Stomatology Hospital Affiliated with Zhejiang Chinese Medicine University, Hangzhou 310053, Zhejiang Province, China
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Ahmed HMA, Farook MS. Micro-computed tomography analysis and ex-vivo detection of six root canals in a four-rooted mandibular first premolar. BMC Oral Health 2025; 25:498. [PMID: 40197269 PMCID: PMC11978089 DOI: 10.1186/s12903-025-05781-1] [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: 08/10/2024] [Accepted: 03/11/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Mandibular first premolar teeth show a wide range of root and canal anatomical variations including accessory roots, deep root proximal grooves and multiple canals. This study provides qualitative and quantitative morphological analysis of a rare four-rooted mandibular first premolar scanned using micro-CT. In addition, it provides clinical implications through endodontic access cavity preparation and negotiation of canals under dental operating microscope (DOM) to assess the difficulty for locating the canals. METHODS An extracted four-rooted mandibular first premolar tooth sample was subjected to 2D radiographic imaging in two views and micro-computed tomography (micro-CT) scanning with a resolution of 25 μm. Subsequently, 3D- reconstruction of the tooth sample was performed using Mimics software (Materialise, Leuven, Belgium). 3D (volume and surface area) and 2D measurements (distances between orifices, area, perimeter, maximum and minimum diameter, roundness, aspect ratio and form factor) were obtained. In addition, endodontic access was prepared, and the canals were explored under the DOM. Location of the canals were confirmed by periapical radiographs with the aid of hand files. RESULTS The 2D imaging showed the presence of four canals. Micro-CT analysis showed a complex canal anatomy which was classified using Ahmed et al. coding system as 444 MB1-2-1-2 DB2-1-2-1-3-2-3 1(ML1 DL1). Quantitative analysis showed that the MB root had the highest canal volume and surface area compared to other canals. The 2D measurements showed wide variations among canals, which reflects the complexity of the canals in terms of size and geometry. The MB and DB canals tend to have more aspect ratio values (more oval/flattened) than other canals. After access cavity preparation and exploration, six root canals were identified [mesio-buccal one (MB1), mesio-buccal two (MB2), disto-buccal (DB), mesio-lingual (ML), disto-lingual (DL) and lingual disto-buccal (LDB)]. The canals in the MB root showed two locations of splitting. CONCLUSIONS Mandibular first premolars may have complex variations in the number of roots and canal configurations. The different anatomical presentations demonstrated in the 2D and 3D measurements of the six canals presented in this report signifies the anatomical variabilities, which could complicate the detection and negotiation of canals during root canal treatment. Ahmed et al. coding system is useful in classifying teeth with complex root and canal anatomy.
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Affiliation(s)
- Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Mohideen Salihu Farook
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia.
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Magat G, Hatipoğlu Ö, Köse T, Hatipoğlu FP. Root canal morphology of mandibular anterior permanent teeth in Turkish sub-population using two classification systems: a cone-beam computed tomography study. Odontology 2025; 113:799-808. [PMID: 39285116 DOI: 10.1007/s10266-024-01000-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/26/2024] [Indexed: 03/28/2025]
Abstract
This study examined the root and canal morphology of mandibular anterior teeth (MA) in the Turkish sub-population using cone-beam computed tomography (CBCT), comparing the findings based on Vertucci's and Ahmed et al. classification systems. The CBCT images were acquired using the 3D Accuitomo CBCT device. Images that were deemed suitable for visualizing the roots, canals, and the complete pulp chamber and apex were included in the study. Vertucci and Ahmed et al. classification systems were employed to determine the root canal morphology. 500 CBCT images and 3000 teeth were analyzed. Type I (1MA1) was the most frequent, followed by Type III (1MA1-2-1). 3.8% of teeth could not be classified with Vertucci system. In canine teeth, Vertucci type III (1MA1-2-1) was significantly more prevalent in males than females (p = 0.038) and Type I (1MA1) was less frequent in individuals aged 41-50 (p < 0.05). Canal divergence/merging was the most common at the middle/apical level for central (15.5%) and lateral (10.3%) teeth, and at the coronal/middle level for canine teeth (1.9%). Bilateral similarity was high for all tooth groups (> 78%). One-third of mandibular incisor teeth have two canals, with a significant number exhibiting canal divergence/merging that was separated in the middle region and merged in the apical region. The Vertucci classification was found to be inadequate in some cases, while Ahmed et al. classification was able to classify all mandibular incisors with a single code. Ahmed et al. classification is a more useful system for classifying all MA.
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Affiliation(s)
- Güldane Magat
- Department of Oral Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
| | - Ömer Hatipoğlu
- Department of Restorative Dentistry, Nigde Omer Halisdemir University, Niğde, Turkey
| | - Tuba Köse
- Orthodontic Clinic, Private Rident Dental Policlinic, Rize, Turkey.
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Hu P, Feng S, Li X, Li G, Li S. Endodontic treatment of a two-rooted mandibular first premolar with four root canals: a case report. FRONTIERS IN DENTAL MEDICINE 2024; 5:1498167. [PMID: 39917697 PMCID: PMC11797773 DOI: 10.3389/fdmed.2024.1498167] [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: 09/18/2024] [Accepted: 11/27/2024] [Indexed: 02/09/2025] Open
Abstract
Background Mandibular first premolar has a complex and variable anatomy of the root canal system, which often leads to failure of endodontic treatment due to missing root canals. Identifying the complete structure of the root canal system to ensure that all root canals are perfectly cleared and filled becomes critical to the success of root canal therapy. This report introduced a unique case of endodontic treatment of a two-rooted mandibular first premolar in the buccolingual direction with a total of four canals. Case presentation An adult male patient with a lower left first premolar was diagnosed with acute apical periodontitis and treated with open pulp drainage in a general hospital. One day later, due to the complexity of the root canal structure, the patient was referred to our clinic for subsequent treatment. The tooth #34 was diagnosed with abnormal central cusp, apical periodontitis, and incomplete fracture through clinical and x-ray examinations. Cone-beam Computed Tomography (CBCT) results showed that the tooth #34 processed two roots with a buccolingual bifurcation and a total of 4 root canals: 1 lingual canal, 2 mesiobuccal canals, and 1 distobuccal canal. Notably, the buccal root presented a C-shaped configuration, and the mesiobuccal canals were of 2-1 type. The tooth was treated with microendodontics and crown restoration. One year after the treatment, the follow-up results showed that the tooth #34 was functioning normally without any abnormalities. Conclusion This report enhances our understanding of the anatomical variations in the root canal system of the mandibular first premolar and emphasizes the importance of CBCT in identifying anatomical variations within the root canal system. Clinicians must be aware of such changes in the mandibular first premolar during treatment to ensure a perfect treatment and better prognosis in clinical practice.
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Affiliation(s)
- Peiling Hu
- Department of Endodontics and Operative Dentistry, The Affiliated Stomatological Hospital, Southwest Medical University, Lu Zhou, China
| | - Shuang Feng
- Department of Endodontics and Operative Dentistry, The Affiliated Stomatological Hospital, Southwest Medical University, Lu Zhou, China
| | - Xin Li
- Department of Endodontics and Operative Dentistry, The Affiliated Stomatological Hospital, Southwest Medical University, Lu Zhou, China
| | - Guangwen Li
- Department of Implantology, The Affiliated Stomatological Hospital, Southwest Medical University, Lu Zhou, China
| | - Shiting Li
- Department of Endodontics and Operative Dentistry, The Affiliated Stomatological Hospital, Southwest Medical University, Lu Zhou, China
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Arshad H, Zahra F, Naved N, Khalid T, Iqbal A, Karobari MI, Maqbool I, Umer F. Evaluation of root canal morphology of mandibular premolars in Pakistani population using the new classification: a CBCT study. BMC Oral Health 2024; 24:1414. [PMID: 39568006 PMCID: PMC11577896 DOI: 10.1186/s12903-024-05149-x] [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: 07/22/2024] [Accepted: 11/05/2024] [Indexed: 11/22/2024] Open
Abstract
BACKGROUND A comprehensive understanding of the root form and canal anatomy is essential for successful endodontic treatment. This study aimed to evaluate the root canal anatomy of mandibular premolars in the Pakistani population using cone beam computed tomography (CBCT) and to classify the findings with the new classification proposed by Ahmed et al. METHODS: Ethical exemption was obtained from Aga Khan University Hospital, Karachi. A total of 707 CBCT scans from Karachi and Lahore were included, comprising 592 scans from a tertiary care hospital in Karachi and 115 scans from a radiology center in Lahore. The study focused on sound, fully formed mandibular first and second premolars, excluding those with significant caries, restorations, or prior root canal treatments. Scans from different equipment were used, and calibration was achieved between a specialist endodontist and two dental residents. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 26. Descriptive statistics, Chi-square tests to determine association between the variables, and a significance level set at 5% (p <0.05) were utilized. RESULTS A total of 2403 mandibular premolars were analyzed. The most common configuration was 1MPM1 (82.90%), with rare variations such as 1MPM1-3-1 (0.04%) and 2MPM1 B1 L2 (0.04%). Single-rooted premolars were predominant (98.87%), and no significant differences were observed when data was stratified by age or gender. CONCLUSIONS This is the first study in Pakistan involving multiple centers and using the classification system by Ahmed et al. to understand the anatomy of mandibular premolars. The findings indicate that while most premolars have a single root and canal, variations exist. These variations highlight the importance of understanding canal morphology for improving the success of endodontic treatment. Future studies should include a larger and more diverse dataset to fully represent the Pakistani population.
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Affiliation(s)
- Hamza Arshad
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Fatima Zahra
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Nighat Naved
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Taimur Khalid
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Azhar Iqbal
- Department of Restorative Dentistry, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Mohmed Isaqali Karobari
- Department of Dental Research, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | | | - Fahad Umer
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
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Özyürek T, Uslu G, Arıcan B, Gündoğar M, Nekoofar MH, Dummer PMH. Influence of endodontic access cavity design on mechanical properties of a first mandibular premolar tooth: a finite element analysis study. Clin Oral Investig 2024; 28:433. [PMID: 39026036 PMCID: PMC11258061 DOI: 10.1007/s00784-024-05808-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES This study aimed to investigate the influence of access cavity designs on the mechanical properties of a single-rooted mandibular first premolar tooth under various static loads using a finite element analysis. MATERIALS AND METHODS 3-dimensional FEA designs were modeled according to the access cavity designs: an intact tooth (control), traditional access cavity (TEC-I), traditional access cavity with Class-II mesio-occlusal cavity design (TEC-II), conservative access cavity (CEC), ninja access cavity (NEC), caries-driven access cavity (Cd-EC), buccal access cavity (BEC) and bucco-occlusal access cavity (BOEC). After the simulated access cavity preparations, root canal treatment was simulated and three different static loads which mimicked oblique and vertical mastication forces were applied to the models. The stress distribution and maximum Von Misses stress values were recorded. The maximum stress values were obtained on both enamel and dentin under multi-point vertical loads. RESULTS The maximum stress values were obtained on both enamel and dentin under multi-point vertical loads. Under all load types, the minimum stress distribution was observed in the control group, followed by CEC, NEC and BEC designs. The highest stress concentration was detected in Cd-EC and TEC-II designs. Under single-point vertical loading, the stress was mostly concentrated in the lingual PCD area, while under multi-point vertical loading, the entire root surface was stress-loaded except for the lingual apical third of the root. CONCLUSION Preserving tooth tissue by simulating CEC, NEC and BEC access cavities increased the load capacity of a single-rooted mandibular first premolar following simulated endodontic treatment.
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Affiliation(s)
- Taha Özyürek
- Department of Endodontics, School of Dental Medicine, Bahçeşehir University, Istanbul, Turkey
| | - Gülşah Uslu
- Department of Endodontics, Faculty of Dentistry, Çanakkale Onsekiz Mart University, Istanbul, Turkey
| | - Burçin Arıcan
- Department of Endodontics, School of Dental Medicine, Bahçeşehir University, Istanbul, Turkey.
| | - Mustafa Gündoğar
- Department of Endodontics, Faculty of Dentistry, Medipol University, Istanbul, Turkey
| | - Mohammad Hossein Nekoofar
- Department of Endodontics, School of Dental Medicine, Bahçeşehir University, Istanbul, Turkey
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Xu M, Ren H, Liu C, Zhao X, Li X. Systematic review and meta-analysis of root morphology and canal configuration of permanent premolars using cone-beam computed tomography. BMC Oral Health 2024; 24:656. [PMID: 38835024 DOI: 10.1186/s12903-024-04419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION The efficacy of root canal treatment is greatly impacted by a thorough understanding of root canal anatomy. This systematic review and meta-analysis aim to thoroughly investigate the root morphology and canal configuration (RMCC) of permanent premolars (PMs). METHODOLOGY A comprehensive analysis was conducted following the PRISMA guidelines. Literature exploration was carried out across four electronic databases (PubMed, Embase, Cochrane, and Web of Science). The risk of bias assessment was conducted for the included studies utilizing the Anatomical Quality Assessment (AQUA) tool. Data analysis was performed utilizing SPSS and RevMAN5.3.3. The meta-analysis was applied with a 95% confidence interval to calculate odds ratios (OR). RESULTS Among the 82 selected studies, 59 studies exhibited potential bias in domain one (objective(s) and subject characteristics), followed by domain three (methodology characterization). The majority of maxillary PM1s had either single root (46.7%) or double roots (51.9%), while three-rooted variants were uncommon (1.4%). Conversely, most other PMs exhibited a single root. In terms of canal configuration, maxillary PM1s predominantly featured double distinct canals (87.2%), with the majority of maxillary PM2s displaying either a single canal (51.4%) or double canals (48.3%). Mandibular PMs were primarily characterized by single canals, accounting for 78.3% of mandibular PM1s and 90.3% of mandibular PM2s. Subgroup analyses revealed higher incidences of single-rooted and single-canalled PMs among Asians compared to Caucasians. Additionally, women exhibited a higher incidence of single-rooted PMs, while men showed a greater frequency of double-rooted PMs. CONCLUSIONS The comprehensive analysis indicated that maxillary PM1s predominantly possess double roots and double canals, whereas maxillary PM2s and mandibular PMs were primarily characterized by single-rooted with a single canal. Notably, single root and single canal were more prevalent among women and Asian samples.
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Affiliation(s)
- Mengchen Xu
- Department of Endodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, Jinan, Shandong, 250012, China
| | - Huiying Ren
- Department of Endodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, Jinan, Shandong, 250012, China
| | - Congrui Liu
- Department of Endodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, Jinan, Shandong, 250012, China
- Science and Technology Innovation Committee of Shenzhen Municipality, Shenzhen Research Institute of Shandong University, A301 Virtual University Park in South District of Shenzhen, Shenzhen, Guangdong, 518000, China
| | - Xinyu Zhao
- Department of stomatology, Jinan Hospital, Jinan, Shandong, 250013, China.
| | - Xiaoyan Li
- Department of Endodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, Jinan, Shandong, 250012, China.
- Science and Technology Innovation Committee of Shenzhen Municipality, Shenzhen Research Institute of Shandong University, A301 Virtual University Park in South District of Shenzhen, Shenzhen, Guangdong, 518000, China.
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Mustafa M, Batul R, Karobari MI, Alamri HM, Abdulwahed A, Almokhatieb AA, Hashem Q, Alsakaker A, Alam MK, Ahmed HMA. Assessment of the root and canal morphology in the permanent dentition of Saudi Arabian population using cone beam computed and micro-computed tomography - a systematic review. BMC Oral Health 2024; 24:343. [PMID: 38493123 PMCID: PMC10944621 DOI: 10.1186/s12903-024-04101-3] [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: 11/07/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION Root canal treatment procedures require a thorough understanding of root and canal anatomy. The purpose of this systematic review was to examine the morphological differences of teeth root and their canals assessed using cone-beam computed and micro-computed tomography in Saudi Arabian population. METHODOLOGY An electronic search was conducted in PubMed / Medline, Scopus, Google Scholar, and Web of Science databases until January 2023 to retrieve related studies. "Root canal morphology," "Saudi Arabia," "Micro-CT," and "cone-beam computed tomography" were used as keywords. A modified version of previously published risk of bias assessment tool was used to determine the quality assessment of included studies. RESULTS The literature search revealed 47 studies that matched the criteria for inclusion, out of which 44 studies used cone beam computed tomography (CBCT) and three were micro-computed tomography (micro-CT) studies. According to the modified version of risk of bias assessment tool, the studies were categorized as low, moderate, and high risk of bias. A total of 47,612 samples were included which comprised of either maxillary teeth (5,412), or mandibular teeth (20,572), and mixed teeth (21,327). 265 samples were used in micro-CT studies while 47,347 teeth samples were used in CBCT studies. Among the CBCT studies, except for three, all the studies were retrospective studies. Frequently used imaging machine and software were 3D Accuitomo 170 and Morita's i-Dixel 3D imaging software respectively. Minimum and maximum voxel sizes were 75 and 300 μm, Vertucci's classification was mostly used to classify the root canal morphology of the teeth. The included micro-CT studies were in-vitro studies where SkyScan 1172 X-ray scanner was the imaging machine with pixel size ranging between 13.4 and 27.4 μm. Vertucci, Ahmed et al. and Pomeranz et al. classifications were applied to classify the root canal morphology. CONCLUSION This systematic review revealed wide variations in root and canal morphology of Saudi population using high resolution imaging techniques. Clinicians should be aware of the common and unusual root and canal anatomy before commencing root canal treatment. Future micro-CT studies are needed to provide additional qualitative and quantitative data presentations.
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Affiliation(s)
- Mohammed Mustafa
- Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia.
| | - Rumesa Batul
- Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
- Dental Research Unit, Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, 600077, Tamil Nadu, India
| | - Mohmed Isaqali Karobari
- Dental Research Unit, Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, 600077, Tamil Nadu, India.
- Department of Restorative Dentistry & Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, 12211, Cambodia.
| | - Hadi Mohammed Alamri
- Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
- Consultant Endodontics, Department of Dentistry, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz Abdulwahed
- Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Ahmed A Almokhatieb
- Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Qamar Hashem
- Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Abdullah Alsakaker
- Consultant endodontist, Department of endodontics, Prince Abdulrahman Advanced Dental Institute, Ministry of defence, Riyadh, Saudi Arabia
| | - Mohammad Khursheed Alam
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, 72345, Saudi Arabia
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
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Ahmed HMA, Rossi-Fedele G, Dummer PMH. Critical analysis of a new system to classify root and canal morphology - A systematic review. AUST ENDOD J 2023; 49:750-768. [PMID: 37688283 DOI: 10.1111/aej.12780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/27/2023] [Accepted: 07/08/2023] [Indexed: 09/10/2023]
Abstract
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.
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Affiliation(s)
- Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
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Buchanan GD, Gamieldien MY, Fabris-Rotelli I, van Schoor A, Uys A. Investigation of mandibular second molar root and canal morphology in a Black South African population using cone-beam computed tomography and two classification systems. J Oral Sci 2023; 65:226-231. [PMID: 37532527 DOI: 10.2334/josnusd.23-0123] [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] [Indexed: 08/04/2023]
Abstract
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.
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Affiliation(s)
- Glynn D Buchanan
- Department of Odontology, School of Dentistry, Faculty of Health Sciences, University of Pretoria
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria
| | - Mohamed Y Gamieldien
- Department of Maxillofacial and Oral Surgery, School of Dentistry, Faculty of Health Sciences, University of Pretoria
| | - Inger Fabris-Rotelli
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria
| | - Albert van Schoor
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria
| | - Andre Uys
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria
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Buchanan GD, Gamieldien MY, Fabris-Rotelli I, Van Schoor A, Uys A. Root and canal morphology of maxillary second molars in a Black South African subpopulation using cone-beam computed tomography and two classifications. AUST ENDOD J 2023; 49 Suppl 1:217-227. [PMID: 36420941 DOI: 10.1111/aej.12720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/18/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
This study investigated the root and canal morphology of maxillary second molars in a Black South African population using high-resolution cone-beam computed tomography. In total, 386 maxillary second molar teeth were evaluated and described according to the classifications of Vertucci (with the additions of Sert and Bayirli), as well as Ahmed et al. Root number, fusions and canal morphology were recorded. Relationships between morphology, sex and age were assessed using Fisher's exact test (p < 0.05). Maxillary second molars were predominantly three-rooted (96.1%), with root fusion observed in 14%. No relationships between sex, age and canal morphology were found. Additional canals were observed in 67.4% of mesiobuccal roots. The Ahmed et al. classification provided a better overall description of the morphology. In this population, maxillary second molar teeth exhibited a diversity of root and canal morphology. Complex variations may render endodontic management more difficult and increase the possibility of missed anatomy.
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Affiliation(s)
- Glynn Dale Buchanan
- Department of Odontology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mohamed Yasin Gamieldien
- Department of Maxillofacial and Oral Surgery, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Inger Fabris-Rotelli
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
| | - Albert Van Schoor
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Andre Uys
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Mirah MA, Bafail A, Baik A, Abu Zaid B, Hakeem M, Ghabbani H. Root Canal Morphology of Premolars in Saudis. Cureus 2023; 15:e45888. [PMID: 37885565 PMCID: PMC10599201 DOI: 10.7759/cureus.45888] [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] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
AIM This study aimed to evaluate root number and morphological variations of the root canal system in maxillary and mandibular premolars among the Saudi subpopulation. METHODOLOGY A total of 500 cone-beam computed tomography (CBCT) images were assessed, including 2442 maxillary and mandibular premolars. The evaluation encompassed the number of roots and canals and their configuration based on the Vertucci classification. Gender differences were considered, along with the position of premolars and unilateral or bilateral symmetry. RESULTS Maxillary first premolars predominantly exhibited two roots (82.6%), followed by one root (16.3%) and three roots (0.97%), with a majority having two root canals (83.6%). Regarding maxillary second premolars, the most common morphology was one root (66.6%), with two root canals (40.5%) observed more frequently than one root canal (38.1%). Mandibular first and second premolars mainly featured one root (84.8% and 96.1%, respectively) with one root canal (70.8% and 90.2%, respectively), whereas two root canals were less prevalent (2.3% and 1.8%, respectively). Three canals and three roots were rarely found in mandibular premolars (0.3%). Regarding maxillary premolars, males exhibited significantly higher type IV and mandibular type I root configurations compared with females. Conversely, regarding mandibular premolars, females showed significant mandibular type V and higher type I root configurations compared with males. CONCLUSION CBCT imaging facilitated precise assessment of root morphology and root canal configurations in maxillary and mandibular premolars. The present findings can aid dentists in diagnosing, evaluating case difficulty, and devising effective root canal treatments, particularly in patients from Saudi Arabia.
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Affiliation(s)
- Mahir A Mirah
- Restorative Dental Sciences Department, College of Dentistry, Taibah University, Madinah, SAU
| | - Arwa Bafail
- Restorative Dental Sciences Department, College of Dentistry, Taibah University, Madinah, SAU
| | - Abdulmajeed Baik
- Internship Program, College of Dentistry, Taibah University, Madinah, SAU
| | - Basim Abu Zaid
- Internship Program, College of Dentistry, Taibah University, Madinah, SAU
| | - Muhannad Hakeem
- Restorative Dental Sciences Department, College of Dentistry, Taibah University, Madinah, SAU
| | - Hani Ghabbani
- Endodontic Department, King Faisal Specialist Hospital and Research Centre, Madinah, SAU
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Saber SM, Elashiry MM, Sadat SMAE, Nawar NN. A microcomputed tomographic analysis of the morphological variabilities and incidence of extra canals in mandibular first molar teeth in an Egyptian subpopulation. Sci Rep 2023; 13:8985. [PMID: 37268728 DOI: 10.1038/s41598-023-36005-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/27/2023] [Indexed: 06/04/2023] Open
Abstract
A well-protected microbial habitat may be present in the root and canal morphology, which is varied and complicated. Before initiating effective root canal treatment, a detailed knowledge of the root and canal anatomical variances in each tooth is a must. This study aimed to investigate the root canal configuration, apical constriction anatomy, location of the apical foramen, dentine thickness, and prevalence of accessory canals in mandibular molar teeth in an Egyptian subpopulation using micro-computed tomography (microCT). A total of 96 mandibular first molars were scanned using microCT, and 3D reconstruction was performed using Mimics software. The root canal configurations of each of the mesial and distal root were classified with two different classification systems. The prevalence and dentin thickness around middle mesial and middle distal canals were investigated. The number, location and anatomy of major apical foramina and the apical constriction anatomy analysed. The number and location of accessory canals were identified. Our findings showed that two separate canals (15%) and one single canal (65%) were the most common configuration in the mesial and distal roots, respectively. More than half of the mesial roots had complex canal configurations and 51% had middle mesial canals. The single apical constriction anatomy was the most common for both canals followed by the parallel anatomy. Disto-lingual and distal locations of the apical foramen are the most common location for both roots. Mandibular molars in Egyptians show a wide range of variations in root canal anatomy with high prevalence of middle mesial canals. Clinicians should be aware of such anatomical variations for successful root canal treatment procedures. A specific access refinement protocol and appropriate shaping parameters should be designated for each case to fulfil the mechanical and biological objectives of root canal treatment without compromising the longevity of treated teeth.
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Affiliation(s)
- Shehabeldin Mohamed Saber
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, 81-11-11 El-Rehab, Cairo, 11841, Egypt.
- The Center for Innovative Dental Sciences, Faculty of Dentistry, The British University in Egypt, Cairo, Egypt.
- Department of Endodontics, Faculty of Dentistry, Ain Shams University in Egypt, Cairo, Egypt.
| | - Mohamed Mohamed Elashiry
- Department of Endodontics, Faculty of Dentistry, Ain Shams University in Egypt, Cairo, Egypt
- Department of Endodontics, Dental College of Georgia, Augusta University, Cairo, Egypt
| | | | - Nawar Naguib Nawar
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, 81-11-11 El-Rehab, Cairo, 11841, Egypt
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Karobari MI, Iqbal A, Syed J, Batul R, Adil AH, Khawaji SA, Howait M, Khattak O, Noorani TY. Evaluation of root and canal morphology of mandibular premolar amongst Saudi subpopulation using the new system of classification: a CBCT study. BMC Oral Health 2023; 23:291. [PMID: 37189077 DOI: 10.1186/s12903-023-03002-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/29/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The clinician should have complete knowledge of the normal anatomy of the root as well as complexities in the root canal configuration for a better outcome, as missed or improper handling of the canal system can lead to the failure of an entire endodontic procedure. The present study aims to assess the morphology of roots and canals in permanent mandibular premolars in the Saudi subpopulation with a new classification system. METHODS The present study includes 1230 mandibular premolars (645 first premolars and 585-second premolars) from 500 CBCT images of the patients, including retrospective data. iCAT scanner system (Imaging Sciences International, Hatfield, PA, USA) was used to obtain the images; scanning of 8 × 8 cm images was performed at 120 KVp and 5-7 mA with a voxel size of 0.2 mm. The new method of classification presented by Ahmed et al. 2017 was used to record and classify the root canal morphology, followed by recording the differences regarding the age and gender of the patients. Comparison of canal morphology in lower permanent premolars and its association with gender and age of the patients was done by Chi-square test/ Fisher exact test; the significance level was set at 5% (p ≤ 0.05). RESULTS The left mandibular 1st and 2nd premolars with one root were 47.31%, with two roots were 2.19%. However, three roots (0.24%) and C-shaped canals (0.24%) were reported only in the left mandibular 2nd premolar. The right mandibular 1st and 2nd premolars with one root were 47.56%, with two roots were 2.03%. The overall percentage of the number of roots and canals in the first and second premolars 1 PM 1 (88.38%), 2 PM 1 B 1 L 1 (3.5%), 2 PM B 1 L 1 (0.65%), 1 PM 1-2-1 (3.08%), 1 PM 1-2 (3.17%), 1 PM 1-2-1-2 (0.24%), 3 PMMB 1 DB 1 L1 (0.48%). However, the C-shaped canals (0.40%) were reported in right and left mandibular second premolars. No statistically significant difference was reported between mandibular premolars and gender. A statistically significant difference was reported between mandibular premolars and the age of the study subjects. CONCLUSION Type I (1 TN 1) was the major root canal configuration in permanent mandibular premolars, which was higher among males. The CBCT imaging provides thorough details about the root canal morphology of lower premolars. These findings could support diagnosis, decision-making, and root canal treatment, for dental professionals.
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Affiliation(s)
- Mohmed Isaqali Karobari
- Department of Restorative Dentistry & Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, 12211, Cambodia.
- Department of Conservative Dentistry & Endodontics, Saveetha Institute of Medical and Technical Sciences University, Chennai 600077, Tamil Nadu, India.
| | - Azhar Iqbal
- Department of Restorative Dentistry, College of Dentistry, Jouf University, Sakaka, 72345, Saudi Arabia
| | - Jamaluddin Syed
- Oral Basic and Clinical Sciences, Faculty of Dentistry, King Abdulaziz University, p.o box 80209, Jeddah, Saudi Arabia.
| | - Rumesa Batul
- Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kota Bharu, Kelantan, 16150, Malaysia
| | - Abdul Habeeb Adil
- Department of Community Dentistry, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kota Bharu, Kelantan, 16150, Malaysia
| | - Sara Akili Khawaji
- Oral Basic and Clinical Sciences, Faculty of Dentistry, King Abdulaziz University, p.o box 80209, Jeddah, Saudi Arabia
| | - Mohammed Howait
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, p.o box 80209, Jeddah, Saudi Arabia
| | - Osama Khattak
- Department of Restorative Dentistry, College of Dentistry, Jouf University, Sakaka, 72345, Saudi Arabia
| | - Tahir Yusuf Noorani
- Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kota Bharu, Kelantan, 16150, Malaysia
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Buchanan GD, Smit C, Gamieldien MY, ElSheshtawy AS. Resolution of apical periodontitis-induced mental nerve paresthesia through non-surgical endodontic retreatment: a case report. J Endod 2023:S0099-2399(23)00247-9. [PMID: 37182791 DOI: 10.1016/j.joen.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Paresthesia is a potential consequence of unsuccessful root canal treatment. Persistent infection resulting in apical periodontitis may enlarge sufficiently to involve the mental neurovascular bundle. METHODS The case presented in this report was referred for endodontic evaluation with a chief complaint of discomfort on mastication and persistent numbness of the lower left lip. Clinical and radiographic evaluation revealed incomplete primary endodontic treatment of the left mandibular second premolar with complex internal anatomy. The untreated root canal system resulted in the progression of apical periodontitis involving the left mental neurovascular bundle as confirmed by CBCT imaging. RESULTS Non-surgical root canal retreatment was performed over two visits. At the 3-year follow-up visit, the paresthesia had resolved with return of normal sensation. CONCLUSION Non-surgical endodontic retreatment may be sufficient to allow healing of large periapical lesions and resolve complications including paresthesia without the need for surgical intervention.
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Affiliation(s)
- Glynn Dale Buchanan
- Department of Odontology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Chane Smit
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mohamed Yasin Gamieldien
- Department of Maxillofacial and Oral Surgery, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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