Accuracy of CBCT, Digital Radiography and Cross-Sectioning for the Evaluation of Mandibular Incisor Root Canals

Distolingual root prevalence in mandibular first molar and complex root canal morphology in incisors: a CBCT analysis in Indian population

Cone-beam computed tomography was used to understand the possible correlation between the prevalence of distolingual root (DLR) in permanent mandibular first molars (MFMs) and the associated complicated mandibular incisor's root canal morphology (MIs) in an Indian population. A total of 400 scans were evaluated for MFMs and MIs. The prevalence of DLRs and root canal anatomy of MIs were assessed based on Vertucci's classification, and then the sample were grouped according to age, sex and side. Statistical analysis was used to evaluate the possible correlation between the presence of DLRs in the first molar and root canal morphology of incisors. Chi square test was used to evaluate the correlation between the root canal configurations of MIs with the existence of DLRs in MFMs. There was no statistically significant difference between sexes or ages for the prevalence of DLRs in the first molars (p > 0.05), which was 6.62%, with the right side having a greater frequency of DLRs (7.8%) than the left (5.5%). Vertucci Type I canal configuration was most common for the mandibular central (66.75%) and lateral incisors (58.62%). Vertucci Type III was the most common complicated canal morphology, followed by Types V, II, and IV for MIs, with no statistically significant difference in the studied sample's age and sex. (p < 0.05). No association was observed between the presence of DLRs in first molars and complicated root canal configurations in MIs. Taken together, the possibility of complicated root canal configuration in MIs was lesser in the presence of DLRs in MFMs among the Indian population.

Root canal anatomy of human permanent mandibular incisors and mandibular canines: A systematic review

Mandibular incisors and canines show variations in their root canal anatomy. It is imperative to be aware of these variations to lower the frequency of missed canals. The objective was to systematically review the existing studies to recognize the root and root canal anatomy of the mandibular incisors and canines among the population of various geographical locations, as studied by different methods. This systematic review was registered in the International Prospective Register of Systematic Reviews database under the number CRD42020185146. An exhaustive search was undertaken in three electronic databases - MEDLINE PubMed, EBSCOhost, and Google Scholar - along with hand-searching for the identification of studies. Studies were selected following strict inclusion and exclusion criteria. Selected studies were scored using the Joanna Briggs Institute Critical Appraisal tool for prevalence studies to determine the risk of bias. This review included data from 26 countries including the analysis of 71,404 mandibular anterior teeth. The risk of bias of all included studies was either low or moderate. Overall, it was seen that the percentage of second canals was higher in lateral than in central incisors. Mandibular canines occasionally showed the presence of two roots. Deviations in anatomy were high in the Middle Eastern European countries and the Indian subcontinent. Limitations are as follows: lack of homogeneity across data reported in the studies concerning the methods used to study the root canal anatomy. Diversities seen in the root canal configurations of mandibular incisors and canines vary according to ethnicity, and thus, one must have a thorough knowledge before commencing endodontic treatment.

Assessment of root canal morphology of mandibular permanent anterior teeth in an Iraqi subpopulation by cone-beam computed tomography

Background/purpose

Endodontic treatment is basically dependent on knowledge of the root canal anatomy. This study aimed to analyze the root canal configuration of mandibular anterior teeth in an Iraqi subpopulation using cone-beam computed tomography (CBCT) imaging.

Materials and methods

A total of 305 CBCT scans involving 1794 mandibular permanent anterior teeth were evaluated. The number of roots, root canals, root canal system configuration according to Vertucci classification, and bilateral symmetry in root number and root canal number were recorded and statistically analyzed. The effects of gender and age on the incidence of root canal morphology and root canal number were investigated. Chi-square test was used to determine the level of significance (p < 0.05) and Kappa value was used to check reliability of results of the research.

Results

Among the study patients, double root canals were found in (right 26.1% and left 26.4%) mandibular central incisors, in lateral incisors (right 28% and left 30.4%) and canines (right 11.7% and left 11%). Most teeth (77.8%) had a Type I Vertucci configuration and Type V was the least common and only present in canines (0.8%). All examined incisors presented with only one root and only around 2% of canines had two roots. Gender differences were identified for central incisors, while for lateral incisors and canines there were none. Patients older than 60 years had fewer teeth with double root canals (p < 0.05). Slight bilateral asymmetries appeared in central, lateral incisors, and canines in relation to root and root canal numbers.

Conclusion

Single rooted with Type I canal configuration is the most prevalent in mandibular anterior teeth in the Iraqi subpopulation. However, the incidence of more than one root canal with different canal configurations is also detected.

To assess the occurrence of middle mesial canal using cone-beam computed tomography and dental operating microscope: An in vitro study

Introduction

Failures of root canal treatments are mainly attributed to missed canals and ignorance about the complex anatomy of the root canal system. One such example of anatomic variation is the middle mesial canal (MMC) in mandibular molars which is often missed, and literature on methods for identifying them is limited.

Aim

This in vitro study aimed to assess the occurrence of MMCs with cone-beam computed tomography (CBCT) and then under magnification in the mandibular first and second molars.

Materials and Methodology

A total of 120 extracted intact human permanent mandibular first and second molars were selected. These were subjected to CBCT imaging and magnification for the detection of MMCs. The percentage of incidence in the detection of MMC was compared between these two methods.

Results

The incidence of MMC detected in mandibular molars using CBCT was 13.33% (16 of 120 teeth), while using a dental operating microscope, the incidence was 18.33% (22 of 120 teeth) and the comparison between the two methods was statistically not significant. The MMCs were classified based on the Pomeranz Classification. The most prevalent canal configuration was a confluent type which was found to be in 72% cases (16 of 22), followed by fin type which was 22.7% (5 of 22) and independent type was only 4.54% (1 of 22). The incidence of the location of MMC orifice was studied. In 50% of the cases, orifice was located closer to the mesiolingual canal, whereas in 27% of the cases, it was closer to the mesiobuccal canal and in 4.95% of the cases, it was detected midway.

Conclusions

Since the incidence of MMC was higher with the use of a microscope, it is preferred to use simpler, chairside aids like magnification and ultrasonic troughing. On the other hand, one should be judicious while subjecting a case to preoperative CBCT evaluation owing to its ionizing radiation.

Second Mesiobuccal Canal Evaluation Features with Cone-Beam Computed Tomography

Aim

The aim of the study is to evaluate the difference in MB2 prevalence with different slice thicknesses in maxillary first molars.

Materials and Methods

Two hundred nonfilled MB2 canals in maxillary first molars of 156 people (75 females and 81 males) aged from 20 to 73 years old were evaluated with CBCT with different slice thicknesses: 0.5 mm, 1 mm, 3 mm, and 10 mm. A general analysis was performed out, as well as in the age groups and on gender groups.

Results

Visualization with 0.5 mm and 1 mm slice thicknesses was 100% and generally equal, in both the male and the female group. General MB2 visualization with 3 mm slice thickness was 42% and 29% for the male group and 27% for the female group. No canals were visualized with 10 mm slice thickness. The study did not demonstrate a statistical difference in the MB2 prevalence between gender and age groups with the 3 mm slice thickness.

Conclusion

The most valuable way to evaluate the root canal system in first maxillary molars with CBCT is using 1 mm slice thickness for both genders and every age group.

Diagnostic Yield of Dental Radiography and Cone-Beam Computed Tomography for the Identification of Anatomic Structures in Cats

The objective of this study was to evaluate the diagnostic yield of dental radiography (DR) and 3 cone-beam computed tomography (CBCT) methods for the identification of predefined anatomic structures in cats. For 5 feline cadaver heads and 22 client-owned cats admitted for evaluation and treatment of dental disease, a total of 22 predefined anatomic structures were evaluated separately by use of the DR method and 3 CBCT software modules [multiplanar reconstructions (MPR), tridimensional (3-D) rendering, and reconstructed panoramic views (Pano)]. A semi quantitative scoring system was used, and mean scores were calculated for each anatomic structure and imaging method. The Friedman test was used to evaluate values for significant differences in diagnostic yield. For values that were significant the Wilcoxon signed rank test was used with the Bonferroni-Holm multiple comparison adjustment to determine significant differences among each of the possible pairs of diagnostic methods. Differences of diagnostic yield among the DR and 3 CBCT methods were significant for 17 of 22 anatomic structures. For these structures, DR scores were significantly higher than scores for Pano views for 2 of 17 structures, but DR scores were significantly lower than scores for Pano views for 6 anatomic structures, tridimensional rendering for 10 anatomic structures, and MPR for 17 anatomic structures. In conclusion, it was found that CBCT methods were better suited than DR for the identification of anatomic structures in cats. Results of this study can serve as a basis for CBCT evaluation of dentoalveolar and other maxillofacial bony lesions in cats.

The Diagnostic Yield of Dental Radiography and Cone-Beam Computed Tomography for the Identification of Dentoalveolar Lesions in Cats

The objective of this study was to evaluate the diagnostic yield of dental radiography (DR) and 3 cone-beam computed tomography (CBCT) software modules for the identification of 32 pre-defined dentoalveolar lesions in cats. For 5 feline cadaver heads and 22 client-owned cats admitted for evaluation and treatment of dental disease, 32 predefined dentoalveolar lesions were evaluated separately and scored by use of dental radiography and 3 CBCT software modules [multiplanar reconstructions (MPR), tridimensional (3-D) rendering, and reconstructed panoramic views]. A qualitative scoring system was used. Dentoalveolar lesions were grouped into 14 categories for statistical analysis. Point of reference for presence or absence of a dentoalveolar lesion was determined as the method that could be used to clearly identify the disorder as being present. Accuracy, sensitivity, specificity, and positive and negative predictive values were calculated with the McNemar χ² test of marginal homogeneity of paired data. When all 3 CBCT software modules were used in combination, the diagnostic yield of CBCT was significantly higher than that of dental radiography for 4 of 14 categories (missing teeth, horizontal bone loss, loss of tooth integrity, feline resorptive lesions), and higher, although not significantly so, for 9 categories (supernumerary teeth, supernumerary roots, abnormally shaped roots, vertical bone loss, buccal bone expansion, periapical disease, inflammatory root resorption, and external replacement root resorption). In conclusion, we found that CBCT provided more clinically relevant detailed information as compared to dental radiography. Therefore, CBCT should be considered better suited for use in diagnosing dentoalveolar lesions in cats.