Root Canal Morphology of Permanent Mandibular Premolars in Iranian Population: A Systematic Review

Root Canal Morphology of Premolars in Saudis

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.

Mandibular Second Premolar with Four Canals: A Case Report

The mandibular second premolar can be considered one of the most challenging teeth to treat endodontically; due to the complexity of its root canal morphology and increased incidence of multiple canals. The knowledge of internal anatomy of root canals and their possible variations as well as use of magnification, e.g. operating microscope, radiographic examination and illumination, can increase the chances of finding additional canals and contribute to the success of endodontic treatment. The purpose of the current investigation is to report the successful endodontic treatment of a mandibular second premolar with 4 canals; all of them in one single root.

Histopathological Investigation of Dental Pulp Reactions Related to Periodontitis

OBJECTIVE

Since the 1960s, there has been contradictory evidence regarding the association between periodontal pathology and the status of the pulp. The purpose of this study was to evaluate the histopathological changes of pulp tissue with severe periodontal disease, including vertical bone loss involving the major apical foramen, and compared them with the histological pulpal status of teeth with healthy periodontium.

METHODS

This case-controlled study included 35 intact teeth with severe periodontitis of hopeless prognosis (test group) and 35 teeth without periodontitis extracted for orthodontic reasons (control group). For each tooth, periodontal and endodontic parameters such as probing depth and pulpal vitality were recorded, and the pulp tissue was evaluated histologically. The data were analysed with a significance level of 0.05.

RESULTS

Vital pulp was observed in all specimens of both groups (P=1). Pulpal inflammation in the apical portion was observed in 81.71% of the severe periodontitis group, whereas all teeth in the control group demonstrated no signs of pulpal inflammation. Dystrophic calcification and pulp stones were observed in 7.5% of the periodontitis group and 5.7% of the healthy group (P>0.05). Pulp fibrosis was observed in 22.8% of the periodontitis group and 2.8% of the control group (P=0.012). Pulpal necrosis was not noted in either group. In the periodontitis group, internal resorption was present in 22.8% of cases (P=0.005) and external resorption was present in 80% of cases (P<0.001). In the control group, no internal or external resorption was observed in any of the specimens. No differences were noted in the study patients with regard to sex or age.

CONCLUSION

Periodontal disease does not significantly affect pulp vitality and pulpal calcifications. However internal and/or external resorption was significantly different between the two groups as well as apical inflammation and pulp fibrosis.

Morphological variations of mandibular first premolar on cone-beam computed tomography in a Saudi Arabian sub-population

In-depth knowledge of common and aberrant pulp morphology is essential for appropriate diagnosis and treatment planning prior to commencing root canal treatment. Radicular morphology of mandibular premolars has been extensively studied. Considerable variation in the number of canals and roots found in these teeth has been reported.

Aim

The purpose of this study is to investigate the root and root canal morphology of mandibular first premolar among Saudi Arabian subpopulation in Aseer using CBCT.

Methods

Cone-beam computed tomography images of Mandibular first premolar were taken from 166 patients which were referred to Armed Forces Hospitals Southern Region (AFHSR), Khamis Mushayt, Asir region Saudi Arabia. All the images were assessed by two Evaluators (An Endodontist and a Radiologist). Inter-examiner reliability was determined and was assessed by KAPPA value.

Results

The mandibular first premolar (n = 216) distributed as 120 teeth in female and 96 teeth in male. Out of the 120 teeth examined in female groups one canal was seen in 95 (79.2%) teeth, two canals in 19 (15.8%) teeth and three canals in 6 (5%) teeth where as in the Male group out of 96 teeth, 52 (54.1%) teeth showed one canal, 32 (33.3%) teeth with two canals whereas 12 (12.5%) teeth showed presence of three canals.

Chi-Square test for mandibular first premolars demonstrated the chance of second canal in the mandibular first premolar more in male than female and these differences was statistically significant (P ≤ 0.05).

Conclusion

Endodontic therapy of mandibular premolars is a challenge for clinician because of their frequent morphological and anatomical abnormalities. Proper knowledge about number of root canals and canal configuration is a key to success in Endodontic. There is a great variability in different population regarding the root canal configuration in mandibular pre-molars. However, most studies state the mandibular first premolar has one root canal. Also, the most prevalent type of root canal found was Type I vertucci.

Endodontic Treatment of Bilateral Mandibular First Premolars with Three Root Canals: A Report of Two Cases

Correct diagnosis of root canal anatomy is very important to ensure successful root canal treatment. Mandibular first premolars with three separate root canals are very rare. Consequently, they often require specific shaping and obturating techniques. This report describes the diagnosis and non-surgical treatment(s) of bilateral mandibular first premolars with three separate root canals.

Endodontic Treatment of C-shaped Mandibular Premolars: A Case Report and Review of Literature

Our article aimed to present a curious case of a mandibular premolar with a C-shaped root canal and to review the available literature on this anatomical variation. Mandibular premolar teeth account for the greatest endodontic challenges in the course of treatment on account of the morphological variations in their root canal systems, including extra root(s)/canal(s) or a C-shaped configuration. A 20-year-old female patient was referred to the Department of Endodontics of Mashhad Faculty of Dentistry, suffering from abscess, and pain while chewing. On examination the culprit was found to be the left mandibular first premolar. Following special tests and periapical radiography, we found an amalgam restoration proximate to the non-vital pulp chamber, as well as an unusually complex root canal anatomy with periapical radiolucency. A non-surgical root canal treatment with the aid of a dental operating microscope was considered as the treatment plan. Clinicians should always anticipate the presence of a C-shaped configuration in mandibular premolars, and make use of all the available tools to locate and treat such cases. A substantial knowledge of root canal anatomy would be prudent to ensure a successful outcome ensuing surgical and non-surgical root canal treatments.

Prevalence and morphology of multiple roots, root canals and C-shaped canals in mandibular premolars from cone-beam computed tomography images in a Thai population

Background/purpose

Variations in root and root canal morphology of mandibular premolars of Thais has not been reported, and understanding these variations enhances endodontic success. The purpose was to investigate prevalence and morphology of multiple roots, root canals and C-shaped canals in mandibular premolars in a Thai population from cone-bean computed tomography (CBCT) images.

Materials and methods

A total of 349 first mandibular premolars and 416 second premolars from CBCT images with 0.125-mm voxel size and 60 × 60 mm field of view were evaluated. Number of roots, root canals, and C-shaped canals were recorded and statistically analyzed using chi-square test. Root canal configurations were defined according to the Vertucci's classification. Levels and distances of separated multiple canals were reported.

Results

Multiple roots in mandibular first premolars were found at 5.73% while none of second premolars had. Multiple root canals were found in the first premolars at 19.48% and the second premolars at 3.85%. C-shaped canals (C1/C2) were found in the first premolars at 3.72% and the second premolars at 0.48%. All parameters in the first premolars were significantly higher than in the second premolars (p < 0.01). The majority of multiple root canals were defined as Vertucci's type V (1–2 canals). Multiple root canals were frequently separated at the middle level of roots about 6.5–7.0 mm from the cementoenamel junction.

Conclusion

Prevalence of multiple roots/root canals and C-shaped canals in mandibular first premolars were significantly higher than in mandibular second premolars. Level of separation in multiple root canals was frequently at the mid-root level.

The effects of pressure in vitro on three methods of root canal obturation

INTRODUCTION

The seal of root canal fillings depends on the anatomy of the root canal system and on the properties of filling materials and their bond to the walls of the root canal. Alterations in pressure may influence these properties. The current study investigated and compared microleakage in a tapered single-cone method versus lateral and vertical condensation after diving simulation.

METHODS

One hundred and thirty five extracted single-rooted teeth were used. Following instrumentation and irrigation to #30.06 Mtwo rotary system, obturations were performed in three groups of 45 teeth: Group 1, tapered single-cone with Endoseal MTA sealer; Group 2, lateral condensation with AH26 sealer; Group 3, vertical condensation with AH26 sealer. Then all specimens were divided into three groups and incubated at ambient room pressure (101.3 kPa), 203 kPa or 304 kPa for 120 minutes respectively 20 times over one month to simulate diving conditions. Microleakage quantitative analysis was recorded by using a 2% Methylene blue dye for 24 hours.

RESULTS

The amounts of microleakage increased with increasing pressure in all obturation groups; however, the differences were not statistically significant (P > 0.05). At all three pressures, the least microleakage was recorded in Group 3, vertical condensation. Although the differences between vertical condensation, lateral condensation, and tapered single-cone methods were statistically significant (P < 0.001), the vertical condensation and lateral condensation groups did not differ from each other (P > 0.05).

CONCLUSIONS

Vertical condensation may be the best technique, based on sealing ability, for people who frequently experience pressure alterations.

Endodontic Treatment of a Mandibular Second Premolar with Type XVII Sert and Bayirli's Canal Anatomy

For a successful root canal treatment, it is critical for the clinician to have a complete knowledge of the root canal morphology, interprets radiographs critically and properly assesses the pulp chamber floor. Anatomical variations are critical in diagnosis and a successful treatment outcome in endodontics. Knowledge of root canal morphology and anomalies is essential to succeed in root canal therapy. Mandibular premolars are famous for their atypical morphology. But the occurrence of type XVII Sert and Bayirli's root canal type is very rare in them. The purpose of this case report is to present treatment of a seldom root canal system in a mandibular second premolar. Reports of unusual cases cause clinicians to do an accurate clinical examination and radiographic interpretation and consider atypical root canal configurations.

Influence of Two Preparation Techniques on Transportation of Simulated Type II Root Canals

Introduction:

The purpose of this study was to evaluate the changes of canal configuration in simulated type II root canals that were instrumented by two different techniques using ProTaper Universal rotary files.

Methods and Materials:

Sixty simulated type II root canal in resin blocks were made and randomly divided into two groups. Pre and post-instrumentation images of resin blocks were prepared using stereomicroscope from three surfaces of blocks included two longitudinal section (mesiodistally and buccolingually), and one cross sectional surface. In the first group (G1) the straight canal was instrumented to the working length and the other canal was instrumented up to the area of canals junction. In second group (G2) both canals were instrumented to working length. The superimposed pre and post instrumentation images were assessed by the Adobe Photoshop software. The degree of transportation, centering ability, perimeter, surface and aspetic ratio (AR) in cross section and longitudinal section at apex, 3 mm and 5 mm above the apex, were measured. SPSS software, t-test and Mann-Whitney test were used for statistics analysis.

Result:

In mesiodistal direction, canal transportation was more (P=0.024) only in junction point in G2 which both canals were instrumented to working length. Also, surface changes were more significant (P=0.02) in G2 in cross sectional direction. The other parameter and also apical transportation had not significant difference in two groups.

Conclusion:

According to the results of this study, it can be concluded that both two preparation methods of type II canals can be used by rotary instruments.

Evaluation of Root Canal Morphology of Mandibular First and Second Premolars Using Cone Beam Computed Tomography in a Defined Group of Dental Patients in Iran

BACKGROUND

Successful dental root canal treatments require a complete knowledge of dental anatomy and root canal morphology.

MATERIALS AND METHODS

One hundred and forty-five cone beam computed tomography (CBCT) images were used to assess the anatomy and morphology of mandibular premolars based on Vertucci's classifications in a defined group of dental patients in Iran. The number of roots and root canals, root canal morphology, root and canal shape (curvature), existence of C-shaped canal, and influence of sex on each of these were evaluated. A chi-squared test was used for statistical analysis.

RESULTS

The mandibular first and second premolars had a single root in 95.97% and 100% cases, respectively. In the mandibular first premolars, 62.2% were of type I, 0.8% type II, 10.9% type III, 0.8% type IV, 20.3% type V, 4.2% type VI, and 0.8% type VII; in the second premolars, 78% of canals were of type I, 3% type II, 11% type III, 7% type V, and 1% type VI. C-shaped canals did not exist in either of the premolars. The most prevalent root and canal shape was straight. The most prevalent root curvature was a distal curvature in both premolars (71.4% and 74% of first and second premolars, resp.). The most prevalent canal curvature was lingual and buccal for the first premolars (7.6% each) and distal for the second premolars (11%). No significant difference was found between men and women in nearly all of the above (P > 0.05).

CONCLUSION

The results suggest that there is a need to conduct further evaluations on finding root and canal variations among more populations to gain better knowledge prior to root canal treatment.

Canal Configuration of Mesiobuccal Roots in Permanent Maxillary First Molars in Iranian Population: A Systematic Review

OBJECTIVES

It is essential for clinicians to have adequate knowledge about root canal configurations; although its morphology varies largely in different ethnicities and even in different individuals with the same ethnic background. The current study aims to review the root canal configurations of mesiobuccal roots of maxillary first molars in an Iranian population based on different epidemiological studies.

MATERIALS AND METHODS

A comprehensive search was conducted to retrieve articles related to root canal configuration and prevalence of each type of root canal based on Vertucci's classification for the mesiobuccal root of maxillary first molars. An electronic search was conducted in Medline, Scopus and Google Scholar from January 1984 to September 2015. The articles were evaluated and methods, population, number of teeth and percentage of each root canal type evaluated in each study were summarized in the data table. Websites such as http://www.magiran.com/ , http://health.barakatkns.com/journal-internal-list and www.sid.ir were used to search all related studies published in Persian.

RESULTS

Totally, out of nine studies conducted on the Iranian populations in nine provinces of Iran and 798 teeth, the Vertucci's type I was the most common type (35.70%), followed by type II (30.37%), type IV (16.66%), type III (7.93%) and type V (2.61%).

CONCLUSIONS

From this review article, it is concluded that the root canal morphology of mesiobuccal roots of maxillary first molars in the Iranian population predominantly has more than one canal. Therefore, careful evaluation of radiographs and anatomy of the pulp chamber is essential in order to achieve a successful root canal therapy.