Application of a new system for classifying root canal morphology in undergraduate teaching and clinical practice: a national survey in Malaysia

Influence of the incorporation of small-group practical seminars to a traditional lecture for the understanding of root canal morphology classification systems

INTRODUCTION

This study aimed to assess if the incorporation of small-group practical seminars into a traditional lecture format improved the understanding and learning of the root canal classification systems in undergraduate students.

MATERIALS AND METHODS

A small-group practical seminar was designed for 3rd year undergraduate students. The seminar consisted of the analysis of a guided summary of root canal morphology classifications, a participative discussion of several cases and drawing exercises of several internal anatomies based on the different classifications in templates presenting the external anatomy of different dental groups. Students were inquired about their perspectives on the different classifications and the learning strategies with an anonymous questionnaire. The knowledge acquired was assessed in an exam. The scores obtained were compared using the Mann-Whitney U-test with those obtained in the cohort of the previous year in which only the traditional lecture was delivered.

RESULTS

Students' scores (mean = 7.7; SD = 2.5) were significantly higher (p = .006) than those from the previous cohort (mean = 6.9; SD = 2.3). Most students agreed that Ahmed's classification system was the most complete (98.8%) and intuitive (84%), but also the most difficult to understand (67%). All the students believed that the learning activity helped them understand the new classification system.

CONCLUSION

The incorporation of small-group practical seminars into traditional lecture improved the understanding and learning of root canal configurations in undergraduate students. Students rated the classification system suggested by Ahmed et al. as the most complete and intuitive out of the three systems, but also the most difficult to learn.

Root canal morphology of anterior permanent teeth in Jordanian population using two classification systems: a cone-beam computed tomography study

BACKGROUND

Adequate knowledge of root canal morphology and its variation is essential for success of root canal treatment and to overcome treatemnt failure. The aim of this study was to investigate the root and canal morphology of mandibular anterior teeth using 2 classification systems.

METHODS

3342 lower anteriors were evaluated from 557 CBCT scans. The images were examined in sagittal, axial and coronal views using a CS 3D imaging software (V3.10.4, Carestream Dental). Demographic data recorded, the number of roots and canal's morphology were described according to Vertucci and Ahmed classifications.

RESULTS

Frequency of Type I configuration was significantly the highest in incisors and canines (76%, N = 2539), followed by Type III (20.6%, N = 687). Type II (1.1%, N = 37), IV (1.1%, N = 37), and V (0.3%, N = 11) were rarely encountered. 0.9% (N = 31) of the teeth could not be classified with the Vertucci System. The frequency of 2 roots (2MA in Ahmed classification) which has no correspondence in the Vertucci classification, was 1.1% (N = 38), it was significantly higher in canines and in females (35 canines and 3 laterals). A moderate correlation in root canal morpology was found between the left and right sides (V > 0.30). 80% (N = 2538) of the teeth did not exhibit any divergence/merging. The bifurcation level occurred mostly in the middle third of the root.

CONCLUSIONS

One fourth of anterior teeth had variation from the simple type I canal configuration and therefore requires attention during treatment. The new classification system offers a more accurate and simplified presentation of canal morphology.

CLINICAL RELEVANCE

The prevalence and mid root bifurcation of second canal in lower anteriors requires attention to ensure adequate quality root canal treatment without compromising the integrity of teeth.

A New Methodology to Determine the Orifice for Root Canal Configurations in First Permanent Molar Root and Canal Morphologies Using Micro-Computed Tomography

BACKGROUND

The distinction between where the pulp chamber ends and the root canal system begins is poorly defined within the existing literature.

METHODS

This paper aimed to describe a range of accurate methods to define the transition from pulp chamber to root canal in different first molar root morphologies using micro-focus computed tomography (micro-CT).

METHODS

The sample consisted of 86 mandibular and 101 maxillary first molars from the skeletal collections housed in the Department of Anatomy and Histology of the Sefako Makgatho Health Sciences University and the Pretoria Bone Collection. A stepwise approach using the cemento-enamel junction (CEJ) and dedicated landmarks was followed to create an automated cross-sectional slice.

RESULTS

Transition from pulp chamber to root canal could be accurately determined on maxillary and mandibular teeth. The occurrence of two separate roots in mandibular molars was 97.7%, with the remaining 2.3% having an additional disto-lingual root, with no mandibular molars displaying fused roots. In the maxillary molars, 92.1% had three separate roots and 7.9% displayed root fusion. Within this group, one tooth displayed a C-shaped root canal configuration and one a mesotaurodont-type morphology.

CONCLUSION

The suggested methodology to determine orifice location was found to be appropriate in all morphological types.

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

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

Parallel endodontic education via social media: An exploratory survey study

There is insufficient research to evaluate social media's influence on endodontic education. Therefore, this study assessed the percentage of students utilising Facebook in their education and the factors influencing their engagement. A survey was conducted on dental students, interns and dentists undertaking specialist programmes. Categorical data were analysed using Fisher's Exact test and multiple pairwise comparisons. The significance level was set at p < 0.05. Responses were received from 801 participants, with 98.4% using Facebook for endodontic knowledge. Although most students knew that scientific evidence is not always provided, they still deemed such information valuable as it was a practical demonstration of clinical cases. Most students turn to Facebook for endodontic education to compensate for the gap between their academic education and clinical practice. The utilisation of social media for education can be a concerning phenomenon and should not be ignored by academic institutes.

A microcomputed tomographic analysis of the morphological variabilities and incidence of extra canals in mandibular first molar teeth in an Egyptian subpopulation

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.

Evaluation of root and canal morphology of mandibular premolar amongst Saudi subpopulation using the new system of classification: a CBCT study

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.

Root Morphology and Canal Configuration of Permanent Canines Among Saudi Population: Systematic Review and Comparison with Worldwide Studies

Aim

The root morphology and canal configuration (RMCC) of mandibular and maxillary canines among Saudi population is systematically reviewed and compared with international studies in this research.

Methods

This study was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The electronic databases of PubMed, Science Direct, Scopus, Wiley Library, Google website search, and Web of Science were searched. Only local and international cross-sectional, comparative, evaluation, and validation studies or case reports published between 2016 and 2022 that directly evaluated canine RMCC and assessed participants using cone beam computed tomography were included.

Results

Forty-three studies that investigated RMCCs (17 local and 26 international) were involved in this review. The original Saudi research recorded that almost 100% of maxillary canines had one root and one canal, whereas 98.4% and 94.1% had one root and one canal in the mandibular arch. Vertucci’s class I had the highest percentages in the maxillary and mandibular arches at 98.3% and 95.8%, respectively, followed by class III with 0.7% and 1.9% for the same arches, respectively. International studies recorded that 100% of maxillary canines had one canal and root; the percentages of the mandibular arch were 92.3 and 98% for single canal and root, respectively; and the highest percentage was obtained by Vertucci’s class I (91.1%), followed by class III (4.7%).

Conclusion

This review reports and confirmed the symmetry of the RMCCs of maxillary and mandibular canines between Saudi studies and other populations. Moreover, Vertucci’s classes I and III were the most frequent RMCCs, and two-rooted canines in both arches were considerably less frequently than single-rooted ones.

Application of a new system for classifying root and canal anatomy in studies involving micro-computed tomography and cone beam computed tomography: Explanation and elaboration

Adequate knowledge and accurate characterization of root and canal anatomy is an essential prerequisite for successful root canal treatment and endodontic surgery. Over the years, an ever-increasing body of knowledge related to root and canal anatomy of the human dentition has accumulated. To correct deficiencies in existing systems, a new coding system for classifying root and canal morphology, accessory canals and anomalies has been introduced. In recent years, micro-computed tomography (micro-CT) and cone beam computed tomography (CBCT) have been used extensively to study the details of root and canal anatomy in extracted teeth and within clinical settings. This review aims to discuss the application of the new coding system in studies using micro-CT and CBCT, provide a detailed guide for appropriate characterization of root and canal anatomy and to discuss several controversial issues that may appear as potential limitations for proper characterization of roots and canals.

Root and Root Canal Morphology Classification Systems

Introduction

While there are many root morphology classification systems with their own distinct advantages, there are many shortcomings that come along with each system.

Objectives

The aim of this review was to compare the various root and root canal morphology classifications, their advantages, limitations, and clinical and research implications. Data Sources and Selection. An extensive literature search was conducted on PubMed and Scopus to identify the published data on root and root canal classification systems published until 1 May 2020 using keywords, root canal classification system, classification systems for root canals, and root morphology. The related literature was reviewed and then summarized. Data Synthesis. Several studies have analysed and detailed root and root canal classifications and further added new subsystems, works of Weine et al. (1969) and Vertucci et al. (1974). Besides, Sert and Bayirli (2004) added supplementary types to Vertucci's classification system. A new classification was most recently introduced by Ahmed et al. (2017) involving the use of codes for tooth numbering, number of roots, and canal configuration.

Conclusions

Weine et al. classified only single-rooted teeth, without considering multirooted teeth and complex configurations. Vertucci's classification included complex configurations, with Sert and Bayirli adding further complex supplemental types. Ahmed et al.'s classification simplifies classifying root and canal morphology while overcoming the limitations of several previous classification systems making it beneficial for implementation in dental schools.