CBCT evaluation of root canal morphology and anatomical relationship of root of maxillary second premolar to maxillary sinus in a western Chinese population

A retrospective study of initial root canal treatment failure in maxillary premolars via using cone-beam computed tomography

BACKGROUND

This case-series study examined canal morphology and common factors for endodontic failure in maxillary first and second premolars that were referred for retreatment owing to clinical symptoms or radiographic signs.

METHODS

Records were retrospectively searched using Current Dental Terminology codes to identify maxillary first and second premolars with endodontic failure. Periapical and cone-beam computed tomographic images were examined to determine Vertucci classifications and suspected factors related to treatment failure.

RESULTS

A total of 235 teeth from 213 patients were included for evaluation. The following Vertucci classification of canal configurations were observed for maxillary first and second premolars: type I (1-1) (4.6% and 32.0%, respectively), type II (2-1) (15.9% and 27.9%, respectively), type III (2-2) (76.1% and 36.1%, respectively), type IV (1-2) (0% and 2%, respectively), and type V (3) (3.4% and 2%, respectively). More treatment failures were noticed in maxillary second premolars than first premolars and in females than in males. The 4 most common factors related to failure were inadequate filling, restorative failure, vertical root fracture, and missed canals. Missed canals were more frequently identified in maxillary second premolars (21.8%) than first premolars (11.4%) (P = .044).

CONCLUSIONS

Multiple factors are associated with primary root canal treatment failures in maxillary premolars. Variations in canal morphology appear to be underappreciated in maxillary second premolars.

PRACTICAL IMPLICATIONS

Maxillary second premolars have more complicated canal configurations than first premolars. Besides adequate filling, clinicians should give extra attention to anatomic variability in second premolars owing to higher failure incidence.

Morphological analysis of anterior permanent dentition in a Chinese population using cone-beam computed tomography

PURPOSE

Morphological analysis of permanent anterior dentition is essential for achieving an ideal treatment outcome and avoiding unnecessary failure. This study aimed to analyze the morphologies of anterior teeth in the Chinese population in depth.

METHODS

In this retrospective study, 4309 anterior teeth from 401 Chinese patients were investigated using cone-beam computed tomography (CBCT) from 2019-2021. We summarized the morphological characteristics of the anterior teeth in terms of the root length, cementoenamel junction curvature (CEJ-C), root furcation and canal variations.

RESULTS

We found that the root lengths of the maxillary anterior incisors were similar (13.3 mm), while the root lengths of the mandibular central (12.2 mm) and lateral incisors (13.4 mm) varied significantly (p < .0001). Both the maxillary (16.6 mm) and mandibular canines (15.5 mm) were found to have greater root lengths than the corresponding incisors (p < .0001). The CEJ-C was significantly greater around incisors (2.5 mm) than around the canines (2.0 mm) in the maxilla (p < .0001), while the curvature remained similar in mandibular anterior teeth (1.8 mm). Root furcation was observed in mandibular canines and lateral incisors. Moreover, all types of Vertucci's classification in anterior dentitions were observed, while two other new types were found. Among them, the maxilla was only observed to exhibit types I, II, III, and ST II, while the mandible was found to exhibit almost all types. However, Type I still accounts for the majority of dentitions.

CONCLUSIONS

Morphological analysis of permanent anterior dentition revealed diversity in the tooth length, CEJ-C, furcation proportion, and canal variations. In general, mandibular anterior teeth showed a more complex structure than maxillary teeth.

Evaluation of Root Canal Morphology of Maxillary Second Premolars and Its Relation to Maxillary Sinus in a Saudi Arabian Population

AIM

This study aimed to evaluate the root canal anatomy of maxillary second premolars, and its relation to the maxillary sinus in a Saudi Arabian population using cone-beam computed tomography.

MATERIALS AND METHODS

Records of 301 patients (602 Teeth) were obtained from a Cone-beam Computed Tomography Database of the College of Dentistry, Jazan University from February 2020 to January 2022. The number of roots, root canals, and the relationship between the root apices of maxillary second premolars and the floor of the maxillary sinuses were studied. The data was recorded, tabulated, and statistically analyzed.

RESULTS

A majority of maxillary second premolars were single-rooted (78.74%), followed by double-rooted (20.76%) and three-rooted (0.5%). Two canals (59.1%) were seen in the majority of the examined teeth, followed by one canal (40.4%) and three canals (0.5%). The roots of the maxillary second premolars were predominantly (69.17%) outside the sinus. Nineteen percent of roots were in contact with the floor of the maxillary sinus with no significant difference between buccal and palatal roots, and around twelve percent (11.73%) of roots were inside the maxillary sinus.

CONCLUSIONS

The root canal system morphology of maxillary second premolars showed a wide range of anatomical variations in the Saudi Arabian population with a predominance of single roots. Most of the roots were located outside the sinus followed by in contact and then inside the sinus. Three-rooted second premolars were exceedingly rare.

CLINICAL SIGNIFICANCE

The cognizance of maxillary second premolar root canal anatomy and its relation to maxillary sinus would be a valuable affirmation for dentists of different nationalities treating the Saudi Arabian population to ensure a successful endodontic treatment.

The morphology of the pulp chamber floor of permanent mandibular first and second molars in an Indian subpopulation-a descriptive cross-sectional study employing Pawar and Singh classification

Background

Mandibular molars are multi-rooted teeth with a complex and strenuous root canal anatomy. Because there is relatively negligible literature describing the pulp chamber floor anatomy, predicting the exact anatomical layout and its variations is daunting. A thorough comprehension and knowledge of the same is required for efficacious endodontic treatment consequence. The purpose of this study was to characterise and ascertain the pulp chamber floor anatomy of permanent mandibular first (ManFMs) and second (ManSMs) molars in an Indian population.

Methods

On 2,134 extracted human mandibular first (ManFMs = 1,067) and second molars (ManSMs = 1,067), a descriptive cross-sectional investigation was executed. Cleaning and removal of hard and soft tissue debris were performed, followed by flattening the anatomical crown until the pupal architecture was uncovered. A stereomicroscope with a magnification of 4.5 magnification was used to investigate the pulpal anatomy. Statistical analysis was carried out using chi square test, with 95% confidence intervals and a p value of 0.05 considered statistically significant.

Results

The majority of the ManFMs showed presence of three canal orifices in 57.73%, followed by four orifices 31.31%, five orifices 8.81%, and six orifices 2.15%. For ManSMs, majorly three orifices were found in 39.83% specimens, followed by two orifices in 37.39%, four orifices in 16.31%, and single root canal orifice was observed in 6.47%. The mesio-buccal, mesio-lingual, disto-buccal, disto-lingual canal orifices exhibited round and oval shapes in both ManFMs and ManSMs. The shape was predominantly oval with a single distal canal orifice (84.25% ManFMs and 74.16% ManSMs). In ManSMs, among the single root canal orifice, 66.66% were round in shape and 33.34% were C-shaped. In ManSMs with two root canal orifices, mesially 79.44% exhibited oval and 20.56% round shape. Distally, 74.16% were oval and 25.84% were round. The shapes of the access cavities for ManFMs were rectangular in 46.67% and triangular in 53.33%. For the ManSMs, the access cavities were triangular in 39.83%, rectangular in 16.31% and non-classified (others) in 43.86% of specimen. In both ManFMs and ManSMs, the pulp chamber floor morphology was predominately Y shaped (57.73% and 39.83%) according to the Pawar and Singh classification© of pulp chamber floor anatomy.

Conclusion

Our study indicated that the orifices on the pulp chamber floor are arranged in a typical manner, supporting the proposed categorization. Furthermore, description of the anatomical patterns of the pulp chamber guides the clinicians in chair-side treatment decisions.