Unusual imaging appearance of cemental tear in the maxillary first molar on cone-beam computed tomography: A case report

A cemental tear (CeT) is a definitive clinical entity and its radiographic appearance is well known in single-rooted teeth. However, the imaging features of CeT in multi-rooted teeth have not been clarified. We report a case of CeT which arose in the maxillary first molar and exhibited an unusual appearance in cone-beam computed tomography images. The torn structure was verified as cementum by micro-computed tomography and histological analysis. The hypercementosis, most likely induced by occlusal force, might have been torn from the root by a stronger occlusal force caused by the mandibular implant. An unusual bridging structure was created between the two buccal roots. These features may occur in multi-rooted teeth with long-standing deep pockets and abscesses that are resistant to treatment.

Complete idiopathic resorption of distobuccal root of a maxillary first molar: A case report

Key Clinical Message

This case report provides a rare case of idiopathic root resorption in maxillary first molar and suggests the importance of CBCT in the diagnosis and treatment outcome of complex endodontic diseases. Endodontic surgery is an effective method for treating teeth with persistent apical periodontitis.

Abstract

Idiopathic root resorption is an unexplained root resorption when the patient experiences root resorption without any local or systemic factors. Early diagnosis and appropriate treatment are crucial for long-term outcomes.

Maxillary first molar with two distobuccal root canals and cervical deformity: A case report

The second distobuccal canal in the maxillary first molar is often missed because of the low prevalence rate (0%-4%). The article reports this kind of variation in one case. Promising outcomes have continued up to the present (2-year follow-up).

Endodontic Treatment of a Maxillary First Molar With Two Separate Palatal Roots: A Case Report

Maxillary first molars exhibit considerable anatomical variation, with a single palatal root being the most common occurrence, while two palatal roots are notably less frequent. This case report details the endodontic treatment of a maxillary first molar with two separate palatal roots. It highlights the critical importance of recognizing these anatomical variations and their unique challenges during endodontic procedures. This report emphasizes the essential role of advanced diagnostic methods, such as cone-beam computed tomography, and the use of microscopic techniques in identifying and treating such cases.

Endodontic Retreatment of a Maxillary First Molar With Orthograde Retrieval of a Separated File by a Combination of Ultrasonic and File Braiding Techniques: A Case Report

The persistence of apical periodontitis after endodontic therapy can be attributed to biological causes or when the treatment approaches have proven insufficient in completely eradicating the intra-radicular infection. This case report describes the endodontic retreatment of a maxillary molar in which file separation occurred during the cleaning and shaping procedure. The separated file was successfully retrieved utilizing a combination of ultrasonic and braiding techniques. The field of ultrasonics has undergone a thorough investigation and has been demonstrated to be a conservative technique with minimal radicular dentin trephination. The braiding technique is also a conservative method that involves the use of several braided H-files to apply a gripping force, facilitating the extraction of foreign bodies. The utilization of this methodology has been documented in the endodontic academic literature.

A Cone-Beam Computed Tomographic Analysis of Mesiobuccal Root Canals of Maxillary First Molars

INTRODUCTION

The maxillary first molar is crucial for proper bite formation and jaw positioning in adulthood. The prevalence of dental caries in the study's sample population suggests it is a common candidate for endodontic therapy. Multiple studies have shown that the canal and root morphology of the maxillary first molar are abnormal.

MATERIALS AND METHODS

The distobuccal and palatal roots of 286 maxillary first molars were removed at the furcation. The mesiobuccal roots were then imaged using cone-beam computed tomography (CBCT) on all specimens. The specimens were analyzed in comparison with one another. The following factors were studied. The number and arrangement of canals, as described by Vertucci; the presence or absence of an isthmus, as described by Kim; the canal curvature angle, as measured by the Schneider method; characteristics such as calcified segments, lateral canals, and an apical delta. For the flow analysis, CBCT was utilized to examine the root channel architecture of 286 mesiobuccal (MB) permanent maxillary first molar.

RESULTS

Type I canal arrangement was found in 51.6% of teeth, Type II in 33.3%, Type III in 4.6%, Type IV in 4.2%, Type V in 2.5%, and Type VII in 1.5%. Type I, II, III, and V isthmus were each present in 26%, 6.7%, 9.5%, and 10.2% of the samples, respectively. Teeth with MB1 canal angulations of 0-20 degrees, 21-40 degrees, and more than 40 degrees were found in 56, 188, and 41 teeth, respectively. From 0 to 20 degrees, 21 to 40 degrees, and more than 40 degrees, 15 teeth, 88 teeth, and 25 teeth, respectively, had angulations in their MB2 canals. Only 9.8% of the samples had lateral canals, while 16.1% had both accessory canals and apical deltas. There were 19 cases with calcified segments in the coronal third of the MB1 canal and 13 cases in the middle third. There were no calcifications at the distal end of the MB1 canal. Thirteen of the specimens showed calcification only in the most caudal third of the MB2 canal, whereas the middle and distal thirds were uncalcified.

CONCLUSION

Utilizing a noninvasive approach, a CBCT scan has the capacity to provide valuable insights into the root canal configuration.

Non-surgical Root Canal Treatment of an Upper First Molar With an Unusual Morphology: A Case Report

This paper presents the unusual morphology of an upper right first molar with two roots, each containing a single canal, in a patient seeking emergency endodontic treatment. Clinical and radiographic examinations revealed the unusual root canal morphology of the tooth, which required further investigation using cone beam computed tomography (CBCT) imaging, which confirmed this unusual anatomical structure. It was also noted that the upper right first molar was asymmetrical to the upper left first molar, which had the normal three-root morphology. The buccal and palatal canals were instrumented using ProTaper Next Ni-Ti rotary instruments and enlarged to ISO size 30, with a taper of 0.7; irrigated with 2.5% NaOCl; filled with gutta-percha using the warm-vertical-compaction technique, with the aid of a dental operating microscope (DOM); and then confirmed via periapical radiograph. The DOM and CBCT are valuable aids that helped us to confirm the endodontic diagnosis and treatment of this unusual morphology.

Clinical analysis on the root fracture of the maxillary first molar

OBJECTIVES

This study aimed to investigate the common types and directions of root fractures of the maxillary first molar and the influence of root canal treatment on the prevalent sites of root fractures.

METHODS

A total of 274 maxillary first molars with root fractures diagnosed via cone beam computed tomography were included. The root fractures of nonendodontically and endodontically treated teeth were identified to be spontaneous and secondary root fractures, respectively. The sites, types, and directions of spontaneous and secondary root fractures were determined.

RESULTS

Among the spontaneous root fractures, the proportion of palatal root fractures (56.1%) was higher than those of mesial buccal root fractures (36.1%) and distal buccal root fractures (7.8%). Among the secondary root fractures, the proportion of mesial buccal root fractures (52.7%) was higher than those of palatal root fractures (36.5%) and distal buccal root fractures (10.8%). The distribution of predominant fracture sites was statistically significant (P<0.05), and vertical root fracture was the most common type. Palatal and buccal roots were commonly fractured at the mesiodistal and buccal-palatal directions, respectively.

CONCLUSIONS

This study provided an epidemiological basis for the clinical features of root fractures of the maxillary first molar. During the dia-gnosis and treatment of the maxillary first molar, the possibility of palatal root fractures should be considered. The occurrence of mesial buccal root fractures may be related to root canal treatment. Therefore, the risk of mesial buccal root fractures caused by iatrogenic factors should be minimized.

First Molars in Permanent Dentition and their Malformations in Various Pathologies: A Review

Permanent maxillary and mandibular first molars are the first permanent teeth to erupt into the oral cavity along with the mandibular incisors. It serves as an excellent record of maternal and fetal health, reflecting the prenatal, perinatal, and postnatal health and diseases. This review focuses on the molar morphogenesis, molar malformations, their etiopathogenesis, and pathologies causing specific pattern of molar malformations.

Assessment of Mesiobuccal Canal Configuration, Prevalence and Inter-Orifice Distance at Different Root Thirds of Maxillary First Molars: A CBCT Study

Aim

The aims of this study were to assess the prevalence and configuration of the second mesiobuccal (MB2) canal in the mesiobuccal MB root of permanent maxillary first molars at different root levels in a Saudi sub-population using cone‑beam computed tomography (CBCT) and to measure the inter-orifice distance between MB & MB2 at the pulpal floor level.

Materials and Methods

This retrospective study was carried out on CBCT images of Saudi patients seen at King Abdul Aziz University. A total of 106 maxillary first molars were evaluated using a specialized software program (iCAT CBCT software). The prevalence of MB2, canal configuration and location of joining (apical-middle-coronal), if present was calculated. Also, the inter-orifice distance between both canals was measured at the level of the pulpal floor. Chi‑square and one-way analysis of variance (ANOVA) were used.

Results

The MB2 canal was found in 92 (86.8%) maxillary first molar teeth. The MB and MB2 canals were joined in 61 (58%) cases, where the location of joining was 14 (23%), 17 (27%), and 31 (50%) in the coronal, middle, and apical third, respectively. The mean inter-orifice distance between both canals at the level of the pulpal floor was 2.52±0.76 mm.

Conclusion

The prevalence of MB2 canal in this Saudi sub-population was high. The prevalence decreased as the root canal approached the apical third. There was no correlation between the average distance and occurrence of canal joining. CBCT is useful in detecting and mapping the mesiobuccal root canal system, with a likelihood of enhancing the quality of root canal treatment.

Evaluating the Effect of Oblique Ridge Conservation on Stress Distribution in an Endodontically Treated Maxillary First Molar: A Finite Element Study

INTRODUCTION

Although the maxillary first molar (MFM) has been frequently subjected to stress analysis in endodontic investigations, the available data about the effect of its oblique ridge are quite sparse. The aim of this study includes evaluating the effect of the residual oblique ridge on the stress distribution after preparing conservative access cavities.

METHODS

Based on the cone-beam computed tomographic data, the model of an intact MFM and 5 cavity designs were prepared for endodontic treatment, which were consequently filled with gutta-percha and dental resin composite (6 total models). All models were subjected to 4 types of occlusal loading; finite element analysis via ABAQUS CAE software (Dassault Systemes, Vélizy-Villacoublay, France) was accomplished, whereas other software programs such as (Mimics Research Materialise, Leuven, Belgium) and 3-Matic Research (Materialise) were also incorporated in different stages for detecting stress distribution.

RESULTS

The stress distribution on the MFM is not only dependent on the remaining width of the oblique ridge but also on the type of loading. The most stress on the cervical region was concentrated on the palatal root in some type of loading, whereas the least stress on the occlusal surface was recorded when the whole oblique ridge was replaced by the composite resin.

CONCLUSIONS

When the occlusal contacts are occurring only on the palatal cusp, the stress distribution on the oblique ridge is noticeably affected by the cavity design.

Evaluation of remaining dentin thickness following use of three different rotary nickel-titanium retreatment files: A cone-beam computed tomography study

Aim:

The aim of the study is to measure the amount of remaining dentin thickness (RDT) following retreatment using three different rotary nickel–titanium (NiTi) systems.

Methodology:

Mesiobuccal roots of 45 extracted maxillary first molars were prepared up to F₂ ProTaper File and obturated. After cone-beam computed tomography (CBCT) imaging, to evaluate the obturation, the samples were randomly assigned to three retreatment groups (n = 15). Group I was retreated with ProTaper Universal retreatment kit, Group II and III with M_TWO and D-Race retreatment files, respectively. Postoperatively, all samples were subjected to CBCT imaging and evaluated with AutoCAD software (AutoDesk, Inc.) Mill Valley, California, U.S. to calculate the RDT. Data were statistically analyzed using one-way ANOVA and Tukey's post hoc tests, and the level of significance was set at P = 0.05.

Results:

The amount of RDT was significantly more in D-Race and M_TWO groups when compared to ProTaper group.

Conclusion:

D-Race and M_TWO instruments were associated with significantly more RDT than ProTaper.

Proximity of Vascular Bone Channel in the Lateral Sinus Wall to Root Apices of Maxillary First Molars: A Cone-beam Computed Tomographic Analysis

INTRODUCTION

Apical surgery is frequently indicated in maxillary first molars. Occasionally, a vascular anastomosis in the lateral maxillary sinus wall can be observed during surgery. The aim of this study was to examine the distance between the vascular bone channel (VBC) and the root apices of maxillary first molars using cone-beam computed tomographic imaging.

METHODS

Cone-beam computed tomographic images of 104 maxillary first molars were oriented in the coronal plane to evaluate the distance between the roots and the VBC. The measurements were only recorded in relation to the buccal roots. In addition, demographic parameters and further measurements such as the diameter of the VBC and the proximity to the periapical pathology were evaluated.

RESULTS

A total of 210 VBCs were assessed. The mean distance from the VBC to the apices of the buccal roots of the maxillary first molars was 6.18 mm ± 3.84 mm. The VBC was mostly located intrasinusally (74.3%) and only rarely superficially (0.5%). The diameter of the VBC was on average 0.88 ± 0.32 mm.

CONCLUSIONS

In this study, the VBC was usually found closer to the mesiobuccal than to the distobuccal root apex. During preparation of the access window, the existence of the VBC should be kept in mind because the mesiobuccal roots of maxillary first molars undergo apical surgery to the buccally positioned roots only.

Endodontic management of maxillary first molar with an anatomical variation of two palatal canals: A case report

An in-depth knowledge of the root canal anatomy is important for any successful root canal treatment; however, complexities exist within the root canal morphology. The maxillary first molar has variations in its root morphology and canal configurations. In literature, this variation is only observed in an estimated 1.12%-1.17%. One such case is described in this case report which provides the endodontic management of a left maxillary first molar with two palatal canals using loupes magnification.

Evaluation of Anatomy and Root Canal Morphology of the Maxillary First Molar Using the Cone-Beam Computed Tomography among Residents of the Moscow Region

BACKGROUND

The success of endodontic treatment depends on the knowledge of root canal system. The root canals have complex morphology and wide individual variations. The aim of this study was to evaluate the root canal morphology of the maxillary first molars among residents of the Moscow region using cone-beam computed tomography (CBCT) scanning.

MATERIALS AND METHODS

Three hundred CBCT images of patients aged 20-70 years old were analyzed to study the root canal system (the number of canals and the configuration according to Vertucci's classification) of the maxillary first molars. The prevalence of a second mesiobuccal (MB2) in the mesiobuccal root (MB) was recorded in each age group.

RESULTS

three separated roots of the maxillary first molar were observed in 100% of cases. MB2 canals were found in 59.8% of cases. A second distobuccal canal was observed in 0.5% of cases. The canal morphology in the MB root was 40.2% in Type I, 22.4% in Type II, and 37.3% in Type IV.

CONCLUSION

The prevalence of MB2 canals was 59.8%, and the most common canal morphology was Vertucci's Type I. Using CBCT scanning is a useful technique to evaluate and analyze the root canal system.

Endodontic management of maxillary first molar with atypical canal morphology: Report of three cases

Maxillary first molar with three roots and 3–4 canals is a common occurrence. However, extreme variations in their canal morphology have been reported ranging from one single canal and one root to as many as eight root canals. This article presents three cases of successful endodontic management of maxillary first molars with atypical canal morphologies, thus highlighting the fact that variations do occur and an endodontist should always be aware of aberrancies in root canal system apart from the knowledge of normal root canal anatomy.

[Maxillary first molar with two distobuccal root canals: a case report]

The root and canal anatomy of maxillary first molar is very complicated. The incidence of having two canals in the mesiobuccal root of maxillary first molar is higher than that in its distobuccal root. This article described a maxillary first molar with five root canals, including two canals in mesiobuccal and distobuccal roots.

Detection and management of a complex canal configuration in mesiobuccal root of maxillary first molar using three dimensional imaging

This case report discusses the identification and management of complex canal configuration of 3-2-1 in the mesiobuccal (MB) root of the maxillary left first molar. Careful attention to details of the pulpal floor and applying the knowledge of the laws of orifice location along with deepening the subpulpal groove with ultrasonic tips helped in identifying the three MB canals. Manual scouting helped in understanding the anatomic configuration; the use of three-dimensional imaging technique and spiral computed tomography (SCT) confirmed the same. SCT images showed buccolingually wide and bulbous mesiobuccal root with three separate canals at coronal third that merged into two canals in the middle and exited as a single canal at the apex. This article highlights the role of SCT in three-dimensionally analyzing the unseen rarest canal configurations that ultimately enabled the clinician to thoroughly explore, debride, and obturate the entire root canal system.

Odontometric analysis of permanent maxillary first molar in gender determination

Aims:

This study was conducted to assess the sex determination potential from mesiodistal (MD) and buccolingual (BL) dimensions of permanent maxillary first molar.

Subjects and Methods:

The study was conducted in the Department of Oral Medicine and Radiology, Al-Badar Rural Dental College and Hospital, Gulbarga, Karnataka, on 600 subjects (300 male and 300 female), aged 17–25 years. The subjects were selected based on the inclusion and exclusion criteria set forth for the study. After obtaining informed consent, the intraoral measurements of MD and BL dimensions on casts of the first maxillary molars were taken using digital vernier caliper with resolution of 0.01 mm.

Statistical Analysis Used:

The data obtained were subjected to statistical analysis using paired and unpaired t-test to compare MD and BL dimensions between males and females. P ≤0.05 was considered statistically significant.

Results:

The mean MD width of the first maxillary molar was 10.60 ± 0.6644 mm (right) and 10.60 ± 0.6644 mm (left) in males and 10.40 ± 0.6255 mm (right) and 10.40 ± 0.6255 mm (left) in females. The mean BL width of the first maxillary molar was 11.60 ± 1.2227 mm (right) and 11.60 ± 1.2227 mm (left) in males and 11.20 ± 0.8440 mm (right) and 11.20 ± 0.8440 mm (left) in females. The differences between males and females in MD and BL dimensions measured were statistically significant (P < 0.05). Right and left MD dimensions exhibited sexual dimorphism of 1.92% and right and left BL dimensions exhibited sexual dimorphism of 3.57%.

Conclusions:

The MD and BL dimensions of the maxillary first molars may be used as an aid in sex discrimination.

Root Canal Morphology and Configuration of 179 Maxillary First Molars by Means of Micro-computed Tomography: An Ex Vivo Study

INTRODUCTION

The objective of this study was to propose a root canal configuration description method and to investigate the root canal system morphology of the maxillary first molar by means of micro-computed tomographic imaging.

METHODS

The root canal configuration, foramina, and accessory canal frequency of 179 maxillary first molars were investigated by means of micro-computed tomographic imaging and 3-dimensional software imaging. The root canal configuration and main foramina number are described from coronal to apical with a 4-digit system.

RESULTS

The most frequent root canal configurations were 1-1-1/1 (45.8%), 2-2-2/2 (25.1%) and 2-2-1/1 (10.1%) in mesiobuccal roots and 1-1-1/1 in distobuccal (97.2%) and palatal (98.9%) roots. The first mesiobuccal (MB1) root canal had 1 accessory canal in 26.3% of the teeth, the distobuccal root canal had 12.3%, and the palatal root canal had 9.5%; in the second mesiobuccal root canal, there was rarely 1 accessory canal. There was 1 accessory canal in 26.3%, 12.3%, and 9.5% in the MB1, distobuccal, and palatal root canals, respectively. The MB1, distobuccal, and palatal root canals had 1 main foramen. The MB2 had 1 main foramen in 39.0% of the teeth and no main foramen in 61.0%.

CONCLUSIONS

The root canal configuration of maxillary first molars is quite diversified. Contrary to our expectations in this research, the mesiobuccal root has predominantly 1 root canal entrance and only 1 main foramen. Anatomic variations including connecting and accessory canals occur in any third of root.

[Maxillary first molar with twin-root canal in palatal side: Two case reports]. Hua Xi Kou Qiang Yi Xue Za Zhi. 2015;33:329-330. [PMID: 26281268 DOI: 10.7518/hxkq.2015.03.024]

Maxillary first molar with twin-root canal in palatal side is rare. This article described two cases of maxillary first molar with twin-root canal. A properly designed and prepared access of the cavity is helpful for the diagnosis and negotiation of the root canal morphology.

Maxillary first molar with 8 root canals detected by CBCT scanning: a case report

Maxillary molars are prone to exhibit some of the most complex root canal configurations in endodontics. These complexities can result in diagnostic dilemmas, as well as management challenges. This case report illustrates how a cone beam computed tomography (CBCT) scan confirmed an unusual maxillary first molar with 3 root canals each in the mesiobuccal and distobuccal roots and 2 canals in the palatal root. This article illustrates how CBCT scanning and a dental operating microscope can facilitate a better understanding of complex root canal anatomies, ultimately allowing the dentist to clean, shape, and obturate root canal systems more efficiently.

Microscope magnification and ultrasonic precision guidance for location and negotiation of second mesiobuccal canal: An in vivo study

Objective:

The aim of this study was to evaluate the influence of using the dental operating microscope (DOM) and ultrasonics for the detection of second mesiobuccal (MB2) canal orifice in maxillary first molars.

Materials and Methods:

Sixty subjects seeking root canal therapy for maxillary first molar were assessed for the presence of MB2 canal using endodontic explorer without magnification. Teeth in which the MB2 canal orifice could not be located were examined under magnification using DOM. If the MB2 canal orifice could not be found even after using DOM, ultrasonic tips were used to prepare 3-mm-long trough from the mesiobuccal canal orifice toward the palatal canal and examined under DOM for location of the canal.

Results:

With naked eye, the MB2 canal was located in 12 teeth; with the use of the DOM, the MB2 canal was located in 21 additional teeth; and with the combined use of ultrasonic tip and DOM, the MB2 canal was located in 9 more teeth. Statistical comparisons between the tested techniques were done by analyzing the Receiver Operating Characteristic (ROC) curves; a statistically significant difference was found (P < 0.001).

Conclusion:

The results of this study indicate that the DOM and ultrasonics provide increased opportunity for the dentist to detect canal orifices.

Endodontic management of maxillary first molar with seven root canals diagnosed using Cone Beam Computed Tomography scanning

The main objective of root canal treatment is thorough cleaning and shaping of the entire pulp space and its complete filling with an inert filling material. A major cause of post-treatment disease is the inability to locate, debride or adequately fill all canals of the root canal system. The form, configuration, and number of root canals in the maxillary first molars have been discussed for more than half a century. Maxillary first molars commonly present with three roots and three canals, with a second mesiobuccal canal (MB2) also present. With the advent of improved magnification there are reports of multiple root canals in the maxillary first molars. Nonsurgical endodontic therapy of a left maxillary first molar with three roots and seven root canals was successfully performed under a dental operating microscope. The diagnosis of multiple root canals was confirmed with the help of Cone Beam Computed Tomography (CBCT) images.

Endodontic management of a maxillary molar with formation supradentalis: A case report

Anatomic variations may be observed in the crown or in the roots of maxillary molars. In rare instances, crown and root morphology, both show variations. Occurrence of paramolar cusp on the occlusal surface as central cusp or on the buccal surface as parastyle has been frequently reported in maxillary molars. However, presence of paramolar cusp on the palatal surface has not been reported. 'Formation supradentalis' is a condition in which supernumerary cusp is associated with a supernumerary root in a molar. The occurrence of such concomitant corono-radicular morphology is multifactorial, that is primary polygenic with secondary environmental influences. This case reports the diagnosis and endodontic management of Formation-supradentalis that had six cusps and four roots in the maxillary first molar. The tooth exhibited a prominent paramolar palatal cusp and cusp of Carabelli along with a supernumerary palatal root. To the best of author's knowledge, this is the first documentation of endodontic management of Formation supradentalis.

Root canal configuration of permanent maxillary first molar in Khasi population of Meghalaya: An in vitro study

AIMS AND OBJECTIVE

To investigate the root canal configuration of permanent maxillary first molar in Khasi population of Meghalaya.

MATERIAL AND METHODS

Sixty (60) permanent maxillary first molars collected from patients of Khasi population of Meghalaya were studied using canal staining and clearing technique. Observations of the number of roots, root canal configuration, lateral canal, apical delta, and presence of the additional type of canals were made.

RESULTS

Based on Vertucci's classification the different types of canal identified are: Mesiobuccal root, Type I (28.3%), Type II (28.3%), Type IV (30.0%), Type V (5.0%), Type VI (6.7%), and an additional type of canal (2-1-2-1-2; 1.7%) were observed. The distobuccal root displayed Type I (95%), Type II (1.7%), Type V (3.3%). The most prevalent canal configuration in the palatal roots is Type I (98.3%), Type II (1.7%).

CONCLUSION

In Khasi population of Meghalaya, the most prevalent root canal configuration in the mesiobuccal root is Type IV followed by Type I and Type II. MB2 canals are present in more than 65% cases. In palatal and distobuccal roots, Type I configuration is present in most cases. Racial divergence may be responsible for such variations.

Determination of canal orifice co-ordinates and MB2 incidence of maxillary first molars in a Turkish sub-population

OBJECTIVES

To measure the co-ordinates of the root canal orifices and to determine the incidence of mesiobuccal-2 (MB2) in maxillary first molars in a Turkish sub-population.

MATERIALS AND METHODS

Standard digital photographs were taken under a stereomicroscope from the occlusal aspect of each tooth (n = 176) before and after crown removal. Canal orifices were negotiated under moderate magnification using dental loupes. The coordinates of the orifices and the distances of each from the central fossa were measured by using geographic software. Intensity maps of the orifice locations were created by using the co-ordinates of all canal orifices. A representative map was drawn using the mean values of orifice locations and access projection area.

RESULTS

In the right maxillary first molars, the mean values for the (X, Y) co-ordinates were (0.67, 2.68) for mesiobuccal-1 (MB1), (0.81, 0.84) for MB2, (-1.12, 1.26) for distobuccal-1 (D1), (-0.89, 0.23) for distobuccal-2 (D2) and (0, -2.50) for palatinal (P); the corresponding mean values in the left maxillary first molars were (-0.78, 2.56), (-0.98, 0.90), (0.99, 1.18), (0.69, 0.78) and (0.00, -2.53), respectively. The average MB1-MB2 distance was 1.97 mm. Distobuccalcanal orifices were localized at the distal side of the center in 98.3% of teeth. The incidence of MB2 was 46.02%.

CONCLUSIONS

The distobuccal canal orifice is mostly located on the distal side of the central fossa. Thus, it should be considered that the access cavity of the maxillary molars may not be always limited mesially. The incidence of MB2 in this sub-population was 46.02%, which is of great importance clinically.

Successful removal of a 16 mm long pulp stone using ultrasonic tips from maxillary left first molar and its endodontic management

To present a case report describing successful removal of a 16 mm long pulp stone in a single mass from a maxillary left first molar and its endodontic management. In the presented case, the conventional approach of dissecting the pulp stone was not considered, as radiographically the calcification was extending up to the apex of the palatal root canal and the separation of the coronal and radicular pulp stone would have risked the obliteration of its orifice. A new set of ultrasonic endodontic tips were used for the removal of significantly large pulp stone in single mass.

An unusual maxillary molar with four roots and four buccal canals confirmed with the aid of spiral computed tomography: a case report

This case report describes an endodontically managed maxillary first molar with an unusual morphology of five canals. Maxillary first molar has one of the most complex root and canal anatomy. The greatest variations observed are the presence of two canals in the mesiobuccal root of maxillary molar, canals in the furcation area and the presence of lateral and accessory canals. The incidence of two distobuccal canals in itself is quite rare. A literature search revealed only a few case reports of four buccal canals in maxillary first molars. This case report presents the successful root canal treatment of the maxillary first molar with four roots and five canals. The use of spiral computed tomography scan in this case greatly contributed towards confirming this rare morphology.

A rare root canal configuration of bilateral maxillary first molar with 7 root canals diagnosed using cone-beam computed tomographic scanning: a case report

INTRODUCTION

The complexity of the root canal system of maxillary molars presents a constant challenge in the diagnosis and treatment of these teeth. This case report describes the importance of a surgical operating microscope and cone-beam computed tomographic (CBCT) imaging.

METHODS

Root canal treatment of a left maxillary first molar with 3 roots and 7 canals was successfully performed. Seven canals were identified with the help of a surgical operating microscope and CBCT imaging. CBCT images also confirmed the 3 roots and 7 canals in the right maxillary first molar.

RESULTS

CBCT images confirmed a type IV canal pattern in the distal and palatal root, whereas the mesial root had a type VIII canal pattern.

CONCLUSIONS

The use of a surgical operating microscope and CBCT imaging helps the clinician to diagnose unusual anatomy of a tooth and facilitate successful endodontic treatment.

Type I canal configuration in a single rooted maxillary first molar diagnosed with an aid of cone beam computed tomographic technique: A rare case report

Anatomic variations in maxillary molars are frequent. These deviations are also one of the major cause for endodontic treatment failure owing to inadequate cleaning, shaping and sealing of root canal system. Diagnosis of such aberrations using newer imaging techniques like cone beam computed tomography is firmly advocated. The present paper highlights the root canal treatment of a rare case of type I canal morphology diagnosed with an aid of cone beam computed tomographic technique.

Maxillary first molar with two palatal roots located under dental operating microscope

An awareness and understanding of the presence of an additional root and unusual root canal morphology is essential as it determines the successful outcome of endodontic treatment. A thorough knowledge of basic root canal anatomy and its variation is necessary for successful completion of endodontic treatment. This report points to the importance of looking for additional roots and canals with the help of operating microscope. Finding additional roots and canals would enable clinician to successfully treat a case that would otherwise not be successful.

Endodontic management of a maxillary first molar with unusual location of second mesio buccal orifice

Maxillary first molar can have a mesio-buccal-2 (MB2) orifice located palatally, but adjacent to the mesio buccal orifice. An awareness and understanding of this root canal morphology can contribute to the successful outcome of root canal treatment. This report discusses endodontic treatment of a maxillary first molar with unusual location of second mesio buccal orifice. Conventional diagnostic aids such as radiographs play an important role in assessment of complex root canal morphologies. These modalities, however, do not provide detailed information of the complexity as a result of their inherent limitations. This article discusses the variations in the orifice location and the use of latest adjuncts in successfully diagnosing and negotiating them.

Sexual dimorphism in the permanent maxillary first molar: a study of the Haryana population (India)

Sexual identification of immature skeletal remains is still a difficult problem to solve in Forensic Anthropology. The aim was to evaluate the existence of sexual dimorphism in maxillary first molars. The base sample comprised 200 subjects (100 males and 100 females) aged 17-25 years. The buccolingual (BL) and mesiodistal (MD) diameters of maxillary first molars were measured using digital vernier calipers both intraorally and on study casts. Data was analyzed using Independent sample t-test and paired t-test. Results showed statistically significant sexual dimorphisms in male and female odontometric features. The mean values of the parameters were greater on the left side than on the right side. Amongst the intraoral group, the right maxillary first molar was found to exhibit the greatest sexual dimorphism (5.34%) in terms of buccolingual dimension. Amongst the study cast group, the left maxillary first molar was found to exhibit the greatest sexual dimorphism (5.54%) in terms of buccolingual dimension. The buccolingual dimensions exhibited greater sexual dimorphism than mesiodistal dimensions.

CONCLUSION

sex determination from an incomplete skeleton or young children may be difficult and in such situations the odontometric features of the teeth can be of immense help in determining the sex.