Prevalence and Distribution of Dental Anomalies in Schoolchildren in Kuwait

OBJECTIVE

Dental anomalies (DA) can affect paediatric patients' aesthetics, function, and psychological well-being. There is a lack of data about the prevalence of DA in children in Kuwait. This study aimed to investigate the prevalence and distribution of DA amongst schoolchildren aged 8 to 12 years.

METHODS

A retrospective study was conducted using panoramic digital radiographs of children who attended a single dental center. All radiographs were evaluated by 2 calibrated and trained examiners.

RESULTS

DA were present in 110 (20.1%) out of the 546 panoramic radiographs examined: 53.6% in females and 46.4% in males. The mean age of children with DA (9.83 ± 1.29) was similar to that of children with no anomalies (9.96 ± 1.46). The most prevalent anomaly was dental agenesis (9.3%), followed by taurodontism (6.6%) and ectopic eruption (EE, 2%). DA were more common in the maxilla (58.2%) compared to the mandible (41.8%, P = .042). Congenitally missing teeth were significantly more frequent in the mandible (56.9%) than in the maxilla (43.1%, P = .003). EE was significantly more common in the maxilla (90.9%) than in the mandible (9.1%, P = .024). Microdontia and root dilacerations were only present in males, whilst supernumerary teeth, transposition, and impacted teeth were noted in females only.

CONCLUSIONS

The prevalence of DA amongst schoolchildren in Kuwait was considered to be relatively high. Certain DA were associated with gender. The significant prevalence of DA highlights the need for early diagnosis using panoramic radiographs, particularly during the ages of 9 and 10, in order to ensure effective patient management.

An improved diagnostic method for taurodontism and a comparative study on its effectiveness evaluation

OBJECTIVE

The two commonly used diagnostic methods for taurodontism are susceptible to aging changes, mastication wear and other factors. Therefore, this study proposed an improved diagnostic method for taurodontism, and compared it with the previous two methods as a supplement for taurodontism diagnosis.

METHODS

The included patients were aged 10-89 years and admitted to the Department of Stomatology of Hebei Eye Hospital from June 1, 2022 to May 31, 2023. Eighty cone-beam computed tomography images were divided equally into 4 groups: 10-29, 30-49, 50-69, and 70-89 years old. The right mandibular first molars were selected as measurement objects. Firstly, |BD| and taurodontism index (TI)-related parameters were measured using Shifman and Chanannel's method and crown-body(CB) and root (R) lengths was measured by Seow and Lai's method. The improved method used the length from the cementoenamel junction(CEJ) to the root bifurcation point(body, B)and the root length(root, R)as the measurement objects. Finally, TI, CB/R ratios, and B/R ratios were calculated according to the formulas given below. One-way ANOVA analysis was mainly used to compare the differences in the values, indices and ratios of taurodontism among different age groups (p<0.05).

RESULTS

With the increase of age, |BD| and TI values decreased significantly (p<0.01). The CB/R ratios of 70-89 years group were significantly lower than those of the other three groups (p<0.01). Ratios derived from the improved method were significantly lower in the 70-89 years than in 10-29 years group (p<0.05).

CONCLUSIONS

The |BD| and TI parameters proposed by Shifman and channel are significantly influenced by age. The measurements of Seow and Lai (CB/R ratios) were less affected by age compared with those of the former. The improved method(B/R ratios) was least affected by age, which would reduce error and bias in the measurement of taurodontism and obtain more objective results in older patients.

CBCT imaging and root canal treatment for taurodontism in mandibular second molar - A case report and literature review

The mandibular second molar exhibits a wide range of intricate root canal variations, which can present challenges and difficulties in achieving successful root canal treatment. This report focuses on two specific cases involving a root canal variation in a typical taurodontism of the mandibular second molar. To provide a comprehensive analysis and illustration of the anatomical structure of intraoral taurodontism and the important considerations for root canal treatment, we utilized advanced imaging techniques such as cone beam computed tomography (CBCT) and a dental microscope. By combining these tools, we were able to gain a deeper understanding of the complex root canal system and make informed decisions during the treatment process.

Root canal treatment of type Ⅱ and ⅢA double dens invaginatus in maxillary lateral incisor: a case report

Dens invaginatus is a rare developmental anomaly of the teeth that is caused by the infolding of enamel organs or the penetration of their proliferations into dental papillae before calcification has occurred. The presence of double dens invaginatus is extremely rare. This paper describes the use of cone beam computed tomography in the evaluation of a maxillary lateral incisor with double dens invaginatus and periapical periodontitis. The tooth was treated through microscopic root canal therapy. The tooth was free of clinical symptoms, and the periradicular lesion narrowed during the follow-up period of 1 year.

Atypical Radicular Anatomy in Permanent Human Teeth: A Systematic Review

The aim of the present study is to classify and quantify the anatomical variations of teeth in terms of form and number of root canals reported in human teeth employing the classification systems proposed previously. An electronic (PubMed) and manual search were performed to identify case reports noting any of the anatomical variations. Each alteration was studied independently. The electronic search was performed using the following keywords: anatomical aberration, root canal, permanent Dentition, case report, c-shaped canal, dens invaginatus, palato-radicular groove, palato-radicular groove, palato-gingival groove, radix entomolaris, dental fusion, dental gemination, taurodontism, dilaceration. The initial search revealed 1497 papers, of which 938 were excluded after analyzing the titles and abstracts. Therefore, 559 potential papers were considered. Of those, 140 articles did not meet the inclusion criteria. For the final revision, 419 papers were considered. We found that the mandibular first premolar had the highest prevalence of C-shaped canals. Dens invaginatus was more frequently found in the mandibular lateral incisor. Taurodontism was more prevalent in the maxillary first molar and in the mandibular first molar. Dilaceration was not clearly associated with a particular tooth. The classifications systems used in this review allowed for the better understanding and analysis of the many anatomical variations present in teeth. The variations in shape most found were dens invaginatus and radix entomolaris. The most frequently reported anatomical variation was in the number of canals.

Taurodontism in maxillary and mandibular molars using cone beam computed tomography in a dental center in Saudi Arabia

BACKGROUND

Taurodontism is a dental anomaly characterized by altered crown root ratio that is often diagnosed by radiographic evaluation. A three-dimensional cone beam computed tomography (CBCT) can aid in the diagnosis and treatment of taurodontic teeth. Only one study has reported the prevalence of taurodontism in a Saudi population.

OBJECTIVE

Determine prevalence and other characteristics of taurodontism in permanent maxillary and mandibular molars, by CBCT in a dental center in Saudi Arabia.

DESIGN

Cross-sectional.

SETTING

College of dentistry.

SUBJECTS AND METHODS

The first and second molars, maxillary and mandibular, from study participants of Saudi origin from Jazan region of Saudi Arabia were evaluated for taurodontism based on the criteria of Shifman and Chanannel. The degree of taurodontism was determined by the taurodontism index. Results were tabulated for analysis and the chi-square test was applied for the differences between age groups, genders, and maxillary and mandibular teeth.

MAIN OUTCOME MEASURES

Characteristics of taurodontism.

SAMPLE SIZE

1839 teeth in 300 individuals.

RESULTS

Taurodontism was seen in 24 (8%) of the study participants and in 71 teeth (3.9%). Taurodontism was significantly more prevalent in individuals between 21 and 40 years of age. Hypotaurodontism (67.6%, n=48) was most prevalent, followed by mesotaurodontism (23.9%, n=17) and hypertaurodontism (8.5%, n=6). The maxillary molars were more commonly involved than mandibular, but the results were not statistically significant. No significant differences in gender were observed.

CONCLUSIONS

Dental clinicians should be familiar with the condition due to the clinical implications in oral surgery, endodontics and prosthodontics. The possibilities of a complex root canal system, an additional canal, difficulties in canal negotiation, instrumentation and subsequent obturation can be challenging for the clinician.

LIMITATIONS

Conducted in a single dental center hence future studies with larger sample sizes in different regions of Saudi Arabia should be conducted to more accurately measure the prevalence.

CONFLICTS OF INTEREST

None.

Taurodontism and its forensic value: a case report

Taurodontism is an anomaly that affects posterior teeth, vertically increasing the size of the pulp chamber, mimicking the shape of bovine teeth, being only evidenced in diagnostic images. This report describes a case of taurodontism in a mandibular second molar, highlighting the forensic importance of this dental anomaly with relevant potential for human identification, not only for its morphological aspect but also for its relatively low frequency in mandibular second molars. In the case under study, the individual did not have any restored teeth. Thus, the set of diverse imaging modalities is fundamental to identify the anatomy of teeth and roots, the only information that could be used in a hypothetical identification situation, assigning to this anomaly an exceptional relevance as a potential characteristic for positive identification.

Analysis of Cause of Endodontic Failure of C-Shaped Root Canals

The purpose of this study was to analyze various characteristics and classification of C-shaped root canals and evaluate the causes of endodontic failure of C-shaped root canals by examining the resected root surface with an endodontic microscope and a scanning electron microscope (SEM). Forty-two teeth with C-shaped root canals were included in this study and had undergone intentional replantation surgery. Before surgery, periapical radiography and cone-beam computed tomography were taken. The root canal configuration was analyzed and classified according to Melton's classification at coronal and apical level. After injection of 1 : 100,000 epinephrine with 2% lidocaine, the tooth was carefully extracted. After the root-end resection, the resected root surface was examined using an operating microscope and SEM. Mandibular second molars were most frequently involved teeth (90.4%). The most frequently observed root canal configurations were C1 at the coronal level (45.2%) and C3 at the apical 3 mm level (45.2%). The most common cause of failure for a C-shaped root canal treatment was a leaky canal (45.2%), followed by an isthmus (23.8%), missing canal, overfilling, and iatrogenic problems. In conclusion, C-shaped root canals were most frequently found in mandibular second molars. The most common cause of failure was a leaky canal and isthmus.

Dental radiographic findings in 18 individuals with SATB2-associated syndrome

OBJECTIVE

To characterize the radiographic dental phenotype of individuals with SATB2-associated syndrome (SAS).

MATERIALS AND METHODS

Participants were evaluated by a multidisciplinary team during a concurrent clinic conducted during the 1st international SAS family meeting held in 2017 at a single institution. Whenever possible, panoramic and/or periapical radiographs were obtained in clinic or previously obtained and provided by the caregiver.

RESULTS

Of the 37 individuals evaluated, 18 (12 males, median age 8.5 years) underwent radiographic examination. Dental radiographs revealed anomalies in all individuals starting at 2 years of age. The most consistent finding was delayed development of the mandibular second bicuspids (83%) with other common radiographic findings including delayed development of the roots of the permanent teeth (78%), severely rotated (56%) or malformed teeth (44%), and taurodontism (44%).

CONCLUSIONS

Dental anomalies are fully penetrant and can be documented radiographically in all individuals with SAS.

CLINICAL RELEVANCE

Dental radiographic findings of delayed second premolar development and delayed development of permanent root formation, especially concurrent with findings of taurodontism and malformed teeth, support a clinical suspicion for SAS and should help differentiate SAS from other neurodevelopmental syndromes.

Comparison of canal transportation and centering ability of Xp Shaper, WaveOne and Oneshape: a cone beam computed tomography study of curved root canals

The aim of the present study was to investigate the shaping abilities of XP Shaper and compare it with other single file rotary NiTi systems utilizing full rotation and reciprocation motion, by cone beam computed tomography. Mesiobuccal canals of forty-five mandibular first molars, were allocated into three equal groups (n=15) according to the rotary system applied; WaveOne, OneShape and XP shaper. Pre-and post-instrumentation images were obtained at 3mm, 5mm and 7mm from the apex using cone beam computed tomography and assessed to determine canal transportation and centering ability. Data were analyzed using Kruskal-Wallis test to compare the three systems and Friedman's test to compare the root levels. Results showed that WaveOne and OneShape rotary systems produced greatest mean transportation with no statistically significant difference between them, while XP Shaper produced the lowest statistically significant mean transportation. Canal centering ability differed significantly among the three systems used. It was concluded that XP shaper preserved the original canal anatomy better than WaveOne and OneShape rotary systems.

Mutations in COL1A1 and COL1A2 and dental aberrations in children and adolescents with osteogenesis imperfecta - A retrospective cohort study

Osteogenesis imperfecta (OI) is a heterogeneous group of disorders of connective tissue, caused mainly by mutations in the collagen I genes (COL1A1 and COL1A2). Dentinogenesis imperfecta (DGI) and other dental aberrations are common features of OI. We investigated the association between collagen I mutations and DGI, taurodontism, and retention of permanent second molars in a retrospective cohort of 152 unrelated children and adolescents with OI. The clinical examination included radiographic evaluations. Teeth from 81 individuals were available for histopathological evaluation. COL1A1/2 mutations were found in 104 individuals by nucleotide sequencing. DGI was diagnosed clinically and radiographically in 29% of the individuals (44/152) and through isolated histological findings in another 19% (29/152). In the individuals with a COL1A1 mutation, 70% (7/10) of those with a glycine substitution located C-terminal of p.Gly305 exhibited DGI in both dentitions while no individual (0/7) with a mutation N-terminal of this point exhibited DGI in either dentition (p = 0.01). In the individuals with a COL1A2 mutation, 80% (8/10) of those with a glycine substitution located C terminal of p.Gly211 exhibited DGI in both dentitions while no individual (0/5) with a mutation N-terminal of this point (p = 0.007) exhibited DGI in either dentition. DGI was restricted to the deciduous dentition in 20 individuals. Seventeen had missense mutations where glycine to serine was the most prevalent substitution (53%). Taurodontism occurred in 18% and retention of permanent second molars in 31% of the adolescents. Dental aberrations are strongly associated with qualitatively changed collagen I. The varying expressivity of DGI is related to the location of the collagen I mutation. Genotype information may be helpful in identifying individuals with OI who have an increased risk of dental aberrations.

Palatal Radicular Groove Morphology of the Maxillary Incisors: A Case Series Report

INTRODUCTION

Teeth with a palatal radicular groove are challenging to diagnose, treat, and save. We classified this condition using cone-beam computed tomographic (CBCT) cross-sectional configurations combined with radiographic and morphologic observations during an intentional replantation procedure to identify and analyze the characteristics of palatal radicular grooves comprehensively as a reference for diagnosis, treatment planning, and prognosis evaluation of this condition.

METHODS

Eight cases with palatal radicular grooves present in permanent maxillary incisors were investigated by radiography and CBCT imaging before intentional replantation.

RESULTS

The palatal radicular grooves were classified into 3 types based on groove depth and cross-sectional shape on CBCT images: type I, with a shallow groove depth, corresponding to a normal, simple, and single root canal; type II, with a medium groove depth, corresponding to a C-shaped canal system; and type III, with a deep groove depth, almost bisecting the root of the tooth, simultaneously present with 2 independent root canals and an apex with normal shape, corresponding to a labial groove connecting with a palatal groove. The extracted teeth and their radiographic images showed corresponding characteristics.

CONCLUSIONS

The CBCT cross-sectional images allowed the best visualization of the depth of the grooves and highlighted the difficulties entailed in treating such teeth. Intentional replantation is an effective therapeutic decision for this type of deformity and can provide better prognosis estimation, especially in teeth with type II and III grooves.

Enamel Pit Defects and Taurodontism in a Patient with Ring Chromosome 14 and 47,XXX

The purpose of this paper is to describe the clinical findings and management of a case involving a patient with co-occurring ring chromosome 14 syndrome and 47,XXX presenting with enamel pit defects and taurodontism. Ring chromosome 14 syndrome is an unusual condition with uncontrolled seizure disorder as its most significant finding; 47,XXX (trisomy X; triple X) is a more common condition and has characteristic physical and behavioral findings. Neither condition has been associated with enamel pit defects.

Pyramidal and Taurodont Molars and Their Association With Other Tooth Anomalies

PURPOSE

Determine the prevalence of pyramidal molars (PMs), associated tooth anomalies, and medical conditions (MC).

METHODS

Pantomograms from 10,168 subjects were searched for PMs.

RESULTS

A total of 148 individuals (75.7 percent females), aged 9.7 to 18.9 years old, had PMs. Subjects with MCs (53.4 percent) had on average 17 percent more PMs (P=.0476) and 2.8 times greater odds of palatally displaced canines (P=.0309). The mean number of pyramidal and taurodont molars per subject was 2.9±1.4 (SD) and 3.1±1.7 (SD), respectively. In both sexes, 63.5 percent of all observed PMs were located in the maxilla and 78.5 percent of all PMs were second molars. Taurodont molars increased by 9.4 percent as other tooth anomalies increased by one, but decreased by 8.2 percent for each additional PM. Tooth anomalies associated with PMs were palatally displaced canines (17.6 percent) and short root anomaly of maxillary central incisors (6.1 percent). Delayed eruption was noted in 9.5 percent, tooth agenesis in 6.1 percent, and supernumerary teeth in 3.4 percent.

CONCLUSIONS

The prevalence of pyramidal molars was 1.4 percent, and the female-to-male ratio was 3.1 to one. Pyramidal molars are often associated with medical conditions and other tooth anomalies.

Apical Canal Confluency: Clinical and Practical Considerations

Accurate knowledge of canal anatomy is a key factor in the success of root canal treatment. Confluent canals are defined as two canals with a common apical foramen in a root. The purpose of this paper is to review prevalence, instrumentation and obturation of confluent root canals.

Oral and craniofacial manifestations of Ellis-van Creveld syndrome: Case series

PURPOSE

The objective of this case series was to determine the oral, dental and craniofacial features of patients with EvC syndrome.

MATERIAL AND METHODS

Eight patients with EvC syndrome were enrolled. A complete family history, pedigree analysis, detailed medical history were collected. Findings of clinical examination, including craniofacial and orodental manifestations, and radiological investigations were thoroughly studied.

RESULTS

All eight patients had characteristic face, hypertrophic frenulum, conical and peg-shaped teeth, hypodontia of deciduous and/or permanent teeth and also skeletal dysplasia, small chest, short stature and hypoplastic nails. Additionally dysmorphic filtrum, serrated appearance of gingiva, diastema, enamel hypoplasia, microdontia, taurodontism, single rooted permanent molar, delayed eruption and high caries rate were observed with varying degrees. Cephalometric evaluation revealed skeletal Class III growth pattern in four subjects and Class II growth pattern in one subject.

CONCLUSION

Evaluation of craniofacial and orodental anomalies of EvC syndrome is required for accurate differential diagnosis from other congenital syndromes.

Microcomputed tomographic evaluation of mandibular molars with single distal canals

The aim of this study was to evaluate, using microcomputed tomography (µCT), the frequency of conjoined mesial canals in first and second mandibular molars with a single distal canal. Mandibular first (n = 114) and second molars (n = 114) with mature apices were randomly selected from a pool of extracted teeth. The specimens were decoronated to establish clinically the existence of a single distal canal. Teeth with C-shaped canals were discarded. Each tooth was scanned with a µCT system and evaluated in 3 dimensions. Of 228 examined teeth, 206 were included in the study. Of these, 129 (62.6%) displayed conjoined mesial canals with a single portal of exit, and 77 (37.4%) displayed 2 distinct mesial canals with 2 separate portals of exit. Of the teeth with conjoined mesial canals, 71 (55.0%) were second molars and 58 (45.0%) were first molars. Conjoined mesial canals exhibited a mean interorifice distance of less than 3.00 mm. These data regarding morphological patterns alert clinicians to the possible need to modify endodontic techniques in mandibular molars with single distal canals.

Endodontic treatment of mandibular molars with atypical root canal anatomy: reports of 4 cases

The variations in root canal anatomy of multirooted teeth represent a continuous challenge to endodontic diagnosis and treatment. Although the most common configuration of mandibular molars is one containing 2 roots and 3 root canals, there are many different combinations. Very rarely, an additional third (supernumerary) root is seen. When it is located distolingually to the main distal root, this third root is called radix entomolaris (RE), and when it is located mesiobuccally to the mesial root, it is called radix paramolaris (RP). Variations of root canal systems need not always be in the form of extra roots or extra canals. Single roots with single canals can also occur. A general dentist should be aware of these unusual root canal morphologies in mandibular molars for the success of endodontic treatment. These case reports describe the root canal treatment of a case of RE in the mandibular first molar, 2 rare cases of RP (1 each in the mandibular first and second molars), and a mandibular second molar with a single root and root canal.

Root and Root Canal Morphology of Human Third Molar Teeth

Successful root canal treatment depends on having comprehensive information regarding the root(s)/canal(s) anatomy. Dentists may have some complication in treatment of third molars because the difficulty in their access, their aberrant occlusal anatomy and different patterns of eruption. The aim of this review was to review and address the number of roots and root canals in third molars, prevalence of confluent canals in third molars, C-shaped canals, dilaceration and fusion in third molars, autotransplantation of third molars and endodontic treatment strategies for third molars.

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.

Optimization of diagnostics and orthodontic treatment planning in children and adolescents with multiply adentia

The data of clinical examination, diagnostic models and panoramic x-rays investigation of the 332 patients at the age from 6 to 18 years with adentia were analysed. The congenital absence of more than 6 teeth was defined as oligodontia. The purpose of the study was to evaluate the prevalence of missing teeth patterns and other dental abnormalities such as microdontia, persistent deciduous teeth, ankylosis, taurodontism, impaction and transposition in children and adolescents with isolated and syndromic oligodontia to optimize the diagnostic and orthodontic treatment plan. The total number of 332 patients were devided into three groups: 1-132 patients with hypodontia, 2-119 subjects with isolated oligodontia and 3 - 81 with syndromic oligodontia. The subgroup comprised of 45 children with ectodermal dysplasia (ED) syndromes and oligodontia 1,5-6 years at baseline examination was selected from the patients of group 3. The main type of inheritance was X-linked recessive and the most spread syndrome was hypohidrotic ectodermal dysplasia or Christ-Siemens-Touraine syndrome. The female patients were twice more than males in hypodontia and isolated oligodontia groups, but in group of 3 syndromic patients the rate of males to females was 1,56:1. The most stable to agenesis teeth were the upper central deciduous and permanent incisors. In group 2 the most often absent teeth were upper second premolars and in group 3-the upper lateral incisors. In syndromic patients with temporary dentition the upper lateral incisors and all lower incisors were always absent. It was concluded that the absence of teeth at the age of 1,5 years, male gender and absense of more than 14 teeth in the temporary dentition and 20 teeth in the permanent dentition were the signs of syndromic oligidontia. It is necessary for such patients to be examined besides dentists and pediatrician by other medical specialist such as dermatologist and geneticist.

Possibilities and limits of imaging endodontic structures with CBCT

An adequate portrayal of the root canal anatomy by diagnostic imaging is a prerequisite for a successful diagnosis and therapy in endodontics. The introduction of dental cone beam computed tomography (CBCT) has considerably expanded the scope of imaging diagnostics. The aim of the following study was to evaluate the imaging of endodontic structures with CBCT. One hundred and twenty teeth were examined with a CBCT device (ProMax 3D). Subsequently, the findings of the three-dimensional images were evaluated and compared to those of dental radiographs and tangential section preparations of the examined teeth. Results with high prevalence, such as existing roots and root canals, as well as results with low prevalence, e.g., extremely fine anatomical structures of the endodontic tissue, could be visualized precisely by dental CBCT; side canals, ramifications, communications, pulp stones, and obliterations could also be detected. Additionally, the length of curved root canals could be determined accurately. Likewise, root fractures were visualized reliably with CBCT. However, carious lesions could not be diagnosed adequately, and the evaluation of fillings and prosthetic restorations was complicated due to scattered X-ray artifacts. CBCT datasets qualify to visualize and diagnose small anatomical structures of the endodontic tissue.

Aetiology, incidence and morphology of the C-shaped root canal system and its impact on clinical endodontics

The C-shaped root canal constitutes an unusual root morphology that can be found primarily in mandibular second permanent molars. Due to the complexity of their structure, C-shaped root canal systems may complicate endodontic interventions. A thorough understanding of root canal morphology is therefore imperative for proper diagnosis and successful treatment. This review aims to summarize current knowledge regarding C-shaped roots and root canals, from basic morphology to advanced endodontic procedures. To this end, a systematic search was conducted using the MEDLINE, BIOSIS, Cochrane Library, EMBASE, Google Scholar, Web of Science, PLoS and BioMed Central databases, and many rarely cited articles were included. Furthermore, four interactive 3D models of extracted teeth are introduced that will allow for a better understanding of the complex C-shaped root canal morphology. In addition, the present publication includes an embedded best-practice video showing an exemplary root canal procedure on a tooth with a pronounced C-shaped root canal. The survey of this unusual structure concludes with a number of suggestions concerning future research efforts.

In vitro analysis of extracted dens invaginatus using various radiographic imaging techniques

AIM

Dens Invaginatus (DI) is a rare malformation of the teeth, showing a broad spectrum of morphologic variations. The aim of this study was to perform in vitro radiographic analyses of three extracted dens invaginatus (DI) teeth with complex root anatomy using plain radiographs, CBCT, MRI and micro CT techniques.

MATERIALS AND METHODS

Study design: Three maxillary lateral incisors (A, B and C) from two patients were extracted due to poor prognosis and were radiographically analysed. Initially, conventional two dimensional digital radiographs were taken. Subsequently CBCT, micro CT and MRI analyses were performed.

RESULTS

According to the Schulze and Brand system of classification, teeth A, B and C were classified as A2, B3 and B2 respectively. To detect the relationship between the invagination to the oral cavity and pulp chamber, conventional two dimensional radiographs were of no help. CBCT and MRI images were found to be complementary to each other but provided lesser structural detail than micro CT images.

CONCLUSION

Reporting on these three DI teeth, normal conventional radiographs did not provide detailed structural information about the malformation due to geometric distortion and lack of information. Even though Oehlers classification system is the most widely used, classification by Schulze and Brand is more applicable in rare and deviant teeth.

Mandibular first molar with six root canals: a rare entity

Recently, there has been an ongoing trend of case reports that highlight the presence of more than four root canals in mandibular first molars. This tendency warns clinicians to be more prudent when dealing with mandibular first molars requiring endodontic treatment. Moreover, radiographic examination should be taken as a clue providing tool rather than as an absolute guide to anatomy and its associated aberrances. This case reports the successful non-surgical endodontic management of a mandibular first molar with six root canal systems with three canals in the mesial root and three in the distal root. The classification of root canal systems found in this case was Sert and Bayirli type XV in both the roots. After non-surgical endodontic treatment, the tooth was restored definitively with a resin composite core followed by porcelain fused to the metal crown. This case adds to the library of previously reported cases of mandibular first molars with six root canals and further emphasises on the importance of rare morphological deviations that may occur in the mandibular first molars.

Complications associated with cheek tooth extraction in the horse

Common indications for cheek tooth extraction in the horse include dental fracture, periodontal disease, severe decay/ caries, mandibular fracture with alveolar/tooth involvement, and periapical abscess. Complications secondary to extraction of cheek teeth are prevalent. Typical complications may include retained root tip(s), collateral damage of neighboring teeth and alveolar bone, mandibular fracture non-union or delayed union, cemental ankylosis, dilacerated root(s), oroantral/oronasal fistula, palatal deviation of cheek teeth, bone sequestration, sinus involvement, alveolar plug failure, and palatine artery laceration. This paper presents a series of cases that had complications following cheek tooth extraction. Anticipation of problematic extractions, recognition of complications, and appropriate treatment will aid the clinician in managing the inevitable cheek tooth extraction complication.

Using cone beam computed tomography images to diagnose multiple taurodontisms

Taurodontism is a developmental anomaly that manifests as an alteration in a patient's internal morphology and is characterized by the lack of constriction at the level of the cementoenamel junction, which results in an apical extension of the pulp chamber that extends into the root area of a multiradicular tooth. This report presents a case of an otherwise healthy patient with 12 hypertaurodontic teeth, which were detected by using cone beam computed tomography (CBCT). It is essential to emphasize the importance of routine imaging examinations for diagnosing developmental dental anomalies such as taurodontism, as this condition is generally not found by routine oral examination, and is not necessarily restricted to syndromic patients. CBCT images contribute to the diagnosis of and treatment plan for taurodontism.

Taurodontism: A minor diagnostic criterion in Laurence-Moon/Bardet-Biedl syndromes

OBJECTIVE

The objective of the study was to present the prevalence of taurodontism in the permanent dentition in individuals with Laurence-Moon/Bardet-Biedl syndromes (LM/BBS).

METHODS AND PARTICIPANTS

Thirty-nine individuals were studied, which comprises the whole population of known LM/BBS patients in Norway. Data were collected retrospectively. Panoramic radiographs (OPG) were evaluated to document taurodontism.

RESULTS

Taurodontism was found in 82.9% of the individuals with LM/BBS. The second mandibular molars had the highest (72.3%) prevalence of taurodontism and the first mandibular molars the lowest (58.2%).

CONCLUSION

This study suggests that taurodontism should be included as a minor diagnostic criterion for the Laurence-Moon/Bardet-Biedl syndromes (LM/BBS).

Management of a 3-canal mandibular premolar in a patient with unusual root canal anatomy in all mandibular premolars

Endodontic treatment of mandibular premolars can be difficult due to their aberrant root canal anatomy. Successful nonsurgical root canal treatment requires knowledge of basic root and root canal morphology, and possible anatomical variations of the root canal system. Mandibular second premolars usually have a single root and a single canal, and the presence of 3 canals in separate roots is very rare. Nonsurgical endodontic treatment of such teeth is a challenge. This article presents a rare case of a mandibular second premolar with 3 root canals in separate roots and its endodontic management, with a special emphasis on radiographic interpretation and access refinement during treatment.

Taurodontism in deciduous molars

Taurodont teeth are characterised by large pulp chambers at the expense of roots. An enlarged pulp chamber, apical displacement of the pulpal floor and no constriction at the level of the cement-enamel junction are the characteristic features of taurodont tooth. It appears more frequently as an isolated anomaly but its association with syndromes and other abnormalities have also been reported. Permanent dentition is more commonly affected than deciduous dentition. This paper presents a case report of taurodontism in relation to mandibular deciduous second molars.

Missed canal systems are the most likely basis for endodontic retreatment of molars

Unfortunately, a small percentage of endodontically treated teeth do not respond favorably to non-surgical root canal treatment. Failure to cate and treat an additional nal system is cited as the principle basis for endodontic retreatment. The aim of this retrospective clinical study was to identify the incidence of additional or missed canal systems in molar retreatment cases in a private practice setting. Missed canals were identified in 64 of the 133 previously treated teeth (48%). Of the total missed canals, 11% involved a maxillary second molar and 44% involved a maxillary first molar. For the maxillary first molars, 93% of all missed canal were identified in the mesiobuccal root. In the mandibular second molars, 29% of missed canals were identified in the distal and 71% were identified in the mesial root. In the mandibular first molars, 86% of missed canals were identified in the distal and 14% were identified in the mesial root. The results of the current study support the findings of previous studies and confirm the importance of locating, instrumenting and obturating the endodontic treatment. Given that failure to locate all canal systems of a tooth contributes significantly to unsuccessful endodontic treatment, all measures available to the clinician to maximize canal identification should be used.

Nonsyndromic tooth agenesis patterns and associated developmental dental anomalies: a literature review with radiographic illustrations

Tooth agenesis is one of the most intriguing phenomena, because it is frequently associated with other oral anomalies, structural variations and malformations of other teeth, late eruption, transposition and crowding. The diagnosis can be quite challenging as radiographic examination is critical for the diagnosis but not always possible and the late developing teeth may be sometimes scored developmentally missing. Accurate diagnosis therefore requires radiographic, clinical, and dental cast examinations. It is an important clinical and public health problem. Patients with missing permanent teeth may suffer from a reduced chewing ability, inarticulate pronunciation, and an unfavorable aesthetic appearance. Clinically, early diagnosis of a dental anomaly can alert the clinician to the possible development of other associated dental anomalies in the same patient or family, and avoid the possible sequelae. Understanding of tooth agenesis patterns and their impact on diagnosis, prevention, and eventually therapeutics are becoming integral parts of comprehensive dental care. Dental examination with radiographic screening of hypodontia in early childhood should be emphasized as part of public oral health policy to allow early diagnosis and timely intervention.

Endodontic treatments of mandibular first molar with middle mesial canal: two case reports

The mandibular first molars mostly have two mesial canals. In this report, two cases of mandibular first molars with three mesial canals are presented. The middle mesial canal was detected under endodontic microscope and further confirmed by cone-beam computed tomography and angled radiography, respectively. The purpose of this paper was to highlight the possibility of an aberrant root canal in a mandibular first molar and to help reduce the failure rates of the dental pulp treatment of the mandibular first molar.

Maxillary first molar with three buccal roots evaluated with cone-beam computed tomography: a rare case report

This case report describes the nonsurgical endodontic management of a maxillary first molar with the unusual morphology of three separate buccal roots. An accurate assessment of this morphology was made with the help of cone-beam computed tomography (CBCT). This report also describes the varied root morphology associated with maxillary first molars and the role of CBCT as a diagnostic tool for managing these complex cases successfully.

Maxillary molar with two palatal canals

The endodontic treatment of maxillary molar with an aberrant root canal morphology can be diagnostically and technically challenging.1 Unusual root canal morphology in multirooted teeth is a constant challenge for diagnosis and successful endodontic treatment. Presence of extra canals, lateral canals, deltas is commonly encountered.2 This case report is presented to illustrate and describe the endodontic treatment of maxillary first molar with an unusual morphological variation of palatal root. The palatal root had two canals that appeared to unite in the apical third of the canal.

Endodontic management of two-rooted mandibular premolars using spiral computed tomography: a report of two cases

AIM

To present a unique case of mandibular first and second premolars with two roots and two root canals with the aid of spiral computed tomography (SCT).

BACKGROUND

Confirmation of morphology of mandibular first and second premolars with the aid of SCT.

CASE DESCRIPTION

Mandibular premolars usually have a single root and a single canal. The occurrence of two roots with two separate root canals is extremely rare. The use of SCT in this rare case greatly contributed toward making a confirmatory diagnosis and successful endodontic management.

CONCLUSION

Successful nonsurgical endodontic management of mandibular first and second premolars with two separate roots and root canals has been presented. In this case, exact root canal anatomy could not be confirmed by using radiographs alone. Hence, the use of SCT helped us in making a confirmatory diagnosis.

CLINICAL SIGNIFICANCE

Developmental anomalies can occur in any tooth and two rooted premolars are no exception. The complexity of such teeth has to be considered for planning endodontic treatment using latest diagnostic equipment to increase the chances of success.

Open apex type III dens invaginatus: a rare case report of an endodontic retreatment with an anatomical redesign

Dens invaginatus is a critical condition for endodontic treatment. It frequently presents a complex internal anatomy and might be associated with incomplete root and apical development. This article presents one of the few reported cases of endodontic retreatment of Type III dens invaginatus. First, the internal anatomy was modified using burs under an operating microscope. Next, conventional chemical and mechanical preparation with hand files and 2.5% sodium hypochlorite was performed. Finally, an intracanal dressing with calcium hydroxide was used for nine months, at which point the anatomical features in the root canal system could be accessed. Adequate periradicular healing was observed and regression of the lesion was noted at the two-year follow-up. This case reinforces the idea that knowledge about the biologic aspects of endodontics, combined with adherence to technical standards, is helpful in resolving complex cases.

Prevalence of taurodontism in primary mandibular first molars of ethnic Indian children

The objective of this study was to determine the prevalence of taurodontism in primary mandibular first molars in ethnic Indian children using periapical radiographs. Periapical radiographs of 274 children obtained from December 2008 to August 2010 were retrospectively screened and examined. Radiographs of 196 patients (99 boys and 97 girls; ages 2.5-10.5) with bilateral primary mandibular first molars were randomly selected and evaluated. The gender, symmetry, and frequencies of occurrence of taurodont primary mandibular first molars were compared and the obtained data were statistically analyzed using the x2 test. Eight (4.08%) taurodont primary mandibular first molars were found with a bilateral incidence of a symmetrical distribution of 38% (3/8). The prevalence of taurodontism in primary mandibular first molars did not differ significantly between right and left sides or with gender (P ≥ 0.05). The results of the present study indicate that approximately 4% of Indian children had taurodontism in primary mandibular first molars. Clinicians should be aware of the prevalence of this anatomic variant in primary mandibular first molars among the Indian population for early identification of taurodonts and for rendering the best care during dental treatment.

Dental Findings and Management in a Mucopolysaccharidosis Type IIIB Patient

Mucopolysaccharidosis type IIIB (MPS IIIB) is an autosomal recessive disorder caused by deficiency of the lysosomal enzyme a-N-acetylglucosaminidase. Affected subjects present developmental delay, attention deficit disorder, uncontrollable hyperactivity, and aggressive behavior, followed by progressive dementia and death in late adolescence. The purpose of this paper is to report the dental findings and treatment in a child with MPS IIIB. His primary molars and permanent mandibular incisors presented obliterated pulp chambers and root canals, which may be a clinical manifestation of this disorder.

Surgical resection technique of a fused supernumerary lateral incisor: a clinical report and review of the literature

This case report presents the surgical and restorative management of a fused supernumerary left lateral incisor. The diagnosis was confirmed using conventional radiographs and CT. The case report discusses the value of CT for evaluation of the root relationships and describes the varied morphology associated with supernumerary incisors, the surgical resection technique, partial pulpotomy, and restoration with composite resin after mechanical exposure of the remaining tooth's pulp.

Case report: Uncommon maxillary lateral incisor with a type 3 invagination and C-shaped root canal system

Dental practitioners are often called upon to provide endodontic services for patients in pain. Maxillary lateral incisors may present added concerns when planning endodontic services. Dens invaginatus (DI) Oehlers Type 3 classification is a relatively rare phenomenon that occurs primarily in maxillary lateral incisors. It is important to consider this condition in all maxillary lateral incisors and to be aware that it can be difficult to treat when the invagination extends past the epithelial attachment apparatus. Successful outcome may be severely compromised in these cases and requires interdisciplinary approaches. This case study describes a maxillary lateral incisor with DI Type 3 that was refractory to treatment.

Endodontic management of three-rooted maxillary first and second premolars: a case report

A thorough knowledge of root canal anatomy is essential for successful root canal treatment, because the number of roots and root canals in any tooth can vary. Failing to detect an extra root or canal can cause root canal treatment to fail. It is essential that clinicians interpret radiographs correctly to detect any anatomic variations and treat them successfully. Anatomic variations occur frequently in the root canal system of maxillary premolars; however, the presence of three separate root canals with three independent roots is rare. This article presents an unusual case of three-rooted maxillary first and second premolars, each with three distinct root canals.

Endodontic management of a maxillary first molar with eight root canal systems evaluated using cone-beam computed tomography scanning: a case report

INTRODUCTION

Root canal treatment of maxillary molars presenting with complex root canal configurations can be diagnostically and technically challenging.

METHODS

Nonsurgical endodontic therapy of a left maxillary first molar with three roots and eight root canals was successfully performed. This unusual morphology was diagnosed using a dental operating microscope (DOM) and confirmed with the help of cone-beam computed tomography (CBCT) images.

RESULTS

CBCT axial images showed that both the mesiobuccal and distobuccal root contained a Sert and Bayirli type XV canal, whereas the palatal root showed a Vertucci type II canal configuration.

CONCLUSIONS

The use of a DOM and CBCT imaging in endodontically challenging cases can facilitate a better understanding of the complex root canal anatomy, which ultimately enables the clinician to explore the root canal system and clean, shape, and obturate it more efficiently.

Diagnostic ability of computed tomography using DentaScan software in endodontics: case reports

Radiographic examination is essential in diagnosis and treatment planning in endodontics. Conventional radiographs depict structures in two dimensions only. The ability to assess the area of interest in three dimensions is advantageous. Computed tomography is an imaging technique which produces three-dimensional images of an object by taking a series of two-dimensional sectional X-ray images. DentaScan is a computed tomography software program that allows the mandible and maxilla to be imaged in three planes: axial, panoramic, and cross-sectional. As computed tomography is used in endodontics, DentaScan can play a wider role in endodontic diagnosis. It provides valuable information in the assessment of the morphology of the root canal, diagnosis of root fractures, internal and external resorptions, pre-operative assessment of anatomic structures etc. The aim of this article is to explore the clinical usefulness of computed tomography and DentaScan in endodontic diagnosis, through a series of four cases of different endodontic problems.

Interdisciplinary management of dental anomalies: fusion and supernumerary teeth

A 16-year-old boy presented with a fused permanent maxillary left central incisor with a supplemental tooth and an additional supplemental tooth lingual to the permanent maxillary right central incisor. Following leveling, alignment, and endodontic therapy, the maxillary fused left central incisor was sectioned and the mesial portion extracted as planned. Fixed orthodontic treatment commenced after 10 days to align the maxillary anterior segment. After completion, the midline diastema was closed with veneers. This case highlights the treatment options of a fused tooth and the need for multidisciplinary planning and treatment.

A case report of six canals in a maxillary first molar

Identifying the variations of root canal morphology is crucial prior to commencing any endodontic treatment. The advancement of current endodontic instrumentation and technology has greatly enhanced treatment outcomes, which are now more predictable. This clinical case report presents a case of a maxillary first molar showing six root canals and apical foramina, i.e. three mesiobuccal canals, two palatal canals and one distobuccal canal. The occurrence of bifurcation in the second mesiobuccal canal is also emphasised.

Maxillary lateral incisor with two roots: a case report

Although the dental literature has indicated that 100% of maxillary lateral incisors have a single canal anatomy, it is possible for these teeth to have extra canals. These extra canals must be identified and debrided to prevent endodontic failure. This report presents an uncommon case involving a maxillary lateral incisor with two roots. Even when the frequency of radicular anatomy abnormality is extremely low, dentists must consider the possibility that a tooth has extra root canals or even extra roots.