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Martins JNR. Worldwide Prevalence of Single-rooted with a Single Root Canal and Four-rooted Configurations in Maxillary Molars: A Multi-center Cross-sectional Study with Meta-analysis. J Endod 2024; 50:1254-1272. [PMID: 38936508 DOI: 10.1016/j.joen.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION To evaluate the prevalence of single root with a single root canal and four-root configurations in the maxillary first and second molars, and analyze how geographic region, ethnicity, sex, and age impact these outcomes. METHODS Researchers from 44 nations examined 26,400 maxillary molars using cone-beam computed tomography scans to gather data on the proportions of single roots with single canals and four-root configurations. All observers underwent prior calibration regarding the step-by-step assessment protocol and anatomical concepts to ensure consistent evaluations across all assessed locations. Tests were conducted to evaluate the intraobserver and interobserver reliability. Demographic data including ethnicity, gender, and age were collected for each participant. The potential impact of imaging voxel size and field-of-view on bias was also assessed. The primary results were depicted as odds ratios and untransformed proportion forest plots with 95% confidence intervals. Additionally, a meta-analysis was performed to compare various subgroups and identify sources of variation among them. Statistical significance was set at 5%. RESULTS The prevalence of single-rooted with a single canal and four-rooted configurations in the maxillary first molar was 0.16% and 0.28%, respectively, while in the maxillary second molar, it was 2.56% and 0.83%. Males tended to exhibit lower percentages of single roots with a single canal (P < .05) and higher percentages of four-rooted configurations (P > .05) in the second molar, whereas the African subgroup displayed lower proportions for both configurations. Additionally, in both teeth, single roots with a single canal were more prevalent among older patients. Voxel size and field-of-view did not significantly influence the results (P > .05). CONCLUSIONS The proportions of single-rooted with a single canal and four-rooted configurations were low, and demographic factors such as geographic region, ethnicity, sex, and age may have influenced the outcomes for the maxillary second molar.
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Affiliation(s)
- Jorge N R Martins
- Faculdade de Medicina Dentária, Department of Endodontics, Universidade de Lisboa, Lisbon, Portugal; Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal.
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Jonker CH, L'Abbé EN, van der Vyver PJ, Zahra D, Oettlé AC. A micro-computed tomographic evaluation of maxillary first molar root canal morphology in Black South Africans. J Oral Sci 2024; 66:151-156. [PMID: 38853002 DOI: 10.2334/josnusd.24-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
PURPOSE This study was conducted to investigate the root canal anatomy of maxillary first molars in Black South Africans. METHODS Micro-computed tomography was used to investigate 101 maxillary first molars (53 teeth from the right, 48 from the left; 50 male and 51 female teeth). The number of root canals in each tooth was determined, and the relationship between side, sex and age was analyzed using chi-squared test. To determine intra- and inter-observer reliability, Cohen's kappa coefficients were calculated. RESULTS Intra- and inter-rater agreements of 96.92% and 98.08% were achieved, respectively. Most teeth contained either three or four canals, but a second, third and fourth mesio-buccal canal was found in 60.39%, 5.94% and 0.99% of teeth, respectively. The disto-buccal and palatal roots contained predominantly single canals, but additional canals were noted in 2.97% and 1.98% of teeth. Four canals were common in females and teeth on the right side often contained a second mesio-buccal canal. However, the prevalence of a third mesio-buccal canal was higher in males than in females. CONCLUSION The teeth studied showed diversity and variations between sexes and arch sides. These findings will aid clinicians in endodontic treatment and will be applicable for educational purposes.
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Affiliation(s)
- Casper H Jonker
- Faculty of Health, Peninsula Dental School, University of Plymouth, Truro Dental Education Facility, Knowledge Spa, Royal Cornwall Hospital
- Department of Anatomy, Forensic Anthropology Research Centre, Faculty of Health Sciences, University of Pretoria
| | - Ericka N L'Abbé
- Department of Anatomy, Forensic Anthropology Research Centre, Faculty of Health Sciences, University of Pretoria
| | | | - Daniel Zahra
- Peninsula Medical and Dental Schools, Faculty of Health, University of Plymouth
| | - Anna C Oettlé
- Anatomy and Histology Department, School of Medicine, Sefako Makgatho Health Sciences University
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Choudhari S, Venkata Teja K, Ramesh S, Jose J, Cernera M, Soltani P, Nogueira Leal da Silva EJ, Spagnuolo G. Assessment of Anatomical Dentin Thickness in Mandibular First Molar: An In Vivo Cone-Beam Computed Tomographic Study. Int J Dent 2024; 2024:8823070. [PMID: 38938693 PMCID: PMC11208803 DOI: 10.1155/2024/8823070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/21/2024] [Accepted: 05/21/2024] [Indexed: 06/29/2024] Open
Abstract
Aim To determine the minimum dentin thickness in the mesial and distal walls of the mesiobuccal (MB) and mesiolingual (ML) canals of the mandibular first molars using cone-beam computed tomography (CBCT). Materials and Methods CBCT examinations of 624 mandibular first molars from an Indian subpopulation were analyzed. The mesial and distal minimum dentin thickness was evaluated in 1 mm intervals apical to the furcation area. Independent t-test was used to analyze the data (α = 0.05). Using Cohen's kappa coefficient, the interexaminer and intraexaminer reliability was evaluated. Results The mesial dentin thickness was significantly higher than the distal dentin thickness for MB and ML canals (P=0.01). The average dentin thickness in the distal and mesial plane of the MB canal was 1.15 ± 0.15 mm and 1.52 ± 0.19 mm at the 1 mm level and 0.83 ± 0.13 and 1.08 ± 0.18 at the 5 mm level, respectively. For the ML canal, the average dentin thickness in the distal plane and the mesial plane was 1.24 ± 0.18 mm and 1.44 ± 0.21 at the 1 mm level and 0.91 ± 0.16 and 1.01 ± 0.17 at the 5 mm level, respectively. Statistical analysis between the MB and ML canals showed significant differences in the dentin thickness at 4 and 5 mm levels in both the distal and the mesial planes (P=0.01). In more than 85% of the cases, the minimum dentin thickness was seen at the 5 mm level in both the distal and mesial planes in MB and ML canals. Conclusion The distal planes of the mesiolingual and mesiobuccal canals were thinner in most cases, making the distal surface more prone to iatrogenic perforations. Considerably, at 4 and 5 mm from the furcation, the distal wall was significantly thinner than the mesial walls. Understanding the anatomy of the danger zone in the mesial roots of the mandibular first molars may serve to minimize the risk of endodontic mishaps such as strip perforations.
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Affiliation(s)
- Sahil Choudhari
- Department of Conservative Dentistry and EndodonticsSaveetha Dental CollegeSaveetha Institute of Medical and Technical SciencesSaveetha University, Chennai, Tamil Nadu, India
| | - Kavalipurapu Venkata Teja
- Department of Conservative Dentistry and EndodonticsSaveetha Dental CollegeSaveetha Institute of Medical and Technical SciencesSaveetha University, Chennai, Tamil Nadu, India
| | - Sindhu Ramesh
- Department of Conservative Dentistry and EndodonticsSaveetha Dental CollegeSaveetha Institute of Medical and Technical SciencesSaveetha University, Chennai, Tamil Nadu, India
| | | | - Mariangela Cernera
- Department of NeuroscienceReproductive and Odontostomatological SciencesUniversity of Naples, Federico II, Via Pansini n°5, Naples 80131, Italy
| | - Parisa Soltani
- Department of NeuroscienceReproductive and Odontostomatological SciencesUniversity of Naples, Federico II, Via Pansini n°5, Naples 80131, Italy
| | - Emmanuel João Nogueira Leal da Silva
- Department of EndodonticsSchool of DentistryGrande Rio University (UNIGRANRIO), Duque de Caxias, Brazil
- Department of EndodonticsSchool of DentistryRio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Gianrico Spagnuolo
- Department of NeuroscienceReproductive and Odontostomatological SciencesUniversity of Naples, Federico II, Via Pansini n°5, Naples 80131, Italy
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Duman ŞB, Çelik Özen D, Bayrakdar IŞ, Baydar O, Alhaija ESA, Helvacioğlu Yiğit D, Çelik Ö, Jagtap R, Pileggi R, Orhan K. Second mesiobuccal canal segmentation with YOLOv5 architecture using cone beam computed tomography images. Odontology 2024; 112:552-561. [PMID: 37907818 DOI: 10.1007/s10266-023-00864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023]
Abstract
The objective of this study is to use a deep-learning model based on CNN architecture to detect the second mesiobuccal (MB2) canals, which are seen as a variation in maxillary molars root canals. In the current study, 922 axial sections from 153 patients' cone beam computed tomography (CBCT) images were used. The segmentation method was employed to identify the MB2 canals in maxillary molars that had not previously had endodontic treatment. Labeled images were divided into training (80%), validation (10%) and testing (10%) groups. The artificial intelligence (AI) model was trained using the You Only Look Once v5 (YOLOv5x) architecture with 500 epochs and a learning rate of 0.01. Confusion matrix and receiver-operating characteristic (ROC) analysis were used in the statistical evaluation of the results. The sensitivity of the MB2 canal segmentation model was 0.92, the precision was 0.83, and the F1 score value was 0.87. The area under the curve (AUC) in the ROC graph of the model was 0.84. The mAP value at 0.5 inter-over union (IoU) was found as 0.88. The deep-learning algorithm used showed a high success in the detection of the MB2 canal. The success of the endodontic treatment can be increased and clinicians' time can be preserved using the newly created artificial intelligence-based models to identify variations in root canal anatomy before the treatment.
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Affiliation(s)
- Şuayip Burak Duman
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inonu University Malatya, Malatya, Turkey.
| | - Duygu Çelik Özen
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inonu University Malatya, Malatya, Turkey
| | - Ibrahim Şevki Bayrakdar
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Oğuzhan Baydar
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ege University İzmir, İzmir, Turkey
| | | | | | - Özer Çelik
- Department of Mathematics-Computer, Faculty of Science, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Rohan Jagtap
- Division of Oral and Maxillofacial Radiology, Department of Care Planning and Restorative Sciences, Medical Center School of Dentistry, University of Mississippi, Jackson, MS, USA
| | - Roberta Pileggi
- Department of Endodontics, College of Dentistry, University of Florida, Florida, USA
| | - Kaan Orhan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Huang D, Wang X, Liang J, Ling J, Bian Z, Yu Q, Hou B, Chen X, Li J, Ye L, Cheng L, Xu X, Hu T, Wu H, Guo B, Su Q, Chen Z, Qiu L, Chen W, Wei X, Huang Z, Yu J, Lin Z, Zhang Q, Yang D, Zhao J, Pan S, Yang J, Wu J, Pan Y, Xie X, Deng S, Huang X, Zhang L, Yue L, Zhou X. Expert consensus on difficulty assessment of endodontic therapy. Int J Oral Sci 2024; 16:22. [PMID: 38429281 PMCID: PMC10907570 DOI: 10.1038/s41368-024-00285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/19/2024] [Indexed: 03/03/2024] Open
Abstract
Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.
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Affiliation(s)
- Dingming Huang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Jingping Liang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Junqi Ling
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Zhuan Bian
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qing Yu
- Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Benxiang Hou
- Department of Endodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Xinmei Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ling Ye
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tao Hu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hongkun Wu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Geriatric dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bin Guo
- Department of Stomatology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qin Su
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhi Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lihong Qiu
- Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Wenxia Chen
- College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Xi Wei
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Zhengwei Huang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jinhua Yu
- Department of Endodontics, School and Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Zhengmei Lin
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Qi Zhang
- Department of Endodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Deqin Yang
- Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Zhao
- Department of Endodontics, First Affiliated Hospital of Xinjiang Medical University, and College of Stomatology of Xinjiang Medical University, Urumqi, China
| | - Shuang Pan
- Department of Endodontics, Schoolof Stomatology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jian Yang
- Department of Endodontics, The Affiliated Stomatological Hospital of Nanchang University, Nanchang, China
| | - Jiayuan Wu
- Key Laboratory of Oral Disease Research, School of Stomatology, Zunyi Medical University, Zunyi, China
| | - Yihuai Pan
- Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Xiaoli Xie
- Department of Cariology and Endodontics, Xiangya Stomatological School, Central South University, Changsha, China
| | - Shuli Deng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xiaojing Huang
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Lan Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Yue
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China.
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Alotaibi BB, Khan KI, Javed MQ, Dutta SD, Shaikh SS, Almutairi NM. Relationship between apical periodontitis and missed canals in mesio-buccal roots of maxillary molars: CBCT study. J Taibah Univ Med Sci 2024; 19:18-27. [PMID: 37868101 PMCID: PMC10585297 DOI: 10.1016/j.jtumed.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/02/2023] [Accepted: 08/30/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives The objectives of this study were to: (1) assess the frequency of missed canals in the mesiobuccal root (MB) of endodontically treated maxillary molars and its association with apical periodontitis (AP); (2) examine the correlation between the presence of a confluent or separate missed MB2 canal and the prevalence of AP; and (3) examine the correlation between the technical quality of endodontic treatment in the MB1 canal and the prevalence of AP. Methods We obtained and examined 800 cone-beam computed tomography (CBCT) scans from 800 patient records over 6 months. The parameters noted for each tooth included the tooth number; presence of missed canals in the MB root; configuration of missed MB2 canals (confluent or separate); technical acceptability of root canal treatment (RCT) of treated MB1 canals; and the CBCT periapical index score. Data were analyzed in SPSS version 24. Results A total of 203 maxillary molars from 148 CBCT scans were included. The MB2 canal prevalence was 88.2% in maxillary first molars and 62.7% in maxillary second molars. MB2 was found in 164 endodontically treated maxillary molars. During treatment, MB2 was missed in 150 (91.5%) and treated in 14 (8.5%) teeth. A total of 103 teeth (50.73%) had AP, which was observed in 67.3% of teeth with a missed MB2 canal but only 14.3% of teeth with a treated MB2 canal. The prevalence of AP was 43.7% in teeth with confluent MB2 canals and 80.9% in teeth with separate MB2 canals. Conclusion The MB2 canal frequency was significantly higher in the examined maxillary first molars than the maxillary second molars. The MB2 canal was missed in most teeth that underwent endodontic treatment. The AP prevalence was relatively higher in endodontically treated maxillary molars with missed MB2 canals.
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Affiliation(s)
- Badi B. Alotaibi
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, Buraidah, KSA
| | - Kiran I. Khan
- Department of Operative Dentistry, Frontier Medical and Dental College, Abbottabad, Pakistan
| | - Muhammad Q. Javed
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, Buraidah, KSA
| | - Smita D. Dutta
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, Buraidah, KSA
| | - Safia S. Shaikh
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Qassim University, Buraidah, KSA
| | - Nawaf M. Almutairi
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, Buraidah, KSA
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Nouroloyouni A, Nazi Y, Mikaieli Xiavi H, Noorolouny S, Kuzekanani M, Plotino G, Walsh JL, Sheikhfaal B, Alyali R, Tavakkol E. Cone-Beam Computed Tomography Assessment of Prevalence of Procedural Errors in Maxillary Posterior Teeth. BIOMED RESEARCH INTERNATIONAL 2023; 2023:4439890. [PMID: 38116330 PMCID: PMC10730252 DOI: 10.1155/2023/4439890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
A range of procedural errors can occur when performing endodontic treatment on posterior teeth. These errors may decrease the success rate in endodontic practice. This study assessed the prevalence of procedural errors and the quality of endodontic treatments in maxillary molars and premolars using cone-beam computed tomography (CBCT). CBCT scans from two private radiology centers were assessed retrospectively to ensure the same calculated sample size of 327 teeth for each of the four maxillary posterior tooth types (a total of 1,308 endodontically treated teeth). Image sets were evaluated for procedural errors categorized as follows: obturation length (overfilling or underfilling by >2 mm short of the root apex), missed canals, perforations, strip perforations (with extrusion of material into the furcation area), separated instruments in the root canal space, and root fracture. Data were analyzed with SPSS version 20 (SPSS Inc., Chicago, IL, USA), and frequency data was assessed using the Monte Carlo test at the 0.05 level of significance. The procedural errors most commonly reported in the present study were from most frequent to least frequent: underfilled canals (50.0%), missed canals (27.5%), overfilled canals (12.5%), apical perforations (5.0%), separated instruments (3.1%), and root fractures (1.9%). No strip perforations (with extrusion of material into the furcation area) were seen in the study (0%). Underfilled and missed root canals were the most frequent procedural errors identified in the present study. These findings underline the importance of more consideration of critical working length management during all stages of root canal treatment, greater awareness of root canal anatomy, and the use of imaging and diagnostic devices that enhance the ability to identify and treat root canals both safely and effectively.
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Affiliation(s)
- Ahmad Nouroloyouni
- Department of Endodontics, School of Dentistry, Ardabil University of Medical Science, Ardabil, Iran
| | - Yousef Nazi
- Department of Endodontics, School of Dentistry, Ardabil University of Medical Science, Ardabil, Iran
| | | | - Sara Noorolouny
- Department of Pediatric Dentistry, School of Dentistry, Ardabil University of Medical Science, Ardabil, Iran
| | - Maryam Kuzekanani
- Endodontology Research Center, Department Of Endodontics, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Gianluca Plotino
- Private Practice, Grande Plotino & Torsello Studio di Odontoiatria, 00187 Rome, Italy
| | - James Laurence Walsh
- UQ Oral Health Centre, School of Dentistry, The University of Queensland, Brisbane, Australia
| | - Behzad Sheikhfaal
- Department of Endodontics, School of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
| | - Rashin Alyali
- Department of Radiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Elham Tavakkol
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
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Srivastava S, Aldakhail NS, Javed MQ. Morphometric relationships in mesio-buccal roots of maxillary first molars in Saudi subpopulation: A CBCT study. AUST ENDOD J 2023; 49:614-622. [PMID: 37665125 DOI: 10.1111/aej.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
This CBCT-based study analysed morphometric relationships in Mesio-Buccal (MB) roots of maxillary first molars (MFM). 133 MFM with two MB canals were assessed and classified using Vertucci's classification. MB roots' length and MB1-MB2 canals inter-orifice distances (IOD) were noted. The data were analysed using SPSS software. The most frequently present canal was type IV (59.4%) followed by type II (40.6%). Mean MB roots' length for canals exhibiting type IV was 9.26 ± 0.21 mm and of those exhibiting type II was 12.8 ± 0.42 mm. Statistically significant relationship was found between MB root length and canal type. Mean IOD for type II and type IV canals was 2.4 ± 0.47 and 3.8 ± 0.21 mm, respectively. Statistically significant relationship was found between IOD and canal type. Length of MB root and IOD had a significant association with canal type present in MFM. This knowledge can enhance clinicians' understanding of canal morphology which can increase predictability and success rate of endodontic treatment.
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Affiliation(s)
- Swati Srivastava
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, Buraidah, Saudi Arabia
| | | | - Muhammad Qasim Javed
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, Buraidah, Saudi Arabia
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Wu L, Ha WN, Decurcio DA, Estrela C, Rossi-Fedele G. Comparison of Curvature Severity Between Sagittal and Coronal Planes of Mesiobuccal Canals in Permanent Maxillary First Molars Using Multiple Complexity-risk Criteria: A CBCT Cross-sectional Study of a Brazilian Subpopulation. J Endod 2023; 49:1682-1689.e4. [PMID: 37816431 DOI: 10.1016/j.joen.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION This study aimed to compare the curvature severity of mesio-buccal (MB) canals between sagittal and coronal planes using cone-beam computed tomography. METHODS In a Brazilian subpopulation, untreated MB1 (n = 141) and MB2 (n = 72) with single curvatures in sagittal and coronal planes were measured to determine their angle and radius (r), plus the prevalence of S-shaped canals was recorded. Curvature severity was defined according to the American Association of Endodontists Case Difficulty Assessment form (AAE) and EndoApp (EA), as well as their modified versions that consider angle and radii (AAE-r, EA-r). Data were converted into mean angle and r, percentage of canals >30°, AAE, EA, AAE-r and EA-r categories. The influence of r on case severity was assessed. Statistical analysis was performed using t-tests and chi-squared tests. The level of significance was set as P ≤ .05. RESULTS For single curvatures, significantly higher mean degrees (SD) angles were found in the sagittal views in both canals (MB1 sagittal: 35 [11]; MB1 coronal: 13 [13]; MB2 sagittal: 29 [14]; MB2 coronal: 22 [15] [P < .05]). A greater percentage of angles >30° (MB1: 56.7% vs 6.4%; MB2: 44.4% vs 22.2%) in sagittal planes compared to coronal planes was also found. Conversely, a higher prevalence of S-shaped canals (MB1: 33.3% vs 7.1% MB2: 31.9% vs 15.3%) was observed in coronal planes. Significant differences between AAE and AAE-r were present with greater case severity when radii were considered (P < .05). CONCLUSIONS Sagittal planes were associated with more severe single curvatures, while coronal planes had a greater prevalence of S-shaped canals.
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Affiliation(s)
- Lee Wu
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - William Nguyen Ha
- Department of Endodontics, Sydney Dental School, University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Giampiero Rossi-Fedele
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.
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10
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Liu J, Tang B, Xu X. Concurrency of additional canals in mandibular incisors and second mesiobuccal canal in maxillary first molars: A cone-beam computed tomography investigation. AUST ENDOD J 2023; 49:563-573. [PMID: 37548258 DOI: 10.1111/aej.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/08/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
This study investigated the concurrency of additional canals in mandibular incisors and the second mesiobuccal canal in maxillary first molars among the Chinese population. In total, 8644 cone-beam computed tomography images from 8644 patients with bilateral mandibular incisors and maxillary first molars were examined. The data were analysed using Chi-square test, binary logistic regression analysis and receiver operating characteristic curve. Among the patients with additional canals in mandibular central and lateral incisors, 96.2% and 95.5% of them had second mesiobuccal canal in maxillary first molars, respectively. Additional canals of mandibular incisors and second mesiobuccal canal in maxillary first molars exhibited a concurrent relationship. The prevalence of second mesiobuccal canal in maxillary first molars increased with the number of mandibular incisors with additional canals. Moreover, when there was at least one mandibular incisor with additional canals, the presence of the second mesiobuccal canal in maxillary first molars could be highly expected.
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Affiliation(s)
- Jinchi Liu
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bei Tang
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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11
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Machado R, Pamplona GF, de Souza Júnior C, Nascimento J, Back EDEE, Comparin D, Ignácio SA, Reinke SMG, Kovalik AC, da Silva Neto UX. Clinical determination of anatomical diameter in different dental groups correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis: an observational clinical study. Sci Rep 2023; 13:16215. [PMID: 37758735 PMCID: PMC10533535 DOI: 10.1038/s41598-023-41967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this observational clinical study (OCS) was to determine the clinical anatomical diameter (CAD) in several dental groups, thus correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis. Three-hundred fifty-nine teeth/584 vital or necrotic root canals from patients of both genders and different ages composed the sample. After performing the necessary previous procedures, K-Flexofiles were used to determine the CAD. Then, the gender and age of the patients, as well as the pulpoperiradicular diagnosis of the teeth were tabulated to conduct the statistical analysis (p < 0.05). Of the 359 teeth/584 root canals evaluated, 208/342 were from women (mean age 38.85 ± 13.42 years) and 151/242 were from men (mean age 45.41 ± 14.90 years). Statistically significant differences between the CAD means of root canals from women and men were not identified (p = 0.411). The analysis of the correlation between the CAD and age also showed a total independence (p = 0.271). Teeth with pulp necrosis and asymptomatic apical periodontitis diagnosed radiographically (TPNAAPDR) had a significantly larger CAD mean than teeth with pulp necrosis and no asymptomatic apical periodontitis diagnosed radiographically (TPNNAAPDR) and teeth with vital pulp and normal apical tissues (TVPNAT) (p = 0.0297); and the last two did not differ statistically (p > 0.05). The largest CAD mean was observed in single canals of maxillary central incisors. The lowest values of this variable were identified in the mesiobuccal and mesial canals of maxillary and mandibular first molars, respectively. The CAD of the root canals was influenced only by the root canal/tooth and pulpoperiradicular diagnosis.
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Affiliation(s)
- Ricardo Machado
- Department of Endodontics, School of Dentistry, Regional University of Blumenau-FURB, Rua São Paulo, 2171, Itoupava Seca, Blumenau, Santa Catarina, 89030-001, Brazil.
| | - Gabriel Filipe Pamplona
- Department of Endodontics, School of Dentistry, Regional University of Blumenau-FURB, Rua São Paulo, 2171, Itoupava Seca, Blumenau, Santa Catarina, 89030-001, Brazil
| | | | - Jaqueline Nascimento
- Department of Endodontics, School of Dentistry, Pontifical Catholic University of Paraná-PUC/PR, Curitiba, Paraná, Brazil
| | | | - Daniel Comparin
- Department of Endodontics, School of Dentistry, Paranaense University-UNIPAR, Francisco Beltrão, Paraná, Brazil
| | - Sérgio Aparecido Ignácio
- Department of Biostatistics, School of Dentistry, Pontifical Catholic University of Paraná-PUC/PR, Curitiba, Paraná, Brazil
| | - Stella Maria Glaci Reinke
- Department of Endodontics, School of Dentistry, Regional University of Blumenau-FURB, Rua São Paulo, 2171, Itoupava Seca, Blumenau, Santa Catarina, 89030-001, Brazil
| | - Ana Cristina Kovalik
- Department of Periodontics, School of Dentistry, Regional University of Blumenau-FURB, Blumenau, Santa Catarina, Brazil
| | - Ulisses Xavier da Silva Neto
- Department of Endodontics, School of Dentistry, Regional University of Blumenau-FURB, Rua São Paulo, 2171, Itoupava Seca, Blumenau, Santa Catarina, 89030-001, Brazil
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12
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Buchanan GD, Gamieldien MY, Fabris-Rotelli I, Van Schoor A, Uys A. Root and canal morphology of maxillary second molars in a Black South African subpopulation using cone-beam computed tomography and two classifications. AUST ENDOD J 2023; 49 Suppl 1:217-227. [PMID: 36420941 DOI: 10.1111/aej.12720] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/18/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
This study investigated the root and canal morphology of maxillary second molars in a Black South African population using high-resolution cone-beam computed tomography. In total, 386 maxillary second molar teeth were evaluated and described according to the classifications of Vertucci (with the additions of Sert and Bayirli), as well as Ahmed et al. Root number, fusions and canal morphology were recorded. Relationships between morphology, sex and age were assessed using Fisher's exact test (p < 0.05). Maxillary second molars were predominantly three-rooted (96.1%), with root fusion observed in 14%. No relationships between sex, age and canal morphology were found. Additional canals were observed in 67.4% of mesiobuccal roots. The Ahmed et al. classification provided a better overall description of the morphology. In this population, maxillary second molar teeth exhibited a diversity of root and canal morphology. Complex variations may render endodontic management more difficult and increase the possibility of missed anatomy.
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Affiliation(s)
- Glynn Dale Buchanan
- Department of Odontology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mohamed Yasin Gamieldien
- Department of Maxillofacial and Oral Surgery, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Inger Fabris-Rotelli
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
| | - Albert Van Schoor
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Andre Uys
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Pessotti VP, Jiménez-Rojas LF, Alves FRF, Rôças IN, Siqueira JF. Post-treatment apical periodontitis associated with a missed root canal in a maxillary lateral incisor with two roots: A case report. AUST ENDOD J 2023; 49:380-385. [PMID: 35801358 DOI: 10.1111/aej.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
Missed canals can be a common cause of persistent intraradicular infection and post-treatment apical periodontitis. This article reports on a rare case of a maxillary lateral incisor with two roots exhibiting symptomatic post-treatment apical periodontitis regardless of a radiographically adequate root canal treatment. The second root, which was only revealed by cone-beam computed tomography, had passed unnoticed during the first treatment, and its missed canal was the most likely cause of symptoms and treatment failure. Reintervention including the proper management of the extra root canal and retreatment of the main canal resulted in the resolution of symptoms and periradicular tissue healing. This case report reinforces the need for three-dimensional radiographic diagnosis to search for the cause of post-treatment disease and guide the decision-making process for proper management.
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Affiliation(s)
- Vanessa P Pessotti
- EndoChat Research Group, Rio de Janeiro, Brazil
- Private Practice, Vila Velha, Brazil
| | - Luis F Jiménez-Rojas
- EndoChat Research Group, Rio de Janeiro, Brazil
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Flávio R F Alves
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Brazil
| | - Isabela N Rôças
- EndoChat Research Group, Rio de Janeiro, Brazil
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Brazil
| | - José F Siqueira
- EndoChat Research Group, Rio de Janeiro, Brazil
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Brazil
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14
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Rosado LPL, Freitas DQ, Rovaris K, Oliveira ML, Neves FS. Can maxillary molar dimensions predict the presence of the second mesiobuccal canal? Oral Radiol 2023; 39:482-490. [PMID: 36266556 DOI: 10.1007/s11282-022-00661-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the potential of maxillary molar dimensions as predictors of the presence of the second mesiobuccal (MB2) canal. METHODS Micro-computed tomography scans were obtained from 47 maxillary molars, out of which 26 had the MB2 canal. The distance between root canals, extension of the canals, and thickness of surrounding dentin were obtained from axial images at the furcation level, 3 mm from the apex, and 5 mm from the apex. The association between the measurements and the presence of the MB2 canal was assessed using multiple logistic regression and odds ratio. RESULTS At the furcation level, the bucco-palatal extension of the MB1 canal significantly decreased the chance of the presence of the MB2 canal. Regarding the thickness of surrounding dentin measurements, the mesial and distal aspects of the MB1 canal at 3 mm from the apex were statistically significant to decrease and increase the chance of presence of the MB2 canal, respectively. Regarding the extension of the canals, only buccal-palatal extension seems to decrease the chance of the presence of the MB2 canal. CONCLUSION The presence of the MB2 canal in the mesiobuccal root of maxillary molars is associated with the bucco-palatal extension and surrounding dentin thickness of the first mesiobuccal canal, and seems to be unrelated to the dimensions of the distobuccal and palatal roots.
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Affiliation(s)
- Lucas P Lopes Rosado
- Division of Oral Radiology, Piracicaba Dental School, Department of Oral Diagnosis, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, 13414-903, Brazil.
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Piracicaba Dental School, Department of Oral Diagnosis, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, 13414-903, Brazil
| | - Karla Rovaris
- Department of Pathology and Dentistry Clinic, School of Dentistry, Federal University of Piauí (UFPI), Teresina, Piauí, Brazil
| | - Matheus L Oliveira
- Division of Oral Radiology, Piracicaba Dental School, Department of Oral Diagnosis, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, 13414-903, Brazil
| | - Frederico Sampaio Neves
- Division of Oral Radiology, Piracicaba Dental School, Department of Oral Diagnosis, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, 13414-903, Brazil
- Division of Oral Radiology, School of Dentistry, Department of Propedeutics and Integrated Clinic, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
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15
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Wahidi A, Ha WN, Alvino LM, Nagendrababu V, Rossi-Fedele G. Association between intracanal medicament radiopacity and streak artifact production using cone-beam computed tomography: a laboratory study. J Endod 2023:S0099-2399(23)00239-X. [PMID: 37149086 DOI: 10.1016/j.joen.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION This study aimed to calculate the correlation between the radiopacity levels of various intracanal medicaments and radiolucent streak formation using cone-beam computed tomography (CBCT). METHODS 7 commercially-available intracanal medicaments were tested, which contained different amounts of radiopacifier [Consepsis, Ca(OH)2, UltraCal XS, Calmix, Odontopaste, Odontocide, and Diapex Plus]. Their radiopacity levels were measured according to the ISO 13116 testing standards (mmAl). Subsequently, the medicaments were placed in 3 canals of radiopaque artificial printed maxillary molars (n=15 roots per medicament), leaving the second mesiobuccal canal empty. CBCT imaging was carried out using an Orthophos SL 3D scanner under recommended manufacturer exposure settings. Radiopaque streak formation was assessed by a calibrated examiner using a previously published grading system (0-3). The Kruskal-Wallis and Mann-Whitney U tests with and without Bonferroni correction were used to compare radiopacity levels and radiopaque streak scores for the medicaments. Their relationship was assessed using the Pearson correlation coefficient. The level of significance was set as (α=0.05). RESULTS Diapex plus presented with the highest radiopacity levels (4.98±0.01) and radiopaque streak scores [middle third (2.8±0.18); apical third (2.73±0.43)]; which was similar to UltraCal XS's radiopaque streak scores [middle third (2.8±0.92); apical third (2.73±0.77)]. Consepsis had the lowest radiopacity levels (0.12±0.05), followed by Odontocide (0.60±0.05). Consepsis and Ca(OH)2 were scored 0 for artifacts in all roots at all levels. A high positive correlation (R=0.95) was found between radiopacity and streak formation. CONCLUSIONS The radiopacity of intracanal medicaments varies and strongly correlates with the formation of radiolucent streak artifacts during CBCT.
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Affiliation(s)
- Alizafar Wahidi
- Adelaide Dental School, University of Adelaide, Adelaide, SA 5005, Australia
| | - William Nguyen Ha
- Sydney Dental School, University of Sydney, Sydney, New South Wales, Australia
| | - Lawrence M Alvino
- Adelaide Dental School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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Mishra A, Natanasabapathy V, Kowsky D, Sharan J, Marya A. Variation in location of the distobuccal root canal in a permanent maxillary second molar: A case report. Clin Case Rep 2023; 11:e7312. [PMID: 37151948 PMCID: PMC10160812 DOI: 10.1002/ccr3.7312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
Key Clinical Message Clinicians should be aware of the variations in the number of roots and root canals and the peculiar or eccentric location of root canals. An intraoperative CBCT can be very useful in improved visualization of the anatomical variations. Abstract This case report describes the unusual location of the distobuccal root canal in a maxillary second molar with root fusion. On access opening, three distinct root canal orifices, the mesiobuccal canal, palatal canal, and a third orifice closer to the palatal canal, were seen, giving an illusion of an additional palatal canal. An attempt was made to search for the distobuccal canal in its usual position, leading to the gouging of the pulp chamber floor. An intraoperative limited field of view cone-beam computed tomography (CBCT) revealed the root orifice adjacent to the palatal canal was the distobuccal canal. CBCT also revealed fusion of both the buccal and palatal roots in the root's coronal and middle third region, but they were not fused apically.
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Affiliation(s)
- Anisha Mishra
- Department of DentistryAll India Institute of Medical SciencesBhubaneswarIndia
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of DentistryMeenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER)ChennaiIndia
| | - Dinesh Kowsky
- Department of Conservative Dentistry and Endodontics, Faculty of DentistryMeenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER)ChennaiIndia
| | - Jitendra Sharan
- Unit of Orthodontics and Dentofacial Orthopedics, Department of DentistryAll India Institute of Medical SciencesBhubaneswarIndia
| | - Anand Marya
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
- Center for Transdisciplinary ResearchSaveetha Dental College, Saveetha Institute of Medical and Technical ScienceSaveetha UniversityChennaiIndia
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Normando PHC, Santos JCMD, Akisue E, Paiva HC, Candeiro GTDM. Location of the Second Mesiobuccal Canal of Maxillary Molars in a Brazilian Subpopulation: Analyzing Using Cone-beam Computed Tomography. J Contemp Dent Pract 2023; 23:979-983. [PMID: 37073909 DOI: 10.5005/jp-journals-10024-3422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
AIM This study aimed to evaluate the spatial location of the second mesiobuccal canal (MB2) of maxillary molars (MMs), using cone-beam computed tomography (CBCT), in a Brazilian subpopulation. MATERIALS AND METHODS The CBCT examination of 250 patients performed on the Eagle 3D device was analyzed, totaling 787 MMs. Using the Radiant Dicom Viewer software, measurements were made of the distances, in millimeters (mm), between the first mesiobuccal canal (MB1), MB2, and palatal (P) canal inputs, from the axial sections. The Image J software evaluated the angle formed by the lines. The data obtained were analyzed statistically by Fisher's exact and Chi-square tests with a significance of 5%. RESULTS The prevalence of MB2 canals observed was 76.44 and 41.73% in the first and second molars (1MMs and 2MMs), respectively (p < 0.05). The average of the distances and angles performed, for the location of the MB2 canals of the analyzed teeth, were MB1-P = 5.83 mm, MB1-MB2 = 2.31 mm, and MB2 for the intersection of the connecting distance from MB2-T = 0.90 mm. The average angle formed between the MB1-P and MB1-MB2 distances was 25.89° and 19.68° for the 1MMs and 2MMs, respectively. It was also observed that 91.4 and 75.4% of the maxillary 1MMs and 2MMs, respectively, presented the MB2 canals mesially located at the line connecting the MB1-P canals (p < 0.0001). CONCLUSION The MB2 canals were located mesially to the MB1 canal with an average distance of 2 mm between the canals. CLINICAL SIGNIFICANCE The anatomical knowledge of the spatial location of the MB2 canal in different ethnicities is important for the planning and execution of endodontic treatment.
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Affiliation(s)
| | | | - Eduardo Akisue
- Department of Endodontics, Santa Cecília University, Santos, São Paulo, Brazil
| | - Hermano Camelo Paiva
- Department of Endodontics, University of São Paulo, São Paulo, São Paulo, Brazil
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18
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Rosado LPL, Freitas DQ, Rovaris K, Oliveira ML, Neves FS. Can the detection of second mesiobuccal canals be enhanced based on the volume of adjacent canals? Arch Oral Biol 2023; 146:105604. [PMID: 36543039 DOI: 10.1016/j.archoralbio.2022.105604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate whether the presence of the second mesiobuccal (MB2) canal is related to volumetric differences on the adjacent canals of maxillary molars. DESIGN Forty-seven maxillary first and second molars with and without the MB2 canal were individually scanned using microcomputed tomography (micro-CT). The volume of each canal was measured by an evaluator with experience in micro-CT analysis. The intraclass correlation coefficient (ICC) was obtained. Multiple logistic regression and odds ratio was calculated. To compare the volume of canals in molars with and without MB2, the Mann-Whitney test was applied (α = 0.05). RESULTS The intra-examiner reproducibility was almost perfect (ICC=0.97). Multiple logistic regression demonstrated that the volume of the mesiobuccal (MB1) canal can possibly act as a predictor of the presence of the MB2 canal. It was also found that the MB1 canal volume is larger in molars without the MB2 canal (p = 0.01). No statistically significant difference was observed in the adjacent canals (p > 0.05). CONCLUSIONS Despite the challenging detection of the presence of MB2 canals, clinicians should be aware that MB1 canals of reduced volume are highly suggestive of their presence.
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Affiliation(s)
- Lucas P Lopes Rosado
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Dentistry, University Center of Espírito Santo (UNESC), Colatina, Espírito Santo, Brazil.
| | - Deborah Q Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Karla Rovaris
- Department of Pathology and Dentistry Clinic, School of Dentistry, Federal University of Piauí (UFPI), Teresina, Piauí, Brazil
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Frederico S Neves
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Propedeutics and Integrated Clinic, Division of Oral Radiology, School of Dentistry, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
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Mufadhal AA, Madfa AA. The morphology of permanent maxillary first molars evaluated by cone-beam computed tomography among a Yemeni population. BMC Oral Health 2023; 23:46. [PMID: 36703140 PMCID: PMC9881305 DOI: 10.1186/s12903-023-02752-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The study's objective was to use CBCT to ascertain the root and root canal anatomy of the permanent maxillary first molars in a Yemeni population. It was considered how gender affected the prevalence of root canal morphology. METHODS A sample of 373 CBCT records of maxillary permanent first molars belonging to 373 Yemeni individuals (162 males and 211 females) aged between 12 and 65 years were included in this study. Using CBCT on the teeth, the root form and canal morphology for each root based on Vertucci's classification were evaluated. The distribution of MB2 occurrence was documented. The prevalence and resemblance of the men and females were investigated. The Chi-square test was performed to evaluate the findings. RESULTS Of the 373 maxillary first molars studied, the three separated root form was found in 94.9% of the studied MFMs while the two fused and one separate root form was found in 4.5%. The majority of the three-rooted MFMs (82.6%) had more than three root canals (four canals in 77.2% and five canals in 5.4%). The prevalence of MB2 was as high as 82.3% of the three-rooted MFMs. Vertucci type II configuration was the most frequent canal type (25%) followed by Vertucci type III (23.1%) and Vertucci type I (17.7%) in the mesiobuccal root. Vertucci type I was the most prevalent canal configuration in the distobuccal root and palatal root of the three-rooted MFMs (96% and 99.5%, respectively). CONCLUSIONS The maxillary first molars' root canal morphology indicated notable variations among a Yemeni population. The maxillary first molars of most of the Yemeni participants in this study had three roots and four canals. In light of the high occurrence of MB2 (82.3%) in permanent maxillary first molars, our findings emphasize the need of searching for and using cutting-edge techniques to locate the MB2 canals. Males outnumbered females in proportion.
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Affiliation(s)
- Abdulbaset A. Mufadhal
- grid.412413.10000 0001 2299 4112Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Sana’a University, Sana’a, Yemen
| | - Ahmed A. Madfa
- grid.443320.20000 0004 0608 0056Department of Restorative Dental Science, Collage of Dentistry, University of Ha’il, Ha’il, Kingdom of Saudi Arabia ,grid.444928.70000 0000 9908 6529Department of Conservative Dentistry, Faculty of Dentistry, Thamar University, Dhamar, Yemen
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Almeida JC, Candemil AP, Bertolini GR, Souza-Gabriel AE, Cruz-Filho AM, Sousa-Neto MD, Silva RG. Cone-beam computed tomographic evaluation of the root canal anatomy of the lower premolars and molars in a Brazilian sub-population. Imaging Sci Dent 2023; 53:77-82. [PMID: 37006788 PMCID: PMC10060753 DOI: 10.5624/isd.20220204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/03/2023] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose This study evaluated anatomical variations in the root canals of the lower premolars and molars in a Brazilian sub-population using cone-beam computed tomography (CBCT). Materials and Methods In total, 121 CBCT images of patients were selected from a database. All images contained lower first and second premolars and molars on both sides of the arch, fully developed roots, and no treatment, resorption, or calcifications. In each image, the root canals of the lower premolars and molars were evaluated according to the Vertucci classification in On-Demand 3D software in the multiplanar reconstruction with dynamic navigation. Twenty-five percent of the images were re-assessed to analyze intraobserver confidence with the kappa test. Data were statistically evaluated with linear regression to evaluate the correlations of anatomic variations with age and sex, and the Wilcoxon test to analyze the laterality of variations, with a significance level of 5%. Results The intraobserver agreement (0.94) was excellent. In general, the root canals of lower premolars and molars showed a higher prevalence of type I than other Vertucci classification types, followed by type V in premolars and type II in molars. When the molar roots were evaluated separately, type II was more frequent in mesial roots and type I in distal roots. Although age showed no correlations with the results, sex and laterality showed correlations with tooth 45 and the lower second premolars, respectively. Conclusion The lower premolars and molars of a Brazilian sub-population showed a wide range of root canal anatomic variations.
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Affiliation(s)
- Jessica Cecilia Almeida
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Amanda Pelegrin Candemil
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Gunther Ricardo Bertolini
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Aline Evangelista Souza-Gabriel
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Antonio Miranda Cruz-Filho
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ricardo Gariba Silva
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Artificial Intelligence (AI) for Detection and Localization of Unobturated Second Mesial Buccal (MB2) Canals in Cone-Beam Computed Tomography (CBCT). Diagnostics (Basel) 2022; 12:diagnostics12123214. [PMID: 36553221 PMCID: PMC9777585 DOI: 10.3390/diagnostics12123214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to develop a deep learning model to automatically detect and segment unobturated mesial buccal 2 (MB2) canals on endodontically obturated maxillary molars depicted in CBCT studies. Fifty-seven deidentified CBCT studies of maxillary molars with clinically confirmed unobturated MB2 canals were retrieved from a dental institution radiology database. One-hundred and two maxillary molar roots with and without unobturated MB2 canals were segmented using ITK-SNAP. The data were split into training and testing samples designated to train and evaluate the performance, respectively, of a convolutional neural network (CNN), U-Net. The detection performance revealed a sensitivity of 0.8, a specificity of 1, a high PPV of 1, and a NPV of 0.83 for the testing set, along with an accuracy of 0.9. The segmentation performance of unobturated MB2 canals, assessed using the custom metric, rendered a mean value of 0.3018 for the testing set. The current AI algorithm has the potential to identify obturated and unobturated canals in endodontically treated teeth. However, the AI algorithm is still somewhat affected by metallic artifacts, variations in canal calcifications, and the applied configuration. Thus, further development is needed to improve the algorithm and validate the accuracy using external validation data sets.
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Xu YQ, Lin JQ, Guan WQ. Cone-beam computed tomography study of the incidence and characteristics of the second mesiobuccal canal in maxillary permanent molars. Front Physiol 2022; 13:993006. [PMID: 36505056 PMCID: PMC9729558 DOI: 10.3389/fphys.2022.993006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aimed to review the characteristics of the second mesiobuccal canal (MB2) in the maxillary first and second permanent molars of 500 patients to analyze the incidence of MB2 and its connection with gender, age, tooth position, and mesiobuccal (MB) root length. The study also aimed to investigate the distribution of the root canal orifice on the pulp chamber floor to obtain an imaging reference for clinical practices related to maxillary molars in Fujian, China. Methods: In accordance with the enrollment criteria, cone-beam computed tomography images of the maxillofacial area were collected from 500 patients, including 1,000 maxillary first molars and 1,000 maxillary second molars. The patients were grouped according to gender and tooth position. The incidence of MB2 was observed, and the MB root length and distribution angle of the mesiobuccal-palatal-distobuccal root canal orifices were measured for statistical analysis. Results: The overall incidence of MB2 in maxillary first and second molars was 51.1% and 32.9%, respectively. The incidence of MB2 in maxillary molars was 50% in male patients and 35.45% in female patients, with a significant difference (p < 0.05). The incidence of MB2 in maxillary molars was significantly higher in subjects aged below 50 (especially in male patients) than those aged 50 and above. The MB root length of maxillary first and second molars with MB2 was longer than that without MB2, and the difference was statistically significant. An association was identified between the incidences of MB2 in contralateral molars of the same type and in ipsilateral adjacent molars. When MB2 occurred in the MB root of maxillary molars, the root canals were mostly classified as type IV, followed by type II. The angle formed by the MB-P-DB orifices on the pulp chamber floor in the maxillary first and second molars was (25.23 ± 5.20) and (20.17 ± 10.88)°respectively. Conclusion: The incidence of MB2 in maxillary molars is high in Fujian, China. The occurrence of MB2 is affected by gender, age, and length of MB root, and it occurs symmetrically in adjacent molars and in contralateral molars of the same type. In addition, the distribution law of the main root canal orifice at the pulp chamber floor is conducive to locating MB2, thereby guiding clinical operations.
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Affiliation(s)
- Yuan-Qing Xu
- Department of Stomatology, Union Hospital, Fujian Medical University, Fuzhou, China,School of Stomatology, Fujian Medical University, Fuzhou, China
| | - Jie-Qi Lin
- Department of Stomatology, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Wei-Qun Guan
- Department of Stomatology, Union Hospital, Fujian Medical University, Fuzhou, China,*Correspondence: Wei-Qun Guan,
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Vhorkate K, Banga K, Pawar AM, Mir S, Arora S, Wahjuningrum DA, Bhardwaj A, Luke AM. Location angle of second mesio-buccal canal in maxillary molars of an Indian population: an in vivo retrospective CBCT evaluation and proposal of a new classification. PeerJ 2022; 10:e14234. [PMID: 36248703 PMCID: PMC9559056 DOI: 10.7717/peerj.14234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background The current investigation was designed for predicting the location angle of second mesio-buccal root canal in permanent maxillary (first and second) molars with the aid of proposed measuring points and line using cone beam computed tomography in an Indian population. Methods Three-hundred and twenty-four scans of permanent maxillary (first (n = 162) and second (n = 162)) molars with mesio-buccal 2 root canals and unassociated to the current evaluation were acquired. The maxillary molars were viewed with CSI imaging software. The images were captured and were further assessed using 3D Slicer. The assessment included of measuring the distance between the main mesio-buccal and mesio-buccal 2 canal and the angle at which the MB2 it is located utilizing proposed lines joining the disto-buccal and palatal canals. The data was tabulated for the incidence of various angles where the MB2 is located and MB-MB2 distance was determined. The angles denoted were either positive; I (0.1° to 1.9°), II (2° to 4°), III (>4°) or negative I (-0.1° to -1.9°), II (-2° to -4°), III (>-4°). On the data tabulated a new Banga Vhorkate and Pawar's (BVP's) angular classification for maxillary molars was proposed. Results The existence of positive angle III was found in 41.35% of maxillary first molars (36 right and 31 left of 162), whereas positive angle II appeared in 41.98% of maxillary second molars (32 right and 36 left of 162). The MB1-MB2 in maxillary 1st molar is seen to be 3.12-3.31 mm and this distance in maxillary 2nd molar is 2.8-3.1 mm. The disto-buccal to palatal canal orifice mean distance was 5.06-5.22 mm in maxillary first molars and 4.9-5.8 mm in maxillary second molars. Conclusion Accurate diagnosis of the location of second mesio-buccal canal increases the success rate of endodontic treatment and a better prognosis. The new proposed classification may be considerably helpful in the urge to locate the mesio-buccal 2 canal.
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Affiliation(s)
- Kishor Vhorkate
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, Maharashta, India
| | - Kulvinder Banga
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, Maharashta, India
| | - Ajinkya M. Pawar
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, Maharashta, India
| | - Shugufta Mir
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Suraj Arora
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Dian Agustin Wahjuningrum
- Department of Conservative Dentistry, Universitas Airlingga, Faculty of Dental Medicine, Surabaya City, East Java, Indonesia
| | - Anuj Bhardwaj
- Department of Conservative Dentistry and Endodontics, College of Dental Sciences & Hospital, Rau, Indore, India
| | - Alexander Maniangat Luke
- Department of Clinical Science, College of Dentistry, Ajman University, Al-Jurf, Ajman, United Arab Emirates,Center of Medical and Bio-allied Health Sciences Research, Ajman University, Al-Jurf, Ajman, United Arab Emirates
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Buchanan GD, Gamieldien MY, Fabris-Rotelli I, van Schoor A, Uys A. A study of mandibular premolar root and canal morphology in a Black South African population using cone-beam computed tomography and two classification systems. J Oral Sci 2022; 64:300-306. [PMID: 36089376 DOI: 10.2334/josnusd.22-0239] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE An investigation of the configurations of mandibular premolar roots and canals in a population of Black South Africans. METHODS Cone-beam computed tomography analysis of 772 mandibular premolars was performed, and the premolars were classified according to the systems proposed by Vertucci and Ahmed et al. Root number, canal morphology, age, and sex were recorded. Fisher's exact test was used to determine relationships based on age and sex (P < 0.05). RESULTS Single roots were seen in the majority of mandibular premolars (97.1%). Single canal configurations (i.e., Vertucci Type 1/Ahmed et al. 1MP1) were observed in 48.5% of first and 81.3% of second mandibular premolars. Mandibular first premolars demonstrated multiple canals in more than half of the sample (51.5%), and C-shaped morphology in more than one-tenth (11.1%). A relationship between sex and the presence of radicular grooves was demonstrated (P = 0.049), males being more likely to demonstrate this feature (P = 0.051). Multiple canals in mandibular first premolars also showed a relationship with sex (P = 0.005), a male predilection being evident (P = 0.007). The Ahmed et al. system proved superior to the Vertucci classification for reporting complex configurations and anatomical variations, although a greater number of unique categories were created. CONCLUSION Diverse mandibular premolar root and canal morphology was observed in the studied population. Clinicians must be aware of common morphological features as well as possible anatomical variations in mandibular premolars, as failure to treat complete root canal systems may negatively impact endodontic treatment outcomes.
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Affiliation(s)
- Glynn D Buchanan
- Department of Odontology, School of Dentistry, Faculty of Health Sciences, University of Pretoria.,Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria
| | - Mohamed Y Gamieldien
- Department of Maxillofacial and Oral Surgery, School of Dentistry, Faculty of Health Sciences, University of Pretoria
| | - Inger Fabris-Rotelli
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria
| | - Albert van Schoor
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria
| | - Andre Uys
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria
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Alhujhuj RR, Jouhar R, Ahmed MA, Almujhim AA, Albutayh MT, Adanir N. Evaluation of Root Canal Configuration of Maxillary and Mandibular First Molar by CBCT: A Retrospective Cross-Sectional Study. Diagnostics (Basel) 2022; 12:diagnostics12092121. [PMID: 36140523 PMCID: PMC9497805 DOI: 10.3390/diagnostics12092121] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 12/04/2022] Open
Abstract
Adequate knowledge of root canal morphology along with its probable variations is imperative to acquire successful endodontic treatment. This retrospective cross-sectional study aimed to investigate the root canal configuration of maxillary and mandibular first molar using Cone-Beam Computed Tomography (CBCT) among patients in Al-Ahsa region, Saudi Arabia. A total of 377 samples were included, out of which 123 CBCT (I-CAT Vision QTM) scans with intact all first permanent molars were selected in this study and scanned in sagittal, axial, and coronal views by using BlueSkyPlan software. The number of canals in each root and their configuration according to the Vertucci classification system was evaluated. Statistical analysis was analyzed using SPSS version 21 (IBM). Chi-square test was applied to evaluate the association of root canal morphology and mandibular and maxillary first molars with respect to gender. Out of 123 CBCT scans, 59 (48.0%) were males and 64 (52.0%) were females; the mean age was 26.95 ± 10.65 years. The mesiobuccal root of bilateral maxillary first molar had Type-I (87.0%) of Vertucci classification followed by Type-IV (9.8%). Additionally, all mesiobuccal roots (100%) of the left mandibular first molar had Type-I of Vertucci’s classification. A significant association has been observed between gender and a number of canals in bilateral maxillary first molars. Females showed a significantly higher prevalence of three-root canal configuration in maxillary first molars of both sides compared four canals found most commonly in males (p = 0.004). This study concluded that the majority of maxillary and mandibular permanent first molars had three roots and three canals with Type-I Vertucci’s classification in patients belonging to the Al-Ahsa region of the Saudi Arabia. It was also proved that gender is significantly associated with the number of canals in a bilateral maxillary molar.
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Asiri AA, AlQahtani KW, Tarrosh MY, Shaiban AS, Al Shawkani HA, Alaajam WH, Bamasud MS, Alqahtani M, Alyousefy MA, Al Moaleem MM. Root Morphology and Canal Configuration of Permanent Canines Among Saudi Population: Systematic Review and Comparison with Worldwide Studies. Int J Gen Med 2022; 15:6849-6860. [PMID: 36061964 PMCID: PMC9439648 DOI: 10.2147/ijgm.s380084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Aim The root morphology and canal configuration (RMCC) of mandibular and maxillary canines among Saudi population is systematically reviewed and compared with international studies in this research. Methods This study was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The electronic databases of PubMed, Science Direct, Scopus, Wiley Library, Google website search, and Web of Science were searched. Only local and international cross-sectional, comparative, evaluation, and validation studies or case reports published between 2016 and 2022 that directly evaluated canine RMCC and assessed participants using cone beam computed tomography were included. Results Forty-three studies that investigated RMCCs (17 local and 26 international) were involved in this review. The original Saudi research recorded that almost 100% of maxillary canines had one root and one canal, whereas 98.4% and 94.1% had one root and one canal in the mandibular arch. Vertucci's class I had the highest percentages in the maxillary and mandibular arches at 98.3% and 95.8%, respectively, followed by class III with 0.7% and 1.9% for the same arches, respectively. International studies recorded that 100% of maxillary canines had one canal and root; the percentages of the mandibular arch were 92.3 and 98% for single canal and root, respectively; and the highest percentage was obtained by Vertucci's class I (91.1%), followed by class III (4.7%). Conclusion This review reports and confirmed the symmetry of the RMCCs of maxillary and mandibular canines between Saudi studies and other populations. Moreover, Vertucci's classes I and III were the most frequent RMCCs, and two-rooted canines in both arches were considerably less frequently than single-rooted ones.
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Affiliation(s)
| | | | - Mohammed Y Tarrosh
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Amal S Shaiban
- Department of Restorative Dental Sciences, Faculty of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Hamed A Al Shawkani
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Wafa H Alaajam
- Department of Restorative Dental Sciences, Faculty of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Maryam S Bamasud
- Dental Department, Ministry of Health, Sakaka City, Jouf Region, Saudi Arabia
| | - Muqbil Alqahtani
- General Practitioner, King Faisal University, Alhafuf City, Saudi Arabia
| | - Mohanad A Alyousefy
- Department of Oral Medicine and Periodontology, College of Dentistry, Sana’a University, Sana’a, Yemen
| | - Mohammed M Al Moaleem
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, 45142, Saudi Arabia
- Faculty of Dentistry, University of Ibn al-Nafis for Medical Sciences, Sana’a, 4337, Yemen
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Barbhai S, Shetty R, Joshi P, Mehta V, Mathur A, Sharma T, Chakraborty D, Porwal P, Meto A, Wahjuningrum DA, Luke AM, Pawar AM. Evaluation of Root Anatomy and Canal Configuration of Human Permanent Maxillary First Molar Using Cone-Beam Computed Tomography: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10160. [PMID: 36011794 PMCID: PMC9408299 DOI: 10.3390/ijerph191610160] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/09/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
The aim of this paper is to review the literature on root canal configuration (RCC) and the frequency of occurrence of a second mesiobuccal canal (MB) in human permanent maxillary first molars where cone-beam computed tomography (CBCT) is used. Online electronic databases such as PubMed-Medline, Embase, Scopus and Cochrane Library were searched using appropriate keywords from the earliest available date until 12th June 2022, without restriction on language. In the mesiobuccal root, type I was the most frequent (33.29%), followed by types II and IV (27.18% and 26.36%, respectively). Moreover, 68.2% of maxillary first molars had a second MB canal. For both the distobuccal and palatal roots, type I was the most prevalent, with 99.08% and 97.83% occurrence, respectively. All other types were infrequent. Type I RCC is most frequent in all the roots of the maxillary first molars. Hence, care must be taken during biomechanical preparation of the MB roots.
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Affiliation(s)
- Sourabh Barbhai
- Department of Conservative Dentistry & Endodontics, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, Maharashtra, India
| | - Rajesh Shetty
- Department of Conservative Dentistry & Endodontics, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, Maharashtra, India
| | - Poonam Joshi
- Department of Conservative Dentistry & Endodontics, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, Maharashtra, India
| | - Vini Mehta
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, Maharashtra, India
| | - Ankita Mathur
- STAT SENSE, Srushti 10, Sector 1 D, Amba Township Pvt. Ltd., Trimandir, Adalaj 382421, Gujarat, India
| | - Tanvi Sharma
- STAT SENSE, Srushti 10, Sector 1 D, Amba Township Pvt. Ltd., Trimandir, Adalaj 382421, Gujarat, India
| | - Damini Chakraborty
- Bhowal’s Dental and Implant Clinic, Bengal GreenField Heights, Galaxy-6FS, beside Apollo Pharmacy, DJ Block (Newtown), Newtown, Kolkata 700136, West Bengal, India
| | - Priyanka Porwal
- STAT SENSE, Srushti 10, Sector 1 D, Amba Township Pvt. Ltd., Trimandir, Adalaj 382421, Gujarat, India
| | - Aida Meto
- Department of Dentistry, Faculty of Dental Sciences, University of Aldent, 1007 Tirana, Albania
| | - Dian Agustin Wahjuningrum
- Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya 60132, East Java, Indonesia
| | - Alexander Maniangat Luke
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman 346, United Arab Emirates
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Ajinkya M. Pawar
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai 400008, Maharashtra, India
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Colakoglu G, Kaya Buyukbayram I, Elcin MA, Garip Berker Y, Ercalik Yalcinkaya S. Association between second mesiobuccal canal and apical periodontitis in retrospective cone‐beam computed tomographic images. AUST ENDOD J 2022; 49:20-26. [PMID: 35908285 DOI: 10.1111/aej.12672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Abstract
This retrospective cone-beam computed tomography study aimed to investigate the possible associations of apical periodontitis (AP) with missed/unmissed second mesiobuccal (MB2) canals. MB2 canals and AP were investigated in 257 endodontically treated and 673 untreated maxillary molars, and the former were analyzed regarding missed/unmissed MB2 canals. The chi-squared test and odds ratio (OR) were used for statistics. The prevalence of MB2 canals in maxillary first molars was higher than that in second molars (p = 0.001). MB2 canals were 1.751 times more common in males than in females (OR: 1.751; 95% CI: 1.334-2.297), with a significant difference in the 18-39 age groups (p = 0.005). The risk for AP was 5.5 times greater in endodontically treated maxillary molars with missed MB2 canals than in those with unmissed MB2 canals (p = 0.012) (OR: 5.5, 95% CI: 1.549-19.527). The findings of this study reveal that the likelihood of the MB2 canal is higher in the maxillary first molars of young adult males.
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Affiliation(s)
- Gizem Colakoglu
- Department of Dentomaxillofacial Radiology, Faculty of DentistryIstanbul Aydin UniversityKucukcekmece, IstanbulTurkey
| | - Isil Kaya Buyukbayram
- Department of Endodontics, Faculty of DentistryIstanbul Aydin UniversityKucukcekmece, IstanbulTurkey
| | - Mehmet Ali Elcin
- Department of Dentomaxillofacial Radiology, Faculty of DentistryIstanbul Aydin UniversityKucukcekmece, IstanbulTurkey
| | | | - Sebnem Ercalik Yalcinkaya
- Department of Dentomaxillofacial Radiology, Faculty of DentistryMarmara UniversityMaltepe, IstanbulTurkey
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Camacho-Aparicio LA, Borges-Yáñez SA, Estrada D, Azcárraga M, Jiménez R, González-Plata-R R. Validity of the dental operating microscope and selective dentin removal with ultrasonic tips for locating the second mesiobuccal canal (MB2) in maxillary first molars: An in vivo study. J Clin Exp Dent 2022; 14:e471-e478. [PMID: 35765353 PMCID: PMC9233913 DOI: 10.4317/jced.59347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background Several investigations have determined whether the use of a dental operating microscope (DOM) in combination with selective dentine removal with ultrasonic tips increases the percentage of location of the Mesiobuccal 2 (MB2) root canal in maxillary first molars (MFM). However, these studies did not report the performance of in vivo measurements with the comparison with a gold standard. The aim of this study was to determine the validity of the DOM and selective dentin removal with ultrasonic tips to locate the MB2 root canal in MFM using Cone Beam Computed Tomography (CBCT) as the gold standard. Material and Methods The initial sample size was 91 patients, but 7 were excluded, so the sample size was 84 patients who signed the informed consent. Inclusion criteria: MFM indicated for root canal treatment. An expert blinded observer identified the MB2 in the CBCT. Two standardized examiners (Kappa=91%) performed the clinical assessment in three stages: Stage 1, canal location with an endodontic explorer and a mirror; Stage 2, use of DOM and Stage 3, use of DOM plus selective dentine removal with ultrasonic tips. The validity of each stage was calculated. Results The prevalence of MB2 using CBCT was 79%, by clinical location was 68%. Sensitivity was 79%, 82%, 86% for stage 1, 2 and 3, respectively. Specificity and Positive Predictive Values were 100% for all methods. Negative Predictive Value was 56%, 60%, 67%, respectively. Positive Likelihood Ratio tends to infinity for all methods, Negative Likelihood Ratio= 0.21, 0.18 and 0.14 and Accuracy= 83%, 86% and 89%, respectively. Conclusions The use of DOM with selective dentine removal with ultrasonic tips is the most valid method for locating MB2 canal in MFM. There was an increase in the location of the MB2 root canal with the DOM and ultrasonic tips, which definitely help the clinician. Key words:Cone beam computed tomography, microscopy, second mesiobuccal canal, sensitivity and specificity, validity.
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Affiliation(s)
- Liliana A Camacho-Aparicio
- Dental Public Health Department, División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Ciudad Universitaria, Av. Universidad 3000, Del. Coyoacán, C.P. 04510, México City, México
| | - S Aída Borges-Yáñez
- Dental Public Health Department, División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Ciudad Universitaria, Av. Universidad 3000, Del. Coyoacán, C.P. 04510, México City, México
| | - Daniel Estrada
- Dental Public Health Department, División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Ciudad Universitaria, Av. Universidad 3000, Del. Coyoacán, C.P. 04510, México City, México
| | - Minerva Azcárraga
- Dental Public Health Department, División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Ciudad Universitaria, Av. Universidad 3000, Del. Coyoacán, C.P. 04510, México City, México
| | - Reneé Jiménez
- Dental Public Health Department, División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Ciudad Universitaria, Av. Universidad 3000, Del. Coyoacán, C.P. 04510, México City, México
| | - Ricardo González-Plata-R
- Dental Public Health Department, División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Ciudad Universitaria, Av. Universidad 3000, Del. Coyoacán, C.P. 04510, México City, México
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Alnowailaty Y, Alghamdi F. The Prevalence and Location of the Second Mesiobuccal Canals in Maxillary First and Second Molars Assessed by Cone-Beam Computed Tomography. Cureus 2022; 14:e24900. [PMID: 35698689 PMCID: PMC9185178 DOI: 10.7759/cureus.24900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
Abstract
Objective This retrospective study aimed to investigate the prevalence and location of the second mesiobuccal (MB2) canal in the mesiobuccal root of the maxillary first molar (MFM) and the maxillary second molar (MSM) through cone-beam computed tomography (CBCT) imaging. Methods One thousand two hundred CBCT images of the MFM and MSM were divided equally and analyzed. To standardize the methodology of MB2 detection, the observation and measurements were located at the pulpal floor by 1 mm apically. The distances between canals were calculated from the center point of the MB2 canal (PMB2) to the center point of both the first mesiobuccal canal (PMB1) and the palatal canal (PP). The data were provided in the form of frequencies and percentages. The chi-square test was used to analyze the differences among maxillary molars, while the significance level was set at 0.05. Results The prevalence of the MB2 canal in the MFM and MSM was 46.7% (p=0.020) and 17.7% (p=0.457), respectively. Additionally, the prevalence of the MB2 canal was more frequent in females. The average distance between PMB1 and PMB2 for MFM and MSM was 1.87±0.42 mm and 1.24±0.76 mm, respectively. Furthermore, the average distances of PMB2 and PP were 0.74±0.21 mm and 0.43±0.18 mm for MFM and MSM, respectively. Conclusion The MB2 canal was found in 386 (32.2%) of the maxillary molars. The Saudi people have a high possibility of discovering the MB2 canal. The CBCT is a useful and high-precision diagnostic tool not only for detecting but also for locating in vivo MB2 canal in the mesiobuccal root of maxillary molars.
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Anirudhan S, Suneelkumar C, Uppalapati H, Anumula L, Kirubakaran R. Detection of second mesiobuccal canals in maxillary first molars of the Indian population - a systematic review and meta-analysis. Evid Based Dent 2022:10.1038/s41432-022-0233-3. [PMID: 35246612 DOI: 10.1038/s41432-022-0233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/09/2021] [Indexed: 11/09/2022]
Abstract
Objective The aim of this systematic review and meta-analysis was to integrate the detection of second mesiobuccal (MB2) canals in maxillary first molars reported by different studies and methods on the Indian population.Methods This systematic review was conducted following Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and PRISMA guidelines. A comprehensive search was conducted in PubMed, Medline, LILACS, Science Direct, Clinicaltrials.gov, CTRI and Cochrane databases to identify manuscripts published until 20 May 2021. Two independent reviewers assessed eligibility for inclusion, extracted data and assessed quality using the Newcastle-Ottawa Scale for cross-sectional studies.Results The database search identified 534 citations, including 36 citations through manual search, and communications from authors. After removing duplicates and going through 534 abstracts followed by 26 full-text articles, 16 articles met the inclusion criteria and contributed data for the review. The included studies used CBCT, radiographs, direct vision (DV), dental operating microscope (DOM) or dental operating microscope with ultrasonic instrumentation (DOMI) for MB2 detection. Meta-analysis and forest plot showed a pooled prevalence of 64.76% of MB2 canals in permanent maxillary first molars using CBCT, 26.5% for DV, 60.4% for using magnification in addition to DV and 71.9% for DV and magnification assisted with ultrasonic instrumentation. The prevalence of MB2 was found to be more in men than women.Conclusion The pooled prevalence in this systematic review and meta-analysis for detection of MB2 canals using CBCT was 64.76% compared to the global prevalence of 73.8%. Further well-designed studies are required to establish maxillary first molar MB2 prevalence in the Indian population.
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Affiliation(s)
- Subha Anirudhan
- Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Coimbatore, The Tamilnadu Dr.MGR Medical University, Tamilnadu, India.
| | - Chinni Suneelkumar
- Department of Conservative Dentistry and Endodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Himasindhu Uppalapati
- Department of Conservative Dentistry and Endodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Lavanya Anumula
- Department of Conservative Dentistry and Endodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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Ahmed HMA. A critical analysis of laboratory and clinical research methods to study root and canal anatomy. Int Endod J 2022; 55 Suppl 2:229-280. [DOI: 10.1111/iej.13702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry Faculty of Dentistry University of Malaya Kuala Lumpur
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Mashyakhy M, Awawdeh M, Abu-Melha A, Alotaibi B, AlTuwaijri N, Alazzam N, Almutairi R, Alessa R. Anatomical Evaluation of Root and Root Canal Configuration of Permanent Maxillary Dentition in the Population of the Kingdom of Saudi Arabia. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3428229. [PMID: 35075425 PMCID: PMC8783711 DOI: 10.1155/2022/3428229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/17/2022]
Abstract
AIM This study is aimed at combining the sample sizes of all studies on permanent maxillary teeth conducted in different regions of the Kingdom of Saudi Arabia (KSA) to obtain a large sample size that represents the population of the KSA. The outcome of these combined studies is compared with international studies in terms of the number of roots, number of canals, and canal configurations on the basis of Vertucci's classification. Methodology. The studies were systematically reviewed using the Preferred Reporting Items for Systematic Review and Meta-analysis chart. Studies were included in the analysis if they were conducted in the KSA, involved permanent human maxillary teeth, and had a sample of more than 10 teeth (power). By contrast, studies were excluded if they involved deciduous teeth in the sample size, investigated nonhuman teeth, were not conducted in the KSA, and were case reports, case series, review studies, and anomalies. Relevant literature was searched from PubMed, Scopus, Web of Science, Embase, Cochrane, and Direct Science by two calibrated teams, starting in August 2020, without time limits or language restrictions. RESULTS The database searches and cross-referencing identified a total of 19 relevant studies. All maxillary canines (N = 1,018) had one root, whereas 98.4% had one canal and 98.3% had Vertucci type I. Moreover, 63.2% of the maxillary first premolars had two roots, and 91.4% had two canals. The most common Vertucci root canal configuration was type IV (64.6%). The maxillary second premolars mostly had one root (84.4%) and one canal (50.4%). The most common canal configuration was Vertucci type I (47.1%). The majority of maxillary first molars had three roots (98.9%), 48.7% of which had three canals, and 46.4% had four canals. The most prevalent feature of the canal morphology of mesiobuccal roots was Vertucci type II (35.3%). The investigated maxillary second molars had three roots, 88.0% of which had three canals. CONCLUSION This systematic review represents the Saudi population since samples were combined from different studies from different regions of the country. Variations in findings were observed in the same group of teeth from different regions and the same region, while the overall combined samples results fell within the range of other international studies.
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Affiliation(s)
- Mohammed Mashyakhy
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Awawdeh
- Department of Preventive Dental Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz Abu-Melha
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | | | - Nada AlTuwaijri
- Department of Preventive Dental Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nouf Alazzam
- Department of Preventive Dental Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rahaf Almutairi
- Department of Preventive Dental Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Reuof Alessa
- Department of Preventive Dental Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Matsunaga S, Yamada M, Kasahara N, Noguchi T, Morita S, Kitamura K, Suzuki M, Tamiya Y, Yamamoto H, Abe S, Furusawa M. Japanese Maxillary First Molar Root Canal Morphology: An Ultrastructural Study Using Micro-Computed Tomography. J HARD TISSUE BIOL 2022. [DOI: 10.2485/jhtb.31.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Norio Kasahara
- Department of Histology & Developmental Biology, Tokyo Dental College
| | | | | | - Kei Kitamura
- Department of Histology & Developmental Biology, Tokyo Dental College
| | | | | | - Hitoshi Yamamoto
- Department of Histology & Developmental Biology, Tokyo Dental College
| | - Shinichi Abe
- Oral Health Science Center, Tokyo Dental College
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Rosado LPL, Oliveira ML, Rovaris K, Freitas DQ, Neves FS. Morphological characteristics of the mesiobuccal root in the presence of a second mesiobuccal canal: a micro-CT study. Restor Dent Endod 2022; 47:e6. [PMID: 35284322 PMCID: PMC8891461 DOI: 10.5395/rde.2022.47.e6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/21/2021] [Accepted: 04/01/2021] [Indexed: 11/11/2022] Open
Abstract
Objectives This study investigated the internal morphology of mesiobuccal (MB) roots of maxillary molars with a second mesiobuccal (MB2) canal. Materials and Methods Forty-seven maxillary first or second molars from Brazilians were scanned using micro-computed tomography. The following measurements were obtained from the MB roots: root thickness, root width, and dentin thickness of the buccal aspect of the first mesiobuccal (MB1) canal, between the MB1 and MB2 canals, and the palatal aspect of the MB2 and MB1 canals at 3 mm from the root apex and in the furcation region. For statistical analysis, the Student’s t-test and analysis of variance with the post-hoc Tukey test were used (α = 0.05). Results In maxillary molars with an MB2 canal, MB roots were significantly thicker (p = 0.0014) and narrower (p = 0.0016) than in maxillary molars without an MB2 canal. The dentin thickness of the palatal aspect of the MB1 canal was also significantly greater than that of MB roots without an MB2 canal at 3 mm from the root apex (p = 0.0007) and in the furcation region (p < 0.0001). In the furcation region of maxillary molars with an MB2 canal, the dentin thickness between the MB1 and MB2 canals was significantly smaller than that in the buccal and palatal aspects (p < 0.0001). Conclusions The internal morphology of MB roots of maxillary molars with an MB2 canal revealed differences in dentin thickness, root diameter, and distance between the canals when compared with maxillary molars without an MB2 canal.
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Affiliation(s)
- Lucas P. Lopes Rosado
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Matheus Lima Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Karla Rovaris
- Department of Pathology and Dentistry Clinic, School of Dentistry, Federal University of Piauí (UFPI), Teresina, Piauí, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Frederico Sampaio Neves
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
- Department of Propedeutics and Integrated Clinic, Division of Oral Radiology, School of Dentistry, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
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Carrion SJ, Coelho MS, Soares ADJ, Frozoni M. Apical periodontitis in mesiobuccal roots of maxillary molars: influence of anatomy and quality of root canal treatment, a CBCT study. RESTORATIVE DENTISTRY & ENDODONTICS 2022; 47:e37. [DOI: 10.5395/rde.2022.47.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
| | - Marcelo Santos Coelho
- Department of Endodontic, São Leopoldo Mandic School of Dentistry, Campinas, SP, Brazil
| | | | - Marcos Frozoni
- Department of Endodontic, São Leopoldo Mandic School of Dentistry, Campinas, SP, Brazil
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Xu F, Zhang Y, Gu Y, Ping Y, Zhou R, Wang J. Shaping ability of four single-file systems in the instrumentation of second mesiobuccal canals of three-dimensional printed maxillary first molars. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1425. [PMID: 34733977 PMCID: PMC8506727 DOI: 10.21037/atm-21-3855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022]
Abstract
Background This study evaluated and compared the shaping ability of four advanced single-file nickel-titanium (NiTi) systems during the preparation of curved second mesiobuccal (MB2) canals in maxillary first molar replicas fabricated by three-dimensional (3D) printing via micro-computed tomography (Micro-CT) imaging. Methods A total of 60 3D-printed maxillary first molar replicas were constructed from one extracted tooth, with an angle of curvature ranging from 15° to 25°. The MB2 canals from these 60 replicas were divided into 4 groups of 15 replicas according to the canal instrumentation system used, namely, Waveone gold (WOG), Reciproc blue (RCB), XP-endo shaper (XPS) and M3-L. The specimens were scanned before and after preparation using Micro-CT. The pre- and post-instrumentation images of each specimen were superimposed, and the amount of resin removed, the change in surface area, the canal transportation, and centering ability were assessed using the Mimics software. Instrumentation time was also recorded. One-way analysis of variance and least significant difference (LSD) tests were used to statistically compare the groups. The significance level was set at 5%. Results Instrumentation time with M3-L was significantly longer than the other systems (P<0.05). The amount of resin removed and the change in surface area generated by the 4 systems were different at the apical, middle, and coronal thirds, and the total canal (P<0.05). Overall, WOG and XPS resulted in the less change than RCB and M3-L. There was no significant difference among the groups at the middle third regarding canal transportation and centering ability (P>0.05). However, a significant difference was found at the apical level (P<0.05), where RCB showed the poorest centering ability and the highest canal transportation (P<0.05). In addition, XPS resulted in the least canal transportation (P<0.05) at the coronal level, while there was no significant difference between the four groups in terms of centering ability. Conclusions The M3-L instrument required more time to prepare the curved MB2 canals compared with the other systems. Overall, WOG and XPS showed the least resin removal and surface area change. M3-L, XPS, and WOG instruments respected the original canal curvature better than RCB files.
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Affiliation(s)
- Fulu Xu
- Department of Endodontics and Operative Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.,Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Yuerong Zhang
- Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China.,Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
| | - Yongchun Gu
- Department of Dentistry, The Ninth People's Hospital of Suzhou, China
| | - Yifan Ping
- Department of Endodontics and Operative Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.,Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Ruyu Zhou
- Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Juan Wang
- Department of Endodontics and Operative Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.,Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
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Ren HY, Kum KY, Zhao YS, Yoo YJ, Jeong JS, Perinpanayagam H, Wang XY, Li GJ, Wang F, Fang H, Gu Y. Maxillary molar root and canal morphology of Neolithic and modern Chinese. Arch Oral Biol 2021; 131:105272. [PMID: 34600333 DOI: 10.1016/j.archoralbio.2021.105272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study aimed to characterize Neolithic human maxillary molars from archeological remains at the Jiaojia site, Shandong, China, and compare their ultrastructural features with sex and age-matched modern locals. DESIGN Maxillary first (n = 86) and second (n = 80) molars in 5000-year-old individuals (n = 50) from the Jiaojia site were scanned by cone-beam computed tomography (CBCT). Sex and age-matched control groups were assigned from oral surgical patients at Shandong University. Images were analyzed for crown size, root length, root morphology, canal inter-orifice distances, mesiobuccal canal morphology, and second mesiobuccal (MB2) canal prevalence and location. Neolithic and modern values were compared statistically using Chi-squared and Mann-Whitney test at p < .05. RESULTS Crown and root size were smaller, and canal inter-orifice distances were shorter in Neolithic maxillary molars than their modern counterparts. For mesiobuccal roots, Weine's Type I single canals were the most prevalent in Neolithic and modern first and second molars. MB2 canal prevalence were not significantly different (p > .05) in Neolithic (53.3%) or modern (60.5%) first molars, and Neolithic (11.3%) or modern (21.3%) second molars. But, MB2 prevalence was significantly higher for modern than ancient male first (p = .032) and second (p = .005) molars. Additionally, MB2 were located more mesially and closer to MB1 in Neolithic than modern molars. CONCLUSIONS Maxillary molar root and canal morphology of ancient 5000-year-old remains at the Jiaojia site resemble that of local patients. A trend towards larger tooth size, and more dispersed MB2 canals over this short evolutionary period warrants additional investigation.
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Affiliation(s)
- H Y Ren
- School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Province, PR China
| | - K Y Kum
- Department of Conservative Dentistry, Dental Research Institute, National Dental Care Center for Persons with Special Needs, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Y S Zhao
- Institute of Cultural and Heritage, Shandong University, Qingdao, PR China
| | - Y J Yoo
- Department of Conservative Dentistry, Dental Research Institute, National Dental Care Center for Persons with Special Needs, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - J S Jeong
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong Province, PR China
| | - Hiran Perinpanayagam
- Division of Restorative Dentistry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - X Y Wang
- Department of Endodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Province, PR China
| | - G J Li
- Department of Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Province, PR China
| | - F Wang
- Department of Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Province, PR China
| | - H Fang
- School of History and Culture, Shandong University, Jinan, PR China
| | - Y Gu
- Department of Endodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Province, PR China.
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Wang D, Wang W, Li YJ, Wang YR, Hong T, Bai SZ, Tian Y. The effects of endodontic access cavity design on dentine removal and effectiveness of canal instrumentation in maxillary molars. Int Endod J 2021; 54:2290-2299. [PMID: 34459005 DOI: 10.1111/iej.13621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate in a laboratory setting, the impact of three designs of endodontic access cavities on dentine removal and effectiveness of canal instrumentation in extracted maxillary first molars using micro-computed tomography (micro-CT). METHODOLOGY A total of 30 extracted intact maxillary first molars were selected and scanned by micro-CT with a voxel size of 24 µm and randomly distributed into three groups: the traditional endodontic cavity (TEC) group, the conservative endodontic cavity (CEC) group and the guided endodontic cavity (GEC) group. The pulp chambers of teeth in the groups were accessed accordingly. After root canal preparation, the teeth were rescanned. The volume of dentine removed after canal preparation, the noninstrumented canal areas, canal transportation and centring ratio were analysed. Data were analysed statistically using one-way analysis of variance. Tukey's post hoc test was used for multiple comparisons. The significance level was set at p < .05. RESULTS The total volume of dentine removed was significantly greater in the TEC group after root canal preparation (p < .05). No significant differences in the volume of dentine removed occurred between the CEC and GEC groups (p > .05). The volume of dentine removed in the crown, pericervical dentine and coronal third of the canal was significantly lower in CEC and GEC groups when compared to that in the TEC group (p < .05), no difference was observed in the middle third of the canal and apical third of the canal amongst the three groups (p > .05). There was no significant difference in noninstrumented canal area, canal transportation and centring ratio amongst the TEC, CEC and GEC groups (p > .05). CONCLUSIONS In extracted maxillary molars tested in a laboratory setting, CEC and GEC preserved more tooth tissue in the crown, pericervical dentine and coronal third of the canal compared with TEC after root canal preparation. The design of the endodontic access cavity did not impact on the effectiveness of canal instrumentation in terms of noninstrumented canal area, canal transportation and centring ratio.
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Affiliation(s)
- Dan Wang
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Wei Wang
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Yu-Jiao Li
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Yi-Rong Wang
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Tao Hong
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Shi-Zhu Bai
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Yu Tian
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
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Cerqueira-Neto ACCL, Prado MC, Pereira AC, Oliveira ML, Vargas-Neto J, Gomes BPFA, Ferraz CCR, Almeida JFA, de-Jesus-Soares A. Clinical and Radiographic Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Teeth: Interappointment Dressing or Single-Visit? J Endod 2021; 47:1598-1608. [PMID: 34310980 DOI: 10.1016/j.joen.2021.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/20/2021] [Accepted: 07/16/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION More data are needed before affirming that single-visit approaches are effective and safe for regenerative endodontic procedures (REPs). This study compared clinical and radiographic outcomes of REPs between interappointment dressing or single-visit protocols. METHODS Twenty young patients presenting traumatized immature teeth with pulp necrosis were divided into 2 groups. Teeth were submitted to 6% sodium hypochlorite and 2% chlorhexidine irrigation and to 17% EDTA use before blood clot induction. In the interappointment dressing group (n = 11), calcium hydroxide was used with 2% chlorhexidine gel for 21 days before scaffold induction. In the single-visit group (n = 9), the scaffold was induced during the only appointment. Patients were followed up for 24 months. Primary, secondary, and tertiary outcomes were assessed by 3 independent evaluators. Preoperative and follow-up radiographs were assessed for quantitative measurements of the apical diameter, root width, root length, and cervical barrier placement and compared between groups using the t test or Mann-Whitney U test. Categoric variables were assessed with the G test and the Fisher exact test and continuous variables with the Mann-Whitney U test. Statistical significance was set at 5%. RESULTS One tooth showed persistence of infection. No difference was observed in cervical barrier placement (P > .05); between groups regarding primary, secondary, and tertiary outcomes (P > .05); and in parameters of quantitative radiographic outcomes (P > .05). CONCLUSIONS Completing REPs with an interappointment dressing or a single-visit protocol presented similar clinical and radiographic outcomes. A single-visit protocol of REPs using 6% sodium hypochlorite, 2% chlorhexidine, and 17% EDTA permitted satisfactory outcomes in necrotic immature permanent teeth.
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Affiliation(s)
- Ana Carolina C L Cerqueira-Neto
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Marina C Prado
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Andréa C Pereira
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Oral Radiology Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Júlio Vargas-Neto
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Caio C R Ferraz
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - José Flávio A Almeida
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil.
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Al-Habib M, Howait M. Assessment of Mesiobuccal Canal Configuration, Prevalence and Inter-Orifice Distance at Different Root Thirds of Maxillary First Molars: A CBCT Study. Clin Cosmet Investig Dent 2021; 13:105-111. [PMID: 33790655 PMCID: PMC8005364 DOI: 10.2147/ccide.s300241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Mey Al-Habib
- Department of Endodontics, Faculty of Dentistry King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Mohammed Howait
- Department of Endodontics, Faculty of Dentistry King Abdul Aziz University, Jeddah, Saudi Arabia
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Aydin H. Analysis of root and canal morphology of fused and separate rooted maxillary molar teeth in Turkish population. Niger J Clin Pract 2021; 24:435-442. [PMID: 33723120 DOI: 10.4103/njcp.njcp_316_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the root canal anatomy and the incidence of fused roots in maxillary first molar (MFM) and maxillary second molar (MSM) teeth in the Turkish population and compare them to teeth with separate roots using cone-beam computed tomography (CBCT). METHODS CBCT images of 616 MFMs and 703 MSMs were analyzed from 402 patients for the number of roots and the presence of fusion. The canal configuration of teeth with separate and fused roots was compared. Type of fusion and canal merging positions were determined. A P value of less than 0.05 was considered significant. RESULTS Five hundred and seventy-one (92.69%) MFMs had three separate roots, one (0.16%) had four roots and the incidence of root fusion was 7.14%. An additional mesiobuccal (MB) canal was present in 79.34% of the teeth with three separate roots. There was no merging of canals in 36 of 44 teeth with fused roots. The prevalence of fusion was higher in the MSMs (23.47%). The incidence of three and four separate roots in MSM teeth was 74.68% and 1.85%, respectively. The prevalence of additional MB canals in teeth with three separate roots was 53.14%. There was no canal merging in 60% of the fused rooted teeth. There were two-merged canals in 31.52% and multiple merged canals in 8.48% of the MSMs. CONCLUSIONS In the Turkish population, the incidence of root fusion in the MFMs and MSMs was 7.14% and 23.47%, respectively, with more canal merging in the MSMs.
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Affiliation(s)
- H Aydin
- Private Practice, Antalya, Turkey
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Four-Rooted Maxillary First Molars: A Systematic Review and Meta-Analysis. Int J Dent 2021; 2021:8845442. [PMID: 33542735 PMCID: PMC7843171 DOI: 10.1155/2021/8845442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/08/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives The majority of human maxillary first molars is usually described as having three roots, but different morphologies were documented in several studies and case reports. One very rare and less investigated anatomical anomaly is the occurrence of four radicular structures in the upper first molars. This communication aimed to define the prevalence of four-rooted maxillary first molars on a meta-analytical basis. The external and internal morphology of these teeth was described by the collection of published case reports. Materials and Methods Six electronic databases were accessed to collect case reports dealing with four-rooted maxillary first molars, as well as population-based cone-beam computed tomography (CBCT) studies. Afterward, the publications were selected according to predefined inclusion/exclusion criteria and evaluated using the Joanna Briggs Institute Critical Appraisal tool. The teeth of the chosen case reports were then independently analyzed by two dental professionals according to different dental classifications. Furthermore, the population studies were meta-analyzed to calculate the global and regional prevalence of four-rooted maxillary molars. Results Included were forty-nine population-based CBCT studies containing 26663 maxillary first molars. Upon these data, the global incidence of four-rooted maxillary molars was meta-analytically determined as 0.047% (95%-CI:0.011-0.103%). In combination with the case reports, it was pointed out that this anomaly is distributed worldwide. Furthermore, forty-eight case reports were included containing fifty-three maxillary molars with four roots. The analyzed teeth exhibited Versiani´s pulpal chamber floor Types A and B. The majority of four-rooted maxillary first molars were classified as Type I regarding Christie's configuration. But, also 7.54% of the altered teeth could not be described by this classification. 62.34% exhibited four root canals, but also variations with five, six, or seven canals were identified. Furthermore, a significant difference was found in the occurrence rate between male and female patients. Conclusion Due to the worldwide occurrence, dental professionals should be aware of this rare anomaly to avoid treatment errors, especially during endodontic or surgical therapies.
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Qiao X, Xu T, Chen L, Yang D. Analysis of Root Canal Curvature and Root Canal Morphology of Maxillary Posterior Teeth in Guizhou, China. Med Sci Monit 2021; 27:e928758. [PMID: 33439855 PMCID: PMC7812699 DOI: 10.12659/msm.928758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background We investigated the root canal curvature and morphology of maxillary posterior teeth in Guizhou, China, to provide references for clinical practice. Material/Methods We collected 274 maxillary posterior teeth in Guizhou Province, China. The root canal curvature was observed by X-ray film measurement. Two hundred teeth were selected to make transparent tooth models, and root canal configuration was recorded according to Vertucci classification criteria. The position of the MB2 root canal orifice and the mesiobuccal root canal configuration were observed by micro-computed tomographic (micro-CT) scanning. The t test and the chi-square test were used for statistical analysis. Results The root canals of the maxillary posterior teeth showed more significant curvature in the mesiodistal direction than in the buccolingual direction (P<0.05). The MB2 root canal of maxillary molars showed severe bending in the mesiodistal direction: 25.16±6.6 degrees and 28.05±8.65 degrees in first and second molars, respectively. The detection rate of MB2 was 48% in maxillary first molars and 32% in maxillary second molars. The results of micro-CT showed that the vertical distances between the MB2 and MB-P line were 0.64±0.34 mm and 0.57±0.28 mm in first and second molars, respectively. Conclusions The root canal morphology and curvature of maxillary posterior teeth varied greatly in the Guizhou population, which increases the difficulty of treatment. It is necessary for clinicians to gain understanding of the root canal and to improve the success rate of root canal therapy.
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Affiliation(s)
- Xin Qiao
- Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China (mainland).,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China (mainland)
| | - Tingting Xu
- Hospital/School of Stomatology, Zunyi Medical University, Zunyi, Guizhou, China (mainland)
| | - Liang Chen
- Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China (mainland).,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China (mainland)
| | - Deqin Yang
- Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China (mainland).,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China (mainland)
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Shen Y, Gu Y. Assessment of the presence of a second mesiobuccal canal in maxillary first molars according to the location of the main mesiobuccal canal-a micro-computed tomographic study. Clin Oral Investig 2021; 25:3937-3944. [PMID: 33404762 DOI: 10.1007/s00784-020-03723-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/01/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the root canal morphology of mesiobuccal (MB) roots in maxillary first molars, and to assess the presence of a second mesiobuccal canal (MB2) according to the location of the main MB canal. MATERIALS AND METHODS A total of 72 extracted permanent maxillary first molars were collected from dental clinics and were scanned with micro-CT and reconstructed three-dimensionally. The root canal systems were recorded according to Vertucci's classification, and the occurrence of accessory canals was also recorded. The root canal dimensions were measured at the coronal (furcation plane), middle, and apical root levels. The long (D) and short (d) diameters as well as the palatal (P) and buccal (B) distances from the center of the first mesiobuccal canal (MB1) to the root surface were measured, and the ratios of D/d and P/B were calculated. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic accuracy of using the ratio of P/B for predicting the presence of an MB2 canal. The best cut-off point was determined according to the sensitivity and specificity. RESULTS The MB roots most frequently had a type 2-2 root canal with an incidence of 37.5% (27/72), followed by the type 1-1 (23.6%, 17/72) and type 2-1 (16.7%, 12/72) canal forms. Type 1-2 canals were detected only in 5 molars (6.9%), and type 2-1-2 canals were detected in 6 molars (8.3%). The other 5 cases included 1 case of type 1-2-1 canal and 4 cases of triple canals. MB2 canals were detected in 76.4% (55/72) of the total sample teeth. The incidence of accessory canals was 56.9% (41/72). The mean ratio of D/d was generally "greatest to least": coronal level > middle level > apical level for different root levels and MB single > MB1 > MB2 for different canals, which reflected a trend from a flat to a circular cross-sectional shape. ROC curve analysis showed that at the coronal and middle root levels, areas under the ROC curve (AUC) were greater than 0.99 (P < 0.01), and the best cut-off point was 1.58 and 1.55, respectively; at the apical level, the AUC was 0.94 (P < 0.01), and the best cut-off point was 1.77. CONCLUSIONS The MB2 canals may be present in the MB roots of maxillary first molars with a high occurrence rate at various levels, and the P/B ratio of the MB1 is a good index for predicting the presence of an MB2. However, since all the sample teeth were collected from a Chinese population, clinicians have to be cautious while trying to apply the conclusions on teeth of other ethnic populations. CLINICAL RELEVANCE By calculating the P/B ratio, an index reflecting the buccal deviation of the MB1, clinicians can predict the presence of an invisible MB2 in cone-beam computed tomography images with inadequate resolution.
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Affiliation(s)
- Yifen Shen
- Central Laboratory, Ninth People's Hospital of Suzhou, Suzhou, China
| | - Yongchun Gu
- Department of Dentistry and Central Laboratory, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist., Suzhou, 215200, China.
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Lee SJ, Lee EH, Park SH, Cho KM, Kim JW. A cone-beam computed tomography study of the prevalence and location of the second mesiobuccal root canal in maxillary molars. Restor Dent Endod 2020; 45:e46. [PMID: 33294411 PMCID: PMC7691260 DOI: 10.5395/rde.2020.45.e46] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/04/2020] [Accepted: 05/29/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives This study aimed to investigate the incidence and location of the second mesiobuccal root (MB2) canal in maxillary molars with the aid of various measuring points and lines using cone-beam computed tomography (CT). Materials and Methods A total of 205 images of patients who underwent cone-beam CT examinations between 2011 and 2015 as part of their dental diagnosis and treatment were included. There were 76 images of the maxillary first molar and 135 images of the maxillary second molar. Canal orifices were detected at −1 mm from the top of the pulpal floor on cone-beam CT images. Image assessment was performed by 2 observers in reformatted image planes using software. Assessments included measurement of the distance between the MB1 and MB2 canals, and the angles between the lines connecting the MB1-MB2 and distobuccal (DB)-palatal (P) canals. The data were analyzed using the student's t-test. Results The prevalence of the MB2 canal was 86.8% in the first molar and 28.9% in the second molar. The angle between the lines connecting the MB1-MB2 and DB-P canals was 2.3° ± 5.7° in the first molar and −3.95° ± 7.73° in the second molar. The distance between the MB1 and MB2 canals was 2.1 ± 0.44 mm in the first molar and 1.98 ± 0.42 mm in the second molar. Conclusions The angles between the lines connecting the MB1-MB2 and DB-P canals was almost parallel. These findings may aid in the prediction of the location of the MB2 canal orifice.
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Affiliation(s)
- Seong-Ju Lee
- Department of Conservative Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Eun-Hye Lee
- Department of Conservative Dentistry, Hanyang University Seoul Hospital, Seoul, Korea
| | - Se-Hee Park
- Department of Conservative Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Kyung-Mo Cho
- Department of Conservative Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Jin-Woo Kim
- Department of Conservative Dentistry, Gangneung-Wonju National University, Gangneung, Korea
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Al-Saedi A, Al-Bakhakh B, Al-Taee RG. Using Cone-Beam Computed Tomography to Determine the Prevalence of the Second Mesiobuccal Canal in Maxillary First Molar Teeth in a Sample of an Iraqi Population. Clin Cosmet Investig Dent 2020; 12:505-514. [PMID: 33235509 PMCID: PMC7678691 DOI: 10.2147/ccide.s281159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose This study aimed to determine the prevalence of the second mesiobuccal canal in maxillary first molar teeth in a sample of population from Basrah city in the south of Iraq. Patients and Methods Cone-beam computed tomography (CBCT) images of 353 Iraqi patients from Basrah city were included in the study. These images revealed 691 maxillary first molars, but only 655 of them were included. The images were obtained using a Gendex (GXDP-7000) CBCT machine (Hatfield, PA, USA) and studied for the prevalence of second mesiobuccal canal in the mesiobuccal root canal configuration, according to Vertucci’s classification, by scrolling through the images. Pearson’s chi-square tests were used to correlate canal type distribution to gender and age. The distributions of canal type on the right and left sides were assessed using the Kendal tau correlation coefficient. A P-value <0.001 was considered highly significant. For intra-examiner reliability analysis, Cohen’s kappa test was used. Results The second mesiobuccal canal was identified in 81.68% of the Iraqi population sample. The most common type was type II (44.58%), followed by type IV (31.30%). Type I occurred in 18.32% of cases. Other types were less frequent. Conclusion The second mesiobuccal canal occurred in most of the examined samples of the Iraqi population (81.68%), with the most common type being type II, followed by type IV.
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Affiliation(s)
- Aqeel Al-Saedi
- Oral Diagnosis Department, College of Dentistry, University of Basrah, Basrah, Iraq
| | - Bahaa Al-Bakhakh
- Conservative Dentistry Department, College of Dentistry, University of Basrah, Basrah, Iraq
| | - Riad G Al-Taee
- Oral and Maxillofacial Surgery Department, College of Dentistry, University of Basrah, Basrah, Iraq
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Analysis of second mesiobuccal root canal instrumentation in maxillary first molars with three nickel-titanium rotary instruments: a micro-computed tomographic study. Odontology 2020; 109:496-505. [PMID: 33175279 DOI: 10.1007/s10266-020-00564-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Abstract
The aim of this study was to evaluate the shaping characteristics of Protaper Universal (PTU; Dentsply Tulsa Dental Specialties, Johnson City, TN), Hero Shaper (HS; MicroMega, Besacon, France) and Hyflex CM (HCM; Coltene-Whaledent, Allstetten, Switzerland) nickel-titanium systems with various apical sizes and tapers in second mesiobuccal (MB2) canal instrumentation using micro-computed tomographic imaging. A total of 27 maxillary first molars with independent patent MB2 canals were selected and randomly assigned to three groups according to the 3-dimensional morphologic aspects obtained from preoperative micro-computed tomographic scans. Canals were first negotiated with a size 8 K-file and finally prepared to F1, F2, and F3 with PTU and to sizes 20.04 taper, 25.04 taper, and 30.04 taper with HS and HCM. Postoperative scans were performed after each instrumentation with the same parameters used in the initial scan. The canal volume, canal transportation, untouched canal surface and wall thickness were measured and calculated using Mimics 10.01 software (Image Works, Materialise, Belgium). Statistical analysis was performed using one-way analysis of variance post hoc LSD tests. PTU removed more dentin than HS and HCM in all sections when instrumented to the same apical size (P < 0.05). HS and HCM presented a lower mean value of canal transportation than PTU in all measured sizes and sections. PTU presented a lower mean value of distal wall thickness than HS and HCM at the level of 1 and 2 mm below the furcation region in all measured sizes. In conclusion, for MB2 canal instrumentation, HS and HCM of 0.04 taper are safer than PTU.
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Al Mheiri E, Chaudhry J, Abdo S, El Abed R, Khamis AH, Jamal M. Evaluation of root and canal morphology of maxillary permanent first molars in an Emirati population; a cone-beam computed tomography study. BMC Oral Health 2020; 20:274. [PMID: 33028327 PMCID: PMC7542868 DOI: 10.1186/s12903-020-01269-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/01/2020] [Indexed: 12/05/2022] Open
Abstract
Background The aim of this study was to analyze the root and canal morphology of the maxillary permanent first molars in an Emirati population using cone-beam computed tomography (CBCT). Methods Two hundred and sixty-one CBCT scans were acquired. The data were extracted and anonymized to remove all patient identifiers. Two observers (an endodontic resident and an endodontist) evaluated all scans on diagnostic quality monitors. Results The prevalence of a second mesiobuccal canal (MB2) was 80.1% in all examined samples. Type II Vertucci classification, was the most common canal configuration (59%) in the mesiobuccal root, followed by Types I (19.9%) and IV (15.3%), while Type III was the least common (5.7%). Types I, II, and IV were significantly more common in the 21–40-year age group (P < 0.001), while Type III was observed significantly more often in the < 20-year age group (P < 0.001). No significant effect of gender on the prevalence of Vertucci classification in the mesiobuccal root of maxillary first molars (P = 0.74) was found. Analysis of bilateral symmetry showed that 80% teeth had perfect bilateral symmetry, whereas 20% were asymmetrical. Type II canal configuration showed the highest prevalence of bilateral symmetry (48.7%), followed by Type I (15%) and Type IV (10%), while Type III showed the least prevalence of symmetry (3%). Conclusions This was the first study to analyze the prevalence of MB2 canal in an Emirati population. Our results indicate high prevalence of MB2 (80.1%) and emphasize the importance of using advanced techniques to locate the MB2 canal.
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Affiliation(s)
- Eman Al Mheiri
- Department of Endodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Health Care City, Dubai, United Arab Emirates, P.O.Box: 505055.,Dental Department, Dubai Health Authority, Dubai, United Arab Emirates
| | - Jahanzeb Chaudhry
- Department of Endodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Health Care City, Dubai, United Arab Emirates, P.O.Box: 505055
| | - Salma Abdo
- Endodontic department, Al Ain Dental Centre, Seha Ambulatory Healthcare Services, Al Ain, Abu Dhabi, United Arab Emirates.,Dental department, Mediclinic, Dubai, United Arab Emirates
| | - Rashid El Abed
- Department of Endodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Health Care City, Dubai, United Arab Emirates, P.O.Box: 505055
| | - Amar Hasan Khamis
- Department of Endodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Health Care City, Dubai, United Arab Emirates, P.O.Box: 505055
| | - Mohamed Jamal
- Department of Endodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Health Care City, Dubai, United Arab Emirates, P.O.Box: 505055.
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Alberton CS, Tomazinho FSF, Calefi PS, Duarte MAH, Vivan RR, Baratto-Filho F. Influence of the Preparation Order in Four-Canal Maxillary Molars with WaveOne Gold System. J Endod 2020; 46:1291-1296. [DOI: 10.1016/j.joen.2020.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/18/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
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