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Javed MQ, Srivastava S, Alotaibi BBR, Bhatti UA, Abulhamael AM, Habib SR. A Cone Beam Computed Tomography-Based Investigation of the Frequency and Pattern of Radix Entomolaris in the Saudi Arabian Population. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2025. [PMID: 38004074 PMCID: PMC10673087 DOI: 10.3390/medicina59112025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: An understanding of the anatomical complexity of teeth is a significant factor for a successful endodontic treatment outcome. The aim of this study was to explore the frequency and pattern of distribution of radix entomolaris (RE) in mandibular first molars (MFMs) of a Saudi Arabian subpopulation using CBCT scans. Materials and Methods: This study was conducted at dental clinics of Qassim University from February to May 2023 by evaluating CBCT scans that were previously obtained for diagnostic purposes. Scans of Saudi national patients with bilaterally present MFMs and fully formed root apices were included. Conversely, scans with one/or two missing MFMs, MFMs with incomplete root apices, full- or partial-coverage prosthesis, endodontic treatment, and associated radicular resorption were excluded from study. A total of 303 CBCT scans with 606 bilateral MFMs were analyzed by two calibrated evaluators for the presence of, and type according to Song's typolgy of RE. The data were analyzed using SPPS-24. The descriptive variables were documented as frequencies and percentages. The chi-square test was used to determine the association between the prevalence of RE with the gender, jaw side and age group. Both inter-rater and intra-rater agreements were estimated for detecting and classifying RE using Cohen's kappa test. Results: The sample had 63.7% males and 36.3% females. The prevalence of RE was 6.6%, with Song's type III (57.5%) as the most common variant. Absolute agreement was noted between the raters about the presence of RE and very strong agreement was noted for the classification of the RE. Conclusions: RE is an uncommon finding among the mandibular first molars of the Saudi population without any gender and quadrant predilection. The clinicians' knowledge of the presence and Song's type of RE may contribute towards the enhancement of endodontic treatment outcomes.
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Affiliation(s)
- Muhammad Qasim Javed
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, P.O. Box 1162, Buraidah 51452, Qassim, Saudi Arabia; (S.S.); (B.B.R.A.)
| | - Swati Srivastava
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, P.O. Box 1162, Buraidah 51452, Qassim, Saudi Arabia; (S.S.); (B.B.R.A.)
| | - Badi Baen Rashed Alotaibi
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, P.O. Box 1162, Buraidah 51452, Qassim, Saudi Arabia; (S.S.); (B.B.R.A.)
| | - Usman Anwer Bhatti
- Department of Operative Dentistry, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan;
| | - Ayman M. Abulhamael
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah 21589, Saudi Arabia;
| | - Syed Rashid Habib
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
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Characterizations of three-dimensional root morphology and topological location of mandibular third molars by cone-beam computed tomography. Surg Radiol Anat 2023; 45:527-536. [PMID: 36884060 DOI: 10.1007/s00276-023-03111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE This study aimed to delineate three-dimensional (3D) root morphology and topological locations of mandibular third molars (MTMs) by cone-beam computed tomography (CBCT) in a Chinese adult dental population. METHODS Adult patients with MTMs were retrospectively screened based on CBCT images at our institution between January 2018 and December 2019. Root morphology and spatial locations of these teeth were defined based on CBCT 3D images. Potential associations with epidemiological and clinical/radiological parameters were analyzed using Chi-square or Fisher exact test. Two-tailed P values less than 0.05 were considered statistically significant. RESULTS A total number of 2680 eligible patients (male/female:0.74; 35 ± 10 years old) with 4180 MTMs were enrolled. The majority of MTMs had 2 roots 3064 (73.30%), followed by 800 (19.14%) 1 root, 302 (7.22%) 3 roots, and 14 (0.33%) 4 roots. More than half of one-rooted MTMs were convergent, followed by club-shaped and C-shaped. Among MTMs with 2 roots, 2860 (93.34%) were M-D (mesio-distal) types. Most MTMs with 3 roots were M-2D (one root in mesial, two roots in distal) types, followed by 2M-D (two roots in mesial, one root in distal) types, and B-2L (one root in buccal, two roots in lingual) types. The presence of root configurations was significantly associated with the angulation, depth, and width classification in two-rooted MTMs (P < 0.05). CONCLUSIONS Although the morphology and spatial locations of MTMs vary greatly, our results from a large dental population reconfirm that most MTMs have two roots with mesial-distal type of spatial distribution.
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Heinrich A, Burmeister U, Lenz JH, Weber MA. [Clinical radiological evaluation of teeth-part 1 : Anatomy and anomalies]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:617-624. [PMID: 35768583 DOI: 10.1007/s00117-022-01015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
Radiological assessment of the teeth and periodontium is often left to the dentist. Nevertheless, it is useful to know the anatomy and possible anomalies of the teeth in order to correctly assess pathological processes in both projection radiographic and slice imaging. Dental radiological examinations, such as panoramic slice imaging (PSA) and dental film are used for targeted diagnostics. In the case of incidental findings, a dental presentation should be made for further clarification. This article first provides an overview of the anatomy and anomalies of teeth.
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Affiliation(s)
- A Heinrich
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - U Burmeister
- Poliklinik für Zahnerhaltung und Parodontologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Jan-Hendrik Lenz
- Klinik und Poliklinik für Mund‑, Kiefer- und Plastische Gesichtschirurgie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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Lee JB, Seo MS. Mandibular incisors with two canals are associated with the presence of the distolingual root in mandibular first molars: a cone-beam computed tomographic study. BMC Oral Health 2022; 22:145. [PMID: 35473630 PMCID: PMC9044624 DOI: 10.1186/s12903-022-02184-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to evaluate the root canal configurations and the association between mandibular first molars and distolingual root (DLR) and mandibular incisors using cone-beam computed tomography (CBCT). Methods Mandibular first molars and incisors were evaluated using CBCT images of 150 patients. Mandibular first molars were classified according to the presence or absence of DLR. The curvature of the DLR was evaluated using Schneider’s method in buccolingual and mesiodistal orientations. The angle of the mesiolingual–distolingual–distobuccal canal orifices (ML–DL–DB) was evaluated at the pulpal floor level. The mandibular central and lateral incisors were classified as either single canal or two canals. The association between the root canal system of the mandibular first molar and mandibular incisors was evaluated. Data were analyzed using the Chi-square test, Student’s t-test, and odds ratios from binary logistic regression. The significance level was set at 5%. Results The frequency of mandibular first molars with DLR was 27.0% and that of mandibular incisors with two canals was 25.8%. The curvature of the DLR was 37.1° in the buccolingual orientation and 10.4° in the mesiodistal orientation. The angle of ML–DL–DB was 79.0°. The presence of two canal systems in mandibular incisors was associated with the presence of DLR in the mandibular first molar (left central incisors: p = 0.001, odds ratio = 4.25; left lateral incisors: p < 0.001, odds ratio = 3.8; right central incisors: p = 0.003, odds ratio = 3.86; right lateral incisors: p = 0.001, odds ratio = 3.44) but not with the curvature of the DLR or angle of the ML–DL–DB orifice (p > 0.05). Conclusions The mandibular first molar showed a high incidence of separate DLRs. It was confirmed that DLR in the mandibular first molar is highly associated with the presence of two-canal system in the mandibular incisors. This association can aid clinicians in successful endodontic treatments.
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Affiliation(s)
- Ju-Bin Lee
- Department of Conservative Dentistry, Dental College, Wonkwang University, Iksan, Korea
| | - Min-Seock Seo
- Department of Conservative Dentistry, Dental College, Wonkwang University, Iksan, Korea. .,Department of Conservative Dentistry, Wonkwang University Daejeon Dental Hospital, 77 Dunsan-Ro, Seo-Gu, Daejeon, 302-120, Republic of Korea.
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Drouri S, Dhaimy S, Benkiran I, Jabri M, Al Jalil Z, Hamza M. Root and canal morphology of mandibular first molars in a Moroccan subpopulation by cone-beam computed tomography and its international comparison: A cross-sectional study. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_104_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wu W, Guo Q, Tan BK, Huang D, Zhou X, Shen Y, Gao Y, Haapasalo M. Geometric Analysis of the Distolingual Root and Canal in Mandibular First Molars: A Micro-computed Tomographic Study. J Endod 2021; 47:779-786. [PMID: 33609601 DOI: 10.1016/j.joen.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/10/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The purpose of this study was to comprehensively assess by micro-computed tomographic imaging the anatomic features of distolingual (DL) roots and canals in mandibular first molars collected from 1 population. METHODS One hundred two specimens were examined for the location and initial direction of the DL canal and the relationship between the distance of apical deviation and the angle of root curvature. RESULTS All DL roots had only 1 canal. A new 7-category classification system is proposed for the DL roots of mandibular first molars. Most DL roots were type IV (28 teeth), type III (26 teeth), and type V (25 teeth). The average canal curvature in all root types was over 25°. There was a positive correlation between the angles of root and canal curvature for types II, IV, and V (P < .05) but not for types I and III (P > .05). In the buccolingual view, most DL roots were straight, whereas in the mesiodistal view the root curvature was close to the maximum value. The orifice of the DL canal was 4 times further from the line that bisects a line between the mesiobuccal and mesiolingual canal orifices than the distobuccal canal. The angle between the mesiobuccal-mesiolingual line and the horizontal projection of the coronal third of the DL canal on the pulp floor was 8.1° ± 10.0° and 6.1° ± 8.2° for teeth from the left and right side, respectively. The angle between the inserted simulated file and the cementoenamel junction was 57.9° ± 6.3°. Seventy-three percent of the DL canals had no constriction in the apical area. The DL canals were narrow and had a conical frustum-like shape with a 0.04 taper at the apical portion. CONCLUSIONS The novel classification of the DL roots helps to better understand the clinically challenging anatomy of the root and canal.
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Affiliation(s)
- Weiwei Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qiang Guo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Boon Kit Tan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Dingming Huang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Yuan Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Markus Haapasalo
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Abstract
Background
Endodontic disease can adversely affect the quality of life and therefore early diagnosis and consequent timely treatment is of paramount importance for the Endodontist. Radiology is an essential component in treatment planning, disease monitoring and assessment of treatment outcome. Periapical radiographs and panoramic radiography are frequently utilised but they provide only two-dimensional representation of three-dimensional structures. The advent of cone beam computed tomography (CBCT) offers three-dimensional accuracy of the hard tissue images with a reasonable cost and this has revolutionised imaging of the dentomaxillofacial structures. This imaging system has been seen to overcome some limitations of conventional radiography, as brought out in this review. The improvement in the accuracy is, however, accompanied at the cost of increased radiation exposure to the patient. Nevertheless, smaller areas of exposure are normally appropriate for endodontic imaging, and adjustment in the exposure parameters can further moderate the effective dose (Loubele et al. 37(6):309-18, 2008).
Aims and objectives
The aim of this review is to present the pertinent literature on the various applications of cone beam computed tomography in the field of endodontics.
Methods
Literature was electronically searched on the following sources; Medline and Keats Library. Further, a manual search was performed on the following journals: International Endodontic Journal, Journal of Endodontics, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodontology, Journal of Dental Research, European Journal of Oral Sciences & Odontology and Dentomaxillofacial Radiology. A preliminary search was performed to gain an idea of the available literature using keywords ‘Cone Beam Computed Tomography’ to view the volume of the literature evident and identify questions to be addressed in this review. The initial search showed 243 potential articles. After scrutinising the titles and abstracts of the retrieved articles, 70 relevant studies were reviewed in full text. Furthermore, ‘published guidelines on the use of CBCT’ were also searched so as to include the results as an additional source material. All the articles eligible to be included in the review were in the English language and ranged from the year 1960 to the present. Also all the studies reviewed were based on the various uses of cone beam computed tomography in the field of endodontics. The keywords used to search were ‘Cone Beam Computed Tomography (CBCT)’, ‘Conventional radiography’, ‘Applications of CBCT in endodontics’, ‘CBCT and tooth morphology’, ‘CBCT and apical periodontitis’, ‘CBCT and vertical root fractures’, ‘CBCT and resorption’, ‘CBCT and pre-surgical assessment’, ‘CBCT and dento-alveolar trauma’ and ‘CBCT and endodontic outcome’.
Results
Every case is unique and CBCT should be considered only after studying each case individually. CBCT imaging needs to be adopted or used where information from conventional imaging systems is either inadequate for the management of endodontic problems or inconclusive. Having said that, it is safe to state that CBCT imaging has the potential to become the first choice for endodontic treatment planning and outcome assessment, especially when new scanners with lower radiation doses and enhanced resolution would be available.
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Lower First Permanent Molar with an Additional Root Diagnosis and Management. Case Rep Dent 2020; 2019:8403140. [PMID: 31934465 PMCID: PMC6942775 DOI: 10.1155/2019/8403140] [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: 10/09/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022] Open
Abstract
Three rooted lower first permanent molar represents one of the main anatomical variants which is a treatment challenge of clinicians. This study is aimed at presenting a case of a lower first molar with an additional root that was diagnosed and managed successfully using new techniques in endodontics. Tooth #46 was diagnosed as a necrotic pulp with symptomatic apical periodontitis. Different angle radiographs were obtained, and they clearly showed three roots. The procedure was completed under magnification and illumination using an operating microscope. The access cavity was modified to achieve straight line access for all the canals. Careful step-by-step instrumentation was performed using flexible NiTi rotary files. The canals were irrigated using 6% sodium hypochlorite. Afterwards, three-dimensional obturation was completed using warm vertical compaction. Knowledge of the anatomy and an early diagnosis are required to achieve high-quality root canal treatment.
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Abstract
Usually first mandibular molars have one mesial and distal root but in some cases there are anatomical variations wherein the number of roots and root canals vary. Presence of an additional lingual root distally in mandibular molars is called radix entomolaris (RE). Appropriate diagnosis is must before starting with root canal procedure in these teeth to ensure successful treatment outcome. The report describes the endodontic management of mandibular molar with RE.
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Affiliation(s)
- Anshul Arora
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India
| | - Ashtha Arya
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India
| | - Latika Chauhan
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India
| | - Gaurav Thapak
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India
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Patel S, Brown J, Pimentel T, Kelly RD, Abella F, Durack C. Cone beam computed tomography in Endodontics - a review of the literature. Int Endod J 2019; 52:1138-1152. [PMID: 30868610 DOI: 10.1111/iej.13115] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/11/2019] [Indexed: 12/14/2022]
Abstract
The use of cone beam computed tomography (CBCT) in the diagnosis and/or management of endodontic problems is increasing and is reflected in the exponential rise in publications on this topic in the last two decades. The aim of this paper is to: (i) Review current literature on the endodontic applications of CBCT; (ii) Based on current evidence make recommendations for the use of CBCT in Endodontics; (iii) Highlight the areas in which more research is required.
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Affiliation(s)
- S Patel
- Department of Conservative Dentistry, King's College London Dental Institute, London, UK.,Specialist Practice, London, UK
| | - J Brown
- Department of Maxillofacial & Dental Radiology, King's College London Dental Institute, London, UK
| | - T Pimentel
- Department of Conservative Dentistry, King's College London Dental Institute, London, UK
| | - R D Kelly
- Department of Conservative Dentistry, King's College London Dental Institute, London, UK
| | - F Abella
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - C Durack
- Speciailist Practice, Limerick, Ireland
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The Impact of Different Diagnostic Imaging Modalities on the Evaluation of Root Canal Anatomy and Endodontic Residents' Stress Levels: A Clinical Study. J Endod 2019; 45:406-413. [DOI: 10.1016/j.joen.2018.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/27/2018] [Accepted: 12/01/2018] [Indexed: 12/12/2022]
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Relationship of the Incidence of C-shaped Root Canal Configurations of Mandibular First Premolars with Distolingual Roots in Mandibular First Molars in a Taiwanese Population: A Cone-beam Computed Tomographic Study. J Endod 2018; 44:1492-1499.e1. [DOI: 10.1016/j.joen.2018.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/16/2018] [Accepted: 05/29/2018] [Indexed: 11/22/2022]
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Patel S, Lambrechts P, Shemesh H, Mavridou A. European Society of Endodontology position statement: External Cervical Resorption. Int Endod J 2018; 51:1323-1326. [DOI: 10.1111/iej.13008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 12/14/2022]
Affiliation(s)
| | - S. Patel
- Endodontic Postgraduate Unit; King's College London Dental Institute; London UK
- Private Practice; 45 Wimpole Street London UK
| | | | - H. Shemesh
- Academic Center for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - A. Mavridou
- Conservative Dentistry; KU Leuven; Leuven Belgium
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Choupani Dastgerdi A, Navabi M, Hafezi L, Khalilak Z, Rakhshan V. Anatomy of Permanent Mandibular First Molars in a Selected Iranian Population Using Cone-beam Computed Tomography. IRANIAN ENDODONTIC JOURNAL 2018; 13:251-256. [PMID: 29707024 PMCID: PMC5911303 DOI: 10.22037/iej.v13i2.19035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Knowledge of radicular anatomy has a crucial impact on endodontic practices. Since some anatomic features such as modifications of Vertucci are not evaluated adequately, this study was conducted. Methods and Materials: In this in vivo study, cone-beam computed tomography (CBCT) images of 312 intact bilateral first molars from 156 patients (79 males and 77 females with an average age of 35.58±11.17 years) were investigated by a trained dentist in terms of number of roots, number of canals in each root and in each tooth, and shapes of canals according to Vertucci’s classification and its modifications. Groups were compared using the Chi-square test. The level of significance was set at 0.05. Results: Of all teeth, 5.2% had 3 roots. Mesial roots had mostly 2 canals while distal roots had a similar frequency of 1 and 2 canals. Of all teeth, 39.7% had 3 canals, 45.2% had 4 canals, 13.8% had 5 canals, and 1.3% had 6 canals. There were no significant differences between males and females, in terms of number of roots (P=0.137), number of canals in mesial (P=0.453) or distal roots (P=0.328), and total number of canals (P=0.138). The most frequent Vertucci classes in mesial and distal roots were IV followed by II and I, respectively. There were no significant differences between males and females in terms of Vertucci classes of mesial (P=0.211) or distal (P=0.205) roots. Conclusion: In this population, there were 3 to 6 canals per tooth (mostly 4 and 3 canals). Males and female’s might be similar regarding the number of roots, or number of canals in each root, number of canals in each tooth, or the predominant canal shape in each root.
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Affiliation(s)
| | - Manije Navabi
- Department of Removable Prosthodontics, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Ladan Hafezi
- Department of Oral Radiology, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Zohre Khalilak
- Department of Endodontics, Dental Branch, Islamic Azad University, Tehran, Iran
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Zhang X, Xu N, Wang H, Yu Q. A Cone-beam Computed Tomographic Study of Apical Surgery-related Morphological Characteristics of the Distolingual Root in 3-rooted Mandibular First Molars in a Chinese Population. J Endod 2017; 43:2020-2024. [PMID: 29033081 DOI: 10.1016/j.joen.2017.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/17/2017] [Accepted: 07/30/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Apical surgery on the separate distolingual (DL) root of a 3-rooted mandibular first molar is thought to be difficult because DL roots are always severely curved, small, and shorter than distobuccal (DB) roots, and they are located far from the buccal cortical bone. The purpose of this study was to use cone-beam computed tomographic images to investigate the apical surgery-related morphological characteristics of DL roots in a Chinese population. METHODS The screening process identified 83 subjects with 128 mandibular first molars with separate DL roots. The degree of root canal curvature was measured in the mesiodistal (MD) and buccolingual (BL) planes using the Schneider method. Distances were measured from the DL root apex to the buccal cortical bone, to the buccal cortical bone opposite the DB root apex, and to the buccal cortical bone opposite the mesiobuccal (MB) root apex. The lengths of the remaining DB, MB, and DL roots were measured after resection of 3 mm of the DL apical root. Angulations of the DL root canal were determined before and after DL apical root resection. RESULTS The teeth were classified into 3 types: type I, straight in the MD and BL planes; type II, straight in the MD plane and curved in the BL plane; and type III, curved in the MD and BL planes. Only 5 molars (3.9%) were classified as type I, whereas 52 (40.6%) molars were type II and 71 (55.5%) molars were type III. The type I DL root has a significantly shorter length and longer distance from the DL root apex to the buccal cortical bone than type II and III roots (P < .05). The distance from the DL root apex to the buccal cortical bone opposite the MB root apex is significantly longer than the distance to the buccal cortical bone opposite the DB root apex in types I and II (P < .05), whereas the distance is nearly equal for type III. The angulations for root-end preparation of types II and III DL roots vary from 57.5° to 129.1° and from 55.8° to 128.1°, respectively. CONCLUSIONS A new classification was proposed for DL roots in 3-rooted mandibular first molars based on the root canal curvature. Type I is unsuitable for apical surgery. Access to the type II DL root apex should be through the DB root apex, whereas access to the type III DL root apex through the MB root apex is more feasible. Apical surgery on types II and III DL roots may be accomplished when the depth of the root-end preparation is reasonably reduced, and fine and personalized angulated ultrasonic retro tips are used.
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Affiliation(s)
- Xiao Zhang
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Ning Xu
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Hanguo Wang
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
| | - Qing Yu
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
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Gupta A, Duhan J, Wadhwa J. Prevalence of Three Rooted Permanent Mandibular First Molars in Haryana (North Indian) Population. Contemp Clin Dent 2017; 8:38-41. [PMID: 28566849 PMCID: PMC5426164 DOI: 10.4103/ccd.ccd_699_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Mandibular first molars typically have two roots but sometimes a supernumerary root presents distolingually called as radix entomolaris (RE). Aim: The present study evaluated the prevalence of permanent mandibular first molars featuring a distolingual root in Haryana (North India). Materials and Methods: Five hundred patients possessing bilateral mandibular first molars were selected for this study. The intraoral periapical radiographs were taken. The radiographs of these patients were evaluated under optimal conditions. A total of 1000 mandibular first molars were screened, and the incidence of three-rooted mandibular first molars, RE and the correlation between left and right side occurrence and between either gender were recorded. Statistical Analysis: The binary logistic regression test and Pearson's Chi-square test were used for statistical analysis. Results: The prevalence of three-rooted permanent mandibular first molars was 13% of the patients examined and 8.3% of the teeth examined. There was no statistically significant difference between gender and side of occurrence (P ≥ 0.05). The bilateral incidence of a symmetric distribution was 27.6 (18/65) among the RE teeth examined. Conclusion: RE is considered as an Asiatic trait. The occurrence of this macrostructure in the Haryana (North India) population was found to be 13%. The clinician must thoroughly examine the radiographs before the initiation of endodontic therapy.
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Affiliation(s)
- Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Jigyasa Duhan
- Department of Conservative Dentistry and Endodontics, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Jitesh Wadhwa
- Department of Orthodontics, K. D. Dental College, Mathura, Uttar Pradesh, India
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Choi MR, Moon YM, Seo MS. Prevalence and features of distolingual roots in mandibular molars analyzed by cone-beam computed tomography. Imaging Sci Dent 2015; 45:221-6. [PMID: 26730369 PMCID: PMC4697006 DOI: 10.5624/isd.2015.45.4.221] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/22/2015] [Accepted: 09/02/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose This study evaluated the prevalence of distolingual roots in mandibular molars among Koreans, the root canal system associated with distolingual roots, and the concurrent appearance of a distolingual root in the mandibular first molar and a C-shaped canal in the mandibular second molar. Materials and Methods Cone-beam computed tomographic images of 264 patients were screened and examined. Axial sections of 1056 mandibular molars were evaluated to determine the number of roots. The interorifice distances from the distolingual canal to the distobuccal canal were also estimated. Using an image analysis program, the root canal curvature was calculated. Pearson's chi-square test, the paired t-test, one-way analysis of variance, and post-hoc analysis were performed. Results Distolingual roots were observed in 26.1% of the subjects. In cases where a distolingual root was observed in the mandibular molar, a significant difference was observed in the root canal curvature between the buccolingual and mesiodistal orientations. The maximum root canal curvature was most commonly observed in the mesiodistal orientation in the coronal portion, but in the apical portion, maximum root canal curvature was most often observed in the buccolingual orientation. Conclusion The canal curvature of distolingual roots was found to be very complex, with a different direction in each portion. No correlation was found between the presence of a distolingual root in the mandibular first molar and the presence of a C-shaped canal in the mandibular second molar.
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Affiliation(s)
- Mi-Ree Choi
- Department of Conservative Dentistry, Wonkang University Daejeon Dental Hospital, Daejeon, Korea
| | - Young-Mi Moon
- Department of Conservative Dentistry, Wonkang University Daejeon Dental Hospital, Daejeon, Korea
| | - Min-Seock Seo
- Department of Conservative Dentistry, Wonkang University Daejeon Dental Hospital, Daejeon, Korea
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Abella F, Morales K, Garrido I, Pascual J, Duran-Sindreu F, Roig M. Endodontic applications of cone beam computed tomography: case series and literature review. GIORNALE ITALIANO DI ENDODONZIA 2015. [DOI: 10.1016/j.gien.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Darcey J, Taylor C, Roudsari RV, Jawad S, Hunter M. Modern Endodontic Planning Part 2: Access and Strategy. DENTAL UPDATE 2015; 42:709-10, 712-4, 717-8 passim. [PMID: 26685470 DOI: 10.12968/denu.2015.42.8.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Poor access and iatrogenic damage can result in failed root canal treatment. Understanding tooth anatomy improves access and ensures that the clinician is cleaning and shaping the whole root canal system. If a canal is missed treatment usually fails. This paper revisits tooth anatomy and discusses how to ensure that access is optimized, but not at the expense of precious tooth structure. The concept of multi-visit root canal treatment is also addressed with emphasis on the, often overlooked, aspect of temporization. CPD/Clinical Relevance: Good anatomical knowledge of teeth is the cornerstone of endodontics. Once root treatment has begun the clinician must be logical about how many visits to take and how to temporize teeth between such visits.
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Zhang X, Xiong S, Ma Y, Han T, Chen X, Wan F, Lu Y, Yan S, Wang Y. A Cone-Beam Computed Tomographic Study on Mandibular First Molars in a Chinese Subpopulation. PLoS One 2015; 10:e0134919. [PMID: 26241480 PMCID: PMC4524594 DOI: 10.1371/journal.pone.0134919] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/15/2015] [Indexed: 12/03/2022] Open
Abstract
The purpose of this study was to conduct a cone-beam computed tomographic (CBCT) investigation on the root and canal configuration of the mandibular first molars, especially the morphology of the disto-lingual (DL) root, in a Chinese subpopulation. A total of 910 CBCT images of the mandibular first molars were collected from 455 patients who underwent CBCT examinations as a preoperative assessment for implants or orthodontic treatment. The following information was analyzed and evaluated: tooth position, gender, root and root canal number per tooth, root canal type of the mesial root(s) and distal root(s), angle of the DL root canal curvature, distance between two distal canal orifices in the teeth with DL root, and angle of disto-buccal canal orifice–disto-lingual canal orifice–mesio-lingual canal orifice (DB-DL-ML). Most of the mandibular first molars (64.9%, n = 591) had two roots with three root canals, and most of the mesial root canals (87.7%, n = 798) were type VI. The prevalence of the DL root was 22.1% (n = 201). The right side had a higher prevalence of DL root than the left side (p<0.05). Additionally, the curvature of the DL root canal were greater in the bucco-lingual (BL) orientation (30.10°±14.02°) than in the mesio-distal (MD) orientation (14.03°± 8.56°) (p<0.05). Overall there was a high prevalence of DL root in the mandibular first molars, and most of the DL roots were curved in different degrees. This study provided detailed information about the root canal morphology of the mandibular first molars in a Chinese subpopulation.
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Affiliation(s)
- Xin Zhang
- VIP Center and Shandong Provincial Key Laboratory of Oral Biomedicine, School and Hospital of Stomatology, Shandong University, Jinan, Shangdong, China
| | - Shijiang Xiong
- VIP Center and Shandong Provincial Key Laboratory of Oral Biomedicine, School and Hospital of Stomatology, Shandong University, Jinan, Shangdong, China
| | - Yue Ma
- VIP Center and Shandong Provincial Key Laboratory of Oral Biomedicine, School and Hospital of Stomatology, Shandong University, Jinan, Shangdong, China
| | - Ting Han
- Department of Endodontics, School and Hospital of Stomatology, Shandong University, Jinan, Shangdong, China
| | - Xinyu Chen
- VIP Center and Shandong Provincial Key Laboratory of Oral Biomedicine, School and Hospital of Stomatology, Shandong University, Jinan, Shangdong, China
| | - Fang Wan
- VIP Center and Shandong Provincial Key Laboratory of Oral Biomedicine, School and Hospital of Stomatology, Shandong University, Jinan, Shangdong, China
| | - Yating Lu
- VIP Center and Shandong Provincial Key Laboratory of Oral Biomedicine, School and Hospital of Stomatology, Shandong University, Jinan, Shangdong, China
| | - Songhe Yan
- VIP Center and Shandong Provincial Key Laboratory of Oral Biomedicine, School and Hospital of Stomatology, Shandong University, Jinan, Shangdong, China
| | - Yan Wang
- VIP Center and Shandong Provincial Key Laboratory of Oral Biomedicine, School and Hospital of Stomatology, Shandong University, Jinan, Shangdong, China
- * E-mail:
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Cone-beam Computed Tomography Analysis of the Root Canal Morphology of Maxillary First and Second Premolars in a Spanish Population. J Endod 2015; 41:1241-7. [DOI: 10.1016/j.joen.2015.03.026] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/16/2015] [Accepted: 03/22/2015] [Indexed: 01/15/2023]
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Štamfelj I. Endodontic Management of the Three-Rooted Mandibular First Permanent Molar: a Case Report. Acta Stomatol Croat 2014; 48:216-23. [PMID: 27688369 DOI: 10.15644/asc48/3/6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The distal root of the mandibular first permanent molar (MFPM) contains one or two canals. More rarely, the second/third distal canal is found in a separate root in a distolingual (DL) position - a radix entomolaris (RE). In Caucasians, this occurs in less than 4% of cases, but it is equally important to be aware of this possibility. Careful examination of the preoperative periapical radiographs (orthoradial and mesially angled) and inspection of the pulp chamber floor during endodontic management may indicate that this radicular variant is present. RE's lingual inclination and buccolingual curvature must be taken into account during cleaning and shaping of the canal within this root to avoid procedural errors, such as straightening and ledging of the root canal, perforation or instrument fracture. The aim of the present paper was to discuss a case report of a young patient, referred to an endodontic office after a ledge was created by inappropriate instrumentation of a buccolingually curved RE canal.
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Affiliation(s)
- Iztok Štamfelj
- Department of Dental Diseases and Dental Morphology, Faculty of Medicine, University of Ljubljana
Department of Operative Dentistry and Endodontics, University Medical Centre Ljubljana, Ljubljana, Slovenia
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The Use of Cone-beam Computed Tomography in the Preservation of Pulp Vitality in a Maxillary Canine with Type 3 Dens Invaginatus and an Associated Periradicular Lesion. J Endod 2014; 40:1501-4. [DOI: 10.1016/j.joen.2014.01.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/12/2014] [Accepted: 01/16/2014] [Indexed: 12/17/2022]
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Ceperuelo D, Lozano M, Duran-Sindreu F, Mercadé M. Root canal morphology of Chalcolithic and early bronze age human populations of El Mirador Cave (Sierra de Atapuerca, Spain). Anat Rec (Hoboken) 2014; 297:2342-8. [PMID: 24943458 DOI: 10.1002/ar.22958] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/27/2014] [Accepted: 05/08/2014] [Indexed: 11/11/2022]
Abstract
This study provides a morphological characterization of the inner anatomy of the root canals of permanent first and second molars in Chalcolithic and early Bronze Age human fossils using cone-beam computed tomography. The general evolutionary trend in present-day human dentition is related to morphological simplification. As little is known about when this trend appeared in Homo sapiens populations, the aim of this work is to test the presence of modern radicular morphology 4,400 years ago. Fifty-four permanent first and second maxillary and mandibular molars of 17 individuals were included in the study. All maxillary first and second molars showed three separate roots. Almost all the lower molars analyzed (100% of first molars and 75% of second molars) had two separate roots. More differences in the canal system configuration were documented in the maxillary mesiobuccal roots than in the palatal or distobuccal roots. The most variable tooth in root and canal configuration is the maxillary second molar. It should be pointed out that 12.5% of the teeth analyzed showed a C-shaped root configuration.
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Affiliation(s)
- Dolors Ceperuelo
- Department of Restorative Dentistry and Endodontics, Universitat Internacional de Catalunya, C/Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain
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Hannah R, Kandaswamy D, Jayaprakash N. Endodontic management of a mandibular second molar with radix entomolaris: a case report. Restor Dent Endod 2014; 39:132-6. [PMID: 24790927 PMCID: PMC3978104 DOI: 10.5395/rde.2014.39.2.132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/30/2014] [Indexed: 11/11/2022] Open
Abstract
The presence of radix entomolaris (RE) in a mandibular first molar is a common occurrence in certain ethnic groups, but the presence of RE in a mandibular second molar is a rare occurrence. In the present case, RE was identified from preoperative radiographs and confirmed using cone-beam computed tomography (CBCT). The access cavity was modified to locate the RE. Cleaning and shaping were performed with nickel-titanium rotary instruments. Obturation was completed with gutta-percha cones using AH Plus (Dentsply Detrey GmbH) as sealer. From the CBCT axial images, the RE was determined to have a Type III curvature by the De Moor classification, Type B separate RE by the Carlsen and Alexandersen classification, and radiographically, a Type i image by the Wang classification. The presence of RE in the mandibular second molar makes it essential to anticipate and treat the distolingual root canal. This case report highlights the usefulness of CBCT for assessing RE in the mandibular second molar, which can help the clinician in making a confirmatory diagnosis and assessing the morphology of the root canal.
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Affiliation(s)
- Rosaline Hannah
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, India
| | - Deivanayagam Kandaswamy
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, India
| | - Nachimuthu Jayaprakash
- Department of Conservative Dentistry and Endodontics, JKK Nataraja Dental College, Komarapalayam, Erode, India
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Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K. Cone beam computed tomography in Endodontics - a review. Int Endod J 2014; 48:3-15. [DOI: 10.1111/iej.12270] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 02/14/2014] [Indexed: 01/27/2023]
Affiliation(s)
- S. Patel
- Department of Conservative Dentistry; King's College London Dental Institute; London & Specialist Practice, London UK
| | - C. Durack
- Riverpoint Specialist Dental Clinic; Limerick Ireland
| | - F. Abella
- Department of Restorative Dentistry and Endodontics; Section for Endodontology; Universitat Internacional de Catalunya; Barcelona Spain
| | - H. Shemesh
- Academic Center for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - M. Roig
- Department of Restorative Dentistry and Endodontics; Section for Endodontology; Universitat Internacional de Catalunya; Barcelona Spain
| | - K. Lemberg
- Institute of Dentistry and Oral Radiology; University of Helsinki; Helsinki Finland
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