Advantages and Applications of a New System for Classifying Roots and Canal Systems in Research and Clinical Practice

Characterization of the root and canal anatomy of maxillary premolar teeth in an Iraqi subpopulation: a cone beam computed tomography study

This study aims to evaluate the number of roots and root canal morphology types of maxillary premolars in relation to a patient's gender and age in an Iraqi population using two classification systems. Cone beam computed tomography (CBCT) scans of 1116 maxillary premolars from 385 patients were evaluated for the number of roots and root canal morphology types according to Vertucci's classification and Ahmed et al. classification systems. Differences in the number of roots and root canal morphology types with regard to tooth type, patients' gender and age groups were evaluated and the degree of bilateral symmetry was determined. Chi-squared test was used for statistical analysis. About 51.1% of the 1st premolars were double rooted. The majority (87.9%) of the 2nd premolars were single rooted. The three-rooted form presented in only 1.2% and 0.7% of the 1st and 2nd premolars, respectively. Vertucci Type IV (Ahmed et al. code 2MaxP B1P1) and Vertucci Type I (Ahmed et al. code 1MaxP1) were the most common canal morphology types in the 1st and 2nd premolars, respectively. Females showed a lower number of roots and a higher prevalence of Vertucci Type I configuration (P < 0.05). Younger age groups showed a higher prevalence of Vertucci Type I configuration (P < 0.05). Bilateral symmetry was seen in more than half of the maxillary premolars. There is a considerable variation in the number of roots and root canal configurations of maxillary premolars in the studied Iraqi population, with a significant difference by gender and age groups. Ahmed et al. classification provided more accurate presentation of the root and canal anatomy in maxillary premolars compared to Vertucci's classification.

Evaluation of the Frequency and Anatomy of Radix Entomolaris and Paramolaris in Lower Molars by Cone Beam Computed Tomography (CBCT) in Northern Iran, 2020-2021: A Retrospective Study

INTRODUCTION AND OBJECTIVE

The presence of an additional root, known as a radix, in the lower molars is of significant importance in the context of root canal therapy since it has the potential to contribute to treatment failure. Furthermore, it is imperative to take this circumstance into consideration when doing tooth extraction using a radix. The present study investigated the anatomical characteristics and prevalence rates of radix entomolaris and paramolaris in mandibular molars using cone beam computed tomography.

MATERIALS AND METHODS

Cone beam computed tomography scans of the lower molars of 376 patients were processed through Newtom's NNT viewer software. Radix type, radix root canal length, radix root curvature, Vertucci's classification of the canal, and gender of patients were recorded. The results of the research were analyzed with chi-squared.

RESULTS

The prevalence of radix was found to be 0.74%, with entomolaris and paramolaris present in 54.54% and 45.46% of cases, respectively. There was no statistically significant difference between the two variables of radix type and gender, as indicated by a p-value of 0.08. The mean curvature and length of the radix root were measured to be 56.63° and 15.09 mm, respectively. The average root curvature in individuals diagnosed with radix entomolaris and paramolaris was found to be 62.33° and 49.80°, respectively. The study found that the root curvature of entomolaris exhibited a statistically significant difference compared to paramolaris (P=0.031). The mean length of the radix entomolaris and paramolaris roots was found to be 15.50 and 14.60 mm, respectively. There was no statistically significant difference observed in the mean root lengths of the various radix types (P=0.37). According to Vertucci's classification, all radixes were classified as type 1.

CONCLUSION

The investigated population had a low incidence of radix. The curvature of radix entomolaris exhibited a statistically significant increase compared to radix paramolaris. There was no observed correlation between gender and the length of radix roots in relation to the type of radix root.

A microcomputed tomographic analysis of the morphological variabilities and incidence of extra canals in mandibular first molar teeth in an Egyptian subpopulation

A well-protected microbial habitat may be present in the root and canal morphology, which is varied and complicated. Before initiating effective root canal treatment, a detailed knowledge of the root and canal anatomical variances in each tooth is a must. This study aimed to investigate the root canal configuration, apical constriction anatomy, location of the apical foramen, dentine thickness, and prevalence of accessory canals in mandibular molar teeth in an Egyptian subpopulation using micro-computed tomography (microCT). A total of 96 mandibular first molars were scanned using microCT, and 3D reconstruction was performed using Mimics software. The root canal configurations of each of the mesial and distal root were classified with two different classification systems. The prevalence and dentin thickness around middle mesial and middle distal canals were investigated. The number, location and anatomy of major apical foramina and the apical constriction anatomy analysed. The number and location of accessory canals were identified. Our findings showed that two separate canals (15%) and one single canal (65%) were the most common configuration in the mesial and distal roots, respectively. More than half of the mesial roots had complex canal configurations and 51% had middle mesial canals. The single apical constriction anatomy was the most common for both canals followed by the parallel anatomy. Disto-lingual and distal locations of the apical foramen are the most common location for both roots. Mandibular molars in Egyptians show a wide range of variations in root canal anatomy with high prevalence of middle mesial canals. Clinicians should be aware of such anatomical variations for successful root canal treatment procedures. A specific access refinement protocol and appropriate shaping parameters should be designated for each case to fulfil the mechanical and biological objectives of root canal treatment without compromising the longevity of treated teeth.

Evaluation of Root Anatomy and Canal Configuration of Human Permanent Maxillary First Molar Using Cone-Beam Computed Tomography: A Systematic Review

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.

Root and Root Canal Morphology Classification Systems

Introduction

While there are many root morphology classification systems with their own distinct advantages, there are many shortcomings that come along with each system.

Objectives

The aim of this review was to compare the various root and root canal morphology classifications, their advantages, limitations, and clinical and research implications. Data Sources and Selection. An extensive literature search was conducted on PubMed and Scopus to identify the published data on root and root canal classification systems published until 1 May 2020 using keywords, root canal classification system, classification systems for root canals, and root morphology. The related literature was reviewed and then summarized. Data Synthesis. Several studies have analysed and detailed root and root canal classifications and further added new subsystems, works of Weine et al. (1969) and Vertucci et al. (1974). Besides, Sert and Bayirli (2004) added supplementary types to Vertucci's classification system. A new classification was most recently introduced by Ahmed et al. (2017) involving the use of codes for tooth numbering, number of roots, and canal configuration.

Conclusions

Weine et al. classified only single-rooted teeth, without considering multirooted teeth and complex configurations. Vertucci's classification included complex configurations, with Sert and Bayirli adding further complex supplemental types. Ahmed et al.'s classification simplifies classifying root and canal morphology while overcoming the limitations of several previous classification systems making it beneficial for implementation in dental schools.

Micro-computed tomography evaluation of the prevalence and morphological features of apical bifurcations

Background/purpose

Apical bifurcation, as a common variation in root canal morphology, has great clinical significance for root canal treatment. The aim of this study was to investigate the morphological characteristics of the apical bifurcated canal in Chinese teeth based on a large sample size using micro-CT.

Materials and methods

One thousand and four hundred Chinese permanent teeth were scanned by using micro-CT with the resolution of 15 μm. The number of apical bifurcations was calculated and the vertical distance of apical bifurcations was recorded. The diameter and angles of the apical bifurcated canals were further measured using the centerline algorithm method.

Results

Ninety-two apical bifurcations were detected in 15 anterior teeth, 27 premolars, and 46 M. The median vertical distance of apical bifurcations was 1.1 mm from the apex (ranging from 0.3 to 3.5 mm). Ninety-eight-point nine percent of the apical bifurcations were located less than 3 mm from the apex. The smaller angle of apical bifurcated canals with the main canal was 20.4°. The larger angle of the apical bifurcated canals with the main canal was 32.9°. The median diameter of apical bifurcated canals was 195.0 μm.

Conclusion

A high prevalence of apical bifurcation can be detected in the human permanent teeth, especially in posterior teeth. Most apical bifurcations locate within the apical 3 mm with a diameter more than 200 μm.