A Clinical Update on the Different Methods to Decrease the Occurrence of Missed Root Canals

Evaluation of Occupational Burnout and Job Satisfaction among Endodontists in Iran

Introduction

Occupational burnout has been introduced as one of the most critical social problems. The present study aimed to evaluate occupational burnout among a group of Iranian endodontists.

Material and Methods

Seventy-two Iranian endodontists participated in this cross-sectional study by completing the abbreviated Maslach Burnout Inventory (aMBI), consisting of one questionnaire in three domains. The data were analyzed with SPSS 21, using the chi-squared test, correlation test, and linear regression.

Results

Concerning occupational burnout, 2.9% of the participants had severe emotional exhaustion, 4.2% exhibited an intense feeling of decreased accomplishment, 67.2% exhibited moderate occupational burnout, and 78.9% of the participants were satisfied with their job. Of all the variables, only the years elapsed since graduation had an inverse and significant correlation with occupational burnout among endodontists.

Conclusion

The overall mean scores of endodontists showed a moderate rate of occupational burnout compared to the standard mean scores in this field. Recent graduates exhibited higher scores.

Prevalence of Radix Entomolaris in Mandibular Permanent Molars Analyzed by Cone-Beam CT in the Saudi Population of Ha'il Province

BACKGROUND

The present study aimed to examine the prevalence of radix entomolaris (RE) in the mandibular permanent molar within a specific sub-population in Saudi Arabia.

METHODS

A comprehensive analysis was conducted on 499 cone-beam computed tomography (CBCT) scans of a mandibular molar from a sample of Saudi patients aged between 18 and 65. The primary objective of this study was to investigate the anatomical characteristics of mandibular permanent molars, specifically focusing on the number of roots present. The chi-square test was employed to examine the relationship between various variables.

RESULTS

In the case of mandibular first molars, it was observed that 95.3% of these molars exhibited a bifurcated root structure. In comparison, the remaining 4.7% displayed a triradicular configuration within the sample population under investigation. Although there were some variations, no significant differences in the number of roots were observed between males and females or left and right sides (p > 0.05). In the case of mandibular second molars, it was observed that 96.9% of them exhibited a bifurcated root structure, whereas 2.5% displayed a trifurcated root configuration, and a mere 0.6% possessed a single root. There were no statistically significant variations in the number of roots between males and females or left and right sides (p > 0.05).

CONCLUSIONS

The identification of RE was observed in the mandibular molars. Moreover, the discovered RE roots were predominantly found in the mandibular first molar, displaying a tendency for bilateral occurrence in both male and female individuals.

Middle mesial canal in mandibular first molar: A narrative review

Purpose

This review aimed to assess the incidence, anatomical characteristics, identification, and clinical management using conventional techniques and advanced tools to manage MMCs successfully.

Methods

Medline/PubMed and Scopus databases were searched using "Middle mesial canal," "Middle mesial root canal," OR "Accessory mesial canal" keywords from 1 January 1970 and 1 February 2023. The most pertinent articles were chosen for the review from the retrieved articles. In addition, relevant articles were added by manually searching the list of references.

Results

The incidence of MMC is noticeable in younger people, and the confluent canal is the most common type. The majority of MMCs merged with mesiobuccal (MB) canals rather than mesiolingual (ML) canals. Clinical management could be employed using the standard endodontics protocol, and recent radiography technologies, magnification, rotary, and obturation materials can facilitate the procedures.

Conclusion

The possibility of the incidence of MMC is not unusual. Detection and thorough debridement followed by obturation of the canal could increase the success rate of clinical outcomes.

Root Morphology and Canal Configuration of Permanent Canines Among Saudi Population: Systematic Review and Comparison with Worldwide Studies

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.

Mandibular Second Premolar with Four Canals: A Case Report

The mandibular second premolar can be considered one of the most challenging teeth to treat endodontically; due to the complexity of its root canal morphology and increased incidence of multiple canals. The knowledge of internal anatomy of root canals and their possible variations as well as use of magnification, e.g. operating microscope, radiographic examination and illumination, can increase the chances of finding additional canals and contribute to the success of endodontic treatment. The purpose of the current investigation is to report the successful endodontic treatment of a mandibular second premolar with 4 canals; all of them in one single root.

Efficacy of Two Different Views of Video Demonstration in Teaching Access Cavity Preparation to Third Year Dental Students

Introduction

Demonstration of the access cavity preparation procedures to dental students is challenging due to the limited operating field and the detailed nature of the procedures. The aim of this study was to develop and evaluate two different views in video demonstrations used to teach access cavity preparation.

Methods and Materials

Two videos of access cavity preparation were filmed, one showing the occlusal view (OV) and one showing the sectional view (SV). Third-year dental students (n=57) who consented to participate in the study were divided into two groups to watch one of the videos. The perception and performance of both groups were compared using the Mann-Whitney U test and Fisher's exact test.

Results

At baseline, group OV (n=29) and group SV (n=28) were not significantly different in terms of operative scores (P=0.330). After watching the videos, the basic understanding of the theories was similar in both groups. However, the SV group responded more positively towards the helpfulness of the video in visualizing the inner anatomy of the tooth and in implementing the procedures (P<0.05). The SV group also completed the exercise within a shorter time (P<0.001). Nevertheless, the quality of the prepared access cavities was not significantly different between groups.

Conclusion

Within the limitations of this study, the additional step in sectioning a tooth before demonstration of access cavity preparation seems well worth the effort, offering the novice students advantages in visualizing certain anatomical landmarks and implementing access cavity preparation procedure within a shorter timeframe. Nevertheless, it did not improve the final quality of the preparations.

Evaluation of Distolingual Canal/Roots in Mandibular Molars and Mesiobuccal Canals in Maxillary Molars by CBCT

Background/Purpose:

The objectives of this study were to identify the bilateral distolingual (DL) canals / roots of the mandibular first molars and second mesiobuccal (MB2) canals of the maxillary first molars in the same Turkish individuals using cone-beam computed tomography (CBCT).

Materials and Methods:

A total of 150 CBCT images including all mandibular and maxillary first molars were retrospectively investigated in a Turkish subpopulation. The patient age, sex and presence of roots and root canals were assessed. The frequency, of bilateral DL canals, DL roots, and MB2 canals were reviewed. Data were analyzed using Fisher’sexact test and Chi-square test.

Results:

The prevalences of right DL canals, DL roots and MB2 canals were 31.3, 14.0 and 34.7%, respectively. The prevalences of left DL canals, DL roots and MB2 canals were 31.3, 4 and 27.3%, respectively. There was no statistically difference in the frequency of right and left DL canals, DL roots of mandibular first molars and MB2 canals of maxillary first molars according to gender.

Conclusion:

CBCT is a competent tool for the detection of additional distolingual canals/roots and second mesio buccal canals, and it is a valuable aid for dentists providing root canal treatment.

Treatment of a Maxillary Second Molar with One Buccal and Two Palatal Roots Confirmed with Cone-Beam Computed Tomography

Root canal configuration is an important subject in endodontic practice and dentists should be familiar with all possible types of root canal configuration. A forty-three year old male was referred for root canal treatment of his maxillary left second molar tooth with symptomatic irreversible pulpitis. Pre-operative radiographs showed a three rooted molar. However, after access cavity preparation two palatal and one buccal orifices were detected. The patient was informed of the unusual root canal anatomy and cone-beam computed tomography (CBCT) was ordered for precise evaluation of the anatomy. CBCT image confirmed the presence of one buccal and two palatal root canals; an exceptionally rare condition.