Morphology of the Second Mesiobuccal Canal in the Maxillary Second Molar / Morfología del Segundo Canal Mesiovestibular en el Segundo Molar Maxilar

SUMMARY: Failure to locate a complete canal system affects the prognosis of root canal treatment. A missed root canal is one of the most common reasons for failed root canal treatment. The prevalence of the second mesiobuccal canal in the maxillary second molar is relatively high and has a variety of configurations. Therefore, knowledge of its morphology is required in clinical endodontics. This review presented the canal in terms of its prevalence, classification, anatomical features, and the method for locating the second mesiobuccal canal in the maxillary second molar. Root canal treatment requires knowledge of tooth morphology, appropriate access preparation, and a thorough examination of the tooth's interior. Thus, clinicians should carefully employ various methods for assessing the anatomy of the entire root canal system to prevent failure in locating the second mesiobuccal canal. This canal can be located by modifying the access cavity design and utilizing specific instruments to improve the second mesiobuccal canal system visualization.

La falta de localización de un sistema completo de canal afecta el pronóstico del tratamiento de éste. La omisión de un tratamiento de canal es uno de los motivos más frecuentes por las que el tratamiento de canal fracasa. La prevalencia del segundo canal mesiovestibular en el segundo molar superior es relativamente alta y tiene una variedad de configuraciones. Por tanto, el conocimiento de su morfología es necesario en endodoncia clínica. Esta revisión presentó el canal en términos de su prevalencia, clasificación, características anatómicas y el método para localizar el segundo canal mesiovestibular en el segundo molar superior. El tratamiento de canal requiere conocimiento de la morfología del diente, una preparación adecuada del acceso y un examen exhaustivo del interior del diente. Por lo tanto, los dentistas deben emplear cuidadosamente varios métodos para evaluar la anatomía de todo el sistema de canales radiculares para evitar fallas en la localización del segundo canal mesiovestibular. Este canal se puede localizar modificando el diseño de la cavidad de acceso y utilizando instrumentos específicos para mejorar la visualización del sistema del segundo canal mesiovestibular.

Microcomputed-Tomographic Analysis of the Root Canal Morphology of the Mandibular First Molars in a Malaysian Subpopulation Using Two Classification Systems / Análisis por Tomografía Microcomputada de la Morfología del Conducto Radicular de los Primeros Molares Mandibulares en una Subpoblación de Malasia Utilizando dos Sistemas de Clasificación

SUMMARY: This work investigated the morphology of the root canal system of the mandibular first molar in a Malaysian subpopulation. Using micro-computed tomography with an isotropic resolution of 22 µm, 140 mandibular first molars were scanned. MIMICS software was used for segmentation, 3-D reconstruction and analysis of the acquired images. The canal configuration was described using Vertucci [supported by the supplementary configurations proposed by Sert & Bayirli (2004)] and Ahmed et al. (2027), coding systems. The chi-square test was used to assess the association between qualitative variables. By non-considering intercanal communications, Vertucci types IV (17.1%) and I (76.4%) were the most frequently reported configurations in the mesial and distal roots, respectively. Of the reported configurations, 24.3% and 4.3% were non-classifiable by Vertucci system in the mesial and distal roots, respectively. Up to 63.6% and 9.3% of the reported configurations were non- classifiable, and type I was the most frequent when considering intercanal communications (7.1% and 76.4% in the mesial and distal roots, respectively). According to Ahmed et al., system, almost half of the sample had more than four digits (47.9%), followed by the 3-digits category (20.71%). In both systems, a significant association was found between the canal configuration and the root type (p<0.001). The mandibular first molar of this Malaysian subpopulation demonstrated a wide range of root canal morphology. When compared to the Vertucci system, the system developed by Ahmed et al., successfully classified all molars configurations despite their level of complexity. The complex canal anatomy of mandibular first molars in this subpopulation warrants special attention during root canal treatment procedures.

En este trabajo se investigó la morfología del sistema de conductos radiculares del primer molar mandibular en una subpoblación de Malasia. Utilizando tomografía microcomputada con una resolución isotrópica de 22 µm, se escanearon 140 primeros molares mandibulares. Se utilizó el software MIMICS para segmentar (enmascarar), reconstruir en 3D, visualizar y analizar las imágenes adquiridas. La configuración del canal se describió utilizando Vertucci respaldado por las configuraciones complementarias propuestas por Sert & Bayirli (2004)] y Ahmed et al. (2017, 2020), sistemas de codificación. Se utilizó la prueba de chi-cuadrado para evaluar la asociación entre variables cualitativas. Sin considerar las comunicaciones intercanales, los tipos Vertucci IV (17,1%) y I (76,4%) fueron las configuraciones reportadas con mayor frecuencia en las raíces mesiales y distales, respectivamente. De las configuraciones reportadas, el 24,3 % y el 4,3 % fueron no clasificables por el sistema de Vertucci en las raíces mesial y distal, respectivamente. Hasta el 63,6 % y el 9,3 % de las configuraciones reportadas fueron no clasificables, siendo la tipo I la más frecuente al considerar las comunicaciones intercanales (7,1 % y 76,4 % en las raíces mesiales y distales, respectivamente). Según Ahmed et al. (2017, 2020) en el sistema, casi la mitad de la muestra tenía más de cuatro dígitos (47,9 %), seguido por la categoría de 3 dígitos (20,71 %). En ambos sistemas se encontró una asociación significativa entre la configuración del canal y el tipo de raíz (p<0,001). El primer molar mandibular de esta subpoblación de Malasia demostró una amplia gama morfológica del conducto radicular. En comparación con el sistema Vertucci, el sistema desarrollado por Ahmed et al. (2017, 2020) clasificaron con éxito todas las configuraciones de los molares a pesar de su nivel de complejidad. La compleja anatomía del canal de los primeros molares mandibulares en esta subpoblación merece una atención especial durante los procedimientos de tratamiento de conducto.

MANDIBULAR PREMOLAR WITH TWO ROOTS AND TWO ROOT CANALS: A CASE REPORT.

For the success of a root canal treatment, an in-depth knowledge of pulpal anatomy and its variations are essential. Failure to perform thorough debridement and improper obturation will lead to reinfection of the root canal, which will adversely affect the treatment outcome. Mandibular premolars usually have single root with single root canal system. Howeveranatomic variations of mandibular premolar have been reported. The clinician should be aware of the configuration of the pulp system for the successful endodontic treatment. The incidence of two roots in these teeth is quite rare. This report presents the clinical management of mandibular premolar having two roots bifurcated at the mid-root level

Root anatomy and canal configuration of maxillary premolars: a cone-beam computed tomography study / Anatomía de la raíz y configuración del conducto de los premolares maxilares: estudio de tomografía computarizada de haz cónico

SUMMARY: The aim of the study was to determine the number and anatomical configuration of roots and root canals of maxillary first and second premolars using cone-beam computed tomography scans. n273 CBCT scans were evaluated, obtaining a sample of 592 maxillary premolars. Root number and root canal anatomy were categorized using Ahmed´s classification. Data was analyzed using Pearson's Chi-squared test. Two roots were present on 157 first premolars, one root in 132 premolars and three roots in 17. Second premolars presented one root in 266 samples and two roots in 20; no second premolars presented three roots. Eight different configurations were found; the most frequent was 2MP B1 P1 in first premolars (51,3 %) and 1MP1 (63.6 %) in second premolars. The most frequent morphology found in maxillary premolars in Chilean population was two and three roots. The analysis of internal anatomy using CBCT revealed a highly variable distribution of root canals, generally of low to medium complexity, similar to what is found in other ethnic groups.

RESUMEN: El objetivo de este estudio fue determinar el número y la configuración de raíces y canales radiculares de primeros y segundos premolares maxilares utilizado tomografía computacional de haz cónico. 273 TCHC fueron evaluados, obtenido una muestra de 592 premolares maxilares. El número de raíces y la anatomía de los canales radiculares fueron categorizados utilizando la clasificación de Ahmed. Los datos fueron analizados con la prueba Chi- Cuadrado de Pearson. Dos raíces fueron observadas en 157 primeros presentaron una raíz en 266 muestras y dos raíces en 20; no se encontraron tres raíces en segundos premolares. Ocho diferentes configuraciones fueron encontradas; siendo la más frecuente 2MP B1 P1 en primeros premolares (51,3 %) y 1MP1 (63,6 %) en segundos premolares. La morfología radicular más frecuentemente encontrada en premolares de población Chilena fue de dos y tres raíces. El análisis de la anatomía interna usando TCHC mostró una gran variabilidad de en la distribución de los canales radiculares. Generalmente de mediana y baja complejidad como los encontrados en otros grupos etnicos.

Mandibular Canine with Two Canals: A Case Report in Saudi Arabia

The Knowledge of the root canal morphology is essential for the success of the endodontic treatment. The most common anatomical configuration in mandibular canines is to have one root with one canal. However, previous studies reported 4.6% to 15% of the cases to have a second canal. In order to increase the knowledge about root canal morphology in the Saudi population, we reported a clinical case about successful endodontic management of mandibular canine with two joined canals (Vertucci type II) in Saudi females.

Reto de la endodoncia: conducto en "C" / Endodontics challenge: C-shaped root canal

El correcto manejo de la configuración del sistema de conductos radiculares en forma de C es un reto en la práctica endodóntica. La complejidad de este tipo de conductos hace que su diagnóstico, instrumentación y sobretodo su limpieza y obturación sea una tarea ardua en la mayoría de las ocasiones. El sistema de conductos tipo C en molares inferiores fue descripto por primera vez en 1979, por Cooke y Cox. Es una variación anatómica vista principalmente en segundos molares inferiores con una prevalencia de hasta un 31,5% en población asiática, aunque también puede ocurrir en premolares y molares, tanto superiores como inferiores. El rasgo anatómico principal de los conductos en C es la presencia de una aleta o cortina que conecta los conductos radiculares individuales. La cámara pulpar tiene un orificio que describe un arco de 180° o más. Se realiza un reporte de dos casos clínicos de conductos en C en segundo molar superior e inferior (AU)

The right management of the configuration of C-shaped root canal system is a challenge in endodontic practice. The complexity of this type of canals makes its diagnosis, instrumentation and especially its cleaning and obturation an arduous task in most of the occasions. The C-shaped canal system in mandibular molars was first described in 1979 by Cooke and Cox.It is an anatomical variation mainly seen in mandibular second molars with a prevalence of up to 31.5% in Asian population, although it can also occur in premolars and molars, both maxillary and mandibular. The main anatomical feature of the C-shaped canals is the presence of a fin or web connecting the individual root canals. The pulp chamber has an orifice that describes an arc of 180° or more. A report of two clinical cases of C-shaped canals in second maxillary and mandibular molar is presented (AU)

Evaluation of root and canal morphology of mandibular premolars in urban Indian population: an in-vivo cone beam computed tomographic study.

Background: Inability to recognize anatomical variations in roots and canal configurations remains one of the principal factors in failure of endodontic therapy. Mandibular premolars, due to their varied internal morphology, present an endodontic challenge more often than other teeth. Objective: To assess the root morphology and canal configuration of mandibular first and second premolars using three-dimensional cone-beam computed tomography imaging (3D CBCT). Methodology: Bilaterally, mandibular premolars were evaluated on 100 CBCT images independently by two experienced endodontists. Vertucci’s classification was used to identify and divide the canal configurations. Results: 97% of first premolars and 99.5% of the second premolars were found to have one root. The most common canal configuration was found to be Type- I. Other types of canal configurations were 5.5% and 5% in first and second premolars respectively. Conclusions: Modern-day endodntist needs to be vigilant at all times to avoid missing canals and consequent failures.

Prevalence of Unclassified Root Canal Configuration in Permanent Maxillary First Molar in Indian Population.

Background: If a canal is left untreated, it is a foci of infection. Therefore, it is critical to know the usual configuration of the root canal along with the variations in root canal anatomy, in order to keep the cause of endodontic failure to a minimum. Aim: This study investigated the canal configuration in maxillary first permanent molar mesiobuccal root radiographically followed by histological evaluation in Indian population. Methods: Endodontic access preparation was performed on 100 human permanent maxillary Ist molars and all the canals were explored. The mesiobuccal root was separated and radiographed in mesiodistal and buccolingual direction. India ink dye was injected actively in the root canal of each sample. The root samples were prepared for histological viewing. The slides made were observed under light microscope and canal configurations were tabulated. Results: The radiographic interpretations by observers were correlated with histological findings and analyzed statistically (p value). The radiographic findings revealed a good inter observer agreement (Cohen kappa). On matching histological and radiographic interpretations, it revealed 69.2% Vertucci type I predominance. New unclassified canal configurations were also observed. Conclusion: To divulge three dimensional architecture of the root canal, application of alone conventional radiography is not enough.

Bilateral Mandibular Centrals with Rare Type IV Canals

The aim of this study was to report the endodontic management of maxillary incisors having two canals with rare type IV vertucci canal configuration. Internal morphology of root canals is variable and often complex. Therefore, to achieve a technically satisfactory endodontic outcome, the clinician must have an adequate knowledge of the internal canal morphology and its variations to debride and obturate the root canal system thoroughly. This case report describes the successful endodontic treatment of both the mandibular central incisors having two-root canals in same individual.

Endodontic Management of Variants of C-Shaped Canal: Case Series

A thorough knowledge of the root canal morphology is required for successful endodontic therapy. One of the most important anatomic variations is the C-shaped configuration of the root canal system. The presence of high incidence of transverse anastomoses, lateral canals, and apical deltas makes it difficult to clean and seal the root canal system in these teeth and may complicate endodontic interventions. Meticulous mechanical and chemical debridement of the canal space with additional efforts is essential for complete elimination of pulpal pathology in the anatomical irregularities. Obturation of the canal space also requires special attention as obtaining a three dimensional fill of a C-shaped canal may prove to be a problem due to the various intricacies present within the root canal system. Hence, this case series presents various types of C-shaped canal morphologies of mandibular second molars and their management.

The occurrence of C-shaped root canal in Malaysian population.

Background: The recognition of unusual canal’s configurations and variations are essential for successful endodontic diagnosis and treatment. This study was aimed to investigate the occurrence of C- shaped root canal in Malaysian population. Design: This is an in vitro study whereby 241 extracted human first and second molars with intact root were collected from several dental clinics in Malaysia. Materials and Methods: The roots were sectioned at three levels: subpulpal level, 3mm from apical tip and middle level between the first and last level. The appearance of the root canal sections were assessed using stereomicroscope (Leica, Germany) and pictures were taken. Data were analyzed statistically using Fisher’s Exact and Binomial test with p<0.05 indicates statistically significant difference. Results: The occurrence of C- shaped canal among molars collected is 3.73%. Hundred percent of the molars with C- shaped root canal configuration are mandibular molars and 77.8% are belonged to Chinese racial. Conclusion: The findings show that C- shaped root canals do occur among Malaysian people especially Chinese racial. Besides, all the teeth that possess C- shaped root canal configuration are lower molars.

Prevalence of two root canals in human mandibular anterior teeth in an Iranian population.

Background: Complete debridement and obturation of the root canal system is a key factor in successful endodontic treatment and the operator should therefore have thorough knowledge of the root canal morphology of the teeth. Numerous studies have been carried out to investigate the canal configuration of different tooth types in various populations. Aims: The aim of the present study was to investigate the internal anatomy of mandibular incisors and canines in an Iranian population. Materials and Methods: A total of 463 mandibular anterior teeth, including 186 centrals, 128 laterals, and 149 canines, were examined. A standard clearing technique was used to make the teeth transparent. India ink was injected into the canals of the teeth and the samples were examined with a magnifying glass. The root canal configurations were categorized according to the Vertucci classification. Results: All the incisors in this study had one root, and 12.08% of the canines had two roots. We found a slightly higher prevalence of the second canal in incisors than in canines (36.62% vs. 20.48%). However, the probability of canines having two separate apical foramina was higher than that for incisors (12.08% vs. 0.64%). Conclusions: In view of the high prevalence of two-canaled mandibular anterior teeth found in this study, it would be prudent to assume that any mandibular anterior tooth being treated is two-canaled until a thorough search proves otherwise.

Dilemmas pertaining to three canals in the mesiobuccal root of a maxillary second molar: a case report

The mesiobuccal root of the maxillary molars is well known to pose a hindrance during endodontic therapy. Presented here is a case of a maxillary left second molar where three canals were located in its mesiobuccal root with the use of visual and diagnostic aids. Difficulties encountered during the process of unveiling the tooth's internal anatomy were discussed. The dilemmas encountered pertained to the root canal configuration, the nomenclature of the extra canals, and the justification for the presence of a third canal. The root canal configuration of 3-2-1 was confirmed for the mesiobuccal root using information gained from clinical, radiographic, and multi-detector computed tomography (MDCT) scan findings. This case demonstrates the need for efforts to locate extra canals in the mesiobuccal root of the maxillary molars as their internal anatomy remains a mystery.

Single rooted maxillary first molar: A rare case.

Adequate knowledge of the root canal morphology and its variations is essential for successful endodontic treatment. Of all the permanent teeth, maxillary first molar has a wide variety of variations in the root canal morphology. One among the rarest variation is to have a single root with a single canal. This case report presents one such unusual variation in maxillary first molar.

Effect of rotational speed of Protaper(TM) rotary file on the change of root canal configuration / 대한치과보존학회지

This study was conducted to evaluate canal configuration after shaping by ProTaper(TM) with various rotational speed in J-shaped simulated resin canals. Forty simulated root canals were divided into 4 groups, and instrumented using by ProTaper(TM) at the rotational speed of 250, 300, 350 and 400 rpm. Pre-instrumented and post-instrumented images were taken by a scanner and those were superimposed. Outer canal width, inner canal width, total canal width, and amount of transportation from original axis were measured at 1, 2, 3, 4, 5, 6, 7 and 8 mm from apex. Instrumentation time, instrument deformation and fracture were recorded. Data were analyzed by means of one-way ANOVA followed by Scheffe's test. The results were as follows 1. Regardless of rotational speed, at the 1~2 mm from the apex, axis of canal was transported to outer side of a curvature, and at 3~6 mm from the apex, to inner side of a curvature. Amounts of transportation from original axis were not significantly different among experimental groups except at 5 and 6 mm from the apex. 2. Instrumentation time of 350 and 400 rpm was significantly less than that of 250 and 300 rpm (p < 0.01). In conclusion, the rotational speed of ProTaper(TM) files in the range of 250~400 rpm does not affect the change of canal configuration, and high rotational speed reduces the instrumentation time. However, appearance of separation and distortion of Ni-Ti rotary files can occur in high rotational speed.

The canal system in the mesiobuccal root of the maxillary first molar / 대한치과보존학회지

This study is to investigate the canal system in the mesiobuccal root of the maxillry first molar. 61 maxillary first molars were randomly selected. Serial transverse sections were made perpendicular to the long axis of the mesiobuccal root. Each section was placed in 3% sodium hypochlorite for 24 hours and rinsed in water and dried. The resected surface was stained with 2% methylene blue dye and examined with stereomicroscope. 1. Canal configuration analysis showed that 36.1% of the specimen classified as type I, 16.4% as type II, 37.7% as type III and 9.8% as type IV. 2. Type II canal was merged in one canal within 1 to 4mm of the apex. 40% of type II canal converged at 2mm of the apex. 3. Type IV canal was divided into two canal within 2 to 4mm of the apex. 66.6% of type IV canal branched off at 2mm of the apex. 4. None of the sections had more than two main root canal. 5. 48.4% of the sections in 3mm with two canals contained an isthmusand more than 70% with two canals has isthmus at 4 to 5mm sections. 63.9% of the mesiobuccal root of maxillary first molar had two canaland 76.5% of sections with two canals in 5 MM had an isthmus. Because of this complexity the clinician should always search for extra canal carefullyand root canal system, including an isthmus, should be cleaned and shaped completelyand obturated three dimensionally for successful endodontic treatment.