Analysis of Bilateral Symmetry of Root Canal Anatomy in Permanent Dentition: An In Vivo CBCT Study in a Saudi Arabian Population.

AIM AND OBJECTIVE: To evaluate the internal symmetry of roots and root canals of permanent maxillary and mandibular teeth. This study used cone-beam computed tomography (CBCT) to examine the bilateral symmetry of root canals, their configuration, and the number of roots in a Saudi Arabian population. MATERIALS AND METHODS: CBCT images of 5,223 teeth from records of 208 patients (age of 28.74 ± 9.56 years) were analyzed using i-Dixel 3D imaging software. Sagittal, axial, and coronal serial sections were used to examine the root canal configuration, the number of roots, and the number of canals of all the teeth in the maxilla and mandible and compare them with the contralateral side for symmetry. Frequencies and percentages were used to represent the results. Cohen's Kappa test was employed to examine bilateral symmetry. The significance level was set at p <0.05 for all statistical tests. RESULTS: Bilateral symmetry of the number of roots was 100% in maxillary central incisors, laterals, canines, first molars, and second molars. The mandibular arch showed greater variation with the roots of the central incisors and second premolars being 100% symmetrical. Maxillary first premolars were frequently asymmetrical (14.9%). Maxillary central and lateral incisors showed 100% bilateral symmetry of the canals. The number of canals in the maxillary second molars showed asymmetry (18.9%). For canal configuration, the bilateral symmetry was found 100% in maxillary central and lateral incisors. Maxillary second premolars (32.2%) showed frequent asymmetry in the canal configuration. CONCLUSION: The mandibular arch showed greater asymmetry than the maxillary arch. Internal canal configurations displayed the highest bilateral asymmetry, followed by the number of canals. Bilateral symmetry was most evident in the number of roots present. CLINICAL SIGNIFICANCE: The findings of this study will enable clinicians to anticipate the variations in canal morphology in both maxillary and mandibular teeth and be cognizant of the contralateral variations in canal contours and anatomy that affect endodontic therapy.

Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study.

INTRODUCTION: This retrospective cohort study compared clinical and radiographic outcomes of endodontic treatment performed in immature nonvital permanent teeth by apexification (calcium hydroxide or apical barrier with mineral trioxide aggregate) versus revascularization. METHODS: A comprehensive chart review was performed to obtain a cohort of previously completed cases with recalls. Clinical and radiographic data were collected for 31 treated teeth (19 revascularization and 12 apexification) with an average follow-up time of 17 months and a recall rate of 63%. Tooth survival, success rate, and adverse events were analyzed. Changes in radiographic root length, width, and area were quantified. RESULTS: The majority of treated teeth survived throughout the study period, with 30 of 31 (97%) teeth surviving (18/19 [95%] revascularization and 12/12 apexification). Most cases were also clinically successful, with 27 of 31 (87%) meeting criteria for success (15/19 [78%] revascularization and 12/12 apexification; nonsignificant difference). A greater incidence of adverse events was observed in the revascularization group (8/19 [42%] vs 1/12 [11%] in apexification) (risk ratio = 5.1; P = .04; 95% confidence interval, 0.719-35.48). Although more revascularization cases than apexification cases showed an increase in radiographic root area and width, the effect was not statistically significant. CONCLUSIONS: In this study, revascularization was not superior to other apexification techniques in either clinical or radiographic outcomes. Studies with large subject cohorts and long follow-up periods are needed to evaluate outcomes of revascularization and apexification while accounting for important covariants relevant to clinical success.