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Profound knowledge of the internal anatomy and configuration of the teeth plays a pivotal role in the success of standard root canal treatment. The presence of unexpected extra root canals has been reported in all the teeth, making root canal treatment a challenge for every clinician. Although the maxillary second premolar is no exception to this rule, the presence of a variety of multiple canals is relatively rare. In fact, the presence of three separate root canals has been reported in only 1-6% of cases. A 33-year-old male was referred for root canal retreatment of his left maxillary second premolar. An intraoral periapical radiograph revealed previous substandard endodontic treatment. Retreatment was performed under an operating microscope, and four root canals were found, which is, in fact, very rare. This case highlights another variation in the morphology of such teeth and it does highlight the importance of using magnification, especially an operating microscope in endodontic treatment.
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INTRODUCTION: The aim of this investigation was to examine the root canal system morphology of maxillary second premolars (Mx2Ps) of a Swiss-German population by means of micro-computed tomography and provide systematic review of the root canal configuration (RCC) literature of Mx2Ps. METHODS: The RCC, main foramina as well as accessory canals and foramina frequency of 116 Mx2Ps, were investigated by means of micro-computed tomography and 3-dimensional software imaging. The RCC from the coronal to apical thirds of the root as well as the main foramina number were described by using a four-digit system code. The literature review follows the PRISMA guideline analyzing randomized controlled trials and cross-sectional, cohort, comparative, validation, and evaluation studies on RCC in Embase, grey literature, PubMed, and Scopus. RESULTS: Most frequently observed RCCs of Mx2Ps were 1-1-1/1 (35.3%), 1-1-1/2 (21.6%), and 2-1-1/1 (14.7%). Another 11 less frequent RCCs were observed. All Mx2Ps had 1 root. One main foramen was observed in 59.5% and two in 37.9%. Accessory foramina were observed in 46.6%. Thirty-one percent of the Mx2Ps showed accessory canals. One connecting canal between the buccal and palatal was observed in 12.1%. CONCLUSIONS: Detailed RCC information of Mx2Ps in a Swiss-German population and the results of a systematic literature review of different populations and research methods used to investigate root canal morphology and configuration of Mx2Ps are given. Within the limitations of the study, a high RCC, connecting and accessory canals variability occur in maxillary second premolars.
Subject(s)
Dental Pulp Cavity , Tooth Root , Bicuspid/diagnostic imaging , Cross-Sectional Studies , Dental Pulp Cavity/diagnostic imaging , Humans , Maxilla/diagnostic imaging , Switzerland , X-Ray MicrotomographyABSTRACT
The purpose of this study was to investigate the expansion of the maxillary sinus and the inclinations of posterior teeth in orthodontic patients with maxillary second premolar agenesis. A total of 30 subjects with one or two congenitally missing maxillary second premolars and retained maxillary deciduous second molars (a agenesis group) were selected and divided into a unilateral agenesis group (20 subjects with one maxillary second premolar missing) and a bilateral agenesis group (10 subjects with two maxillary second premolars missing). As controls, 30 sex- and age-matched subjects without agenesis of the maxillary second premolars were selected. Oblique cephalograms were used to investigate the association of maxillary second premolar agenesis and lower maxillary sinus size and posterior tooth inclinations. Agenesis of the maxillary second premolars induced significantly large lower maxillary sinus length, depth, area and mesial inclination of the maxillary first premolar, a significantly small anterior maxillary length, and a significantly more distal position for root apex of the maxillary first premolar. There were no significant differences in any measurements of the lower maxillary sinus and posterior teeth between the non-agenesis side in the unilateral agenesis group and the control group. Maxillary second premolar agenesis caused inferior and anterior expansion of the lower maxillary sinus and the mesial inclination of the maxillary first premolars with a distal position of root apex. Unilateral agenesis of the maxillary second premolar did not affect on the lower maxillary sinus size or posterior tooth inclinations of the unaffected antimere.
Subject(s)
Maxillary Sinus , Molar , Bicuspid , Humans , Japan , MaxillaABSTRACT
OBJECTIVE: This study aimed to suggest criteria for the early diagnosis of agenesis of the maxillary second premolars (U5) based on the developmental stages of the maxillary canines (U3), first premolars (U4), and second molars (U7). DESIGN: Overall, 303 control patients and 72 patients with agenesis who met the inclusion criteria were analyzed among 5136 patients aged 5-11 years for whom panoramic radiographs were obtained at Seoul National University Dental Hospital from June 2008 to December 2009. All developmental stages of U3, U4, U5, and U7 in both groups were evaluated and categorized into the stages proposed by Demirjian et al. To confirm the delayed dental development in the agenesis group, the Wilcoxon rank sum test was used. For verifying the tooth with the most similar developmental pattern to U5, the Kendall tau Rank Correlation and Bootstrap methods were used. Moreover, survival analysis and leave-one-out-cross-validation were performed to identify the earliest developmental stages of U3, U4, and U7 at which agenesis of U5 can be confirmed. RESULTS: The developmental stage of U4 in the agenesis group was significantly delayed compared with that in the control group at ages 5-10. All of the stages of U3, U4, and U7 showed high correlation coefficients with U5. CONCLUSION: U5 agenesis can be confirmed with high prediction accuracy when at least two of the three conditions are satisfied: U3, U4, and U7 in Demirjian stages E, D, and C, respectively.
Subject(s)
Molar , Anodontia , Bicuspid , Child , Child, Preschool , Humans , Radiography, PanoramicABSTRACT
Objective @# To study root morphology, the incidence of three root canals and the root canal anatomy of maxillary premolars.@*Methods@#The cone-beam computed tomography (CBCT) data of 779 maxillary first premolars and 728 maxillary second premolars were collected from 412 patients in Zhuhai Stomatological Hospital. The root and canal morphology, incidence of three canals, bilateral symmetry and location of root canal bifurcation were analyzed. @*Results @#The incidence of three canals in the maxillary first premolars was 1.8% and that in the maxillary second premolars was 0.3%. The incidence of three canals in the maxillary first premolars was significantly higher than that in the maxillary second premolars (c2=8.304, P=0.004). The symmetrical ratio of the three-canal maxillary first premolar was 27.3%. There was no symmetrical three-canal maxillary second premolar. The anatomical morphology of the maxillary premolar can be single root, double root or trident root. Its internal root canal system is complex and diverse. There are seven kinds of Vertucci morphology: the first maxillary premolar is mainly Vertucci IV type, and the second maxillary premolar is mainly Vertucci I type. Most of the root canal bifurcations of the three-canal maxillary premolars were observed in the midthird or the cervical third of the root. All three-canal maxillary premolars had three independent apical foramens. @*Conclusion @#The root canal morphology of maxillary premolars is complex and changeable. CBCT plays an important role in the discovery of variation and extra root canals.
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Objective @#To explore the discovery and treatment of multiple root canals in the maxillary second premolar to provide a reference for root canal therapy.@*Methods @#A case of maxillary second premolar occlusal discomfort accompanied by cold and heat stimulation pain and spontaneous pain was analyzed retrospectively.@*Results@# In this case, the number of roots and root canals in the tooth was determined by CBCT to be three roots with four canals. Root canal therapy was performed with Ni-Ti endodontic files and thermoplastic gutta-percha via root optical microscopy. The clinical symptoms disappeared after the operation.@*Conclusion@#The maxillary second premolar root canal system is complex, and additional root canals can be found and located with CBCT and optical microscopy. High-quality root canal therapy was completed.
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INTRODUCTION: The principal goal of dentistry is to maintain and improve the quality of life of the dental patients. As many of these objectives require the replacement or alterations of the existing tooth structure, the main challenge for centuries has been the development and selection of biocompatible materials that can withstand the unique conditions of the oral environment.Finite element analysis (FEA) is a modern technique of numerical stress analysis that has become a solution to the task of predicting failure due to unknown stresses by showing problem areas in a material and allowing designers to see all of theoretical stresses within. AIMS AND OBJECTIVES: To evaluate and compare the effect of various temperature changes on the stress distribution, in class II mesial-occlusal-distal (MOD) cavity when restored with different restorative materials, using the finite element method (FEM). MATERIALS AND METHODS: Using FEA, various thermal stresses generated in class II MOD lesion using different restorative materials were studied. RESULTS: The computer-generated models of intact tooth and teeth restored with the different restorative materials were designed, and thermal stress at different temperatures was observed when subjected to the thermal loads of 5°C, 20°C, 36°C, and 55°C. From the results of the study, it can be concluded that glass ionomer cement (GIC) performed best, followed by intact tooth, composite resin, silver amalgam, and zinc oxide eugenol cement. CONCLUSION: Restoration of class II MOD lesions with materials of lower modulus of elasticity and lower coefficient of thermal expansion will enable better stress distribution.How to cite this article: Srivastava B, Devi NN, Gupta N, Singh R. Comparative Evaluation of Various Temperature Changes on Stress Distribution in Class II Mesial-occlusal-distal Preparation restored with Different Restorative Materials: A Finite Element Analysis. Int J Clin Pediatr Dent 2018;11(3):167-170.
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Successful root canal treatment relies on correct access cavity preparation, sufficient cleaning, adequate shaping, and complete obturation. Prior to these, location of all existing canals in the tooth plays an important part in the initial treatment procedures. While most teeth have a normal morphology, we should recognize that variations do exist. Normal maxillary second premolars have one or two root canals. Maxillary second premolars are less likely to have three canals. To date, only a few cases of maxillary second premolars with three roots (and three canals) have been reported in the literature. This case presentation reports a 20-year-old female who had three root canals in a maxillary second premolar, which underwent endodontic treatment at a teaching hospital in Taiwan.
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Knowledge and understanding the anatomical configuration of individual tooth play a significant role in success of endodontic treatment, in addition to through debridement and obturation of the canals. The canal anatomy of maxillary second premolar has been studied extensively, and the presence of a significant variety of multirooted canals is relatively rare in it. A 27-year-old female reported with a chief complaint of pain in her upper right posterior region for 10 days. On intraoral hard tissue examination, ill-defined access preparation was seen in maxillary right second premolar with exposed pulp. An intraoral periapical radiograph reveals radiolucency involving the pulp space and varied morphology in the same tooth. The occurrence of three roots with four canals in the maxillary second premolar is rare and not documented in the literature so far. This case report describes the nonsurgical endodontic management of such varied anatomical configuration using cone beam computed tomography as an evaluating diagnostic tool.
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Traditional configuration of maxillary second premolars has been described to have two cusps, one root and one or two root canals. The endodontic literature reports considerable anatomic aberrations in the root canal morphology of maxillary second premolar but the literature available on the variation in cuspal anatomy and its relationship to the root canal anatomy is sparse. The purpose of this clinical report was to describe the root and root canal configuration of a maxillary second premolar with four cusps.
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Accurate diagnosis of the root canal morphology and anatomy is essential for thorough shaping and cleaning of the entire root canal system and consequent successful treatment. This report describes a case of maxillary second premolar with two roots and three root canals (two mesial and distal palatal canals). The case report underlines the importance of complete knowledge about root canal morphology and possible variations, coupled with clinical and radiographic examination in order to increase the ability of clinicians to treat difficult cases.
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Anatomical variations in root canal morphology are an enigma and it is this variability, which is often a complicating factor in a successful root canal treatment. To achieve success in endodontic therapy it is imperative that all the canals are located, cleaned and shaped and obturated three dimensionally. Maxillary first premolar having three separate roots has an incidence of 0.5-6%. Even rarer are reported clinical case reports of maxillary second premolar with three separate roots and three canals. This case report describes the endodontic management of maxillary second premolar with two palatal roots and one buccal root having three root canals.
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INTRODUCTION: The purpose of this study was to investigate root canal morphology of maxillary second premolars in an Indian population. MATERIALS AND METHODS: Two hundred maxillary second premolars were collected, stained, decalcified, and cleared. Cleared teeth were examined in a steromicroscope under 7.5× magnification and the following observations were made: (1) length of the teeth, (2) number of root canals, (3) root canal configuration by Vertucci's classification, (4)number of isthmi between the canals, (5) frequency of apical deltas. RESULTS: Of the two hundred maxillary second premolars, 64.1% had one root canal at the apex and 35.4 % had two root canals at the apex. The average length of the teeth was 21.5 mm. Concerning the canal morphology, 33.6% of the teeth exhibited Vertucci type II configuration followed by type IV pattern (31.1%); 29.2% of the teeth possessed type I pattern. An additional canal configuration type XIX was found in one tooth. Isthmi and apical deltas was found in 19% and 14% of the cases, respectively. CONCLUSION: The root canal morphology of Maxillary second premolars can be complex and requires careful evaluation prior to endodontic therapy.
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In this study, endodontic treatments of maxillary second premolars with unusual anatomical configuration were presented. Maxillary second premolars usually have one root with one or two root canals. The occurrence of variations in anatomical configuration is also common; therefore, it must be taken into account in clinical and radiographic evaluation during the endodontic treatment. These teeth may also require special shaping and filling techniques. This article reports and discusses the treatment recommendations for unusual occurrences of anatomical configurations in four different maxillary second premolars.
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The objective of this study was to investigate the effects of various occlusal loads on the stress distribution of the buccal cervical region of a normal maxillary second premolar, using a three dimensional finite element analysis (3D FEA). After 3D FE modeling of maxillary second premolar, a static load of 500N of three load cases was applied. Stress analysis was performed using ANSYS (Swanson Analysis Systems, Inc., Houston, USA). The maximum principal stresses and minimum principal stresses were sampled at thirteen nodal points in the buccal cervical enamel for each four horizontal planes, 1.0 mm above CEJ, 0.5 mm above CEJ, CEJ, 0.5 mm under CEJ. The results were as follows 1. The peak stress was seen at the cervical enamel surface of the mesiobuccal line angle area, asymmetrically. 2. The values of compressive stresses were within the range of the failure stress of enamel. But the values of tensile stresses exceeded the range of the failure stress of enamel. 3. The tensile stresses from the perpendicular load at the buccal incline of palatal cusp may be shown to be the primary etiological factors of the NCCLs.
