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      Cone-beam computed tomographic analysis of middle mesial canals and isthmus in mesial roots of mandibular first molars-prevalence and related factors

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          Abstract

          Context:

          The internal anatomy of mandibular first molars has been studied in depth in different populations. However, limited information is present in differentiating a true middle mesial (MM) canal from an isthmus.

          Aims:

          The primary aim of this study was to identify the prevalence of a true MM canal and isthmus by retrospectively analyzing cone-beam computed tomography (CBCT) images in vivo. The secondary aim was to determine any correlation between related factors such as sex and age.

          Materials and Methods:

          CBCT images of 130 patients with the age group of 13–70 years were selected. Findings of MM canals and isthmus were recorded along with variables such as age and sex. Prevalence was compared using the Chi-square test ( P < 0.05).

          Results:

          Out of 143 mandibular first molars, the prevalence of the MM canal was 18.2%. There was no statistically significant difference between sex and prevalence of the MM canal and isthmus. The prevalence of isthmi in the mesial roots was 78.4%. Their presence was significantly higher in the apical third area (37.1%) ( P < 0.05). Both MM canal and isthmus were seen significantly higher in the age group of 31–50 years ( P < 0.05).

          Conclusions:

          This study showed a high prevalence of MM canals (18.2%) and isthmus (78.4%). The prevalence of the MM canal and isthmi was significantly higher in the middle age groups. This knowledge may direct the clinicians in locating them leading to good endodontic prognosis.

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          Analysis of the internal anatomy of maxillary first molars by using different methods.

          Flares Baratto-Filho, Gisele Aihara Haragushiku, Edson Alves Campos … (2009)
          The success of endodontic treatment depends on the identification of all root canals so that they can be cleaned, shaped, and obturated. This study investigated internal morphology of maxillary first molars by 3 different methods: ex vivo, clinical, and cone beam computed tomography (CBCT) analysis. In all these different methods, the number of additional root canals and their locations, the number of foramina, and the frequency of canals that could or could not be negotiated were recorded. In the ex vivo study, 140 extracted maxillary first molars were evaluated. After canals were accessed and detected by using an operating microscope, the teeth with significant anatomic variances were cleared. In the clinical analysis, the records of 291 patients who had undergone endodontic treatment in a dental school during a 2-year period were used. In the CBCT analysis, 54 maxillary first molars were evaluated. The ex vivo assessment results showed a fourth canal frequency in 67.14% of the teeth, besides a tooth with 7 root canals (0.72%). Additional root canals were located in the mesiobuccal root in 92.85% of the teeth (17.35% could not be negotiated), and when they were present, 65.30% exhibited 1 foramen. Clinical assessment showed that 53.26%, 0.35%, and 0.35% of the teeth exhibited 4, 5, and 6 root canals, respectively. Additional root canals were located in this assessment in mesiobuccal root in 95.63% (27.50% could not be negotiated), and when they were present, 59.38% exhibited 1 foramen. CBCT results showed 2, 4, and 5 root canals in 1.85%, 37.05%, and 1.85% of the teeth, respectively. When present, additional canals showed 1 foramen in 90.90% of the teeth studied. This study demonstrated that operating microscope and CBCT have been important for locating and identifying root canals, and CBCT can be used as a good method for initial identification of maxillary first molar internal morphology.
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            Use of cone-beam computed tomography to evaluate root and canal morphology of mandibular molars in Chinese individuals.

            Fu-Shin Yu, Hong-Hui Wang, Tina Hu … (2011)
            To evaluate the root canal configuration of permanent mandibular first and second molar teeth in a Chinese subpopulation using cone-beam computed tomography (CBCT). Patients who required CBCT radiographic examinations as part of their routine examination, diagnosis and treatment planning, were enrolled. Cases where the anatomy was compromised by physiological or pathological processes and the original root canal morphology was not clear were excluded. A total of 389 healthy, untreated, fully developed mandibular molars in Chinese individuals were included. The following observations were recorded: (i) the number of roots and their morphology; (ii) the number of canals per root; (iii) the canal configuration; (iv) the frequency of distolingual roots in the mandibular first molars and (v) the frequency of C-shaped canals in the mandibular second molars. The root canal configurations were classified according to the method of Vertucci (Oral Surgery, Oral Medicine, and Oral Pathology58, 1984, 589). The majority of mandibular molars (70% of first molars, 76% of second molars) had two separate roots; however, three roots were identified in 29% of first molars. C-shaped roots occurred in 29% of second molars. Three canals were found in 56% of mandibular first molars and 43% had four canals. In the mandibular second molars, 46% had three canals and 38% had two canals. Most distal roots had a simple type I configuration, whereas mesial roots had more complex canal systems, with more than one canal. There were seven variants of the root canal morphology amongst the mandibular first molars and eight variants amongst the mandibular second molars, without considering the various root types. Three-rooted mandibular first molars and C-shaped mandibular second molars occurred frequently in this Chinese population. CBCT is an effective tool for the detection of additional distolingual roots and C-shaped roots/canals, and it is a valuable aid for dentists providing root canal treatment. © 2011 International Endodontic Journal.
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              Root and canal morphology of permanent mandibular molars in a Sudanese population.

              H. Ahmed, N Abu-bakr, N Yahia … (2007)
              To investigate variations in the root canal systems of first and second permanent mandibular molar teeth in a Sudanese population using a clearing technique. Two hundred extracted first and second permanent mandibular molars from three cities in the state of Khartoum were studied. Access cavities were prepared and pulp tissue was removed by immersion in 5% sodium hypochlorite under ultrasonication; Indian ink was then injected into the root canal systems assisted by a vacuum applied apically. The teeth were rendered clear by demineralization and immersion in methyl salicylate before evaluation. The following observations were made (i) number of roots and their morphology; (ii) number of root canals per tooth; (iii) number of root canals per root and (iv) root canal configuration. Overall 59% of mandibular first molars had four canals with 3% having a third distolingual root. Seventy-eight per cent of second mandibular molars had two separate flat roots, whilst 10% were C-shaped. The most common canal system configurations were type IV (73%) and type II (14%). Inter-canal communications were more common in the mesial roots. The prevalence of inter-canal communications was 65% in first molars and 49% in second molars. In this sample of Sudanese teeth, 59% of the mandibular first permanent molars had four root canals whilst 10% of the mandibular second molars had C-shaped roots/canals.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Conserv Dent
                Journal ID (iso-abbrev): J Conserv Dent
                Journal ID (publisher-id): JCD
                Title: Journal of Conservative Dentistry : JCD
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0972-0707
                ISSN (Electronic): 0974-5203
                Publication date (Print): Sep-Oct 2018
                Volume: 21
                Issue: 5
                Pages: 526-530
                Affiliations
                [1]Department of Conservative Dental Sciences, College of Dentistry, Qassim University, Buraydah, Saudi Arabia
                Author notes
                Address for correspondence: Dr. Swati Srivastava, College of Dentistry, Qassim University, Buraydah, Saudi Arabia. E-mail: swatisrivastava412@ 123456gmail.com
                Article
                Publisher ID: JCD-21-526
                DOI: 10.4103/JCD.JCD_205_18
                PMC ID: 6161522
                PubMed ID: 30294115
                SO-VID: a6ea9e9f-9b26-4672-bf42-5f6ee227c16d
                Copyright © Copyright: © 2018 Journal of Conservative Dentistry
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 27 April 2018
                Date revision received : 04 July 2018
                Date accepted : 24 July 2018
                Categories
                Subject: Original Research Article

                ScienceOpen disciplines: Dentistry
                Keywords: cone-beam computed tomography,isthmus,mandibular first molar,middle mesial canal
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: cone-beam computed tomography, isthmus, mandibular first molar, middle mesial canal

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