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Research Article
Predictor factors of 1-rooted mandibular second molars on complicated root and canal anatomies of other mandibular teeth
Hakan Aydın, Hatice Harorlı
Restor Dent Endod 2024;49(1):e2.   Published online January 3, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e2
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to determine the effects of 1-rooted mandibular second molar (MnSM) teeth on root canal anatomy complexities of the mandibular central incisor (MnCI), mandibular lateral incisor (MnLI), mandibular canine (MnCn), mandibular first premolar (MnFP), mandibular second premolar (MnSP), and mandibular first molar (MnFM) teeth.

Materials and Methods

Cone-beam computed tomography images of 600 patients with full lower dentition were examined. Individuals with 1-rooted MnSMs were determined, and the complexity of root canal anatomy of other teeth was compared with individuals without 1-rooted MnSMs (Group-1; subjects with at least one 1-rooted MnSM, Group-2; subjects with more than a single root in both MnSMs). A second canal in MnCIs, MnLIs, MnCns, MnFPs, and MnSPs indicated a complicated root canal. The presence of a third root in MnFMs was recorded as complicated.

Results

The prevalence of 1-rooted MnSMs was 12.2%, with the C-shaped root type being the most prevalent (9%). There were fewer complicated root canals in MnCIs (p = 0.02), MnLIs (p < 0.001), and MnFPs (p < 0.001) in Group 1. The other teeth showed no difference between the groups (p > 0.05). According to logistic regression analysis, 1-rooted right MnSMs had a negative effect on having complex canal systems of MnLIs and MnFPs. Left MnSMs were explanatory variables on left MnLIs and both MnFPs.

Conclusions

In individuals with single-rooted MnSMs, a less complicated root canal system was observed in all teeth except the MnFMs.

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Case Report
Successful nonsurgical treatment of type II dens invaginatus with 5 root canals using a self-adjusting file: a case report
George Táccio de Miranda Candeiro, Antônio Sérgio Teixeira de Menezes, Ana Carolina Saldanha de Oliveira, Flávio Rodrigues Ferreira Alves
Restor Dent Endod 2023;48(2):e17.   Published online April 27, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e17
AbstractAbstract PDFPubReaderePub

The present report describes the endodontic treatment of an Oehlers type II dens invaginatus in a maxillary lateral incisor with 5 root canals, an extremely rare condition. Apical periodontitis and related symptoms were noted. Cone-beam computed tomography was used to aid the diagnosis, reveal tooth morphology, and assist in canal location. The pulp chamber was carefully accessed, and the root canals were explored under magnification. All root canals were prepared with an R25 Reciproc Blue system and sodium hypochlorite (NaOCl) irrigation. After initial preparation, a self-adjusting file (SAF) with NaOCl and ethylenediaminetetraacetic acid was used to complement the disinfection. Additionally, calcium hydroxide medication was applied. Vertical compaction was used to fill the canals with a calcium silicate-based endodontic sealer and gutta-percha. After 12 months, the patient exhibited healing of the periapical region, absence of symptoms, and normal dental function. In conclusion, this nonsurgical treatment protocol was successful in promoting the cure of apical periodontitis. Both complementary disinfection with an SAF and use of calcium hydroxide medication should be considered when choosing the best treatment approach for dens invaginatus with very complex anatomy.

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Research Articles
Apical periodontitis in mesiobuccal roots of maxillary molars: influence of anatomy and quality of root canal treatment, a CBCT study
Samantha Jannone Carrion, Marcelo Santos Coelho, Adriana de Jesus Soares, Marcos Frozoni
Restor Dent Endod 2022;47(4):e37.   Published online September 19, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e37
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the prevalence of apical periodontitis (AP) in the mesiobuccal roots of root canal-treated maxillary molars.

Materials and Methods

One thousand cone-beam computed tomography images of the teeth were examined by 2 dental specialists in oral radiology and endodontics. The internal anatomy of the roots, Vertucci’s classification, quality of root canal treatment, and presence of missed canals were evaluated; additionally, the correlation between these variables and AP was ascertained.

Results

A total of 1,000 roots (692 first molars and 308 second molars) encompassing 1,549 canals were assessed, and the quality of the root canal filling in the majority (56.9%) of the canals was satisfactory. AP was observed in 54.4% of the teeth. A mesiolingual canal in the mesiobuccal root (MB2 canal) was observed in 54.9% of the images, and the majority (83.5%) of these canals were not filled. Significant associations were observed between the presence of an MB2 canal and the quality of the root canal filling and the presence of AP.

Conclusions

AP was detected in more than half of the images. The MB2 canals were frequently missed or poorly filled.

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Morphological characteristics of the mesiobuccal root in the presence of a second mesiobuccal canal: a micro-CT study
Lucas P. Lopes Rosado, Matheus Lima Oliveira, Karla Rovaris, Deborah Queiroz Freitas, Frederico Sampaio Neves
Restor Dent Endod 2022;47(1):e6.   Published online January 18, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e6
AbstractAbstract PDFPubReaderePub
Objectives

This study investigated the internal morphology of mesiobuccal (MB) roots of maxillary molars with a second mesiobuccal (MB2) canal.

Materials and Methods

Forty-seven maxillary first or second molars from Brazilians were scanned using micro-computed tomography. The following measurements were obtained from the MB roots: root thickness, root width, and dentin thickness of the buccal aspect of the first mesiobuccal (MB1) canal, between the MB1 and MB2 canals, and the palatal aspect of the MB2 and MB1 canals at 3 mm from the root apex and in the furcation region. For statistical analysis, the Student’s t-test and analysis of variance with the post-hoc Tukey test were used (α = 0.05).

Results

In maxillary molars with an MB2 canal, MB roots were significantly thicker (p = 0.0014) and narrower (p = 0.0016) than in maxillary molars without an MB2 canal. The dentin thickness of the palatal aspect of the MB1 canal was also significantly greater than that of MB roots without an MB2 canal at 3 mm from the root apex (p = 0.0007) and in the furcation region (p < 0.0001). In the furcation region of maxillary molars with an MB2 canal, the dentin thickness between the MB1 and MB2 canals was significantly smaller than that in the buccal and palatal aspects (p < 0.0001).

Conclusions

The internal morphology of MB roots of maxillary molars with an MB2 canal revealed differences in dentin thickness, root diameter, and distance between the canals when compared with maxillary molars without an MB2 canal.

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Shape and anatomical relationship of the mental foramen to the mandibular premolars in an Indian sub-population: a retrospective CBCT analysis
Komal Sheth, Kulvinder Singh Banga, Ajinkya M. Pawar, James L. Gutmann, Hyeon-Cheol Kim
Restor Dent Endod 2022;47(1):e1.   Published online December 13, 2021
DOI: https://doi.org/10.5395/rde.2022.47.e1
AbstractAbstract PDFPubReaderePub
Objectives

This study assessed the shape and anatomical relationship of the mental foramen (MF) to mandibular posterior teeth in an Indian sub-population.

Materials and Methods

In total, 475 existing cone-beam computed tomography records exhibiting 950 MFs and including the bilateral presence of mandibular premolars and first molars were assessed. Images were evaluated 3-dimensionally to ascertain the position, shape, and anatomical proximity of MFs to mandibular teeth. The position and shape of MFs were measured and calculated. The Pythagorean theorem was used to calculate the distance between the root apex of the mandibular teeth and the MF.

Results

MFs exhibited a predominantly round shape (left: 67% and right: 65%) followed by oval (left: 30% and right: 31%) in both males and females and in different age groups. The root apices of mandibular second premolars (left: 71% and right: 62%) were closest to the MF, followed by distal to the first premolars and mesial to the second premolars. The mean vertical distance between the MF and the nearest tooth apex calculated on sagittal sections was 2.20 mm on the right side and 2.32 mm on the left side; no significant difference was found according to sex or age. The distance between the apices of the teeth and the MF was ≥ 4 mm (left; 4.09 ± 1.27 mm and right; 4.01 ± 1.15 mm).

Conclusions

These findings highlight the need for clinicians to be aware of the location of the MF in treatment planning and while performing non-surgical and surgical endodontic procedures.

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Enhanced visualization of the root canal morphology using a chitosan-based endo-radiopaque solution
Shashirekha Govind, Amit Jena, Satabdi Pattanaik, Mahaprasad Anarasi, Satyajit Mohapatra, Vinay Shivagange
Restor Dent Endod 2021;46(3):e33.   Published online June 4, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e33
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to investigate the efficacy of ionic and non-ionic-based contrast media (in vitro study) and the combinatorial effect of chitosan-based endo-radiopaque solution (CERS) (in vivo study) for visualization of the root canal anatomy.

Materials and Methods

In vitro study (120 teeth): The root canal of maxillary premolars and molars (in vitro group 1 and 2 respectively, n = 60 each) were analyzed using 4 different contrast media (subgroups: Omnipaque 350, Iopamidol, Xenetix 350, and Urografin 76; n = 15 each) in combination with 5.25% sodium hypochlorite (NaOCl). Based on the results of the in vitro study, in vivo study (80 teeth) was done to compare Xenetix 350 + 5.25% NaOCl with CERS (in vivo group 1 and 2 respectively, n = 40 each) on maxillary and mandibular premolars and molars. Two endodontists used radiovisiography to assess the depth of ingress and identify the aberrant root anatomy after access cavity preparation, and after initial cleaning and shaping of canals. Kruskal-Wallis test was used for in vitro comparison (p < 0.05), and Wilcoxon signed-rank test and Mann-Whitney U test for in vivo analysis (p < 0.01).

Results

In vitro study, Xenetix 350 + 5.25% NaOCl facilitated a significant higher visualization (p < 0.05). For in vivo study, CERS had a statistically significant depth of ingress (p < 0.01), and was efficient in identifying the aberrant root canal anatomy of premolars and molars.

Conclusions

CERS facilitates better visualization of the root canal anatomy of human premolars and molars.

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Isthmuses, accessory canals, and the direction of root curvature in permanent mandibular first molars: an in vivo computed tomography study
Aria Chuppani Dastgerdi, Manizheh Navabi, Vahid Rakhshan
Restor Dent Endod 2020;45(1):e7.   Published online December 12, 2019
DOI: https://doi.org/10.5395/rde.2020.45.e7
AbstractAbstract PDFPubReaderePub
Objectives

This study was performed to assess the anatomy of mandibular first molars.

Materials and Methods

In this in vivo study, cone-beam computed tomography (CBCT) volumes of 312 bilateral intact first mandibular molars from 156 patients (79 men and 77 women; average age, 35.6 ± 11.2 years) were investigated in terms of the direction of each canal's curvature in the buccolingual and mesiodistal dimensions (direction of the position of the apex in relation to the longitudinal axis of the root), the presence of an isthmus (a narrow, ribbon-shaped communication between 2 root canals) in 3 segments (0–2, 2–4, and 4–6 mm) from the apex), and the presence and number of accessory canals (smaller canals besides the main root canals, connecting the pulp to the periodontium). Data were analyzed statistically (α = 0.05).

Results

Mesiolingual canals were mostly buccally and distally inclined, while mesiobuccal and distolingual canals were mostly distally curved. Isthmuses were more common in younger patients (χ2 test, p < 0.05). The average numbers of accessory canals in the apical, middle, and coronal segments were 9.9 ± 4.2, 6.9 ± 2.9, and 9.3 ± 3.0 canals per segment, respectively (analysis of variance, p < 0.001). Age and sex were not associated with the number of accessory canals (p > 0.05).

Conclusions

The complex anatomy of these teeth deserves attention during non-surgical or surgical endodontic treatment. Around the apex, isthmuses might be more prevalent in younger and female individuals.

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Fused roots of maxillary molars: characterization and prevalence in a Latin American sub-population: a cone beam computed tomography study
Maytté Marcano-Caldera, Jose Luis Mejia-Cardona, María del Pilar Blanco-Uribe, Elena Carolina Chaverra-Mesa, Didier Rodríguez-Lezama, Jose Hernán Parra-Sánchez
Restor Dent Endod 2019;44(2):e16.   Published online April 22, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e16
AbstractAbstract PDFPubReaderePub
Objectives

The upper molars generally have three roots; therefore, different combinations of fusion can occur, increasing the possibility of finding more complex root canal systems. The purpose of this study was to evaluate the prevalence and characterization of fused roots in first and second maxillary molars using cone-beam computed tomography (CBCT) in a Colombian population.

Materials and Methods

A total of 1274 teeth were evaluated, of which 534 were maxillary first molars and 740 were maxillary second molars. Axial sections were made at the cervical, middle, and apical levels to determine the prevalence of root fusion and the types of fusion.

Results

Overall, 43% of the molars (n = 551) presented some type of fused root. Root fusion was present in 23.4% of the maxillary first molars. The most frequent type of fused root was type 3 (distobuccal-palatal; DB-P) (58.9%). Root fusion was observed in 57.6% of the maxillary second molars, and the most prevalent type of fused root was type 6 (cone-shaped) (45.2%). Of the maxillary molars, 12.5% were classified as C-shaped.

Conclusion

Within the limitations of this study, there was a high prevalence of fused roots in maxillary molars in the Colombian population, mainly in the maxillary second molars. In first molars, the most common type of fused root was type 3 (DB-P) and in second molars, the most common type was type 6 (cone-shaped). Additionally, molars with root fusion presented variation at different levels of the radicular portion, with implications for treatment quality.

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Case Report
Maxillary first molar with 7 root canals diagnosed using cone-beam computed tomography
Evaldo Rodrigues, Antônio Henrique Braitt, Bruno Ferraz Galvão, Emmanuel João Nogueira Leal da Silva
Restor Dent Endod 2017;42(1):60-64.   Published online August 29, 2016
DOI: https://doi.org/10.5395/rde.2017.42.1.60
AbstractAbstract PDFPubReaderePub

Root canal anatomy is complex, and the recognition of anatomic variations could be a challenge for clinicians. This case report describes the importance of cone beam computed tomographyic (CBCT) imaging during endodontic treatment. A 23 year old woman was referred by her general dental practitioner with the chief complaint of spontaneous pain in her right posterior maxilla. From the clinical and radiographic findings, a diagnosis of symptomatic irreversible pulpitis was made and endodontic treatment was suggested to the patient. The patient underwent CBCT examination, and CBCT scan slices revealed seven canals: three mesiobuccal (MB1, MB2, and MB3), two distobuccal (DB1 and DB2), and two palatal (P1 and P2). Canals were successfully treated with reciprocating files and filled using single-cone filling technique. Precise knowledge of root canal morphology and its variation is important during root canal treatment. CBCT examination is an excellent tool for identifying and managing these complex root canal systems.

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Letter to Editor
Working width, a deserted aspect of Endodontics
Denzil Albuquerque, Jojo Kottoor
Restor Dent Endod 2015;40(4):334-335.   Published online September 23, 2015
DOI: https://doi.org/10.5395/rde.2015.40.4.334
PDFPubReaderePub
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Case Reports
Endodontic treatment of a mandibular first molar with 8 canals: a case report
Ankit Arora, Shashi Rashmi Acharya, Padmaja Sharma
Restor Dent Endod 2015;40(1):75-78.   Published online October 13, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.75
AbstractAbstract PDFPubReaderePub

Presented here is a case where 8 canals were located in a mandibular first molar. A patient with continuing pain in mandibular left first molar even after completion of biomechanical preparation was referred by a dentist. Following basic laws of the pulp chamber floor anatomy, 8 canals were located in three steps with 4 canals in each root. In both of the roots, 4 separate canals commenced which joined into two canals and exited as two separate foramina. At 6 mon follow-up visit, the tooth was found to be asymptomatic and revealed normal radiographic periapical area. The case stresses on the fact that understanding the laws of pulp chamber anatomy and complying with them while attempting to locate additional canals can prevent missing canals.

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Surgical endodontic management of infected lateral canals of maxillary incisors
Ji-Hyun Jang, Jung-Min Lee, Jin-Kyu Yi, Sung-Baik Choi, Sang-Hyuk Park
Restor Dent Endod 2015;40(1):79-84.   Published online October 10, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.79
AbstractAbstract PDFPubReaderePub

This case report presents surgical endodontic management outcomes of maxillary incisors that were infected via the lateral canals. Two cases are presented in which endodontically-treated maxillary central incisors had sustained lateral canal infections. A surgical endodontic treatment was performed on both teeth. Flap elevation revealed vertical bone destruction along the root surface and infected lateral canals, and microscopy revealed that the lateral canals were the origin of the lesions. After the infected lateral canals were surgically managed, both teeth were asymptomatic and labial fistulas were resolved. There were no clinical or radiographic signs of surgical endodontic management failure at follow-up visits. This case report highlights the clinical significance and surgical endodontic management of infected lateral canal of maxillary incisor. It is important to be aware of root canal anatomy variability in maxillary incisors. Maxillary central incisors infected via the lateral canal can be successfully managed by surgical endodontic treatment.

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Root canal treatment of a mandibular second premolar with three separate root canals
Seok-Ryun Lee, Seol-Hee Shin, Sung-Ok Hong, Chang-Kyu Song, Hoon-Sang Chang, Kyung-San Min
J Korean Acad Conserv Dent 2010;35(4):302-305.   Published online July 31, 2010
DOI: https://doi.org/10.5395/JKACD.2010.35.4.302
AbstractAbstract PDFPubReaderePub

Mandibular premolars show a wide variety of root canal anatomy. Especially, the occurrence of three canals with three separate foramina in mandibular second premolars is very rare. This case report describes the root canal treatment of an unusual morphological configuration of the root canal system and supplements previous reports of the existence of such configuration in mandibular second premolar.

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