The aim of this article was to review age-dependent clinical recommendations for appropriate root canal instrumentation techniques. A comprehensive narrative review of canal morphology, the structural characteristics of dentin, and endodontic outcomes at different ages was undertaken instead of a systematic review. An electronic literature search was carried out, including the Medline (Ovid), PubMed, and Web of Science databases. The searches used controlled vocabulary and free-text terms, as follows: ‘age-related root canal treatment,’ ‘age-related instrumentation,’ ‘age-related chemo-mechanical preparation,’ ‘age-related endodontic clinical recommendations,’ ‘root canal instrumentation at different ages,’ ‘geriatric root canal treatment,’ and ‘pediatric root canal treatment.’ Due to the lack of literature with practical age-based clinical recommendations for an appropriate root canal instrumentation technique, a narrative review was conducted to suggest a clinical algorithm for choosing the most appropriate instrumentation technique during root canal treatment. Based on the evidence found through the narrative review, an age-related clinical algorithm for choosing appropriate instrumentation during root canal treatment was proposed. Age affects the morphology of the root canal system and the structural characteristics of dentin. The clinician’s awareness of root canal morphology and dentin characteristics can influence the choice of instruments for root canal treatment.

Variation in root canal morphology, especially in maxillary first molar presents a constant challenge for a clinician in their detection and management. This case report describes the successful root canal treatment of a three rooted right maxillary first molar presenting with three canals each in the mesiobuccal and distobuccal roots and one canal in the palatal root. The clinical detection of this morphologic aberration was made using a dental operating microscope, and the canal configuration was established after correlating and computing the clinical, radiographic and cone-beam computed tomography (CBCT) scan findings. CBCT images confirmed the configuration of the canals in the mesiobuccal and distobuccal roots to be Al-Qudah and Awawdeh type (3-2) and type (3-2-1), respectively, whereas the palatal root had a Vertucci type I canal pattern. This report reaffirms the importance of careful examination of the floor of the pulp chamber with a dental operating microscope and the use of multiangled preoperative radiographs along with advanced diagnostic aids such as CBCT in identification and successful management of aberrant canal morphologies.

The C-shaped canal system is an anatomical variation mostly seen in mandibular second molars, although it can also occur in maxillary and other mandibular molars. The main anatomical feature of C-shaped canals is the presence of fins or web connecting the individual root canals. The complexity of C-shaped canals prevents these canals from being cleaned, shaped, and obturated effectively during root canal therapy, and sometimes it leads to an iatrogenic perforation from the extravagant preparation.

The purpose of this study was to provide further knowledge of the anatomical configuration and the minimal thickness of dentinal wall according to the level of the root.

Thirty extracted mandibular second molars with fused roots and longitudinal grooves on lingual or buccal surface of the root were collected from a native Korean population. The photo images and radiographs from buccal, lingual, apical direction were taken. After access cavity was prepared, teeth were placed in 5.25% sodium hypochlorite solution for 2 hours to dissolve the organic tissue of the root surface and from the root canal system. After bench dried and all the teeth were embedded in a self-curing resin. Each block was sectioned using a microtome (Accutom-50, Struers, Denmark) at interval of 1 mm. The sectioned surface photograph was taken using a digital camera (Coolpix 995, Nikon, Japan) connected to the microscope. 197 images were evaluated for canal configurations and the minimal thickness of dentinal wall between canal and external wall using' Root Thickness Gauge Program' designed with Visual Basic.

The results were as follows:

1. At the orifice level of all teeth, the most frequent observed configuration was Melton's Type C I (73%), however the patterns were changed to type C II and C III when the sections were observed at the apical third. On the other hand, the type C III was observed at the orifice level of only 2 teeth but this type could be seen at apical region of the rest of the teeth.

2. The C-shaped canal showed continuous and semi-colon shape at the orifice level, but at the apical portion of the canal there was high possibility of having 2 or 3 canals.

3. Lingual wall was thinner than buccal wall at coronal, middle, apical thirds of root but there was no statistical differences.

Complete understanding of the exterior and interior structure of the tooth would be prerequisite to the successful clinical results, especially in the restorative and endodontic treatment.

Although three-dimensional reconstruction method using x-ray microtomography could not be used in clinical cases, it may be the best way to reconstruct the morphologic characteristics of the tooth structure in detail without destructing the tooth itself. This study was done to three dimensionally reconstruct every teeth in the arch in order to increase the understanding about the endodontic treatment and to promote the effective restorative treatment by upgrading the knowledge of the tooth morphology.

After placing tooth between the microfocus x-ray tube and the image intensifier to obtain two-dimensional images of each level, scanning was done under the condition of 80 keV, 100 µA, 16.8 magnification with the spot size of 8 µm. Cross-section pixel size of 16.28 µm and 48.83 cross-section to cross-section distance were also used.

From the results of this study, precise three dimensional reconstructed images of every teeth could be obtained. Furthermore, it was possible to see image that showed interested area only, for example, enamel portion only, pulp and dentin area without enamel structure, pulp only, combination image of enamel and pulp, etc.

It was also possible to see transparent image without some part of tooth structure. This image might be used as a guide when restoring and preparing the full and partial crown by showing the positional and morphological relationship between the pulp and the outer tooth structure.

Another profit may be related with the fact that it would promote the understanding of the interior structure by making observation of the auto-rotating image of .AVI file from the various direction possible.