Morphology of the apical root canal system in Korean mandibular first molar

Hyeon Jeong; Sang-jin Park; Sang-Hyuk Park; Gi-Woon Choi

doi:10.5395/JKACD.2009.34.2.137

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Original Article Morphology of the apical root canal system in Korean mandibular first molar: Hyeon Jeong, Sang-jin Park, Sang-Hyuk Park, Gi-Woon Choi; 2009;34(2):-144.
DOI: https://doi.org/10.5395/JKACD.2009.34.2.137
Published online: March 31, 2009

Department of Conservative Dentistry, Division of Dentistry, Graduate of Kyung Hee University, Korea.

Corresponding Author: Gi-Woon Choi. Professor of Division of Dentistry, Graduate school of KyungHee University, 1, Hoegi Dong, Dongdaemun Gu, Seoul, Korea, 130-702. Tel: 82-2-958-9336, gwchoi@khu.ac.kr

• Received: November 26, 2008 • Revised: December 26, 2008 • Accepted: March 7, 2009

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Abstract
REFERENCES

Abstract

The aim of this study was to investigate the shapes and diameters of the physiological foramen and anatomy of the root canal at 3mm from apex in mandibular first molars.

Sixty mandibular first molars were randomly selected. The apical anatomy of 60 mandibular first molars was investigated by means of a stereomicroscope (60x magnification).

The results were as follows;

1. There was a high percentage of two physiological foramina in mesial (61.67%) and one foramen in distal(71.66%) roots of mandibular first molars.

2.There was a high frequency of accessory foramina in mesial roots with one foramen (26.07%).
3. The diameters of physiological foramen was as follows:
- 0.329mm in single mesial foramen
- 0.266mm in mesiobuccal foramen and 0.246mm in mesiolingual foramen
- 0.375mm in single distal foramen
- 0.291mm in distobuccal foramen and 0.237mm in distolingual foramen
4. The most common physiological foramen shape was oval (69.93%).

5. The incidence of isthmus in mesial root at 3mm from apex was 55%. The 3mm-sections contained a complete isthmus 31.66% and a partial isthmus 23.34%.

6. 3mm from the apex, the most common canal shape was oval (50.64%).

Knowledge of the apical anatomy of mandibular first molar would be necessary for success of surgical and nonsurgical endodontic treatment.
Keywords: Mandibular first molar; Apical foramen; Physiological foramen shape

Figure 1

Photograph of the physiologic foramen of distal root (×60)

Figure 2

Photograph of the physiologic foramen of mesial root (×60)

Figure 3

Photograph of section in distal root at 3mm from root apex (×60)

Figure 4

Photograph of section with no isthmus (×40)

Figure 5

Photograph of section with a partial isthmus (×40)

Figure 6

Photograph of section with a complete isthmus (×40)

Table 1

Number of physiological foramen and accessory foramen frequency in mesial and distal roots of mandibular first molars (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

D : single distal, DB : distobuccal, DL : distolingual

Table 2

Frequency of accessory foramen (<0.10mm) in mandibular first molars (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingua

D : single distal, DB : distobuccal, DL : distolingual

Table 3

Narrow and wide diameters of the mesial physiological foramina of mandibular first molars (mm)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

N : narrow diameter, W : wide diameter

Table 4

Narrow and wide diameters of the distal physiological foramina of mandibular first molars (mm)

D : single distal, DB : distobuccal, DL : distolingual

N : narrow diameter, W : wide diameter

Table 5

Shape of the mesial and distal physiological foramina of mandibular first molar (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

D : single distal, DB : distobuccal, DL : distolingual

Table 6

Incidence of isthmus in the mesial roots of mandibular first molars(%, n)

Table 7

Shape of the distal canals at 3mm level (%, n)

D : single distal, DB : distobuccal,

DL : distolingual

REFERENCES

1. Schilder H. Filling root canals in three dimensions. J Endod. 2006;32(4):281-290.Article PubMed
2. Jou YT, Karabucak B, Levin J. Endodontic working width: current concepts and techniques. Dent Clin North Am. 2004;48(1):323-335.Article PubMed
3. Simon JHS. The apex: how critical is it? Gen Dent. 1994;42(4):330-334.PubMed
4. Baugh D, Wallace J. The role of apical instrumentation in root canal treatment: a review of the literature. J Endod. 2005;31(5):333-340.Article PubMed
5. Weine F. Endodontic therapy. 1982;3rd ed. St. Louis: C. V. Mosby; 282-283.
6. Walton RE. Histologic evaluation of different methods of enlarging the pulp canal space. J Endod. 1976;2(10):304-311.Article PubMed
7. Wu MK, Barkis DRA, Wesseling P. Does the first file to bind correspond to the diameter of the canal in the apical region? Int Endod J. 2002;35(3):264-267.Article PubMed
8. Lumley PJ, Walmsley AD, Walton RE, Rippin JW. Cleaning of oval canals using ultrasonic or sonic instrumentation. J Endod. 1993;19(9):453-457.Article PubMed
9. Wu MK, Wesselink PR. A primary observation on the preparation and obturation in oval canals. Int Endod J. 2001;34(2):137-141.PubMed
10. Marroquin BB, Al-sayed MAA, Willershausen-Zonnchen B. Morphology of the physiological foramen: 1. Maxillary and mandibular molars. J Endod. 2004;30(5):321-328.PubMed
11. Wu MK, R'oris A, Barkis D, Paul R, Wesselink PR. Prevalance and extent of long oval canals in the apical third. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(6):739-743.PubMed
12. Weller NR, Niemczyk SP, Kim S. Incidence and position of the canal isthmus. Part 1. Mesiobuccal root of the maxillary first molar. J Endod. 1995;21(7):380-383.Article PubMed
13. Mannocci F, Peru M, Sherriff M, Pitt Ford TR, Cook R. a micro-computed tomographic study. Int Endod J. 2005;38(8):558-563.PubMed
14. Hsu YY, Kim S. The resected root surface. The issue of canal isthmuses. Dent Clin North Am. 1997;41(3):529-540.PubMed
15. von Arx T. Frequency and type of canal isthmuses in first molars detected by endoscopic inspection during periradicular surgery. Int Endod J. 2005;38(3):160-168.Article PubMed
16. von Arx T, Walker W. Microsurgical instruments for root-end cavity preparation following apicoectomy. Endod Dent Traumatol. 2000;16(2):47-62.PubMed
17. Rubinstein RA, Kim S. Short-term observation of the results of endodontic surgery with the use of a surgical operation microscope and super-EBA as root-end filling material. J Endod. 1999;25(1):43-48.Article
18. Kim S, Pecora G, Rubinstein RA. Color atlas of microsurgery in endodontics. 2001;Philadelphia: W.B. Saunders Company; 89-92.
19. Morfis A, Sylaras SN, Georgopoulou M, Kernani M, Prountzos F. Study of the apices of human permanent teeth with the use of a scanning electron microscope. Oral Surg Oral Med Oral Pathol. 1994;77(2):172-176.PubMed
20. Peak JD, Hayes SJ, Bryant ST, Dummer PM. The outcome of root canal treatment. A retrospective study within the armed forces. Br Dent J. 2001;190(3):140-144.Article PubMed
21. Harty FJ, Parkins BJ, Wengraf AM. Success rate in root canal therapy. A retrospective study of conventional cases. Br Dent J. 1970;128(2):65-70.Article PubMed PDF
22. Cohen S, Burns RC, Herbranson EJ. Pathways of the pulp. 2002;8th ed. St. Louis: Mosby; 710-713.
23. Blaskovic-Subat V, Smojver B, Maricic B, Sutalo J. A computerized method for the evaluation of root canal morphology. Int Endod J. 1995;28(6):290-296.Article PubMed
24. Peters OA, Laib B, Ruegsegger P, Barbakow F. Three-dimensional analysis of root canal geometry by high-resolution computed tomography. J Dent Res. 2000;79(6):1405-1409.PubMed
25. Kuttler Y. Microscopic investigation of root apexes. J Am Dent Assoc. 1955;50(5):544-552.Article PubMed
26. Burch JG, Hulen S. The relationship of the apical foramen to the anatomical apex of the tooth root. Oral Surg Oral Med Oral Pathol. 1972;34(2):262-268.PubMed
27. Ponce EH, Vilar Fernandez J. The cemento-dentino-canal junction, the apical foramen, and the apical constriction: evaluation by optical microscopy. J Endod. 2003;29(3):214-219.Article PubMed
28. Buchanan Ls. The standardized-taper root canal preparation: part 1. concept for variably tapered shaping instruments. Int Endod J. 2000;33(6):516-529.PubMed
29. Teixeira FB, Sano CL, Gomes BPFA, Zaia AA, Ferraz CCR, Souza Filho FJ. A preliminary in vitro study of the incidence and position of the root canal isthmus in maxillary and mandibular first molars. Int Endod J. 2003;36(4):276-280.Article PubMed PDF
30. Pineda F. Roentgenographic investigation of the mesiobuccal root of the maxillary first molar. Oral Surg. 1973;36(2):253-260.Article PubMed
31. Yang SF, Rivera EM, Baumgardener KR, Walton RE, Stanford C. Anaerobic tissue-dissolving abilities of calcium hydroxide and sodium hypochlorite. J Endod. 1995;21(12):613-616.Article PubMed

Tables & Figures

Figure 1

Photograph of the physiologic foramen of distal root (×60)

Figure 2

Photograph of the physiologic foramen of mesial root (×60)

Figure 3

Photograph of section in distal root at 3mm from root apex (×60)

Figure 4

Photograph of section with no isthmus (×40)

Figure 5

Photograph of section with a partial isthmus (×40)

Figure 6

Photograph of section with a complete isthmus (×40)

Table 1

Number of physiological foramen and accessory foramen frequency in mesial and distal roots of mandibular first molars (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

D : single distal, DB : distobuccal, DL : distolingual

Table 2

Frequency of accessory foramen (<0.10mm) in mandibular first molars (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingua

D : single distal, DB : distobuccal, DL : distolingual

Table 3

Narrow and wide diameters of the mesial physiological foramina of mandibular first molars (mm)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

N : narrow diameter, W : wide diameter

Table 4

Narrow and wide diameters of the distal physiological foramina of mandibular first molars (mm)

D : single distal, DB : distobuccal, DL : distolingual

N : narrow diameter, W : wide diameter

Table 5

Shape of the mesial and distal physiological foramina of mandibular first molar (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

D : single distal, DB : distobuccal, DL : distolingual

Table 6

Incidence of isthmus in the mesial roots of mandibular first molars(%, n)

Table 7

Shape of the distal canals at 3mm level (%, n)

D : single distal, DB : distobuccal,

DL : distolingual

REFERENCES

1. Schilder H. Filling root canals in three dimensions. J Endod. 2006;32(4):281-290.Article PubMed
2. Jou YT, Karabucak B, Levin J. Endodontic working width: current concepts and techniques. Dent Clin North Am. 2004;48(1):323-335.Article PubMed
3. Simon JHS. The apex: how critical is it? Gen Dent. 1994;42(4):330-334.PubMed
4. Baugh D, Wallace J. The role of apical instrumentation in root canal treatment: a review of the literature. J Endod. 2005;31(5):333-340.Article PubMed
5. Weine F. Endodontic therapy. 1982;3rd ed. St. Louis: C. V. Mosby; 282-283.
6. Walton RE. Histologic evaluation of different methods of enlarging the pulp canal space. J Endod. 1976;2(10):304-311.Article PubMed
7. Wu MK, Barkis DRA, Wesseling P. Does the first file to bind correspond to the diameter of the canal in the apical region? Int Endod J. 2002;35(3):264-267.Article PubMed
8. Lumley PJ, Walmsley AD, Walton RE, Rippin JW. Cleaning of oval canals using ultrasonic or sonic instrumentation. J Endod. 1993;19(9):453-457.Article PubMed
9. Wu MK, Wesselink PR. A primary observation on the preparation and obturation in oval canals. Int Endod J. 2001;34(2):137-141.PubMed
10. Marroquin BB, Al-sayed MAA, Willershausen-Zonnchen B. Morphology of the physiological foramen: 1. Maxillary and mandibular molars. J Endod. 2004;30(5):321-328.PubMed
11. Wu MK, R'oris A, Barkis D, Paul R, Wesselink PR. Prevalance and extent of long oval canals in the apical third. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(6):739-743.PubMed
12. Weller NR, Niemczyk SP, Kim S. Incidence and position of the canal isthmus. Part 1. Mesiobuccal root of the maxillary first molar. J Endod. 1995;21(7):380-383.Article PubMed
13. Mannocci F, Peru M, Sherriff M, Pitt Ford TR, Cook R. a micro-computed tomographic study. Int Endod J. 2005;38(8):558-563.PubMed
14. Hsu YY, Kim S. The resected root surface. The issue of canal isthmuses. Dent Clin North Am. 1997;41(3):529-540.PubMed
15. von Arx T. Frequency and type of canal isthmuses in first molars detected by endoscopic inspection during periradicular surgery. Int Endod J. 2005;38(3):160-168.Article PubMed
16. von Arx T, Walker W. Microsurgical instruments for root-end cavity preparation following apicoectomy. Endod Dent Traumatol. 2000;16(2):47-62.PubMed
17. Rubinstein RA, Kim S. Short-term observation of the results of endodontic surgery with the use of a surgical operation microscope and super-EBA as root-end filling material. J Endod. 1999;25(1):43-48.Article
18. Kim S, Pecora G, Rubinstein RA. Color atlas of microsurgery in endodontics. 2001;Philadelphia: W.B. Saunders Company; 89-92.
19. Morfis A, Sylaras SN, Georgopoulou M, Kernani M, Prountzos F. Study of the apices of human permanent teeth with the use of a scanning electron microscope. Oral Surg Oral Med Oral Pathol. 1994;77(2):172-176.PubMed
20. Peak JD, Hayes SJ, Bryant ST, Dummer PM. The outcome of root canal treatment. A retrospective study within the armed forces. Br Dent J. 2001;190(3):140-144.Article PubMed
21. Harty FJ, Parkins BJ, Wengraf AM. Success rate in root canal therapy. A retrospective study of conventional cases. Br Dent J. 1970;128(2):65-70.Article PubMed PDF
22. Cohen S, Burns RC, Herbranson EJ. Pathways of the pulp. 2002;8th ed. St. Louis: Mosby; 710-713.
23. Blaskovic-Subat V, Smojver B, Maricic B, Sutalo J. A computerized method for the evaluation of root canal morphology. Int Endod J. 1995;28(6):290-296.Article PubMed
24. Peters OA, Laib B, Ruegsegger P, Barbakow F. Three-dimensional analysis of root canal geometry by high-resolution computed tomography. J Dent Res. 2000;79(6):1405-1409.PubMed
25. Kuttler Y. Microscopic investigation of root apexes. J Am Dent Assoc. 1955;50(5):544-552.Article PubMed
26. Burch JG, Hulen S. The relationship of the apical foramen to the anatomical apex of the tooth root. Oral Surg Oral Med Oral Pathol. 1972;34(2):262-268.PubMed
27. Ponce EH, Vilar Fernandez J. The cemento-dentino-canal junction, the apical foramen, and the apical constriction: evaluation by optical microscopy. J Endod. 2003;29(3):214-219.Article PubMed
28. Buchanan Ls. The standardized-taper root canal preparation: part 1. concept for variably tapered shaping instruments. Int Endod J. 2000;33(6):516-529.PubMed
29. Teixeira FB, Sano CL, Gomes BPFA, Zaia AA, Ferraz CCR, Souza Filho FJ. A preliminary in vitro study of the incidence and position of the root canal isthmus in maxillary and mandibular first molars. Int Endod J. 2003;36(4):276-280.Article PubMed PDF
30. Pineda F. Roentgenographic investigation of the mesiobuccal root of the maxillary first molar. Oral Surg. 1973;36(2):253-260.Article PubMed
31. Yang SF, Rivera EM, Baumgardener KR, Walton RE, Stanford C. Anaerobic tissue-dissolving abilities of calcium hydroxide and sodium hypochlorite. J Endod. 1995;21(12):613-616.Article PubMed

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Morphology of the apical root canal system in Korean mandibular first molar

J Korean Acad Conserv Dent. 2009;34(2):137-144. Published online March 31, 2009

DOI: https://doi.org/10.5395/JKACD.2009.34.2.137

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Figure

Morphology of the apical root canal system in Korean mandibular first molar

Figure 1 Photograph of the physiologic foramen of distal root (×60)

Figure 2 Photograph of the physiologic foramen of mesial root (×60)

Figure 3 Photograph of section in distal root at 3mm from root apex (×60)

Figure 4 Photograph of section with no isthmus (×40)

Figure 5 Photograph of section with a partial isthmus (×40)

Figure 6 Photograph of section with a complete isthmus (×40)

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Morphology of the apical root canal system in Korean mandibular first molar

Table 1

Number of physiological foramen and accessory foramen frequency in mesial and distal roots of mandibular first molars (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

D : single distal, DB : distobuccal, DL : distolingual

Table 2

Frequency of accessory foramen (<0.10mm) in mandibular first molars (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingua

D : single distal, DB : distobuccal, DL : distolingual

Table 3

Narrow and wide diameters of the mesial physiological foramina of mandibular first molars (mm)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

N : narrow diameter, W : wide diameter

Table 4

Narrow and wide diameters of the distal physiological foramina of mandibular first molars (mm)

D : single distal, DB : distobuccal, DL : distolingual

N : narrow diameter, W : wide diameter

Table 5

Shape of the mesial and distal physiological foramina of mandibular first molar (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

D : single distal, DB : distobuccal, DL : distolingual

Table 6

Incidence of isthmus in the mesial roots of mandibular first molars(%, n)

Table 7

Shape of the distal canals at 3mm level (%, n)

D : single distal, DB : distobuccal,

DL : distolingual

Table 1 Number of physiological foramen and accessory foramen frequency in mesial and distal roots of mandibular first molars (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

D : single distal, DB : distobuccal, DL : distolingual

Table 2 Frequency of accessory foramen (<0.10mm) in mandibular first molars (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingua

D : single distal, DB : distobuccal, DL : distolingual

Table 3 Narrow and wide diameters of the mesial physiological foramina of mandibular first molars (mm)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

N : narrow diameter, W : wide diameter

Table 4 Narrow and wide diameters of the distal physiological foramina of mandibular first molars (mm)

D : single distal, DB : distobuccal, DL : distolingual

N : narrow diameter, W : wide diameter

Table 5 Shape of the mesial and distal physiological foramina of mandibular first molar (%, n)

M : single mesial, MB : mesiobuccal, ML : mesiolingual

D : single distal, DB : distobuccal, DL : distolingual

Table 6 Incidence of isthmus in the mesial roots of mandibular first molars(%, n)