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CBCT of maxillary first premolar with three roots: (a) the axial plane, (b) the coronal plane, and (c) the sagittal plane.
Source publication
Objective
The aim of the study was to investigate the root canal morphology of maxillary first and second premolars in a Saudi population using Cone-Beam Computed Tomography (CBCT).
Methods
This retrospective cross-sectional study assessed CBCT images of 707 Saudi patients. The number of roots and canal configuration were identified based on Vertu...
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Background: This research aims to identify the most common morphology of the upper premolars in a group of local and nonlocal people in the UAE using cone-beam computed tomography (CBCT).
Methods: CBCT images of a total of 214 intact maxillary premolars were analysed with 3D reconstruction GALAXIS viewer software. The Pearson Chi squared test and t...
This study aimed to conduct a compendious review of root canal morphology of “permanent mandibular teeth in different regions of Saudi Arabia” to obtain a large sample representing the total population. A detailed search through the databases Web of Science, Scopus, and PubMed was conducted following the PRISMA guidelines. The data were analyzed ba...
Objective:
The study aims to evaluate maxillary molars' root and root canal morphology among the Saudi population using Cone-Beam Computed Tomography scanning (CBCT).
Subjects and methods:
Retrospectively, the CBCT scans of 483 Saudi nationals were evaluated to identify the number of roots and root canals in maxillary first and second molars. Th...
![C-shaped canal structure categories [13].](publication/374428569/figure/fig1/AS:11431281195783477@1696465228325/C-shaped-canal-structure-categories-13_Q320.jpg)
Objectives
The complex anatomy of C-shaped canals poses challenges for clinicians compared to teeth with normal root canal anatomy. This study is aimed at evaluating the frequency and morphology of C-shaped canals in the mandibular first and second molars among an Iranian population using cone-beam computed tomography (CBCT).
Materials and Methods...
Background
Mandibular molars are multi-rooted teeth with a complex and strenuous root canal anatomy. Because there is relatively negligible literature describing the pulp chamber floor anatomy, predicting the exact anatomical layout and its variations is daunting. A thorough comprehension and knowledge of the same is required for efficacious endodo...
Citations
... The findings are in accordance with the study done by Kafle et al. 5 in Nepali population, Dinakar et al. 9 in South Indian population, Gupta et al. 6 in North Indian population, Tian et al. 4 in Chinese population, Celikten et al. 8 in Turkish population. In contrast, two-rooted premolars were common in the study done by Abella et al. 10 in Spanish population, Alqedairi et al. 11 in Saudi population and Neelakantan et al. 12 in Indian population. The prevalence of three-rooted premolar is in the range of 0.4%-9.2%. 1 ...
... Maxillary premolars are one challenging tooth type to treat endodontically due to variations in the root, canal and their configurations [55,56]. Maxillary first premolars among the included studies performed in the different regions including Riyadh, Hail city, Jazan, Sakakah and Southern region of Saudi Arabia, predominantly had higher percentages of two roots (51.2-75.1%) ...
... Four canals were present in (0.3-0.6%) of first premolar in the Jazan city [57,85], in contrast to this, one study conducted in the southern region of Saudi Arabia had no presence of single canal [86]. Type IV canal configuration was higher (57.8-75%) than other types [55][56][57][84][85][86] except one study performed in Sakaka region where type I configuration was higher (58%) [81]. Variations in the results could be due to sample size, examination technique and regional differences [81]. ...
Introduction Root canal treatment procedures require a thorough understanding of root and canal anatomy. The purpose of this systematic review was to examine the morphological differences of teeth root and their canals assessed using cone-beam computed and micro-computed tomography in Saudi Arabian population. Methodology An electronic search was conducted in PubMed / Medline, Scopus, Google Scholar, and Web of Science databases until January 2023 to retrieve related studies. “Root canal morphology,” “Saudi Arabia,” “Micro-CT,” and “cone-beam computed tomography” were used as keywords. A modified version of previously published risk of bias assessment tool was used to determine the quality assessment of included studies. Results The literature search revealed 47 studies that matched the criteria for inclusion, out of which 44 studies
used cone beam computed tomography (CBCT) and three were micro-computed tomography (micro-CT) studies. According to the modified version of risk of bias assessment tool, the studies were categorized as low, moderate, and high risk of bias. A total of 47,612 samples were included which comprised of either maxillary teeth (5,412), or mandibular teeth ( 20,572), and mixed teeth (21,327). 265 samples were used in micro-CT studies while 47,347 teeth samples were used in CBCT studies. Among the CBCT studies, except for three, all the studies were retrospective studies. Frequently used imaging machine and software were 3D Accuitomo 170 and Morita’s i-Dixel 3D imaging software respectively. Minimum and maximum voxel sizes were 75 and 300 μm, Vertucci’s classification was mostly
used to classify the root canal morphology of the teeth. The included micro-CT studies were in-vitro studies where SkyScan 1172 X-ray scanner was the imaging machine with pixel size ranging between 13.4 and 27.4 μm. Vertucci, Ahmed et al. and Pomeranz et al. classifications were applied to classify the root canal morphology. Conclusion This systematic review revealed wide variations in root and canal morphology of Saudi population using high resolution imaging techniques. Clinicians should be aware of the common and unusual root and canal anatomy
before commencing root canal treatment. Future micro-CT studies are needed to provide additional qualitative and quantitative data presentations.
... reported in Yemen [27][28][29]. Among studies in Saudi Arabia, the presence of 2-rooted MFP was 54.5-75.1% [20,21,30]. These disparities could be related to the sample size, with only 69 MFP evaluated in 1 of the studies [21]. ...
... In other studies, among Saudis, the prevalence of single-rooted MSP is 71.5-83.2% [20,21,30]. The highest reported incidence of single-rooted MSP (96.7%) was seen among Pakistanis, but 54% was reported in Jordan [33,34]. ...
... Comparing between males and females, although higher percentages of single-rooted and 2-rooted premolars were seen in females and 3-rooted maxillary premolars were more common in males, but the difference was not statistically significant. The results agree with studies in Poland, Qatar, Spain, and in Saudi Arabia, where sex-based difference between the number of root and types of canals were not significant [24,25,30,32]. In contrast, differences were seen in a Chinese population, where the MP in males were 2-rooted more commonly than in females, and in the study by AlZubaidi et al among Saudis [20,37]. ...
Background
Understanding the root canal morphology is important for successful endodontic treatment. This retrospective cone-beam computed tomography (CBCT) study aimed to compare the adult maxillary premolars (MP), root, and canal morphology among a Saudi Arabian subpopulation based on Vertucci and Ahmed classifications.
Material/Methods
Scans of 1336 MP – 656 first premolars (MFP) and 680 second premolars (MSP) – were analyzed for the number of roots, morphology of the canals, and symmetry among them. The data were grouped based on the traditional preestablished Vertucci system and newer instantaneous code-based Ahmed classification. Comparative analysis was done using the chi-square test.
Results
Two roots were common in MFP with 84.4% of the population, followed by those with 1 root and those with 3 roots. In MSP, single roots were more common. The results were non-significant with P values of 0.859 and 0.471, respectively. Most of these MFP had Type IV Vertucci configuration/²TNB¹P¹ Ahmed et al code (TN-tooth number, B-buccal canal, P-palatal canal). In MSP, Type I Vertucci/¹TN¹ Ahmed et al code was most common. However, the results were not statistically significant for the PM with P values of 0.997 and 0.732, respectively. Sex-based difference among them for the roots and root canals was also non-significant. Symmetry among PM in opposite quadrants was 87.1% in MFP and 90% in MSP.
Conclusions
Two roots with Type IV (²TNB¹P¹) and 1 root with Type I (¹TN¹) were most common in MFP and MSP, respectively. Symmetry among opposing PM was high.
... In the medical field, improved visual aids like digital operating microscopes are a non-invasive technique that provides a magnified picture and good visualisation of the subject. Cone beam computed tomography (CBCT) has recently been included as a diagnostic tool, increasing the success of precise diagnosis to greater levels (7). When combined with 3D software imaging, micro-CT has been described as a reproducible, non-destructive, and non-invasive high-resolution ex vivo technique that is really thought to be the most accurate way to study root canal morphology (8). ...
... Management of such anatomies can be aided by a careful analysis of two or more excellent diagnostic periapical radiographs taken at various horizontal angulations, combined with the appropriate application of the arsenal at hand. Also, if standard radiography techniques are unable to identify such abnormalities or are insufficient to offer the necessary information, sophisticated diagnostic radiographic techniques like CBCT and micro-CT might be very beneficial (7,8). ...
Background: Root canal morphology and internal anatomy shows a great variation across all the teeth. Mandibular premolars possess a great challenge to the clinicians due to its aberrant root morphology. The presence of bacteria and other microbes is the main factor in endodontic failure in missed canals. It is very essential to perform a complete debridement of the root canals including the accessory canals for a successful outcome attained using irrigants, agitation techniques and intra-canal medicaments. This article aims to provide a detailed review about the etiology, prevalence, clinical features, radiographic features & techniques, magnification, treatment choices and difficulties encountered in managing aberrant anatomies in mandibular premolar along with the presentation of a case report. Case Description: A 19-year-old female patient presented to the department with a chief complaint of sharp shooting, lingering and continuous pain in the lower right back region of the jaw since 1 month. On digital radiographic investigation, an aberrant root canal anatomy was observed with deep disto-occlusal caries with mandibular right second premolar for which a non-surgical root canal therapy was performed using dental operating microscope (DOM) and advanced irrigation activation system. Besides, PubMed/ inclusion and exclusion criteria, 25 articles were included. Conclusions: The case report and literature review come to the conclusion that cases with aberrant mandibular premolars can be successfully treated with conventional root canal therapy, good diagnostic tools, and, if necessary, surgical intervention. Our case illustrates how anatomical variations could make endodontic treatment more challenging. With an emphasis on access modifications and radiographic interpretations, the application of the DOM and essential adjustments to the standard clinical procedures and more novel diagnostic methods for difficult root canal morphologies will be essential in the future of endodontics to successfully manage such complex anatomies.
... There is an agreement with two studies that show high rates of anatomical variations in male patients but without a clear relationship with sex 13,17 . Although most studies state that there is no statistical correlation and a consensus in the literature because this information depends more on the number of patients involved in each sex 15,18 . Obtaining that the other premolars in this study presented similar results regarding the variation by sex. ...
Introduction: Root canal cleaning is the main objective of endodontic treatment and requires knowledge of the internal anatomy. The premolars are evidenced in the literature with great anatomical variations. In view of this, studies indicate that the use of Cone Beam Computed Tomography helps in the visualization of highly complex anatomy. Objective: to describe the anatomical variations in maxillary and mandibular premolars using cone beam computed tomography in a radiologic clinic in Piaui. Methods: 54 cone beam computed tomography scans with 160 premolars were used, produced using the Orthopantomograph OP300 equipment and analyzed by multiplanar reconstructions: axial, coronal and sagittal. Data regarding sex, number of roots and canals were recorded to compare and classify according to Vertucci. Results: the maxillary first pre-molars had 63.5% two roots,83.7% with one root and the mandibular pre-molars mostly with one root. Regarding the number of channels, 92.3% of the first premolars had two channels, most of them maxillary second premolars and mandibular premolars only one channel. Vertucci variations of types I, II, III and IV were verified in single-rooted elements, observing a great variation in superior elements. As for the prevalence of sex, only the first superiors showed greater variation in males. Conclusions: the upper first premolars prevailed with a great anatomical variation in relation to the other premolars with prevalence of Vertucci Type I and in males.
... Our findings demonstrate that type 1SP B1 P1 and 1SP 1-2 codes were ordinarily seen in maxillary second premolars and were in agreement with a study published in 2019 by Saber et al. [58] In contrast, a study conducted on a South African subpopulation by Buchanan GD et al. [59] established that 1MP1 was the most common code in maxillary second premolars. With respect to the prevalence of the second canal, many studies by Atieh MA [28], Elkady AM et al. [28], Maghfuri S et al. [44], Alqedairi A et al. [60], and Al-Zubaidi SM et al. [55] found that the majority of maxillary first premolars had two roots among the Saudi population, which is similar to our findings. Regarding mandibular premolars, the majority of mandibular premolars in the Saudi population had one root with a single canal. ...
The objective of this paper is to assess the prevalence of a second canal in maxillary and mandibular premolars based on two classification systems of root canal morphology using Cone beam computed tomography (CBCT) images. A total of 286 CBCT scans from the archive of the Radiology department of a hospital were assessed for the presence of a second canal in maxillary and mandibular premolars. The canal configuration and its assessment was undertaken using Vertucci and Ahmed’s classification. A Chi-square test was used to test the significance of the difference between gender and age. A total of 286 premolars were examined (217 mandibular premolars and 69 maxillary premolars); of these, 173 teeth (60.5%) were from males and 113 were from females (39.5%). Some 62% of maxillary left first premolars had two roots, followed by maxillary right first premolars (47%), and then maxillary left second premolars (30%) and maxillary right ones (27%), respectively. Type IV Vertucci were seen in maxillary premolars, while type I were ordinarily seen in the included mandibular premolars. Surprisingly, Vertucci type III was only found in mandibular left first premolars at a frequency of 2%. One orifice with two separate canals and two orifices of two distinct canals with two portals of exit were predominantly noticed with maxillary first premolars (2 FP B1 P1) in 73% and 81%, respectively, followed by (1 FP 2) 19%. The prevalence of a second canal in maxillary and mandibular premolars was low in the investigated premolars in comparison to the premolars that had just one root and canal, as assessed based on Vertucci and Ahmed’s root canal system classification.
... Any seasoned operator is aware that searching for substantially repaired teeth's root-canal orifices, carefully broken down or gouged by prior accessing is quite challenging. The purpose of this study was to examine the anatomy of the pulp chamber and the pulp chamber floor and determine the approximate distance between the proximal margin to the orifices [3]. ...
... The field of vision ranged from 40 to 60 millimetres. All of the CBCT scans were conducted by a certified oral radiologist in compliance with the product's suggested procedure [3][4][5][6]. ...
Treatment of a tooth that is severely calcified, malposed, or repaired might make it difficult to determine the number and position of orifices on the floors of pulp chambers. After evaluating pulp chambers from 3000 teeth that had to be pulled, a novel method for locating root-canal orifices and pulp chambers is offered.
... Any seasoned operator is aware that searching for substantially repaired teeth's root-canal orifices, carefully broken down or gouged by prior accessing is quite challenging. The purpose of this study was to examine the anatomy of the pulp chamber and the pulp chamber floor and determine the approximate distance between the proximal margin to the orifices [2]. ...
Identifying the number and location of orifices on floors in pulp chambers can be challenging when a tooth is being treated, especially when it is heavily calcified, malposed, or restored. Upon evaluation 3000 extracted tooth pulp chambers, new approach for finding root-canal orifices and pulp chambers is proposed.
... Saber et al., 2019 [19] CBCT 700 premolars Egyptian First premolar -2 roots most predominant (53.1) Second premolar -One root most predominant (72.8) Alqedairi et al., 2018 [20] CBCT 707 CBCT images (334 first premolars +318 second premolars) ...
Background:
There have been numerous cone-beam computed tomography (CBCT) studies done over the years to analyze the canal configurations among various racial and ethnic population groups. Several of these studies have highlighted a certain consistency in the incidence of particular features within these population subsets.
Aim:
The study aimed to analyze the root morphology and canal configurations of the maxillary first premolar (Mx1PM) in the Indian Dravidian subpopulation using CBCT.
Setting and design:
This study involved a retrospective analysis of 200 CBCT scans, which included 400 Mx1PM.
Methods:
The CBCT images were evaluated, and the number of roots and canal configurations was recorded as per the Vertucci's classification.
Statistical analysis:
Variations in the number of roots and canal anatomies were statistically interpreted using the Chi-square test of association with the significance level set at P < 0.05.
Results:
Among the 400 Mx1PM studied, 116 (29%) teeth displayed single roots and 284 (71%) showed the presence of two roots. The single-rooted premolars revealed a varied canal configuration with a predominance of Vertucci's Type II configuration in around 53.4% of the Mx1PM. The two-rooted premolars revealed 100% Type I canal configuration.
Conclusion:
The Mx1PM studied predominantly showed the two-rooted morphology with independent canals in each root. There was no significant difference between the teeth on either side of the same arch. The CBCT is an excellent nondestructive modality that can help us study the internal anatomy of pulp space accurately.
... In the study by Alqedairi et al., of the 318 maxillary second premolars analyzed, 85.2% were single-rooted with no notable difference across gender (87% in males versus 83% in females). Additionally, the most frequent canal configuration was type I (49%), irrespective of gender, followed by type II (26%) and type IV (12%) [12]. Concordantly, maxillary second premolars were found to be single-rooted in 83% of the Spanish and German populations; however, while Vertucci's type I was predominant in the Spanish population [9], types V (29%) and IV (25%) were most frequent in the German population [17]. ...
... By focusing on premolars, (75.1%), and type IV (70.6%) to be the predominant pattern. Similar to the findings in this study, type I was the second most common (11%), followed by type II (8.4%) [12]. Furthermore, Alqedairi et al. reported 2.3% versus 0% three-rooted teeth in males versus females, respectively, which is consistent with 4.2% versus 0% the findings in this study. ...
Objectives: To estimate the prevalence of different root canal morphological variants in maxillary first and second premolars, and to analyze differences across gender and nationality in western Saudi Arabia individuals using cone-beam computed tomography (CBCT) who presented for dental care during February 2021-April 2021.
Methods: Maxillary first and second premolars were analyzed independently to determine the number of roots and canal configuration using Vertucci's classification. The distribution by gender and nationality was analyzed using Fisher's exact test with Monte Carlo simulation. Inter-examiner and intra-examiner reliability were evaluated using Cohen's kappa coefficient (1.0; P<0.001 and 0.9; P<0.001, respectively).
Results: Maxillary first premolars were double-rooted in 57.8% and type IV was the most frequent (63.6%), followed by type II (18.3%). Second premolars were single-rooted in 77.6%, with type I being the most frequent (37.8%) in females (48.2%); while type IV being most frequent in males (33.8%). In both first and second premolars, females had a significant predilection to single root pattern. Differences across nationality were statistically significant with respect to canal configuration of maxillary first premolars.
Conclusion: There is a high heterogeneity in the maxillary premolar root canal configuration among the studied Saudi population, with significant gender disparities supporting fewer roots and canals in females.
