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-shaped root canal system in mandibular premolars according to Fan et al. classifications, and gender
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Background: Mandibular premolars are complicated teeth to endodontically treat due to the anatomical variations
that can present. The purpose of this study was to determine the presence of C-shaped configurations in mandibular
premolars by cone-beam computed tomography (CBCT).
Methods: 380 mandibular first premolars and 308 mandibular second premol...
Context in source publication
Context 1
... to the gender and C-shaped configuration to Fan criteria to the 100% (n = 132) of the C-shaped samples studied, male patients showed 47.72% and female patients 52.27% (Table 3). No significant difference was found between C-shaped root canal system configuration and gender or C-shaped configuration according to Fan criteria and gender (P > .05). ...Similar publications
The success of an Endodontic treatment relies on the position and morphology of root canals. It is important for a clinician to be familiar with the canal morphology to negotiate and thereby filling the canals with an inert material. But, the possibility of negotiating the canals with the use of conventional technique alone is difficult. Hence, car...
Variations in the root canal anatomy of multirooted teeth represent a continuous challenge to the practitioners. Knowledge of the internal canal anatomy is the key to the success of endodontic treatment. Commonly, in the literature, there are two fused roots with three canals in mandibular second molar teeth, which can be diagnosed as a C-shaped ca...
Introduction: The maxillary first molar is crucial for proper bite formation and jaw positioning in adulthood. The prevalence of dental caries in the study's sample population suggests it is a common candidate for endodontic therapy. Multiple studies have shown that the canal and root morphology of the maxillary first molar are abnormal.
Materials...
Introduction:
For the correct diagnosis and endodontic therapy, a complete understanding of root canal morphology is required. One of the causes of endodontic failure is the inability to identify every canal in the root canal system; the second mesiobuccal canal (MB2) in the permanent maxillary first molar is the most commonly missed canal. Studie...
The aim of this study was to assess cone beam computed tomography (CBCT) as a root canal anatomy diagnostic tool by comparison with micro-CT gold-standard.
216 two-rooted mandibular molars were first scanned in a CBCT device (200 μm voxel size) and posteriorly in a micro-CT scanner (19.61 μm). The volumes were sequentially screened to classify main...
Citations
... The 53.36% canal bifurcation in mandibular first premolars and 50.09% in mandibular second premolars are in the middle third [12]. ...
... However, another study conducted on the Turkish population could not find any difference between genders (24). Overall review of the literature demonstrated some studies reporting higher prevalence for males in terms of C-shaped morphology in mandibular premolars (20,22,28), while others showed higher prevalence for females (30). Moreover, there were many studies that could not state a significant distinction between genders in regard to C-shaped canal morphology in mandibular premolars (23,24,27). ...
... However, similar to the results of the present study, many studies have reported that, in the mandibular premolar teeth, the coronal third of the root of the canal begins as an oval, round or flat, and the C-shaped configuration appears in the apical half of the root (20). In addition, Vertucci type V configuration was highly associated with C-shaped canal morphology in mandibular premolars (24,28), and the bifurcation in such teeth was usually detected at the middle third of the root (30). Therefore, clinicians should be conscious and attentive to variable canal configurations that can be seen in the middle and apical thirds of the root in the mandibular premolars, as well as possible unusual anatomy of the pulp chamber for the success of endodontic treatment. ...
Purpose: The aim of this study was to evaluate the prevalence and the morphology of c-shaped root canal(s) in mandibular premolars using cone beam computed tomography (CBCT) images.
Materials and Methods: CBCT images of 1095 mandibular premolars were examined at coronal, middle, and apical levels of the root canals. The type, the level, and the position (buccal or lingual) of the c-shaped anatomy were recorded. Absolute counts and percentages of different groups and subgroups of C-shape morphologies were calculated. The Chi-square test was used to compare the prevalence of C-shaped morphology between mandibular first and second premolars. The Z-test for proportions in independent groups was used to analyze the differences in mandibular C-shaped premolar proportions between location (left and right side) and tooth (first or second premolars) (p=0.05).
Results: c-shaped root canal morphology was present in 44 teeth. The percentage of c-shaped morphologies was 6.9% and 1.6% in mandibular first and second premolars, respectively. Comparison of the first and the second premolars showed that C1 type (p=0.008) and C4b type (p=0.013) configurations are more common in the first premolars at the coronal level. In contrast, the C2 type configuration showed significantly higher prevalence in the second premolars (p=0.009). Additionally, the C4c type configuration was significantly frequent on the right premolars at the coronal level (p=0.038).
Conclusions: C-shape canal morphology is a rare but complex anatomic feature in mandibular premolars. Therefore, clinicians should be aware of this complex root canal anatomy for the success of endodontic treatment in mandibular premolar teeth.
... Some studies have reported anatomical variations of this dental group, such as the presence of two or more roots, more than one canal and the presence of bifurcations of the root canal system. [3,4]Other studies have reported unusual anatomy in the mandibular premolars described as radicular grooves that cause a C-shaped morphology when these teeth are analyzed in their cross sections [5] Generally, periapical radiographs, panoramic radiographs, and cone beam computed tomography (CBCT) imaging are the most widely used diagnostic strategies for determining appropriate treatments. CBCT imaging has been demonstrated to provide higher accuracy than radiography for assessing root and root canal con gurations. ...
Background:
The internal root canal morphology of the mandibular first premolar can be quite diversified, which pose great challenge and can directly affect the outcome of endodontic therapy. The aim of this paper was to examine the diagnostic performance of a deep learning system to determine whether the mandibular first premolar has single root canal or not. Dental cone beam CT was used as the gold standard.
Methods:
CBCT and panoramic radiographs of 1630 mandibular first premolar from 815 patients were analyzed. The CBCT images of the roots were examined to determine whether the mandibular first premolar has single root canal or not. Image patches of the mandibular first premolars were segmented from panoramic radiographs. Then deep-learning network approaches were applied to the patched images. The performance of the deep-learning networks and the dentists were compared in terms of Precision (PR), Recall (RE), Accuracy (ACC), F1-score and Area Under Curve (AUC).
Results:
Using the ResNet-101(CBAM) system showed an accuracy of 85%, a positive predictive value of 81.4%%, and a negative predictive value of 82.35% in the determination of whether the mandibular first premolar has single root canal or not. There was a significant difference between the results of experienced dentists and those of less experienced dentists. There was no difference between the results of experienced dentists and those of the ResNet-101(CBAM). And the results of the ResNet-101(CBAM) are much better than the average of the dentists.
Conclusions:
The deep learning systems showed high levels of performance in differentiating whether the mandibular first premolar has single root canal or not based on panoramic radiographs. It is a promising artificial intelligence approach that may assist dentists in preoperative diagnosis.
... They are minor in number and this result is in accordance with the previous studies [38,48,49]. In contrast to this Venezuelan population [50] presented a higher incidence of the canal which are C shaped in the lower first premolar (28.94%) and second premolar (7.14%). Astonishing to the above findings the studies of Saudi [17] and Iranian populations [42] had no C-shaped canals in their samples. ...
... It is an unusual anatomy of premolars which is supposed to happen due to lack of formation of dentine on the lingual side or it can also occur if Hartwig's epithelial root sheath fails to fuse during the stage of tooth development. Hence it is challenging work to clean and achieve successful results of the treatment as these canals are present with the thinness dentinal walls, narrow canals, and concavities on the roots [49,50]. The likelihood of a C-shaped canal in lower second premolars was suggested by this prevalence. ...
Background The clinician should have complete knowledge of the normal anatomy of the root as well as complexities in the root canal configuration for a better outcome, as missed or improper handling of the canal system can lead to the failure of an entire endodontic procedure. The present study aims to assess the morphology of roots and canals in permanent mandibular premolars in the Saudi subpopulation with a new classification system.
Methods: The present study includes 1230 mandibular premolars (645 first premolars and 585-second premolars) from 500 CBCT images of the patients, including retrospective data. iCAT scanner system (Imaging Sciences International, Hatfield, PA, USA) was used to obtain the images; scanning of 8 × 8 cm images was performed at 120 KVp and 5–7 mA with a voxel size of 0.2 mm. The new method of classification presented by Ahmed et al. 2017 was used to record and classify the root canal morphology, followed by recording the differences regarding the age and
gender of the patients. Comparison of canal morphology in lower permanent premolars and its association with gender and age of the patients was done by Chi-square test/ Fisher exact test; the significance level was set at 5% (p ≤ 0.05).
Results: The left mandibular 1st and 2nd premolars with one root were 47.31%, with two roots were 2.19%. However, three roots (0.24%) and C-shaped canals (0.24%) were reported only in the left mandibular 2nd premolar. The right mandibular 1st and 2nd premolars with one root were 47.56%, with two roots were 2.03%. The overall percentage of the number of roots and canals in the first and second premolars 1 PM 1 (88.38%), 2 PM 1 B 1 L 1 (3.5%), 2 PM B 1 L 1 (0.65%), 1 PM 1–2−1 (3.08%), 1 PM 1–2 (3.17%), 1 PM 1–2−1–2 (0.24%), 3 PMMB 1 DB 1 L1 (0.48%). However, the C- shaped canals (0.40%) were reported in right and left mandibular second premolars. No statistically significant difference was reported between mandibular premolars and gender. A statistically significant difference was reported between mandibular premolars and the age of the study subjects.
Conclusion: Type I (1 TN 1) was the major root canal configuration in permanent mandibular premolars, which was higher among males. The CBCT imaging provides thorough details about the root canal morphology of lower premolars. These findings could support diagnosis, decision-making, and root canal treatment, for dental professionals.
... Moreover, frequent morphologic variations like C-shaped canals and extra root canals cause challenges in the biomechanical preparation and in obturation phases. [9][10][11][12][13][14][15] Various methods have been used to identify and record the root canal morphologies, some of which are two-dimensional radiographs, staining methods for root canals, sectioning of the dental hard tissues, micro-CT, and CBCT (Cone-Beam Computed Tomography) scanning. ...
Objective: The study aimed to evaluate the variations in the RCM of mandibular first premolars (MFP) in south Indians and also evaluated the gender dimorphism and contralateral symmetry of the pattern. Methods: 200 Cone Beam Computed Tomography (CBCT) images of MFP of patients above 18 years were analyzed for the root canal morphology after excluding the distorted images, endodontically treated tooth or fractured root. The teeth were carefully evaluated in cross-sectional, axial and coronal sections and the information regarding the number of roots and the type of root canal as per Vertucci’s classification. Interobserver and intraobserver reliability were also checked. Results: Single rooted teeth with Type I (73.01%) variation was the most prevalent pattern observed in the study population, which was followed by Type III (14.11%) and Type V (5.52%), respectively. Type IV and Type VIII variations were not found in our study. Conclusions: In both males and females, type I configuration was the most common pattern with symmetry in contralateral mandibular single-rooted first premolars.
... The prevalence of CSRCs in mandibular posterior teeth varies between countries and teeth, 1% 21 36 , some studies considered C1 and C2 as standard 1,33,46,51 , and others included C3 or C4 31,35,47,49,52,53 . The optimal sample size means that there are enough patients included in the study to find a statistically significant or clinically worthwhile effect if there is one. ...
... This study was the first to find gender differences in the prevalence of CSRCs in Chinese MFPs. This finding was consistent with other studies 1,46 but contradicted other studies 30,35,47 . Two studies 46,47 investigating the Thai population reached different conclusions on whether there is a gender difference in the occurrence of CSRCs in premolars. ...
... RGs in MFPs and MSPs were mainly located on the ML surface of the root. This finding was consistent with earlier studies 1,22,30,35,46,[51][52][53]63 . Most of the RGs in MFMs and MSMs were located on the lingual surface of the root. ...
The aim of this study was to investigate the prevalence, correlation, and differences of C-shaped root canals (CSRCs) morphology in permanent mandibular premolars and molars in Eastern Chinese individuals using cone-beam computed tomography (CBCT). A total of 8000 mandibular first premolars (MFPs), mandibular second premolars (MSPs), mandibular first molars (MFMs), and mandibular second molars (MSMs) CBCT images from 1000 patients (692 females and 308 males) were collected. The prevalence, correlation, bilateral/unilateral presence, the morphology of CSRCs, level of canal bifurcation, gender differences, and location of radicular grooves (RGs) were evaluated. The prevalence of CSRCs in MFPs, MSPs, MFMs and MSMs were 10.25%, 0.25%, 0.55% and 47.05%, respectively. The prevalence of CSRCs in MFPs of males was higher than that in females, while the prevalence of CSRCs in MSMs of females was higher than that in males (P < 0.05). The bilateral symmetry presence of CSRCs in MSMs was significant but not in MFPs, MSPs, and MFMs. RGs were predominantly found on the mesiolingual (ML) surface of premolars and the lingual surface of molars. There was a high prevalence of CSRCs in MFPs and MSMs in the Eastern Chinese population, but there was no correlation. The prevalence of CSRCs in MFPs and MSMs differ significantly by gender (P < 0.05).
... In recent times, cone-beam computed tomography (CBCT) has been successfully applied to the study of dental anatomy and endodontics [5,12,13], and its role in these disciplines is well established. The present study aimed to describe the root and canal anatomy of permanent mandibular premolars in a Black South African population group using CBCT and the above two classifications. ...
... Both the mandibular first and second premolars in the present study demonstrated predominantly single roots, with a small number of two-and three-rooted teeth. This is similar to findings reported for several other populations [3,5,13,20]. The most common canal configuration demonstrated in mandibular first premolars was a single canal (Vertucci Type I or 1 MP 1 ). ...
... The most common canal configuration demonstrated in mandibular first premolars was a single canal (Vertucci Type I or 1 MP 1 ). This is in agreement with the findings of a number of other studies of individual populations including; Jordanian [3], Turkish [21], German [22], Portuguese [5], Venezuelan [13], two different Korean [6,23] and Chinese [24] subjects. These findings were also reiterated in a worldwide multicenter study of diverse populations from 23 countries [7]. ...
Purpose: An investigation of the configurations of mandibular premolar roots and canals in a population of Black South Africans.
Methods: Cone-beam computed tomography analysis of 772 mandibular premolars was performed, and the premolars were classified according to the systems proposed by Vertucci and Ahmed et al. Root number, canal morphology, age, and sex were recorded. Fisher’s exact test was used to determine relationships based on age and sex (P < 0.05).
Results: Single roots were seen in the majority of mandibular premolars (97.1%). Single canal configurations (i.e., Vertucci Type 1/Ahmed et al. ¹MP¹) were observed in 48.5% of first and 81.3% of second mandibular premolars. Mandibular first premolars demonstrated multiple canals in more than half of the sample (51.5%), and C-shaped morphology in more than one-tenth (11.1%). A relationship between sex and the presence of radicular grooves was demonstrated (P = 0.049), males being more likely to demonstrate this feature (P = 0.051). Multiple canals in mandibular first premolars also showed a relationship with sex (P = 0.005), a male predilection being evident (P = 0.007). The Ahmed et al. system proved superior to the Vertucci classification for reporting complex configurations and anatomical variations, although a greater number of unique categories were created.
Conclusion: Diverse mandibular premolar root and canal morphology was observed in the studied population. Clinicians must be aware of common morphological features as well as possible anatomical variations in mandibular premolars, as failure to treat complete root canal systems may negatively impact endodontic treatment outcomes.
... In Venezuela, the prevalence of a C-shaped canal in the mandibular first and second premolar was higher than in Saudi Arabia, as they were 28.94% and 7.14%, respectively. [52] Furthermore, it was higher in the USA (14%) for the first premolar. [53] However, it was much less in the Indian population for first and second mandibular premolar, which were 0.92% and 0.7%, respectively. ...
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 based on the following inclusion criteria: original full-length original articles that reported the variables of interest “(number of roots, number of canals, Vertucci’s classification system and C-shaped canals or mid-mesial canals)” of the mandibular teeth and conducted on Saudi subjects. The retrieved data were presented as frequencies and percentages. The results revealed that 56.6% of mandibular central incisors had one canal and Vertucci type I (56.6%), while 57.4% of the mandibular lateral incisors had one canal, with Vertucci types I and III most frequent. In mandibular canines, 91.8% had one canal and 8.2% had two canals. Most of the mandibular first premolars had one root (86.6%), while almost all mandibular second premolars (91.5%) had one canal, and 96.9% had Vertucci type I configuration. Among the mandibular first molars, three and four canals were prevalent in 58.7% and 40.6%, respectively. The majority of mesial roots had Vertucci type IV (60.6%), and most of distal roots had Vertucci type I (72.2%). Most of the mandibular second molars had three canals (87.3%) and showed Vertucci type IV (39.4%) canals for mesial roots and Vertucci type I (95.6%) for distal roots. The C-shaped canals were seen in 8% of first premolars and 9.8% of second molars. The middle mesial canal was found in 4.2% and 0.4% of first and second molars, respectively. This review could represent “the population of Saudi Arabia as the included samples were combined from different regions of the country.” Some variations were noticed within the same group of teeth from different regions. However, the overall results of combined samples were comparable to the other international studies.
... Two-orifice n (%) 33 mostly severe curvature of 177 (58.0%), however, in the distal root, the straight were found in 104 (35.6%) of the studied sample. There was no statistically significant difference between groups in terms of gender (p > 0.05). ...
... In the current study, Vertucci's classification [32] was chosen as a reference for canal types since it was the first system to detect more complicated canal system configurations than prior classifications. Despite the fact that it has been a fundamental categorization for a long time, it is still frequently employed in new research in the literature by most authors [28,33], and it was utilized in the current study for easy comparison with the results of other investigations. Furthermore, the Zhang et al. [9] classification was chosen in this study because it is a complete classification that relates the number of roots to the number of root canals in each tooth and provides a straightforward description of tooth internal and exterior anatomy. ...
Background
The study's goal was to use Cone Beam Computed Tomography (CBCT) to assess the root and root canal anatomy of mandibular second molars with C-shaped root canal configurations in residents of the Hail district. The impact of gender and side on the frequency of root canal morphology was considered.
Methods
The sample size for this study was 304 untreated mandibular second molars with completely developed roots on the right and left sides. Using CBCT on the teeth, the root form and canal morphology for each root are based on Vertucci's classification. The occurrence of canals in the shape of a C. The prevalence and resemblance of the left and right sides or men and females were investigated. The Chi-square test was performed to evaluate the findings.
Results
Of the 304 mandibular second molars studied, 286 teeth had two roots (94.1%), whilst 13 (4.3%) were C-shaped root canal systems. 77 molars (25.3%) had two canal orifices, 219 (72.0%) had three canal orifices, and six (2.0%) and one (0.3%) had four and five root canal orifices, respectively. Type IV was the most common for mesial root, accounting for 57.7% of the sample (n = 176). For distal root, the most common occurrence was type I, which occurred 282 times (96.60%). The most prevalent root canal morphology was the presence of two canals in the mesial root and one canal in the distal root of teeth with two distinct roots (variant 3). (69.4%). The overall prevalence of C-shaped root canal systems is (4.3%) (n = 13).
Conclusions
The patient's race is an undeniable factor that influences root canal anatomy. The root canal morphology of mandibular second molars revealed significant differences between Saudi subpopulations. The majority of mandibular second molars had two roots and three root canals. When treating these molars, the presence of a C-shaped root canal system must be taken into account.
... Staining and clearing 2017b), distance between root canal orifice and the external root surface (Akbarzadeh et al., 2017), root dentine thickness (Zhou et al., 2020), angles for root curvatures (Zhang et al., 2015), angles between canal orifices (Zhang et al., 2015), levels of canal merging and splitting (Martins et al., 2017) in addition to studies related to specific anatomical variations such as mandibular molars with disto-lingual roots (Kim et al., 2018), C-shaped canals (Brea et al., 2021) and dens invaginatus (Różyło et al., 2018). Voxel size is an important setting parameter in CBCT studies related to canal anatomy (Vizzotto et al., 2013). ...
The technical execution of root canal treatment procedures demands a thorough understanding and knowledge of root and canal anatomy. Over the decades, and with the aid of various research methods such as staining and clearing, 2D radiographic imaging, sectioning procedures, cone beam computed tomography and micro‐computed tomography, many laboratory and clinical studies have been undertaken to understand the root and canal anatomy of the human dentition. This has resulted in a tremendous increase in the body of knowledge with a wide range of qualitative and quantitative presentations of the root and canal anatomy. This review aims to provide a critical analysis for the laboratory and clinical research methods in root and canal anatomy studies. In addition, it aims to identify existing gaps and present insights for directions of future research and ways for translation to clinical endodontics.
