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Purpose: The present study investigated the root canal configuration of maxillary second molars with root fusion using micro-computed tomography (micro-CT). Materials & Methods: A total of 136 fused maxillary second molars were scanned with micro-computed tomography. Images were transferred to CTAn v.1.18.8 software (Bruker-microCT) to obtain three-dimensional models. The specimens were classified according to the fusion type. According to Vertucci, classification of the root canal configuration of fused roots was determined using CTVol v. 2.3.2.0 (Bruker-microCT) and DataViewer v.1.5.6 (Bruker-microCT) softwares. The specimens that could not be represented were also specified. The frequency of canal configuration according to the fusion type was calculated. Results: For Type 1 fusion (n=40) and Type 2 fusion (n=22), the most common canal configuration for mesiobuccal (MB), distobuccal (DB) and palatal (P) canals was Type I. In type 3 fusion specimens (n = 21), DB and P canals were completely fused in 1 sample in accordance with Vertucci type IV, while in the remaining specimens, types II, I, V, VI and IV were observed in decreasing order in the MB canal. In type 4 fusion, MB and DB canals were completely fused in 4 of 21 specimens and showed Vertucci type VI, II, I and III configurations. In the remaining 17 samples, MB had Vertucci type I, II, IV, V, VI, VII configurations, while DB showed type I, V and III configurations. In 7 samples with type 5 fusion all canals displayed different configurations. In type 6 fusion, the canal configurations of 6 samples could not be classified. Type II, I, and V configurations were seen in 9 of the remaining 19 samples with a single canal. Conclusion: Vertucci type I was the dominant canal configuration in the P and DB, however, MB showed much more diverse configurations either independently or when included in fusion.

Objectives The aim of this study was to investigate whether file design and taper significantly influence microcrack initiation during machine preparation. Materials and methods Sixty extracted teeth with straight single canals were selected. The teeth were randomly assigned to four groups based on their root canal anatomy and the corresponding NiTi rotary file system (I, Mtwo; II, ProTaper Universal; III, F6 SkyTaper; control, no preparation and filling). The root canals of the experimental groups were filled using the single-cone technique. The tested teeth were all subjected to a mechanical chewing simulation with flat lead loading over a period of 3 years (corresponding to 150,000 cycles). The teeth were checked for dentinal defects (accumulative crack growth in length) under the digital microscope (Keyence VHX-5000) at time 0 (baseline prior to chewing simulation) and after 3, 6, 12, 24, and 36 months of loading. The cumulative crack increase was statistically analyzed using the Kruskal–Wallis test, Jonckheere–Terpstra test, and the Wilcoxon rank-sum test. The significance was set at p Results In contrast to preparation with greater-tapered instruments, ProTaper Universal (group II) and F6 SkyTaper (group III) instrumentation with the smaller tapered Mtwo files (group I) showed less accumulative propagation of craze lines (p Conclusion Instruments with greater taper for root canal instrumentation should be used with care to avoid negative long-term effects in the form of propagation of dentinal defects over time. A positive cutting-edge angle and a smaller taper have a positive effect on a lower craze line development. Clinical relevance Instruments with a positive cutting-edge angle and a smaller taper are beneficial for the long-term preservation of dentinal tooth structure.

To investigate the three-dimensional morphology of isthmuses in molars according to their boundary characteristics using micro-computed tomography (micro-CT). Micro-CT reconstructed images of 248 molars were evaluated. Isthmuses were classified into four types based on the boundary characteristics: isthmus with roof, isthmus with floor, band-shaped isthmus, and isthmus without boundary. The tooth and root with isthmuses, the number and location of the isthmuses in the root, and the canal configurations were recorded. The maximum of the major diameter of all canal cross-sections in one isthmus (dmax), the minor diameter of the canal in same cross-section (dmin), the distance between the dmax cross-section and apex (Dm−a), isthmus length (Li), and distance from the isthmus ending cross-section to apex (De−a) were measured and analysed with a significance threshold set to 5%. Isthmuses were present in 75.4% specimens. The four types of isthmuses were found in various molars and roots. Their distribution in different root locations and canal configurations was significantly different. The dmax, dmin, Li, and De−a were analysed according to different molars and different isthmus types; their respective median values were 2.508 mm, 0.07 mm, 3.09 mm, and 3.96 mm. The three-dimensional classification of isthmuses according to the boundary characteristics provides a comprehensive picture of the isthmus in molars. Their corresponding distributions in different molars, location in roots, and canal configurations will be helpful in predicting the type of isthmus based on the tooth position and canal configurations.

Introduction: Understanding root canal morphology is important to achieve successful root canal treatment (RCT). Studies on mandibular premolars showed that, there is a significant variation in the root canal anatomy between different ethnicities. Therefore, this retrospective study aimed to evaluate the root canal anatomy of mandibular premolars in Egyptian population using cone-beam computed tomography (CBCT). Materials and Methods: 248 CBCT scans were evaluated and the anatomy of 392 mandibular first and 384 second premolars was classified according to Vertuci's classification. Data was statistically analyzed using SPSS software to calculate the incidences of root and canal number, each canal type, bilateral symmetry, and the association between gender and variation in root canal morphology. Results: First and second premolars with two roots were found in 1.8% and 1% of scans respectively. Most of the mandibular first (80.1 %) and second premolars (93.5%) showed (type I) root canal morphology followed by, type II (6.4 %) and type V (2.1%) in the first and second premolars respectively. While, Type VIII showed the least frequency in both premolars. Only the second premolars showed a statistically significant association between gender and both canal type and number. Bilateral symmetrical anatomy was observed more in the second premolar (94.8 %) than the first premolar (85.7%). Conclusions: Mandibular premolars in Egyptian population showed great variation in root canal configuration. Therefore, preoperative CBCT evaluation is advantageous to avoid missing of existing extra canals during RCT. New classification systems for root canal morphology is highly recommended in further studies.

Purpose of Review: Cone-beam computed tomography (CBCT) is an imaging modality with high-resolution diagnostic value that provides accurate and high-quality three-dimensional information on the elements of the maxillofacial complex. Therefore, this study aimed to present an up-to-date status of the main indications for the use of CBCT in endodontics, and to discuss its main limitations relative to diagnosis in endodontics. Recent Findings: The data captured by CBCT devices and processed by a specific software programs create a reconstruction of the scanned volume. Thus, they allow dynamic and interactive analysis of the information, by means of simultaneously scanning the object in different anatomical planes of imaging: axial, coronal, or sagittal, and their subsequent reconstruction thereby revealing structures that are not visible in periapical radiographs. Although periapical radiographs continue to be the imaging method of choice for the evaluation of endodontic treatment, a significant leap has occurred in the growth of CBCT use Endodontics in recent years. However, the importance of recognizing the different types of artifacts generated during the image acquisition and reconstruction process is emphasized, especially in the presence of high-density endodontic materials that can compromise the quality of the diagnosis. Summary: Considering the findings of this study, and based on international guidelines, it was concluded that the possibilities of using CBCT during endodontic treatment were mainly focused on diagnosis, assessment [of existent dental conditions], and preoperative treatment; establishing the morphology, diagnosis, and treatment planning of root canal systems; evaluation of root resorption; planning and evaluation of the treatment of traumatic dental injuries, perforations, fractures, and for the preparation of endodontic guides.

A comprehensive knowledge of the root canal anatomy is essential for successful endodontic treatment. However, presence of anatomic variation in the tooth can be diagnostically and technically challenging and hence may pose difficulties during endodontic therapy. The anatomical variations associated with permanent mandibular canines have been reported by several investigators. Mandibular canines are recognized as usually having one root with one root canal in majority of cases. The occurrence of two root canals in single-rooted mandibular canine is considered unusual in Indian population. This case report describes non-surgical endodontic management of right permanent mandibular canine having one root with two canals and one apical foramen (Vertucci Type II). Keywords: Anatomical variation, Endodontic management, Mandibular canine, Vertucci type II

Background: The knowledge of root canal anatomy is considered essential in the diagnoses and treatment of endodontic cases to assure successful outcomes. Although the mandibular canine is known to be a single- rooted tooth with a single canal, variations can be seen. However, the incidence of a mandibular canine having two roots and two canals is extremely rare. Case Presentation: This article reports a case of non-surgical retreatment of mandibular canine, with two roots and two canals, presented to the clinic with a periapical lesion. Chloroform and H-files were used to remove previous gutta percha, canals were shaped with a profile rotary system, and irrigated with 2.5% sodium hypochlorite. The canals were then obturated with gutta percha and AH Plus sealer. Conclusion: Clinicians must use all the available tools to help them detect anatomical variations to manage their cases successfully.

This study aimed to determine the prevalence of four-rooted teeth and the corresponding crown, root and canal morphology in maxillary molars. Cone-beam computed tomographic images for 1200 patients were examined, and 1799 maxillary first molar (MFM) and 2123 maxillary second molar (MSM) teeth were evaluated. Statistical analyses were performed at a 5% significance level. Only three MFMs (0.17%) and 30 maxillary MSMs (1.41%) were four-rooted. The most common four-root type was the double palatal root. A higher proportion of four-rooted teeth were observed in men (P < 0.05), and a high percentage of root fusion was seen in these teeth. The palatal half of the crown was wider in teeth with double palatal roots. Although rarely encountered, the diagnosis and proper treatment of these teeth are very important for endodontic success.

Aqeel Al-Saedi,1 Bahaa Al-Bakhakh,2 Riad G AL-Taee3 1Oral Diagnosis Department, College of Dentistry, University of Basrah, Basrah, Iraq; 2Conservative Dentistry Department, College of Dentistry, University of Basrah, Basrah, Iraq; 3Oral and Maxillofacial Surgery Department, College of Dentistry, University of Basrah, Basrah, IraqCorrespondence: Aqeel Al-Saedi Oral DiagnosisDepartment, College of Dentistry, University of Basrah Kut Al-Hujaj, Basrah 61004, IraqTel +964 7706910561Fax +964 7700636421Email Aqeel.lazim@uobasrah.edu.iqPurpose: This study aimed to determine the prevalence of the second mesiobuccal canal in maxillary first molar teeth in a sample of population from Basrah city in the south of Iraq.Patients and Methods: Cone-beam computed tomography (CBCT) images of 353 Iraqi patients from Basrah city were included in the study. These images revealed 691 maxillary first molars, but only 655 of them were included. The images were obtained using a Gendex (GXDP-7000) CBCT machine (Hatfield, PA, USA) and studied for the prevalence of second mesiobuccal canal in the mesiobuccal root canal configuration, according to Vertucci’s classification, by scrolling through the images. Pearson’s chi-square tests were used to correlate canal type distribution to gender and age. The distributions of canal type on the right and left sides were assessed using the Kendal tau correlation coefficient. A P-value < 0.001 was considered highly significant. For intra-examiner reliability analysis, Cohen’s kappa test was used.Results: The second mesiobuccal canal was identified in 81.68% of the Iraqi population sample. The most common type was type II (44.58%), followed by type IV (31.30%). Type I occurred in 18.32% of cases. Other types were less frequent.Conclusion: The second mesiobuccal canal occurred in most of the examined samples of the Iraqi population (81.68%), with the most common type being type II, followed by type IV.Keywords: maxillary molars, root canal anatomy, Vertucci’s classification, mesiobuccal root

Premolars have been blessed for having an aberrant root canal anatomy. The occurrence of more than 2 canals with different portal of exit is very rare. If one is facing the scenario of treating the maxillary and mandibular premolars clinically than he must be aware of the internal anatomy of these teeth. These teeth may require special shaping and obturating techniques. This case series is the reflection of the endodontic challenges clinicians face to manage such cases. Careful examination of pre-operative radiograph and careful negotiation is necessary to deal with such variable anatomies. Keywords: Premolars, Canal negotiation.

Unusual root canal anatomy always poses a diagnostic and treatment challenge.Therefore a thorough knowledge of root canal anatomical variations along with proper diagnosis, treatment planning and clinical expertise is the key to their successful management. The C-shaped root canal configuration is one such aberrant canal anatomy, common in the mandibular second molar. It often goes undetected and due to the intricate root canal configuration, it is often difficult to negotiate, debride and obturate such canalsleading to failure of root canal treatment. Case Reports: This article presents management of four different C-shape root canal configurations using the cold lateral condensation and thermoplasticized obturation techniques. Conclusion: Understanding the anatomical presentations of this variation will enable the clinician to manage these cases effectively. Advanced irrigation and obturation techniques help in managing such anomalous canal configurations. Keywords: Anatomic variation, Cshaped canal, Mandibular second molars, Endodontic treatment, Thermoplasticized obturation.

AIM To introduce virtual reality (VR) into the endodontic curriculum for teaching root canal anatomy and to evaluate the effectiveness of this new method on third-year undergraduate students. METHODOLOGY Extracted human teeth were digitized using a CBCT scan and converted into STL files. The corresponding files were either 3D printed or imported into a VR software program. Subsequently, forty-two third-year undergraduate dental students in preclinical training were asked to respond to a questionnaire analysing their ability to detect all the anatomic features of the replica teeth and their comprehension of the underlying root canal anatomy. The investigation was based on three different methods: two-dimensional radiography, CBCT scanning and VR simulation. Data were analysed using McNemar's and binomial test, and the level of significance was set to 0.05 (P = 0.05). RESULTS Students reported that CBCT and VR allowed them to detect all anatomic features more than radiography (P

The maxillary molars especially the third molars have the most complicated root canal system in permanent dentition There are many variations in root canal number system and configuration in maxillary molars It is imperative and paramount for the clinician to seek out every possible aberration of root canal anatomy for all teeth undergoing treatment This paper relates a case of a maxillary right third molar with a canal configuration rarely reported in the literature The tooth had four roots with four root canals two separate palatal roots mesiopalatal and distopalatal with their own distinct canals and orifices The mesiobuccal and distobuccal roots had normal anatomy This paper escalates the complexity of maxillary molar variation and is intended to brace clinician rsquo s awareness of the rare morphology of root canal system

BACKGROUND As the complex anatomy of maxillary first molars is one of the major challenges in endodontic therapy, knowledge of the complicated root canal anatomy and configuration is crucial to ensure the success of endodontic treatment and prognosis. This article presents an endodontically managed left maxillary first molar with an unusual palatal root morphology. The available literature on the anatomic variation of maxillary first molars is also reviewed. CASE SUMMARY A 36-year-old man with no medical history presented to the Stomatology Department of Peking University Third Hospital complaining of a toothache during mastication in the maxillary left posterior region for approximately 3 mo. He had a spontaneous and intermittent toothache that had worsened, particularly at night. The diagnosis based on clinical examination, X-ray imaging, and cone beam computed tomography (CBCT) was symptomatic irreversible pulpitis. Nonsurgical endodontic therapy was performed for the left maxillary first molar. Five root canals revealed by CBCT included a special palatal root canal (1-2-1-shaped), two mesiobuccal root canals, and one distobuccal root canal. Evaluation of the CBCT images confirmed the root canal morphology and the clinician performed more effective cleaning, obturation, and therapy. Finally, the tooth was restored using composite resin, and the patient was satisfied with the result. CONCLUSION CBCT and a complete review of the literature may be beneficial for investigating the root canal system to achieve a biological and functional therapeutic effect.

International audience; INTRODUCTION: Teaching in French universities has undergone deep changes for several years. Dental studies are no exception to the rule. Endodontics is one of the most difficult fields requiring good knowledge of anatomy before performing clinical procedures. The access cavity is the key step of endodontic therapy. The aim of this study was to collect and understand what students feel and expect from theoretical and practical training on endodontic access cavity. MATERIALS AND METHODS: A questionnaire survey on the teaching and learning of endodontic access cavities in a French dental school was sent by e-mail to the 4th-year students (n = 66). The questionnaire consisted of 13 questions of different formats. Qualitative variables were analysed using a word cloud according to the words of the participants. Students were also asked how to improve teaching with new educational tools. RESULTS: 60 students answered the questionnaire (response rate of 90.9%). When students were asked which stage of endodontic treatment they feared the most, performing access cavity came in 3rd place. Upper molar (71%) and lower molar (58%) appeared to have the most difficult endodontic access cavities. Within the word cloud gathered after students’ answers analysis, the words "fear," "perforation," "cavity" and "axis" were highlighted. Amongst the 3 new educational tools proposed to students, most were in favour of realistic models of teeth with their ideal endodontic access cavity (79%). DISCUSSION: This study highlighted the feelings of students during their hands-on training on endodontic access cavities. Although they seemed satisfied with practical classes on endodontic access cavities, this step seemed to be stressful for students especially because of the great internal anatomical variabilities of teeth. To help them better understand the root canal anatomy and improve their training, students asked for new educational resources, especially macro-models of teeth with their optimal access cavities. CONCLUSION: This study showed that students are seeking for innovative resources in addition to traditional resources that would make it easier for them to visualise the root canal system and help them feel more comfortable and facilitate learning when performing endodontic access cavities.

This study describes a methodology to identify accessory root canals using the e-Vol DX software in CBCT scans. Accessory root canals are strategic shelters for microorganisms present in root canal infections. The identification of these small canals in periapical radiographic exams has limitations, besides being markedly limited accessibility to the action of endodontic instruments and to the antimicrobial agents. A significant number of accessory canals have sufficient diameters to be visible on cone-beam computed tomography (CBCT) images of high spatial resolution. Therefore, it may go unnoticed or even confused when there is no specific training for this type of diagnosis. The methodology consists in establishing thin slices (0.1mm or smaller) obtained from coronal, sagittal and axial slices. The method consists of the following steps: during navigation along the long axis of a root canal when finding a possible hypodense line of main root canal in a tomographic section (axial, sagittal or coronal), the navigation software lines of the multiplanar reconstruction (MPR) must be adjusted so that they are parallel and perpendicular to the hypodense line (parallax correction). Then, after judiciously adjusted, the accessory canal image will invariably appear as a line on one of the MPR tomographic slices, another line on another slice, and a dot on the third slice. The three sections of the MPR present images with the “line-line-dot” sequence. In this way, it is possible to identify an accessory root canal and also visualize it in volumetric reconstruction in a specific filter. The application of this method is easy to employed and may benefit the diagnosis when you want to visualize accessory root canals and distinguish it from root fracture line. Resumo Este estudo descreve um método para identificar canais radiculares acessórios usando o software e-Vol DX em imagens de TCFC. Os canais radiculares acessórios constituem abrigos estratégicos aos micro-organismos presentes nas infecções endodônticas. A identificação destes pequenos canais em exames radiográficos periapicais apresenta limitações, além de apresentar baixa acessibilidade natural a ação dos instrumentos endodônticos e dos agentes antimicrobianos. Os canais acessórios apresentam diâmetros suficientes para ficarem visíveis em imagens de tomografia computadorizada de feixe cônico (TCFC) de alta resolução espacial. Porém, podem passar despercebidos ou até confundidos quando não ocorrer treinamento específico para este tipo de diagnóstico. A metodologia consiste em estabelecer finos slices (0,1 mm ou menor) obtidos a partir de cortes coronal, sagital e axial. O método consiste nos seguintes passos: ao encontrar uma linha hipodensa de um canal radicular principal em um corte tomográfico (axial, sagital ou coronal) deve-se ajustar as linhas de navegação da reconstrução multiplanar (MPR) para que fiquem paralelas ao canal principal e perpendiculares a esta linha hipodensa (correção de paralaxe). A seguir, depois de criterioso ajuste da imagem em busca do canal acessório, aparece invariavelmente como uma linha em um dos cortes tomográficos da MPR, outra linha em outro corte e um ponto no terceiro corte. Os três cortes da MPR apresentam imagens com a sequência linha-linha-ponto. Desta maneira, pode-se identificar um canal acessório e visualizá-lo em reconstrução volumétrica em filtro específico. Esta metodologia é fácil de ser aplicada e pode beneficiar o diagnóstico quando se deseja identificar canais radiculares acessórios e distingui-lo de linha de fratura radicular.

Endodontic mishaps are very unfortunate and most of the time iatrogenic Causes include inadequate knowledge of radicular morphology and some are due to the negligence of the dental surgeon. Maxillary first molar having three roots and three distinct canals is normal anatomical finding but presence of fourth root with a patent root canal is rare phenomenon to found in routine endodontic practice. Present case report discusses successful non surgical root canal treatment of maxillary first molar with a exceptional root canal anatomy of four separated roots. Invariably maxillary first molar has most complicated root canal anatomy. Most commonly found variation in maxillary molar are presence of two canals i.e.MB1 AND MB2 in mesiobuccal root and accessory canals in the area of furcation. Extra root or fourth root is a rare finding and least documented. This case report explains the successful root canal treatment of first maxillary molar with four distinct roots and four canals. Access cavity modified according to root canal anatomy, cleaning and shaping done with rotary instruments and obturation done with the help of calcium hydroxide based sealer. Keywords: Four Roots, Endodontically, Irreversible Pulpitis, Heat Test, Periapical

A detailed acquaintance of root canal anatomy is essential for the endodontic root canal therapy. Aberrations or unusual variations in the root canal morphology, mainly in multirooted teeth, can cause a substantial challenge to the endodontist during endodontic management. Knowledge of these variations, mostly concerning the position and treatment of all canals, is very essential for the successful outcomes of endodontic therapy; the failure to find and properly treat the root canals may cause treatment failure because it is important to assess individual case for variations. Endodontist should be suspicious while treating maxillary first molars because of its root curvatures, additional canals and variations in internal morphology. Keywords: Two palatal canals, Maxillary first molar, Endosequence BC Sealer.

Procedural accidents are eventualities that may occur during endodontic treatment because of lack of attention to detail or even unforeseeable situations. Knowledge of the root canal anatomy and its variations is a prerequisite for successful endodontic treatment. This case report describes an endodontic treatment where there was an intercurrence, generating deviation and perforation, which was solved with the aid of guided endodontics. A 37 years old, ASA1, was referred to the clinic for localisation and treatment of a calcified canal of the second right upper premolar. The tomographic images revealed the presence of only one canal and deviation with apical perforation. With the help of CBCT and CAD/CAM, it was possible to perform the guided access technique even after deviation and root perforation. Once again, this technique proved to be safe and predictable, allowing for a favourable prognosis in the long term.

The aim of this in vitro pilot study was to describe the shaping ability of a rotary nickel-titanium (NiTi) instrument in combination with different torque-controlled endodontic devices and to compare them with NiTi files in combination with a conventional preparation by hand in severely curved root canals of plastic blocks. Thirty blocks simulating a severely curved root canal were divided into three groups (n=10 for each). All canals were prepared with NiTi files to an ISO size of 40 using an apical-coronal preparation technique. Mity Roto 360° files (Loser, Leverkusen, Germany) were used for the automatic systems, while Mity K-Files (Loser, Leverkusen, Germany) were used for the preparation by hand. We evaluated the frequency of instrument failure, the preparation time, loss of working length, loss of weight, elbow-zip effects, and changes in root canal anatomy.

This study aimed at establishing a comprehensive specification of the root canal anatomy of second primary mandibular molars using micro computed tomography (CT). 10 s primary molars from Caucasian young patients were selected for this purpose. Micro CT imaging with a high resolution of 20 microns was performed to observe the roots and canals according to specific criteria. The Vertucci canal configuration, the presence of lateral canals and their location, the presence of an isthmus and its location, were first observed. Then, the length of the canals, their diameter in the mesio-distal and vestibulo-lingual direction, the dentinal thickness and the direction of the minimal dentinal thickness were measured. The mean working length was not significantly different between the canals (p = 0.710). The bucco-lingual diameter was significantly higher when the tooth had a single distal canal at the coronal (p

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.

Summary: An electronic apex locator(EAL) is a device used to measure the working length (WL) of theroot canal space(RCS) and proved to be a great help to the endodontist reducing radiation exposure ofboth patients and clinicians and providing accurate reading for the WL. Evolution of different generationsof EAL helped to eradicate the shortcomings of the previous generations providing precise measurementof the WL. Electronic Apex locators are used to detect any perforations, furcation involvement, also usedto detect horizontal fractures, also to detect internal or external resorption. With so many uses, it is stillcontraindicated in patients with pace makers and inaccurate reading in canals with common irrigants likeEthylenediamine tetraacetic acid and sodium hypochlorite. It requires dry or partially dry canals to givereadings with accuracy. It also gives inaccurate reading in the presence of semi-conductive materials andhence the canals should be free of them. Though it provides almost precise measurement of the WL it cannotbe replaced with radiographs but can be used as an adjunct with it. Pre- and post-operative radiographs arestill necessary for the success of the endodontic treatment as it provides an idea for any periapical lesionand degree of curvature of roots. Acceptance of an electronic apex locator to determine the correct WLhas still not gained approval worldwide. Lack of exposure to the technology by the operator, inadequateknowledge of the root canal anatomy and cost of the instrument are also the factors for it not gainingworldwide acceptance.

INTRODUCTION: Mandibular premolars are some of the most challenging teeth to be treated endodontically, with wide variations in canal anatomy, unexpected morphology, and high incidence of rare configurations. OBJECTIVES: Investigation of root canal anatomical configurations in mandibular premolars in an Egyptian population, and evaluation of Digital Periapical Radiography efficacy in root canal anatomy identification. MATERIALS AND METHODS: The study was approved by the ethical committee at faculty of dentistry, Alexandria University (IRBNO:00010556-IORG0008839). One hundred and eighteen extracted(for periodontal reasons) human mandibular premolars were randomly selected from an Egyptian population at the outpatient clinic of the maxillofacial department in Alexandria University according to selection criteria that ensures the presence of a fully formed root canal system that was neither filled or deteriorated by decay, or restorations, or resorption or cracks. No information regarding age or gender were collected. All samples were mounted in acrylic blocks and scanned by digital periapical radiography from two horizontal angles and then dissected by grinding longitudinally buccolingually till visualizing root canal anatomy highlighted by methylene blue dye. Digital radiographs were analyzed by 5 evaluators who identified the anatomy of each sample according to Vertucci’s classification. Then anatomy displayed by each dissected sample was recorded. Data were statistically analyzed. RESULTS: (Type-I) was the most prevalent configuration (76.3%), followed by Type-V (16.9%) and Type-III (5.1%), and only (1.7%) presented 3-Canal configuration. Periapical radiography failed to correctly detect root canal anatomy in 24 teeth (20.3%). CONCLUSIONS: Presence of more than one canal in mandibular premolars is not rare in the Egyptian population, and periapical radiography is not reliable to identify root canal anatomy of mandibular premolars.

Attempting exploration at the expense of dentin tissue to reveal anatomical variation is still a common practice in root canal treatment, mainly because it relies on bi-dimensional radiographic images and clinical assessments to comprehend root morphology and root canal anatomy. The main purpose of this chapter is to understand the role of technological advances in finding the appropriate resources and maneuvers to (a) completely treat root canal anatomy avoiding residual intracanal infection, (b) balancing the size of the access cavity and the degree of root canal enlargement with the requirements of irrigation methods to achieve optimum disinfection, and (c) preserving root dentin during instrumentation to maintain the mechanical integrity of the root, minimizing the risk of fractures, all of them considered relevant causes of endodontic treatment failure.

Comprehensive knowledge of the entire root canal system is an essential prerequisite for successful routine endodontic treatments. The internal and external morphological configurations of roots and root canals are quite complex. Thus, several classifications have been put forth by researchers to appropriately understand the distinguishable features of root and root canal systems of multirooted teeth. Until now, the researchers have proposed new classification systems for a thorough understanding of the root canal systems, mainly concentrating on the root canal anatomy and anomalies. Moreover, with the advent of newer digital imaging systems, these classifications are more reproducible and relevant. They have further gained importance for the clinicians by acting as an aid in decision-making based on evidence-based dentistry. However, these classifications are primarily focused on the root canals, but none have assessed the anatomy of the pulp chamber floor. This review article delineates a novel Pawar and Singh molar pulp chamber floor classification© for the anatomy of maxillary and mandibular molars to ease the clinician's skills and further increase the prevailing literature for the benefit of researchers.

Information regarding the canal anatomy especially in complex cases such as C-shaped canals is essential for a successful treatment. In this study, five different methods for identification of C-shaped canal configuration were compared. 108 extracted mandibular molars with fused roots were studied. Radiographic evaluation was carried out using periapical radiography and CBCT. After access cavity preparation, all specimens were evaluated by direct visual examination and then under dental operating microscope. Finally, the actual anatomy of each sample was determined by preparing horizontal cross sections of the roots (1 mm thick) and examining them under stereomicroscope as the gold standard. Among the techniques used, high-resolution CBCT manifested the highest accuracy, whereas periapical radiography had the lowest. All approaches can be useful in reaching a correct diagnosis. CBCT, especially the low-resolution modality, is an effective technique in the diagnosis of C-shaped anatomy.

Introduction This cone-beam computed tomographic (CBCT)-based study evaluated the root canal configurations of mandibular anterior teeth in a large Brazilian population, along with the influence of sex and the frequency of symmetry between the contralateral teeth. Methods Overall, 2543 CBCT scans, including those of 4773 lower central incisors (LCIs), 4835 lower lateral incisors (LLIs), and 4805 lower canines (LCs), were analyzed. The scans were obtained from a private radiologic clinic using the PreXion 3D device (Yoshida Dental Mfg Co, Ltd, Tokyo, Japan) with a 0.14-mm voxel size; exposure parameters of 90 kV, 4 mA, and 19 seconds; and a field of view of 80 × 80 mm. Root canal anatomy was analyzed according to the Vertucci classification. Sex influence on the canal distribution and symmetry between the contralateral teeth were analyzed. The data were analyzed statistically and were considered significant when P Results All LCIs and LLIs had 1 root, whereas 2.4% of LCs had 2 roots. Two root canals were observed in approximately 20% of LCIs and LLIs and in approximately 11% of LCs. The most common configuration was type I followed by type III. Bilateral symmetry occurred in a majority of the individuals (ie, 91% in LCIs, 87% in LLIs, and 87% in LCs). No sex influence was noted with LLIs and LCs (P > .05). However, LCIs showed a higher prevalence of 2 canals in men (P Conclusions The prevalence of 2 root canals in the mandibular anterior teeth in Brazilians was approximately 20% for central and lateral incisors and 10% for canines.

This study discusses a method to determine the root canal anatomic dimension by using e-Vol DX software. The methodology consists in initially establishes the correct positions which will be measured, define the point on the edge of the anatomical structure, and next adjust the intermediate position in the grayscale of CBCT image. Afterward, thin sections (0.10 mm) are obtained from 3D reconstructed slices in the filter for the measurements, in order to determine the edge of the anatomical surface in the axial plane. A replication of positions in 3D mode is done in multiplanar reconstruction (MPR) of CBCT images, where the correct position is established with the aid of a positioning guide. The 3D density is adjusted so that it is in the same dimension as the 2D image, and a dimension calibration occurs to the point where there is a coincidence between 3D and 2D. This calibration is done only at the beginning of the measurement. Next, the intermediate position of the division between the grayscale is verified in the CBCT scan. Once one side has been completed, it is moved to the other side and follows the same guidelines described above. When setting the position of the courses in the other margin, being that 2D mode is used as reference. Thus, one obtains the required measure, being checked in the two points. The creation of this filter in the e-Vol DX software for measurement, and its appropriate management, allows more effective applications when it is desired to obtain diameters of anatomical structures. Resumo Este estudo discute um método para determinar a dimensão anatômica do canal radicular usando o software e-Vol DX. A metodologia consiste em inicialmente estabelecer as posições corretas que serão medidas, definir o ponto na borda da estrutura anatômica e ajustar a posição intermediária na escala de cinza na imagem em tomografia computadorizada de feixe cônico (TCFC). A seguir, slices finos (0,10mm) são obtidos a partir de cortes 3D reconstruídos no filtro para as medidas, a fim de determinar a borda da superfície anatômica no plano axial. Uma replicação de posições no modo 3D é feita em reconstrução multiplanar (MPR) em imagens de TCFC, onde a posição correta é estabelecida com o auxílio de um guia de posicionamento. A densidade 3D é ajustada de modo a ficar na mesma dimensão da imagem 2D, e então realiza-se uma calibração de dimensão até o ponto em que há uma coincidência entre o modo 3D e 2D. Essa calibração é feita apenas no início da medição. Posteriormente, a posição intermediária da divisão entre a escala de cinza é verificada na TCFC. Uma vez que um lado tenha sido concluído, o guia é movido para o outro lado, e segue-se as mesmas diretrizes descritas. Define-se a posição do marcador na outra margem, sendo que o modo 2D usado como referência. Assim, obtém-se a medida necessária, sendo verificado nas duas margens do canal radicular. A criação deste filtro no software e-Vol DX para medição e seu uso apropriado permite aplicações eficazes quando se deseja obter diâmetros de estruturas anatômicas.

AIM To conduct a bibliographic analysis of the research studies published in Endodontics using micro-computed tomography (micro-CT) as an analytical tool over a 25-year period. METHODOLOGY The Web of Science electronic database was accessed, and an advanced search using strict criteria was undertaken from January 1995 to June 2020 for studies in the field of Endodontics that used micro-CT as an analytical tool. A further search was conducted between January and August of 2020 for a combination of specific terms and descriptors. For each selected article, the following parameters were recorded: field of the study, analysed specimen, publication title and year, authorship, journal of publication, institution and country of origin, collaborating institutions and countries, and number of citations. The acquired data were analysed using descriptive statistics and graphical mappings. RESULTS The screening process identified 877 relevant articles that were classified into 30 thematic categories. The main fields of research were root canal preparation (23.8%), root canal anatomy (17.4%), canal filling (9.2%) and root canal retreatment (7.0%). The most productive half-decade comprised the period of 2015-2019 (n = 513; 58.5%), with the highest number of articles published in 2019 (n = 146; 16.6%). The authors who lead the list as first authors were G De-Deus, A Keles, F Paque, MA Versiani and Y Gu, respectively, whilst Versiani was the most productive (n = 51). The leading countries regarding the number of studies were Brazil, China and Turkey with 236, 130 and 65 publications, respectively. The University of Sao Paulo (n = 90; 10.3%) followed by Wuhan University (n = 37; 4.2%) and the University of Zurich (n = 18; 2.1%) were the prominent contributors by producing the largest number of articles, whilst the University of Zurich was the most-cited institution. The selected studies were published in 140 scientific journals, but the Journal of Endodontics and International Endodontic Journal accounted for almost 50% of the publications. CONCLUSION This bibliometric analysis portrayed an original and comprehensive view on the progress and trends of the use of micro-CT technology in endodontic research, and enabled a deep understanding of the development process in this field over the last 25 years.

Introduction. Incomplete understanding of the root canal system leads to endodontic failure. Missed canal was the fourth most common endodontic failure, which needed retreatment. There were a few studies on internal morphology of posterior teeth of Myanmar population. However, there was no report on root canal anatomy of anterior teeth. So, the aim of the in vitro study was to investigate root canal anatomy of Myanmar permanent mandibular incisors in Mandalay Region by the staining and clearing method. Materials and Methods. A total of 96 teeth from the tertiary hospitals and one academic department in Mandalay Region were selected according to inclusion and exclusion criteria. Then, they were cleaned, drilled, stained with Indian ink, and decalcified with 5% nitric acid for 3 days. After that, they were dehydrated with ascending concentration of ethanol (80% overnight, 90% for 1 hour, and full strength for three hours). Finally, they were clarified with 98% methyl salicylate and investigated by calibrated observer in case of Vertucci’s classification, allocation of apical foramen, and the detailed anatomy. Result. Almost 70% of the teeth had type Ι followed by 21.8% type ΙΙΙ, 4% 1-2-1-2-1 and type ΙΙ, and 1-3-2 and 2-3-1 comprised 1% each. Nearly 70% of apical foramen at central allocation of the root and 14% of detailed anatomy were seen in the sample teeth. Conclusion. Most of the sampled Myanmar teeth comprised one canal and one foramen followed by type ΙΙΙ. However, unusual anatomies, such as 1-2-1-2-1, 1-3-2, and 2-3-1, were also seen. Contrastively, proportions of central location of apical foramen and of detailed anatomy were differed from the former reports. This study summarized that 3 in 10 mandibular incisors comprised the evidence of second or third canal configuration. Three types of intercanal calcifications, fusiform, islet, and bead, were additionally explored.

A maxillary central incisor presenting with more than one root or root canal is an exceptionally rare scenario considering the fact that most of the anatomic studies describe maxillary central incisor as a single rooted tooth with single canal. However, several case reports have shown the presence of up to four canals in maxillary central incisors. The aim of this article is to present a case report of maxillary central incisor with a rare anatomic variation, i.e. Vertucci’s type V root canal anatomy. Failure to locate and clean additional root canal system may lead to post treatment disease. Hence, an astute clinician should be aware of possible anatomic variations this tooth might present with.

Mandibular incisors show variations in their root canal anatomy from regular pattern in some cases. Magnification plays a vital role to identify those unusual canal morphologies. A certain modification in access cavity preparation is required to locate those extra canals. Not only the functional restoration but also aesthetic harmony should be restored while treating anterior teeth. In these cases, post space preparation should be done with extra care to prevent vertical root fracture. This case report illustrates the importance of proper radiograph and magnification in the successful identification and management of complex canal systems in mandibular incisors.

Mandibular kanin dişlerin kök kanal sayıları ve konfigürasyonlarındaki varyasyonlar morfolojilerini araştıran çalışmalarda gösterilmiştir. Bu olgu raporunun amacı, iki köke sahip iki mandibular kanin dişin endodontik tedavisini sunmaktır. Bu olgu raporu ile başarılı bir endodontik tedavi için detaylı klinik ve radyografik incelemeyle beraber kök kanal morfolojisi ve varyasyonları hakkında yeterli bilgiye sahip olmanın önemi vurgulanmaktadır, The variations in the numbers of root canal and root canal configurations of mandibular canine teeth have shown in studies investigating morphology of these teeth. The objective of this case report is to present the endodontic treatments of two mandibular canine teeth having two roots. The importance of complete knowledge about root canal morphology and possible variations with detailed clinical and radiographic examination for successful endodontic treatment is emphasized with this case report

Mandibular premolar can present a complex pulp anatomy. Apart from the usual single root and single canal a many other variations may be seen. Hence not only a thorough knowledge of the root canal anatomy but also it’s variations are indispensable pre requisites for the success of any endodontic treatment. Good magnification and CBCT scans will definitely be beneficial for successful endodontic treatment. The present case provides evidence that mandibular premolars may have more than one canal.

To report a case of endodontic treatment of a maxillary canine in which an extra canal was located and successfully treated. Endodontic therapy is essentially a micro neurologic surgical procedure involving complete debridement and three dimensional obturation of the root canal system to obtain a fluid impervious seal. The foundation of the procedure is based on the intimate knowledge and thorough understanding of the anatomy of both the pulp chamber and the root-canal system. A tooth exhibit variations in their root canal anatomy and poses a challenge in diagnosis and treatment. In the teeth particularly with additional root canals or anatomical variations, root canals are often left untreated and that would be the main reason for unfavourable outcome of the treatment. Maxillary canine are statistically more commonly single rooted, single canal but rarely may have single root with two root canals.Journal of Universal College of Medical Sciences, Vol. 5, No. 2, 2017, Page: 53-56

An appreciation of the anatomic complexity of the root canal system is essential at every step of endodontic treatment. Endodontic treatment of teeth with unusual root canal anatomy presents a unique challenge. Eight patients underwent nonsurgical root canal treatment of 3-rooted maxillary first molars in a specialty endodontic private practice. Four cases of Weine type II and 4 cases of Weine type III canal configurations in the distobuccal root of maxillary first molars were presented.This article highlighted an uncommon anatomic variation of 2 canals in the distobuccal root of the maxillary first molar.

Ali/0000-0003-2835-767X WOS: 000419353900010 PubMed: 28846136 Aim To conduct a quantitative and qualitative analysis of the band-shaped isthmus area, the floor of which was in the apical third in the mesial roots of mandibular first molars using micro-computed tomography (micro-CT). Methodology Micro-CT images of 269 mesial roots of mandibular first molars were evaluated, and 40 specimens with a band-shaped isthmus, with a floor in the apical third, were selected. The major diameter, minor diameter, roundness, area and perimeter values for the most coronal and apical slices where the isthmus was visible were measured. The distances between these slices were measured as the isthmus length, and the total volume, structure model index and surface area of the isthmus were measured. The distances between the isthmus floor and two apical foramina and the number of root canal orifices were calculated. The dimensions of the isthmus roof and the floor were compared, and the data were analysed using descriptive statistics and Student's t-tests with a significance threshold set at 5%. Results A total of 15% of the specimens had band-shaped isthmuses with a floor in the apical third. The isthmus roof exhibited significantly greater major and minor diameter values compared to the isthmus floor (P < 0.05). No significant difference was detected between the isthmus roof and the floor with regard to roundness (P > 0.05). Conclusion Three- and two-dimensional analyses of the mesial roots of mandibular molars revealed that band-shaped isthmuses had complex shapes. Scientific and Technological Research Council of Turkey-TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [114S002] This study was supported by the Scientific and Technological Research Council of Turkey-TUBITAK (grant no. 114S002). Authors deny any conflicts of interest.

Cilj: Usporediti reznu površinu, očuvanje anatomije korijenskog kanala i neinstrumentiranu površinu nakon instrumentacije sustavima F360®, F6SkyTaper®, HyflexEDM®, iRace®, Neoniti®, O.Shape®, P.Next®, Reciproc®, Revo-S® i WaveOneGold® s veličinom instrumenta 25. Materijali i metode: Tristo zubi s jednim ravnim korijenom i okruglim ili eliptičnim presjekom korijenskog kanala podijeljeno je u 10 skupina (1-F360®, 2-F6SkyTaper®, 3-HyflexEDM®, 4-iRace®, 5-Neoniti®, 6-O Shape®, 7-P.Next®, 8-Reciproc®, 9-Revo-S® i 10-WaveOneGold®) i poprečno prerezano na trećine ultrafinim reznim diskovima. Uzorci su fotografirani pod stereomikroskopom i provedena je predinstrumentacijska analiza prije ponovnog spajanja zuba K-instrumentom #10 i epoksi smolom. Ručno je uspostavljena prohodnost K-instrumentima #10 i #15 te je svaka skupina instrumentirana jednim od rotacijskih ili recipročnih sustava. Rezna površina, očuvanje anatomije korijenskog kanala i neinstrumenirana površina analizirani su s pomoću AutoCAD-a 2015. Za statističku analizu korišteni su Leveneov test, Welchov test, Games-Howellsov test i Pearsonov hi-kvadrat test. Rezultati: Leveneov test nije pokazao jednakost varijacije (P < 0,05), pa su primijenjeni Welchov i Games-Howellov test u analizi rezne površine, pokazujući statistički značajne razlike za sve trećine i ukupno (P < 0,05). Nisu zabilježene razlike u očuvanju anatomije korijenskog kanala (P > 0,05). Što se tiče neinstrumentirane površine, pronađene su statistički značajne razlike (P < 0,05), pri čemu su u srednjoj trećini bili bolji Reciproc®, Neoniti® i WaveOneGold®, a u apikalnoj trećini P.Next®, Reciproc®, HyflexEDM®, Neoniti® i WaveOneGold®. Zaključci: Što se tiče rezne površine, P.Next® i Reciproc® bili su bolji u koronarnoj trećini, Neoniti® i HyflexEDM® u sredini i apikalno, a sveukupno Neoniti® i Reciproc®. Što se tiče očuvanja anatomije korijenskog kanala, svi su sustavi bili slični. S obzirom na neinstrumentiranu površinu, svi su sustavi postigli slične rezultate koronarno, ali Reciproc®, Neoniti® i WaveOneGold® bili su bolji u srednjoj trećini te P.Next®, Reciproc®, HyflexEDM®, Neoniti® i WaveOneGold® apikalno., Objective: The aim of this study was to compare the cutting are, root canal anatomy preservation and non-instrumented areas of F360®, F6-SkyTaper®, Hyflex-EDM®, iRACE®, Neoniti®, O.Shape®, P.Next®, Reciproc®, Revo-S® and Wave-One-Gold® size 25 files. Materials and Methods: 300 teeth with a single straight root and a circular or elliptical root canal were divided into 10 groups (1-F360®, 2- F6-SkyTaper®, 3-Hyflex-EDM®, 4-iRACE®, 5-Neoniti®, 6-O.Shape®, 7-P.Next®, 8-Reciproc®, 9-Revo-S® and 10-Wave-One-Gold®) cut into 3 cross sections using an ultrafine cutting disc. They were photographed under a stereo microscope and preinstrumentation analyses were made before rebuilding the teeth with# 10 K- File and epoxy glue. A glide path was created with #10 and #15 K files and each group was instrumented using rotary or reciprocating systems. Cutting areas, root canal anatomy preservation and non-instrumented areas were analyzed using the AutoCAD 2015 Levene’s test, the Welch´s test, and the Games-Howell´s test. The Pearson’s chi-squared test was used for statistical analysis. Results: Levene’s test showed no equality of variances (P0.05). In non-instrumented areas, significant differences were found (P

Lateral and apical ramifications of the main root canal create potential pathways through which bacteria can spread and remain unaffected by treatment procedures. It is a challenge for the specialty to find techniques that can predictably reach, disinfect, and obturate these ramifications. Here, we report the use of a novel instrumentation approach to aid in the negotiation and management of a lateral canal discernible on cone-beam computed tomography (CBCT) in an unusual maxillary central incisor. A 23-year-old female patient was referred for evaluation and possible treatment of tooth 9. The periapical radiographic examination revealed pulp chamber obliteration, existence of a lateral lesion, and a possible complex internal root canal anatomy. The CBCT evaluation revealed the existence of a lateral lesion, a periapical lesion, an additional distopalatal canal, and a lateral canal exiting at the lateral lesion. The diagnosis of asymptomatic apical and lateral periodontitis of tooth 9 was reached. CBCT-aided access cavity preparation and scouting resulted in the successful negotiation of all canals, main and lateral. A novel instrumentation technique with precurved controlled memory files was used for the mechanical preparation of the lateral canal to a 25/04 enlargement. Obturaton of the lateral canal was achieved with a single gutta-percha cone and AH Plus Root Canal Sealer. At the 2-year follow-up, the patient was asymptomatic, and the 2-dimensional radiographic examinations revealed resolution of both the periapical and the lateral lesions. This case report describes the application of a novel instrumentation technique for the mechanical debridement of an infected lateral canal discernible on CBCT and reinforces the importance of treating the root canals as systems that possesses anatomic intricacies that need to be addressed.

Maxillary lateral incisors classically has configuration of one root with one canal. However, variation in anatomy and morphology is not an exception. Radiographs from different angulations specially mesial and distal are critical in such cases of atypical root canal anatomy, although more precision can be expected with operating microscope and cone-beam computerized tomography (CBCT). Meticulous knowledge and careful diagnosis of canal configurations, developmental anomalies and careful pretreatment assessment of radiographs is essential. This case report enlightens the need for consideration during endodontic management of maxillary lateral incisors. Keywords: Maxillary lateral incisor, Two canals, Endodontic management.

The endodontic failure is usually due to the failure in recognizing the variations in root and its root canal anatomy. Hence, it is important to have a detailed knowledge of commonest possible aberrations and anamolies of the tooth being treated. Mandibular premolar is considered as “Endodontist Enigma” due its unpredictable root canal anatomy which often complicates the endodontic treatment. The present case report i.e mandibular first premolar with two roots highlights the importance of sound knowledge of root canal anatomy and the importance of dental operating microscope in treating such complex cases.

Knowledge of root canal anatomy and morphology is one of the significant elements for the successful result of endodontic therapy. Absence of knowledge relating to internal anatomy will lead to mistakes like access, localization of canals, cleaning and shaping and obturation of the root canal. Slowey expressed that root canal morphology has boundless variations and clinicians ought to consistently know that anatomic variations contribute a great challenge to the successful finishing of endodontic treatment.