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Persistent pain after endodontic treatment is often associated with evidence of periapical pathology. Nonetheless, this case report presents two instances of persistent pain in maxillary premolars post root canal treatment (RCT), without evident periapical radiolucency on imaging. A 35-year-old Asian female experienced dull, aching pain on biting in tooth #25, whereas a 40-year-old Caucasian female reported similar symptoms in tooth #15. Both teeth showed tenderness to percussion but not palpation. Periapical radiographs and cone-beam computed tomography (CBCT) scans revealed completed RCT with apical transportation but no detectable periapical pathology. Thus, both teeth were diagnosed as previously treated with symptomatic apical periodontitis. Non-surgical retreatment successfully addressed untreated canal spaces, resolving symptoms. This report suggested persistent pain following RCT might stem from endodontic reasons, even in the absence of visible apical pathology on CBCT scans, highlighting the importance of thorough canal debridement to resolve symptoms associated with untreated canal spaces in apical transportation. Furthermore, this case report demonstrates that clinicians should make a diagnosis through thorough dental history and other clinical investigations, without relying solely on CBCT for the diagnosis of posttreatment endodontic pain. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the agreement between six currently available periapical radiography‐based methods for measuring the root canal curvatures in mesial roots of mandibular first molars, assessed by two examiners with different proficiency levels. Methodology: Non‐endodontically treated mesial roots of 41 human mandibular first molars were radiographed using the parallelling technique. Two independent observers (a specialist in endodontics and radiology and a final‐year dental student) assessed their root canal curvature using the methodologies described by Schneider (1971, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 32, 271), Weine (1982, Endodontic therapy), Berbert and Nishiyama (1994, Revista Gaúcha de Odontología, 356), Luiten et al. (1995, Journal of Endodontics, 21, 26), Hankins and ElDeeb (1996, Journal of Endodontics, 22, 123) and Pettiette et al. (1999, Journal of Endodontics, 25, 230). Intra‐ and inter‐examiner reliability was assessed using the intraclass correlation coefficient. The differences in curvature angle measured by the different methods were compared using the one‐way anova for repeated measures test, followed by Tukey's post hoc analysis. The effect was calculated using the Cohen's d method. To determine the agreement between methods, the Bland–Altman analysis was used. The significance level was set at 5%. Results: Agreement for the observers was excellent (>0.81) for the six methods considered. For the angle comparisons between methods, the maximum differences were for Schneider versus Weine (35.77°) and Luiten versus Hankins (35.14°), whilst the highest percentage of angles with a difference >10° were Weine versus Luiten and Berbert versus Pettiette (90%) and the comparison Weine versus Hankins presented with the lowest frequency (15%). Excellent agreement was found for five comparisons: Weine versus Luiten (0.940), Berbert versus Pettiette (0.917), Weine versus Pettiette (0.907), Luiten versus Pettiette (0.904) and Berbert versus Luiten (0.812). Compared to Schneider's method, the other methods showed a tendency of increasing difference as the angles became more acute. The other methods exhibited linear differences, remaining constant for smaller and larger angles. Conclusions: Reliability was excellent for all methods assessed separately. Maximum differences in curvature angles were found when comparing Schneider versus Weine and Luiten versus Hankins. Excellent agreement was found for Weine versus Luiten, Berbert versus Pettiette, Weine versus Pettiette, Luiten versus Pettiette and Berbert versus Luiten. In the presence of dilacerations, the method by Schneider was less sensitive. [ABSTRACT FROM AUTHOR]

Background: A comprehensive understanding of the root form and canal anatomy is essential for successful endodontic treatment. This study aimed to evaluate the root canal anatomy of mandibular premolars in the Pakistani population using cone beam computed tomography (CBCT) and to classify the findings with the new classification proposed by Ahmed et al. Methods: Ethical exemption was obtained from Aga Khan University Hospital, Karachi. A total of 707 CBCT scans from Karachi and Lahore were included, comprising 592 scans from a tertiary care hospital in Karachi and 115 scans from a radiology center in Lahore. The study focused on sound, fully formed mandibular first and second premolars, excluding those with significant caries, restorations, or prior root canal treatments. Scans from different equipment were used, and calibration was achieved between a specialist endodontist and two dental residents. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 26. Descriptive statistics, Chi-square tests to determine association between the variables, and a significance level set at 5% (p <0.05) were utilized. Results: A total of 2403 mandibular premolars were analyzed. The most common configuration was 1MPM1 (82.90%), with rare variations such as 1MPM1−3–1 (0.04%) and 2MPM1 B1 L2 (0.04%). Single-rooted premolars were predominant (98.87%), and no significant differences were observed when data was stratified by age or gender. Conclusions: This is the first study in Pakistan involving multiple centers and using the classification system by Ahmed et al. to understand the anatomy of mandibular premolars. The findings indicate that while most premolars have a single root and canal, variations exist. These variations highlight the importance of understanding canal morphology for improving the success of endodontic treatment. Future studies should include a larger and more diverse dataset to fully represent the Pakistani population. [ABSTRACT FROM AUTHOR]

Abstract Background A comprehensive understanding of the root form and canal anatomy is essential for successful endodontic treatment. This study aimed to evaluate the root canal anatomy of mandibular premolars in the Pakistani population using cone beam computed tomography (CBCT) and to classify the findings with the new classification proposed by Ahmed et al. Methods Ethical exemption was obtained from Aga Khan University Hospital, Karachi. A total of 707 CBCT scans from Karachi and Lahore were included, comprising 592 scans from a tertiary care hospital in Karachi and 115 scans from a radiology center in Lahore. The study focused on sound, fully formed mandibular first and second premolars, excluding those with significant caries, restorations, or prior root canal treatments. Scans from different equipment were used, and calibration was achieved between a specialist endodontist and two dental residents. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 26. Descriptive statistics, Chi-square tests to determine association between the variables, and a significance level set at 5% (p

Background: Knowledge of the anatomy and morphology of root canal orifices and variations are vital elements affecting treatment outcomes. Aim: The objective of this study was to evaluate variations in the number of root canal orifices and their patterns in primary teeth, as identified by both the naked eye and under magnifying loupes. Materials and methods: Total of 173 primary teeth was scheduled for pulpectomy over a period of 18 months. Two examiners assessed the number and pattern of the root canal orifices. After access cavity preparation, the operator recorded the number of root canal orifices with naked eye, and examiner recorded the same using magnifying loupes (3.5×). After cleaning and shaping, the same protocol was used. Collected data were statistically analyzed using SPSS version 23.0 and compared using a paired t-test. Results: The overall variation in the in the identification of root canal orifices between the naked eye and magnifying loupes (3.005 ± 0.971) was statistically significant after access cavity preparation (P ≤ 0.05). Conclusion: Magnifying loupes significantly enhances the determination of the number and pattern of root canal orifices in primary teeth. Therefore, the application of magnifying loupes is essential for accurately assessing variations in root canal orifices in primary dentition.

Large-scale clinical studies on the incidence of middle mesial canals (MMCs) in nonsurgical root canal treatment (RCT) and retreatment of mandibular molars are lacking. The primary aim of this observational study was to determine the incidence of MMCs in mandibular first and second molars that received RCT or nonsurgical retreatment (NSRetx). The secondary aim was to determine factors associated with incidence of MMCs. Included were 3018 mandibular molars that received RCT (n = 1624) or NSRetx (n = 1394) by 3 endodontists in a private practice. Demographic and procedural data were collected. Bivariate and multivariable (Poisson regression model) analyses were performed. Incidence of MMCs was 8.8% (n = 267). Although the bivariate analysis showed that NSRetx was significantly associated with incidence of MMCs, this association did not reach the threshold for statistical significance after controlling for all covariates (P =.07). Multivariable analysis on the entire cohort showed that incidence of MMCs was significantly associated with younger age (risk ratio [RR] = 1.62; 95% confidence interval [CI], 1.28–2.06), male gender (RR = 1.48; 95% CI, 1.18–1.85), preoperative cone-beam computed tomography (CBCT) (RR = 1.48; 95% CI, 1.17–1.89), and first molar (RR = 2.30; 95% CI:1.74–3.05). Subgroup multivariable analyses revealed that incidence of MMCs was associated with male gender only in the RCT group (RR = 2.26; 95% CI, 1.55–3.30) but not in the NSRetx group (RR = 1.11; 95% CI, 0.82, 1.50); and with preoperative CBCT only in the NSRetx group (RR = 1.78; 95% CI, 1.28, 2.50) but not in the RCT group (RR = 1.10; 95% CI, 0.71, 1.69). Associations with younger age and first molar remained unchanged. Overall incidence of MMCs was 8.8%. Incidence of MMCs was significantly higher in younger patients and in mandibular first molars but was not associated with the type of treatment. [ABSTRACT FROM AUTHOR]

Variations in the root canal anatomy of a maxillary first molar are often challenging to diagnose and treat; thus, clinicians must have a thorough knowledge of the same. This case report highlights the successful nonsurgical endodontic management of a maxillary first molar with an unusual morphology of three roots and six root canals. A total of six root canals (mesiobuccal [MB] 1, MB2, MB3, distobuccal [DB] 1, DB2, and palatal) were detected after initiating root canal therapy and access cavity preparation. Conventional root canal treatment was completed, and postoperative cone-beam computed tomography scanning was done to verify the total number of canals and ensure the adequacy of root canal fillings. Managing such cases with rare variations in the root canal systems could be arduous and thus, clinicians should be well-versed in the methods to identify and manage such complexities to facilitate the successful outcomes of endodontic treatment. [ABSTRACT FROM AUTHOR]

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). Conclusion 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. [ABSTRACT FROM AUTHOR]

Objectives: 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. Materials and methods: 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 root canal anatomy according to Vertucci classification, and for the presence of lateral canals and apical deltas, in both mesial and distal roots. Results: Both methods revealed a higher prevalence of Vertucci Type II and IV in the mesial root, and Vertucci Type I in the distal root. The percentage of agreement for main root canal anatomy classification between CBCT and micro-CT scores was high (85.2%). Conclusion: Sensibility to detect both lateral canals and apical deltas with CBCT was low. These results attest to the fact that minor anatomical changes might be difficult to identify with CBCT imaging, hampering its diagnostic value. [ABSTRACT FROM AUTHOR]

Abstract This study aimed to compare the quality of root canal obturation (ratio of area occupied by gutta-percha (G), sealer (S), and presence of voids (V)) in different anatomical irregularities (intercanal communications, lateral irregularities, and accessory canals) located at different thirds of the root canal system of mandibular molar replicas. Sixty-seven 3D printed replicas of an accessed mandibular molar were prepared using ProGlider and ProTaper Gold rotatory systems. Three specimens were randomly selected to be used as controls and did not receive further treatment. The rest were randomly distributed in 4 experimental groups to be obturated using either cold lateral compaction (LC), continuous wave of condensation (CW), and core-carrier obturation (ThermafilPlus (TH) or GuttaCore (GC)) (n=16 per group). AHPlus® sealer was used in all groups. The three controls and a specimen from each experimental group were scanned using micro-computed tomography. The rest of the replicas were sectioned at the sites of anatomical irregularities and examined at 30× magnification. The G, S, and V ratios were calculated dividing the area occupied with each element by the total root canal area and then compared among groups using the Kruskal-Wallis test. Voids were present in all obturation techniques with ratios from 0.01 to 0.15. CW obtained a significantly higher G ratio in the irregularity located in the coronal third (0.882) than LC (0.681), TH (0.773), and GC (0.801) (p

It is difficult to predict the outcomes of non-surgical root canal treatment (NSRCT) for mandibular second premolars with multiple root canals. In these teeth, the complicated anatomy with fin(s), or a C-shape, and possible secondary canal(s) varies unpredictably. The morphology of the root canals provides shelters for bacteria to remain, regrow, and form biofilms despite the endodontic treatment. Moreover, the prevalence of mandibular second premolars with multiple canals is extremely infrequent. Therefore, the clinical management of NSRCT in such cases is not sufficiently reported. This case report introduces two cases of NSRCT for mandibular second premolars with a radicular groove and also presents the appropriate clinical strategies and techniques. Cone-beam computed tomography (CBCT) imaging was used preoperatively. After the completion of NSRCT, CBCT was reused to review the completed procedures using the Nerve Canal tool in CS 3D Imaging v3.2.9 and v3.8.7. Five canals were obturated in case 1, and four canals in case 2 along with a C-shape morphology. Analyzing the configuration of the root canals by CBCT was critical to achieve successful NSRCT because the numbers, exits, configurations, and volumes of the secondary canals were not anticipated after reviewing 2D radiographs. Based on the interpretation, the advanced protocols of NSRCT were planned: first, augmentation of chemo-mechanical cleaning, but minimizing the loss of dentine; second, the tactile examination to locate and negotiate the orifices of the secondary canals; and lastly, the optimized plan and technique for root canal filling of the complex canal systems.

Background & Objective: Successful root canal therapy requires knowledge of the anatomy of the root canal system and complete clearance. Given the possibility of a second canal in mandibular incisors, it is important to find and completely debride this canal Therefore, in this study, we investigated the anatomy of the root canal of mandibular incisor teeth using CBCT.Material & Methods: In this descriptive analytical and cross-sectional study, CBCT images were evaluated from three sagittal dimensions (number of roots, channel type, apical foramen deviation from radiographic apex), coronal (apical foramen deviation from radiographic apex) and axial (channel type). Data were analyzed in SPSS software (Version 2016) through descriptive statistics using frequency distribution and Chi-square test. cases less than 0.05 were considered significant. Results: In this study, 606 mandibular incisor teeth were examined. The mean deviation of apical foramen from radiographic apex was 0.431 ± 0.296 mm. Only 1 double-rooted tooth was observed. 34.5% of the teeth were double-channel and 65.5% were single-channel. Class 1 and 3 Vertucci morphology was the most common and other classes included about 1.5% of the samples.Conclusion: According to the results, mandibular incisors in females and males are more single rooted and have a single canal. Regarding the Vertucci classification, the most prevalent type was type I.

A novel system to classify root and canal morphology was recently introduced (Ahmed et al. 2017). This systematic review aimed to answer the following research question: Does the Ahmed et al. system provide a more accurate and practical classification of root and canal anatomy compared to other classifications? A literature search was conducted in Google Scholar, Scopus and Wiley Online Library to identify the citation counts for the article entitled 'A new system for classifying root and root canal morphology; doi.org/10.1111/iej.12685'. After removal of duplicates and unrelated articles, 15 studies were included and analysed. All studies compared the Ahmed et al. system with the Vertucci classification. Results revealed that both systems were able to classify simple canal configurations in single‐rooted anterior and premolar teeth, disto‐buccal and palatal roots of maxillary molars. However, the Ahmed et al. system provided more accurate and comprehensive categorisations of single‐rooted teeth with complex canal anatomy, multi‐rooted maxillary and mandibular premolars and the mesio‐buccal root of maxillary molars. Further evidence on the utility of the Ahmed et al. system is required using other diagnostic devices especially in molars. [ABSTRACT FROM AUTHOR]

Objectives: This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures. Methods: This narrative review was undertaken to address two main questions – why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures. Results: Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up. Conclusions: Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups. Clinical relevance: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots. [ABSTRACT FROM AUTHOR]

Background and Objectives: An understanding of the anatomical complexity of teeth is a significant factor for a successful endodontic treatment outcome. The aim of this study was to explore the frequency and pattern of distribution of radix entomolaris (RE) in mandibular first molars (MFMs) of a Saudi Arabian subpopulation using CBCT scans. Materials and Methods: This study was conducted at dental clinics of Qassim University from February to May 2023 by evaluating CBCT scans that were previously obtained for diagnostic purposes. Scans of Saudi national patients with bilaterally present MFMs and fully formed root apices were included. Conversely, scans with one/or two missing MFMs, MFMs with incomplete root apices, full- or partial-coverage prosthesis, endodontic treatment, and associated radicular resorption were excluded from study. A total of 303 CBCT scans with 606 bilateral MFMs were analyzed by two calibrated evaluators for the presence of, and type according to Song's typolgy of RE. The data were analyzed using SPPS-24. The descriptive variables were documented as frequencies and percentages. The chi-square test was used to determine the association between the prevalence of RE with the gender, jaw side and age group. Both inter-rater and intra-rater agreements were estimated for detecting and classifying RE using Cohen's kappa test. Results: The sample had 63.7% males and 36.3% females. The prevalence of RE was 6.6%, with Song's type III (57.5%) as the most common variant. Absolute agreement was noted between the raters about the presence of RE and very strong agreement was noted for the classification of the RE. Conclusions: RE is an uncommon finding among the mandibular first molars of the Saudi population without any gender and quadrant predilection. The clinicians' knowledge of the presence and Song's type of RE may contribute towards the enhancement of endodontic treatment outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground In recent years, with advancements in science and technology, artificial intelligence (AI) has been gaining more relevance in the field of dentistry in general, as well as endodontics. AI-guided algorithms have a great potential to better diagnose, treatment plan, and execute endodontic treatments, as well as outcome prediction of the various endodontic treatments. A review of literature was conducted to assess the application of AI in the field of endodontics.Results AI has been used in a variety of clinical applications including the assessment of root canal anatomy, working length, presence of root fractures, and outcome prediction.Conclusion Within the field of endodontics, AI has already been proven to be useful. The evolution of this technology and its continuous application can positively impact the field of endodontics and assist in preserving the natural dentition. Clinical implications: AI is currently being used for specific endodontic applications and possible potential applications in the future horizon.

The aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide. CBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/no) was identified and recorded. Six thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P <.05). The prevalence of DLC ranged from 3% to 50%, and the overall prevalence was 22% (95% CI: 15%–29%). RE prevalence ranged from 0% to 12%, and the overall prevalence was 3% (95% CI: 2%–5%). There were no significant differences between left and right M1Ms or between genders for either DLC or RE (P >.05). The overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to determine the prevalence of the second mesiobuccal canal in permanent maxillary second molar in patients presenting to Peshawar Dental College and Hospital. Methods: One hundred and twenty patients advised for root canal treatment in the maxillary second molars participated in the study. Two detection procedures, clinical and radio graphical examination were used. Two pre-operative radiographs with different angulations and one post-operative radiograph were taken to examine roots and root canals. Access cavities were prepared and the second mesiobuccal canal was explored using magnifying dental loupes (3.5 x), endodontic explorer (DG16) and size 10 K-file. Descriptive statistics were recorded as percentages, frequencies and mean. The chi-square test was used for gender, age-wise comparison and right and left side of the maxillary jaw. Results: One hundred and twenty patients were recruited in the study. There were 65 (54.2%) males and 55 (45.8%) females. The second mesiobuccal canal was more common in males compared to females (p-value=0.434). The second mesiobuccal canal was most commonly found in 3rd decade with mean age, of 40.5±12.31, (p-value =0.51). The frequencies and percentages of the second mesiobuccal canal in maxillary second molars on the right and left side of the jaw were 70 (58.3%) and 50 (41.7%) respectively (p-value =0.310). Conclusion: The second mesiobuccal canal was found in less than half of the second molars. The most successful method of detection in this study was both clinical and radiographic. [ABSTRACT FROM AUTHOR]

Introduction and aim. One of the imperative reasons for endodontic failure is an extra or missed root and root canals. Permanent mandibular lateral incisors generally present as monoradicular tooth with one or two canals, but aberrancies in the form of extra root are also rarely seen. There is insufficiency in the literary work regarding the presence of an extra root in permanent mandibular lateral incisor. We hereby report two illustrious cases of biradicular permanent mandibular lateral incisors and their endodontic management and brief review regarding the case reports published so far regarding the existence of an extra root in permanent mandibular lateral incisor in the literature. Also, we intend to apprise the scientific documentation with the aforementioned. Description of the cases. Case 1. A twenty-two-year-old male patient of Indian origin was referred to endodontic clinic for intentional root canal therapy. Pre-operative radiograph revealed 32 exhibited aberrancy in the form of an extra root, with normal periodontal structures and bone architecture. Case 2. A sixty-two-year-old male patient came to the Department of Conservative Dentistry and Endodontics with the chief complaint of pain in the lower anterior tooth region. Radiographic examination revealed root caries on the mesial side and two roots with two canals with bifurcation at the level of middle third of root. Conclusion. Clinicians should be well prepared in advance for management of any anatomical aberrancy in their clinical practice by having a scrupulous knowledge of root canal system. [ABSTRACT FROM AUTHOR]

Background: The design of minimally invasive access has become a hotspot. This study aimed to evaluate the coronal root canal morphology of permanent maxillary first molars to facilitate the design of endodontic access cavities for minimally invasive linear access. Materials and methods: A selection of 91 permanent maxillary first molars was evaluated. Three-dimensional tooth models were reconstructed using micro-computed tomography data. Root canal prevalence and coronal root canal landmarks were recorded. The positional coordinates of landmarks in the horizontal plane and the angles and directions of coronal root canal curvature in the horizontal and axial planes were also assessed. Results: The detection rates of the mesiobuccal (MB), distobuccal (DB), and palatal (P) canals were 100%, whereas that of the second mesiobuccal (MB2) canals was 68.1%. All landmarks were located near the central fossa. In the axial plane, the average angles of coronal root canal curvature were DB (27.05°) > MB (25.43°) > P (20.71°) in teeth with three canals, and MB2 (33.20°) > MB (29.61°) > DB (28.40°) > P (23.69°) in teeth with four canals. In the horizontal plane, the average angles were P (78.15°) > DB (42.34°) > MB (32.41°) in teeth with three canals, and P (81.26°) > DB (43.44°) > MB (41.22°) > MB2 (9.41°) in teeth with four canals. Conclusion: In maxillary first molars, coronal root canals tend to converge towards the occlusal surface. The results of this study could be applied to improve the precision of endodontic access cavity designs of minimally invasive access.

Missed canals pose a potential risk in the treatment of teeth with anatomical variations, even when multi-angled radiographs have been used. Incomplete mechanical and chemical debridement of the root canal system can lead to treatment failure. Therefore, clinicians must have adequate knowledge of normal root canal systems as well as any possible variations in order to prevent any failure during or after the treatment of teeth with anatomical variations. Any case report of such rare variations would add to this critically required body of knowledge. The current case report presents the diagnosis and endodontic treatment of a maxillary first premolar with one root and three canals (one palatal and two buccal canals, all buccolingually positioned, bifurcating in the apical region), which was different from premolars with 3 canals reported up to now. This configuration describes an unusual root canal system for the maxillary first premolar and does not fit into any of the well-known root canal classification systems.

This meta-analysis sought to identify the in vivo prevalence and influencing factors of middle mesial canal (MMC) in mandibular first and second molars based on cone-beam computed tomography (CBCT) scans. MEDLINE/PubMed, Web of Science, Scopus, SciELO, Google Scholar databases/search engines were searched in period between 15th and 21st November 2022, to retrieve the in vivo CBCT-based studies that assessed the prevalence of MMC in mandibular first and/or second molars. The studies were strictly assessed using predefined inclusion and exclusion criteria for relevancy and eligibility through screening the title and abstract, and then assessed through reading the full texts using the same criteria. Subsequently, the fulfilled studies were assessed qualitatively using the Newcastle-Ottawa Quality Assessment Scale, and quantitatively using meta-analysis to calculate the pooled prevalence rates of MMC. The publication bias was assessed using funnel plot and Egger's test. Out of 1122 studies, 33 studies comprised of 13,349 and 7624 mandibular first and second molars, respectively, were eligible for inclusion. Twenty studies scored high quality, while 13 scored moderate quality. The global prevalence of MMC in the first molar was 4.4% (95% CI = 0.035–0.053, P <.001), significantly higher than that of the second molar which was 1.3% (95%, CI = 0.008–0.018, P <.001). Gender, molar side, and age were not influencing factors of MMC prevalence. The prevalence of MMC is not uncommon, being higher in the mandibular first molar compared to the mandibular second molar. The prevalence of MMC is not influenced by age, molar's side, and gender. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to determine and compare the dentine thickness around the root canals of maxillary molars with fusion using micro‐computed tomography (micro‐CT). Methodology: A total of 120 fused maxillary molars having more than a single canal with distinct canal orifices near the cementoenamel junction were selected from a pool of extracted maxillary molars, which were scanned on a micro‐CT device (SkyScan 1172, Bruker‐microCT). The minimum dentine thickness around the root canals in furcal direction was measured using CTAn software (v.1.18.8 Bruker‐microCT) at each millimetre. The specimens were grouped according to their fusion type, and dentine thickness around the canals was compared. The data were statistically analysed using anova and post hoc Tukey–Kramer tests following an assessment of the normality of their distribution with the Kolmogorov–Smirnov test (p <.05). Results: Dentine thickness showed a statistically significant decrease at 2 mm apical to the orifice level irrespective of fusion type. The minimum dentine thickness values were detected around the second mesiobuccal canal as 0.30 mm at 6 mm below orifice. Dentine thickness around the mesiobuccal canal was significantly greater in fusion type 1 than those of types 2 and 3 (p <.05), while those of distobuccal and palatal canals were significantly thinner in type 3 fusion compared with type 1 or 6 (pDentine thickness showed a statistically significant decrease at 2 mm apical to the orifice level irrespective of fusion type. The minimum dentine thickness values were detected around the second mesiobuccal canal as 0.30 mm at 6 mm below orifice. Dentine thickness around the mesiobuccal canal was significantly greater in fusion type 1 than those of types 2 and 3 (Conclusion: Minimum dentine thickness values at the danger zone of distobuccal and palatal canals change according to the fusion type in fused maxillary second molars. [ABSTRACT FROM AUTHOR]

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.

The design of minimally invasive access has become a hotspot. This study aimed to evaluate the coronal root canal morphology of permanent maxillary first molars to facilitate the design of endodontic access cavities for minimally invasive linear access. A selection of 91 permanent maxillary first molars was evaluated. Three-dimensional tooth models were reconstructed using micro-computed tomography data. Root canal prevalence and coronal root canal landmarks were recorded. The positional coordinates of landmarks in the horizontal plane and the angles and directions of coronal root canal curvature in the horizontal and axial planes were also assessed. The detection rates of the mesiobuccal (MB), distobuccal (DB), and palatal (P) canals were 100%, whereas that of the second mesiobuccal (MB2) canals was 68.1%. All landmarks were located near the central fossa. In the axial plane, the average angles of coronal root canal curvature were DB (27.05°) > MB (25.43°) > P (20.71°) in teeth with three canals, and MB2 (33.20°) > MB (29.61°) > DB (28.40°) > P (23.69°) in teeth with four canals. In the horizontal plane, the average angles were P (78.15°) > DB (42.34°) > MB (32.41°) in teeth with three canals, and P (81.26°) > DB (43.44°) > MB (41.22°) > MB2 (9.41°) in teeth with four canals. In maxillary first molars, coronal root canals tend to converge towards the occlusal surface. The results of this study could be applied to improve the precision of endodontic access cavity designs of minimally invasive access. [ABSTRACT FROM AUTHOR]

Introduction: Pulp therapy procedures especially pulpectomy, aids in retaining the teeth in oral cavity. The complex morphology and pulp-periodontal intricacies insists the need for the understanding of internal pulp canal morphology to treat the primary teeth with dental caries and dental trauma which aids for efficient endodontic therapy. Aim: To explore the root canal morphology of primary mandibular first molar in different ethnic population based on different diagnostic aids used. Materials and Methods: Present systematic review was registered in PROSPERO database and was carried out from August 2021 till October 2021 including data from January 1970 to May 2021 by following PRISMA guidelines. Four electronic databases (Web of Science, Pub Med, Scopus, and Cochrane) were searched. In-vivo, in-vitro studies, comparative and evaluative studies have been included and studies mentioning anamolies, accessory canals and case reports all were excluded. Quality assessment was done by using Anatomical Quality Assessment tool (AQUA). Results: Out of 215 studies, nine studies were retrieved and those investigated root canal morphology of primary mandibular first molar was included. Most predominantly two rooted primary mandibular first molar (99.9%) with four canals (81.25%) of straight morphology (>90% even 100% in few studies) showing root length of 6.4 to 9.4 mm exhibiting vertuccis type of I and IV were reported to be prevalent. Conclusion: Inspite of varying ethnicity most predominantly two rooted primary mandibular first molar with four canals of straight anatomy seems to be prevalent be prevalent in all the included diagnostic techniques. [ABSTRACT FROM AUTHOR]

Abstract 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.

Purpose: The prevalence of the middle distal (MD) canal in the mandibular molar is significantly low among countries including the USA, Spain, Turkey, and Jordan; however, analysis of its prevalence and configuration has not been performed in Saudi Arabia. Therefore, we aimed to assess the prevalence and configuration of the MD canal in Saudi Arabia. Methods: A retrospective analysis of 132 cone-beam computed tomography (CBCT) images was performed to evaluate the presence of the MD canal in patients visiting the Radiology Department of The College of Dentistry in King Saud University between July 2018 and July 2019. The canal was examined if it was confluent with the distobuccal (DB) or distolingual (DL) canals, fin, or independent. Moreover, the distances from the MD canal to the DL and DB canals and cementoenamel junction (CEJ) were recorded. Results: One MD canal (0.7%) was observed in 145 teeth. It was confluent with the DL canal. No statistical significance was observed among sex and age. The distances from the MD canal to the DL canal, DB canal, and CEJ were 1.4 mm, 1.9 mm, and 3.1 mm, respectively. Conclusions: The prevalence of the MD canal was significantly low in a Saudi subpopulation (0.7%). Careful evaluation of CBCT images and the pulpal floor is significantly important to detect the MD canal to ensure a good prognosis.

Objectives: The aim of this study was to investigate the root anatomy of the maxillary and mandibular premolars among a sample of the Lebanese population and to explore their incidence by sex and the symmetry between the left and right sides. Materials and Methods: This retrospective analysis of 250 cone-beam computed tomography (CBCT) scans consisted of 960 maxillary and 972 mandibular premolars. Roots, canals, and morphology types were recorded. Vertucci's classification was used to categorize the canal morphologies. Fisher's exact and chi-square tests were applied (P≤.05). Results: The majority of maxillary first premolars had two roots (85.3%) with two canals (91.3%). Most of the maxillary second premolars showed one root (79.8%). Two-root canals (53.55%) were more common than one canal (44.2%). The three-root, three-canal morphology was rarely spotted in the maxillary first (0.4%) and second premolars (2.3%). The one-root (99.2%) and one-canal (84.5%) morphologies were most frequently located in the mandibular first and second premolars (100%, 88.6%), and two canals being less common (15.5%, 11.4%) correct same as before. The total prevalence of premolars with a complex root canal morphology was 62.4%, found in types II, III, and V to VIII. Men had significantly more roots and root canals in their maxillary first premolars than women (P≤.05). No significant differences were observed between the contralateral premolars (P>.05). Conclusions: Premolars displayed wide variations in root and root canal morphology and symmetry between the contralateral premolars. [ABSTRACT FROM AUTHOR]

Background: In recent years, with advancements in science and technology, artificial intelligence (AI) has been gaining more relevance in the field of dentistry in general, as well as endodontics. AI-guided algorithms have a great potential to better diagnose, treatment plan, and execute endodontic treatments, as well as outcome prediction of the various endodontic treatments. A review of literature was conducted to assess the application of AI in the field of endodontics. Results: AI has been used in a variety of clinical applications including the assessment of root canal anatomy, working length, presence of root fractures, and outcome prediction. Conclusion: Within the field of endodontics, AI has already been proven to be useful. The evolution of this technology and its continuous application can positively impact the field of endodontics and assist in preserving the natural dentition. Clinical implications: AI is currently being used for specific endodontic applications and possible potential applications in the future horizon. [ABSTRACT FROM AUTHOR]

Missed canals pose a potential risk in the treatment of teeth with anatomical variations, even when multi-angled radiographs have been used. Incomplete mechanical and chemical debridement of the root canal system can lead to treatment failure. Therefore, clinicians must have adequate knowledge of normal root canal systems as well as any possible variations in order to prevent any failure during or after the treatment of teeth with anatomical variations. Any case report of such rare variations would add to this critically required body of knowledge. The current case report presents the diagnosis and endodontic treatment of a maxillary first premolar with one root and three canals (one palatal and two buccal canals, all buccolingually positioned, bifurcating in the apical region), which was different from premolars with 3 canals reported up to now. This configuration describes an unusual root canal system for the maxillary first premolar and does not fit into any of the well-known root canal classification systems. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effects of progressive root canal enlargements on the unprepared surface area and remaining dentine thickness of three‐rooted maxillary first premolars with different root configurations. Methodology: Thirty three‐rooted maxillary first premolars with three root configurations (n = 10) were selected and scanned in a micro‐CT device. The root canals were sequentially enlarged with rotary instruments sizes 30.02 (step 1), 30.04 (step 2) and 30.06 (step 3). After each step, a new scan was taken. Analysed parameters included morphometric measurements (length, volume and surface area), number of static voxels and minimal dentine thickness. Statistical analyses were performed with one‐way anovapost hoc Tukey tests and paired sample t‐test at a significance level of 5%. Results: No statistical differences were observed amongst groups regarding the morphometric parameters and static voxels (p >.05). The minimal dentine thickness of the distobuccal root significantly changed depending on the root configuration (p <.05), whilst no differences were observed in the other roots (p >.05). A great variation in the position of the minimal dentine thickness was observed after preparation. Overall, mean percentage reduction in dentine thickness was higher in the buccal roots than in the palatal root (p <.05). In the mesiobuccal and distobuccal root, the number of slices with minimal dentine thickness lower than 0.05 mm increases 2 to 3 times and 3 to 4 times, respectively, from steps 1 to 3. Conclusions: Instruments sizes 30.02 and 30.04 can be safely and effectively used to enlarge the buccal and palatal canals of three‐rooted maxillary first premolars. [ABSTRACT FROM AUTHOR]

Mandibular premolars exhibit intricate and diverse root canal anatomy, presenting substantial challenges in endodontic treatment. Uncommon variations, such as the presence of three canals, demand meticulous diagnostic and therapeutic approaches to mitigate the risk of overlooking canals and subsequent treatment failure. This case report highlights three cases of mandibular premolars exhibiting a rare root canal configuration with one mesial and two distal canals, successfully managed using cone beam computed tomography (CBCT) for accurate diagnosis and ultrasonic activation for disinfection. The findings underscore the significance of utilizing three-dimensional imaging and precise canal identification in addressing anatomical anomalies in mandibular premolars, which have been sparsely documented in the existing literature. This report aims to contribute to understanding and managing the rare and complex root canal configurations in endodontics., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, A et al.)

Teeth may exhibit a wide range of anatomical variations in their roots and root canal systems, making them challenging to treat in endodontic procedures. Generally, maxillary canines and mandibular premolars present with a single root with one canal, and variations are comparatively rare. Achieving a fluid-impervious seal in endodontic therapy requires thorough debridement and three-dimensional obturation of the root canal system, which is considered a complex micro-neurologic procedure. Clinicians may fail to achieve the successful outcome without a comprehensive understanding of the pulp chamber and root canal system anatomy. We present a report of successful management of previously failed root canal treatment of two such cases, a maxillary canine and a mandibular premolar, with a previously missed second canal due to their uncommon root canal morphological presentation. This report also comprehensively reviews the literature, focusing on the clinically significant anatomical variations and detailing techniques for the effective management of such anomalies in endodontic treatment. The review provides an in-depth explanation of each stage of treatment, including preoperative diagnosis, intraoperative identification of morphological variations, and evidence-based modern endodontic treatment approaches. Emphasis is placed on ensuring a thorough understanding of these steps to achieve successful outcomes in the management of complex cases involving root canal anatomical variations., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, AlTamimi et al.)

Objectives: This micro-computed tomography (micro-CT) study analyzed band-shaped isthmuses having their floor at the apical third of the mesiobuccal roots of maxillary molars in terms of 2D and 3D morphological parameters. Materials and methods: A total of 199 maxillary first molars were scanned with micro-CT. Twenty-seven specimens, confirmed to have a band-shaped isthmus, were further examined in terms of the isthmus length, volume, structure model index (SMI), and surface area. The distance of apical foramina of mesial canals from the isthmus floor and major-minor diameters, roundness, perimeter, and area of the isthmus roof and floor were compared. Statistical analyses were performed with descriptive statistics and t-test with a 5% significance threshold. Results: The band-shaped isthmus frequency was 13.5% and its length reached up to 5.5 mm. The distances of the apical foramina of mesiobuccal canals (MB1 and MB2) from the isthmus floor were similar (p >.05). Isthmus roof and floor showed significant differences in terms of their major diameter and area (p <.05), whereas their minor diameter, roundness, and perimeter values were similar (p >.05). Conclusion: The band-shaped isthmuses are not rare and can reach through the half of the root length with oval cross-sections in the floor and roof anatomy. The distance between the isthmus floor and apical foramina did not differ between MB1 and MB2. Clinical relevance: The band-shaped isthmus morphology contributes to the complexity of the apical anatomy of maxillary first molar teeth with various lengths and diameters. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the root morphology and root canal configuration of the lower and upper premolars using cone-beam computed tomography (CBCT), according to gender and right-left position of the tooth in the Turkish subpopulation. For the evaluation of root canal anatomy of mandibular and maxillary premolar teeth, 494 patients were used. In total, 3,880 premolar teeth were evaluated. CBCT images were examined in the coronal, sagittal, and axial planes. Number of roots, canals, and canal configurations of the teeth were determined according to Vertucci's classification. Qualitative data were analysed with Chi-square, Fisher Exact, and Bonferroni tests (α=0.05%). According to the results of this study, in maxillary first premolars, 64.5% two roots, 87.7% two canals, and 67.8% Type Ⅳ canal configuration; in maxillary second premolars 77.3% one root, 50.4% one canal, and 50.4 Type Ⅰ canal configuration; in mandibular first premolars 89.9% one root, 76.9% one canal, and 76.9% Type Ⅰcanal configuration; and in mandibular second premolars 98.4% one root, 95.9% one canal, and 95.9% Type Ⅰcanal configuration were observed. No statistically significant effect of the tooth position (right, left) on the number of roots, canals, and canal configuration in maxillary and mandibular premolars was observed (p>0.05). Maxillary second premolar and mandibular first premolars showed a statistically significant effect on number of roots, canals, and canal configuration by gender (p=0.00, p=0.032). In addition, gender had a significant effect on number of roots in maxillary first premolars (p=0.017). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Root canal curvature and calcification introduce factors that increase the risk of procedural accidents during root canal treatment. The inability to achieve patency to the apical third, asymmetrical dentine removal leading to transportation, perforation, and instrument fracture inside the curved trajectories are some of the procedural problems that might jeopardize the management of intraradicular infection and result in poor treatment outcomes. In fact, curved and constricted canals introduce such complexity that total instrumentation concepts and specially designed instruments have been developed to deal with the challenge. This narrative review seeks to provide and consolidate the principles necessary for understanding the dynamics of curved and constricted canal management and to improve the understanding for future developments in this field. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective To observe the anatomical morphology of root canal system of human mandibular first premolar based on the reconstructed images of cone-beam CT (CBCT). Methods The CBCT images of 1 102 mandibular first premolars meeting the inclusion criteria were reconstructed. We observed the root canal morphology and root canal groove (depression)of mandibular first premolars, and measured the thinnest root canal wall thickness of single premolars in different cross sections by one volume viewer software. Results Among the 1 102 mandibular first premolars, there were 958 type I root canals, 92 type V root canals, 42 type C root canals and 10 type III root canals. The detection rates of type I, type III, type V and C root canals in 424 male patients were 75. 0%, 2. 4%, 15. 6% and 7. 1%, respectively. The detection rates of type I, type III, type V and C root canals in 678 female patients were 94. 4%, 0, 3. 8%, and 1. 8%, respectively (all P<0. 05). Among the 1 102 mandibular first premolars, 524 (564) had root groove (depression), and the incidence of root groove (depression)was 47. 5%. Among the 524 teeth with root surface groove (depression), the starting positions were 4 at 1/3 of root crown, 500 at 1/3 of root middle and 20 at 1/3 of root apex. Among the 564 root surface grooves (depressions), 356 were on the mesial root surface, 194 on the distal root surface, 10 on the lingual root surface, and 4 on the buccal root surface. The starting positions were 4 at 1/3 of the root crown, 536 at 1/3 of root middle, and 24 at 1/3 of root apex. The thickness of the thinnest root canal wall at the junction of crown and root was (1. 74±0. 14)mm, and the thickness of the thinnest root canal wall at the junction of crown and root in men was greater than that in women (P< 0. 05). The thinnest root canal wall thickness at the junction of 1/3 of root neck and 1/3 of root middle was (1. 24± 0. 10)mm, with no significant difference between men and women (P>0. 05). The thinnest root canal wall thickness at the junction of 1/3 of the middle root and 1/3 of the apical root was (0. 85±0. 11)mm, with no significant difference between men and women (P>0. 05). Conclusions The root canal morphology of mandibular first premolar is complex and changeable. Type I is the most common root canal type, and there are differences between men and women. The incidence of root surface groove (depression)of mandibular first premolar is high. And it often occurs on the mesial root surface and mostly starts at 1/3 of the root. The thickness of the thinnest root canal wall of a mandibular first premolar with a single root canal in different cross sections is different, and the thickness of the thinnest root canal wall at the junction of crown and root differs in gender. [ABSTRACT FROM AUTHOR]

Introduction: Thorough management of root canal anatomy and its variants is important for good prognosis of endodontic treatment. C-shaped root canal is one such important variation in root canal anatomy. Due to the complex nature of C-shaped root canals the clinicians should be familiar with this variation to achieve better success rate in endodontic treatment. Aim: To assess Knowledge, Attitude and Practice (KAP) among dental students and dentists of the Makkah region of the Kingdom of Saudi Arabia towards C-shaped root canals. Materials and Methods: A cross-sectional questionnaire survey was conducted for a period of five months from 25th September 2020 to 25th February 2021 in Dentistry program of Ibn Sina National College for Medical Studies, Jeddah using a selfstructured, close-ended, multiple-choice questionnaire consisting of 21 questions. The questionnaire was sent using online to 503 Dental students and Dentists of Makkah region of Saudi Arabia. The study population was selected using convenient random sampling. The questionnaire was constructed and validated with the help of five endodontists with adequate teaching and clinical experience. The data were analysed using IBM Statistical Package for the Social Sciences (SPSS) version 22.0 and descriptive statistics followed by Chi-square test was applied to test of variables in the questionnaire. Results: In the study population, 68.4% (n=344) were males and 31.6% (n=159) were females, 25.2% (n=127) were undergraduate students and 74.7% (n=376) were graduate dentists, 63.2% (n=318) believe most commonly C-shaped root canals are found in mandibular second molars, 49.3% (n=248) have strongly agreed that they are proficient in diagnosing C-shaped root canals, 75.7% (n=381) have agreed that knowledge of canal anatomy will be helpful during access preparation of C-shaped root canals, 48.5% (n=244) felt use of crown down technique will be effective in managing C-shaped root canals, 72.8% (n=366) felt multiple visit endodontics is needed for successful management of C-shaped root canals and 25.8% (n=130) felt use of thermoplasticised gutta-percha compaction will be helpful in obturation. Conclusion: Knowledge of anatomical variations of root canal system and the use of advanced endodontic instruments and techniques will enable the dentists to handle difficult root canal cases thoroughly for good prognosis of dentition. [ABSTRACT FROM AUTHOR]

• CBCT should be performed before treatment of complex root canal anatomy. • Occurrence of middle distal (MD) canal in the mandibular molar has been reported. • The prevalence of the MD canal in a Saudi subpopulation was found to be low. • It is crucial to determine additional canals to achieve successful root canal therapy. The prevalence of the middle distal (MD) canal in the mandibular molar is significantly low among countries including the USA, Spain, Turkey, and Jordan; however, analysis of its prevalence and configuration has not been performed in Saudi Arabia. Therefore, we aimed to assess the prevalence and configuration of the MD canal in Saudi Arabia. A retrospective analysis of 132 cone-beam computed tomography (CBCT) images was performed to evaluate the presence of the MD canal in patients visiting the Radiology Department of The College of Dentistry in King Saud University between July 2018 and July 2019. The canal was examined if it was confluent with the distobuccal (DB) or distolingual (DL) canals, fin, or independent. Moreover, the distances from the MD canal to the DL and DB canals and cementoenamel junction (CEJ) were recorded. One MD canal (0.7%) was observed in 145 teeth. It was confluent with the DL canal. No statistical significance was observed among sex and age. The distances from the MD canal to the DL canal, DB canal, and CEJ were 1.4 mm, 1.9 mm, and 3.1 mm, respectively. The prevalence of the MD canal was significantly low in a Saudi subpopulation (0.7%). Careful evaluation of CBCT images and the pulpal floor is significantly important to detect the MD canal to ensure a good prognosis. [ABSTRACT FROM AUTHOR]

To achieve success in endodontic treatment, it is essential to have a thorough understanding of the root and canal morphology. While maxillary canines typically have a single root and canal, studies have reported variations in different populations. This case report details the non-surgical endodontic management of a maxillary canine (tooth no. 13) with a Vertucci type 3 canal configuration in a 69-year-old female patient. The patient reported pain in the maxillary right canine (#tooth no. 13) and was diagnosed clinically with apical periodontitis. The patient's dental history revealed an ameloblastoma in the right mandibular region, successfully treated five years ago. Cone beam computed tomography aided the treatment. After completing the root canal treatment (#13) involving the two canals, an incidental loop-type accessory canal was noted. After three years of follow-up, the patient reported being asymptomatic. This paper reports the endodontic management of an uncommon type 3 canal configuration in the maxillary canine. Clinicians must remain aware of canal variations and utilize modern diagnostic tools like cone beam computed tomography to ensure all canals are located and adequately treated., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gehlot et al.)

Objectives: The aim of this research was to compare the penetration ability of calcium silicate-based sealers (iRoot SP and TotalFill BC HiFlow) and an epoxy resin-based sealer (AH Plus) into the lateral canals using the single-cone (SC) or continuous wave compaction (CW) obturation techniques., Methods: Ninety single-rooted human teeth received canal instrumentation and diaphanisation before artificial lateral canals were created at 3 different root levels. The specimens were randomly allocated into 6 groups based on the combination of obturation technique and sealer used. Radiographic and photographic measurements evaluated the percentage of sealer penetration. Statistical analysis was performed to compare the penetration ability amongst different types of sealers, obturation methods, and root levels., Results: Although TotalFill BC HiFlow sealer combined with the CW technique demonstrated greater sealer penetration at the coronal level (P < .05), the overall penetration ability of iRoot SP, TotalFill BC HiFlow, and AH Plus was not significantly different. The deepest sealer penetration was observed at the apical root level., Conclusions: All sealers showed similar penetration abilities into the lateral canals using the SC or CW techniques in vitro. Calcium silicate-based sealers have comparable penetration ability into lateral canals compared to epoxy resin-based sealers using SC or CW obturation techniques., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

This article aims to focus on the brief knowledge about the anatomical and morphological variations of the root canal anatomy of the maxillary second molar. The present case report reveals the endodontic management of the four-rooted right maxillary second molar diagnosed with the help of cone-beam computed tomography (CBCT) imaging. The CBCT findings confirmed the presence of four roots (mesiobuccal, distobuccal, distopalatal, and mesiopalatal) and four root canals. This case report demonstrates the importance of CBCT which is a valuable tool for diagnosis and management of these complex root canal systems. [ABSTRACT FROM AUTHOR]

Mandibular lateral incisors sometimes feature an additional lingual canal, which, if not identified and missed during endodontic treatment, can lead to postoperative pain. Thus, a proper diagnosis of the internal anatomy of a tooth is necessary before treatment begins. Radiovisiography (RVG), a cost-effective and widely employed dental imaging technique, is used in clinics to visualize the internal root structure of teeth. The zoom function of RVG allows for a detailed examination of complex internal anatomical variations, facilitating a more accurate diagnosis and treatment planning process. This case study identified a rare Vertucci Type VII root canal system in a mandibular left lateral incisor using the zoom-in feature of radiovisiography (Vatech, EZ sensor). Additionally, horizontal sectioning was performed, and these sections were imaged to verify the accuracy of digital radiographs in diagnosing such cases as part of a preclinical demonstration for aspiring endodontists., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jethi et al.)

Knowledge of the root canals configuration is essential for the success of endodontic treatment. The main aim of the systematic review is to determine the number of roots and the number of root canals in maxillary third molars, in addition, where possible, to determine the Vertucci classification. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. The study protocol was registered and approved on the International Prospective Register of Systematic Reviews PROSPERO (Reg. No: CRD42022366444) before the start of the study. Twelve studies were included in the analysis, differing in sample origin and methodology. The combined studies were analyzed based on the number of roots, number of canals, and root canal configurations, and the findings were compared with those of other international studies. Analyzing the available research results regarding the root anatomy and canal configuration of the third maxillary molar, the most commonly maxillary third molars had 3 roots (59.00%). Single-rooted teeth (24.20%) or double-rooted teeth (13.80%) were less common. In addition, it was observed that maxillary third molars typically possessed three root canals (47.28%) and the MB (mesiobuccal), DB (distobuccal), and P (palatal) canals most often showed Vertucci Type I (59.53%, 95.83% and 98.61%, respectively) in three-rooted form. Due to the small number of available studies, it is necessary to conduct further analyses taking into account demographic and ethnic differences that may affect the anatomical and morphological structure of the teeth.

Background Understanding root canal anatomy variations, particularly C-shaped canals, is crucial for successful endodontic treatment. This study used clinical and radiographic methods to assess the prevalence and characteristics of C-shaped canals in mandibular second molars in Western Maharashtra. Materials and methods This prospective study was conducted in the western region of Maharashtra, India. The samples included patients requiring endodontic treatment for mandibular second molars. Clinical evaluation was conducted using a surgical endodontic microscope and cone beam computed tomography (CBCT) imaging. Inclusion and exclusion criteria ensured the selection of a focused and homogeneous sample. Data analysis included assessment of unilateral/bilateral occurrence, canal distribution, and cross-sectional characteristics. Results Out of 200 mandibular second molars, 7.5% exhibited C-shaped root canals, with no significant gender differences. Canal distribution varied across coronal, middle, and apical levels, with prevalent configurations being C1, C2, C3, and C4. No significant differences were observed in canal distribution based on root levels. No significant gender differences were found in the presence of grooves on the root surfaces. Conclusion This study provides valuable insights into the prevalence and characteristics of C-shaped canals in mandibular second molars in Western Maharashtra. Further research into histological and genetic aspects can enhance our understanding, leading to improved treatment strategies for complex root canal anatomy variations., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Committee of Krishna Institute of Medical Sciences, Deemed University issued approval KIMSDU/DR/573. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shaikh et al.)

This is a unique case of a single-rooted maxillary premolar with two separate canals in bayonet or S-shaped radicular anatomy undergoing post-endodontic reinforcement prior to crown placement. Bayonet-shaped canals present challenges in canal negotiation, cleaning, shaping, and obturation. The complexity of these canals heightens the risk of accidental file breakage and other iatrogenic errors, posing significant challenges. Post-endodontic restoration in S-shaped canals with double curvature poses challenges in precise placement and material adaptation. A novel technique was implicated to preserve the functionality and structural aesthetics of a decayed maxillary first premolar tooth., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jethi et al.)