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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]

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]

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]

Purpose: To investigate the three-dimensional morphology of isthmuses in molars according to their boundary characteristics using micro-computed tomography (micro-CT). Methods: 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%. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed at establishing a comprehensive specification of the root canal anatomy of second primary mandibular molars using micro computed tomography (CT). Methods: 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. Results: 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 < 0.001), middle (p < 0.001) and apical (p = 0.012) levels. The root dentin thickness on the distal wall of the mesial root and the mesial wall of the distal roots were reduced, respectively, from the coronal to the apical thirds. Conclusions: The results obtained in this case series report clearly show a complex, sometimes unpredictable, anatomy with dangerous areas where dentin is extremely thin. The plethoric presence of anastomoses, large bands of isthmus, lateral canals at all levels induces the need for the development of instruments specific to pulpectomies on primary teeth. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence of isthmi and middle mesial (MM) canals in the mesial roots of mandibular first molars (MFM) in a Mongoloid subpopulation and to evaluate their association with demographic and anatomic characteristics. Methods: Cone-beam computed tomography (CBCT) images of 496 patients with 823 MFMs were selected and analyzed. The following data were collected: patient age and gender, side, presence and distribution of MM canal and isthmus, distance between mesiobuccal (MB) and mesiolingual (ML) orifices, and MB–ML root canal system (RCS) morphology. Logistic regression was used to determine the association between demographic and anatomic characteristics and the presence of isthmi in the apical third. Results: The overall prevalence of isthmus and an MM canal in MFM was 64.6% and 10.8%, respectively. The highest prevalence of isthmi and MM canals was found in patients of ≤ 20 and of 41–60 years, respectively (p < 0.05). The prevalence of isthmi declines with age. A total of 41.3% of the MFMs had isthmi in the apical third of the mesial roots. Younger age, shorter MB–ML orifice distance, and Weine type II RCS increased the probability of the presence of an isthmus in the apical third (p < 0.05). Conclusion: The prevalence of isthmus in MFM is high in the subject population, but the prevalence of MM canals is not as high as previously reported. Demographic and anatomic characteristics could aid clinicians to better predict the presence of MM canal and an isthmus. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to evaluate the influence of the internal anatomy on the leakage of root canals filled with the thermoplastic technique.Materials and methods: The upper central incisors (UCI) and mesial roots of the lower molars (MRLM) (n = 12 each) were tested regarding leakage using the gas-enhanced permeation test (GEPT) after root filling. The quality of the root fillings was assessed using micro-computed tomography (μCT) by superimposing scans before and after treatment to calculate unfilled volume. The calculated void volume was compared between the groups and correlated to the measured leakage values. Data were analyzed using t test and Pearson’s correlation tests (p < 0.05).Results: The mean void volume did not differ between UCI and MRLM (13.7 ± 6.2% vs. 14.2 ± 6.8%, respectively). However, significantly more leakage was evident in the MRLM (p < 0.001). While the leakage correlated highly to the void volume in the MRLM group (R2 = 0.981, p < 0.001), no correlation was found in UCI (R2 = 0.467, p = 0.126).Conclusion: MRLM showed higher leakage values, which correlated to the void volume in the root canal fillings.Clinical relevance: Care should always be taken while doing root canal treatments, but attention to teeth with known/expected complex root canal anatomy should be considered. [ABSTRACT FROM AUTHOR]

Objectives: Microorganisms in untreated or overlooked root canals can cause endodontic failure or infection and inflammation. Therefore, clinicians should familiarize themselves with patient's root canal anatomy and morphology. The objective of this retrospective study was to analyze and characterize mandibular root canal morphology using cone beam computed tomography (CBCT) in a Turkish Cypriot population. Materials and methods: This cross-sectional study consisted of retrospective evaluation of CBCT scans from 272 adult patients (aged 16-80 years). The number of roots and canals and the canal configuration in each root were evaluated using Vertucci's classification. The incidence of additional roots and of C-shaped canals in the mandibular first and second molars was also noted. Pearson chi-square tests were performed to analyze canal configurations, laterality, and gender ( p ≤ 0.05). Results: For the female and male patients, 94.5 and 94.4 % of the mandibular first and 96.7 and 97.2 % of the mandibular second molars had two roots, respectively. In females, 4.4 % of mandibular first molars had three roots versus 2.7 % of mandibular first molars in male patients. Type IV was the most prevalent canal configuration regardless of the gender (female 61.3 % and male 64.2 %) in the mesial roots. No statistically significant differences according to gender or laterality were found in the incidence of additional canals for either maxillary first or second molars. Conclusions: Type IV was the most prevalent canal configuration of both the mandibular first and second molar teeth. There was a low prevalence of three-rooted mandibular molars in this particular population. Clinical relevance: The current study is the first of its kind to include a Turkish Cypriot population and, thus, provides baseline data for these patients regarding appropriate root canal treatments. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to analyze the variations in canal and root cross-sectional area in three-rooted maxillary premolars between high-resolution computed tomography (μCT) and cone beam computed tomography (CBCT). Materials and methods: Sixteen extracted maxillary premolars with three distinct roots and fully formed apices were scanned using μCT and CBCT. Photoshop CS software was used to measure root and canal cross-sectional areas at the most cervical and the most apical points of each root third in images obtained using the two tomographic computed (CT) techniques, and at 30 root sections equidistant from both root ends using μCT images. Canal and root areas were compared between each method using the Student t test for paired samples and 95 % confidence intervals. Results: Images using μCT were sharper than those obtained using CBCT. There were statistically significant differences in mean area measurements of roots and canals between the μCT and CBCT techniques ( P < 0.05). Root and canal areas had similar variations in cross-sectional μCT images and became proportionally smaller in a cervical to apical direction as the cementodentinal junction was approached, from where the area then increased apically. Conclusion: Although variation was similar in the roots and canals under study, CBCT produced poorer image details than μCT. Clinical relevance: Although CBCT is a strong diagnosis tool, it still needs improvement to provide accuracy in details of the root canal system, especially in cases with anatomical variations, such as the three-rooted maxillary premolars. [ABSTRACT FROM AUTHOR]

Although four-rooted mandibular first molars have been observed on a few occasions in the literature, to the best of our knowledge, four-rooted second molars have not been reported. Here, we describe a mandibular second molar with four roots and canals: two mesial and two distal. Mesial roots were separated in the cervical one-third near the cervical margin, while distal roots were divided at a lower level in the middle one-third of the root. We discuss the possibility of different root and canal variations of the mandibular second molar from a developmental point of view. [ABSTRACT FROM AUTHOR]