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Dental radiographs used in endodontic therapy are two-dimensional (2D) and do not provide full information on the tooth cavity. In recent years the investigation of patients with disorders of the teeth and jaws are increasingly using dental computed tomography. When comparing the anatomical topography of the tooth extraction and its image into 3D CT revealed that the topography of the root canal is transferred reliably enough to make a decision on the choice of the method of preparation and obturation. Investigated tooth removed and created endodontic access. Extracted tooth was treated by the procedure, which can make it transparent. The proposed method of visualization of the root canals of teeth makes possible a detailed analysis of the anatomy of the root canal, while maintaining its anatomical shape and size, which is important in the learning process.

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]

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]

Objective: Several studies demonstrate variability of root canal morphology of anterior teeth. This in-vivo study was designed to analyze and characterize root canal morphology of maxillary and mandibular anterior teeth using three-dimensional imaging. Method and Materials: Patients who required CBCT radiographic examinations as part of their routine examination, diagnosis, and treatment planning were enrolled on the study. A total of 1,200 healthy, untreated, fully developed maxillary and mandibular incisors and canines were included. The following observations were recorded: (i) number of roots and their morphology; (ii) number of canals per root; and (iii) primary variations in the morphology of the root canal systems. Results: Root canal morphology of maxillary teeth was consistent with a single canal extending from the pulp chamber to the apex in 98% of the cases. In contrast, in mandibular central and lateral incisors, the presence of a single canal represented 64.5% and 60.5% respectively. The second most common morphology was the presence of one canal leaving the pulp chamber, which divided into two within the root, and then merged to exit as one canal in 18% and 25.5% respectively. The presence of one canal leaving the pulp chamber and dividing short of the apex into two separate and distinct canals with separate apical foramina (variant 5) was recorded in 14.5% and 12% respectively. Conclusion: There was a low incidence of anatomical variation in maxillary anterior teeth. In contrast, mandibular anterior teeth presented with a high prevalence of two canals, especially central and lateral incisors. The reported data may help clinicians understand the variations in root canal morphology of anterior teeth in order to overcome problems associated with shaping and cleaning procedures. [ABSTRACT FROM AUTHOR]

Objective: The purpose was to first identify if there was a difference between the root canal morphology of maxillary first molars of Malaysians and Caucasians by using horizontal sectioning. Secondly, it was to see if there was a difference between the root canal morphology of maxillary first molars of Malaysians and other Eastern Asian populations found in the literature. Methods: Extracted maxillary first molars were collected from a Caucasian population (n = 133) and a Malaysian population (n = 139). The mesiobuccal root was horizontally sectioned. Data was taken from the apex, 1 mm coronal to the apex, the apical one third of the root, the apical middle two-thirds of the root, and the apical five-sixths of the root. Canal configuration was classified according to Vertucci's classification. Results: The greatest difference between the two populations was that of Type 1 (Caucasians: 42.86%, Malaysians: 34.56%) and Type 3 (Caucasians: 3.76%, Malaysians: 7.35%). No statistical difference was found when comparing each Vertucci type between Caucasians and Malaysians (P = 0.799). The total percentage of two mesiobuccal canals was 57.14% for Caucasians and 65.44% for Malaysians. No statistical difference was found (P = 0.171). No statistical difference was found between the total percentage of two mesiobuccal canals between Malaysians and findings in previous literature (P > 0.05). Conclusion: There was no statistically significant difference between the incidence of the second mesiobuccal canal of maxillary first molars of Caucasian, Malaysian and other Eastern Asian populations. [ABSTRACT FROM AUTHOR]

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

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

It is very rare (2%–6% cases) for a mandibular canine to have two root canals and the incidence of finding two roots with two root canals in a mandibular canine that too bilaterally is almost negligible. This case report discusses the presence and multidisciplinary management of such rarest configuration in both mandibular canines of a female patient. This case shows the importance of recognition of anatomical variations in successful accomplishment of root canal treatment.

Introduction: Elusive second mesiobuccal canal (MB2) in maxillary first molar are often missed during endodontic therapy and are a major cause of treatment failures. Its prevalence is known to vary among different populations and there is limited information on its prevalence in Indian population. Aim: This study investigated the prevalence and location of second mesiobuccal (MB2) canal in mesiobuccal root of maxillary first molar using cone beam computed tomography (CBCT) images in an Indian population. Materials and methods: CBCT images of 598 three rooted maxillary first molars were studied. In each CBCT image, the floor of pulp chamber was located and advanced by 2 mm to standardize the observation for MB2 canal. Its location was determined in relation to mesiobuccal (MB1) and palatal (P) canal. Statistical analysis: The data was analysed using descriptive statistics. The presence of MB2 canal was correlated with age, gender and tooth position using Chi square test. Results: The prevalence of MB2 canal in three rooted maxillary first molar was 61.9%. It was seen that the prevalence of MB2 was highest in 20–40years age group (67.4%) followed by > 40 years (57.5%) and lowest in

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

Purpose The aim of this study was to evaluate the efficacy of endoscopic visualisation to detect the presence and type of isthmuses within the mesial root canals of mandibular first molar teeth compared with micro-computed tomography (micro-CT) images as reference. Materials and Methods Thirty-two mesial roots of mandibular first molars presenting isthmuses were selected based on micro-CT scans. In all, 12 type I and 20 band-shaped isthmuses were collected. The specimens were mounted in the posterior socket of dental phantom manikin for endoscopic visualisation. The ability of endoscopes to visualize the presence of isthmuses and distinguish the type of isthmuses was compared. Micro-CT images of the specimens were used as references. Data were analyzed using Fisher's exact tests. Results Sensitivity of endoscope to detect isthmuses were also calculated for each isthmus type. In 37.5% of the samples, isthmus presence was correctly diagnosed via orthograde endoscopic visualization. Type I istmuses were significantly more detected than band-shaped isthmuses (P<0.05). Endoscope showed higher sensitivity to detect type I isthmus than band-shaped isthmus. Conclusion The endodontic endoscope could detect type I isthmuses more accurately than band-shaped isthmuses. [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.)

It is a well-recognised fact that incomplete cleaning, shaping and obturation of root canals will lead to endodontic failure. Mandibular second premolars usually have a single root and a single root canal. The presence of four separate roots and four root canals is quite rare. Hence, a comprehensive knowledge about the normal canal configuration along with its variations becomes an indispensable pre-requisite to achieve the success of endodontic treatment. Authors hereby present a case of a 26-year-old male patient and describe its succesful treatment of the mandibular second premolar with four roots and four root canals. The clinical implications of this paper aim at establishing an accurate diagnosis of the root canal system using diagnostic aids such as angulated radiographs and making use of advanced endodontic instruments for successful retreatment of endodontic therapy (C+ files and NiTi rotary endodontic instruments).

Aim: Reciproc and WaveOne (WO) system was used to evaluate the canal centering ability and apical transportation by cone-beam computed tomography. Materials and Methods: Forty extracted human single-rooted mandibular premolars were used in the present study. Preinstrumentation scans of all teeth were taken; canal curvatures were calculated; and the samples were randomly divided into two groups with 20 samples in each group, where Group 1-Reciproc system and Group 2-WO reciprocation system. Postinstrumentation scans were performed using DICOM software and the two scans were compared to determine centering ability and canal transportation at 3, 6, and 9 mm from the root apex. Results: Using Student's unpaired t-test results were as follows, for centering ability Group 1 showed nonstatistically significant difference at 3 mm and 9 mm, whereas a statistically significant difference (P < 0.05) at 6 mm was obtained. For canal transportation, Group 1 showed a statistically significant difference (P < 0.05) at 3 mm and 6 mm, and nonsignificant difference was obtained at 9 mm, but for Group 2, nonstatistically significant difference (P > 0.05) was obtained at 3 mm, 6 mm, and 9 mm. Conclusion: WO single reciprocation file has better centering ability, maintains original canal curvature, and causes lesser canal transportation as compared to reciproc.

Introduction: Various studies have reported variations in the number of canals and canal configurations in maxillary second premolars. Root canal configurations have been studied by various methods. The purpose of this study was to evaluate the different canal configurations and the incidence of two canals in the maxillary second premolar teeth of a north Indian population by using computed tomography. Materials and methods: One hundred completely formed, extracted non-carious maxillary second premolar teeth were collected and used in this study. The teeth were subjected to a high quality computed tomography (GE Light Speed Pro; GE Healthcare, Waukesha, WI, USA) scanner, which acquires forty slices per second. Each tooth was viewed in longitudinal as well as in transverse sections. The teeth were then grouped according to Vertucci's classification. Results and conclusions: This study showed that in almost 38% of the cases one root canal was found at the apex, and in 62% of cases two canals were found at the apex. The canal morphology was best visualised in the buccolingual plane. Seven types of canal configurations (type I, type II, type III, type IV, type V, type VI, type VII) were found. The most prevalent canal configuration was found to be type IV. [ABSTRACT FROM AUTHOR]

In this case report, we present a maxillary second molar variant, which had two palatal roots with two canals and two buccal roots with three canals, including a second mesiobuccal canal. A 44-year-old female patient complained about a tooth crown fracture and severe pain in her right maxillary second molar. A clinical intraoral inspection and radiography were carried out on the tooth, and a diagnosis of chronic apical periodontitis was made. Four roots (two buccal and two palatal) and five canals (three buccal and two palatal) were found. The anatomical variation of the tooth was further confirmed by cone-beam computed tomography, a cone-fit procedure, and a radiograph with a shifted projection angle. Root-canal treatment was performed under an endodontic microscope.

The purpose of this study was to determine root canal cross-sectional shapes (RCCSSs) of human permanent teeth using new cone-beam computed tomographic (CBCT) software. RCCSS was determined on CBCT scans of 1400 teeth (422 patients) as follows: (1) circular, (2) conical/pyramidal, (3) oval/long oval, (4) flat/ribbonlike, (5) 8 shaped, (6) C shaped, (7) calcified, (8) trapezoidal, (9) drop shaped, and (10) other shapes. Root canal shapes were evaluated in the coronal and middle thirds, 2 mm below their beginning, and in the apical third, 1 and 2 mm short of the apical foramen. Categoric variables were described as frequencies and percentages and analyzed using the chi-square test. The level of significance was set at P =.05. Maxillary anterior teeth and maxillary first and second premolars had a circular RCCSS at 1 and 2 mm from the apical foramen in more than 45% of the cases. The most frequent RCCSS in the buccal canal of maxillary first premolars at 1 mm from the apical foramen was circular (71%) followed by flat/ribbonlike (10%) and oval/long oval (6%). In mesiobuccal roots of maxillary and mandibular first molars at 1 mm from the apical foramen, the circular shape was found in 52% and 49%, respectively. The RCCSSs in human permanent teeth are variable according to the tooth group and root thirds. The highest frequency of the circular-shaped canal at 1 and 2 mm from the apical foramen was found in maxillary central incisors and mandibular first and second premolars. Oval-shaped canals were detected in practically all tooth groups and root thirds. [ABSTRACT FROM AUTHOR]

It is a well-recognised fact that incomplete cleaning, shaping and obturation of root canals will lead to endodontic failure. Mandibular second premolars usually have a single root and a single root canal. The presence of four separate roots and four root canals is quite rare. Hence, a comprehensive knowledge about the normal canal configuration along with its variations becomes an indispensable pre-requisite to achieve the success of endodontic treatment. Authors hereby present a case of a 26-year-old male patient and describe its succesful treatment of the mandibular second premolar with four roots and four root canals. The clinical implications of this paper aim at establishing an accurate diagnosis of the root canal system using diagnostic aids such as angulated radiographs and making use of advanced endodontic instruments for successful retreatment of endodontic therapy (C+ files and NiTi rotary endodontic instruments). [ABSTRACT FROM AUTHOR]

The root canal system of the maxillary first premolar (MFP), present a high rate of variation, especially at apical level. This complicates the action of antiseptic solutions and endodontic instruments at this level. The object of this in vivo study was to analyse by Cone Beam Computed Tomography (CBCT) the radicular and canalicular morphology of MFP in a Chilean sub-population. We carried out a cross sectional, descriptive and observational in vivo study with CBCT examinations of 70 MFP, both left and right. The data were analysed using descriptive statistics (mean (M), standard deviation (SD), with a confidence interval of 95 %), and one-factor ANOVA was used to relate the sections observed. Tooth 1.4 presented one root in 64.86 % of cases and two roots in 35.15 %. Tooth 2.4 presented one root in 66.67 % of cases and two roots in 33.33 %. The frequency of one and two canals was observed to be 30 % and 70 % respectively. The walls with the smallest cementodentinal thickness were the mesial (1.11±0.55) and distal (1.08±0.52). The thickest dentinal wall was the palatine (2.07±1.29), followed by the buccal (1.6±1.0). No statistical differences between males and females were found in the thickness of the root wall, nor in the location of the premolar in the maxilla (p>0.05). In conclusion, the root morphology of the MFP is highly variable. Care must be taken not to over-instrument the proximal walls to avoid perforations or fractures. CBCT has proved to be a useful and effective diagnostic tool for in vivo study of dental morphology. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the accuracy of endoscopic visualization to detect root canal anastomoses at the coronal half of the mesial root canals of mandibular molars using micro-computed tomographic (micro-CT) images as reference.Material and methods: Seventy-four mesial roots of mandibular first molars with (n = 47) or without (n = 27) intercanal anastomosis were selected based on the micro-CT scans of 269 mandibular first molars at a pixel size of 10 µm. The specimens were mounted on the mannequins and their root canals were evaluated using dental operating microscope (DOM) and endoscope. The endoscopic probe was inserted into the main mesial root canals and 2 blinded observers evaluated the presence of a divergence point of anastomosis (where the branching occurs) as 'present' or 'absent'. The scorings were compared with the three-dimensional reconstructed images of the specimens and recorded as 'correct' or 'incorrect' evaluation. Degree of agreement between evaluators was assessed with Kappa test and the accuracy of endoscopic visualization according to the presence and location of anastomosis was compared using Fisher exact tests with a significance threshold at 5%.Results: High inter-examiner reliability was reported (0.91). None of the divergence points were identified using DOM whereas 11 divergence points were detected using endoscope, corresponding the 23.4% of the intercanal anastomoses. The endoscope also showed the absence of an intercanal anastomosis correctly in all of the specimens without an anastomosis. Detectability of a divergence point using endoscope was not affected by its location within the coronal half of root canal (p > .05).Conclusions: The endoscopes were able to visualize the divergence points of 23.4% of the intercanal anastomoses located at the coronal halves of root canals. [ABSTRACT FROM AUTHOR]

It is necessary to anticipate and to have insight of the internal anatomy relationships before undertaking endodontic therapy. As there is limited information available, the aim of the study is to evaluate the number of root canals present in the mandibular permanent first molars (36,46). A retrospective study was carried out using digital records of 3,785 patients who reported to the Department of Paediatric and Preventive Dentistry and the Department of Endodontics from June 2019 to March 2020. A total of 1,618 patients were finally included for the study evaluation. The number of root canals per tooth were observed from the digital records and tabulated on a spreadsheet. The collected data was analysed by computer software SPSS version 21. In the present study, out of a total of 1,618 patients, 892 were males and 726 were females with a mean age of 30.77years. Overall 63% of the permanent mandibular first molars had three root canals, 32.5% had four root canals, 2.5% had two root canals and 2% had five root canals. Within the limits of the study, it was observed that the majority of the permanent mandibular first molars had three canals followed by four, two and five canals. Clinicians should be aware of the complex root canal morphology of mandibular first molars before and during the root canal treatment. [ABSTRACT FROM AUTHOR]

• Most of the scans showed three roots (92%), while two roots is (6.6%), four roots is (1.1%), and one root is (0.3%). • Males and females showing greater tendencies for three and two roots, respectively. • There was no differences between teeth sides. Root morphology and canal anatomy of maxillary molars shows several complexities and variations. Knowledge of these is essential for successful endodontic treatment. This study aimed to investigate the morphology of the maxillary second molars in a Saudi Arabian sub-population in relation to gender, age, and nationality, as well as to analyze the anatomical symmetry between the left and right side in each individual. 420 digitized cone-beam computed tomography (CBCT) scans were collected, of which 351 scans met the inclusion criteria. Number of roots and canals at three different levels of the root in each case was counted at all available sides and compared on the basis of the study variables. Statistical significance was set at P ≤ 0.05. Most of the patients (n = 323, 92%) had three roots, while two roots (n = 23, 6.6%), four roots (n = 4, 1.1%), and one root (n = 1, 0.3%) were less frequently observed. A significant correlation between female patients and the presence of two canals, while male patients showed a higher correlation with the presence of four canals at all levels. There also was a correlation between Saudi participants and the presence of four canals at all levels. No significant correlation in symmetry between the left and right side root canal anatomy was found. There was an inverse relation between the number of canals and age. Considering the limitations in this study, it appears that the Saudi population is more likely to have three- and two-rooted maxillary second molars, with males and females showing greater tendencies to having three and two roots, respectively. [ABSTRACT FROM AUTHOR]

It is very rare (2%–6% cases) for a mandibular canine to have two root canals and the incidence of finding two roots with two root canals in a mandibular canine that too bilaterally is almost negligible. This case report discusses the presence and multidisciplinary management of such rarest configuration in both mandibular canines of a female patient. This case shows the importance of recognition of anatomical variations in successful accomplishment of root canal treatment. [ABSTRACT FROM AUTHOR]

The root canal system is considering the most important factor in endodontic treatment, due to the complexity of its anatomy and morphology. The aim of this study was to evaluate the cross-sectional root canal shape in three thirds (coronal, middle, apical) in different age groups using cone-beam computed tomography scanning (CBCT) and to present a new classification for root canal shape changes. This cross-sectional study included 300 CBCT scans for patient aged 20–70, and these scans were evaluated to study the morphology of the cross-sectional root canal shape in coronal, middle, and apical thirds among three age groups, namely the young (20–44), middle (45–59), and elderly (60–70). The root canal shape was classified as round, oval, long oval, and ribbon (with or without isthmus). The cross-sectional root canal shape was identified in two groups: canals with an unchanging (constant) shape and canals with changing shape. In turn, in canals with changing shape, the change could be identified in the region of the middle or apical thirds of the canal. The results showed that root canal shape changes in two cases: (1) the presence of one or more canals in the root (with or without isthmus between them), and (2) with age, as it was observed that the cross-sectional shape of the root canal becomes round in the apical third with age. A new classification of the changes of root canal shape in three thirds (coronal, middle, apical) was presented in this study. [ABSTRACT FROM AUTHOR]

Knowledge of the root canal anatomy and its variations is essential for successful completion of the endodontic treatment. Root canal treatment of maxillary first molars with aberrant canal configuration can be challenging. The incidence of two palatal canals in a palatal root is quite rare and had never been reported among Lebanese population. This manuscript reviews the incidence of maxillary molars with two palatal root canals reported in the literature as well as reporting the endodontic management of a maxillary first molar having two canals in the palatal root one mesial and another distal, in addition to one mesiobuccal and one distobuccal canals for a Lebanese patient. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the root canal morphology of Vertucci type I root canal configuration detected in mesial roots of mandibular first molar teeth using micro-computed tomography (Micro-CT). Methodology: Micro-CT datasets of 269 specimens were evaluated for the detection of specimens with Vertucci type I root canal configuration for further analysis. Major and minor diameter, area, perimeter and roundness of root canal cross-sections at the beginning and midline of each root thirds were measured and recorded. The presence of apical delta, accessory canals, and deviation of major apical foramen from anatomical apex were investigated. Data was analyzed using descriptive analysis, ANOVA-Tukey, and Kruskal-Wallis H-Wilcoxon signed-rank tests. Results: Vertucci type I canal configuration was present in the 4.46% of the specimens. The specimens often showed accessory root canals (50%) and apical deltas (41,6%). From the visual analysis of the 3D and 2D images, significant differences were detected among coronal, middle and apical thirds of the specimens regarding major and minor diameter, area, perimeter, and roundness (p<0.05). Conclusion: Three- and two-dimensional analyses of mesial roots with Vertucci type I canal configuration indicated that this type of configuration presents large buccolingual diameters with long oval shape and has isthmus at coronal and middle thirds. At the apical third the root canals often terminate in an oval cross-sectional shape. [ABSTRACT FROM AUTHOR]

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This study aimed to evaluate the prevalence of internal symmetry (the number and morphology of root canals) in the mandibular incisors using cone beam computed tomography (CBCT). A total of 302 CBCT scans involving 1,208 mandibular incisors were evaluated using the Vertucci's classification regarding the number and configuration of root canals. The central mandibular incisors exhibited two root canals in 22.6% of patients and lateral incisors in 24.3% of patients. Most teeth (76.4%) had a type I configuration (a single root canal, 1-1), 21.7% had type II (2-1), 1.1% had type V (1-2), and 0.8% had type IV (2-2). Teeth with a type-III configuration (1-2-1) were not found. In total, 17.5% of patients had a symmetric appearance of the two-canalled central mandibular incisors and 20.5% had a bilateral appearance of the two-canal lateral incisors. Moreover, in 12.3% of the patients, all four incisors showed two root canals. The highest degree of symmetry was found in incisors that had one root canal (central incisors: 217 of 302, lateral incisors: 229 of 302), followed by type 2-1 incisors (central incisors 50, lateral incisors 58). The influence of sex and age on the prevalence of symmetries was not significant. Concluding, the internal anatomy of the mandibular incisors cannot not be sufficiently predicted from the root canal anatomy of the contralateral tooth. Thorough clinical and radiographic inspection of each tooth remains mandatory to address the internal anatomy of the mandibular incisors correctly. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to emphasise the importance of familiarisation with the internal anatomy of the mesial root of human permanent mandibular molars. Materials and methods: A literature review was conducted and four clinical cases of mandibular molars exhibiting an additional middle mesial canal are presented. Non-surgical treatment and retreatment procedures are described. Results: The middle mesial canals in all cases demonstrated a merging configuration with either the mesiobuccal or the mesiolingual canal. Acknowledgement of this configuration bears significant clinical implications. Enhanced magnification and illumination were indispensable for the detection and negotiation of the intermediate canal. Conclusions: The middle mesial canal constitutes an anatomic component that needs to be acknowledged during endodontic treatment of the mandibular molars. Awareness of its occurrence along with visual augmentation may aid a higher detection rate. [ABSTRACT FROM AUTHOR]

Root canal anatomy may present clinicians with a complex clinical challenge that requires diagnostic approaches, access modification, and clinical skills to successfully localize, negotiate, disinfect, and seal the root canal system. This article discusses the clinical implications of endodontic therapy on permanent mandibular first molars. The number of roots on the mandibular first molar is directly related to ethnicity. Canal morphology has a significant effect on treatment protocol: Mesial roots present two canals on a regular basis, adopting 2-2 and 2-1 as the most common configurations. A third canal is present in 2.6% of the population. The most common configuration in the distal root is type I (62.7%), followed by type II (14.5%) and type IV(12.4%). Diagnosis and treatment of complex root canal systems often require specialized training that may be beyond the scope of the average general practitioner. Access modifications are required to find extra roots and/or canals. The instrumentation of the third root requires a different access and small, flexible instruments, given the curvature that is usually present buccally in the apical third. The incidence of isthmuses is 55% in the mesial root and 20% in the distal root. This anatomical configuration should be taken into consideration during endodontic treatment as well as during periapical surgery. [ABSTRACT FROM AUTHOR]

Aim: The literature shows a wide variation in the number of root canals and canal morphology of maxillary premolar's. The aim of the present study was to evaluate the root canal anatomy of maxillary premolar's in an Indian subpopulation with the aid of spiral computed tomography (CT). Materials and methods: Computed tomographic scans of 67 patients were taken and analyzed from a radiology database. A total of 119 maxillary first premolar's and 121 maxillary second premolar's were studied. Axial images of maxillary premolar's, obtained from CT scans, were evaluated at all levels. The criteria evaluated were: number of root canals, root canal morphology classified by Weine (I–IV) and canal morphology classified by Vertucci (I–VIII). Results: A total of 2.5% of maxillary first premolar's had one canal (Weine type I, Vertucci type I), whereas the rest had two canals (Weine type II-III, Vertucci type II-IV). In maxillary second premolar's, 55.3% of teeth had one canal (Weine type I, Vertucci type I). One case demonstrated a Vertucci type VII canal configuration. Conclusions: Maxillary premolar's of an Indian subpopulation demonstrated various canal morphologies and shapes, with predominantly two canals in the maxillary first premolar. A CT scan can be a useful tool in the accurate determination of root canal configuration. [ABSTRACT FROM AUTHOR]

Aim: To report the root canal treatment performed on a three-rooted maxillary first premolar. Summary: Many of the difficulties found in endodontic therapy are caused by variations in root canal anatomy. Most commonly bi-rooted, the maxillary first premolar can also have three roots with three independent canals at the apex. This case report describes the root canal treatment performed on a maxillary first premolar with three independent root canals in three distinct roots. Good knowledge of the endodontic anatomy and good interpretation of the periapical radiographs are very important skills in recognising the unusual morphology of the teeth and performing a predictable endodontic treatment. Special care needs to be taken during clinical examination, refining the access cavity, locating the orifices of the root canals on the pulpal floor and cleaning, shaping and filling all identified root canals [ABSTRACT FROM AUTHOR]

Rotary root canal instruments manufactured from nickel-titanium alloy have proved to be a valuable adjunct for root canal therapy. Over the past two decades, instrument design has been considerably modified; progress has been made in manufacturing, as well as alloy processing. Clinical procedures and ideal working parameters are still being refined as new instruments continue to be introduced to the market. This review is intended to summarize clinical and laboratory findings for several current instruments. Some guidelines and usage parameters are also detailed. [ABSTRACT FROM AUTHOR]

An accurate diagnosis of the morphology of the root canal system is a prerequisite for successful root canal treatment. A review of the literature reveals a low incidence of three root canals. Diagnostic means, such as pre-operative radiographs and examination of the pulp chamber floor, are helpful in locating root canal entrances. This case report describes the successful treatment of maxillary second premolars with three root canals. [ABSTRACT FROM AUTHOR]

Aim: The current study aimed to investigate the root canal anatomy and their variations associated with premolar teeth in a defined population using tooth-clearing technique. Materials and Methods: Three hundred extracted premolar teeth (maxillary and mandibular) were collected from western Maharashtra (Pune). Access cavities were prepared and samples were placed in 2.5% sodium hypochlorite for 48 h. They were then decalcified with 5% nitric acid, dehydrated, and rendered clear by immersion in methyl salicylate, and methylene blue dye was injected. After staining, cleared teeth were evaluated for (i) number of roots and root canals, (ii) number of apical foramina, (iii) shape of root, (iv) type of root canal based on Vertucci's classification, (v) presence of lateral canals and their locations, and (vi) presence of root curvatures. Results: Vertucci Type I canal configuration represented the highest percentage (72.66%) followed by Type II (11.66%), Type III (6.33%), Type IV (4.66%), Type VI (2.66%), Type V (1.66%), Type VIII (0.66%), and C shaped (2.33%). Accessory canals were detected in 22.8% and intercanal connections were observed in 24.8% while 54% showed apical delta. Conclusion: Such knowledge is clinically useful for localization, negotiation, and subsequent management of premolar teeth in the studied population.

The objective of this article is to highlight the importance of having a thorough knowledge about the root canal anatomy and the possible anatomical variations in maxillary second molar. This case report presents the endodontic management of the left maxillary second molar with four roots and four canals. A cone-beam computed tomography (CBCT) imaging was performed to ascertain this complex root canal anatomy. The CBCT findings revealed that the distobuccal canal and the distopalatal canal of the left maxillary second molar exhibits Vertucci Type VI root canal anatomy. This case report demonstrates the usefulness of CBCT in the understanding of complex root canal anatomy of maxillary second molar and its potential use as an endodontic diagnostic tool.

Maxillary canines are usually found to be the single-rooted, single-canaled teeth1. Two roots with two root canals are a very rare condition2. Here we report a rare case of anatomic variation of permanent maxillary canine with three roots and three root canals which is first of its kind in the literature.

The description of non-surgical retreatment is to eliminate all previous filling materials and correct any mishaps. An adequate understanding of root and canal morphology is a fundamental requirement for obtaining a favorable outcome in endodontic treatment. The endodontic diagnosis was previously treated through therapy with symptomatic apical periodontitis. Treatment was performed under a dental operative microscope. Gates Glidden (GG) drills size 2 and 3 were used to remove the coronal part of gutta-percha for all canals. A braiding technique with a Hedstrom file size 15 without a solvent was used to remove gutta-percha and separate the file together for the palatal canal whereas the mesiobuccal canal was retreated by ProTaper Retreatment Kit. Proper understanding of root canal morphology and using an endodontic armamentarium could reduce endodontic mishaps. This case report described the successful management of overextended gutta-percha, a separated file, and a missed canal., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alnassar et al.)

Introduction: A simple tooth extraction method usually involves using elevators and forceps to remove the tooth easily. In contrast, a surgical extraction method requires utilizing a straight handpiece to facilitate the tooth extraction, either removing bone or sectioning the tooth into pieces., Objective: In this research, we aim to diagnose a tooth radiographically before extraction and determine certain factors to observe which extraction method might be more feasible, either simple or surgical., Methodology: This study followed a retrospective cross-sectional study design. The x-ray radiographs (periapical (PA) or panoramic) were collected from the R4 system in the university dental hospital for data collection. Different radiographic influencing factors were measured, such as bone density, bone level, endodontic involvement (RCT/post and core), crowned or remaining root, and root morphology. Statistical associations were performed using SPSS (IBM Corp., Armonk, NY) with a one-way ANOVA test., Results: There were 62 cases with 47 simple and 15 surgical extractions. There was a non-significant (p>0.05) association between the measured factors and the extraction method, either simple or surgical tooth extraction. Although bone density measurements showed a slight tendency toward PA lesions and simple tooth extraction., Conclusion: There was no significant association between the factors and extraction methods. Future research is required to determine whether or not preoperative radiographic evaluation can influence the decision for the tooth extraction method., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Darwish et al.)