Root Canal Morphology of Maxillary First Molars Using Cone Beam Computed Tomography

Background and objective: Root canal variations can be a challenge to detect and manage when performing root canal therapy, and failure to detect these variations in the root canals of the teeth will lead to unsatisfactory results of the treatment. An important tool for observing the root canal anatomy of teeth that are indicated for root canal treatment is cone beam computed tomography (CBCT). The objective of this study is to find out the rate of anatomical variations in the root canals of maxillary premolars and molars using CBCT among a Kurdish subpopulation in Erbil, Iraq. Materials and method: Data were collected from five dental clinics and radiographic centers in Erbil City. A total of about 690 CBCT images were used for the study, after applying the exclusion criteria, 205 CBCT images were included for the study. maxillary premolars and molars were examined for the number of roots, number of canals, and presence of root canal variations. Results: The prevalence of the second mesiobuccal (MB2) canal in maxillary first molars (MFM) was 47.8%, while in maxillary second molars (MSM), it was 18.05%. The prevalence of the second distobuccal (DB2) canal in (MFM) was 1.46%, with three recorded cases, while none of the (MSM) had a (DB2) canal. Additionally, only 2 cases (0.98%) in MSM had two palatal canals, whereas no such cases were recorded in MFM. A single case of MFM (0.49%) was recorded with two roots and canals, whereas in (MSM), 10 cases (4.88%) had two canals. In maxillary first premolars, five cases (2.44%) were reported with three roots and canals (molarized premolars). Similarly, five cases (2.44%) had a single canal, while 195 cases (95.12%) had two canals: one buccal and one palatal. In maxillary second premolars, 135 cases (65.85%) had two canals (buccal and palatal), and 70 cases (34.15%) had a single canal. Conclusion: There is a wide range of variations among maxillary molars and premolars, which need careful diagnostic evaluation to prevent missing canals during root canal treatment. Keywords: Anatomical variations, second mesiobuccal canal (MB2), Second distobuccal canal (DB2), Three rooted premolars (Molarized premolars), Second palatal canal (P2), Cone Beam Computed Tomography (CBCT), Erbil city

Introduction:The second canal of the mesiobuccal root (MB2) of the maxillary first molars (MFM) is difficult to detect in conventional radiographs and can be a major cause of failure in endodontic treatments. The aim of this study was to investigate the prevalence and anatomy of the MB2 by using high-resolution cone-beam computed tomography (CBCT). Methods and Materials:Three radiologists examined 414 high-resolution CBCTs. Of these, the CBCTs of 287 patients (mean age 49.43±16.76) who had at least one MFM were selected, making a total of 362 teeth. Prevalence and its relation with gender and age of the patients, side of the tooth, and Vertucci’s classification were analyzed. Data were statistically analyzed (P<0.05). Results:A total of 68.23% of the teeth exhibited the MB2. The presence of the MB2 was equivalent in both genders and significantly higher in younger patients. There was no correlation between the presence of the MB2 in relation to both the sides of the MFM and the FOV size. Smaller FOV recognized higher Vertucci’s grades.Conclusions:It was concluded that the prevalence of the MB2 canal in maxillary first molars in this Brazilian population examined with high-resolution CBTCs is 68.23%, being more prevalent in young patients. Gender and the side examined are no factors for determining the presence of MB2. Although the both FOVs of the high-resolution CBTCs (FOV 8 and 5) detect the MB2 canal, smaller FOV (FOV 5) is more accurate in the analysis of the internal anatomy of such root canals, according to the Vertucci´s classification.

The aim of this study was to evaluate the accuracy of the results of cone beam computed tomography (CBCT) examinations, confirm the presence or absence of the second mesiobuccal (MB2) root canal in maxillary first and second molars, estimate the distance between the root canal orifices, observe the root types based on Vertucci classification system, and make comparisons between CBCT and periapical techniques in relation to the identification of the root canal form and the second root canal of the MB root. The CBCT and periapical radiographic data from the Department of Maxillofacial Radiology were used to select 156 individuals (78 females and 78 males) for the evaluation of the anatomy of maxillary first and second molars. The prevalence rate of the second root canal in the MB root in the maxillary first molars was 55.1%, with 44.1 and 63.3% in females and males respectively. The prevalence rate in maxillary second molars was 23.7%, with 15.7 and 30.2% in females and males respectively. In addition, the longest and shortest distances between the root canal orifices were 2.4 and 0.3 mm respectively, with a mean of 1.3 mm. There was a significant difference between the results of periapical and CBCT radiographic techniques in relation to the presence or absence of the second root canal in the MB roots of maxillary first and second molars (p < 0.01), with better results being provided by the CBCT technique. The results of CBCT images about the existence of the second root canal in the MB roots of maxillary first and second molars are more reliable, and we can use this technique in the finding of additional canals in the clinic. Keyword: Cone beam computed tomography, Dental radiography, Root canal therapy.

Root canal variations frequently occur in maxillary first molars, which greatly affects the success of its treatment. The second mesiobuccal (MB) root canal is the most common root canal variation. However, only a few studies have been conducted on palatal root canal variations. Herein, we report the presence of two separate root canals in a palatal root of the maxillary first molar. A 39-year-old woman complained of pain in the maxillary right region for 1 year, which recently worsened. Clinical examination revealed a poorly restored right maxillary first molar and caries detected at the filling marginal. Cold and heat test results indicated severe pain in the right maxillary first molar. The patient was diagnosed with irreversible pulpitis, and subsequently, root canal treatment (RCT) was performed. In total, five root canals were found in the maxillary first molar, including two separate root canals in the palatal root. RCT was successfully performed using an endodontic microscope and cone-beam computed tomography (CBCT). The CBCT image revealed a vertucci type I canal morphology in the distobuccal root, while the MB and palatal root canals were type Ⅳ. At the 1-mo follow-up, the maxillary first molar was completely asymptomatic, and the X-ray results indicated a successful RCT. Finally, the ceramic crown restoration was performed. An endodontic microscope and CBCT are useful in effectively identifying and treating root canal variations.

Objective: As human 2nd molar teeth demonstrate considerable anatomic complexities and abnormalities in the number of roots and root canals, this study aimed to determine and investigate the root canal system of the mandibular 2nd molar teeth of a sample using cone-beam computed tomography. Variation can be found among different ethnic backgrounds. However, cone-beam computed tomography (CBCT) images eliminate the superimposition of anatomic structures. Methods: A total of 350 CBCTs were examined in this study. The analysis was conducted using the GALILEOS Viewer computer software program equipped with a disk containing the CBCT data. The Vertucci classification was used to categorize the data and the chi-square test to compare age groups, gender, and mouth sides. Results: Twenty-one two-handed CBCTs met the study criteria. Mandibular 2nd molar teeth were examined, and type 2 canal configuration was the most prevalent in the mesial root (57.1%), whereas type 1 canal configuration was the most prevalent in the distal canal (96.5%). Gender had no significant effect on the root canals' configuration except for the distal root of the right side. In contrast, age had a significant effect on root canal type, except for the right mesial root. There was a strong correlation between root canal types on the right and left sides. Conclusions: Type 1 and 2 root canal types were most prevalent in the distal and mesial root canal. Age was found to affect root canal type, and a correlation between right and left side root canal types was detected.

Permanent maxillary first molar morphology has been studied widely. Usually, it has three roots with three canals and the frequent deviation being incidence of a second mesiobuccal canal, thus showing a multifaceted root canal anatomy. Other variations comprise four and five roots and abnormal root canal morphology within individual roots. Many case reports with five and six root canals or a C-shaped canal configuration have been reported in the past. This varying number of root canals poses a challenge for endodontist in detecting and treating by root canal treatment. This problem can be avoided using techniques such as using the dental operating microscope and cone-beam computed tomography (CBCT). We report a change in canal morphology case of maxillary first molar having seven root canals, its evaluation, and management using latest equipment such as CBCT.

As is commonly understood, the root canal morphology of the maxillary molars is usually complex and variable. It is sometimes difficult to detect the distobuccal root canal orifice of a maxillary second molar with root canal treatment. No literature related to the distobuccal root canals of the maxillary second molars has been published.ObjectiveTo investigate the position of the distobuccal root canal orifice of the maxillary second molars in a Chinese population using cone-beam computed tomography (CBCT). Material and methodsIn total, 816 maxillary second molars from 408 patients were selected from a Chinese population and scanned using CBCT. The following information was recorded: (1) the number of root canals per tooth, (2) the distance between the mesiobuccal and distobuccal root canal orifice (DM), (3) the distance between the palatal and distobuccal root canal orifice (DP), (4) the angle formed by the mesiobuccal, distobuccal and palatal root canal orifices (∠ PDM). DM, DP and ∠ PDM of the teeth with three or four root canals were analyzed and evaluated. ResultsIn total, 763 (93.51%) of 816 maxillary second molars had three or four root canals. The distance between the mesiobuccal and distobuccal orifice was 0.7 to 4.8 mm. 621 (81.39%) of 763 teeth were distributed within 1.5-3.0 mm. The distance between the palatal and distobuccal orifice ranged from 0.8 mm to 6.7 mm; 585 (76.67%) and were distributed within 3.0-5.0 mm. The angle (∠ PDM) ranged from 69. 4º to 174.7º in 708 samples (92.80%), the angle ranged from 90º to 140º. ConclusionsThe position of the distobuccal root canal orifice of the maxillary second molars with 3 or 4 root canals in a Chinese population was complex and variable. Clinicians should have a thorough knowledge of the anatomy of the maxillary second molars.

Root canal anatomy is complex, and understanding anatomical variations is essential for successful treatment. This case report highlights a maxillary first molar with a rare anatomical variation consisting of seven canals: three in the mesiobuccal (MB1, MB2, MB3), two in the distobuccal (DB1 and DB2), and two in the palatal (P1 and P2) roots. Cone beam computed tomography (CBCT) examination was performed to confirm the presence of these seven canals. Diagnosing and managing such complex canal configurations presents significant challenges in endodontics. The patient was treated with the lateral compaction technique for obturation. A thorough understanding of root canal morphology and its potential variations is crucial for achieving effective access, cleaning, and obturation. Reporting rare cases like this helps expand clinical knowledge and improve the management of complex root canal systems in endodontic practice. Keywords: Anatomy, Cone-Beam Computed Tomography, Maxillary molar, Root canal therapy, Tooth abnormality

A cephalometric analysis was designed to evaluate several factors that may affect the sagittal position of the maxillary first permanent molar. A total of 184 Class II and Class I malocclusion patients were randomly selected before orthodontic treatment. The mandibular and palatal planes were related to Frankfort Horizontal and used to create the interjaw or B angle. Age and cephalometric landmarks (Ba, N, point A, pterygomaxillary fissure, and maxillary molars) were projected at right angles to the Frankfort Horizontal for effective length. Actual maxillary length and actual molar location were determined by projecting landmarks at right angles to the palatal plane. Correlation coefficients and P values were used to evaluate the data with a minimal significance value of .05 to determine a 95% confidence level. A statistically significant linear and proportional positive correlation (P < .0001) existed between molar location, age, and maxillary size. There was a strong negative correlation (P < .0001), both linearly and as a proportion of the actual length of the maxilla, between the actual position of the maxillary molar and the interjaw and mandibular plane angles. A significant correlation also existed between the molar position and palatal plane angles. The results show that increased interjaw, mandibular, and palatal plane angles are accompanied by a more posterior position of the maxillary first molar in the maxilla, whereas the molar occupied a continuing more forward position in the maxilla with increasing age, cranial base length, and maxillary size.

BackgroundThe study's objective was to use CBCT to ascertain the root and root canal anatomy of the permanent maxillary first molars in a Yemeni population. It was considered how gender affected the prevalence of root canal morphology.MethodsA sample of 373 CBCT records of maxillary permanent first molars belonging to 373 Yemeni individuals (162 males and 211 females) aged between 12 and 65 years were included in this study. Using CBCT on the teeth, the root form and canal morphology for each root based on Vertucci's classification were evaluated. The distribution of MB2 occurrence was documented. The prevalence and resemblance of the men and females were investigated. The Chi-square test was performed to evaluate the findings.ResultsOf the 373 maxillary first molars studied, the three separated root form was found in 94.9% of the studied MFMs while the two fused and one separate root form was found in 4.5%. The majority of the three-rooted MFMs (82.6%) had more than three root canals (four canals in 77.2% and five canals in 5.4%). The prevalence of MB2 was as high as 82.3% of the three-rooted MFMs. Vertucci type II configuration was the most frequent canal type (25%) followed by Vertucci type III (23.1%) and Vertucci type I (17.7%) in the mesiobuccal root. Vertucci type I was the most prevalent canal configuration in the distobuccal root and palatal root of the three-rooted MFMs (96% and 99.5%, respectively).ConclusionsThe maxillary first molars' root canal morphology indicated notable variations among a Yemeni population. The maxillary first molars of most of the Yemeni participants in this study had three roots and four canals. In light of the high occurrence of MB2 (82.3%) in permanent maxillary first molars, our findings emphasize the need of searching for and using cutting-edge techniques to locate the MB2 canals. Males outnumbered females in proportion.

Introduction: Limited information is available about the canal morphology of mandibular first molars in North Indian population. The purpose of this study was to evaluate the root canal morphology of North Indian mandibular first molars by clearing and staining technique. Materials and Methods: A total of 863 mandibular first molars collected from various places in North India were subjected to canal staining and decalcification procedures. Access cavities were prepared, and pulp tissue dissolved with sodium hypochlorite. Indian ink was injected into the root canals aided by negative pressure applied at the root tips. The stained teeth were decalcified with 7% hydrochloric acid. Instead of ascending concentrations of alcohol, a nonalcohol-based drying agent (anhydrous calcium chloride) was used to remove traces of acid and water from the specimens. The dried specimens were immersed in methyl salicylate to render them transparent. The following features were observed under operating microscope at ×6 magnification: (i) Number of root canals per tooth, (ii) number of root canals per root, (iii) root canal configuration in each root (Vertucci’s classification), and (iv) lateral canals, intercanal communications, and their location. Results: Majority had two roots (85%) with three (61%) and four (30%) canals. Three roots were present in 15% of the specimens. Type IV (49%) and type I (48%) were the most common configurations in mesial and distal roots, respectively. Conclusion: First molars with two roots and three canals are a common feature in North Indian patients. Both roots showed wide variations in canal anatomy with type IV and type I configurations predominating in mesial and distal roots, respectively.

BackgroundThis retrospective study aims to characterise the root canal morphology of maxillary and mandibular second molars using cone-beam computed tomography (CBCT). The number of roots and canal configurations were evaluated using both the Vertucci and Benjamı´n Brisen˜ o Marroquı´n classification systems.MethodsA total of 1084 second molar images (523 maxillary; 266 right and 257 left side and 561 mandibular; 285 right and 276 left side) were evaluated from 320 CBCT scans analyzed for the Turkish subpopulation. CBCT imaging provided superior visualisation of root canal anatomy compared to periapical radiography. The findings revealed diverse root canal configurations, with variations observed even within the same population. Statistical analyses, including the chi-squared test, were used to assess correlations between root number and demographic variables such as age and sex.ResultsAccording to Benjamı´n Brisen˜ o Marroquı´n classification system, the most common configuration for upper right three-rooted teeth mesial root was 3URM2−1 (n:66, 35.7%), for distal root was 3URM1 (n:169, 91.4%), and for palatal root was 3URM1 (n:165, 89.2%). Additionally, the most common configuration for upper left three-rooted teeth mesial root was 3271 (n:50, 28.4%), for distal root was 3ULM1 (n:160, 90.9%), and for palatal root was 3ULM1 (n:158, 89.8%). In lower left molars, the most common configuration in the two-rooted teeth mesial root was 2LLM2 (n:114, 49.4%), and for the distal root was 2LLM1 (n:170, 73.6%). For lower right the most common configuration for two-rooted teeth mesial root was 2LRM2 (n:125, 52.5%), and for distal root was 2LRM1 (n:173, 72.7%)(p < 0.05).ConclusionThe primary outcome was observed that the root canal anatomy of upper and lower second molars may differ in both classifications of Turkish subpopulation. While Vertucci's classification was inadequate in some cases, Briseno-Marroquin classification was able to classify all upper and lower second molars with a single code. This new classification is a more useful system for classifying all second molars. There is a statistically significant difference exists among the new configuration according to the distribution of the teeth analyzed.

Cone beam computed tomography analysis of the root and canal morphology of the maxillary second molars in a Hail province of the Saudi population

Aim The aim of this study was to investigate the root and canal morphology of maxillary first and second molars in Southern West Coastal Indian population using cone beam computed tomography (CBCT). Materials and methods Cone beam computed tomography images of (n = 143) maxillary first molar and (n = 139) maxillary second molar were obtained from Southern West Coastal Indian population. The number of roots, root canals, and presence of second mesiobuccal (MB2) canal were determined. Results Two roots were seen only in 1.4% of first molars and 8.6% of second molars. Three- rooted were the most common and seen in 98.6% of first molars and 89.9% of second molars. Single root was seen in 1.4% of second molars. The incidence of MB2 canal in the first molar is 64.1% and in second molar 23%. C-shaped canals were found in 1.4% of the second molars Conclusion Southern West Coastal Indian population showed features that were similar to other regions of Indian Population. The CBCT is a wonder tool for the study of root canal morphology and a reliable source of information for retrospective studies. How to cite this article Mohan RP, Thomas MS, Shetty N, Ahmed J, Pallippurath G, Tallada A. Evaluation of the Root and Canal Morphology of Maxillary First and Second Molar using Cone Beam Computed Tomography: A Retrospective Study. World J Dent 2017;8(2):134-138.

The aim of this study was to evaluate the frequency of roots, root canals and apical foramina in human permanent teeth using cone beam computed tomography (CBCT). CBCT images of 1,400 teeth from database previously evaluated were used to determine the frequency of number of roots, root canals and apical foramina. All teeth were evaluated by preview of the planes sagittal, axial, and coronal. Navigation in axial slices of 0.1 mm/0.1 mm followed the coronal to apical direction, as well as the apical to coronal direction. Two examiners assessed all CBCT images. Statistical data were analyzed including frequency distribution and cross-tabulation. The highest frequency of four root canals and four apical foramina was found in maxillary first molars (76%, 33%, respectively), followed by maxillary second molars (41%, 25%, respectively). The frequency of four root canals in mandibular first molars was 51%. Mandibular first premolars had two root canals and two apical foramina in 29% and 20% of the cases, respectively. Mandibular central and lateral incisors and canines presented two root canals in 35%, 42% and 22% of the cases, respectively. The navigation strategy in CBCT images favors a better identification of frequency and position of roots, root canals and apical foramina in human permanent teeth.