|Year : 2021 | Volume
| Issue : 1 | Page : 49-53
Evaluation of root canal configuration of mandibular incisors among a Saudi subpopulation of Qassim region using cone-beam computed tomography: A retrospective study
Ahmed Nabil Mohamed1, Ahmed Abdulrahaman Alhirabi2, Abdelaleem Hassan Elsantawy3, Faris Sulaiman Aldakheel2
1 Department of Conservative Dental Sciences, Qassim University, Saudi Arabia
2 General Dental Practitioner, qassim university, Saudi Arabia
3 Department of oral and Maxillofacial Surgery and Diagnostic Sciences, qassim university, Saudi Arabia
|Date of Submission||03-Dec-2019|
|Date of Decision||23-Mar-2020|
|Date of Acceptance||08-Apr-2020|
|Date of Web Publication||09-Jan-2021|
Dr. Ahmed Abdulrahaman Alhirabi
General Dental Practitioner, P.O. Box 3635, Onaizah 53437, Buraydah
Source of Support: None, Conflict of Interest: None
Introduction: This study aimed to determine the root canal configuration of mandibular incisors among a Saudi subpopulation of Qassim region using cone-beam computed tomography (CBCT).
Materials and Methods: CBCT images of 94 patients aged from 13 to 69 years with 376 healthy mandibular incisors fulfilling the inclusion criteria were evaluated. The root canal configurations of the examined teeth were recorded in accordance with the Vertucci's classification for each tooth. Data were statistically analyzed.
Results: All the examined mandibular incisors had a single root. Type I root canal configuration represented 44.4%, Type II 8%, Type III 44.9%, Type IV 0.5%, and Type V 2.1%. Chi-square tests showed no statistically significant association between the type of tooth and the presence of a second canal (P = 0.177).
Conclusions: Within the limitations of this study, it can be concluded that a single root with two root canals of Type III was the most common root canal configuration of the mandibular incisors within a Saudi subpopulation of the Qassim region.
Keywords: Cone-beam computed tomography, endodontics, mandibular incisors, root canal configuration
|How to cite this article:|
Mohamed AN, Alhirabi AA, Elsantawy AH, Aldakheel FS. Evaluation of root canal configuration of mandibular incisors among a Saudi subpopulation of Qassim region using cone-beam computed tomography: A retrospective study. Saudi Endod J 2021;11:49-53
|How to cite this URL:|
Mohamed AN, Alhirabi AA, Elsantawy AH, Aldakheel FS. Evaluation of root canal configuration of mandibular incisors among a Saudi subpopulation of Qassim region using cone-beam computed tomography: A retrospective study. Saudi Endod J [serial online] 2021 [cited 2022 Jan 19];11:49-53. Available from: https://www.saudiendodj.com/text.asp?2021/11/1/49/306597
| Introduction|| |
The endodontic treatment of the teeth depends on the following three main steps: (1) the recognition of root canals, which results in a complete debridement of the tissues of the pulp; (2) complete chemo-mechanical cleaning and shaping; and (3) three-dimensional (3D) obturation of the root canals.
Any failure to detect, clean, shape, or obturate all the root canals may result in untreated spaces inside the tooth., Therefore, to improve the prognosis of endodontic treatment, every clinician should have a proper knowledge of the possible variation of the root canal system.
According to different studies, all groups of teeth may have anatomical variations with different incidences., The majority of mandibular incisors have a single root with one canal., However, the root canal configuration of mandibular incisors can be complicated by the presence of three anatomical variations, which are the second root canal, lateral root canals, and apical deltas.
The most common reason for the unsuccessful endodontic treatment of permanent mandibular incisors is the presence of an undetected lingual root canal or the presence of an untreated isthmus. It represents a corridor, a lateral connection, or anastomosis of two separate root canals that contain the pulpal tissue.
The prevalence of the second root canal in mandibular incisors varies by race, gender, and population. In a Palestinian population, Mukhaimer and Jarbawi found that 29.3% of the examined teeth have a second root canal. In a northern Brazil population, Nogueira reported that 18% of the examined teeth had a second root canal. In a North Indian population, Bhat et al. found that 49% of the examined teeth had a second root canal. In Saudi Arabia, three studies that evaluated the root canal morphology of mandibular incisors were published. The first study was conducted by Al-Fouzan et al., who used canal staining and clearing techniques to evaluate the incidence of a second root canal in the extracted mandibular incisor teeth. They found that one-third of the examined teeth had a second root canal. The second study conducted by Mashyakhy using cone-beam computed tomography (CBCT) images of patients at the Jazan region revealed that two canals appeared in 28.6% of the examined teeth. The third study conducted by Ghabbani et al. at Al-Madinah Al-Munawarah region using CBCT images indicated that only 50.3% of the examined teeth have one root canal.
CBCT has become an effective tool in successfully exploring the morphology of root canals. It has a high degree of accuracy, similar to the modified staining and clearing technique. In addition, it allows the examination of a larger number of teeth in 3D view. However, there is no reported study that deals with the root canal configuration of mandibular incisors among the residents of the Al-Qassim region in Saudi Arabia. Therefore, the aim of this study was to determine the root canal configuration in mandibular incisors among a Saudi subpopulation of the Qassim region using CBCT.
| Materials and Methods|| |
This cross-sectional retrospective study was conducted based on the radiographic assessment of the collected CBCT Digital Imaging and Communications in Dental files already made for other diagnostic purposes of 94 male and female Saudi dental patients. These patients were identified from the available database of CBCT at the archive of the Oral and Maxillofacial Radiology Department, Dental Clinics Center, Qassim University, Saudi Arabia. The study was approved by the Research Ethics Committee of the College of Dentistry, Qassim University (Code #: EA/6019/2019).
The inclusion criteria included patients from both genders, above the age of 13 years, and having all mandibular anterior dentitions with fully formed apices without endodontic treatment, crowns, or pathologies. Furthermore, the exclusion criteria included completely edentulous patients; patients with missing mandibular anterior teeth; or those with open apex, root resorption, calcifications, developmental disorders, a history of an orthodontic treatment, or blurred CBCT images.
CBCT radiographs were taken using the Galileos® ComfortPLUS System Sidexis software (SIDEXIS XG) (Sirona 3D, Germany) with the following specifications:
- The X-ray generator has 98 kV and 3–6 mA
- The focal spot size was 0.5 mm, in accordance with the institutional ethical committee (IEC) 60336
- The total filtration was >2.5 mm, in accordance with the IEC 60522
- An image intensifier detector by Siemens has the following settings: 1000 pixels, 15–30 frames per second, 12-bit dynamics, 15.4-cm image volume, 15 cm × 8.5 cm-spherical volume (collimated), 0.25/0.125-mm voxel size, and 14 s/2–5-s scan time/exposure time. Galileos software was used.
CBCT scans were oriented to standardize the measurements so that the bilateral mandibular condyles were at the same level in the axial view. The mental foramina of the right and left sides were parallel to the horizontal line in the coronal view. In the sagittal view, the Frankfort plane represented the true horizontal axis.
The CBCT images were evaluated by two dentists, both with a 1-year clinical experience. To reduce errors in determining the root canal morphology, all examinations were repeated on two separate occasions at 1-week intervals. Differences between the two readings for intra-examiner variations were tested by Kappa test.
The examined teeth were classified in accordance with the Vertucci's classification.,
The collected data were statistically analyzed using the Statistical Package for the Social Sciences (SPSS) software version 22 (SPSS Inc., Chicago, IL, USA). The level of statistical significance was set at P < 0.05. The association between the type of tooth and the number of canals was analyzed with Chi-square test. Kappa test was also used to examine inter- and intra-examiners' reliability.
| Results|| |
The total number of examined mandibular incisor teeth was 376 (188 central and 188 lateral), of these 128 teeth were of females and 248 of males. All the examined teeth (100%) had a single root. All types of root canal configuration were seen [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5]. Type I (23.9%) in lateral incisor and Type III (22.9%) in central incisor were most frequently seen [Table 1]. In total, the percentage of the second root canal was present in 55.6% of the examined teeth.
|Figure 1: Cone-beam computed tomography section of the mandibular central incisor with Type I root canal configuration: (a) sagittal plane, (b) axial plane|
Click here to view
|Figure 2: Cone-beam computed tomography section of the mandibular central incisor with Type II root canal configuration: (a) sagittal plane, (b) axial plane|
Click here to view
|Figure 3: Cone-beam computed tomography section of the mandibular lateral incisor with Type III root canal configuration: (a) sagittal plane, (b) axial plane|
Click here to view
|Figure 4: Cone-beam computed tomography section of the mandibular central incisor with Type IV root canal configuration: (a) sagittal plane, (b) axial plane|
Click here to view
|Figure 5: Cone-beam computed tomography section of the mandibular lateral incisor with Type V root canal configuration:(a) sagittal plane, (b) axial plane|
Click here to view
|Table 1: Frequency of root canal configuration of the mandibular incisors by tooth type and gender according to Vertucci's classification|
Click here to view
No association was found between the incidence of a second root canal (Types II, III, IV, and V) and type of tooth (P = 0.177), which indicates that there is no statistically significant difference. The presence of two root canals (Type III) was higher in females.
| Discussion|| |
Mandibular central and lateral incisor teeth are similar in their root and canal morphology. They have one root and one canal and may have some variations such as presence of second canals and apical deltas.,
In clinical practice, the main reason for endodontic treatment failure is the inability to locate a second root canal, which results in untreated areas of the root canal system. Therefore, the knowledge of root canal anatomy and its possible variations is necessary in endodontic treatment. Accordingly, various methods have been employed in the study of root canal anatomy, including staining and grinding, dye injection of decalcified teeth,, and CBCT., In the present study, CBCT images were used to study the root canal configuration of the mandibular incisors where fine details can be viewed in high-quality –3D view that helps dentist to get an accurate diagnosis of many conditions.
Types I–V of Vertucci's root canal configuration were observed in the current study., The prevalence of having one apical foramen (Types I, II, and III) in the present study was very high, which is consistent with the results of Vertucci, Al-Fouzan et al., Mashyakhy, and Ghabbani et al.
The incidences of two root canals in mandibular incisors differ in previous studies. Sert et al. reported 68%, whereas Lin et al. found that only 10.9% of mandibular central incisors have a second root canal. This could be attributed to the ethnic backgrounds of the participants. In the current study, 55.6% of the examined teeth had a second root canal, which is slightly higher than the findings of Ghabbani et al., who found that 47.8% of the examined mandibular incisors in a Saudi Arabian subpopulation have a second canal. By contrast, the difference in the sample size and differences in the experience of the examiners may explain the difference in the results.
In terms of gender, no difference was found between central and lateral incisors in terms of number of root canals. The presence of one root canal was higher in males and two canals was higher in females. The findings of this study regarding two canals were similar to those reported by Geduk et al. and Verma et al. and in contradiction with Mashyakhy, Lin et al., and Martin et al. This incidence should give the endodontist an important information when performing root canal therapy.
Age is also considered a factor affecting root canal morphology due to the calcifications of canals, which are associated with increasing age that may result in the disappearance of root canals. However, age was not analyzed as an influencing factor in the present study.
As this study found that the majority of mandibular incisors have a second canal, the access preparation should be extended lingually beneath the cingulum to avoid missing the second canal. In addition, instruments and materials become easy to handle properly in case of a complex root canal system. However, this study is limited to one specific geographic area. This characteristic is a limitation of the study. Therefore, a large number of teeth that represent several regions of Saudi Arabia should be evaluated.
| Conclusions|| |
Within the limitations of this study, it can be concluded that the most common root canal configuration of mandibular incisors within a Saudi subpopulation of the Qassim region is Type III.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Slowey RR. Radiographic aids in the detection of extra root canals. Oral Surg Oral Med Oral Pathol 1974;37:762-72.
Vertucci FJ. Root canal morphology and its relationship to endodontic procedures. Endod Topics 2005;10:3-29.
Cantatore G, Berutti E, Castellucci A. Missed anatomy: Frequency and clinical impact. Endod Topics 2009;15:3-31.
Kulild JC, Peters DD. Incidence and configuration of canal systems in the mesiobuccal root of maxillary first and second molars. J Endod 1990;16:311-7.
Gulabivala K, Aung TH, Alavi A, Ng YL. Root and canal morphology of Burmese mandibular molars. Int Endod J 2001;34:359-70.
Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589-99.
Rahimi S, Milani AS, Shahi S, Sergiz Y, Nezafati S, Lotfi M. Prevalence of two root canals in human mandibular anterior teeth in an Iranian population. Indian J Dent Res 2013;24:234-6.
] [Full text]
Weine FS, Healey HJ, Gerstein H, Evanson L. Canal configuration in the mesiobuccal root of the maxillary first molar and its endodontic significance. Oral Surg Oral Med Oral Pathol Oral Radiol 1969;28:419-25.
Uma CH, Ramachandran S, Indira R, Shankar P. Canal and isthmus morphology in mandibular incisors – An in vitro
study. Endod 2004;16:7-11.
Mukhaimer R, Jarbawi M. Radiographic study of the root canal system of mandibular incisors in Palestinian population. Open J Stomatol 2013;3:452-6.
Nogueira BM, Nogueira BC, Fagundes NC, Menezes TO, Lima RR, Brandão JM. Root canal morphology of permanent mandibular incisors. Int J Odontostomatol 2017;11:95-100.
Bhat S, Sheth R, Kumar P, Khilosiya A. Root canal morphology and assessment of incidence, type, and position of isthmus in permanent mandibular central incisor in North Indian population: An in vitro
Al-Fouzan KS, AlManee A, Jan J, Al-Rejaie M. Incidence of two canals in extracted mandibular incisors teeth of Saudi Arabian samples. Saudi Endod J 2012;2:65-9. [Full text]
Mashyakhy M. Anatomical analysis of permanent mandibular incisors in a Saudi Arabian population: An in vivo
cone-beam computed tomography study. Niger J Clin Pract 2019;22:1611-6.
] [Full text]
Ghabbani HM, Marghalani AA, Alabiri HR. Assessment of root canal morphology of mandibular incisors using cone-beam computed tomography among residents of Al-Madinah Al-Munawara Region, Saudi Arabia. Europ J Gen Dentist 2020;9:40-4.
Neelakantan P, Subbarao C, Subbarao CV. Comparative evaluation of modified canal staining and clearing technique, cone-beam computed tomography, peripheral quantitative computed tomography, spiral computed tomography, and plain and contrast medium-enhanced digital radiography in studying root canal morphology. J Endod 2010;36:1547-51.
Miyashita M, Kasahara E, Yasuda E, Yamamoto A, Sekizawa T. Root canal system of the mandibular incisor. J Endod 1997;23:479-84.
Lin Z, Hu Q, Wang T, Ge J, Liu S, Zhu M, et al
. Use of CBCT to investigate the root canal morphology of mandibular incisors. Surg Radiol Anat 2014;36:877-82.
Green D. Double canals in single roots. Oral Surg Oral Med Oral Pathol 1973;35:689-96.
Sert S, Aslanalp V, Tanalp J. Investigation of the root canal configurations of mandibular permanent teeth in the Turkish population. Int Endod J 2004;37:494-9.
Geduk G, Deniz Y, Zengin AZ, Eroglu E. Cone-beam computed tomography study of root canal morphology of permanent mandibular incisors in a Turkish sub-population. J Oral Maxillofac Radiol 2015;3:7-10. [Full text]
Verma GR, Bhadage C, Bhoosreddy AR, Vedpathak PR, Mehrotra GP, Nerkar AC, et al
. Cone beam computed tomography study of root canal morphology of permanent mandibular incisors in Indian subpopulation. Pol J Radiol 2017;82:371-5.
Martins JN, Marques D, Mata A, Caramês J. Root and root canal morphology of the permanent dentition in a Caucasian population: A cone-beam computed tomography study. Int Endod J 2017;50:1013-26.
Kaya S, Adiguzel O, Yavuz I, Tumen EC, Akkus Z. Cone-beam dental computerized tomography for evaluating changes of aging in the dimensions central superior incisor root canals. Med Oral Patol Oral Cir Bucal 2011;16:e463-6.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]