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ORIGINAL ARTICLE
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 162-167

Cone-beam computed tomography evaluation of the root morphology of the maxillary and mandibular premolars in a Moroccan subpopulation: Canal configurations and root curvatures (Part 2)


1 Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Hassan II University, Casablanca, Morocco
2 Private Practice, Casablanca, Morocco

Date of Submission17-Jul-2019
Date of Decision01-Apr-2020
Date of Acceptance15-Apr-2020
Date of Web Publication8-May-2021

Correspondence Address:
Prof. Said Dhaimy
Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Hassan II University, Casablanca
Morocco
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sej.sej_77_19

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  Abstract 

Introduction: The aim of this study is to investigate canal configurations and root curvatures of maxillary and mandibular premolar teeth in a Moroccan subpopulation using cone-beam computed tomography (CBCT) images.
Materials and Methods: The root curvature and canal configuration of 919 CBCT images of maxillary (358) and mandibular (561) premolar teeth were investigated using “Planmeca viewer” software. Data were analyzed using descriptive statistics.
Results: About 46.8% of the maxillary first premolars with two roots had Type I canal configuration of each roots and 27.5% of single-rooted ones presented Type VII. The two-rooted maxillary second premolars showed Type I (39.35%) canal configuration. As for the single-rooted premolars, 32.8% showed Type III canal configuration. The distobuccal curvature was the most frequent for the single-rooted teeth (30.4%) as well as for the palatal (32.4%) root of the two-rooted ones. More than 70% of each root, had Type I of the two rooted mandibular first premolars while 41.8% of the single-rooted premolars had Type V. Type I canal configuration was the most revealed in single-rooted mandibular second premolars with a percentage of 60.6%. Few teeth with two and three roots were seen. The distolingual curvature showed the highest incidence among single-rooted premolars (37.8%) as well as the buccal roots of the two-rooted ones (51.8%).
Conclusion: The Moroccan subpopulation's premolars showed a high prevalence of Vertucci's canal configuration Type I with distobuccal curvature for maxillary teeth and distolingual for mandibular teeth.

Keywords: Canal configuration, cone-beam computed tomography, mandibular premolar; maxillary premolar, root curvature


How to cite this article:
Dhaimy S, Dhoum S, Diouri M, Bedida L, Elmerini H, Benkiran I. Cone-beam computed tomography evaluation of the root morphology of the maxillary and mandibular premolars in a Moroccan subpopulation: Canal configurations and root curvatures (Part 2). Saudi Endod J 2021;11:162-7

How to cite this URL:
Dhaimy S, Dhoum S, Diouri M, Bedida L, Elmerini H, Benkiran I. Cone-beam computed tomography evaluation of the root morphology of the maxillary and mandibular premolars in a Moroccan subpopulation: Canal configurations and root curvatures (Part 2). Saudi Endod J [serial online] 2021 [cited 2021 Jun 17];11:162-7. Available from: https://www.saudiendodj.com/text.asp?2021/11/2/162/315654


  Introduction Top


To perform endodontic treatments skillfully and effectively, dentists ought to know tooth anatomy very well, especially the internal one.[1] A thorough knowledge of root canal anatomy is extremely important for locating canals, full canal debridement and for preventing misdiagnosis as well as errors during instrumentation.[2] Nevertheless, the variation of the root canal morphology presents clinical difficulties that often might lead to unfavorable outcomes.[3]

A successful management of endodontic problems depends on diagnostic imaging techniques to provide critical information about the teeth under examination and their surrounding anatomy.[4] Most of this core information would be obtained from conventional radiographs. However, intraoral and panoramic assessments have inherent limitations in the fact that three-dimensional (3D) anatomy is compressed in a 2D image; the superimposition of anatomic structures may cause a geometric distortion of the area and an anatomic noise that can hide the region of interest. Cone-beam computed tomography (CBCT) imaging may overcome these problems by producing 3D images of teeth and their surrounding tissues.[5] Slices can be selected to avoid adjacent anatomic noise. For example, the roots of maxillary posterior teeth and their periapical tissues can be visualized separately and in all three orthogonal planes without superimposition of the overlying zygomatic buttress, alveolar bone, and adjacent roots.[6]

Many studies have evaluated the root and canal morphology of premolars.[1],[2],[3],[5] However, no morphological study with any technique on the premolars of the Moroccan subpopulation had been published yet. Therefore, the aim of this study was to investigate root canal configurations and curvatures of maxillary and mandibular premolar teeth in a Moroccan subpopulation using CBCT images.


  Materials and Methods Top


The study was approved by the ethical committee of the School of Dentistry, Hassan II University. Casablanca, Morocco (#104/15). To comply with the principles of radioprotection (principles of justification and optimization) of ionizing radiation examinations, no cone-beam examination has been prescribed specifically for this study.

A total of 919 premolar teeth, of which 180 first maxillary premolars, 178 s maxillary premolars, 304 first mandibular premolars, and 257 s mandibular premolars were randomly collected from a radiology center's database in the region of Casablanca between January and December 2017. The samples were made of 493 females and 426 males, who presented fully formed first and second premolars of all quadrants, with no root canal filling, post or crown restorations, and free from teeth anomalies. The CBCT images presenting the kinetic of metallic artifacts lead to a difficulty of interpretation were excluded.

The CBCT images were obtained using a Planmeca Promax 3D plus (Planmeca Oy, Helsinki, Finland) scanner, with the following parameters: 90 kV, 10 mA, with a field of view of 601 × 601 × 601 and 150 μm voxels. Serial sagittal, coronal, and axial views of CBCT images from the coronal portion of the tooth to the root apex of each tooth were examined carefully by an experienced radiologist using “Planmeca viewer” software according to the following features: Root canal configuration according to Vertucci's classification [Figure 1],[7] and root curvature referring to the deviation of the apex to the major vertical axis [Figure 2].
Figure 1: Canal configuration according to Vertucci's (1984) classification. (a) Type I; (b) Type VII; (c) Type V; (d) Type II

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Figure 2: Root curvatures: (a) Palatal; (b) Distal

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The data were collected using Digital Imaging and Communications in Medicine format. Statistical analysis was performed using the software Epi info (version 6.04d, CDC, Atlanta, USA). Various canal configurations and the presence or absence of root curvatures were expressed in percentage.


  Results Top


Canal configuration

The root canal configurations of the maxillary and mandibular premolars, as well as their frequencies, are shown in [Table 1].
Table 1: Root canal configuration according to the Vertucci's (1984) classification

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Maxillary premolars

Overall, most of the two-rooted maxillary first premolars had Type I canal configuration (46.8%) in both buccal and lingual root. The single-rooted premolars revealed 27.5% of Type VII.

For the maxillary second premolars with two roots, Type I was also the most prevalent with a percentage of 31.9% and 46.8% buccally and lingually, respectively. The rate of Type III (32.8%) was high in single-rooted teeth. Other canal configurations were present, but in small quantities [Table 1].

Mandibular premolars

The Type I canal configuration was the most prevalent in the two-rooted first premolars in proportion to 72.4% in the buccal root and 75.9% in the lingual root, while most of the premolars with one root presented Type V canal configuration (41.8%).

As for the mandibular second premolars, the majority of single-rooted premolars had Type I in the rate of 60.6%. Few two rooted teeth showed an equal incidence of Type I (40%) and Type V (40%) in both of the buccal and lingual roots. Other canal configurations were present, but in small quantities [Table 1].

Root curvatures

The root curvatures of the examined maxillary and mandibular teeth are shown in [Table 2] and [Table 3].
Table 2: The presence of curvatures and their orientation within maxillary premolars

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Table 3: The presence of curvatures and their orientation within mandibular premolars

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Maxillary premolars

In broad terms, the single-rooted maxillary first premolars have shown root curvatures in 97.1% of cases and 100% of the buccal roots and in 98.2% of the palatal for the two-rooted ones. The distobuccal curvature was the most frequent for the single-rooted teeth (30.4%) as well as for the palatal (32.4%) root of the two-rooted ones. About 49.5% of the buccal roots curved distopalatally.

For the maxillary second premolars, root curvatures were detected in 96.2% of single-rooted teeth and 100% of the buccal roots of the two-rooted teeth and in 95.7% of the palatal roots. The most prevalent curvature was toward the distobuccal. This was for the single-rooted teeth (48.9%) as well as for the palatal root of the two-rooted ones (34%). The buccal roots of the two-rooted premolars curved toward the distopalatal direction (25.5%).

Mandibular premolars

About 98.2% of the single-rooted mandibular first premolars teeth have curvatures, as well as 96.6% of the two-rooted teeth's buccal roots and 100% of their lingual ones. The distolingual curvature showed the highest incidence among single-rooted premolars (37.8%) as well as the buccal roots of the two-rooted ones (51.8%). The lingual roots mostly exhibited a distobuccal curvature (41.4%).

Ninety-eight percent of the single-rooted mandibular second premolars have shown root curvatures, with the distobuccal one being the most prevalent (45.4%). All two-rooted teeth had curvatures where the distolingual one was the most predominant within the buccal roots (40%), whereas the distal one was so within the lingual roots (40%). As for the three-rooted mandibular second premolar found, its mesiobuccal root had a distolingual curvature, its distobuccal one had a distobuccal curvature and its lingual one had a mesiobuccal curvature.


  Discussion Top


Knowledge of root canal morphology, including the configuration and degree of canal curvatures, is of critical importance to increase clinical success. Maxillary and mandibular premolars may be the most difficult teeth in the mouth to treat. This is probably due to the failure of clinicians to recognize the numerous variations in canal morphology that may exist in these teeth.[8] The present study provides a detailed anatomic description of the maxillary and mandibular first and second premolars of Moroccan subpopulation based on a retrospective analysis of CBCT images.

The complex anatomy of the canal system in the premolars makes it difficult to assess with some techniques such as conventional radiography, nevertheless, a radiograph of good quality using in the right direction will provide additional insight into the internal anatomy of the root canal.[9]

Three-dimensional analysis with cone-beam tomographic has become a widely used analytical tool in implantology, maxillofacial reconstruction, and surgery and in endodontic diagnosis in terms of canal assessment, preparation, and obturation, especially for the complicated root canal morphology such the second mandibular premolar.[10],[11] With the use of CBCT equipment, it is possible to obtain images with sufficient resolution to allow the study of the canal system anatomy, as performed in the present work.[12] Although CBCT investigation cannot be used routinely because of economic and radiation-exposure concerns.[9]

In the present study, the maxillary first premolars had mostly Type I, these results are in accordance with the ones found in the study conducted by Bulut et al.[3] whom stated that most of the maxillary first premolars had Type I (62.6%) canal configuration. Unlike the study of Abella et al.[13] whom revealed a higher incidence of Type IV with a rate of (52.8%). This result was proved in two other studies.[14],[15]

For the maxillary second premolars, the highest prevalence of Type I canal configuration was found in the current study. This was in agreement with some reported studies such as Bulut et al.[3] (77.6%), Abella et al.[13] (39.3%), and Kartal et al.[16] (48.66%), whereas others showed different results regarding the canal configurations of this group of teeth, such as Al-Ghananeem et al.,[17] whom reported a high prevalence of Type IV (60.8%). The findings of the current study are in concert with the majority of the previously stated studies.[3],[13],[16]

The distobuccal curvature was found to be the most frequent for the single-rooted maxillary first premolar teeth (30.4%) as well as in and palatal (32.4%) roots, whereas 45.9% of the buccal roots curved in the distopalatal direction of the two-rooted ones. A study by Ng'ang'a et al.[18] found most of the roots of the maxillary first premolars to be straight while Percora et al.[1] reported most of the roots to curve distally. These differences might be related to methodological and racial factors.

The mandibular first premolars were found to have Type I in most cases. Similar findings were reported in many morphological studies,[12],[19],[20],[21],[22],[23],[24] as well as in the systematic reviews.[25],[26]

As for the root curvatures of this group of teeth, Llena et al.,[12] as well as Khedmat et al.[27] respectively found the roots to be straight in 34.3% and 72.3% of cases, respectively, which is definitely higher than the findings of the current study. According to both authors, the distal curvature was the most common, whereas it only represents 16.4% of the single-rooted cases in the present study.

For the mandibular second premolars, all the previous studies[12],[20],[22],[23],[25],[26] agreed that this group of teeth had Type I canal configuration in most cases, which complies with the present findings and is different from the ones reported by Bürklein et al.,[15] where Type V was the most frequent. With regard to root curvatures, Llena et al.[12] stated that 45.3% of the roots were straight. Conversely, our findings revealed only 2% of straight roots, and the bucco-distal curvature was the most predominant. These differences are related to methodological and racial factors.

Knowing the root curvature of the tooth is important to assess the difficulty of the root canal treatment before starting. Despite the limitations of this study represented in the Kinetic or metallic scanning artifacts due to patient mobility during acquisition, the CBCT could provide useful information for endodontic treatment owing to prior analysis that might help dentists to view the root canal system easily and thus clean and obturate it more efficiently.


  Conclusion Top


The current study is the first to provide supplemental information about the canal configuration and root curvatures of maxillary and mandibular premolar in the Moroccan subpopulation. Using CBCT as an analysis tool provided a better image of the existence of numerous anatomical variations in this population. The Moroccan subpopulation's premolars showed a high prevalence of Vertucci's canal configuration Type I with distobuccal curvature for maxillary teeth and distolingual for mandibular teeth. The findings of the current study are in agreement with the majority of previously conducted research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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