Saudi Endodontic Journal

ORIGINAL ARTICLE
Year
: 2012  |  Volume : 2  |  Issue : 1  |  Page : 1--5

Radiographic investigation of in vivo endodontically treated maxillary premolars in a Saudi Arabian sub-population


Saad Al-Nazhan1, Abdullah Al-Daafas2, Nassr Al-Maflehi3,  
1 Department of Endodontics, King Saud University, College of Dentistry, Riyadh, Saudi Arabia
2 Department of Endodontics, King Fahad Security Force College, Dental Clinics, Riyadh, Saudi Arabia
3 Department of Preventive Dental Sciences, King Saud University, Riyadh, Saudi Arabia

Correspondence Address:
Saad Al-Nazhan
King Saud University, College of Dentistry, Department of Restorative Dental Science, Division of Endodontics, P. O. Box 60169, Riyadh 11545
Saudi Arabia

Abstract

Aim: To determine the prevalence of the number of root canals in permanent maxillary first and second premolars of a Saudi Arabian sub-population. Results will be compared to previous Asian studies. Materials and Methods: A total of 894 periapical radiographs of endodontically treated maxillary first and second premolars of 628 Saudi patients (268 males and 360 females) were viewed. The teeth were segregated into maxillary first premolars (463) and maxillary second premolars (431). The diagnostic, working length, master cone and final films with different angles were mounted, projected and, with the utilization of written clinical records, evaluated. Teeth with multiple canal systems were categorized according to whether the canals exited the root by common or separate apical foramen. Data was analyzed statistically using Chi-square test and professional t-test, by comparing pairs of groups with the significant level established at 5% (P < 0.05). Results: More than 90% of first maxillary premolar and more than 50% of the second maxillary premolar was found to have two canals. There was no significant difference between male (92%) and female (95%) in the distribution of the two root canals of the first maxillary premolar (t-test = 1.21, P value = 0.228), however, there was significant difference between the distributions of male (69.4%) and female (52.2%) of the two root canals within the second maxillary premolar (t-test = 3.75, P value = 0.000). Few teeth showed three canals. Conclusion: The number of root canals of the maxillary first premolar in Saudi population shows a higher incidence of two canals (93.6%) than previously reported. In addition, the figure is higher than most of the Asian countries.



How to cite this article:
Al-Nazhan S, Al-Daafas A, Al-Maflehi N. Radiographic investigation of in vivo endodontically treated maxillary premolars in a Saudi Arabian sub-population.Saudi Endod J 2012;2:1-5


How to cite this URL:
Al-Nazhan S, Al-Daafas A, Al-Maflehi N. Radiographic investigation of in vivo endodontically treated maxillary premolars in a Saudi Arabian sub-population. Saudi Endod J [serial online] 2012 [cited 2020 Oct 20 ];2:1-5
Available from: https://www.saudiendodj.com/text.asp?2012/2/1/1/104407


Full Text

 Introduction



A thorough knowledge of root canal morphology and its potential for variations related to race may be important for endodontic therapy. Such knowledge will facilitate proper cleaning and filling of all canals which leads to better prognosis. The anatomy of maxillary premolars in different races have reported different estimated incidence about the root canal morphology of maxillary premolars. These anatomical variations of maxillary premolars are well documented in the literature. Studies with various findings and significant racial variations have been reported. [1],[2],[3],[4],[5],[6] These studies were mainly performed on teeth of North American, [1],[2] far Eastern, [5] and Africa [6] populations.

The continent of Asia is considered to be the world's largest continent in terms of area and population. The Asian populations are of different racial variations and not a homogeneous group; rather, it comprises many groups who differ in language, culture and body constitution. A number of studies [5],[7],[8],[9],[10],[11] have been published dealing with the morphology of the maxillary premolars in Asia [Table 1]. Saudi Arabia is part of Asia with an estimated population of more than 20 million. The Saudi population is characterized by a high degree of cultural homogeneity and by an equally high degree of social stratification.{Table 1}

The internal anatomy of maxillary premolars in a Saudi population has only been studied by Atieh. [11] He examined extracted first maxillary premolar teeth that were collected from orthodontic patients. No information was given regarding the maxillary second premolar. The purpose of this radiographic investigation was to determine the prevalence of the number of root canals in permanent maxillary first and second premolars of a Saudi Arabian sub-population. Results will be compared to previous Asian studies.

 Materials and Methods



Clinical endodontic records covering a span of 10-yr were randomly selected and reviewed. A total of 894 periapical radiographs of endodontically treated maxillary first and second premolars of 628 Saudi patients were viewed. Two hundred and sixty-eight were males and 360 were females. These patients were treated by undergraduate dental students, endodontic postgraduate students and endodontic staff at the University of King Saud, College of Dentistry in Riyadh, Saudi Arabia. Each step of the treatment of student cases were carefully checked by the endodontic staff and recorded on a special form. Magnifying loupes and digital radiographs were used. The teeth were segregated into maxillary first premolars (463) and maxillary second premolars (431). The diagnostic, working length, master cone and final films with different angles were mounted, projected and, with the utilization of written clinical records, evaluated. Teeth with multiple canal systems were categorized according to whether the canals exited the root by common or separate apical foramen. The examined teeth were free of root resorption, had no canal calcification, open apices, broken instruments and no previous root canal therapy. Data was analyzed statistically using Chi-square test and professional t-test, by comparing pairs of groups with the significant level established at 5% (P < 0.05).

 Results



Results are summarized in [Table 2] and [Table 3].{Table 2}{Table 3}

The frequency of two root canals in maxillary premolar teeth was found to be more in both male and female patients. More than 90% of first maxillary premolar and more than 50% of the second maxillary premolar was found to have two canals. There was no significant difference between male (92%) and female (95%) in the distribution of the two root canals of the first maxillary premolar (t-test = 1.21, P value = 0.228), however, there was significant difference between the distributions of male (69.4%) and female (52.2%) of the two root canals within the second maxillary premolar (t-test = 3.75, P value = 0.000). Few teeth showed three canals. There was an association between gender and types of two canal of maxillary second premolar. Males distributed almost equally among the three types, while female were higher, almost twice within one root and one apex compared to other types (Chi-square = 6.68, P value = 0.032).

 Discussion



Success of Endodontic therapy requires a correct diagnosis and careful clinical and radiographic inspection. In addition, the morphological variations in pulpal anatomy must always be considered before starting treatment. Radiographs however, may not always determine the correct morphology particularly when only a buccolingual view is taken; therefore, two or more periapical radiographs of different angulations are mandatory for better evaluation. These angled radiographs provide much needed information about root canal morphology. Martinez-Lozano et al.[20] examined the effect of X-ray tube inclination on accurately determining the root canal system present in premolar teeth. They found that by varying the horizontal angle 201 and 401 the number of root canals observed in maxillary first and second and mandibular first premolars coincided with the actual number of canals present.

The critical importance of carefully evaluating each radiograph taken prior to and during endodontic therapy was stressed by Friedman et al.[21] In a case report of five canals in a mandibular first molar, the authors emphasized that it was the radiographic appearance which facilitated recognition of the complex canal morphology. They cautioned that any attempt to develop techniques that require fewer radiographs runs the risk of missing information which may be significant for the success of therapy.

Both visual and radiographic determinations were employed to accurately examine the root canal morphology. Radiographic and clinical determination of the number of root canals was not always undertaken in previous studies. [3],[14] Other workers utilized sections of teeth, casts of teeth and their canals. There were several teeth in which axial radioopaque masses were found in the pulpal tissues, although externally they had a clear single root. These masses could be due to secondary dentin deposits and this phenomenon is associated with age changes. It had been noted in the literature that this could lead to the appearance of two developing canals. However, this radiographic appearance was clearly dissimilar to that created by two separate canals at origin from the pulp chamber. There could be a variation in interpretation in other reports and perhaps even errors in a proper classification between a one-root form and the fused-root form. In this study, the detailed description of the canal anatomy was evaluated by using endodontic hand files and radiographs.

An important aid for locating root canals is the dental-operating microscope and the magnifying loupes. According to Buhrley et al.[22] both were equally effective in locating MB-2 canals of maxillary molars. Magnifying loupes were used only to locate the canal orifices in this study.

It is natural to assume ethnology influences dental morphology, as it does for other features. It has been observed that different populations show distinctive variations of tooth morphology. In the present study, 3.6% of the first maxillary premolar teeth had one root canal. This value is much lower than reported in Asian studies in Singapore [15] and Sichuan province, China [16] but similar to North Jordan populations. [9] The second maxillary premolar recorded higher percentage of one canal (39.7%) compared to the first premolar. This is much lower than previously reported Asian studies. [10],[12],[14] A prevalence of two root canals were recorded in 93.6% for the first premolar in the present study, which is higher than values observed in other Asian populations. [5],[14],[16] However, Caliskan et al.[12] recorded 96.1% of two root canals in first premolars in the Turkish population while Weng et al.[19] recorded 72.3% of two root canals in second premolars in the Chinese population. The number of three canals in maxillary first premolars was reported in a number of Asian studies [Table 1]. The percentages ranged from 0.63 to 3.8%. The percentage of three canals in this study was in the same range (2.4%).

The number of root canals in the maxillary first premolars of the Saudi population in the previously reported study by Atieh [11] showed slightly lower percentages compared to the present study. This could be related to the lower number of examined teeth and the source of the collected teeth. Most of the teeth of the Atieh study were collected from orthodontic patients. The age of the patients were not mentioned and incompletely formed teeth might be used which would affect the result. In addition, no definite criteria were followed to evaluate the teeth.

The number of root canals in the maxillary second premolars shows a wide variation among the Asian population [Table 1]. In this study, it was found that 59.4% of maxillary second premolars had two root canals which were similar to Kuwaiti and Pakistani populations. [14],[18] It is higher than Raj and Mylswamy [10] and lower than Weng et al.[19] The percentage of maxillary second premolars with three canals of the present study was similar to Kuwaiti populations. [14]

 Conclusion



The number of root canals of the maxillary first premolar in Saudi population shows a higher incidence of two canals (93.6%) than previously reported. In addition, the figure is higher than most of the Asian countries. The number of 3 canals in the second maxillary premolar was similar to the only reported Asian study by Zaatar et al.[14] An awareness of root canal morphology and careful interpretation of preoperative radiographs is necessary for success in endodontic therapy.

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