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Original Research

Open Access

Micro-computed tomography (micro-CT) evaluation of root canal morphology in immature maxillary third molars

  • Krasimir Hristov1,*,
  • Ralitsa Gigova1
  • Nataliya Gateva1
  • Liliya Angelova2

1Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University of Sofia, 1431 Sofia, Bulgaria

2Department of Dental Public Health, Faculty of Dental Medicine, Medical University of Sofia, 1431 Sofia, Bulgaria

DOI: 10.22514/jocpd.2024.067 Vol.48,Issue 3,May 2024 pp.139-145

Submitted: 15 August 2023 Accepted: 26 September 2023

Published: 03 May 2024

*Corresponding Author(s): Krasimir Hristov E-mail: k.christov@fdm.mu-sofia.bg

Abstract

The endodontic treatment of immature permanent teeth with necrotic pulp is a significant clinical challenge. The success of regenerative endodontic procedure is highly dependent on disinfection of the root canal and an accurate anatomical knowledge of the root canal. The aim of this study was to use micro-computed tomography (micro-CT) analysis to investigate the configuration of root canals in the upper permanent third maxillary molars with incomplete root development in their coronal, apical and middle third portions. Thirty immature third permanent maxillary molars were scanned using a micro-CT system. Then, we measured the diameters and areas of the root canal in the coronal, middle and apical third of the roots. The ratio between the long and short diameter of each root canal was then calculated and the canals were divided into several groups: round, oval, long oval, flat and irregular. The round configuration was not observed in the distobuccal and mesiobuccal roots in any of their anatomical regions. Oval and long oval canals predominated in the distobuccal root. The greatest variations were observed in the mesiobuccal root, with the ribbon-shaped canal predominating in the middle region and an irregular shape in the apical region. In the coronal region of the palatal canal, the round configuration predominated; in the middle third, we observed an almost equivalent distribution between round and oval configurations; apically, the oval shape predominated. In conclusion, we observed significant complexity and variation in the morphology and configuration of root canals in immature permanent molars, thus generating additional obstacles for the success of regenerative endodontics.


Keywords

Immature permanent teeth; Canal anatomy; Regenerative endodontics; Apexification


Cite and Share

Krasimir Hristov,Ralitsa Gigova,Nataliya Gateva,Liliya Angelova. Micro-computed tomography (micro-CT) evaluation of root canal morphology in immature maxillary third molars. Journal of Clinical Pediatric Dentistry. 2024. 48(3);139-145.

References

[1] Zhu F, Chen Y, Yu Y, Xie Y, Zhu H, Wang H. Caries prevalence of the first permanent molars in 6–8 years old children. PLOS ONE. 2021; 16: e0245345.

[2] Taylor GD, Vernazza CR, Abdulmohsen B. Success of endodontic management of compromised first permanent molars in children: a systematic review. International Journal of Paediatric Dentistry. 2020; 30: 370–380.

[3] Tajmehr N, Graham A, Deery C. Should we root treat children’s first permanent molars? Evidence-Based Dentistry. 2020; 21: 142–143.

[4] Wei X, Yang M, Yue L, Huang D, Zhou X, Wang X, et al. Expert consensus on regenerative endodontic procedures. International Journal of Oral Science. 2022; 14: 55.

[5] Rodd H, Noble F. Psychosocial impacts relating to dental injuries in childhood: the bigger picture. Dentistry Journal. 2019; 7: 23.

[6] Lee SM. Regenerative endodontic procedures: management of immature necrotic permanent teeth. Compendium of Continuing Education in Dentistry. 2022; 43: 238–239.

[7] Gürcan AT, Bayram M. Children’s dental treatment requirements of first permanent molars with poor prognosis. Clinical Oral Investigations. 2022; 26: 803–812.

[8] Lin J, Zeng Q, Wei X, Zhao W, Cui M, Gu J, et al. Regenerative endodontics versus apexification in immature permanent teeth with apical periodontitis: a prospective randomized controlled study. Journal of Endodontics. 2017; 43: 1821–1827.

[9] Nicoloso GF, Goldenfum GM, Pizzol TDSD, Scarparo RK, Montagner F, de Almeida Rodrigues J, et al. Pulp revascularization or apexification for the treatment of immature necrotic permanent teeth: systematic review and meta-analysis. Journal of Clinical Pediatric Dentistry. 2019; 43: 305–313.

[10] Yoshpe M, Kaufman AY, Lin S, Ashkenazi M. Regenerative endodontics: a promising tool to promote periapical healing and root maturation of necrotic immature permanent molars with apical periodontitis using platelet-rich fibrin (PRF). European Archives of Paediatric Dentistry. 2021; 22: 527–534.

[11] Murray PE. Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth. International Endodontic Journal. 2023; 56: 188–199.

[12] Diogenes A, Ruparel NB. Regenerative endodontic procedures: clinical outcomes. Dental Clinics of North America. 2017; 61: 111–125.

[13] Joshi PS, Shetty R, Sarode GS, Mehta V, Chakraborty D. Root anatomy and canal configuration of human permanent mandibular second molar: a systematic review. Journal of Conservative Dentistry. 2021; 24: 298–306.

[14] Lee C, Song M. Failure of regenerative endodontic procedures: case analysis and subsequent treatment options. Journal of Endodontics. 2022; 48: 1137–1145.

[15] Boutsioukis C, Arias-Moliz MT. Present status and future directions—irrigants and irrigation methods. International Endodontic Journal. 2022; 55: 588–612.

[16] Velozo C, Prado VFF, Sousa ISDS, Albuquerque MBA, Montenegro L, Silva S, et al. Scope of preparation of oval and long-oval root canals: a review of the literature. The Scientific World Journal. 2021; 2021: 5330776.

[17] Villalta-Briones N, Baca P, Bravo M, Solana C, Aguado-Pérez B, Ruiz-Linares M, et al. A laboratory study of root canal and isthmus disinfection in extracted teeth using various activation methods with a mixture of sodium hypochlorite and etidronic acid. International Endodontic Journal. 2021; 54: 268–278.

[18] Martins JNR, Marques D, Silva EJNL, Caramês J, Versiani MA. Prevalence studies on root canal anatomy using cone-beam computed tomographic imaging: a systematic review. Journal of Endodontics. 2019; 45: 372–386.e4.

[19] Sanghvi R, Cant A, de Almeida Neves A, Hosey MT, Banerjee A, Pennington M. Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis. Community Dentistry and Oral Epidemiology. 2023; 51: 755–766.

[20] Ertuğrul C, Özbey H, Gün AI. Early extraction of the first permanent molars: a five-year follow-up study. European Journal of Paediatric Dentistry. 2022; 23: 111–115.

[21] Al-Qudah AA, Bani Younis HAB, Awawdeh LA, Daud A. Root and canal morphology of third molar teeth. Scientific Reports. 2023; 13: 6901.

[22] Turner S, Harrison JE, Sharif FN, Owens D, Millett DT. Orthodontic treatment for crowded teeth in children. Cochrane Database of Systematic Reviews. 2021; 12: CD003453.

[23] Jou Y, Karabucak B, Levin J, Liu D. Endodontic working width: current concepts and techniques. Dental Clinics of North America. 2004; 48: 323–335.

[24] Wolf TG, Anderegg AL, Yilmaz B, Campus G. Root canal morphology and configuration of the mandibular canine: a systematic review. International Journal of Environmental Research and Public Health. 2021; 18: 10197.

[25] Barbhai S, Shetty R, Joshi P, Mehta V, Mathur A, Sharma T, et al. Evaluation of root anatomy and canal configuration of human permanent maxillary first molar using cone-beam computed tomography: a systematic review. International Journal of Environmental Research and Public Health. 2022; 19: 10160.

[26] Mufadhal AA, Madfa AA. The morphology of permanent maxillary first molars evaluated by cone-beam computed tomography among a Yemeni population. BMC Oral Health. 2023; 23: 46.

[27] Karobari MI, Arshad S, Noorani TY, Ahmed N, Basheer SN, Peeran SW, et al. Root and root canal configuration characterization using microcomputed tomography: a systematic review. Journal of Clinical Medicine. 2022; 11: 2287.

[28] Papic M, Papic M, Zivanovic S, Vuletic M, Zdravkovic D, Misic A, et al. The prevalence of oval-shaped root canals: a morphometric study using cone-beam computed tomography and image analysis software. Australian Endodontic Journal. 2022; 48: 158–169.

[29] Shi L, Wan J, Yang Y, Yao Y, Yang R, Xie W. Evolution of the combined effect of different irrigation solutions and activation techniques on the removal of smear layer and dentin microhardness in oval-shaped root canal: an in-vitro study. Biomolecules & Biomedicine. 2023; 23: 126–136.

[30] Bueno MR, Estrela C, Azevedo BC, Cintra Junqueira JL. Root canal shape of human permanent teeth determined by new cone-beam computed tomographic software. Journal of Endodontics. 2020; 46: 1662–1674.

[31] Siqueira Junior JF, Rôças IDN, Marceliano-Alves MF, Pérez AR, Ricucci D. Unprepared root canal surface areas: causes, clinical implications, and therapeutic strategies. Brazilian Oral Research. 2018; 32: e65.

[32] Poly A, Tseng WL, Marques F, Setzer FC, Karabucak B. Micro-computed tomographic analysis of the shaping ability of XP-endo shaper in oval-shaped distal root canals of mandibular molars. European Endodontic Journal. 2021; 6: 271–277.

[33] Almutairi W, Yassen GH, Aminoshariae A, Williams KA, Mickel A. Regenerative endodontics: a systematic analysis of the failed cases. Journal of Endodontics. 2019; 45: 567–577.

[34] Elnawam H, Abdelmougod M, Mobarak A, Hussein M, Aboualmakarem H, Girgis M, et al. Regenerative endodontics and minimally invasive dentistry: intertwining paths crossing over into clinical translation. Frontiers in Bioengineering and Biotechnology. 2022; 10: 837639.

[35] Lui JN, Lim WY, Ricucci D. An immunofluorescence study to analyze wound healing outcomes of regenerative endodontics in an immature premolar with chronic apical abscess. Journal of Endodontics. 2020; 46: 627–640.

[36] Cameron R, Claudia E, Ping W, Erin S, Ruparel NB. Effect of a residual biofilm on release of transforming growth factor β1 from dentin. Journal of Endodontics. 2019; 45: 1119–1125.

[37] Zaky SH, AlQahtani Q, Chen J, Patil A, Taboas J, Beniash E, et al. Effect of the periapical “inflammatory plug” on dental pulp regeneration: a histologic in vivo study. Journal of Endodontics. 2020; 46: 51–56.

[38] Pérez AR, Alves FRF, Marceliano-Alves MF, Provenzano JC, Gonçalves LS, Neves AA, et al. Effects of increased apical enlargement on the amount of unprepared areas and coronal dentine removal: a micro-computed tomography study. International Endodontic Journal. 2018; 51: 684–690.

[39] Amoroso-Silva P, Alcalde MP, Hungaro Duarte MA, De-Deus G, Ordinola-Zapata R, Freire LG, et al. Effect of finishing instrumentation using NiTi hand files on volume, surface area and uninstrumented surfaces in C-shaped root canal systems. International Endodontic Journal. 2017; 50: 604–611.

[40] Zuolo ML, Zaia AA, Belladonna FG, Silva EJNL, Souza EM, Versiani MA, et al. Micro-CT assessment of the shaping ability of four root canal instrumentation systems in oval‐shaped canals. International Endodontic Journal. 2018; 51: 564–571.

[41] Sousa-Neto MD, Silva-Sousa YC, Mazzi-Chaves JF, Carvalho KKT, Barbosa AFS, Versiani MA, et al. Root canal preparation using micro-computed tomography analysis: a literature review. Brazilian Oral Research. 2018; 32: e66.

[42] Buyukozer Ozkan H, Kont Cobankara F, Sayin Z, Ozer F. Evaluation of the antibacterial effects of single and combined use of different irrigation solutions against intracanal enterococcus faecalis. Acta Stomatologica Croatica. 2020; 54: 250–262.

[43] Siqueira JF Jr, Pérez AR, Marceliano-Alves MF, Provenzano JC, Silva SG, Pires FR, et al. What happens to unprepared root canal walls: a correlative analysis using micro-computed tomography and histology/scanning electron microscopy. International Endodontic Journal. 2018; 51: 501–508.

[44] Paqué F, Balmer M, Attin T, Peters OA. Preparation of oval-shaped root canals in mandibular molars using nickel-titanium rotary instruments: a micro-computed tomography study. Journal of Endodontics. 2010; 36: 703–707.

[45] Neelakantan P, Devaraj S, Jagannathan N. Histologic assessment of debridement of the root canal isthmus of mandibular molars by irrigant activation techniques ex vivo. Journal of Endodontics. 2016; 42: 1268–1272.

[46] Namsoy E, Serefoglu B, Hulsmann M, Caliskan M. Influence of various application systems on the amount of extruded irrigant in simulated immature teeth with regard to gravity: an ex-vivo study. Nigerian Journal of Clinical Practice. 2022; 25: 1831–1837.

[47] Magni E, Jäggi M, Eggmann F, Weiger R, Connert T. Apical pressures generated by several canal irrigation methods: a laboratory study in a maxillary central incisor with an open apex. International Endodontic Journal. 2021; 54: 1937–1947.

[48] Cai C, Chen X, Li Y, Jiang Q. Advances in the role of sodium hypochlorite irrigant in chemical preparation of root canal treatment. BioMed Research International. 2023; 2023: 8858283.

[49] Zbańska J, Herman K, Kuropka P, Dobrzyński M. Regenerative endodontics as the future treatment of immature permanent teeth. Applied Sciences. 2021; 11: 6211.


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