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ORIGINAL ARTICLE
Year : 2015  |  Volume : 3  |  Issue : 1  |  Page : 7-10

Cone-beam computed tomography study of root canal morphology of permanent mandibular incisors in a Turkish sub-population


1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
2 Department of Statistics, Ondokuz Mayis University, Samsun, Turkey

Date of Web Publication18-Feb-2015

Correspondence Address:
Research Assistant Gediz Geduk
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ondokuz Mayis University, Atakum, 55139 Samsun
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-3841.151638

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  Abstract 

Aims: The aim was to examine root canal morphology of permanent mandibular incisors in a Turkish sub-population using cone-beam computed tomography (CBCT). Materials and Methods: Cone-beam computed tomography images of 382 patients with 1438 healthy permanent mandibular incisors were evaluated. According to Vertucci's classification, teeth were examined to determine the number of roots, the number of canals and canal configurations. The effects of gender and age on the incidence of root-canal morphology were investigated. Results: All of the permanent mandibular incisors had a single root. The majority of mandibular incisors (64.4%) had a single root with a single canal. A second root canal was present more frequently (35.6%) in the mandibular incisors. The prevalence of the two canals system was as follows: Left central incisor 37.9%, right central incisor 38.6%, left lateral incisor 37.4% and right lateral incisor 35.6% (P > 0.05). According to gender, 15.2% of teeth in males and 20.4% in females had a second canal (P > 0.05). Type 1 Vertucci configuration (64.4%) was the most prevalent configuration followed by type 3 (19.4%), type 2 (15.2%), type 5 (0.8%) and type 4 (0.2%). There was no effect of age and gender on the number of roots, number of canals and canal configurations. Conclusion: The prevalence of the second canal in mandibular incisors was high but within the range of previous studies performed on different populations. CBCT imaging is an excellent method for detection of different canal configurations of mandibular incisors.

Keywords: Cone-beam computed tomography, morphology, permanent mandibular incisors


How to cite this article:
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

How to cite this URL:
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 [serial online] 2015 [cited 2019 Sep 17];3:7-10. Available from: http://www.joomr.org/text.asp?2015/3/1/7/151638


  Introduction Top


Knowledge of root and canal morphology is important for confirming the most successful outcome in endodontic treatment. Lack of knowledge of variations in root canal anatomy has been regarded as one of the main reasons for endodontic failure.

The morphology of mandibular central and lateral incisors is very similar, and the root canal systems of these single-rooted teeth often have a single-root canal. However, the root canal anatomy of mandibular incisors is not as simple as it appears to be on standard periapical radiographs, and it may be complicated by the presence of second (bifurcated) canals, lateral canals and apical deltas. [1]

Various methods have been adopted to demonstrate canal anatomy, including radiographic examination, root sectioning and staining and clearing techniques. Cone-beam computed tomography (CBCT) designed for dental use is a noninvasive tool that can provide three-dimensional morphological evaluations of dental and maxillofacial anatomy. [2]

The literature review found that CBCT studies on the root canal morphology of permanent mandibular incisors were conducted mainly in China, [3],[4],[5] while the information on the Turkish population was scarce.

The purpose of this study is to use the CBCT method to:

  1. Investigate configuration and morphology of the root canal system of permanent mandibular incisors and,
  2. Compare the incidence of second canal between genders and ages in a Turkish sub-population.



  Materials and Methods Top


This study was conducted at the Oral and Maxillofacial Radiology Department, Faculty of Dentistry, University of Ondokuz Mayis. The CBCT images of patients taken between August 2013 and January 2014 were examined and studied. The present study investigated the root canal morphology of mandibular incisors using CBCT images taken for general dental diagnosis and treatment planning.

The images were taken using a CBCT dental imaging system (GALILEOS, Sirona Dental Systems, Bensheim, Germany), operating at 98 Kv and 15-30 mA. The age and gender of the patients and location of permanent teeth were also recorded.

The CBCT images of 1438 permanent mandibular incisors were included in this study according to the eligibility criteria:

  1. No obvious dental caries,
  2. Fully developed root and canal without resorption or calcification,
  3. Untreated permanent mandibular central or lateral incisors and
  4. CBCT images of good quality within the interested region.


The roots and canals of the permanent incisors were observed in sagittal and horizontal sections by one investigator using image-analysis software, which is included in CBCT image acquisition program (SIDEXIS XG 2.56, Sirona Dental Inc., Benheim, Germany).

The following observations were recorded:

  1. The number of roots,
  2. The number of canals and
  3. Canal configuration.


The canal configuration classification was made according to the Vertucci [6] method [Figure 1]. The male and female incidence of a second canal was examined and compared.
Figure 1: Illustration and cone-beam computed tomography images showing the five variants in permanent mandibular incisors according to the method by Vertucci [6]


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For statistical analysis, the Chi-square test was used.


  Results Top


The CBCT views of patients (156 male and 198 female) were studied. The patients' ages were from 11 to 71 years old (39.5 years on average).

All of the imaged teeth were single rooted. The plurality of permanent mandibular incisors had a single root and a single canal (64.4%). The prevalence of the two canals system was as follows: Left central incisor 37.9%, right central incisor 38.6%, left lateral incisor 37.4% and right lateral incisor 35.6% (P > 0.05) [Table 1].
Table 1: Distributions and percentages of the five categories of variants in sex


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Type 1 Vertucci configuration (64.4%) was the most prevalent configuration, followed by type 3 (19.4%), type 2 (15.2%), type 5 (0.8%) and type 4 (0.2%).

According to gender, 15.2% of teeth in males and 20.4% of females had a second canal. However, no statistical difference was found between males and females (P > 0.05), and there was no relationship between age and number of canals and canal configurations (P > 0.05).


  Discussion Top


In the present study, all mandibular incisors were single rooted in accordance with previous studies that focused on mandibular incisors. [3],[4],[5]

In clinical practice, the primary reason for failure in endodontic treatment of permanent mandibular incisors is noted as the inability to locate a second canal. The presence of a second canal in mandibular incisors reported was between 45% and 11.5%. [4],[5],[6],[7],[8],[9] In this study, 35.6% of the mandibular incisors had a second canal, which is lower than the findings of Kartal's and Yanikoğlu[7] study, but higher than most earlier studies [Table 2]. [4],[5],[6],[8],[9] These differences can be attributed to the ethnic background of the participants.
Table 2: Percentages of root canal systems found in mandibular incisors in the previous studies


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According to gender, the incidence of a second canal in permanent mandibular incisors was relatively high in females in this study, which contrasts with the Liu et al. [4] study, which reported that a slightly higher occurrence of a second canal was found in males than in females.

Liu et al. [4] reported that mandibular lateral incisors had a higher incidence (17.5%) of a second canal compared with mandibular central incisors (8.9%) The result of this study demonstrates that mandibular central incisors have a much higher incidence of two root canals compared with mandibular lateral incisors. The differences between the results of the studies may be due to variations in examination methods, sample size, and ethnic origin.

In the present study, all types of Vertucci canal configuration [6] were seen in mandibular incisors. Type 1 Vertucci configuration was the most prevalent configuration, which was in accordance with previous studies [4],[5],[10] [Table 2]. However, while they reported the type 5 canal configuration was the least prevalent type, Type 4 was the least prevalent type in our study.

Cone-beam computed tomography is very useful technology for diagnosis in all areas of dentistry. The most notable advantages are a significantly lower effective radiation dose, a short exposure time and lower costs compared with conventional computed tomography. However, CBCT imaging is not a replacement for panoramic or conventional projection radiographic applications; it is best used as a complementary modality for specific applications. The use of CBCT imaging in endodontic treatments should be limited to assessment and treatment of complex endodontic treatments, such as identifying potential accessory canals in teeth with suspected complex morphology, root canal system anomalies, determination of root resorptions, root curvature, fractures etc. [2]


  Conclusion Top


  • Under the conditions of this study, a second root canal consisted more frequently (35.6%) in the mandibular incisors in the Turkish sub-population studied.
  • Mandibular central incisors had a much higher incidence of two root canals compared with mandibular lateral incisors. However, a significant difference was not found (P > 0.05).
  • The incidence of a second canal did not differ between males and females. In addition, there was no relationship between age and number of canals and canal configurations (P > 0.05).
  • Type 1 Vertucci configuration was the most prevalent, and type 4 was the least prevalent.
  • CBCT imaging is an excellent method for detection of different canal configurations of mandibular incisors.



  Acknowledgment Top


This study was presented as a poster presentation in 17 th International Congress on Oral Pathology and Medicine. 25-30 May 2014, İstanbul/TURKEY.

 
  References Top

1.
Carrotte P. Endodontics: Part 4. Morphology of the root canal system. Br Dent J 2004;197:379-83.  Back to cited text no. 1
    
2.
Scarfe WC, Farman AG. Cone beam computed tomography: Volume preperation. In: White and Pharoah. Oral Radiology Principles and Interpretation. 7 th ed., Ch. 12. China: Elsevier; 2014. p. 206.  Back to cited text no. 2
    
3.
Han T, Ma Y, Yang L, Chen X, Zhang X, Wang Y. A study of the root canal morphology of mandibular anterior teeth using cone-beam computed tomography in a Chinese subpopulation. J Endod 2014;40:1309-14.  Back to cited text no. 3
    
4.
Liu J, Luo J, Dou L, Yang D. CBCT study of root and canal morphology of permanent mandibular incisors in a Chinese population. Acta Odontol Scand 2014;72:26-30.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    
6.
Vertucci FJ. Root canal anatomy of the mandibular anterior teeth. J Am Dent Assoc 1974;89:369-71.  Back to cited text no. 6
[PUBMED]    
7.
Kartal N, Yanikoðlu FC. Root canal morphology of mandibular incisors. J Endod 1992;18:562-4.  Back to cited text no. 7
    
8.
Madeira MC, Hetem S. Incidence of bifurcations in mandibular incisors. Oral Surg Oral Med Oral Pathol 1973;36:589-91.  Back to cited text no. 8
[PUBMED]    
9.
Miyashita M, Kasahara E, Yasuda E, Yamamoto A, Sekizawa T. Root canal system of the mandibular incisor. J Endod 1997;23:479-84.  Back to cited text no. 9
    
10.
Al-Qudah AA, Awawdeh LA. Root canal morphology of mandibular incisors in a Jordanian population. Int Endod J 2006;39:873-7.  Back to cited text no. 10
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]


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Journal of Endodontics. 2019; 45(4): 372
[Pubmed] | [DOI]



 

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Abstract
Introduction
Materials and Me...
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