EC Paediatrics

Purpose: For successful root canal treatments in pediatric dentistry, it is critical increasing knowledge of the root canal morphology of primary teeth using an accurate and simple classification technique. The present study aimed to: (i) Characterize the root canal anatomy in primary molars in the Turkish population (ii) Compare the accuracy of two classification systems to describe the complexity of the canal system.

Methods: A total of 59 human primary mandibular second molar (PMSM) teeth were included in this study. Root canal systems were analyzed using 3D reconstructed images obtained from Micro-CT. Two classification systems were used (Vertucci and Ahmed., et al.). The analyzes results of root morphology with axial slices at the different root levels in addition to 3D images, were used as the gold standard for both systems and the differences were calculated with Spearman’s Rho.

Results: The root canal morphology in primary molars is highly complex. The Vertucci classification was not able to characterize 37 (62.7%) and 19 (32.2%) of the mesial and distal roots, respectively; however, all canal types were classified using the Ahmed classification. According to the gold standard, only 10 (16.94%) of the mesial roots had two canals starting at the orifice and ending at the apex. For the distal root, 15 (25%) of the teeth had one canal starting at the orifice and ending with one canal at the apex. The most common types were Type IV and Type I for mesial and distal roots, respectively, according to Vertucci. Micro-CT results allowed detailed and accurate characterization of the root canal morphology in the primary molar teeth and revealed that the primary teeth had a more complicated canal morphology compared to previous reports.

Conclusion: Although reports were classified using the Vertucci classification, it was found to be deficient in classifying many of the canal types in primary molars. The use of the new system developed by Ahmed was more accurate and provide more detailed information compared to Vertucci.

 Keywords: Micro-CT; Primary Molars; Root Canal Classification

1. Kishen A., et al. “An investigation on the antibacterial and antibiofilm efficacy of cationic nanoparticulates for root canal disinfection”. Journal of Endodontics12 (2008): 1515-1520.
2. Fuks AB. “Pulp therapy for the primary and young permanent dentitions”. Dental Clinics of North America3 (2000): 571-596.
3. Cleghorn B., et al. “Primary human teeth and their root canal systems”. Endodontic Topics 1 (2012): 6-33.
4. Rouhani A., et al. “Cone-beam computed tomography evaluation of maxillary first and second molars in Iranian population: a morphological study”. Iranian Endodontic Journal3 (2014): 190-194.
5. Silva EJ., et al. “Evaluation of root canal configuration of maxillary molars in a Brazilian population using cone-beam computed tomographic imaging: an in vivo study”. Journal of Endodontics2 (2014): 173-176.
6. Zheng QH., et al. “A cone-beam computed tomography study of maxillary first permanent molar root and canal morphology in a Chinese population”. Journal of Endodontics9 (2010): 1480-1484.
7. Ahmed HM. “Anatomical challenges, electronic working length determination and current developments in root canal preparation of primary molar teeth”. International Endodontic Journal11 (2013): 1011-1022.
8. Fumes AC., et al. “Root canal morphology of primary molars: a micro-computed tomography study”. European Archives of Paediatric Dentistry: Official Journal of the European Academy of Paediatric Dentistry 5 (2014): 317-326.
9. Katge F and Wakpanjar MM. “Root canal morphology of primary molars by clearing technique: An in vitro study”. Journal of the Indian Society of Pedodontics and Preventive Dentistry2 (2018): 151-157.
10. Poornima P and Subba Reddy VV. “Comparison of digital radiography, decalcification, and histologic sectioning in the detection of accessory canals in furcation areas of human primary molars”. Journal of the Indian Society of Pedodontics and Preventive Dentistry2 (2008): 49-52.
11. Krishnamurthy NH., et al. “Evaluation of anatomical variations in root and canal morphology of primary maxillary second molars: a cone-beam computed tomography study”. International Journal of Clinical Pediatric Dentistry 5 (2021): 628-632.
12. Mohd Ariffin S., et al. “Root canal morphology of primary maxillary second molars: a micro-computed tomography analysis”. European Archives of Paediatric Dentistry4 (2020): 519-525.
13. Acar B., et al. “Comparison of micro-computerized tomography and cone-beam computerized tomography in the detection of accessory canals in primary molars”. Imaging Science in Dentistry4 (2015): 205-211.
14. El Hachem C., et al. “Three-dimensional modeling and measurements of root canal anatomy in second primary mandibular molars: a case series micro CT study”. European Archives of Paediatric Dentistry: Official Journal of the European Academy of Paediatric Dentistry5 (2019): 457-465.
15. Wang Y., et al. “A study on the root canal morphology of primary molars by high-resolution computed tomography”. Journal of Dental Sciences3 (2013): 321-327.
16. Waterhouse P., et al. “Pediatric endodontics: endodontic treatment for the primary and young permanent dentition”. In: Hargreaves KM CS, ed. Pathways of the Pulp. 10^th Mosby Elsevier (2011): 808-857.
17. Verma P and Love RM. “A Micro CT study of the mesiobuccal root canal morphology of the maxillary first molar tooth”. International Endodontic Journal3 (2011): 210-217.
18. Ahmed HMA., et al. “Application of a new system for classifying tooth, root and canal morphology in the primary dentition”. International Endodontic Journal1 (2020): 27-35.
19. Ahmed HMA IN., et al. “Application of a new system for classifying root and canal anatomy in studies involving micro-computed tomography and cone beam computed tomography: Explanation and elaboration”. International Endodontic Journal 7 (2021): 1056-1082.
20. Karobari MI., et al. “Root and root canal morphology classification systems”. International Journal of Dentistry (2021): 6682189.
21. Saber SEDM., et al. “Root and canal morphology of maxillary premolar teeth in an Egyptian subpopulation using two classification systems: a cone beam computed tomography study”. International Endodontic Journal 3 (2019): 267-278.
22. Martins JNR., et al. “Root and root canal morphology of the permanent dentition in a Caucasian population: a cone-beam computed tomography study”. International Endodontic Journal 11 (2017): 1013-1026.
23. Vertucci F., et al. “Root canal morphology of the human maxillary second premolar”. Oral Surgery, Oral Medicine, and Oral Pathology3 (1974): 456-464.
24. Bagherian A., et al. “An in vitro study of root and canal morphology of human deciduous molars in an Iranian population”. Journal of Oral Science3 (2010): 397-403.
25. Aminabadi NA., et al. “Study of root canal accessibility in human primary molars”. Journal of Oral Science1 (2008): 69-74.
26. Demiriz L., et al. “Evaluation of root canal morphology of human primary mandibular second molars by using cone beam computed tomography”. Nigerian Journal of Clinical Practice4 (2018): 462-467.
27. Gaurav V., et al. “A study of root canal morphology of human primary incisors and molars using cone beam computerized tomography: an in vitro study”. Journal of the Indian Society of Pedodontics and Preventive Dentistry4 (2013): 254-259.
28. Sarkar S and Rao AP. “Number of root canals, their shape, configuration, accessory root canals in radicular pulp morphology. A preliminary study”. Journal of the Indian Society of Pedodontics and Preventive Dentistry3 (2002): 93-97.
29. Weine FS., et al. “Canal configuration of the mandibular second molar using a clinically oriented in vitro method”. Journal of Endodontics5 (1988): 207-213.
30. Gulabivala K., et al. “Root and canal morphology of Burmese mandibular molars”. International Endodontic Journal 5 (2001): 359-370.
31. Silva EJ., et al. “Evaluation of root canal configuration of mandibular molars in a Brazilian population by using cone-beam computed tomography: an in vivo study”. Journal of Endodontics7 (2013): 849-852.