Analysis of Bilateral Symmetry of Root Canal Anatomy in Permanent Dentition: An In Vivo CBCT Study in a Saudi Arabian Population
Mohammed Mashyakhy, Abdulaziz S Abu-Melha
Bilateral symmetry, Cone-beam computed tomography, Internal root anatomy, Root morphology, Root symmetry, Saudi population
Citation Information :
Mashyakhy M, Abu-Melha AS. Analysis of Bilateral Symmetry of Root Canal Anatomy in Permanent Dentition: An In Vivo CBCT Study in a Saudi Arabian Population. J Contemp Dent Pract 2021; 22 (8):867-875.
Aim and objective: To evaluate the internal symmetry of roots and root canals of permanent maxillary and mandibular teeth. This study used cone-beam computed tomography (CBCT) to examine the bilateral symmetry of root canals, their configuration, and the number of roots in a Saudi Arabian population.
Materials and methods: CBCT images of 5,223 teeth from records of 208 patients (age of 28.74 ± 9.56 years) were analyzed using i-Dixel 3D imaging software. Sagittal, axial, and coronal serial sections were used to examine the root canal configuration, the number of roots, and the number of canals of all the teeth in the maxilla and mandible and compare them with the contralateral side for symmetry. Frequencies and percentages were used to represent the results. Cohen\'s Kappa test was employed to examine bilateral symmetry. The significance level was set at p <0.05 for all statistical tests.
Results: Bilateral symmetry of the number of roots was 100% in maxillary central incisors, laterals, canines, first molars, and second molars. The mandibular arch showed greater variation with the roots of the central incisors and second premolars being 100% symmetrical. Maxillary first premolars were frequently asymmetrical (14.9%). Maxillary central and lateral incisors showed 100% bilateral symmetry of the canals. The number of canals in the maxillary second molars showed asymmetry (18.9%). For canal configuration, the bilateral symmetry was found 100% in maxillary central and lateral incisors. Maxillary second premolars (32.2%) showed frequent asymmetry in the canal configuration.
Conclusion: The mandibular arch showed greater asymmetry than the maxillary arch. Internal canal configurations displayed the highest bilateral asymmetry, followed by the number of canals. Bilateral symmetry was most evident in the number of roots present.
Clinical significance: The findings of this study will enable clinicians to anticipate the variations in canal morphology in both maxillary and mandibular teeth and be cognizant of the contralateral variations in canal contours and anatomy that affect endodontic therapy.
Peters OA, Schönenberger K, Laib A. Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography. Int Endod J 2001;34(3):221–230. DOI: 10.1046/j.1365–2591.2001.00373.x.
Hoen MM, Pink FE. Contemporary endodontic retreatments: an analysis based on clinical treatment findings. J Endod 2002;28(12): 834–836. DOI: 10.1097/00004770-200212000-00010.
Song M, Kim HC, Lee W, et al. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod 2011;37(11):1516–1519. DOI: 10.1016/j.joen.2011.06.032.
Smadi L, Khraisat A. Detection of a second mesiobuccal canal in the mesiobuccal roots of maxillary first molar teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(3):e77–e81. DOI: 10.1016/j.tripleo.2006.10.007.
Weng XL, Yu SB, Zhao SL, et al. Root canal morphology of permanent maxillary teeth in the Han nationality in Chinese Guanzhong area: a new modified root canal staining technique. J Endod 2009;35(5): 651–656. DOI: 10.1016/j.joen.2009.02.010.
Schwarze T, Baethge C, Stecher T, et al. Identification of second canals in the mesiobuccal root of maxillary first and second molars using magnifying loupes or an operating microscope. Aust Endod J 2002;28(2):57–60. DOI: 10.1111/j.1747-4477.2002.tb00379.x.
Yoshioka T, Kikuchi I, Fukumoto Y, et al. Detection of the second mesiobuccal canal in mesiobuccal roots of maxillary molar teeth ex vivo. Int Endod J 2005;38(2):124–128. DOI: 10.1111/j.1365-2591.2004.00918.x.
Coutinho Filho T, La Cerda RS, Gurgel Filho ED, et al. The influence of the surgical operating microscope in locating the mesiolingual canal orifice: a laboratory analysis. Braz Oral Res 2006;20(1):59–63. DOI: 10.1590/s1806-83242006000100011.
Gilles J, Reader A. An SEM investigation of the mesiolingual canal in human maxillary first and second molars. Oral Surg Oral Med Oral Pathol 1990;70(5):638–643. DOI: 10.1016/0030-4220(90)90415-o.
Somma F, Leoni D, Plotino G, et al. Root canal morphology of the mesiobuccal root of maxillary first molars: a micro-computed tomographic analysis. Int Endod J 2009;42(2):165–174. DOI: 10.1111/j.1365-2591.2008.01472.x.
Maghfuri S, Keylani H, Chohan H, et al. Evaluation of root canal morphology of maxillary first premolars by cone beam computed tomography in Saudi Arabian southern region subpopulation: an in vitro study. Int J Dent 2019;2019:1–6. DOI: 10.1155/2019/2063943.
Alfawaz H, Alqedairi A, Alkhayyal AK, et al. Prevalence of C-shaped canal system in mandibular first and second molars in a Saudi population assessed via cone beam computed tomography: a retrospective study. Clin Oral Investig 2019;23(1):107–112. DOI: 10.1007/s00784-018-2415-0.
Versiani MA, Ordinola-Zapata R, Keleş A, et al. Middle mesial canals in mandibular first molars: a micro-CT study in different populations. Arch Oral Biol 2016;61:130–137. DOI: 10.1016/j.archoralbio.2015.10.020.
Sperber GH, Moreau JL. Study of the number of roots and canals in Senegalese first permanent mandibular molars. Int Endod J 1998;31(2):117–122. DOI: 10.1046/j.1365-2591.1998.00126.x.
Boruah LC, Bhuyan AC. Morphologic characteristics of root canal of mandibular incisors in North-East Indian population: an in vitro study. J Conserv Dent 2011;14(4):346–350. DOI: 10.4103/0972–0707.87195.
Reichart PA, Metah D. Three-rooted permanent mandibular first molars in the Thai. Community Dent Oral Epidemiol 1981;9(4):191–192. DOI: 10.1111/j.1600-0528.1981.tb01053.x.
Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58(5):589–599. DOI: 10.1016/0030-4220(84)90085-9.
Lin Z, Hu Q, Wang T, et al. Use of CBCT to investigate the root canal morphology of mandibular incisors. Surg Radiol Anat 2014;36(9): 877–882. DOI: 10.1007/s00276-014-1267-9.
Zhao Y, Dong Y, Wang X, et al. Cone-beam computed tomography analysis of root canal configuration of 4674 mandibular anterior teeth. Beijing Da Xue Xue Bao 2014;46(1):95–99. PMID: 24535357.
Kayaoglu G, Ucok O, Sarikir C, et al. Root and canal symmetry in the mandibular anterior teeth of patients attending a dental clinic: CBCT study. Braz Oral Res 2015;29(1):1–7. DOI: 10.1590/1807-3107BOR-2015.vol29.0090.
Huang YD, Wu J, Sheu RJ, et al. Evaluation of the root and root canal systems of mandibular first premolars in northern Taiwanese patients using cone-beam computed tomography. J Formos Med Assoc 2015;114(11):1129–1134. DOI: 10.1016/j.jfma.2014.05.008.
Felsypremila G, Vinothkumar TS, Kandaswamy D. Anatomic symmetry of root and root canal morphology of posterior teeth in Indian subpopulation using cone beam computed tomography: a retrospective study. Eur J Dent 2015;9(4):500–507. DOI: 10.4103/1305-7456.172623.
Plotino G, Tocci L, Grande NM, et al. Symmetry of root and root canal morphology of maxillary and mandibular molars in a white population: a cone-beam computed tomography study in vivo. J Endod 2013;39(12):1545–1548. DOI: 10.1016/j.joen.2013.09.012.
Cotton TP, Geisler TM, Holden DT, et al. Endodontic applications of cone-beam volumetric tomography. J Endod 2007;33(9):1121–1132. DOI: 10.1016/j.joen.2007.06.011.
Alqedairi A, Alfawaz H, Al-Dahman Y, et al. Cone-beam computed tomographic evaluation of root canal morphology of maxillary premolars in a Saudi population. Biomed Res Int 2018;2018:1–8. DOI: 10.1155/2018/8170620.
Mashyakhy M, Chourasia HR, Halboub E, et al. Anatomical variations and bilateral symmetry of roots and root canal system of mandibular first permanent molars in Saudi Arabian population utilizing cone-beam computed tomography. Saudi Dent J 2019;31(4):481–486. DOI: 10.1016/j.sdentj.2019.04.001.
Al-Dahman Y, Alqedairi A, Alfawaz H, et al. Cone-beam computed tomographic evaluation of root canal morphology of mandibular canines in a Saudi subpopulation. Saudi Endod J 2019;9(2):113–118. DOI: 10.4103/sej.sej_85_18.
Alshammari FR, Alamri H, Aljohani M, et al. Dental caries in Saudi Arabia: a systematic review. J Taibah Univ Med Sci 2021. Available from: https://www.sciencedirect.com/science/article/pii/S1658361221001359. DOI: 10.1016/j.jtumed.2021.06.008.
Al Agili DE. A systematic review of population-based dental caries studies among children in Saudi Arabia. Saudi Dent J 2013;25(1):3–11. DOI: 10.1016/j.sdentj.2012.10.002.
Chandra A. Discuss the factors that affect the outcome of endodontic treatment. Aust Endod J 2009;35(2):98–107. DOI: 10.1111/j.1747-4477.2009.00199.x.
Matherne RP, Angelopoulos C, Kulild JC, et al. Use of cone-beam computed tomography to identify root canal systems in vitro. J Endod 2008;34(1):87–9. DOI: 10.1016/j.joen.2007.10.016.
Kamburoğlu K. Use of dentomaxillofacial cone beam computed tomography in dentistry. World J Radiol 2015;7(6):128–130. DOI: 10.4329/wjr.v7.i6.128.
Michetti J, Maret D, Mallet JP, et al. Validation of cone beam computed tomography as a tool to explore root canal anatomy. J Endod 2010;36(7):1187–1190. DOI: 10.1016/j.joen.2010.03.029.
Neelakantan P, Subbarao C, Subbarao CV. Comparative evaluation of modified canal staining and clearing technique, cone-beam computed tomography, peripheral quantitative computed tomography, spiral computed tomography, and plain and contrast medium-enhanced digital radiography in studying root canal morphology. J Endod 2010;36(9):1547–1551. DOI: 10.1016/j.joen.2010.05.008.
Ordinola-Zapata R, Bramante CM, Versiani MA, et al. Comparative accuracy of the Clearing Technique, CBCT and Micro-CT methods in studying the mesial root canal configuration of mandibular first molars. Int Endod J 2017;50(1):90–96. DOI: 10.1111/iej.12593.
Martins JNR, Marques D, Francisco H, et al. Gender influence on the number of roots and root canal system configuration in human permanent teeth of a Portuguese subpopulation. Quintessence Int 2018;49(2):103–111. DOI: 10.3290/j.qi.a39508.
Pan JYY, Parolia A, Chuah SR, et al. Root canal morphology of permanent teeth in a Malaysian subpopulation using cone-beam computed tomography. BMC Oral Health 2019;19(1):14. DOI: 10.1186/s12903-019-0710-z.
Martins JNR. Root and root canal morphology of the permanent dentition in a Caucasian population : a cone-beam computed tomography study. Int Endod J 2017;50(11):1013–1026. DOI: 10.1111/iej.12724.
Burklein S, Heck R, Schafer E. Evaluation of the root canal anatomy of maxillary and mandibular premolars in a selected German population using cone-beam computed tomographic data. J Endod 2017;43(9):1448–1452. DOI: 10.1016/j.joen.2017.03.044.
Naseri M, Safi Y, Akbarzadeh Baghban A, et al. Survey of anatomy and root canal morphology of maxillary first molars regarding age and gender in an Iranian population using cone-beam computed tomography. Iran Endod J 2016;11(4):298–303. DOI: 10.22037/iej.2016.8.
Tian YY, Guo B, Zhang R, et al. Root and canal morphology of maxillary first premolars in a Chinese subpopulation evaluated using cone-beam computed tomography. Int Endod J 2012;45(11):996–1003. DOI: 10.1111/j.1365-2591.2012.02059.x.
Al-Ghananeem MMF, Haddadin K, Al-Khreisat AS, et al. The number of roots and canals in the maxillary second premolars in a group of Jordanian population. Int J Dent 2014;2014:797692. DOI: 10.1155/2014/797692.
Abella F, Teixidó LM, Patel S, et al. Cone-beam computed tomography analysis of the root canal morphology of maxillary first and second premolars in a Spanish population. J Endod 2015;41(8):1241–1247. DOI: 10.1016/j.joen.2015.03.026.
Li YH, Bao SJ, Yang XW, et al. Symmetry of root anatomy and root canal morphology in maxillary premolars analyzed using cone-beam computed tomography. Arch Oral Biol 2018;94(639):84–92. DOI: 10.1016/j.archoralbio.2018.06.020.
de Pablo OV, Estevez R, Péix Sánchez M, et al. Root anatomy and canal configuration of the permanent mandibular first molar: a systematic review. J Endod 2010;36(12):1919–1931. DOI: 10.1016/j.joen.2010.08.055.