Aim and objectives: Evaluation of the root canal morphology of maxillary premolars was the primary objective of this study, on the criteria of the roots present, canals detected in the roots, and anatomical canal patterns according to Vertucci\'s classification observed in the Saudi population using cone-beam computed tomography (CBCT) radiographic analysis comparing them to previous reports in the same population.
Materials and methods: A total of 710 maxillary 1st and 2nd premolars were considered in this research; of which 351 were 1st premolars and 359 were 2nd premolars. These premolars were investigated for their external and internal anatomy using CBCT. Teeth with apical closure and complete root development were included in the study. Endodontically treated teeth, teeth with calcified canals or resorbed roots, as well as unclear teeth on CBCT images were excluded.
Results: Among the 351 maxillary 1st premolars, 40.7% of teeth had 1 root, 57.5% had 2 roots, and 1.7% had 3 roots. Around 93.2% of teeth had 2 canals, 3.7% had 1 canal, 2.6% had 3 canals, and 0.4% had 4 canals. According to Vertucci\'s classification, 63.8% of teeth had class IV configuration, 14.8% had class V configuration, 7.7% had class III configuration, and 6.8% had class II configuration. Likewise, among the maxillary second premolars, 88% of teeth had 1 root and 12% of teeth had 2 roots. Around 38.2% of teeth had a single canal while 61.0% of teeth had 2 canals, and 3 teeth were found with the extra canal (had 3 canals). More than one-third (38.2%) of teeth had Vertucci type I, 19.2% had Vertucci type IV, 15.3% had Vertucci type III, and 12.3% had Vertucci type V.
Conclusion: Maxillary first premolars had a higher prevalence of 2 roots, whereas one root was predominant in second premolars. Most of the maxillary premolars had 2 canals with the majority having Vertucci type IV in the first premolars and type I in the second premolars.
Clinical significance: Maxillary premolars present with external and internal anatomical variations, so clinician should be aware about these varieties by taking small field of view CBCT when needed which will be of great value.
Vertucci FJ. Root canal morphology and its relationship to endodontic procedures. Endod Top 2005;10(1):3–29. DOI: 10.1111/j.1601-1546.2005.00129.x.
Cantarone G, Berutti E, Castelucci A. Missed anatomy: frequency and clinical impact. Endod Top 2006;15(1):3–31. DOI: 10.1111/j.1601-1546.2009.00240.x.
Ingle JI, Bakland LK. Endodontics. 2nd ed. Philadelphia: Lea and Febiger; 1976.
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.
Nair MK, Nair UP. Digital and advanced imaging in endodontics: a review. J Endod 2007;33(1):1–6. DOI: 10.1016/j.joen.2006.08.013.
Cleghorn BM, Christie WH, Dong CCS. The root and root canal morphology of the human mandibular first premolar: a literature review. J Endod 2007;33(5):509–516. DOI: 10.1016/j.joen.2006.12.004.
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;2018:8170620. DOI: 10.1155/2018/8170620.
Elkady A, Allouba K. Cone beam computed tomographic analysis of root and canal morphology of maxillary premolars in Saudi subpopulation. Edj 2013;59(3):3419–3429.
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):1–5. DOI: 10.4103/1658-5984.104407.
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;2019:2063943. DOI: 10.1155/2019/2063943.
Atieh MA. Root and canal morphology of maxillary first premolars in a Saudi population. J Contemp Dent Pract 2008;9(1):46–53. PMID: 18176648.
Elnour M, Khabeer A, AlShwaimi E. Evaluation of root canal morphology of maxillary second premolars in a Saudi Arabian sub-population: an in vitro microcomputed tomography study. Saudi Dent J 2016;28(4):162–168. DOI: 10.1016/j.sdentj.2016.08.001.
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.
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.
Bellizzi R, Hartwell G. Radiographic evaluation of root canal anatomy of in vivo endodontically treated maxillary premolars. J Endod 1985;11(1):37–39. DOI: 10.1016/S0099-2399(85)80104-7.
Baratto Filho F, Zaitter S, Haragushiku GA, et al. Analysis of the internal anatomy of maxillary first molars by using different methods. J Endod 2009;35(3):337–342. DOI: 10.1016/j.joen.2008.11.022.
Durack C, Patel S, Davies J, et al. Diagnostic accuracy of small volume cone beam computed tomography and intraoral periapical radiography for the detection of simulated external inflammatory root resorption. Int Endod J 2011;44(2):136–147. DOI: 10.1111/j.1365-2591.2010.01819.x.
Walker RT. Root form and canal anatomy of maxillary first premolars in a southern Chinese population. Endod Dent Traumatol 1987;3(3):130–134. DOI: 10.1111/j.1600-9657.1987.tb00614.x.
Vertucci FJ, Gegauff A. Root canal morphology of the maxillary first premolar. J Am Dent Assoc 1979;99(2):194–198. DOI: 10.14219/jada.archive.1979.0255.
Ahmad IA, Alenezi MA. Root and root canal morphology of maxillary first premolars: a literature review and clinical considerations. J Endod 2016;42(6):861–872. DOI: 10.1016/j.joen.2016.02.017.
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;94:84–92. DOI: 10.1016/j.archoralbio.2018.06.020.
Abella F, Teixido 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.
Buchanan GD, Gamieldien MY, Tredoux S, et al. Root and canal configurations of maxillary premolars in a South African subpopulation using cone beam computed tomography and two classification systems. J Oral Sci 2020;62(1):93–97. DOI: 10.2334/josnusd.19-0160.
de Lima CO, de Souza LC, Devito KL, et al. Evaluation of root canal morphology of maxillary premolars: a cone-beam computed tomography study. Aust Endod J 2019;45(2):196–201. DOI: 10.1111/aej.12308.
Tian Y-Y, 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.
Pécora JD, Sousa Neto MD, Saquy PC, et al. In vitro study of root canal anatomy of maxillary second premolars. Braz Dent J 1993;3(2):81–85.
Kartal N, Özçelik B, Cimilli H. Root canal morphology of maxillary premolars. J Endod 1998;24(6):417–419. DOI: 10.1016/S0099-2399(98)80024-1.
Martins JNR, Gu Y, Marques D, et al. Differences on the root and root canal morphologies between Asian and White ethnic groups analyzed by cone-beam computed tomography. J Endod 2018;44(7):1096–1104. DOI: 10.1016/j.joen.2018.04.001.
Nazeer MR, Khan FR, Ghafoor R. Evaluation of root morphology and canal configuration of maxillary premolars in a sample of Pakistani population by using cone beam computed tomography. J Pak Med Assoc 2018;68(3):423–427. PMID: 29540878.
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.