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      Use of cone-beam computed tomography and three-dimensional modeling for assessment of anomalous pulp canal configuration: a case report

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          Abstract

          Three-dimensional (3D) reconstruction of cone-beam computed tomography (CBCT) scans appears to be a valuable method for assessing pulp canal configuration. The aim of this report is to describe endodontic treatment of a mandibular second premolar with aberrant pulp canal morphology detected by CBCT and confirmed by 3D modeling. An accessory canal was suspected during endodontic treatment of the mandibular left second premolar in a 21 year old woman with a chief complaint of pulsating pain. Axial cross-sectional CBCT scans revealed that the pulp canal divided into mesiobuccal, lingual, and buccal canals in the middle third and ended as four separate foramina. 3D modeling confirmed the anomalous configuration of the fused root with a deep lingual groove. Endodontic treatment of the tooth was completed in two appointments. The root canals were obturated using lateral compaction of gutta-percha and root canal sealer. The tooth remained asymptomatic and did not develop periapical pathology until 12 months postoperatively. CBCT and 3D modeling enable preoperative evaluation of aberrant root canal systems and facilitate endodontic treatment.

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          Most cited references22

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          Cleaning and shaping the root canal.

          H Schilder (1974)
          Article 0 comments Cited 240 times – based on 0 reviews     Review now
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            The root and root canal morphology of the human mandibular first premolar: a literature review.

            B Cleghorn, Catherine Dong, W Christie (2007)
            The purpose of this study was to undertake a comprehensive literature review of the root and root canal morphology of the mandibular first premolar. Published studies citing the anatomy and morphology of mandibular premolars report data for over 6,700 teeth. These studies were divided into anatomical studies reporting number of roots, number of canals, and apical morphology. Variations because of sex and ethnic background have also been reported, along with case reports of anomalies. Approximately 98% of the teeth in these studies were single-rooted. The incidence of two roots was 1.8%. Three roots when reported were found in 0.2% of the teeth studied. Four roots were rare and were found in less than 0.1% of the teeth studied. Studies of the internal canal morphology revealed that a single canal was present in 75.8% of the teeth. Two or more canals were found in 24.2% of the teeth studied. A single apical foramen was found in 78.9% of the teeth, whereas 21.1% had two or more apical foramina. The role of genetics and racial variation may result in differences of incidence of root number and canal number in human populations. The dental literature is not unique in studying ethnicity and sex variations. Higher incidences of teeth with additional canals and roots have been reported in Chinese, Australian, and sub-Sahara African populations. Physical anthropology studies seem to show the lowest incidence in Western Eurasian, Japanese and American Arctic populations. The root and root canal morphology of this tooth can be complex and requires careful evaluation prior to root canal therapy.
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              The root and root canal morphology of the human mandibular second premolar: a literature review.

              B Cleghorn, W Christie, C. Dong (2007)
              The objective was to review thoroughly the literature of the root and root canal morphology of the human mandibular second premolar and compare the results with the mandibular first premolar. Published studies cite the anatomy and morphology of the mandibular second premolar tooth for more than 7700 teeth. These studies were divided into anatomic studies reporting the number of roots, number of canals, and apical anatomy. Differences caused by gender and ethnicity have also been reported. Individual case reports of anomalies were included to demonstrate the extreme range of variation. Almost all of the teeth in the anatomic studies were single-rooted (99.6%). The incidence of 2 roots (0.3%) and 3 roots (0.1%) was extremely rare. Anatomic studies of the internal canal morphology found that a single canal was present in 91.0% of the teeth. A single apical foramen was found in 91.8% of the teeth. The incidence of more than 1 root (0.4%), more than 1 canal system (9.9%), and more than 1 foramen (8.2%) is lower than that of the mandibular first premolar tooth (2.0%, 24.2%, and 21.1%, respectively). However, the root and root canal morphology of the mandibular second premolar can be extremely complex and requires careful assessment.
              Article 0 comments Cited 44 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Restor Dent Endod
                Journal ID (iso-abbrev): Restor Dent Endod
                Journal ID (publisher-id): RDE
                Title: Restorative Dentistry & Endodontics
                Publisher: The Korean Academy of Conservative Dentistry
                ISSN (Print): 2234-7658
                ISSN (Electronic): 2234-7666
                Publication date (Print): May 2015
                Publication date (Electronic): 04 December 2014
                Volume: 40
                Issue: 2
                Pages: 161-165
                Affiliations
                [1 ]Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey.
                [2 ]Department of Endodontics, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey.
                [3 ]Department of Biomechanical Engineering, Faculty of Technology, Kocaeli University, Kocaeli, Turkey.
                Author notes
                Correspondence to Alper Sinanoglu, DDS, PhD. Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kocaeli University, Yuvacık Yerleşkesi, Başiskele, Kocaeli, Turkey 41190. TEL, +90 2623442222; FAX, +90 2623442109; alpersinanoglu@ 123456yahoo.com
                Article
                DOI: 10.5395/rde.2015.40.2.161
                PMC ID: 4432260
                PubMed ID: 25984479
                SO-VID: 17161133-9b38-45bb-9993-4bcaa035671a
                Copyright © ©Copyrights 2015. The Korean Academy of Conservative Dentistry.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 08 August 2014
                Date accepted : 22 October 2014
                Categories
                Subject: Case Report

                Keywords: cone-beam computed tomography,c-shaped canal,fused root,mandibular second premolar,three-dimensional modeling
                Data availability:
                Keywords: cone-beam computed tomography, c-shaped canal, fused root, mandibular second premolar, three-dimensional modeling

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