Root and Root Canal Configuration Characterization Using Microcomputed Tomography: A Systematic Review

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Abstract

This systematic review’s objective was to conduct a complete analysis of the literature on the root canal morphology using advanced micro-computed tomography. The electronic web databases PubMed, Scopus, and Cochrane were examined for research papers concerning the chosen keywords, evaluating the root canal morphology using Micro-CT, published up to 2021. The articles were searched using MeSH keywords and searched digitally on four specialty journal websites. DARE2 extended (Database of Attributes of Reviews of Effects) was used to assess bias risk. The information was gathered from 18 published studies that strictly met the criteria for inclusion. In the included studies, a total of 6696 samples were studied. The studies were conducted on either maxillary (n-2222) or mandibular teeth (n-3760), permanent anteriors (n-625), and Third molars (n-89). To scan samples, a Scanco Medical machine in was used in 10 studies, Bruker Micro-CT in 34, and seven other machines were utilized in the rest. Bruker Micro-CT software from Kontich, Belgium, VG-Studio Max 2.2 software from Volume Graphics, Heidelberg, Germany, was the most commonly used software. The minimum Voxel size (resolution) adopted in the included studies was 11.6 µm. However, 60 µm was the maximum. Most studies classified the root canal morphology using Vertucci’s classification system (n-16) and the four-digit system (n-6).

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Most cited references 115

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Root canal anatomy of the human permanent teeth.

Frank J Vertucci (1984)

Two thousand four hundred human permanent teeth were decalcified, injected with dye, and cleared in order to determine the number of root canals and their different types, the ramifications of the main root canals, the location of apical foramina and transverse anastomoses, and the frequency of apical deltas.

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Root and canal morphology of Burmese mandibular molars.

K Gulabivala, Ali A. Alavi, T Aung … (2001)

To study the root canal morphology of Burmese mandibular molars using a canal staining and tooth clearing technique. Mandibular molars (331) were collected from indigenous Burmese patients and designated; first (139), second (134), third (58) molars. Following pulp tissue removal and staining of the canal systems with Indian ink, the teeth were decalcified and rendered clear with methyl salicylate. Under magnification (x3), the following features were evaluated: (i) root number and morphology, (ii) number of canals per root, (iii) root canal configuration (Vertucci's classification), (iv) number of apical foramina per root, (v) number and location of lateral canals and (vi) the presence of intercanal communications. Most of the mandibular molars had two separate roots (90% in first molars, 58% in second molars, 53% in third molars) and three-rooted teeth were (10%) confined to first molars. C-shaped roots occurred in 22.4% of mandibular second molars and a further 14.9% had two fused roots. The majority (81-100%) of conical distal roots possessed a simple type I (single canal) configuration. Whilst the canal system of mesial roots was more complex: 52-85% contained two canals, of which type II (two orifices, one foramen) and type IV (two separate canals) were the most prevalent. A broad range of 6.5-70% had intercanal communications. Fused/single-rooted molars had a wide variety of canal system types but intercanal communications were rare except in C-shaped roots (33%) of second molars. The majority of roots of all molars contained one or two apical foramina (91-96%) and the apical third had the highest prevalence of lateral canals. There was a high prevalence of three-rooted mandibular first molars and C-shaped roots/canals in mandibular second molars from a Burmese population. Conical roots tend to have simple canal systems, whilst flatter/broader roots have more complex canal systems.

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C-shaped canal system in mandibular second molars: Part I--Anatomical features.

James Gutmann, Gary S P Cheung, Jian-Bing Fan … (2004)

The purpose of this study was to investigate the anatomical features of C-shaped root canal system in mandibular second molars using micro-computed tomography (microCT). Fifty-eight extracted mandibular second molars with fused roots were collected from a native Chinese population. The teeth were scanned into layers of 0.5-mm thickness by microCT and measurements were made at eleven levels. The ratio of the depth of the deepest part of the groove to the buccal-lingual thickness of the cross-section of the root was calculated for each tooth. The canal shapes of the scanned cross-sections were assessed and classified according to a modified Melton's method. Results were subject to the Kruskal-Wallis test. Of the 58 molars, 54 had a C-shaped canal system with a mean groove-to-thickness ratio of 47.96%; the four teeth without a C-shaped canal had a mean ratio of 14.82%. Most orifices (98.1%) were found within 3 mm below the cementoenamel junction. Of teeth with a C-shape canal system, a majority demonstrated an orifice with an uninterrupted "C" configuration. Seventeen canals divided in the apical portion, most of which did so within 2 mm from the apex. The cross-sectional shape varied drastically along the length of the canal. Teeth with a high groove-to-thickness ratio had at least one section with C1, C2, or C3 configuration. The canal shape in middle and apical thirds of C-shaped canal systems could not be predicted on the basis of the shape at the orifice level. Section 2 of this paper addressed the correlation between the radiographic appearance and these microCT images.