Radiographic In-Vivo Determination of the number of Canals in maxillary premolars of a - PowerPoint Presentation

Slide1

Radiographic In-Vivo Determination of the number of Canals in maxillary premolars of a Ghanaian population

Ampofo

P

.,

Nyako

E.A

.,

Blankson

P

.

,

and

Konadu

A

.

University

of Ghana School of Medicine and Dentistry, Accra, Ghana

Korle

-Bu

Teaching Hospital, Accra, Ghana

 

Slide2

OUTLINEBackgroundIntroductionObjectives

Materials and Methods

Results

Discussion

References

Slide3

Meet Mr. Kpodzro…

Slide4

Mr.

Kpodzro

presented at the Emergency Unit with a 4-day history of swelling in the right maxillary region which gradually increased in size.

He was subsequently referred to the Dental department where thorough investigation was done.

Hb-10.8 g/

dL

; WBC- 10.30 x 109

/L; Vitals and other results were grossly normalHe had apparently been seen by a Dentist 3-months prior to presentation where a root-canal was done on the second upper premolar which was confirmed on X-ray.

Slide5

X-RAY OF MR. KPODZRO’S TOOTH

Slide6

INTRODUCTIONBack to BasicsThe Concept of Reversible

vrs

Irreversible

Pulpistis

Slide7

WHAT IS ROOT CANAL THERAPYA sequence of treatment for the infected pulp of a tooth which results in the elimination of infection and the protection of the decontaminated tooth from future 

microbial invasion

.

Slide8

It is evident

that the root canal varies with size, shape and number of roots in different teeth,

1

it is a known pertinent consideration in

endodontics

. Successful General dental procedures and Root canal therapy in particular requires a thorough knowledge of tooth anatomy and root canal morphology

2,3

Slide9

With a variation in the number of canals

4

, the maxillary premolars remain one of the challenging teeth to treat

endodontically

,

A

lso because of the direction and longitudinal depressions of the roots, the various pulp cavity configurations, and the difficulties in visualizing the apical limit by radiographs

5

Slide10

The Objective?Many factors contribute to differences in canal morphology4

but largely influenced by ethnic background, age and gender of the populations studied

5,6,7,8

Despite

copious data on several populations worldwide, data is scarce for Ghana.

This study thus describes a clinical survey by use of radiographs to determine the number of canals in maxillary premolars in a Ghanaian population.

Slide11

Materials And MethodsFour hundred and two (402) participants were selected from patients who had opted for, and were referred to the Restorative Dentistry Department of the University Ghana School of Medicine and Dentistry for endodontic treatment of maxillary premolar from January 2012 till December 2015

.

Preoperative radiographs were taken for evaluation (root morphology, number of canals, and

periapical

status).

Slide12

The teeth that were included in this study were those teeth that required nonsurgical endodontic treatment. The

included teeth were free of root

resorption

, had no calcifications or open apices and no retreatment cases were included in the study, patients who defaulted treatment at any point were also excluded.

Consent

was sought from each patient.

Slide13

The teeth included were both clinically and radiographically examined by three specialists with more than 10 years of experience in

endodontics

and all patients operated on by the same certified Dental

Surgeons

The endodontic procedures undertaken were as follows: local anesthesia consisting of 2%

Lidocaine

in 1:100,000 adrenaline was administered by infiltration.

Slide14

After the contents of the pulp chamber were removed, a sharp endodontic explorer was used to explore the developmental grooves carefully to locate the orifices of the canals. Copious amount of 2.5% sodium hypochlorite irrigation was used.

Pulp

tissue was extirpated using barbed broaches and the canals were flared with gates

glidden

burs.

Examination

of the floor of the pulp chamber to locate canals orifices was done using 3.5 high resolution magnification loupes (

Azdent). The number of root canals in the maxillary first and second premolars was recorded with correlated folder numbers, age and gender. The data was analyzed

Slide15

RESULTSA total of 402 patients were used in the study. 239 of these were females and 163 males, representing 59.45% and 40.55% respectively. Of the total number of teeth used, 160 were maxillary

first premolars while 242 were maxillary second premolars.

The age ranged from 16yrs to 82yrs with a mean age of 40yrs.

Slide16

Slide17

Slide18

DISCUSSIONDetermination of pulp anatomy generally fall within In-vivo (Clinical) or In-vitro studies.

While

in-vitro methods encompass teeth sectioning of extracted or cadaveric teeth, to apply dyes, contrasting media or scanning electron microscopy for analysis,

6,7

Clinical

methods on the other hand uses Anatomy studies, exploration, high resolution CT, Visualization endogram,

Fibreoptic endoscopy, magnetic resonance imaging and radiographs, which our study employs6,8

Slide19

While Maxillary first premolars are considered to have two canals, Maxillary second premolar are generally considered to have one canal.

9,10,11,12

In the present study, the latter had one canal in 24.7% of cases. This is at variance with the studies of Green

9

and

Vertucci

et al. 10 in which the maxillary second premolars was reported to have one canal in 72% and 75% of cases respectively.

Slide20

Like other anatomical features, it is natural to assume racial and ethnology influences on dental morphology differences. It

has been observed that different populations show distinctive variations of tooth morphology.

18

Our

study’s 95.4% and 75.3% finding for the first and second maxillary premolars respectively

is

much higher than reported in Asian studies in Singapore 20

and Sichuan province, China 21

Slide21

In 1969, Weine et al.22,23 provided the first classification of more than one canal system in a single root and used the

mesiobuccal

root of the maxillary first molar as the type specimen.

Vertucci

further studied the canal anatomy extensively establishing eight different classification of pulp anatomy.

24,25

which the authors propose for the curriculum in Ghana

Slide22

Type I: A single canal extends from the pulp chamber to the apexType II: Two separate canals leave the pulp chamber and join short of the apex to form one canal

Type III: One canal leaves the pulp chamber and divides into two in the root; the two then merge to exit as one canal

Type IV: Two separate, distinct canals extend from the pulp chamber to the apex

Type V: One canal leaves the pulp chamber and divides short of the apex into two separate, distinct canals with separate apical foramina

Type VI: Two separate canals leave the pulp chamber, merge in the body of the root, and

redivide

short of the apex to exit as two distinct canals

Type VII: One canal leaves the pulp chamber, divides and then rejoins in the body of the root, and finally redivides into two distinct canals short of the apex

Type VIII: Three separate, distinct canals extend from the pulp chamber to the apex

Slide23

A LOGICAL EXPLANATION FOR MR KPODZRO

Slide24

SUMMARY

This study was done to determine the number of canals in maxillary premolars in a Ghanaian population.

402 participants

were selected from patients who were referred for endodontic treatment of maxillary premolars. These consisted of 239 females (59%) and 163 males (41%).

The

teeth included in the study were examined clinically and

radiographically for the number of root canals

using.95.4% of the maxillary first premolars had two canals while 75.3% of the maxillary second premolars also had two canals. There was no significant association between gender and the number of canals in each premolar.

Slide25

CONCLUSIONThe incidence of two canals in maxillary premolars of the Ghanaian population is very high.

Students

and Clinicians should be made aware of this extreme variation so that further inspection and careful interpretation of preoperative radiographs is done for success in endodontic therapy, especially of the maxillary second premolar

.

Slide26

“…the end? We’re not at the end, we’re nowhere near the end. We are not at the beginning of the end. If anywhere, then perhaps end of the beginning.”Winston Churchill

Slide27

REFERENCE

Ingle, John

Ide

&

Bakland

, Leif K & Health Communication Network 2002,

Endodontics, 5th ed, B C Decker, Hamilton, Ont. ; London

D'Souza R. Development of the pulpodentinal complex. In: Hargreaves K, editor. Seltzer and Bender's Dental Pulp. Chicago, Ill, USA: Quintessence Books; 2002.

Cleghorn

B, Christie W, Dong C. Root and root canal morphology of the human

mandibular

first premolar: A literature review. J

Endod

. 2007;33:509–16. [

PubMed

]

Jayasimha

Raj U,

Mylswamy

S. Root canal morphology of maxillary second premolars in an Indian population. Journal of Conservative Dentistry : JCD. 2010;13(3):148-151. doi:10.4103/0972-0707.71648.

Pecora

JD, Sousa

Neto

MD,

Saquy

PC,

Woelfel

JB. Root form and canal anatomy of maxillary second premolars.

Braz

Dent J. 1992;3:81–5. [

PubMed

]

Author/Editor:

Garg

Nisha

,

Garg

Amit

,

Speciality:Conservative

Dentistry and

Endodontics

Jayasimha

Raj U,

Mylswamy

S. Root canal morphology of maxillary second premolars in an Indian population. J

Conserv

Dent. 2010;13:148–51. [

PMC free article

] [

PubMed

]

Nur

BG, Ok E,

Altunsoy

M,

Aglarci

OS,

Colak

M,

Gungor

E. Evaluation of the root and canal morphology of

mandibular

permanent molars in a south-eastern Turkish population using cone-beam computed tomography.

European Journal of Dentistry

. 2014;8(2):154-159. doi:10.4103/1305-7456.130584

.

Slide28

9. Green

D. Double canals in single roots. Oral

Surg

Oral Med Oral

Pathol

1973; 35: 689-96.

10. Vertucci

F, Seelig A, Gillis R. Root canal morphology of the human maxillary second premolar. Oral Surg Oral Med Oral Pathol 1974; 58 456-6411. G

.

Cantatore

, E.

Berutti

, and A.

Castellucci

, “Missed anatomy: frequency and clinical impact,” Endodontic Topics, vol. 15, no. 1, pp. 3–31, 2006.

12. L

. J.

Buhrley

, M. J. Barrows, E. A.

BeGole

, and C. S.

Wenckus

, “Effect of magnification on locating the MB2 canal in maxillary molars,” Journal of

Endodontics

, vol. 28,no. 4, pp. 324–327, 2002.

13.

Chima

O. Number of root canals of the maxillary second premolar in Nigerians.

Odonto-stomatol

Trop

1997; 78 : 31-2

14.

Pecora

JD, Sousa

Neto

MD,

Saquy

PC,

Woelfel

JB. In vitro study of root canal anatomy of maxillary second premolars.

Braz

Dent J 1993; 3: 81-5.

15.

Weng

XL, Yu SB, Zhao SL, Wang HG, Mu T, Tang RY

.

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;35:651-6.

16. Pineda

F,

Kuttler

Y.

Mesiodistal

and

buccolingual

roentogenic

investigations of 7,275 root canals. Oral Surg. 1972;33:101–10. [

PubMed

]

17.

Rwenyonyi

CM,

Kutesa

A,

Muwazi

L,

Buwembo

W. Root and canal morphology of maxillary first premolar teeth in a Ugandan population. Open J

Stomatol

2011;1:7-11.  

18. 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;2:1-5.

Slide29

19. Ahmad

IA. Root and root canal morphology of Saudi Arabian permanent dentition. Saudi

Endod

J 2015;5:99-106.  

20.

Loh

HS. Root morphology of the maxillary first premolar in Singaporeans. Aust

Dent J 1998;43:399-402.21. Deng D, Zhang M, Wu W. The morphology study of root canal system of permanent teeth. Sichuan J Anat 2004;12:226.22. Weine

FS, Healey HJ, Gerstein H,

Evanson

L. Canal configuration in the

mesiobuccal

root of the maxillary first molar and its endodontic significance. Oral

Surg

Oral Med Oral

Pathol

. 1969;28:419–25. [

PubMed

]

23.

Gulabivala

K,

Aung

TH,

Alavi

A, Ng YL. Root and canal morphology of Burmese

mandibular

molars.

Int

Endod

J. 2001;34:359–70. [

PubMed

]

24.

Awawdeh

LA, Al-

Qudah

AA. Root form and canal morphology of

mandibular

premolars in a Jordanian population.

Int

Endod

J. 2008;41:240–8. [

PubMed

]

25.

Vertucci

FJ. Root canal morphology and its relationship to endodontic procedures.

Endod

Topics. 2005;10:3–29

26.

Sert

S,

Bayirli

GS. Evaluation of the root canal configuration of the

mandibular

and maxillary permanent teeth by gender in the Turkish population. J

Endod

. 2004;30:391–8. [

PubMed

]