• Restorative Dentistry and Endodontics
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• v.47 no.2
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• pp.19.1-19.15
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• 2022

Objectives: The aim of this study was to evaluate and compare the apical constriction (AC) and apical canal morphology of maxillary first and second molars, using micro-computed tomography (micro-CT). Materials and Methods: The anatomical features of 313 root canals from 41 maxillary first molars and 57 maxillary second molars of patients with known age and sex were evaluated using micro-CT, with a resolution of 26.7 ㎛. The factors evaluated were the presence or absence of AC, the morphotypes, bucco-lingual dimension, mesio-distal dimension, and the profile (shape) of AC and the apical root canal. The apical root canal dimensions, location of the apical foramen (AF), AC to AF distance, and presence of accessory canals in the apical 5 mm were also assessed. Descriptive and analytical statistics were used for data evaluation. Results: AC was present in all 313 root canals. Patients' age and sex did not significantly impact either AC or the apical canal dimensions. The most common AC morphotype detected was the traditional (single) constriction (52%), followed by the parallel (29%) morphotype. The mean AC dimensions in maxillary first molars were not significantly different from those in maxillary second molars. Sixty percent of AF were located within 0.5 mm from the anatomic apex. Conclusions: The most common morphotype of AC detected was the traditional constriction. Neither patients' age nor sex had a significant impact on the dimensions of the AC or the apical root canal. The majority of AF (60%) were located within 0.5 mm from the anatomic apex.

• Restorative Dentistry and Endodontics
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• v.37 no.3
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• pp.175-179
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• 2012

The aim of this study was to present a method for endodontic management of a maxillary first molar with unusual C-shaped morphology of the buccal root verified by cone-beam computed tomography (CBCT) images. This rare anatomical variation was confirmed using CBCT, and nonsurgical endodontic treatment was performed by meticulous evaluation of the pulpal floor. Posttreatment image revealed 3 independent canals in the buccal root obturated efficiently to the accepted lengths in all 3 canals. Our study describes a unique C-shaped variation of the root canal system in a maxillary first molar, involving the 3 buccal canals. In addition, our study highlights the usefulness of CBCT imaging for accurate diagnosis and management of this unusual canal morphology.

• Restorative Dentistry and Endodontics
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• v.23 no.1
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• pp.391-400
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• 1998

The aim of this study was to determine the shaping ability of stainless-steel K file (S-S K file), nickel-titanium K file (Ni-Ti K file) and engine driven nickel-titanium file (Quantec file) in resin simulated root canal. Computed tomography was used to evaluate the change of the root canal morphology. Thirty nine resin simulated root canal were divided into four groups (A:12, B:12, C:12, D:3). Resin simulated canals were scanned by computed tomography before instrumentation (1st C-T scan). Canals were instrumented using step back preparation technique with S-S K file in group A and Ni-Ti K file in group B. Group C was prepared with engine driven Ni-Ti file. Group D was uninstrumented to compare the 1st C-T scan images with 2nd C-T scan images of root canal. Instrumented canals were again scanned using computed tomography (2nd C-T scan), and reformated images of the uninstrumented canals were compared with images of the instrumented canals. In the sections of 2mm and 6mm from the apex, Quantec file caused significantly less canal transportation than S-S K file and Ni-Ti K file (p<0.05). Quantec file produced more centered than S-S K file and Ni-Ti K file in the sections of 2mm and 4mm from the apex (p<0.05). There was no significant difference in the removed volume of canals among the each groups (p>0.05). However the removed canal volume from the apex to 5mm were significantly higher than them from 5mm to 1mm (p<0.05) in each groups. Under the conditions of this study, preparation with Quantec file was more effective and produce more appropriate canal shapes than S-S K file and Ni-Ti K file.

• Restorative Dentistry and Endodontics
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• v.32 no.1
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• pp.37-46
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• 2007

The C-shaped canal system is an anatomical variation mostly seen in mandibular second molars, although it can also occur in maxillary and other mandibular molars. The main anatomical feature of C-shaped canals is the presence of fins or web connecting the individual root canals. The complexity of C-shaped canals prevents these canals from being cleaned, shaped, and obturated effectively during root canal therapy, and sometimes it leads to an iatrogenic perforation from the extravagant preparation. The purpose of this study was to provide further knowledge of the anatomical configuration and the minimal thickness of dentinal wall according to the level of the root. Thirty extracted mandibular second molars with fused roots and longitudinal grooves on lingual or buccal surface of the root were collected from a native Korean population. The photo images and radiographs from buccal, lingual, apical direction were taken. After access cavity was prepared, teeth were placed in 5.25% sodium hypochlorite solution for 2 hours to dissolve the organic tissue of the root surface and from the root canal system. After bench dried and all the teeth were embedded in a self-curing resin. Each block was sectioned using a microtome (Accutom-50, Struers, Denmark) at interval of 1 mm. The sectioned surface photograph was taken using a digital camera (Coolpix 995, Nikon, Japan) connected to the microscope. 197 images were evaluated for canal configurations and the minimal thickness of dentinal wall between canal and external wall using 'Root Thickness Gauge Program' designed with Visual Basic. The results were as follows : 1. At the orifice level of all teeth, the most frequent observed configuration was Melton's Type C I (73%), however the patterns were changed to type C II and C III when the sections were observed at the apical third. On the other hand, the type C III was observed at the orifice level of only 2 teeth but this type could be seen at apical region of the rest of the teeth. 2. The C-shaped canal showed continuous and semi-colon shape at the orifice level, but at the apical portion of the canal there was high possibility of having 2 or 3 canals 3. Lingual wall was thinner than buccal wall at coronal, middle, apical thirds of root but there was no statistical differences.

• Restorative Dentistry and Endodontics
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• v.45 no.1
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• pp.1.1-1.9
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• 2020

Objectives: The purpose of this study was to determine the incidence of radix molaris (RM) (entomolaris and paramolaris) in the mandibular first permanent molars of a sample Saudi Arabian subpopulation using cone-beam computed tomography (CBCT). Materials and Methods: A total of 884 CBCT images of 427 male and 457 female Saudi citizens (age 16 to 70 years) were collected from the radiology department archives of 4 dental centers. A total of 450 CBCT images of 741 mature mandibular first molars that met the inclusion criteria were reviewed. The images were viewed at high resolution by 3 examiners and were analyzed with Planmeca Romexis software (version 5.2). Results: Thirty-three (4.5%) mandibular first permanent molars had RM, mostly on the distal side. The incidence of radix entomolaris (EM) was 4.3%, while that of radix paramolaris was 0.3%. The RM roots had one canal and occurred more unilaterally. No significant difference in root configuration was found between males and females (p > 0.05). Types I and III EM root canal configurations were most common, while type B was the only RP configuration observed. Conclusions: The incidence of RM in the mandibular first molars of this Saudi subpopulation was 4.5%. Identification of the supernumerary root can avoid missing the canal associated with the root during root canal treatment.

• Restorative Dentistry and Endodontics
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• v.38 no.1
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• pp.26-30
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• 2013

Objectives: The aim of this study was to investigate the relationship between the apical foramen morphology and the length of merged canal at the apex in type II root canal system. Materials and Methods: This study included intact extracted maxillary and mandibular human premolars (n = 20) with fully formed roots without any visible signs of external resorption. The root segments were obtained by removing the crown 1 mm beneath the cementum-enamel junction (CEJ) using a rotary diamond disk. The distance between the file tip and merged point of joining two canals was defined as Lj. The roots were carefully sectioned at 1 mm from the apex by a slow-speed water-cooled diamond saw. All cross sections were examined under the microscope at ${\times}50$ magnification and photographed to estimate the shape of the apical foramen. The longest and the shortest diameter of apical foramen was measured using ImageJ program (1.44p, National Institutes of Health). Correlation coefficient was calculated to identify the link between Lj and the apical foramen shape by Pearson's correlation. Results: The average value of Lj was 3.74 mm. The average of proportion (P), estimated by dividing the longest diameter into the shortest diameter of the apical foramen, was 3.64. This study showed a significant negative correlation between P and Lj (p < 0.05). Conclusions: As Lj gets longer, the apical foramen becomes more ovally shaped. Likewise, as it gets shorter, the apical foramen becomes more flat shaped.

• Journal of the korean academy of Pediatric Dentistry
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• v.47 no.1
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• pp.25-35
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• 2020

The purpose of this study is to evaluate the morphological characteristics of the roots and roots canals of primary molar teeth using Cone-Beam Computed Tomography (CBCT). A total of 68 CBCT images of children aged 4 - 5 years was used for this study. A total of 160 molar teeth were analyzed. Various parameters such as the number of roots and canals, length of root and root canal, and the angulation and shape of the roots were analyzed. All maxillary primary molars had 3 roots. The presence of 2 root canals in 1 root was only observed in the mesiobuccal root of maxillary primary second molars. Most mandibular primary molars had 2 roots, and most mesial roots had 2 root canals. Concerning the length of the roots, the palatal root of the maxillary primary molar was found to be longest whereas the distobuccal root was shortest. In mandibular primary molars, the mesial root was longer than the distal root. In maxillary primary molars, the palatal root had the greatest angulation whereas the distal root has the greatest in mandibular molars. The root and root canals of maxillary primary molars were more curved in shape whereas mandibular primary molars were straight.

• Restorative Dentistry and Endodontics
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• v.46 no.1
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• pp.5.1-5.13
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• 2021

Objectives: The aim of the current study was to assess whether the amount of extruded debris differs for straight and severely curved root canals during retreatment using H-files, R-Endo, Reciproc and ProTaper Universal Retreatment (PTU-R) files. Additionally, the area of residual filling material was evaluated. Materials and Methods: Severely curved (n = 104) and straight (n = 104) root canals of maxillary molar teeth were prepared with WaveOne Primary file and obturated with gutta-percha and AH Plus sealer. Root canal filling materials were removed with one of the preparation techniques: group 1: H-file; group 2: R-Endo; group 3: Reciproc; group 4: PTU-R (n = 26). The amount of extruded material and the area of the residual filling material was measured. The data were analyzed with 2-way analysis of variance (ANOVA) and 1-way ANOVA at the 0.05 significance level. Results: Except for Reciproc group (p > 0.05), PTU-R, R-Endo, and H-file systems extruded significantly more debris in severely curved canals (p < 0.05). Each file system caused more residual filling material in severely curved canals than in straight ones (p < 0.05). Conclusions: All instruments used in this study caused apical debris extrusion. Root canal curvature had an effect on extruded debris, except for Reciproc system. Clinicians should be aware that the difficult morphology of the severely curved root canals is a factor increasing the amount of extruded debris during the retreatment procedure.

• Restorative Dentistry and Endodontics
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• v.46 no.1
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• pp.4.1-4.16
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• 2021

Objectives: This study evaluated the biocompatibility and bioactive potential of NeoMTA Plus mixed as a root canal sealer in comparison with MTA Fillapex. Materials and Methods: Polyethylene tubes filled with NeoMTA Plus (n = 20), MTA Fillapex (n = 20), or nothing (control group, CG; n = 20) were inserted into the connective tissue in the dorsal subcutaneous layer of rats. After 7, 15, 30 and 60 days, the specimens were processed for paraffin embedding. The capsule thickness, collagen content, and number of inflammatory cells (ICs) and interleukin-6 (IL-6) immunolabeled cells were measured. von Kossa-positive structures were evaluated and unstained sections were analyzed under polarized light. Two-way analysis of variance was performed, followed by the post hoc Tukey test (p ≤ 0.05). Results: At 7 days, the capsules around NeoMTA Plus and MTA Fillapex had more ICs and IL-6-immunostained cells than the CG. However, at 60 days, there was no significant difference in the IC number between NeoMTA Plus and the CG (p = 0.1137) or the MTA Fillapex group (p = 0.4062), although a greater number of IL-6-immunostained cells was observed in the MTA Fillapex group (p = 0.0353). From 7 to 60 days, the capsule thickness of the NeoMTA Plus and MTA Fillapex specimens significantly decreased, concomitantly with an increase in the collagen content. The capsules around root canal sealers showed positivity to the von Kossa stain and birefringent structures. Conclusions: The NeoMTA Plus root canal sealer is biocompatible and exhibits bioactive potential.

• Restorative Dentistry and Endodontics
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• v.48 no.2
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• pp.17.1-17.8
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• 2023

The present report describes the endodontic treatment of an Oehlers type II dens invaginatus in a maxillary lateral incisor with 5 root canals, an extremely rare condition. Apical periodontitis and related symptoms were noted. Cone-beam computed tomography was used to aid the diagnosis, reveal tooth morphology, and assist in canal location. The pulp chamber was carefully accessed, and the root canals were explored under magnification. All root canals were prepared with an R25 Reciproc Blue system and sodium hypochlorite (NaOCl) irrigation. After initial preparation, a self-adjusting file (SAF) with NaOCl and ethylenediaminetetraacetic acid was used to complement the disinfection. Additionally, calcium hydroxide medication was applied. Vertical compaction was used to fill the canals with a calcium silicate-based endodontic sealer and gutta-percha. After 12 months, the patient exhibited healing of the periapical region, absence of symptoms, and normal dental function. In conclusion, this nonsurgical treatment protocol was successful in promoting the cure of apical periodontitis. Both complementary disinfection with an SAF and use of calcium hydroxide medication should be considered when choosing the best treatment approach for dens invaginatus with very complex anatomy.