The aim of this study is to analyze root canal anatomy and symmetry of maxillary and mandibular first and second molars of the Bulgarian population using cone-beam computed tomography (CBCT) as a diagnostic tool.
A total of 100 patients who required CBCT examination as part of their dental treatment were enrolled in our study. A total of 561 untreated, well-developed maxillary and mandibular molar teeth (139 maxillary first molars, 162 maxillary second molars, 116 mandibular first molars and 144 mandibular second molars) were examined by CBCT to establish the number of root canals and the symmetry in canal anatomy between both sides in the same patient.
Three separate root canals presented normal anatomy of maxillary second and mandibular first and second molars. Maxillary first molars presented in over 60% of the cases with an additional mesio-buccal root canal.
Maxillary first molars were found to be symmetrical in 84% of the patients, whereas maxillary second molars - in 68.5%; 16.3% of the mandibular first and 8.1% of the mandibular second molars showed asymmetry.
The results of the present study reported a high percentage of maxillary first molar teeth with four root canals in the Bulgarian population, as well as percentage of asymmetry between the first and second maxillary and mandibular molar teeth that varied from 8.1-31.5%. These variations of symmetry should be taken into consideration in cases when endodontic treatment of two opposite molars in the same patient is required, because their root canal anatomy can present with significant differences.
Plotino G., Tocci L., Grande N.M., Testarelli L., Messineo D., et al. (2013) Symmetry of Root and Root Canal Morphology of Maxillary and Mandibular Molars in a White Population: A Cone-beam Computed Tomography Study- In Vivo. Journal of Endodontcs Vol 39, Issue 12, pp 1545-1548.
Peters O.A., Laib A., Ruegsegger P., Barbakow F.(2000). Three-dimensional analysis of root canal geometry by high-resolution computed tomography. J Dent Res.Vol. 79 pp. 1405-9.
Silva E.J., Nejaim Y., Silva A.J., Haiter-Neto F., Zaia A.A., Cohenca N. (2014) Evaluation of root canal configuration of maxillary molars in a Brazilian population using cone-beam computed tomography imaging: an in vivo study. J Endod. Vol. 40 pp. 173-6.
Sempira H.N., Hartwell G.R. (2000) Frequency of second mesiobuccal canals in maxillary molars as determined by use of an operating microscope: a clinical study. J Endod. Vol. 26, pp. 673-4
Reit C., Petersson K., Molven O. Diagnosis of pulpal and periradicular disease. In: Bergenholtz G, Horsted-Bindslev P, Reit C, eds, Textbook of Endodontology, (2003) 1st ed. Oxford UK: Blackwell Publishing Ltd. pp. 9-18.
Ramamurthy R., Scheetz J.P., Clark S.J., Farman A.G. (2006). Effects of imaging system and exposure on accurate detection of the second mesio-buccal canal in maxillary molar teeth. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. Issue 102. Vol. 6. Pp.796-802.
Matherne R.P, Angelopoulos C., Kulild J.C., Tira D. (2008). Use of cone-beam computed tomography to identify root canal systems in vitro. Journal of Endodontics. Issue 34. Vol. 1. Pp. 87-89.
Degerness R.A., Bowles W.R. (2010). Dimension, anatomy and morphology of the mesiobuccal root canal system in maxillary molars. J Endod. Vol.36. pp. 85-9.
Борисова-Папанчева Цв., Панов Вл. , Занева Д. (2017). Честота на втори медио-вестибуларен канал при горни първи молари-обзор. Варненски медицински форум. том 6. брой 1. МУ-Варна, стр 113-116. [Borisova-Papancheva Ts. Panov Vl. Zaneva D. (2017). Chestota na vtori medio-vestibularen kanal pri gorni pyrvi molari-obzor. Varnenski meditsinski forum. Tom 6 (1). Pp. 113-116.]
Smadi L., Khraisat A. Detection of a second mesiobuccal canal in the mesiobuccal roots of maxillary first molar teeth. (2007). Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Vol.103. pp. 77-81
Scares de Toubes K.M., Cortes M.I., Valadares Ma., et al. (2012). Comparative analyses of accessory masial canal identification in mandibular first molars by using four different diagnostic methods. J Endod. Vol.38, pp. 436-41
Hartwell G., Appelstein C.M., Lyons W.W., Guzek M.E. (2007).The incidence of four canals in maxillary first molars: a clinical determination. J Am Dent Assoc. Vol. 138. Pp.1344-6.
Neelakantan P.,Subbarao C., Ahuja R., et al. (2010). Cone-beam computed tomography study of root and canal morphology of maxillary first and second molars in an Indian population. J Endod. Vol. 36. Pp. 1622-7.
