The Open Dentistry Journal


ISSN: 1874-2106 ― Volume 11, 2017

Evaluation of Distolingual Canal/Roots in Mandibular Molars and Mesiobuccal Canals in Maxillary Molars by CBCT



Filiz Namdar Pekiner*, M. Oğuz Borahan, Asım Dumlu
Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Marmara University, İstanbul, Turkey

Abstract

Background/Purpose:

The objectives of this study were to identify the bilateral distolingual (DL) canals / roots of the mandibular first molars and second mesiobuccal (MB2) canals of the maxillary first molars in the same Turkish individuals using cone-beam computed tomography (CBCT).

Materials and Methods:

A total of 150 CBCT images including all mandibular and maxillary first molars were retrospectively investigated in a Turkish subpopulation. The patient age, sex and presence of roots and root canals were assessed. The frequency, of bilateral DL canals, DL roots, and MB2 canals were reviewed. Data were analyzed using Fisher’sexact test and Chi-square test.

Results:

The prevalences of right DL canals, DL roots and MB2 canals were 31.3, 14.0 and 34.7%, respectively. The prevalences of left DL canals, DL roots and MB2 canals were 31.3, 4 and 27.3%, respectively. There was no statistically difference in the frequency of right and left DL canals, DL roots of mandibular first molars and MB2 canals of maxillary first molars according to gender.

Conclusion:

CBCT is a competent tool for the detection of additional distolingual canals/roots and second mesio buccal canals, and it is a valuable aid for dentists providing root canal treatment.

Keywords: CBCT, Endodontic treatment, Root canal, Molar, Mesiobuccal Canal.


Article Information


Identifiers and Pagination:

Year: 2017
Volume: 11
Issue: Suppl-1, M4
First Page: 360
Last Page: 366
Publisher Id: TODENTJ-11-360
DOI: 10.2174/1874210601711010360

Article History:

Received Date: 30/11/2016
Revision Received Date: 07/12/2016
Acceptance Date: 14/12/2016
Electronic publication date: 30/06/2017
Collection year: 2017

© 2017 Pekiner et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Marmara University, Guzelbahce Buyukciftlik Sok. No: 6, 34365 Nisantasi-Istanbul, Turkey, Tel: +90 (212) 231 91 20, Fax: +90 (212) 246 52 47; E-mail: fpekiner@gmail.com




1. INTRODUCTION

Success of endodontic management depends on the accurate debridement of the root canal space followed by complete obturation for obtaining the three-dimensional seal [1Vertucci FJ. Root canal morphology and its relationship to endodontic procedures. Endod Topics 2005; 10: 3-29.
[http://dx.doi.org/10.1111/j.1601-1546.2005.00129.x]
, 2Nair PN. On the causes of persistent apical periodontitis: A review. Int Endod J 2006; 39(4): 249-81.
[http://dx.doi.org/10.1111/j.1365-2591.2006.01099.x] [PMID: 16584489]
]. Especially in multirooted teeth, root and root canal morphology variations are a constant challenge for management [3Rathi S, Patil J, Jaju PP. Detection of mesiobuccal canal in maxillary molars and distolingual canal in mandibular molars by Dental CT: A retrospective study of 100 Cases. Int J Dent 2010; 2010: 291276.
[http://dx.doi.org/10.1155/2010/291276]
]. Therefore, a comprehensive knowledge of the root canal anatomy and its morphological variations is essential for successful treatment [2Nair PN. On the causes of persistent apical periodontitis: A review. Int Endod J 2006; 39(4): 249-81.
[http://dx.doi.org/10.1111/j.1365-2591.2006.01099.x] [PMID: 16584489]
].

The mandibular first molars is known to display the most complex root and root canal morphology of the mandibular dentition [4Miloglu O, Arslan H, Barutcugil C, Cantekin K. Evaluating root and canal configuration of mandibular first molars with cone beam computed tomography in a Turkish population. J Dent Sci 2013; 8: 80-6.
[http://dx.doi.org/10.1016/j.jds.2012.09.002]
]. Therefore many studies have reviewed the anatomy of the root canals of the mandibular first molars, and noted both complex anatomic variations and abnormalities [5de Pablo OV, Estevez R, Péix Sánchez M, Heilborn C, Cohenca N. Root anatomy and canal configuration of the permanent mandibular first molar: A systematic review. J Endod 2010; 36(12): 1919-31.
[http://dx.doi.org/10.1016/j.joen.2010.08.055] [PMID: 21092807]
, 6Kim S, Choi MR, Yoo JJ. Concurrent relationship between additional canals of mandibular first molars and maxillary first molars using cone-beam computed tomography. Oral Radiol 2013; 29: 146-50.
[http://dx.doi.org/10.1007/s11282-012-0115-z]
]. In these studies, the presence of a distolingual (DL) root of the mandibular first molars was reported to be 21.09-33.33% in various populations [7Kottoor J, Sudha R, Velmurugan N. Middle distal canal of the mandibular first molar: A case report and literature review. Int Endod J 2010; 43(8): 714-22.
[http://dx.doi.org/10.1111/j.1365-2591.2010.01737.x] [PMID: 20491988]
, 8Jeger FB, Lussi A, Bornstein MM, Jacobs R, Janner SF. [Cone beam computed tomography in endodontics: A review for daily clinical practice]. Schweiz Monatsschr Zahnmed 2013; 123(7-8): 661-8. [İn Germen].
[PMID: 23966013]
]. However, it is reported that the presence of second mesiobuccal (MB2) canals of maxillary first molars is noticeably rare [6Kim S, Choi MR, Yoo JJ. Concurrent relationship between additional canals of mandibular first molars and maxillary first molars using cone-beam computed tomography. Oral Radiol 2013; 29: 146-50.
[http://dx.doi.org/10.1007/s11282-012-0115-z]
].

CBCT provides three-dimensional information of maxillofacial region and is increasingly being used in many of the dental specialties [8Jeger FB, Lussi A, Bornstein MM, Jacobs R, Janner SF. [Cone beam computed tomography in endodontics: A review for daily clinical practice]. Schweiz Monatsschr Zahnmed 2013; 123(7-8): 661-8. [İn Germen].
[PMID: 23966013]
]. In terms of three-dimensional evaluation, two-dimensional imaging like periapical radiography and panoramic radiography loses the battle for the lack of perception [3Rathi S, Patil J, Jaju PP. Detection of mesiobuccal canal in maxillary molars and distolingual canal in mandibular molars by Dental CT: A retrospective study of 100 Cases. Int J Dent 2010; 2010: 291276.
[http://dx.doi.org/10.1155/2010/291276]
,9Durack C, Patel S. Cone beam computed tomography in endodontics. Braz Dent J 2012; 23(3): 179-91.
[http://dx.doi.org/10.1590/S0103-64402012000300001] [PMID: 22814684]
]. Anatomical variations in the anatomy of the distal root/canal of mandibular molars and mesiobuccal (MB) canal of maxillary first molars may be determined through careful evaluation with the aid of multiple angled pretreatment radiographs. A two-dimensional image is obtained by conventional radiographs and they do not always reveal the actual number of roots and canals present in cases [10Gupta S, Jaiswal S, Arora R. Endodontic management of permanent mandibular left first molar with six root canals. Contemp Clin Dent 2012; 3(Suppl. 1): S130-3.
[http://dx.doi.org/10.4103/0976-237X.95124] [PMID: 22629055]
]. Recently, CBCT has been used in endodontics for the evaluation of the root canal morphology. An advantage of the CBCT imaging over the conventional radiograph is that it is proved to be a valuable technique for the diagnosis and evaluation of root canal anatomy [9Durack C, Patel S. Cone beam computed tomography in endodontics. Braz Dent J 2012; 23(3): 179-91.
[http://dx.doi.org/10.1590/S0103-64402012000300001] [PMID: 22814684]
, 11Patel S, Dawood A, Whaites E, Pitt Ford T. New dimensions in endodontic imaging: part 1. Conventional and alternative radiographic systems. Int Endod J 2009; 42(6): 447-62.
[http://dx.doi.org/10.1111/j.1365-2591.2008.01530.x] [PMID: 19298577]
, 12Nance R, Tyndall D, Levin LG, Trope M. Identification of root canals in molars by tuned-aperture computed tomography. Int Endod J 2000; 33(4): 392-6.
[http://dx.doi.org/10.1046/j.1365-2591.2000.00330.x] [PMID: 11307216]
]. Neelakantan et al. Found that CBCT was as accurate in identifying root canal systems as the modified canal staining [13Neelakantan P, Subbarao C, Subbarao CV. Comparative evaluation of modified canal staining and clearing technique, cone-beam computed tomography, peripheral quantitative computed tomography, spiral computed tomography, and plain and contrast medium-enhanced digital radiography in studying root canal morphology. J Endod 2010; 36(9): 1547-51.
[http://dx.doi.org/10.1016/j.joen.2010.05.008] [PMID: 20728725]
]. Likewise, Tu et al. Showed a higher prevalence of extra roots in the mandibular first molars assessed by CBCT when compared with conventional radiography [14Tu MG, Liu JF, Dai PW, Chen SY, Hsu JT, Huang HL. Prevalence of three-rooted primary mandibular first molars in Taiwan. J Formos Med Assoc 2010; 109(1): 69-74.
[http://dx.doi.org/10.1016/S0929-6646(10)60023-X] [PMID: 20123588]
].

The aims of this study were to identify the bilateral distolingual (DL) canals / roots of the mandibular first molars and second mesiobuccal (MB2) canals of the maxillary first molars in the same Turkish individuals using cone-beam computed tomography (CBCT).

2. MATERIALS AND METHODS

2.1. Patient Data

This retrospective study sample is consisted of 150 patients (77 female, 73 male; 21-55 years old, mean 27.66 ± 6.08 years) who visited the department of Oral Diagnosis and Radiology at Dentistry Faculty and had CBCT scans for different purposes. 150 cone beam CT examinations of these patients with large FOVs showing all the mandibular and maxillary first molars fully erupted, formed apices and lacked root canal fillings, posts, and crown restorations, were picked up from the PACS (Picture Archiving Communication Systems) between 2012-2013 and were included in this study. CBCT was performed on a Planmeca Promax 3D Mid (Planmeca Oy, Helsinki, Finland). The ProMax 3D Mid CBCT machine was operated at 84 kVp and 4 mA with an 16×16 cm FOV, with the voxel size was 0.2 mm. The CBCT assessment was performed directly on monitor screen (Monitor 23 inch acer 1920x1080 pixel HP Reconstruction PC, USA). All of the included mandibular and maxillary first molars had completely form root apices and lacked root canal fillings, post, and crown restorations.

The exclusion criteria included patients with history of trauma and/or surgery involving the maxillofacial region, systemic diseases which affect growth and development, or clinical and/or radiographic evidence of developmental anomalies/pathologies affecting the maxillofacial region. All digital imaging were viewed in the axial plane by Romexis 2.92 software (Planmeca Oy, Helsinki, Finland).

The study was carried out according to the recommendations of the Helsinki declaration and the study protocol was approved by the Local Committee of Research and Ethics of Yeditepe University (Protocol No: 212).

2.2. Observer

An oral and maxillofacial radiologist (FNP) interpreted all images. Firstly, the assesment of patient age, gender and presence of roots and canals were performed. Secondly, the presence of DL roots and DL canals in the 150 right and 150 left mandibular first molars and their bilateral concurrence were recorded. If a DL root or DL canal was clearly separated from the distobuccal root or distobuccal canal, respectively, their presences were defined on the axial plane images (Fig. 1). Lastly, the presence of an MB2 canal in the 150 right and 150 left maxillary first molars was recorded if it was clearly separated from main MB canal (Fig. 2).

2.3. Statistical Analysis

The data were analysed with SPSS (Statistical Package for Social Sciences) for Windows 15.0. (SPSS Inc., Chicago. IL., USA). Descriptive statistical methods (mean, standard deviation, frequency) were used for the evaluation of the data. Chi-square test, Continuity (yates) Correction and Fisher’s exact test were used to evaluate the comparison of qualitative data. P values of less than 0.05 were interpreted as significant.

Fig. (1)
Axial sections showing bilateral mandibular first molars with DL roots.


Fig. (2)
Axial sections showing right maxillary first molar with an MB2 canal and a left maxillary first molar without an MB2 canal.


3. RESULTS

A total 300 mandibular first molars and 300 maxillary first molars were included in the study sample since every subject had mandibular and maxillary first molars on both sides. The prevalences of DL roots, DL canals of mandibular first molars, and MB2 canals of maxillary first molars were 11.3, 62.6, and point 6.0%, respectively.

The distributions of right DL canals, DL roots and MB2 canals were 31.3 14.0 and 34.7%, respectively. The distributions of left DL canals, DL roots and MB2 canals were 31, 3, 4.0 and 27.3%, respectively. There was no statistically difference in the frequency of right and left DL canals, DL roots of mandibular first molars and MB2 canals of maxillary first molars according to gender (Table 1).

Table 1
Distribution of right and left DL canals, DL roots of mandibular first molars and MB2 canals of maxillary first molars according to gender.


In Tables (2-4), the prevalences of the bilateral distolingual (DL) roots / canals of the mandibular first molars and second mesiobuccal (MB2) canals of the maxillary first molars are shown respectively. The rates of bilateral concurrence were significant for all variables p < 0.01.

Table 2
Evaluation of the relationship between 36 DL root and 46 DL root.


Table 3
Evaluation of the relationship between 36 DL canal and 46 DL canal.


Table 4
Evaluation of the relationship between 16 MB2 canal and 26 MB2 canal.


DISCUSSION

CBCT imaging technique was used in this study to evaluate the presence of mandibular first molars having distolingual roots/canals and second mesiobuccal canals of the maxillary first molars .

The prevalence of DL roots of mandibular first molars in this study was 11.3%, which was similar to those in previous reports [15Al-Qudah AA, Awawdeh LA. Root and canal morphology of mandibular first and second molar teeth in a Jordanian population. Int Endod J 2009; 42(9): 775-84.
[http://dx.doi.org/10.1111/j.1365-2591.2009.01578.x] [PMID: 19549153]
, 16Garg AK, Tewari RK, Kumar A, Hashmi SH, Agrawal N, Mishra SK. Prevalence of three-rooted mandibular permanent first molars among the Indian Population. J Endod 2010; 36(8): 1302-6.
[http://dx.doi.org/10.1016/j.joen.2010.04.019] [PMID: 20647084]
]. In addition, Scafer et al. Observed that the overall incidence of patients with three-rooted mandibular first molars was 1.35% and rare in a German population [17Schäfer E, Breuer D, Janzen S. The prevalence of three-rooted mandibular permanent first molars in a German population. J Endod 2009; 35(2): 202-5.
[http://dx.doi.org/10.1016/j.joen.2008.11.010] [PMID: 19166773]
]. In contrast, the prevalence of DL roots of mandibular first molars was assesed by Kim et al. and it was reported that 24.7% had DL roots which was higher than our results [6Kim S, Choi MR, Yoo JJ. Concurrent relationship between additional canals of mandibular first molars and maxillary first molars using cone-beam computed tomography. Oral Radiol 2013; 29: 146-50.
[http://dx.doi.org/10.1007/s11282-012-0115-z]
]. Their result was similar to previous reports in Korean population with Mongolian traits [18Song JS, Choi HJ, Jung IY, Jung HS, Kim SO. The prevalence and morphologic classification of distolingual roots in the mandibular molars in a Korean population. J Endod 2010; 36(4): 653-7.
[http://dx.doi.org/10.1016/j.joen.2009.10.007] [PMID: 20307739]
, 19Song JS, Kim SO, Choi BJ, Choi HJ, Son HK, Lee JH. Incidence and relationship of an additional root in the mandibular first permanent molar and primary molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107(1): e56-60.
[http://dx.doi.org/10.1016/j.tripleo.2008.09.004] [PMID: 19101484]
]. In other study, Tu et al. Determined the high prevalence of the DL root in mandibular first molars among the Taiwanese population [14Tu MG, Liu JF, Dai PW, Chen SY, Hsu JT, Huang HL. Prevalence of three-rooted primary mandibular first molars in Taiwan. J Formos Med Assoc 2010; 109(1): 69-74.
[http://dx.doi.org/10.1016/S0929-6646(10)60023-X] [PMID: 20123588]
]. In the present study, the prevalences of DL roots of mandibular first molars were lower in Turkish patients compared with Mongolian traits confirming previous findings that its incidence has been linked to specific ethnic groups [4Miloglu O, Arslan H, Barutcugil C, Cantekin K. Evaluating root and canal configuration of mandibular first molars with cone beam computed tomography in a Turkish population. J Dent Sci 2013; 8: 80-6.
[http://dx.doi.org/10.1016/j.jds.2012.09.002]
, 6Kim S, Choi MR, Yoo JJ. Concurrent relationship between additional canals of mandibular first molars and maxillary first molars using cone-beam computed tomography. Oral Radiol 2013; 29: 146-50.
[http://dx.doi.org/10.1007/s11282-012-0115-z]
].

The percentage of DL roots of mandibular first molars was higher on the right side (14%) than on the left side (4%), and there was a siginifcant difference in this present study. In addition, the results of our study indicated a higher rate of unilateral prevalence of DL roots of mandibular first molars. Tu et al. and Song et al. also have observed right side predominance for DL roots of mandibular first molars [18Song JS, Choi HJ, Jung IY, Jung HS, Kim SO. The prevalence and morphologic classification of distolingual roots in the mandibular molars in a Korean population. J Endod 2010; 36(4): 653-7.
[http://dx.doi.org/10.1016/j.joen.2009.10.007] [PMID: 20307739]
, 20Tu MG, Huang HL, Hsue SS, et al. Detection of permanent three-rooted mandibular first molars by cone-beam computed tomography imaging in Taiwanese individuals. J Endod 2009; 35(4): 503-7.
[http://dx.doi.org/10.1016/j.joen.2008.12.013] [PMID: 19345794]
]. On the contrary, some studies showed that DL roots of mandibular first molars occur more frequently on left side [21Gulabivala K, Aung TH, Alavi A, Ng YL. Root and canal morphology of Burmese mandibular molars. Int Endod J 2001; 34(5): 359-70.
[http://dx.doi.org/10.1046/j.1365-2591.2001.00399.x] [PMID: 11482719]
, 22Curzon ME. Three-rooted mandibular permanent molars in English Caucasians. J Dent Res 1973; 52(1): 181-91.
[http://dx.doi.org/10.1177/00220345730520011901] [PMID: 4509495]
]. In other study, Miloğlu et al. [4Miloglu O, Arslan H, Barutcugil C, Cantekin K. Evaluating root and canal configuration of mandibular first molars with cone beam computed tomography in a Turkish population. J Dent Sci 2013; 8: 80-6.
[http://dx.doi.org/10.1016/j.jds.2012.09.002]
] observed that the ratio of right/left side was quite similar, and the authors explained this incoordination could have resulted from variations in the populations, sample size, case selection and methods used.

Similarly, like in other studies, our study portrayed that there were no significant differences between the female and male subject for DL roots of mandibular first molars [23Park JB, Kim N, Park S, Kim Y, Ko Y. Evaluation of root anatomy of permanent mandibular premolars and molars in a Korean population with cone-beam computed tomography. Eur J Dent 2013; 7(1): 94-101.
[PMID: 23407684]
-25Garg AK, Tewari RK, Kumar A, Hashmi SH, Agrawal N, Mishra SK. Prevalence of three-rooted mandibular permanent first molars among the Indian Population. J Endod 2010; 36(8): 1302-6.
[http://dx.doi.org/10.1016/j.joen.2010.04.019] [PMID: 20647084]
].

Although as many as five canals and as few as one and two canals occasionally occur in mandibular molars, the presence of four canals is relatively frequent [21Gulabivala K, Aung TH, Alavi A, Ng YL. Root and canal morphology of Burmese mandibular molars. Int Endod J 2001; 34(5): 359-70.
[http://dx.doi.org/10.1046/j.1365-2591.2001.00399.x] [PMID: 11482719]
, 26Weine FS, Pasiewicz RA, Rice RT. Canal configuration of the mandibular second molar using a clinically oriented in vitro method. J Endod 1988; 14(5): 207-13.
[http://dx.doi.org/10.1016/S0099-2399(88)80171-7] [PMID: 3251974]
, 27Walker RT. Root form and canal anatomy of mandibular second molars in a southern Chinese population. J Endod 1988; 14(7): 325-9.
[http://dx.doi.org/10.1016/S0099-2399(88)80192-4] [PMID: 3251992]
]. In this study, the prevalence of DL canals of mandibular first molars was 31.3% on the left side and 31.3% on the right side, which was similar to the results of previous studies [6Kim S, Choi MR, Yoo JJ. Concurrent relationship between additional canals of mandibular first molars and maxillary first molars using cone-beam computed tomography. Oral Radiol 2013; 29: 146-50.
[http://dx.doi.org/10.1007/s11282-012-0115-z]
, 15Al-Qudah AA, Awawdeh LA. Root and canal morphology of mandibular first and second molar teeth in a Jordanian population. Int Endod J 2009; 42(9): 775-84.
[http://dx.doi.org/10.1111/j.1365-2591.2009.01578.x] [PMID: 19549153]
]. In addition, similar with other studies there was not a significant difference in incidence of distolingual canals according to gender of patients.

There are many variations in canal number and configuration in maxillary first molar [28Imura N, Hata GI, Toda T, Otani SM, Fagundes MI. Two canals in mesiobuccal roots of maxillary molars. Int Endod J 1998; 31(6): 410-4.
[PMID: 15551608]
, 29Ma L, Chen J, Wang H. Root canal treatment in an unusual maxillary first molar diagnosed with the aid of spiral computerized tomography and in vitro sectioning: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107(6): e68-73.
[http://dx.doi.org/10.1016/j.tripleo.2009.01.051] [PMID: 19464648]
]. Therefore, the authors stressed that failure to detect, debride, and fill a second mesiobuccal canal (MB2) of first permanent maxillary molars was one of the main causes of poor long-term prognosis after root canal treatment in these teeth [26Weine FS, Pasiewicz RA, Rice RT. Canal configuration of the mandibular second molar using a clinically oriented in vitro method. J Endod 1988; 14(5): 207-13.
[http://dx.doi.org/10.1016/S0099-2399(88)80171-7] [PMID: 3251974]
]. According to the results of our study, there was not a significant difference in incidence of MB2 canals in terms of gender of patients and the prevalence of MB2 canals of maxillary molars falls within the range of these previous studies. The study protocols (in vivo or in vitro) and the techniques used to identify canal configuration may lead to differences observed between these studies.

CBCT scanning has been used in endodontics for the efficient evaluation of the root canal morphology although intraoral radiographs still remain the imaging technique of choice for the evaluation of endodontic patients. CBCT with relatively low patient doses and small voxel sizes should be preffered for diagnosis in patients who present with contradictory or non-specific clinical signs and symptoms associated with untreated or previously endodontically-treated teeth [30Yılmaz F, Kamburoglu K, Yeta NY, Öztan MD. Cone beam computed tomography aided diagnosis and treatment of endodontic cases: Critical analysis. World J Radiol 2016; 8(7): 716-25.
[http://dx.doi.org/10.4329/wjr.v8.i7.716] [PMID: 27551342]
]. The position paper published jointly by the American Association of Endodontists (AAE) and the American Academy of Oral and Maxillofacial Radiology (AAOMR) does not support the routine use of CBCT for all cases except when complex root canal anatomy is suspected [31Mohammadi Z, Asgary S, Shalavi S, V Abbott P. A cinical update on the different methods to decrease the occurrence of missed root canals. Iran Endod J 2016; 11(3): 208-13.
[http://dx.doi.org/10.7508/iej.2016.03.012] [PMID: 27471533]
].

To determine variations in root canal morphology, various techniques have been suggested: conventional and modified tooth staining and clearing, conventional and digital radiography, contrast media radiography and computed tomography (CT). CBCT has a superiority over conventional periapical films due to its ability of to reduce or eliminate superimposition of surrounding structures [32Rouhani A, Bagherpour A, Akbari M, Azizi M, Nejat A, Naghavi N. Cone-beam computed tomography evaluation of maxillary first and second molars in Iranian population: A morphological study. Iran Endod J 2014; 9(3): 190-4.
[PMID: 25031592]
]. Therefore, CBCT is the best imaging technique for the evaluation and identification of additional root/canals. For this reason, we evaluated these root/canal anatomic variations by using CBCT from axial sections.

CONCLUSION

Dentists should be familiar with root canal morphology and should be aware of unexpected canal morphology when performing endodontic treatment. Also, clinicians should carefully observe CBCT scans of patients justified for other reasons to investigate the presence of extra root/canal. The present report portrayed the use of a cone-beam computed tomography examination as a tool for the diagnosis and negotiation of extra canals in the distal root/canals of mandibular first molars and second mesibuccal canals of maxillary first molars. Information gained through this type of studies will be used in the future for diagnosis and endodontic therapy which may contribute to aid clinicians in the prediction of additional canals.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Not applicable.

HUMAN AND ANIMAL RIGHTS

No Animals/Humans were used for studies that are base of this research.

CONSENT FOR PUBLICATION

Not applicable.

CONFLICT OF INTEREST

The editor declares no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

This study is presented in 14th European Congress of Dentomaxillofacial Radiology on 25-28June 2014, Cluj-Napoca, Romania and supported by Marmara University Scientific Research Project Council (Project no: SAG-D-090414-0085).

REFERENCES

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[http://dx.doi.org/10.1111/j.1601-1546.2005.00129.x]
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[http://dx.doi.org/10.1111/j.1365-2591.2006.01099.x] [PMID: 16584489]
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[http://dx.doi.org/10.1155/2010/291276]
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[http://dx.doi.org/10.1016/j.jds.2012.09.002]
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[http://dx.doi.org/10.1016/j.joen.2010.08.055] [PMID: 21092807]
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[http://dx.doi.org/10.1007/s11282-012-0115-z]
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[http://dx.doi.org/10.1111/j.1365-2591.2010.01737.x] [PMID: 20491988]
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[PMID: 23966013]
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[http://dx.doi.org/10.1590/S0103-64402012000300001] [PMID: 22814684]
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