Root Canal Morphological Variations of Permanent Mandibular Second Molars Among Patients Reporting to Private Clinics in Vellore District, South India” – An In Vitro Cone Beam Computed Tomography Study.
Journal Title: International Journal of Dental Science and Innovative Research (IJDSIR) - Year 2019, Vol 2, Issue 3
Abstract
A sound knowledge of root canal anatomy and its variations is essential for treatment planning and executing root canal procedures1, 2. It helps to reduce the chances of missed canals and procedural errors thus increasing the success rates3. The Mandibular molars pose challenges to Endodontist owing to its anatomic variations. They usually have two roots & three canals. Few common variations include combinations of one or two roots with one, two, three or even four canals and the C-shaped canals4, 5, 6, 7. The developments in imaging modalities such as CT, MRI, nuclear medicine and ultrasonography not only revolutionized medical and dental diagnosis but also led to a shift in the diagnosis that was dependent upon static projection images to the digital 3-dimensional and interactive imaging. This is attributed to CT technology known as cone-beam Computerised Tomography. The original CT technology is used extensively in medical diagnosis and is designated as medical CT and the newer modality used primarily in dentistry is Cone beam computed tomography (CBCT) and also termed as cone beam volumetric tomography(CBVT), dental volumetric tomography, cone beam volumetric imaging,(CBVI) or dental computed tomography. 8, 9, 10, 11. Cone beam technology is medical image acquisition technique that uses a cone shaped beam of radiation centred on a two –dimensional detector. The source detector system performs one rotation around the object producing a series of 2-D images. During the exposure sequence, hundreds of plannar projection images are acquired in the field of view (FOV). Each pixel in 3D picture is called voxels. The images are reconstructed in a 3-D data set using a modification of the original cone beam algorithm developed by Feldkemp et al in 1984.In addition to increased accuracy and higher resolution, CBCT offers significant scan- time reduction and reduced cost for the patient. 12,13 In Endodontics CBCT plays a wide role from diagnosis of pulp and periodontal pathology, identification of missed, accessory canals, internal and external root resorption, vertical root fracture and elucidation of the cause of non-healing endodontically treated teeth.14,15 Although numerous research papers have evaluated the prevalence of variations of root canal anatomy of Mandibular Second molar, minimal research data was available amongst South Indian population. Hence, the purpose of this study was to investigate the variations in root canal anatomy of South Indian population using CBCT. Hence the aim of this study was to investigate the root canal anatomy of permanent mandibular second molar in South Indian population using Cone Beam Computed Tomography to identify the number of roots & root canals, C-shaped canals, lateral canals, level of bifurcation and convergence along with the apical foramen exit which would be an eye opener for future generation. Materials & Methodology The study was approved by Institutional Review Board on 8/12/2015 with the QR CODE [IGIDSIRB2015NDP12PGPRCDE] and Institutional Ethical Committee at Indira Gandhi Institute of Dental Sciences [IGIDSIEC2016NDP12PGPRCDE] on 29/01/2016. This study was an observational invitro study and a multicentric study. The extracted human carious and non carious mandibular second molars were collected from various private clinics in Vellore district, Tamilnadu, India. Patient consent form has been obtained prior to extraction. Inclusion criteria were non carious tooth extracted due to periodontal pathologies such as aggressive Periodontitis, juvenile periodontitis which are highly destructive form of periodontal disease occurring in healthy patients whose clinical features include rapid loss of periodontium and supporting structures that leads to mobility of teeth. Conditions involving extraction of deep cavitated carious teeth in patients of 40 – 60 years of both male and female , whom presumably not willing for endodontic therapy. Teeth excluded in the study are pathological and physiological conditions such as root fracture, root caries ,incompletely formed roots [open apex] respectively and restored teeth with silver amalgam, light cure composite resin restoration owing to possibility of generation of artifacts during CBCT. The sample size was calculated using a Formula is 4pq/d*d [ p = proportion of population with bilateral c shaped roots (0.33), q = 1-p (0.67), d = absolute precision (0.05)]. Prevalence of subjects with bilateral C-shaped roots = 0.33 Kim SY et al43. Freshly extracted teeth were washed under running tap water immediately and stored in formalin10 %. All the collected samples fulfilled the inclusion & Exclusion criteria. Selected samples [n= 354] were then cleaned of residual soft tissues, bone fragments, stains and calculus using ultrasonic scaler.(CE approved Woodpecker Dental Ultrasonic Scaler UDS- P, Guilin Woodpecker Medical Instrument Co. Ltd., China.). Selected samples were examined visually and categorized based on the number of roots. Four selected samples were mounted in a modeling wax block (Jig) vertically at the level of cementoenamel junction and scanned by a CBCT scanner (3D Imaging / CS 9300,Carestream Health, New York, USA ) Aarthi Scan Center , Vadapalani and Baba Scan Center , Mylapore, Chennai, Tamil Nadu, India` The values were tabulated using 3D Care stream version1.8. Software. The 3-dimensional resolution or isotropic Voxel size was 90µmx90µmx90µmm with Spherical imaging volume of 5x5, real time image no magnification and reconstruction time is 2 minutes. The scan setting is 84 kVp5mA. The exposure time is 19.96 sec. Total radiation exposure 596mGy.cm2.The software was also used in rendering the three-dimensional images through selective integration and measurement of adjacent voxels (all voxels are isotropic) in the display. (Objects within the volume are accurately measured in different direction). The images generated by CBCT system are processed and all the parameters were recorded. Incidence of C-shaped canal in mandibular second molars were classified based on modified Melton’s Classification. In Melton’s classification, there has been no clear description of the difference between categories II and III (i.e. C2 and C3, respectively) and clinical significance, hence modified Melton’s classification was used. Incidence of roots and root canal morphology were classified based on Weine’s classification. Similarly isthmus configuration, level of bifurcation or convergence - Apical, middle and coronal were also analysed.
Authors and Affiliations
Prabhu A. R.
Keywords
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