The Root Canal Anatomy Project: November 2019

November 25, 2019

Canal Morphology using Micro-CT

In the last decade, micro-CT has gained increasing popularity in endodontics. This noninvasive, nondestructive, high-resolution technology allows the three-dimensional study of the root canal system and can be used to understand its influence on the different treatment/retreatment procedures, by reconstructing digital cross sections of the teeth, which can be stacked to create 3D volumes. These volumes can be used to generate computerized images of specimens that can be manipulated, or measured, to reveal both internal and external morphologies. Nowadays, micro-CT technology is considered the most important and accurate research tool to the study of root canal anatomy. Images below were acquired in a micro-CT device (so, they are based on real teeth) and processed with dedicated modelling 3D software for the book ROOT CANAL ANATOMY IN PERMANENT DENTITION.

Additional information regarding the use micro-CT technology in endodontics can be found in this book CHAPTER.

MB3 Canal [Maxillary First Molar]

The internal anatomy of the mesiobuccal root (MB) of maxillary molars is complex and commonly presents 2 main root canals, named MB1 and MB2, but also a high incidence of fine anatomical structures, which may include the presence of a 'middle mesial canal', the so-called MB3. MB3 canal can be defined as a third main root canal located in between MB1 and MB2 main canals of the MB root of maxillary molars. Literature regarding morphological description of MB3 canal is scarce and most of the information comes as a clinical report or an incidental finding of laboratorial studies, but not as the main topic of the research.

More information about this topic in a well-designed micro-CT study is going to be published very soon...

CLICK HERE to download the images and video below in high resolution

Missed MB2 Canal [Maxillary Molars]

The morphology of the mesiobuccal (MB) root of maxillary molars commonly presents 2 main root canals, named MB1 and MB2, and a high incidence of fine anatomical structures including intercanal communications, loops, accessory canals and apical ramifications, resulting in a very complex canal system. The orifice of the MB2 is usually located either mesial to or in the sub pulpal groove within 3.5 mm palatally and 2 mm mesially from MB1, often hidden under the shelf of the dentine wall or calcifications in a small groove. In the literature, percentage frequency of MB2 canal in maxillary molars has ranged from 10 to 95%, depending not only on the method used in the study, such as sectioning, dye injection, radiography, scanning electron microscopy, or micro-CT, but also on ethnic and demographic factors related to the studied population, which may include geographic region, age and gender. Consequently, it can be missed in routine clinical practice, especially without using magnification or special lighting equipment. This inability to recognize its presence and to adequately treat it have been considered the major cause of failure in root canal therapy of maxillary molars. Clinicians, therefore, must be aware of MB2 prevalence and adopt procedural steps to locate and prepare it properly.

More information about this topic can be found in this SYSTEMATIC REVIEW

CLICK HERE to download the pictures and video below in high resolution.

Legend

In yellow: original root canal (before preparation)

In purple: root canal after preparation with ProTaper Universal System (up to F2)

MB2 Canal [Maxillary First Molar]

The morphology of the mesiobuccal (MB) root of maxillary molars commonly presents 2 main root canals, named MB1 and MB2, and a high incidence of fine anatomical structures including intercanal communications, loops, accessory canals and apical ramifications, resulting in a very complex canal system. The orifice of the MB2 is usually located either mesial to or in the sub pulpal groove within 3.5 mm palatally and 2 mm mesially from MB1, often hidden under the shelf of the dentine wall or calcifications in a small groove. In the literature, percentage frequency of MB2 canal in maxillary molars has ranged from 10 to 95%, depending not only on the method used in the study, such as sectioning, dye injection, radiography, scanning electron microscopy, or micro-CT, but also on ethnic and demographic factors related to the studied population, which may include geographic region, age and gender. Consequently, it can be missed in routine clinical practice, especially without using magnification or special lighting equipment. This inability to recognize its presence and to adequately treat it have been considered the major cause of failure in root canal therapy of maxillary molars. Clinicians, therefore, must be aware of MB2 prevalence and adopt procedural steps to locate and prepare it properly.

More information about this topic can be found in this SYSTEMATIC REVIEW

CLICK HERE to download the pictures and videos below in high resolution