Endodontic and clinical considerations in the management of variable anatomy in mandibular premolars: a literature review.

Mandibular premolars are known to have numerous anatomic variations of their roots and root canals, which are a challenge to treat endodontically. The paper reviews literature to detail the various clinically relevant anatomic considerations with detailed techniques and methods to successfully manage these anomalies. An emphasis and detailed description of every step of treatment including preoperative diagnosis, intraoperative identification and management, and surgical endodontic considerations for the successful management of these complex cases have been included.

Root anatomy and root canal configuration of human permanent mandibular premolars: a systematic review.

Introduction. Mandibular premolars have been reported with complex anatomical aberrations, making them one of the most difficult teeth to manage endodontically. Methodology. An exhaustive search was undertaken to identify associated anatomic studies of mandibular premolars through MEDLINE/PubMed database using keywords, and a systematic review of the relevant articles was performed. Chi-square test with Yates correction was performed to assess the statistical significance of any anatomic variations between ethnicities and within populations of the same ethnicity. Documented case reports of variations in mandibular premolar anatomy were also identified and reviewed. Results. Thirty-six anatomic studies were analyzed which included 12,752 first premolars and nineteen studies assessing 6646 second premolars. A significant variation in the number of roots, root canals, and apical foramen was observed between Caucasian, Indian, Mongoloid, and Middle Eastern ethnicities.The most common anatomic variation was C-shaped canals in mandibular first premolars with highest incidence in Mongoloid populations (upto 24%) while dens invaginatus was the most common developmental anomaly. Conclusions. A systematic review of mandibular premolars based on ethnicity and geographic clusters offered enhanced analysis of the prevalence of number of roots and canals, their canal configuration, and other related anatomy.

A new anatomically based nomenclature for the roots and root canals-part 2: mandibular molars.

Several terminologies have been employed in the dental literature to describe the roots and root canal systems of mandibular molars with no consensus being arrived at, thus far. The anatomical relation of roots and their root canals were identified and a naming system was formulated. The proposed nomenclature attempts to make certain essential modifications to the traditional approach to accommodate the naming of various aberrations presented in mandibular molars. A simple, yet extensive nomenclature system has been proposed that appropriately names the internal and external morphology of mandibular molars.

A new anatomically based nomenclature for the roots and root canals-part 1: maxillary molars.

Numerous terminologies have been employed in the dental literature to describe the roots and root canal systems of maxillary molars. This multiplicity in naming of roots and canals makes the reader susceptible to misinterpretation and confusion. No consensus thus far has been arrived at for defining the names of roots and root canals in maxillary molars, including their various morphological aberrations. The anatomical relation of roots and their root canals were identified and were subsequently named based on definite sets of criteria. A new method for identification and naming of roots and root canal anatomy in maxillary molars, based on their root and canal relationship, was formulated and is presented in this paper. The nomenclature makes certain essential modifications to the traditional approach to accommodate naming of the various aberrations presented in the maxillary molars. A simple, yet extensive, nomenclature system has been proposed that appropriately names the internal and external morphology of maxillary molars.

Four-rooted mandibular first molar with an unusual developmental root fusion line: a case report.

The paper describes the anatomical variation of four roots in a mandibular permanent first molar diagnosed using multiple angulated preoperative radiographs and its successful nonsurgical endodontic management. Careful observation and exploration of the pulpal floor using a dental operating microscope revealed a peculiar developmental root fusion line on the pulp chamber floor. Based on the above observation, a correlation between this unusual line and the existence of additional roots has been proposed and discussed.

Comparison of Endovac irrigation system with conventional irrigation for removal of intracanal smear layer: an in vitro study.

AIM: This study comparatively evaluated the efficacy of Endovac irrigation system with conventional needle irrigation in removing smear layer from the root canal. STUDY DESIGN: Thirty permanent maxillary central incisors were divided into 3 groups of 10 teeth each. In group I, the teeth were instrumented and irrigated by conventional irrigation using 27-gauge irrigation needle. In group II, irrigation was done using Endovac irrigation system. In group III (negative control) chemomechanical preparation was performed using saline solution. Scanning electron microscope evaluation was done for assessment of smear layer removal in the coronal, middle, and apical thirds. RESULTS: Data were analyzed using post hoc test and Kruskal-Wallis test for significance at P < .05. Statistically significant difference was seen between the 2 test groups in smear layer removal from the apical third (3 mm) of the root canal, although no significant difference was seen in the coronal and middle thirds. The most efficient smear layer removal was seen in group II (Endovac) compared with other groups (P < .05). CONCLUSIONS: The study showed significantly better removal of smear layer from the apical third of root canal using Endovac compared with conventional needle irrigation.

Endodontic management of maxillary permanent first molar with 6 root canals: 3 case reports.

This article discusses the successful endodontic management of 3 permanent maxillary first molars presenting with the anatomical variation of 3 roots and 6 root canals. A literature review pertaining to the variable root canal morphology of the permanent maxillary first molar is also presented. Modifications in the root canal access preparation and methods for examination of the pulpal floor with the aid of magnification for identification of additional canals are emphasized.