Evaluation of root canal morphology of human primary molars on CBCT literature review

TKf V*: -u ACKNOWLEDGMENTS would not have been able to finish this report without the help of my supervisor, my family, and my friends I would like to express my gratitude to A/Prof Vo Truong Nhu Ngoc Vice Dean of School of Odonto-Stomatology Hanoi Medical University, for his dedicated guidance, enthusiastic encouragement and precious advice he had for me It is my honour to have him as a supervisor in my life Last but not least I would like to extend my thanks to my family and all my friends, who always accompany and support me in all of my decisions If it were not for you I would not be where I am today Hanoi May 24:h 2021 DINH VIET HA DECLARATION I Dinh Viet Ha declare that the report entitled “Evaluation of root canal morphology of human primary molars on CBCT: A literature review" IS my original research and has not been submitted for any other degree or professional qualification in this university or other institution This work IS my own except where explicitly stated otherwise Hanoi, May 24th 2021 DINH VIF.T HA TABLE OF CONTENTS ACKNOWLEDGMENTS DECLARATION LIST OE TABLES LIST OF FIGI RES LIST OF ABBREVIATIONS INTRODUCTION ••••••••••••(•••••••••••••••••••••••••••■■•••a I CHAPTER 1: BACKGROUND 1.1 1.2.1 1.2.2 Classification of root and canal morphology 1.2 Techniques used 111 evaluating primary morphology 12 1.3.1 Clearing method 12 1.3 1.4 1.3.2 2.1.1 1.3.3 CHAPTER 3: ããããããããããããããããôããããããôãããããããããããããããããããããããããããããããããããããããããããããããããããããã 26 RESULTS 1.3.4 1.3.5 1.3.6 REFERENCES 1.3.7 APPENDIX 1.3.8 LIST OF TABLES 1.3.9 1.3.10 1.3.11 LIST OF FIGVRF.S 1.3.12 1.3.13 1.3.14 LIST OI ABBREVIATIONS 1.3.15 CBCT 1.3.17 CT 1.3.19 M 1.3.21 D 1.3.23 B 1.3.25 L 1.3.27 DL 1.3.29 DB 1.3.31 MB 1.3.33 ML 1.3.16 Conebeam Computed Tomography 1.3.18 Computed Tomography 1.3.20 Mesial 1.3.22 Distal 1.3.24 Buccal 1.3.26 Lingual 1.3.28 Distolingual 1.3.30 Distobuccal 1.3.32 Mesiobuccal 1.3.34 Mcsiolingual 1.3.35 ABSTRACT 1.3.36.Title: Evaluation of root canal morphology of human primary molars on CBCT: A literature review 1.3.37.Abstract: Understanding root canal morphology of primary teeth can bring many benefits during root canal treatment in pediatric patients This study was conducted with the aim of evaluating the root canal morphology of human primary molars on CBCT by literature review method Research was conducted by searching, synthesizing and analyzing documents on electronic databases The results obtained show that in the maxillary primary molars, there are usually roots, each root usually has 1-2 canals, the most common curvature IS the curved canal form, and almost type I or IV according to Vertucci's classification Mandibular primary molars usually have 2-4 roots, each root has 1-2 canals, straight or curved curvature, almost type I or type IV according to Vertucci’s classification It is concluded that the root canal morphology of human primary molars is very diverse and CBCT is a good option for studying root canal morphology 1.3.38.Keywords: root canal morphology, primary molar CBCT 1.3.39 TĨM TÁT 1.3.40 Tiêu (lề: Đánh giã hình thãi ồng tùy hám sừa ỡ người phim CBCT: tổng quan tài liộu 1.3.41 Tõm tắt: Việc hiếu bicl hình thài ống túy ráng sữa sê mang lai nhiều lợi ích trinh điều tri tùy toán bệnh nhân trê em Nghiên cứu thục nhằm mục đích đành giã hình thái túy râng hàm sừa người phim CBCT băng phương pháp tống quan lý thuyẻt Nghiên cứu tiên hãnh bàng cách tim kiếm, tống hợp phàn tích tài liệu tảng điện từ Kết thu rãng hám sừa hàm thường có chân, mổi chân thường có I -2 ống tủy, hay găp lả dang ống tùy cong thuộc loai hojc IV theo phân loai cùa Vertucci Rang hâm síta hãm dirữi thường cõ 2-4 chán, chân có -2 ống tùy cõ thề gặp cã dang ồng lũy thăng vã cong, thuộc loại I hoẠc IV theo phán loại cúa Vertucci Kct luận ràng hình thái ống tùy ráng hãm sừa người đa dạng vá CBCT lã lưa chọn tốt đẻ nghiên cữu hình thái ống tùy 1.3.42 Từ khóa: hình thai ơng tùy râng hãm sừa CBCT TM/ zfci V*: 4Ả 'V 86 morphology classification In the studies based of on Ozcan Vcrtucci's and Reddy, I molars, and IV type were IV, encountered was the most in commonly which with observed the maxillary Inin the mandibular the mesical first root molar, while type type I IV had was higher the most percentage common in distal root has root the As highest in mandibular percentage second in type molars, IV canal, mesial type distolingual was common at root distal However, root, in distobuccal Abdclkhalik’s and study It was type reported II type that type root VI canal type morphology VII type can VIII be as found as Vertucci’s classification 1.3.1515 1.3.1516 CHAP I ER 4: DISCUSSION In children, caries is very common and requires a complete root canal therapy Therefore, having a good understanding of the root canal morphology of primary teeth will be very useful to the dentist during treatment In fact, there are many methods of studying root canal morphology that have been applied [40] [4IỊ [44], [46], but with the development of science CBCT was developed to analyze the hard tissue of the maxillofacial region, assisting in the diagnosis of maxillofacial pathology, surgery, orthodontic therapy, implantation, and tooth size measurement The advantages of CBCT are low beam output, fast scanning time, reduced radiation, providing 3D images that can be reproduced within minutes on a computer, measurements can be made on a computer without making any noise, image distortion Therefore CBCT is being applied 111 studies related to root canal morphology and has yielded remarkable results According to Ncelakantan et III [16], CBCT was accurate as the modified canal staining and tooth clearing technique in identifying root canal systems It was as accurate as the gold standard in identifying root canal anatomy Out of the selected studies, included them concluded that CBCT is an effective option for assessing root canal moiphology in primary teeth (Ozcan et al [39], Joshi et al [50] Yang et al [36], Reddy at al [48]) 1.3.1517 In selected studies that were evaluated for quality based on the Joanna Briggs Institute (JB1) Critical Appraisal tool's evaluation criteria, risk of bias of these articles were rated low to moderate, of w hich five were scored lowlevel score (69% - 100%) indicate risk of bias at low level, with three articles scoring medium (from 50 to 69%) and five articles scoring low' The selected articles lost points in these questions: Was the sample frame appropriate to address the target population? (4 studies) Were study participants recruited in an appropriate way? (3/8 studies); Were the study subjects and setting described in detail (1.8 studies); Was there appropriate statistical analysis? (1/8 studies); Was the response rate adequate, and if not, was the low response rate managed appropriately? (9/9 studies) It can be seen that the cause of the unclear and inappropriate sample selection comes from the fact that in order to study the root canal morphology of primary teeth It is necessary to select teeth at an appropriate stage, especially in children aged 5- years years old when the period of root resorption has not occurred 1.3.1518 Regarding to the maxillaty molars, the palatal root was found to be tile longest and the shortest one was distobuccal root, the most common curvature of the root was curved, then followed by straight root and S-shapcd root in mesiobuccal root, distobuccal root and palatal root For the maxillary first molar, most of the mesiobuccal distobuccal and palatal have one root canal, however 111 the maxillary second molars, studies showed that two canals were almost found in the mesiobuccal root With the clearing technique in the study of Katge Ct al (40J, it was found that in maxillary first molar, the mesiobuccal roots were almost in curved shape (72.41%) and one canal (89.66%) the distobuccal and palatal roots had higher prevalence in straight shape and one canal, however, the maxillary' second molar, the curved shape and one canal were found to be highest prevalence in three roots Datta et al (43) used multidetector computed tomography found that 93.75% of primary maxillary molars had three canals, only 6.25% had four canals 1.3.1519 Regarding to the mandibular molars, there is no significant difference between mesial root and distal root With the mandibular first molars, the curved type was most common in the mesial roots while the straight one was often in tire distal root With the mandibular second molars, the curved curvature also has the highest prevalence than the other two forms in all root canals With mandibular first molars, mesial and distal roots were likely to have one or two canals, if there was a case of the distal root, there was only one canal For mandibular second molars, the mesial and distal roots may also have one or two canals, with the distolingual or distobuccal It IS common to have one canal By using multidctcctor computed tomography Datta [43] found that 81.25% of the primary first molar had four canals while in the primary' second molars, It was 87.5% Katge [40] found that in mandibular first molars, mesial root had a single canal 111 20% teeth, which was curved in 33.33% samples and straight in 66.67% samples, and two canal in 80% teeth, however, mesiolingual canals had higher prevalence in straight shape while mesiobuccal canals were curved in 70.83%, distal root had one canal in 76.76% teeth and 23.33% had two canals, straight canal was present with the highest percentage in all types of distal canal For mandibular second molars in the study of Katge el III [40], 100% mesial root had two canals, distal root had one canal 111 43.33% and two canals in 56 67% both mesial and distal root can have curved canals or straight canals 1.3.1520 Studies dealing with root canal morphological classification almost exclusively used Vertucci’s classification According to the results obtained from studies [39] [48| [38] [49] dealing with this issue, of the root canal classifications Vcrtucci mentioned, type I and type IV canals were the most common (according to Ozcan et al [40] and Reddy et al) However, in Demiriz [38] and Abdelkhalik’s studies [50] other types of canals were found For example, in tile 228 mandibular second molars studied by Demiriz et al [38], the prevalence of type canals was 14 47% and ty pe was 15 79%, while in the study of Ozcan el al [39] there were only type I and IV canals In comparison With Katge’s research [40], type I and type IV were the most common types of configuration, type III was also be found in mesial root of mandibular first molar and palatal root of maxillary second molars In these included studies, Yang [36] and Navin [51] used another classification by Yang [36], Jose [52] used the classification by Ozcan [39] Furthermore, in the study of Joshi el al [49], the number of accessoiy canals appeared in both the maxillary and mandibular teeth, this was not mentioned in Vcrtucci's classification With the development of technology, devices such as CT or CBCT machines provide three-dimensional images, allowing more details not to be included in Vertucci's classification This is also the limitation of this one Recently, Ahmed Ct a! [12], 114] [15] published a new root canal morphology classification applicable for both permanent and primary teeth, allowing the clearest and most detailed description of root canal morphology, including accessory canals and root abnormalities 1.3.1521 This literature review was conducted to analyzed the data extracted from published articles that evaluated root and canal morphology of human primary molars by CBCT The primary intention of this research was to provide detailed information in the variation of root canal morphology according to these factors: number of canals per root, length of canal, curvature of canal, canal morphology based on Vertucci’s classification However, this research had these following issues not all included articles had fully information describing all the variables above, the research sample may not selected properly and not be large enough to assess the population, the difficulty in performing CBCT on children This led to biases and drawbacks related to sampling method, investigation methodology, inter- or intra-examincr reliability 1.3.1522 1.3.1523 CONCLUSIONS Ỉ) There are many variations of root canal morphology of human primary molars: 1.3.1524 o Number of canals: Regarding 10 lite maxillary molars, the distobuccal and palatal roots usually have one canal whereas the mesiobuccal root may have 1-2 canals With the mandibular molars, the mesial root often has two canals, distal root usually has one canal 1.3.1525 o Length of canals: For the maxillary molars, the palatal root was found to be the longest and the shortest one was distobuccal root For the mandibular molars, canals in mesial roots arc longer than those in distal roots 1.3.1526 o Curvature of canals: The most common curvature of canals in maxillaiy molars was curved shape In the mandibular molars, the curved type was most common in the mesial roots while the straight one was often in the distal root 1.3.1527 o Vertucct's classification: For the maxillary teeth, type I had the highest prevalence, followed by type IV For flic mandibular teeth, the highest prevalence was type IV in the mesial root and type in distal root 1.3.1528 CBCT is an effective option for assessing root canal morphology 1.3.1529 1.3.1530 RECOMMENDATION This research supports the application of CBCT more in the evaluation of root canal morphology Further review should be done at a larger scale as systematic review and meta-analysis Further investigations should be done on Vietnamese children based on Ahmed’s new classification to describe more accurately and systematically 1.3.1531 1.3.1532 REFERENCES Handbook of Pediatric Dentistry, McDonald and Avery's Dentistry for the Child and Adolescent, THỰC TRẠNG BỆNH RĂNG MIỆNG VA MỘT SỐ YÊU TỐ LIÊN QUAN Ờ TRẺ 4-8 TUỒI TẠI TĨNH THÀNH CÙA VIỆT NAM NĂM 2010 - Tạp Chi Y hoc Thực Hãnh - Bộ Y Tế , accessed: 11 26/2020 Pediatric Dentistry: Infancy Through Adolescence, Clarke M., Locker D., Berall G, et al (2006) Mai nourishment in a population of young children with severe early childhood caries Pedtatr Dent,23(3), 254 259 1.3.1533 Fuks A.B Kupietzky A., and Guelmann M (2019) 23 - Pulp Therapy for the Primary Dentition Pediatric Dentistry (Sixth Edition) Elsevier, Philadelphia 329-35l.cl Cavalcanti AL PREVALENCE OF EARLY LOSS OF PRIMARY MOLARS IN SCHOOL CHILDREN IN CAMPINA GRANDE, BRAZIL 28(1) Cantatore G Berutti E , and Castellucci A (2006) Missed anatomy frequency and clinical impact Endod Top 15(1), 3-31 Vcrtucci F I (2005) Root canal morphology and Ils relationship to endodontic procedures Endoil Top l(k I) 3-29 10 Vertucci F., Seelig A., and Gillis R (1974) Root canal morphology of the human maxillary second premolar, ơra/ Surg Oral Med Ora! 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