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ORIGINAL ARTICLE
Year : 2013  |  Volume : 4  |  Issue : 4  |  Page : 139-142

Root canal morphology of human primary maxillary molars in Indian population using spiral computed tomography scan: An in vitro study


1 Department of Pedodontics, SRM Dental College, SRM University, Chennai, India
2 Department of Pedodontics, Faculty of Dental Sciences, Sri Ramachandra University, Chennai, India
3 Specialist Pedodontist, Sunny Dental Centre, Sharjah, United Arab Emirates
4 Department of Pedodontics, Vinayaka Mission's Sankarachariyar Dental College and Hospital, Vinayaka Missions Deemed University, Salem, Tamil Nadu, India

Date of Web Publication22-Jan-2014

Correspondence Address:
Haridoss Selvakumar
AG1 Guru Royal Palace, Rayala Nagar 1st Main Road, Ramapuram, Chennai - 600 089, Tamil Nadu
India
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DOI: 10.4103/0976-433X.125587

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  Abstract 

Aim: The aim of the study was to evaluate the root canal morphology of primary maxillary molars in Indian population using spiral computed tomography (SCT). Materials and Methods: The 30 extracted primary maxillary molars were collected. The teeth were scanned using SCT. The scanned data was then transferred to image analysis software and evaluated for the following: Distance between the central fissure to furcation, distance between the central fissure to the floor of the pulp chamber, height of the pulp chamber (roof-floor), distance between the floor of the pulp chamber to the furcation and number of canals. Results: The results of this study shows that the average mean distance from the central fissure to the floor of the pulp chamber is 5.02 mm and 5.32 mm in first maxillary primary molar and second maxillary primary molar. Conclusion: Knowledge of the root canal morphology and anatomical landmarks of the primary maxillary molar might be a very helpful indicator to the dentist during access opening.

Keywords: Primary maxillary molars, pulp morphology, spiral computed tomography scan


How to cite this article:
Vijayakumar R, Selvakumar H, Swaminathan K, Thomas E, Ganesh R, Palanimuthu S. Root canal morphology of human primary maxillary molars in Indian population using spiral computed tomography scan: An in vitro study. SRM J Res Dent Sci 2013;4:139-42

How to cite this URL:
Vijayakumar R, Selvakumar H, Swaminathan K, Thomas E, Ganesh R, Palanimuthu S. Root canal morphology of human primary maxillary molars in Indian population using spiral computed tomography scan: An in vitro study. SRM J Res Dent Sci [serial online] 2013 [cited 2019 Sep 16];4:139-42. Available from: http://www.srmjrds.in/text.asp?2013/4/4/139/125587


  Introduction Top


Knowledge of the size, morphology and disparity of the root canals of primary teeth are helpful in visualizing the pulp cavity during treatment. Since primary teeth exhibit morphologic differences from the permanent teeth both in size, external and internal morphology. [1] Successful endodontic treatment lies in understanding the complex root canal system. Many of the errors occur during the access cavity preparation or when locating the canals orifices, which is dependent on the dentists tactile perception and knowledge of the dental anatomy. [2]

The use of computed tomography (CT) to evaluate the quality of root canal preparation has been reported to provide better results than other methods such as radiographic imaging, cross-sectioning and longitudinal cleavage. [3]

There is a lack of literature regarding the pulpal measurements in primary teeth. The purpose of this study was to evaluate the root canal morphology of primary maxillary molars in Indian population using spiral computed tomography (SCT).


  Materials and Methods Top


A total of 30 extracted human primary maxillary molars were collected. The teeth were divided into two groups. Group I - maxillary primary first molar-15, Group II - maxillary primary second molar-15. The extracted teeth were collected from the Department of Pedodontics and Preventive Dentistry from various Dental Colleges in Chennai. Teeth that were badly mutilated, severely attrited, endodontically treated, or restored with glass ionomer cement or stainless steel crown were excluded. The age, gender and systemic condition of the patient were unknown. The teeth were stored in formalin and any attached soft-tissue and calculus were removed with an ultrasonic scaler.


  Scanning Procedure Top


The teeth were mounted horizontally on a modeling wax sheet and scanned using a Light Speed Plus CT Scanner (GE Electricals, Milwaukee, USA). They were then viewed both cross-sectionally and longitudinally with a constant thickness of 0.65 mm/slice and a constant spiral or table speed of 0.75 and 120 kVp. The scanned data was then transferred to Advantage windows workstation (GE Systems, Milwaukee, WI) image analysis and evaluated for the following:

  1. Distance between the central fissure to furcation,
  2. Distance between the central fissure to the floor of the pulp chamber,
  3. Height of the pulp chamber (roof-floor),
  4. Distance between the floor of the pulp chamber to the furcation,
  5. Number of canals.


For evaluating pulp chamber morphology, the centermost CT scan slice of each tooth in the longitudinal section was taken and all the measurements were taken from the central fissure.

For finding out the number of root canals present, the cross-sectional view was used. Data were collected and the results were statistically analyzed.


  Results Top


  1. Distance between the central fissure to furcation:

    The mean distance between the central fissure to furcation was found to be 7.13 (12.5%) in first primary maxillary molars, 7.38 (33%) in second primary maxillary molars.[Figure 1]
  2. Distance between the central fissure to the floor of the pulp chamber:

    The mean distance between the central fissure to the floor of the pulp chamber was found to be 5.02 (25%) in first primary maxillary molars, 5.32 (25%) in second primary maxillary molars.[Figure 2]
  3. Height of the pulp chamber (roof-floor):

    The height of the pulp chamber was found to be 1.6 (25%) in first primary maxillary molars, 1.71 (28.57%) in second primary maxillary molars.
  4. Distance between the floor of the pulp chamber to the furcation:

    The mean distance between the floor of the pulp chamber to furcation was found to be 2.03 (25%) in first primary maxillary molars, 1.73 (28.57%) in second primary maxillary molars.
  5. Number of root canals:

    In Group I (first primary maxillary molars), 2 of the samples had 2 canals both distobuccal and palatal root canals are fused and in 13 of the samples had 3 canals (mesiobuccal, distobuccaland palatal). In Group II (second primary maxillary molars), 2 of the samples had 4 canals (mesiobuccal, distobuccal and 2 palatal canals) [Figure 3] [Table 1].
Figure 1: Longitundal spiral computed tomography showing the maxillary second primary molar tooth sample's measurement from central pit to furcation

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Figure 2: Longitundal spiral computed tomography showing the maxillary second primary molar tooth sample's measurement from central pit to floor of the pulp chamber

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Figure 3: Axial spiral computed tomography images showing a maxillary second primary molar teeth sample with 4 canals

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Table 1: Number of root canals

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  Discussion Top


Understanding the depth of the pulp chamber will be a first step for precise access cavity preparation in primary multirooted teeth. An attempt was made to understand the pulpal chamber better to reduce the common errors like perforation in primary maxillary molars.

Earlier studies on root canal anatomy were performed using demineralizing and injecting a dye technique. However, this technique had the disadvantage of producing irreversible changes to the studied sample. Few studies have used radiographs as the methodology to evaluate root canal morphology. [4] The radiographs produce only a two-dimensional image of a three-dimensional object and can lead to superimposition of the root canals (i.e., they tend to lie one behind the other in the buccolingual plane and can easily go undetected). [5] SCT is being used in the treatment planning for dental implants, management of maxillofacial trauma and assessment of unusual root canal morphology. [6]

Tachibana and Matsumoto in their study concluded that CT scans allowed the observation of the morphology of the root canals, the roots and the appearance of the tooth in every direction and it also permits its three-dimensional reconstruction. [7] Hence, in our study we used SCT to assess the root canal morphology of primary maxillary molars.

In the present study, average distance between the central fissure to the floor first primary maxillary molar-5.02 mm, second primary maxillary molar-5.32 mm. We chose the central fissure as the reference point because this is the point at which the access cavity preparation is usually initiated. In our study, it was observed that all deciduous maxillary and mandibular molars had minor variations in pulpal morphology. Similar observations were made by Edwin and Ralph. [8]

In the present study Group I, 2 (13%) of the samples had 2 canals both distobuccal and palatal root canals are fused and in 13 (87%) of the samples had 3 canals (mesiobuccal, distobuccal and palatal). Sarkar and Rao in their study on maxillary primary first molars 50% of tooth sample had fused distobuccal and palatal canals. [9] Zoremchhingi et al. reported 8 samples had fused distobuccal and palatal canals. [1] Variations in root canal anatomy are so common that many authors now consider it as a normal phenomenon. [10]

In Group II, 2 (13%) of the samples had 4 canals (mesiobucaal, distobuccal and 2 palatal canals). Sarkar and Rao in their study on maxillary second molars 2 (22.2%) of tooth sample had 4 canals. [9] Zoremchhingi et al. reported 4 (26.6%) samples had 4 canals. [1] A search of the literature also reveals that very few studies have been performed on root canal morphology of primary teeth in Indian population.


  Conclusion Top


From the results presented it can be concluded that the maximum depth to which a bur can go during access opening without violating the furcation is 5.02 mm in first primary maxillary molar and 5.32 mm in second primary maxillary molar. Whereas, having measurement markings in access opening burs might be a very helpful indicator to the dentist during access opening.


  Acknowledgment Top


We would like to thank Dr. Joseph Reuben, MDS for his support.

 
  References Top

1.Zoremchhingi, Joseph T, Varma B, Mungara J. A study of root canal morphology of human primary molars using computerised tomography: An in vitro study. J Indian Soc Pedod Prev Dent 2005;23:7-12.  Back to cited text no. 1
    
2.Velmurugan N, Venkateshbabu N, Abarajithan M, Kandaswamy D. Evaluation of the pulp chamber size of human maxillary first molars: An institution based in vitro study. Indian J Dent Res 2008;19:92-4.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Kummer TR, Calvo MC, Cordeiro MM, de Sousa Vieira R, de Carvalho Rocha MJ. Ex vivo study of manual and rotary instrumentation techniques in human primary teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e84-92.  Back to cited text no. 3
[PUBMED]    
4.Sert S, Bayirli GS. Evaluation of the root canal configurations of the mandibular and maxillary permanent teeth by gender in the Turkish population. J Endod 2004;30:391-8.  Back to cited text no. 4
[PUBMED]    
5.Gupta D, Grewal N. Root canal configuration of deciduous mandibular first molars - An in vitro study. J Indian Soc Pedod Prev Dent 2005;23:134-7.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.Alder ME, Deahl ST, Matteson SR. Clinical usefulness of two-dimensional reformatted and three-dimensionally rendered computerized tomographic images: Literature review and a survey of surgeons′ opinions. J Oral Maxillofac Surg 1995;53:375-86.  Back to cited text no. 6
[PUBMED]    
7.Tachibana H, Matsumoto K. Applicability of X-ray computerized tomography in endodontics. Endod Dent Traumatol 1990;6:16-20.  Back to cited text no. 7
[PUBMED]    
8.Edwin DH, Ralph L. Morphology of root canal of the primary molar teeth. J Dental child. 1957;24:250-257  Back to cited text no. 8
    
9.Sarkar S, Rao AP. Number of root canals, their shape, configuration, accessory root canals in radicular pulp morphology. A preliminary study. J Indian Soc Pedod Prev Dent 2002;20:93-7.  Back to cited text no. 9
[PUBMED]    
10.Reuben J, Velmurugan N, Kandaswamy D. The evaluation of root canal morphology of the mandibular first molar in an Indian population using spiral computed tomography scan: An in vitro study. J Endod 2008;34:212-5.  Back to cited text no. 10
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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  In this article
Abstract
Introduction
Materials and Me...
Scanning Procedure
Results
Discussion
Conclusion
Acknowledgment
References
Article Figures
Article Tables

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