A Study of Root Canal Morphology of Human Primary Molars Using Computerised Tomography - An in Vitro Study Zoremchhingi, Joseph T, Varma B, Mungara J - J Indian Soc Pedod Prev Dent

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A study of root canal morphology of human primary molars using computerised tomography: An in vitro study Zoremchhingi, Joseph T, Varma B, Mungara J -
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ORIGINAL ARTICLE
Year : 2005 | Volume : 23 | Issue : 1 | Page : 7-12
Computed Tomography
Primary molars
Root canal morphology
A study of root canal morphology of human primary molars using computerised tomography: An in vitro study
Zoremchhingi, T Joseph, B Varma, J Mungara
Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, India
Correspondence Address:
Zoremchhingi
Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai
India
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Abstract
Introduction
Materials and Me...
Results
Discussion
References
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DOI: 10.4103/0970-4388.16019
PMID: 15858299
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Abstract
Knowledge of the size, morphology and variation of the root canals of primary teeth are useful in visualizing the pulp
cavity during treatment. This study was carried out to investigate the applicability of Computed Tomography in studying
the root canal morphology of the primary molars. A total of 60 primary molars.without any macroscopic root resorption
were collected and divided into four groups. The samples were arranged in wax block and then scanned for evaluation in
the CT Scanner both in axial and coronal plane. The results obtained from the scanned images were statistically analyzed
to know the frequency, mean and standard deviation for all the groups. The images showed the complexity of the root
canals of the primary molars and also several capabilities of the CT Scan in advance Endodontic research in primary teeth
were observed.
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Keywords: Computed Tomography, Primary molars, Root canal morphology
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Zoremchhingi, Joseph T, Varma B, Mungara J. A study of root canal morphology of human primary molars using
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computerised tomography: An in vitro study. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2014 Jun
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Introduction
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Knowledge of the size, morphology and variation of the root canals of primary teeth are useful in visualizing the pulp
cavity during treatment. As primary teeth exhibit morphologic differences from the permanent teeth both in size and in
general external and internal design, a thorough knowledge of the root canal systems of the primary teeth aids in their
successful treatment.
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Endodontics involves cleaning, shaping and obturation of the root canal system. To improve success in endodontics, each
of these steps should be evaluated throughout treatment to determine the effects of each stage of therapy. Work by many
researchers has added understanding of the intricacies of the root canals.[1-4] To gather this knowledge, different
techniques were used which either destroyed or altered the tooth structure, thus precluding further studies on the same
teeth.
The tooth is composed of unique tissues with distinct radiographic densities and it lends itself to evaluation by
tomographic techniques. Computed Tomography data seemed to offer significant advances in the ability to reconstruct
with optimum detail the tissues of the tooth before and after instrumentation and obturation; also remain fully retrievable
for future evaluations.[5]
Literature revealed very few studies on root canal morphology of the primary teeth and so far no studies had been done
using a Computed Tomograph. So, the aim of this study was to study the applicability of Computed Tomography in
studying the root canal morphology in the following parameters:
Number of roots;
Angulation of the roots;
Number of the root canals;
Diameter of the root canals;
Materials and Methods
Armamentarium and Material used

1. Airotor handpiece
2. 557 carbide burs
3. No. 10 broaches
4. 5.25% sodium hypochlorite solution
5. Paper points
6. Pink wax
7. 10% formalin
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8. Light speed plus CT Scanner (G.E Medical Systems, Milwaukee, USA)

Specimen Tooth Selection
Sixty extracted primary molars were collected and divided into 4 groups:
Group I - Mandibular first molars-15
Group II - Mandibular second molars-15
Group III - Maxillary first molars-15
Group IV - Maxillary second molars-15
The teeth were selected randomly. The criteria for selection was to confirm the teeth removed were intact with
completely formed root apices, and without any macroscopic root resorption. The teeth were stored in 10% formalin
solution.
Specimen Preparation
The teeth were then cleaned with ultrasonic scaler and access cavity prepared on the Occlusal surfaces with 557 carbide
bur. No. 10 broach was used gently and advanced to the apical foramen to ensure its patency. Canals were irrigated with
5.25% sodium hypochlorite solution, then dried with paper points and the access cavity was filled with sticky wax.
Arrangement of Samples for Scanning Procedure
Pink wax was liquefied and poured in an aluminium mould and the teeth were mounted after determining the various
aspects of the tooth i.e., Buccal, lingual, mesial and distal, so as to maintain uniformity in the samples. Each root was
marked with a marker pen. Also care was taken to ensure that the apices of each roots of the teeth were in single plane.
Imaging System
The mounted teeth were then scanned in the CT Scanner in axial and coronal plane.
CT Acquisition was as follows:
Constant thickness- 1.25
Constant spiral or table speed- 0.75
KVP-120
MAS- 200
Subsequently, Volume rendering and Multiple planar volume reconstruction (MPVR) for root canal measurement were
done using Advantage Windows Workstation (GE System) Image Analysis.
The length and angulations of the roots were measured by taking the greatest area of constriction as a cervical line, and
the midpoint was chosen by a line through the cervical line divided by 2 and drawing a line perpendicular to the cervical
lines, then rotating the MPVR in axial plane.
The diameter of the root canals was measured at the greatest diameter from the cross section of the roots irrespective of
the various aspects of the canal.
Statistical Analysis
Descriptive statistics was used to find out the frequency, mean, standard deviation and range for all the four groups.
Results
The following observations were made after scanning number of roots.

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The following observations were made after scanning number of roots.
Table 1 represents the number of roots in all the four groups. In group I, all the samples had 2 roots i.e. 1 mesial and 1
distal, whereas in Group II, 2 of the samples there were 3 roots i.e. 2 mesial roots and 1 distal root. In Group III (Table
1b), in 8 of the samples, both distobuccal and palatal roots were fused and in 7 of the samples, all the three roots were
separated. In Group IV, in all the samples the three roots were well differentiated.
Number of canals
Table 2 shows the number of canals in all the groups. In Group I, out of 15 samples only one sample had one canal in the
mesial root (6.67%), and 14 samples had 2 canals (93.33%). In the distal root, six samples had one canal (40%) and
nine of the samples had two canals (60%).
In Group II, 2 canals were seen in the mesial root in all the samples whereas in the distal root 3 canals were seen in one
of the samples; 2 canals in 8 of the samples (53.3%), and 1 canal in 6 of the samples (40%).
In Group III, seven of the samples had three roots, which were separated; in all the samples both the distobuccal and
palatal roots had one canal each. In one of the samples the mesial root had two canals and the rest of the samples had 1
canal. In eight of the samples, both the distobuccal and palatal roots were fused and in all the samples two canals were
seen. i.e. 1 disto buccal canal and 1 palatal canal.
In Group IV out of 15 samples, in the mesiobuccal root- 1 canal was seen in 7 (46.6%) and 2 canals were seen in 8
(53.3%) of the samples. In the distobuccal root, 1 canal was seen in eleven (73.3%) and two canals in four (26.6%) of
the samples respectively. In the palatal root, 9 (60%) of the samples had 1 canal and 6 (40%) of the samples had 2
canals. There were no fused distobuccal and palatal roots in group IV.
Diameter of the canals
As can be inferred from Table 3, in group I, maximum diameter in each thirds of the root was seen in the distal canal
which had a mean canal diameter of I.imm, 0.83 mm and 0.51 mm in the cervical, middle and apical thirds of the root
respectively. The minimum diameter was seen in the mesiolingual canal (cervical third - 0.57 mm, middle third -0.40 mm
and apical third - 0.30 mm). Similarly in Group II, maximum diameters of the canals were seen in the distal root (cervical
third -1.6 mm, middle third - 1.2 mm and apical third - 1.0 mm) and minimum diameter in the mesiolingual root (cervical
third - 0.73 mm, middle third -0.55 mm and apical third - 0.4 mm).
In group III and IV, maximum diameter of the canals were seen in the palatal canals Group III - (cervical third - 1.0 mm, middle third - 0.85 mm and apical third - 0.78 mm).
Group IV- (cervical third - 1.3 mm, middle third - 1.02 mm and apical third - 0.81 mm).
Minimum diameters in Group III were seen in the distobuccal canal (cervical third - 0.86 mm, middle third - 0.46 mm
and apical third -0.38 mm) whereas in Group IV it was seen in the mesiobuccal canal (cervical third - 0.78 mm, middle
third - 0.50 mm and apical third -0.39 mm).
Length and Angulation of the roots
[Table - 4] shows the length and angulations of the roots in all the four groups. In group I, the distal root showed the
maximum measurement i.e 9.0 mm as compared to the mesial root, which had a maximum of 8.7 mm. The table also
showed that in Group I, the angulations of the mesial root (34.9) was more than that of the distal root (28.5).
In Group II, the mean length of the distal root (9.2mm) was more than the mesial (8.5 mm) and the mesial root were
more angulated (36.2) than the distal root (25.8).
In Group III, the distobuccal root showed maximum root length with a mean length of 7.3mm and the palatal root
showed minimum root length with a mean length of 6.7 mm. The palatal root had maximum angulation (41.7) followed
by mesiobuccal root (39.7) and the distobuccal root (34.2) showed the least.
Conversely, in Group IV, the palatal root showed the maximum length (8.27 mm) and the distobuccal root showed the
minimum length (8.06 mm). The palatal root also showed maximum angulation (41.5), and the distobuccal showed the
minimum angulation (34.2).
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Discussion
It is imperative that the childs dental integrity be kept intact for preservation of space, esthetics, prevent aberrant tongue
habits, phonation, mastication and also prevent the psychologic effects associated with tooth loss.[6]
Micro-organisms are the principal etiologic factors for pulpal and periapical pathology. Therefore, the therapeutic goal of
root canal therapy is to render the canal system bacteria free.
Several methods were used to investigate the anatomy of the root canals, such as direct observation with the aid of a
microscope (Sempira and Hartwell, 2000);[7] macroscopic sections (Salama et al, 1992);[4] filling of canals with inert
material and then decalcification (Rosenthiel, 1957);[8] filling of canals and clearing (Ayhan et al, 1996).[9] But all these
methods had serious limitations, as most of the relationship of the external structure to the pulp was lost during
preparation of samples.[6] A significant constraint of conventional radiography is the superimposition of overlying
structures, which obscures the object of interest.
Tachibana and Matsumoto (1990)[10] studied the applicability of Computerized Tomography to endodontics. They
concluded that this method allowed the observation of the morphology of the root canals, the roots and the appearance
of the tooth in every direction. Moreover, the image could be analyzed, altered and reconstructed by the computer.
In this study, in all the samples the number of roots in group I were two i.e., mesial and distal, but there was variation in
group II where in 2 of the samples there were 2 roots and one distal root in all the samples. In Group IV all the samples
had three roots i.e., mesiobuccal, distobuccal and palatal roots. Zurcher[3] made reference to the occurrence of the tworooted type maxillary molar and mentioned considerable variation in the number of canals. In this study, out of 15
samples in Group III, 8 samples had fused palatal and distobuccal roots but there is not much variation seen in the root
canals and all had two root canals.
The number of root canals observed in mandibular molars varied from three to four. Almost invariably there were two
canals in the mesial root in both mandibular molars. In group I, 93.3% had two mesial root canals and in Group II, all the
samples had two mesial canals. But in the distal root, two root canals were seen in 60% and 53.3% in both Group I and
II respectively. It was interesting to find 3 distal canals in one of the samples in Group II.
In Group III, in 14.2% of the samples, two mesiobuccal canals were observed and the rest of the samples had only one
canal in each of the roots. More variations were observed in Group IV, especially in the mesiobuccal root where in 53%
of the samples, two canals were present as compared to the distobuccal and palatal roots where two canals were present
in 26% and 40% respectively.
Most of the variations within the root canals of the primary molars observed in this study were in the buccolingual
dimension, which would not be detected in clinical radiographic examination.
From the measured diameter of the root canals in this study, the primary molars did exhibit tapering of the canals towards
the apex but not uniformly and rather like a ribbon-shaped canal system as described by Ash.[12] It was seen that the
measurement of the canals diameter in the cervical third and middle third did not show much difference, but the apical
third showed some amount of apical constriction.
Cross-sections at various levels revealed that the root canal anatomy varied from round to oval or triangular. In the lower
primary molars, the canals are widened buccolingually in the form of a ribbon in both mesial and distal canals and when
only one root canal is present in the distal root there may be constriction in its center, reflecting the outside contour of the
root. On the other hand, in the upper primary molars, the canals followed the general contour of the tooth and resembled
a triangle with rounded corners.
In this study, it was observed that the angulations of the mesial root was more in both group I and II (34.9 and 36.2
respectively) as compared to the distal root (28.5 and 25.8)- In group III and IV, maximum angulation was seen in the
palatal roots (41.7 and 41.5 respectively).
The length of the roots of the primary molars, in group I, both mesial and distal roots showed somewhat the same length
i.e 7.57 mm and 7.51 mm respectively. In group II, the distal root (9.24 mm) were longer than the mesial root (8.59 mm)
and in group III, the distobuccal root (7.32 mm) showed the longest measurement in contrast to what Zurcher had
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and in group III, the distobuccal root (7.32 mm) showed the longest measurement in contrast to what Zurcher had
observed. However, in group IV, the palatal root (8.27 mm) showed the longest measurement. There was a discrepancy
between the length of the roots of the primary molars observed in this study and the length of roots given by Ash. The
explanation for this may be that in this study the area with a greatest constriction was taken as a cervical line (or
radiographic cervical line) and measurements were made from this line. Whereas Ash had taken the cementoenamel
junction as a cervical line and used a Boley gauge to take the measurement. Also racial difference may be the reason as in
this study samples were collected from an Indian population. From this study, the following conclusions were drawn
1. It was not uncommon to find the distobuccal and palatal roots of the maxillary molars fused. When fusion of these
two roots occurred it does not mean that the canals are also fused.
2. The mesial root canals of the mandibular molars and the mesiobuccal root canals of the maxillary molars showed
more frequent and greater variations than did the distal and distobuccal root canals of these molar teeth.
3. The primary root canal has a ribbon-shaped root canal system and the apical portion is less constricted without
uniform tapering of the root canals. So, a root canal system with a graceful, tapering canal and a single apical
foramen ending at the apical foramen is the exception rather than the rule.
4. Most of the variations within the root canals of the primary molars were observed in the buccolingual dimension
which would not be detected in clinical radiographic examination.
5. The length of the roots are more variable in the maxillary molars but in the mandibular molars the distal root is
invariably longer than the mesial root.
6. It is also not uncommon to have two well developed and separated mesial roots in the lower primary molars but
this may be more prevalent in the second molar.
References
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Hibbard ED, Ireland RL. Morphology of the root canals of the Primary molar teeth. ASDC J Dent Child
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Mayo VC, Montgomery S, del Rios C. A Computerized method for evaluating Root Canal Morphology. JOE.
1986;12:2-7.
Zurcher E. The anatomy of the root canals of the teeth of the Deciduous dentition and of the 1st permanent molar.
William Wood 8s Co., New York.
Salama FS, Anderson RW, et al. Anatomy of Primary incisors and molars Root Canals. Int J Pediatr Dent.
1992;14;117-8.
Nielsen BR, Alyassin AM, Peters DD, Carnes DL, Lancaster J. Micro-Computed Tomography: An advanced
System for Detailed Endodontic. JOE. 1995;21:561-8.
Simpson I. An investigation of root canal anatomy of primary teeth. J Canad Dent Ass 1973;9:634-40.
Sempira HN, Hartwell GR. Frequency of Second Mesiobuccal Canals in Maxillary Molars as Determined by Use
of an Operating Microscope: A Clinical Study. JOE. 2000;26:673-4.
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Rosenthiel E. Transparent model teeth with pulp. Dental Digest 1957;63:154.
Ayhan H, Alacam A, Olmoz A. Apical microleakage of primary teeth root canal filling materials by clearing
technique. J Clin Pediatr Dent 1996;20:113-7.
Tachibana H, Matsumoto K. Applicability of X-ray Computerised tomography in endodontics. Endod Dent
Traumatol 1990;6:16-20.
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Sarkar S, Rao AP. Numbers of Root Canals, their shape, configuration, accessory root canals in radicular pulp
morphology. A preliminary study. J Indian Soc Pedo Prev Dent 2002;20:93-97.
Ash MM. Wheeler's Dental Anatomy, Physiology and Occlusion, 6th Ed.
Figures
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
Tables
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9], [Table 10]
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A Study of Root Canal Morphology of Human Primary Molars Using Computerised Tomography - An in Vitro Study Zoremchhingi, Joseph T, Varma B, Mungara J - J Indian Soc Pedod Prev Dent

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Keywords: Computed Tomography, Primary molars, Root canal morphology

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Crown Tooth Root Canal

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Materials and Methods

Armamentarium and Material used

8. Light speed plus CT Scanner (G.E Medical Systems, Milwaukee, USA)

The following observations were made after scanning number of roots.

The following observations were made after scanning number of roots.

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Primary human teeth and their root canal systems

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