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Abstract
Introduction: The present study aimed to quantita-
tively analyze apical foramen deviations of mesial root
canals of mandibular first molar teeth by means of
E ndodontic treatment
aims to eliminate or
prevent infection by disin-
Significance
The present study shows clinically important
anatomic structures of the apical third by present-
micro–computed tomographic (micro-CT) imaging. fecting the root canal sys-
ing deviations of the apical foramina of mesial root
Methods: Micro-CT images of the mesial roots of 109 tem through cleaning and
canals from their anatomic apices and recom-
mandibular first molar teeth with independent mesio- shaping of root canals to
mends the use of electronic apex locators for the
buccal (MB) and mesiolingual (ML) root canals were an adequate geometry
determination of the working length because peri-
analyzed. The deviations of the apical foramina of the (1). Knowledge of root ca-
apical radiographs could be misleading because
MB, ML, and middle mesial root canals from the nal anatomy is 1 of the
of the superimpositions of the deviated mesial
anatomic apex were measured. The vertical distance be- most important factors
root canals.
tween the apical foramina of each mesial root canal in for accomplishing these
relation to each other was also calculated. Results: goals (2). However, the
The distances from the apical foramina of the MB, ML, complex internal anatomy of a root canal system often presents challenges for root canal
and middle mesial root canals to the anatomic apex of treatment (3, 4). Mandibular molars have been reported to exhibit a very complicated
the mesial root were up to 2.51 mm, 3.21 mm, and internal anatomy because of their mesial roots showing branching, dividing, and
5.67 mm, respectively. There was no significant differ- rejoining root canals, accessory root canals, isthmuses, and fins at different levels (5).
ence between the deviations of MB and ML root canals The internal anatomy of mandibular molar teeth has been revealed by several tech-
from each other (P > .05). The middle mesial root canal niques, including the clearing method, plastic resin injection, histology, radiography,
showed the greatest deviation compared with the MB scanning electron microscopy, cone-beam computed tomographic imaging, and
and ML canals (P < .05). Conclusions: The apical micro–computed tomographic (micro-CT) imaging (6). Among these techniques,
foramina of mesial root canals of mandibular first molar micro-CT imaging has emerged as the most promising because it provides high-
teeth showed greater variations from each other and resolution accurate images of the internal anatomy without destroying the specimen
anatomic apices than previously reported. Clinically, (6). Micro-CT imaging has led to the discovery of new anatomic features of the root
the use of electronic apex locators for the detection of canal system and a new classification system for categorizing root canal configurations
minor apical foramen of each mesial root canal is of (4, 7).
the utmost important. (J Endod 2018;-:1–3) Mesial roots of mandibular molars often have at least 2 root canals extending from
independent orifices to their own apical foramina. Conventional periapical radiography
Key Words of these root canals might cause superimposed images, which makes it difficult to differ-
Apical foramen deviation, micro–computed tomogra- entiate the terminus of root canals during routine root canal treatment (8). A previous
phy, root canal anatomy study reported that the major foramen of the middle mesial root canal exhibits devia-
tions from the root apex (9). The major foramina of the mesiobuccal (MB) and me-
siolingual (ML) roots might also present deviations from each other and the
anatomic apex. The aim of the present study was to quantitatively analyze the deviations
of mesial root canals of mandibular molars at the apical third by means of micro-CT
imaging.
From the Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey.
Address requests for reprints to Dr Ali Keles, Department of Endodontics, Faculty of Dentistry Ondokuz Mayıs University, 55400 Samsun, Turkey. E-mail address:
Alikeles29@yahoo.com
0099-2399/$ - see front matter
Copyright ª 2018 American Association of Endodontists.
https://doi.org/10.1016/j.joen.2018.02.028
Figure 1. Three- and 2-dimensional images of mesial roots of 2 mandibular molar teeth at the levels of apical foramina of the MB, ML, and middle mesial root
canals showed their deviations from the anatomic apex. (A) The apical foramen of the middle mesial root canal revealed a significantly greater deviation than those
of the MB and ML root canals. Deviations of apical foramina of MB and ML canals did not show statistical differences; however, in some specimens, deviation of the
apical foramen could reach greater values. (B) This specimen showed 2.69 mm deviation from the anatomic apex.
cementum apposition (13). Unfortunately, in the present study, the ages Acknowledgments
of the patients from whom the specimens were collected were un- Supported by the Scientific and Technological Research Coun-
known. cil of Turkey (grant no. 114S002).
In the present study, a large number (N = 269) of mesial roots of The authors deny any conflicts of interest related to this study.
mandibular first molar teeth were scanned, and 106 (39.4%) roots pre-
senting 2 separate MB and ML apical foramina were detected. Only in 10
specimens (9.4%) did the MB and ML apical foramina terminate at the References
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