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ORIGINAL RESEARCH Table of Contents   
Year : 2006  |  Volume : 17  |  Issue : 1  |  Page : 7-10
Anatomical variations of mandibular premolars in Chennai population


Department of Conservative Dentistry & Endodontics, Ragas Dental College & Hospital, 2/102, East Coast Road, Uthandi, Chennai - 600 119, Tamilnadu, India

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   Abstract 

AIM : To analyse the prevalence of anatomical variations of mandibular premolars in Chennai population. METHODOLOGY : It was observed, during the routine treatment of mandibular premolars that aberrations were becoming common. This necessitated an encompassing study on 500 patients, evaluating the occurrence of these aberrations. The parameters of this study included sex predilection, unilateral/ bilateral occurrences, and comparison of the incidence of anatomical variations in mandibular first and second premolar canal configuration. The study pattern was designed to observe these premolars using Radiovisiography (RVG) in different angulations to highlight the anatomical aberrations. The results were subjected to statistical analysis, which were performed using SPSS (Statistical Package for Social Science) statistical program version 10.0.5. Descriptive statistics were computed for all the variables. RESULT : The present study revealed high incidence of anatomical aberrations in mandibular premolars among Chennai population. Out of the 500 patients studied, 123 patients [24.6%] showed anatomical variance in the canal configuration. There was high incidence of Vertucci's Type IV canal configuration as compared to Type V, Type II and Type VIII in the descending order of occurrence. CONCLUSION : Within the limitations of this in-vivo study, it was inferred that the incidence of aberrations in the canal configuration of mandibular premolars is common and due considerations are to be given during endodontic intervention.

Keywords: Aberrations, Mandibular premolar root, Modified. access cavity

How to cite this article:
Iyer VH, Indira R, Ramachandran S, Srinivasan M R. Anatomical variations of mandibular premolars in Chennai population. Indian J Dent Res 2006;17:7-10

How to cite this URL:
Iyer VH, Indira R, Ramachandran S, Srinivasan M R. Anatomical variations of mandibular premolars in Chennai population. Indian J Dent Res [serial online] 2006 [cited 2020 Aug 15];17:7-10. Available from: http://www.ijdr.in/text.asp?2006/17/1/7/29898

   Introduction Top


Pulp cavity anatomy takes the lead as far as complexities in its studies are concerned. External morphologic features in teeth are seen as variations in crown size, root length, division of roots etc. Internal anatomical variations occur in root canal configurations. Ethnic variations and sexual dimorphism are also observed [1].

Mandibular premolars exhibit a high degree of complex anatomy with fine ribbon shaped canal system; which are difficult to access, clean and obturate. The aberrations generally occurring in the root canal system create a challenge for the clinician and also influence the outcome ofthe endodontic procedure.

The present study highlights the recognition of these aberrations in mandibular premolars in Chennai population.


   Materials and methods Top


From the patients reporting to the Department of Conservative Dentistry and Endodontics, 500 patients were randomly selected and screened with RVG bilaterally to obtain the digital images of the mandibular posterior region. The 1000 mandibular first premolars and 1000 mandibular second premolars were divided into 4 groups based on the RVG findings, on the extent of caries lesion and the treatment modality.

  1. Group I -Thepremolars without anydental caries.
  2. Group II - The premolars with dental caries but without pulpal involvement- where restorations were done.
  3. Group III - The premolars with dental caries involving pulp, but without any anatomical aberrations - routine endodontic treatment were carried out.
  4. Group IV - The premolars with dental caries with pulpal involvement exhibiting anatomical variations - endodontic intervention done with modified access.


The other parameters of this study were sex predilection, unilateral/ bilateral occurrences of the anatomical aberrations and comparison of the incidence of anatomical variations in mandibular first and second premolar's canal configuration. All the mandibular premolars that needed endodontic intervention were anaesthetized using 2% Lignocaine hydrochloride with 1:80,000 Adrenaline, by means of inferior alveolar, mental and long buccal nerve blocks. Routine access opening was done in Group III and modified buccolingually in Group W favoring easy location of additional canals. Skewing of the access was done slightly mesial to the routine access, on the occlusal surface, to facilitate easy instrumentation and to explore additional canals. Diagnostic radiograph was taken after location of the canals and determination of working length was done. Cleaning and shaping was carried out in a sequential manner using Crown-Down pressureless technique and the canals were obturated with gutta-percha cone filling material with zinc oxide eugenol sealer. Lateral compaction technique was used for obturation and finally a radiograph was taken to confirm the quality of obturation.


   Statistical analysis Top


All statistical calculations were performed using SPSS (Statistical Package for Social Science) statistical program version 10.0.5. Descriptive statistics were computed for all the variables.

These consisted of standard parametric statistics for continuous variables (e.g. age) and non-parametric frequency statistics for variables measured as counts or on an ordinal or nominal scale. Associations between variables were determined using Pear son's chi-square test The student's t-test was used when a comparison was made between a continuous variable with two groups.

A significance level of p<0.05 was used for all tests and comparisons.


   Result and discussion Top


Out of the 500 patients studied, 123 patients [24.6%] showed anatomical variance in the canal configuration, which has been categorized asper Vertucci's classification[2] [Figure - 1].

The 2000 mandibular premolars screened in this study through RVG for the 500 patients showed I, II, IV, V and VIII types of Vertucci's classification. The percentages of occurrence of aberrations aretabulated [Table 1 ].

As regards to canal configuration [Table - 1], a single canal from the pulp chamber to the apex (Type I) was observed in 1508 teeth [75.4%], two separate canals leaving the pulp chamber but joining short of apex to form one canal (Type II) was observed in 20 teeth [1%], two separate and distinct canals from the pulp chamber to the apex (Type IV) was observed in 416 teeth [20.8%], one canal leaving the pulp chamber and dividing short of the apex into two separate and distinct canals with separate apical foramen (Type V) was observed in 48 teeth [2.4%] and three separate and distinct canals from the pulp chamber to the apex (Type VIII) was observed in 8 teeth [0.4%].

The results indicated that Type I was the commonest occurrence. There was a high incidence of Type IV [Figure - 4] anatomical variation as compared to Type V [Figure - 2], Type It [Figure - 3] and Type VIII [Figure - 2] in the descending order. Results of the present study correlated with the studies by Takatomo Yoshioka [3] on extracted teeth. Regarding the sex predilection, there were 255 females and 245 males in this study of 500 patients. There was a higher prevalence of anatomical variations in females than males (31.76% [n=81] females: 16.9% [n=42] males). There is not much documentation regarding correlation of sex predilection in patients with aberrations.

With regards to bilateral symmetrical occurrence of the anatomical complexity in the mandibular premolars, 16 [3.2%] out of 123 patients exhibited bilateral symmetry. The incidence of anatomical variation was high with reference to mandibular first premolar [n=276 teeth] than mandibular second premolars [n=216 teeth] in our study. This may be the reason why the mandibular first premolars are considered an endodontist's enigma [4],[5].

With regards to the anatomical aberration in root division, out of 2000 teeth the bifurcation of the roots was seen in 39 mandibular first premolars and 62 mandibular second premolars, with mesiodistal bifurcation [Table - 2]. This is in concurrence with the previous studies.[7],[8],[9],[10],[11],[12],[13],[14],[15],[16] The truncation of roots was seen in 2 mandibular first premolars and 6 mandibular second premolars [17][Table - 2] [Figure - 5]. The premolars being the transition tooth in the arch may be the reason for these variations simulating the molars. These multi-rooted premolars offer better periodontal support for fixed prosthesis [18].

Use of Radiovisiogaphy (RVG) in different angulations helped in highlighting the various aberrations in this study. RVG a low-dose, rapid imaging system is a useful tool in endodontics as images can be stored and retrieved.

The increased prevalence of anatomical variations documented in the present study makes it imperative for analyzing the possibilities of variations in root canal anatomy of mandibular premolars These aberrations, further demands the need for proper diagnosis, treatment planning and careful execution of the treatment modality. The failure of an endodontically treated mandibular premolar necessitates the clinician to think about these aberrations, so that the tooth can be salvaged. The clinician must be familiar with the anatomic variations encountered in different teeth and must explore for them in every tooth using state of art technology such as RVG, magnifying loops / operating microscope and prudently execute the endodontic procedure by good tactile sensation.


   Conclusion Top


Mandibular premolars are undoubtedly an endodontic challenge, because of the presence of extra roots / root canals which may occur far too often than one can expect. A thorough knowledge of the root canal anatomy, careful interpretation of the radiographs, proper modification of the conventional access cavity are the essentials for recognition and adequate treatment of these anatomical variations.

 
   References Top

1.Trope M, Elfenbein L, Tronstad L: Mandibular premolars with more than one root canal in different race groups, J Endod,12: 343-5,1986.   Back to cited text no. 1    
2.Vertucci EJ: Root canal anatomy of the human permanent teeth oral Surg Oral Med Oral Patho1,58:589-599,1984.  Back to cited text no. 2    
3.Takatomo Yoshioka et al : Radiographic valuation of root canal multiplicity in mandibular first premolars, J Endod, 30: 73-74, 2004.  Back to cited text no. 3    
4.Amos E.R: Incidence of bifurcated canals in mandibular bicuspids, I Am Dent Assoc, 50:70-1,1955.  Back to cited text no. 4    
5.Green D: Double canals in single roots oral Surg Oral Med Oral Pathol, 35: 689-96,1973.   Back to cited text no. 5    
6.Kerekes K and Tronstad L: Morphometric observation on root canals of human premolars, J Endod, 3: 74-9,1977.  Back to cited text no. 6    
7.Al-Fouzan.K.S: The microscopic diagnosis and treatment of a mandibular second premolar with 4 canals, Intl Endodontic Journal, 34: 406-410, 2001.  Back to cited text no. 7    
8.Bram S and Fleisher R: Endodontic therapy in a mandibular second bicuspid with four canals, JEndod,17:513-5,1991.  Back to cited text no. 8    
9.Chan K, Yew SC, Chao SY et al : Mandibular premolar with three root canals - two case reports, Intl Endodontic Journal, 25: 261-4, 1992.  Back to cited text no. 9    
10.El Deeb ME: Three root canals in mandibular second premolars: Literature review and a case report, J Endod, 8:376-7,1982.  Back to cited text no. 10    
11.England MC, Hartwell GR, Lance JR: Detection and treatment of multiple canals in mandibular premolars, J Endod,17:174-8,1991.  Back to cited text no. 11    
12.Elsa Macri et al : Five canals in a mandibular secondpremolar.JEndod,26:304-5,2000.  Back to cited text no. 12    
13.HoltzmanL:Root canal treatment ofmandibular second premolar with four root canals: a case report, Intl Endod J, 31: 364-6,1998.  Back to cited text no. 13    
14.Rhodes JS: A case of unusual anatomy; a mandibular second premolar with 4 canals,Intl Endodf,34:645-648,2001.  Back to cited text no. 14    
15.Shapira Y, Delivanis P: Multiple-rooted mandibular second premolars, J Endod, 8: 231­2,1982.  Back to cited text no. 15    
16.Wong M: Four root canals in mandibular second premolar, J Endod,17:125-6,1991.  Back to cited text no. 16    
17.Serman MJ and Hasselgren G: The radiographic incidence of multiple roots and canals in human mandibular premolar, Intl Endod J; 25: 234-7, 1992.  Back to cited text no. 17    
18.Mousumi Goswami, Satish Chandra et al Mandibular premolar with two roots, J Endod, 23:187,1997.  Back to cited text no. 18    

Top
Correspondence Address:
Vidyaa Hari Iyer
Department of Conservative Dentistry & Endodontics, Ragas Dental College & Hospital, 2/102, East Coast Road, Uthandi, Chennai - 600 119, Tamilnadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.29898

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

    Tables

[Table - 1], [Table - 2]

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