Assessment of root morphology and canal configuration of maxillary premolars in a Saudi subpopulation: a cone-beam computed tomographic study

(2021) 21:397 Al‑Zubaidi et al. BMC Oral Health https://doi.org/10.1186/s12903-021-01739-1 Open Access RESEARCH Assessment of root morphology and canal configuration of maxillary premolars in a Saudi subpopulation: a cone‑beam computed tomographic study Saad M. Al‑Zubaidi1*, Moazzy I. Almansour1, Nada N. Al Mansour2, Ahad S. Alshammari2, Ahad F. Alshammari1, Yazeed S. Altamimi1 and Ahmed A. Madfa1 Abstract Background: The objective of this study was to use CBCT to look into the root canal morphology of maxillary premo‑ lars in a Saudi Arabian subpopulation and associate the results to existing canal morphology classifications. Methods: The sample size for this analysis was 500 right and left untreated maxillary first and second premolars with fully formed roots from 250 Saudi residents (125 male and 125 female). The following observations were made using CBCT on the teeth related: (1) The number and morphology of roots; (2) The canal morphology for each root accord‑ ing to Vertucci’s classification. The frequency and similarities between the right and left sides, as well as between females and males, were studied. The Chi-square test was used to assess the results. Results: Of the 500 maxillary first premolars studied, 199 teeth had one root (39.8%), whilst 293 (58.6%) were tworooted. Three-rooted maxillary first premolars were found in 8 (1.6%). For maxillary second premolars, 416 premolars had one root (83.2%), whilst 79 (15.8%) had two roots and the rest 5 (1.0%) were three roots. There were significant differences of number of root were found between groups (p > 0.05). For maxillary first premolar, Type IV was the most frequent, accounting for 57.8% of the sample (n = 289), followed by type II (32.8%, n = 164). For maxillary second premolar, Type I was mainly occurrence 302 (60.4%), followed by Type II (16.4%, n = 82). Conclusions: The majority of maxillary first premolars had two roots and two root canals, while one root and one root canal was the most common anatomical configuration for maxillary second premolars. Additional canal forms do occur on occasion, and clinicians should pay close attention to them. Keywords: Cone beam computed tomography, Canal morphology, Maxillary premolars, Saudi subpopulation Background The science of root canal care is founded on the anatomy of the base tooth. Today, root apex is not the only field of endodontic research, but the concept of *Correspondence: 1 Department of Restorative Dental Science, Collage of Dentistry, University of Ha’il, Ha’il, Kingdom of Saudi Arabia Full list of author information is available at the end of the article three-dimensional root canal filling implies that, while working length and maintaining it are more important, access to all canal within complications is also essential to facilitate root canal filling [1]. Failure to consider differences in root and canal morphologies is the most common cause of failed root canal care. To avoid endodontic failure due to incomplete debridement and obturation, a detailed knowledge of the anatomy of the teeth and an expectation of their possible © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Al‑Zubaidi et al. BMC Oral Health (2021) 21:397 deviations is essential [1]. Previous research has found that different populations have different patterns in the number and shape of roots and canals [2–6], which tend to be hereditarily determined [7–9] and are significant for locating population ethnic backgrounds. As a result, it is critical to be aware with the differences in tooth morphology and distinguishing structures among different ethnic groups, as this information can help with canal position and negotiation, as well as their subsequent management [10]. Current research has shown that the root canal system is not a single canal that runs uniformly from orifice to apex, but rather a complex system that splits and joins canals along the way to the apex [11–13]. A root canal begins with an orifice in the pulp chamber and ends with an apical foramen in the periodontium. Root canals offer a number of configurations from tooth to tooth in different as well as the same individual during their course [14]. The maxillary premolars are considered among the most problematic teeth during endodontic treatment because of various of the root canal configuration [15]. Furthermore, the root canal morphology of maxillary premolars has been found to be highly variable [16–19]. Clinical treatment of maxillary premolars with unpredictably morphological roots and canals can be difficult [20, 21]. Among the difficulties are repeated endodontic treatment errors due to missing canals or the inability to radiographically image the apical limit of multi-rooted premolars. As a result, a detailed information of the anatomical features of the root canal system in the maxillary premolars is critical for improving root canal therapy and post core restoration success rates while also reducing complications. Root modeling, sectioning, tooth-clearing procedure, radiographic inspection, cone-beam computed tomography (CBCT), and micro-computed tomography (microCT) imaging are some of the methods used to assess the anatomy and morphology of root canals [22–27]. Neelakantan et al. [28] compared the effectiveness of four tomography methods with tooth-clearing technique and a digital radiography. They found that peripheral quantitative computed tomography and CBCT were as effective as tooth-clearing technique and canal staining in recognizing root canal systems. While micro-CT has grown in popularity as a result of its precision, high resolution, and ability to perform comprehensive qualitative and quantitative measurements of root canal anatomy, it is not available in every country. In addition, the cost and radiation dose of micro-CT are important considerations. The objective of this research was to use CBCT to look into the root canal morphology of maxillary premolars i (...truncated)