Tuesday, June 18, 2024

Root Canal Anatomy: A Comprehensive Review of Permanent Premolars

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Understanding the intricate root canal anatomy is pivotal for the success of root canal treatments. A recent systematic review and meta-analysis delved into the root morphology and canal configuration of permanent premolars, providing invaluable insights for dental professionals. This extensive study meticulously analyzed data from multiple databases and assessed the risk of bias, contributing to a nuanced understanding of premolar root canal anatomy.

Methodology and Analysis

The study adhered to PRISMA guidelines and involved an exhaustive search across four major electronic databases: PubMed, Embase, Cochrane, and Web of Science. The risk of bias in the included studies was evaluated using the Anatomical Quality Assessment (AQUA) tool. Data analysis was conducted with SPSS and RevMAN5.3.3, with a 95% confidence interval employed to calculate odds ratios.

Among the 82 studies selected, 59 were found to have potential bias in the first domain, which pertains to objectives and subject characteristics, and in the third domain, related to methodological characterization. Despite these biases, the analysis revealed critical trends in premolar morphology and canal configuration.

Key Findings

The results indicated that the majority of maxillary first premolars (PM1s) have either a single root (46.7%) or double roots (51.9%), with three-rooted variants being quite rare (1.4%). Maxillary second premolars (PM2s) and mandibular premolars predominantly displayed single roots. In terms of canal configuration, 87.2% of maxillary PM1s exhibited double distinct canals, while maxillary PM2s were almost evenly split between single (51.4%) and double canals (48.3%). Mandibular premolars were largely characterized by single canals, observed in 78.3% of mandibular PM1s and 90.3% of mandibular PM2s.

Subgroup analyses highlighted demographic variations, with higher incidences of single-rooted and single-canalled premolars among Asians compared to Caucasians. Additionally, gender differences were notable; women showed a higher prevalence of single-rooted premolars, whereas men had a greater frequency of double-rooted premolars.

User-Usable Inferences

  • Dentists should anticipate double canals in maxillary first premolars for effective treatment planning.
  • Single-rooted premolars are more common in Asian populations, which may influence regional dental practices.
  • Gender-specific trends suggest that men are more likely to have double-rooted premolars, an important consideration for personalized dental care.
  • Bias in study methodology underscores the need for rigorous research designs in future anatomical studies.

The meticulous analysis underscores that maxillary first premolars predominantly possess double roots and double canals, whereas the maxillary second premolars and mandibular premolars are primarily single-rooted with a single canal. The findings also reveal significant demographic variations, emphasizing the importance of personalized approaches in dental treatments.

Original Article: BMC Oral Health. 2024 Jun 4;24(1):656. doi: 10.1186/s12903-024-04419-y.

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