In-depth morphological evaluation of tooth anatomic lengths with root canal configurations using cone beam computed tomography in North American population

KULKARNI, Varun; DURUEL, Onurcem; ATAMAN-DURUEL, Emel Tuğba; TÖZÜM, Melek Didem; NARES, Salvador; TÖZÜM, Tolga Fikret

doi:10.1590/1678-7757-2019-0103

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Brasil

Journal of Applied Oral Science

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Brasil

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Original Article • J. Appl. Oral Sci. 28 • 2020 • https://doi.org/10.1590/1678-7757-2019-0103 copy

In-depth morphological evaluation of tooth anatomic lengths with root canal configurations using cone beam computed tomography in North American population

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

This study aimed to assess the association between tooth size and root canal morphology by using CBCT analysis.

Methodology

In this retrospective study, tooth anatomic lengths (crown and root lengths, buccolingual and mesiodistal dimensions) of 384 patients were assessed and correlated with Vertucci’s root canal morphology classification. Data was analyzed for gender-related differences using the independent sample t-test, ANOVA, and the Pearson’s correlation for a possible relation between anatomic lengths and canal morphology.

Results

The maxillary first and second premolars showed a greater predilection for Type IV and II variants, respectively, while the mandibular first premolar showed a greater predilection for Type II canal system. The root canal system of the mandibular second premolar showed maximal diversity (47% Type I, 30% Type II, and 20% Type III). The dimensions were greater in men regardless of tooth type. The most significant relation (p<0.05) between the anatomic size and canal morphology was observed in the maxillary first premolars, followed by the mandibular canines (buccolingual dimension) and the lower second premolars (crown length). Negative correlations existed between the crown length and the patient’s age for the anterior teeth and mandibular second premolar (r=−0.2, p<0.01).

Conclusions

The most common canal formation for anterior teeth was the Type I. The anatomic lengths had the strongest influence on the canal configuration of the maxillary first premolar, with Type IV being the most common root canal system. The mandibular second premolars showed maximal diversity in the canal classification terms and had a significant correlation with their crown lengths.

Clinical Relevance

The complex relationship between the canal morphology and anatomic tooth sizes need meticulous awareness and recognition during endodontic procedures, in conjunction with the demographic variabilities.

Tooth anatomy; Cone beam computed tomography; Root canal morphology; Endodontics; Crown size; Root size

Tooth type	Variable	n	Gender	Mean ± SD	t	Sig (2 tailed)
Central Incisor	TL	57	M	23.3 ± 1.9	-3.1	0.005**
	TL	78	F	22.3 ± 1.8	-3.1	0.005**
	CL	57	M	9.7 ± 1.2	1.3	0.16
	CL	78	F	10 ± 1.0	1.3	0.16
	RL	57	M	13.9 ± 1.5	-2.3	0.02*
	RL	78	F	12.9 ± 1.5	-2.3	0.02*
	BL	57	M	7.62 ± 0.5	-0.2	0.84
	BL	78	F	7.59 ± 0.6	-0.2	0.84
	MD	57	M	8.32 ± 0.3	1.44	0.15
	MD	78	F	8.2 ± 0.6	1.44	0.15
Lateral Incisor	TL	60	M	22.6 ± 2	-2.2	0.02*
	TL	81	F	21.7 ± 1.7	-2.2	0.02*
	CL	60	M	8.8 ± 1.1	-0.7	0.4
	CL	81	F	8.7 ± 1.04	-0.7	0.4
	RL	60	M	14.2 ± 1.7	-2	0.03*
	RL	81	F	13.5 ± 1.6	-2	0.03*
	BL	60	M	7.05 ± 0.8	-0.6	0.3
	BL	81	F	7.05 ± 0.3	-0.6	0.3
	MD	60	M	6.9 ± 0.8	0.1	0.8
	MD	81	F	6.9 ± 0.2	0.1	0.8
Canine	TL	62	M	26.2 ± 2.2	-3.9	0.000**
	TL	91	F	24.8 ± 1.7	-3.9	0.000**
	CL	62	M	10.1 ± 1.2	-3	0.002**
	CL	91	F	9.5 ± 0.8	-3	0.002**
	RL	62	M	17.8 ± 0.8	-2.1	0.02*
	RL	91	F	16.1 ± 1.4	-2.1	0.02*
	BL	62	M	8.9 ± 0.7	-2.4	0.01*
	BL	91	F	7.9 ± 0.6	-2.4	0.01*
	MD	62	M	7.8 ± 0.5	-0.7	0.4
	MD	91	F	7.7 ± 0.6	-0.7	0.4
First Premolar	TL	43	M	21.4 ± 1.8	-3.5	0.001**
	TL	54	F	20.1 ± 1.8	-3.5	0.001**
	CL	43	M	8.1 ± 0.8	-3.2	0.001**
	CL	54	F	7.4 ± 0.8	-3.2	0.001**
	RL	43	M	13.8 ± 1.8	-2.1	0.03*
	RL	54	F	13.0 ± 0.5	-2.1	0.03*
	BL	43	M	9.6 ± 0.8	0.09	0.9
	BL	54	F	9.55 ± 0.8	0.09	0.9
	MD	43	M	7.3 ± 0.5	0.4	0.6
	MD	54	F	7.2 ± 0.2	0.4	0.6
Second Premolar	TL	30	M	21.8 ± 1.6	-2.7	0.008**
	TL	42	F	19.8 ± 2.0	-2.7	0.008**
	CL	30	M	7.7 ± 0.4	-2.7	0.009**
	CL	42	F	7.0 ± 1.0	-2.7	0.009**
	RL	30	M	14.6 ± 1.2	-2.3	0.02
	RL	42	F	12.9 ± 0.8	-2.3	0.02
	BL	30	M	9.7 ± 0.9	-0.2	0.8
	BL	42	F	9.7 ± 1.0	-0.2	0.8
	MD	30	M	7.2 ± 0.6	1.4	0.1
	MD	42	F	7.1 ± 0.5	1.4	0.1

Tooth type	Variable	n	Gender	Mean ± SD	t	Sig (2 tailed)
Central Incisor	TL	104	M	21 ±1.63	-4.5	0.00**
	TL	154	F	20 ± 1.3	-4.5	0.00**
	CL	104	M	8.1 ± 1	-0.4	0.1
	CL	154	F	8 ± 0.8	-0.4	0.1
	RL	104	M	13.7 ± 1.4	-5.4	0.000**
	RL	154	F	12.7 ± 1.1	-5.4	0.000**
	BL	104	M	6.1 ± 0.5	-2.4	0.02*
	BL	154	F	5.3 ± 0.6	-2.4	0.02*
	MD	104	M	5.5 ± 0.6	-0.0	0.9
	MD	154	F	5.5 ± 0.65	-0.0	0.9
Lateral Incisor	TL	102	M	22.1 ± 1.8	-4.3	0.000**
	TL	158	F	21.1 ± 1.5	-4.3	0.000**
	CL	102	M	8.5 ± 1	-1.7	0.07
	CL	158	F	8.3 ± 0.9	-1.7	0.07
	RL	102	M	14.3 ± 1	-4.6	0.000**
	RL	158	F	13.3 ± 1	-4.6	0.000**
	BL	102	M	6.5 ± 0.6	-1.6	0.09
	BL	158	F	6.1 ± 0.6	-1.6	0.09
	MD	102	M	5.8 ± 0.6	-0.2	0.8
	MD	158	F	5.8 ± 0.5	-0.2	0.8
Canine	TL	96	M	25 ± 2	-6.3	0.000**
	TL	163	F	23 ± 1	-6.3	0.000**
	CL	96	M	9.7 ± 1.2	-4.8	0.000**
	CL	163	F	9.1 ± 1	-4.8	0.000**
	RL	96	M	16.6 ± 1.8	-5.1	0.000**
	RL	163	F	15.5 ± 1.6	-5.1	0.000**
	BL	96	M	8.2 ± 0.7	-7.4	0.000**
	BL	163	F	7.5 ± 0.7	-7.4	0.000**
	MD	96	M	7.2 ± 0.6	-2.6	0.009**
	MD	163	F	6.8 ± 0.5	-2.6	0.009**
First Premolar	TL	78	M	22.2 ± 1.6	-4.4	0.000**
	TL	129	F	21.1 ± 1.5	-4.4	0.000**
	CL	78	M	7.9 ± 0.7	-2.6	0.008**
	CL	129	F	7.6 ± 0.7	-2.6	0.008**
	RL	78	M	15.2 ± 1.5	-3.5	0.001**
	RL	129	F	14.3 ± 1.3	-3.5	0.001**
	BL	78	M	8.2 ± 0.7	-2.9	0.004**
	BL	129	F	7.9 ± 0.6	-2.9	0.004**
	MD	78	M	7.2 ± 0.6	-1.3	0.1
	MD	129	F	7.2 ± 0.5	-1.3	0.1
Second Premolar	TL	53	M	22 ± 1.6	-4.4	0.000**
	TL	93	F	20 ± 1.3	-4.4	0.000**
	CL	53	M	7.7 ± 0.7	-1.7	0.08
	CL	93	F	7.5 ± 0.7	-1.7	0.08
	RL	53	M	15 ± 1.5	-4.3	0.000**
	RL	93	F	14 ± 1.1	-4.3	0.000**
	BL	53	M	8.4 ± 0.8	-1.5	0.1
	BL	93	F	8.1 ± 0.8	-1.5	0.1
	MD	53	M	7.2 ± 0.5	-0.8	0.4
	MD	93	F	7.2 ± 0.6	-0.8	0.4

Tooth Number	Variable
14 (First Premolar)	TL (mm)
	Vertucci Type I	20.3 ± 3.1
	Vertucci Type III	20.4 ± 2
	Vertucci Type IV	21 ± 2.1
	p value	0.03
	CL (mm)
	Vertucci Type I	6.7 ± 2.1
	Vertucci Type III	7.8 ± 0.8
	Vertucci Type IV	7.8 ± 0.8
	p value	0.004
	BL (mm)
	Vertucci Type I	8.9 ± 2.1
	Vertucci Type III	9.5 ± 0.7
	Vertucci Type IV	9.7 ± 0.9
	p value	0.004
24 (First Premolar)	TL (mm)
	Vertucci Type II	19.5 ± 1.9
	Vertucci Type III	18.6 ± 3
	Vertucci Type IV	21.1 ± 2
	p value	0.04
	RL (mm)
	Vertucci Type II	12.1
	Vertucci Type III	11.5 ± 2.6
	Vertucci Type IV	13.9 ± 1.8
	p value	0.03
	BL (mm)
	Vertucci Type II	7.8 ± 0.9
	Vertucci Type III	9.5 ± 0.3
	Vertucci Type IV	9.5 ± 0.9
	p value	0.03
25 (Second Premolar)	BL (mm)
	Vertucci Type I	10 ± 1.1
	Vertucci Type II	7
	Vertucci Type III	9.5 ± 0.8
	Vertucci Type IV	10.2 ± 0.9
	p value	0.001

Tooth Number	Variable
35 (Second Premolar)	CL (mm)
	Vertucci Type I	7.4 ± 0.7
	Vertucci Type II	7.6 ± 0.7
	Vertucci Type III	7.9 ± 0.7
	p value	0.006
33 (Canine)	BL (mm)
	Vertucci Type I	7.7 ± 0.7
	Vertucci Type II	8 ± 0.7
	Vertucci Type III	8.8
	p value	0.000
43 (Canine)	BL (mm)
	Vertucci Type I	7.6 ± 0.7
	Vertucci Type II	8 ± 0.8
	Vertucci Type III	9.1
	p value	0.002

Arch	Variable	Variable	Central Incisor	Lateral Incisor	Canine	First Premolar	Second Premolar
Maxilla	Age	TL (r)	-0.3	-0.1	0.06	0.2	0.2
		p value	0.000**	0.03**	0.44	0.04**	0.09
		CL (r)	-0.1	-0.2	-0.1	0.06	0.03
		p value	0.04**	0.003**	0.02**	0.5	0.7
		RL (r)	0.07	-0.07	0.06	0.1	0.1
		p value	0.4	0.3	0.4	0.2	0.1
		BL (r)	0.04**	-0.05	0.09	-0.1	0.03**
		p value	0.8	0.9	0.2	0.3	0.8
		MD (r)	-0.06	-0.2	-0.02**	-0.1	-0.2
		p value	0.4	0.01**	0.7	0.1	0.04**
Mandible	Age	TL (r)	-0.1	-0.04**	0.004**	-0.1	-0.08
		p value	0.08	0.4	0.9	0.02*	0.3
		CL (r)	-0.2	-0.2	-0.1	-0.1	-0.2
		p value	0.000**	0.001**	0.007**	0.08	0.003**
		RL (r)	0.03**	0.06	0.1	0.04**	0.008**
		p value	0.5	0.2	0.04*	0.55	0.9
		BL (r)	0.02**	0.02**	0.02**	-0.01**	-0.02**
		p value	0.6	0.6	0.7	0.8	0.7
		MD (r)	0.02**	-0.01**	-0.007**	-0.05	0.000**
		p value	0.7	0.7	0.9	0.4	0.9

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