DR. DEEPA ASTEKAR Dissertation - 52.172.27.147:8080

i

Evaluation of Root canal Morphology And Configuration of

Mesio buccal root of Maxillary First molar having Mesio

buccal second root canal by means of Cone-beam

Computed Tomography-An in vitro study

BY

DR. DEEPA ASTEKAR

Dissertation

Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment

of the requirements for the degree of

MASTER OF DENTAL SURGERY (M.D.S.)

in

CONSERVATIVE DENTISTRY AND ENDODONTICS

Under the guidance of

DR. HEMANT VAGARALI MDS

Professor DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

MARATHA MANDAL’S NATHAJIRAO G. HALGEKAR INSTITUTE OF DENTAL

SCIENCES AND RESEARCH CENTRE,

BELGAUM, KARNATAKA.

2017-2020

v

VI

ACKNOWLEDGEMENT

I would like to begin by Expressing my heartfelt thanks to the President, Maratha

Mandal Educational Society, Mrs Rajshree Nagraj.

I thank Dr. Ramakanth Nayak, Principal, Maratha Mandal’s Nathajirao

G.Halgekar Institute of Dental Sciences& Research Centre, Belgaum, for providing

me the opportunity and facilities to study in this esteemed institution.

It is my utmost privilege and honor to express my sincere gratitude to my guide and

esteemed teacher, Dr.Hemant Vagarali, Professor, Department of Conservative

Dentistry and Endodontics, MMNGH Institute of Dental Sciences, I have always

considered it an honour to be his student. This dissertation would not have reach

without his guidance, support, suggestions, encouragement. Thank you very much sir

for being my guide.

I would also like to express my deepest gratitude to my esteemed teacher Dr. Madhu

Pujar, Professor and Head of the Department, for her constant efforts and

encouragement at every stage of my post graduate training and motivaton, support

and suggestions have made this thesis achievable.

My deepest thanks to Dr.Veerendra Uppin, Professor, my mentor For constant

support and encouragement at every moment.

I wish to thank Dr. Sheetal Kubasad , Dr Praveen Byakod, Dr.Pallavi Gopishetti

,Dr.Chetan Patil,Dr.Amulya,Dr.Asim who was has been a constant supporter,

motivator have helped me tremendously.

I humbly give thanks to God and my beloved uncle Late.Mr.Manohar K

Ghorpade and Grand Parents for their blessings on me. I would like to specially

thank to my aunt Miss. Kasturi K Ghorpade, My parents My father Mr.Kallappa R

Astekar and mother Mrs. Sarojini K Astekar and I also thank my uncle

Mr. Subhash K Ghorpade, aunts Mrs. Jayashree K Ghorpade, Mrs. Usha M

Ghorpade, my Siblings Roopa, Sandeep, Vinayak, Ujwala, Priti, Harish,Vinay,

VII

VIII

LIST OF ABBREVIATIONS

3D - Three dimensional.

CBCT - Cone Beam Computed Tomography.

DB - Disto buccal

MB root - Mesio buccal root

MB2 - Mesio buccal second canal.

P - Palatal

IX

LIST OF TABLES

TABLE NO. LEGENDS PAGE NO.

1. Incidence of MB2 canal configuration 20

2. Percentage of incidence of MB2 canal in maxillary

first molar

22

3. Configuration of the root canal(s) of mesiobuccal

roots of maxillary first molars according to Weine’s

classification by different investigators.

26

X

LIST OF FIGURES

Fig No. Figures Page No.

1. Armamentarium used for the study. 41

2. MB2 canal orifices instrumented with 10 no K File 41

3. The templates 42

4. CBCT 3D images 42

5. CBCT 3D images according to Weine’s classification 43

6. Location of MB2 canal 43

7. Other aids to detect of additional canals. 44

8. Axial, Coronal and Sagittal CBCT images 44

LIST OF GRAPHS

GRAPH

NO.

GRAPHS PAGE NO.

1. Incidence of MB2 canal configuration 20-21

I

ABSTRACT

Aim: To evaluate the root canal morphology of mesiobuccal root of maxillary

permanent first molar having mesiobuccal second root canal(MB2) using CBCT

and To categorise the root canal configuration of mesiobuccal root of maxillary

first molar having MB2 root canal as per Frankline S Weine’s classification.

Materials and Methods: 75 samples having MB2 canal were selected for the

study. Samples were embeded in a square shaped templet made up of wax

measuring 5X5 cm. Each templet has 3 samples embeded in it,with crowns

exposed. There were 25 templetes in total with 3 teeth embeded in each. The

templetes were identified with letters A-Y and samples identified by letters A1-

A3,B1-B3….Y1-Y3 respectively. All the templetes embeded with teeth were

subjected to 3D imaging by CBCT. Images of axial, coronal and sagittal sections

were taken of mesiobuccal roots. Categorisation of root canal configuration of MB

root was done according to Weine’s classification after obtaining 3D CBCT

images.

Results: The canal configuration observed for Type I is 0.8%, Type II 48% ,Type

III 37% and for Type IV 0.6%.

Conclusion: Categorising the root canal morphology of mesiobuccal root as per

Weine’s classification by using CBCT sensitize the operator about the location,

morphology and possible complications related to MB2 canal. Canal configuration of

Type II is 48% was maximum and Type IV 0.6% was least.

Key words: MB2 Canal; Maxillary first molar; CBCT; Canal configuration.

Introduction

Page 1

INTRODUCTION

Complete debridement, disinfection, and obturation of the root canal system

are essential to increase the favorable outcome of root canal treatments. A thorough

knowledge of tooth morphology, careful interpretation of radiographs, proper access

preparation and detailed exploration of the pulp chamber of the tooth are essential for

successful outcome of root canal treatment. The identification and access to pulp

cavity is a tedious task in treatment of teeth with atypical canal configurations, one of

them being maxillary molar. The principle etiology of failure of endodontic treatment

while treating maxillary molar is inability to complete debridement of infected pulp

tissue. This occurs due to following incompetence of the clinician to detect additional

root canals.1 Therefore, clinicians should be aware of common root canal

configurations and possible anatomic variations.2

Each human tooth has its unique root anatomy and has been studied in details.

For example, mesiobuccal root of maxillary 1st molar has been reported to have two

distinct canals. The first molar is the earliest permanent tooth to appear in the oral

cavity exposing it for decay and in need of endodontic treatment3,4

.

Maxillary first molar is largest in volume and most complex in root and root canal

anatomy, and possibly the most treated least understood posterior teeth, and

unquestionably one of the most important teeth. The mesiobuccal root of the first

molar has generated more research, clinical investigation, and pure frustration than

has probably any other root in the mouth.5

The incidence of having two canals in the

mesial root of the maxillary first molar has been well established by several authors

using different approaches, such as radiographs, decalcification, sectioning,

ultrasonics, loups and dental operating microscope ect.The mesiobuccal root of the

Introduction

Page 2

first maxillary molar can be challenging due to the high incidence of two MB

canals.6,7

Anatomical structures such as isthmuses and accessory canals also add to

failures of the endodontic treatment, as they can act as reservoirs of bacteria

and

necrotic pulp tissues.8According to Weller et al. an isthmus is defined as a narrow

ribbon-shaped communication between two root canals containing pulp

tissue. The

incidence of isthmuses in mesiobuccal roots of maxillary first molars ranges from 5 to

53%, higher at 3-5 mm from the apex.

9

Ingle lists the most frequent cause of endodontic failure as apical percolation

and subsequent diffusion stasis into the canal. Until, an article written by Weine et al

in 1969, virtually all dentists believed presence of only one canal in the mesiobuccal

root of maxillary molars10,11

. Since that article, many papers have been published

regarding the types of canal systems present in the maxillary 1st molar

12,13. The

maxillary first molar always has four canals, the access cavity has a rhomboid shape,

with the corners corresponding to the four orifices (MB-1, MB-2, DB ,and

P).Mesiobuccal canal is the narrowest of the three canals, flattened in mesiodistal

direction at cervix but becomes round as it reaches apically14,15

. Sometimes isthmus is

present between mesiobuccal canals, it should be cleaned properly for success of the

treatment .Mesiobuccal canals show curvature sometimes which is not visible

radiographically16

.So, care should be taken while doing endodontic therapy. Several

methods have been presented to locate the MB2 canal. Foremost was a modification

of the access preparation to a rhomboidal shape for maxillary molars as compared to

the classical triangular outline17,18.

The MB2 orifice openings are usually found mesial to an imaginary line

between the MB1 and palatal orifices, and commonly, about 2-3 mm palatal to the

Introduction

Page 3

MB1 orifice19

.To categorize the canal system in each root, Weine described four

different types of configurations as follows: type I, single canal from the pulp

chamber to apex; type II, two canals leaving the chamber, but merging short of the

apex to form a single canal; type III, two separate canals leaving the chamber and

exiting the root in separate foramina; and type IV, one canal leaving the chamber, but

dividing short of the apex into two separate and distinct canals with separate

foramina.20,21

A literature review has demonstrated wide variation in the prevalence of the

MB2 canal. Hess, in a classical study, reported finding of four canals in 54% of the

maxillary first molar.Weine et al evaluated maxillary first molars and located four

canals in 62% of the cases.22

Bjorndal and Skidmore (1983) affirmed that the

difficulty in locating the mesiolingual canal during the root canal treatment may have

effect on the long-term prognosis.Neaverth et al (1987) studied roots of 228 maxillary

first molars. During endodontic therapy, their canal configuration was categorized23.

Mesiobuccal roots in 77.2% cases were judged as having two canals. Hence, they

suggested that more attention should be directed toward search of second canal in the

mesiobuccal root of maxillary first molar8.

In the past, dentists were dependent on conventional radiography, studying the

dentin map assessing tooth morphology and other relatively unpredictable techniques

to for clear understanding of canal anatomy and morphology. Many of these

techniques have been hallmarks of endodontic treatment and have helped successful

outcomes. The evolution of computerized tomography in the recent past has however

made it possible for dentists to use enhanced radiology techniques for identifying

canal anatomy and morphology24

. While computerized tomography has been available

for sometime, these techniques expose the patient to a significant amount of radiation.

Introduction

Page 4

The advent of Cone Beam Computed Tomography has significantly reduced radiation

and affordable CT in many dental institutions and practices. Cone Beam computerized

Tomography obtains a cone based volume of data which can be analyzed using

appropriate software 3-dimensionally in the axial, saggital and coronal planes.25,26

The images can be assessed using a software viewer at a reasonable degree of

resolution. This enables pre-endodontic access assessment of canal anatomy and

morphology giving the dentist accurate information to help him explore the pulp

chamber and identify all canals. This kind of information reduces the risk of canal

perforation, missed canal anatomy or morphology and greatly improves the chances

for endodontic success27,28

. CBCT scanning has observed to be more accurate than

digital radiographs in determining root canal morphology. CBCT scanning can also be

used in vivo in diagnosis and preoperative assessments29,30

.

Morphologic variation in human teeth is quite common. The incidence of

MB2 canal is more predictable and every effort should be done to locate, clean and

fill the MB2 canals to avoid the possible complications.

Objectives

Page 5

AIM AND OBJECTIVES

AIM; To categorise the root canal configuration of mesiobuccal root of maxillary

first molar having MB2 root canal as per Frankline S Weine’s classification.

OBJECTIVE; To evaluate the root canal morphology of mesiobuccal root of

maxillary permanent first molar having mesiobuccal second root canal (MB2)

using CBCT.

Review Of Literature

Page 6

REVIEW OF LITERATURE

Emmanuel Nogueira Leal Silva et al. (2014)1

conducted an in Vivo Study on

Evaluation of root canal configuration of maxillary molars in a Brazilian population

using cone-beam computed tomographic imaging. Patients referred for a CBCT

radiographic examination for accurate diagnosis and treatment planning were enrolled

in the study. A total of 620 healthy, untreated, fully developed maxillary first and

second molars were included (314 first molars and 306 second molars).The following

observations were recorded: (1) number of roots and their morphology, (2) number of

canals per root, (3) fused roots, and (4) primary variations in the morphology of the

root canal systems. They concluded that Mesiobuccal roots of maxillary molar teeth

had more variation in their canal system than the distobuccal or palatal roots. The root

canal configuration of the maxillary second molars was more variable than the first

molars in a Brazilian population. CBCT imaging is a clinically useful tool for

endodontic diagnosis and treatment planning.

Benjam Brise Marroqu et al. (2015)2 conducted an Ex Vivo Study to evaluate root

canal morphology and configuration of 179 maxillary first molars by means of micro–

computed tomography. The root canal configuration, foramina, and accessory canal

frequency of 179 maxillary first molars were investigated by means of micro–

computed tomographic imaging and 3-dimensional software imaging. The root canal

configuration and main foramina number are described from coronal to apical with a

4-digit system. They concluded that The root canal configuration of maxillary first

molars is quite diversified.


Page 7

Bestoon M. Faraj et al. (2012)3 conducted an Ex Vivo Study to evaluate the

Incidence of Two Root Canals in the Mesial Root of the Extracted Permanent

Maxillary First Molars Among a Sulaimani-Iraq Population. The aim of this study

was to assess the incidence of two root canals in the mesial root of the extracted

permanent maxillary first molars of a Sulaimani population. An ex vivo study on 180

extracted permanent maxillary first molars was conducted. The teeth were examined

clinically and radiographically. The results showed that 23.3 % of the examined teeth

had two canals in the mesial root (17.0 % with one apical foramen and 6.3 % with two

separate foramens.

Gary Hartwell et al. (2007)4

an in vivo study to evaluate the incidence of four canals in

maxillary first molars .The authors conducted an in vivo study to report the incidence

of fourth root canals located and treated in maxillary first molars during a seven-

month period in a postgraduate endodontic program. In this retrospective study, the

authors determined the number of canals treated by postgraduate students in an

endodontic program. The attending postgraduate endodontic faculty member

supervising the case verified the number of canals in the teeth. The authors then

collected the data from each resident and compiled them. The residents treated a total

of 121 maxillary molars, 85% of which met the criterion of having four or more

canals treated .Approximately 99 %of the fourth canals were located in the

mesiobuccal root.

Chadi Torby et al.(2016)5

an case report was presented on Use of CBCT in the

Detection of Second Mesiobuccal (MB2) Canal in Maxillary First Molar. Multiple

procedures were used to detect the presence of second mesiobuccal canal in the


Page 8

mesial root of the upper first molar. In this article, a case was presented in order to

show the use of cone-beam computed tomography (CBCT) in the detection of a

second mesiobuccal (MB2) canal in maxillary first molar, unidentified neither

clinically nor with conventional radiographic methods. The results concluded that Cone

beam computed tomography is a useful addition to the endodontist’s armamentarium

for identifying the number of root canals or the missed ones. Compared to standard

radiographic techniques, it has higher mean values of specificity and sensitivity due to

the ability to manipulate the cuts in different plans providing by that a better way to

examine root canal anatomy in fine details.

Carina Maria Lara et al. (2015)6 conducted an ex vivo study to evaluate

Morphology of Mesiobuccal Root Canals of Maxillary First Molars, a comparison of

CBCT scanning and Cross-sectioning. The aim of this study was to evaluate the

mesiobuccal root of maxillary first molars, according to the root canal configuration,

prevalence and location of isthmuses at 3 and 6 mm from the apex, comparing cone-

beam computed tomography (CBCT) analysis and cross sectioning of roots by thirds.

Images of the mesiobuccal root of 100 maxillary first molars were acquired by CBCT

and then roots were cross-sectioned into two parts, starting at 3 mm from the apex.

Data were recorded and analyzed according to Weine’s classification for root canal

configuration, and Hsu and Kim’s classification for isthmuses. In the analysis of

CBCT images, 8 root canals were classified as type I, 57 as type II, 35 as type III. In

the cross-sectioning technique, 19 root canals were classified as type I, 60 as type II,

20 as type III and 1 as type IV.


Page 9

Neeraj Surathu et al. (2015)7 conducted an in vivo study to evaluate and determine

the incidence of variation in canal anatomy of maxillary posterior teeth in patients in

Chennai using non invasive Cone Beam Computerized Tomography. In the present

study, 36 numbers of patients with a total of 60 maxillary first molars were assessed.

CBCT's of these patients obtained for other reasons were sourced and a software

viewer was used to analyze and record variations in maxillary first molar anatomy.

Multiple variations in root morphology, canal numbers and configurations were

identified and statistically assessed. The results from this study indicate that 86.6 % of

maxillary first molars have at least an extra canal, most commonly in the mesiobuccal

root. The Type II and Type III configurations (Vertucci's classification) were

observed in 3.3 and 40 % of teeth respectively. The results suggests that there is a

high incidence of variation in canal anatomy and morphology in maxillary first molars

and emphasize the use of CBCT in endodontic diagnosis in order to achieve better

treatment outcomes.

Sanjyot Mulay et al. (2016)8 conducted an in vivo study to evaluate the Accuracy of

Various Diagnostic Aids in Detection of MB2 Canal in Maxillary First Molar. One

hundred males and females patients in age group of 20 to 45 years with maxillary first

molar teeth indicated for root canal treatment were selected for the study. The

presence of MB2 canal in maxillary first molar was observed by four independent

observers using radiographic, visual, dye, magnification diagnostic aids.The results

were concluded that the incidence of MB2 canal in mesiobuccal roots of permanent

maxillary first molars was detected most using magnification method, i.e., 87%.

Accuracy of radiographic method was found to be least, i.e., 19%.


Page 10

Bestoon Mohammed Faraj et al.9

(2014) conducted an in vitro study on the

Sulaimani population to check Prevalence of MB2 canal in maxillary first molars. The

aim of this study was to investigate the prevalence of Mesiobuccal canal number two

(MB2 canal) in the extracted permanent maxillary first molars of a Sulaimani

population. An ex vivo study on 180 extracted permanent maxillary first molars was

conducted and the floor of the pulp was clearly exposed. The canal orifice was

examined clinically by the aid of a chelating agent and magnifying lens. Patency of

each canal was established by a no.10 k-type file. The results showed that 23.3% of

the examined teeth had two canals in the mesial root (17.0% with one apical foramen

and 6.3% with two separate foramens). The occurrence of MB2 canals of the

permanent maxillary first molar of a Sulaimani population were within the normal

range.

Prasanna Neelakantan et al. (2010)10

conducted an in vitro study to evaluate Cone-

Beam Computed Tomography Study of Root and Canal Morphology of Maxillary

First and Second Molars in an Indian Population. Maxillary first (n = 220) and second

(n = 205) molars were collected from an indigenous Indian population and scanned by

using a CBCT scanner at a constant slice thickness of 125 mm/slice. Volume

rendering and multiplanar volume reconstruction were performed. The number of root

canals was examined, and root canal system configurations were classified by using

historical and contemporary classifications. The results concluded that the root

number, morphology, and canal morphology of Indian maxillary molars showed

features that were different from both Caucasian and Mongoloid traits. CBCT is an

exciting and clinically useful tool in studying root canal morphology.


Page 11

Franklin S. Weine et al.(1969)11

conducted an in vitro study to evaluate Canal

configuration in the mesiobuccal root of the maxillary first molar and its endodontic

significance. The mesiobuccal roots of 208 extracted maxillary first molars were

sectioned from a mesial approach in a buccolingual direction, using a coarse

sandpaper disk. The root canal or canals were exposed, when possible, from the roof

of the pulp chamber to the apex, and the typical configurations were classified and

tabulated. The results concluded the frequency of occurrence of the bifurcated or

double canal must be taken into consideration when surgical treatment is planned and

as a possible cause of otherwise unexplained failure.

Pardo et al. (2012)12

conducted an in vitro study to evaluate CBCT and microscopic

analysis of the incidence of second mesiobuccal canal of maxillary molars. The aim of

this study was to determine the incidence of second mesiobuccal (2MB) canal in

mesiobuccal roots of maxillary molars,comparing the efficacy of three methods for

their identification:Cone beam computed tomography (CBCT), clinical analysis and

operating microscope. The existence of the second mesiobuccal (2MB) canal was

evaluated by two examiners in 42 first and second molars without pulp involvement.

The teeth were subsequently evaluated by the three methods and later these

mesiobuccal roots were sectioned at 3 and 7 mm from the apex in the axial plane and

observed with a digital microscope. Results revealed the real presence of 10, 2MB

canals (23.81%).The results concluded that none of the three methods made possible

the determination of the 2MB canal in all cases, however CBCT showed the better

results.


Page 12

Mustafa Altunsoy et al. (2015)13

conducted an in vivo study to evaluate Root canal

morphology analysis of maxillary permanent first and second molars in a southeastern

Turkish population using cone-beam computed tomography. The aim of this

retrospective study was to determine the root and canal morphology of the maxillary

first and second molars in a Turkish subpopulation using cone-beam computed

tomography (CBCT). Results concluded that in both first and second maxillary

molars, the presence of three roots was the most common occurrence. The prevalence

of additional canals (type II, III, or greater) in mesiobuccal roots of maxillary first and

second molars was approximately 62% and 37.5%, respectively. Type I canal

configuration was the most prevalent in the distobuccal (99.6%) and palatal (99.8%)

roots of maxillary first molars, and in the distobuccal (99.7%) and palatal (99.2%)

roots of maxillary second molars.

Yu Hua Lin et al. (2017)14

conducted an in vitro study to evaluate the root and canal

systems of maxillary molars in Taiwanese patients. A cone beam computed

tomography study. The root canal systems of 114 Taiwanese patients with bilateral

maxillary first or second molars were examined using CBCT images. The number of

roots, canals per root, and additional mesiobuccal (MB) canals, as well as the canal

configuration were enumerated and recorded. Of the 196 maxillary first molars

examined, three (1.5%) had a single root, two (1.0%) had two roots, and 191 (97.5%)

had three separate roots. Out of all first molar roots examined, 44% of mesiobuccal

(MB) roots had a single canal and the remainder had a second MB (MB2) canal.

These findings demonstrate CBCT as a useful clinical tool for endodontic diagnosis

and treatment planning.


Page 13

Oleg Mordanov et al. (2019)15

conducted an in vivo study to evaluate Second

Mesiobuccal Canal Evaluation Features with Cone-Beam Computed Tomography.

The aim of the study was to evaluate the difference in MB2 prevalence with different

slice thicknesses in maxillary first molars. Two hundred non filled MB2 canals in

maxillary first molars of 156 people (75 females and 81 males) aged from 20 to 73

years old were evaluated with CBCT with different slice thicknesses: 0.5 mm, 1 mm,

3 mm, and 10 mm. A general analysis was performed out, as well as in the age groups

and on gender groups. Visualization with 0.5mm and 1mm slice thicknesses was

100% and generally equal, in both the male and the female group. General MB2

visualization with 3mm slice thickness was 42% and 29% for the male group and 27%

for the female group. No canals were visualized with 10mm slice thickness. The

results concluded that the most valuable way to evaluate the root canal system in first

maxillary molars with CBCT is using 1mm slice thickness for both genders and every

age group.

Sushmita et al.(2016)16

conducted an in vivo study to investigate the presence of

second mesiobuccal canals in first maxillary molar and to correlate findings with

patients gender and age. In the clinical situation the conventional radiographs were

used at various stages of root canal treatment. Results concluded that an awareness

and understanding of this root canal morphology can contribute to the successful

outcome of treatment. The prevalence of MB2 canal decreases as age increases and

not much association with gender of the patient was observed.

Pablo Betancourt et al. (2017)17

conducted an in vitro study to evaluate CBCT

technique for location of the MB2 canal of maxillary first molar. 60 maxillary first


Page 14

molars were analysed. To detect the MB2 canal, the observation and measurements

were done 1 mm apically to the pulpal floor to standardize the methodology. The

results concluded that the MB2 canal was identified in 68.3% of cases. The MB2

canal was found in a high percentage in the maxillary first molar. When present,it is

advisable to take the main mesiobuccal canal as a parameter and explore some

millimeters mesially and palatally to display it. CBCT is a good diagnostic tool for its

detection and exploration.

Aysun Kara Tuncera et al. (2010)18

conducted an in vitro study to evaluate the

Location and Accessibility of the Second Mesiobuccal Canal in Maxillary First

Molar. The purpose of this study was to examine the location and accessibility of the

second mesibuccal canal in maxillary first molar of a Turkish sub-population.

Presence and accessibility of the MB2 canal in 110 extracted maxillary first molars

was examined with unaided vision, dental loups and the DOM. To characterize the

geometrical location of MB2 canals, photographs of pulp chambers were obtained.

The Results concluded that with the unaided vision, 58 MB2 canal orifices and after

evaluation with the dental loup, DOM an additional 28 MB2 canal orifices were

detected. In 65 molars, the MB2 canal orifices was located 0.87 mm distally and 1.73

mm palatally to the main mesiobuccal canal and in the remaining 21 molars was 0.72

mm mesially and 1.86 mm palatally.

Vasudev SK et al. (2003)19

conducted an in vivo study on Endodontic Miscellany

Negotiation and management of MB2 canal in maxillary second molar. Failure to find

and to fill a canal influences the prognosis of endodontic treatment. The frequency of

second canal in mesiobuccal root of maxillary second molar is quite high, so time


Page 15

should be devoted in its location and treatment. The present article describes the

possible location of these canals and various methods proposed to help in locating the

fourth canal. It is almost axiomatic to accept the fact that the root system of the

mesiobuccal root of maxillary molars frequently has a root canal system containing

more than one canal. This fact should lead to an awareness that has to be reflected in

our routine practice of clinical endodontics.

Heeresh Shetty et al. (2017)20

conducted an in vivo study to evaluate A Cone Beam

Computed Tomography (CBCT) evaluation of MB2 canals in endodontically treated

permanent maxillary molars. A retrospective study of 100 CBCTs of patients were

underwent scanning for various treatment modalities, with asymptomatic

endodontically treated permanent first and second maxillary molars were selected.

Axial and paraxial images obtained were used to assess the presence of MB2 canal.

Paraxial images were used to assess the periapical status. The incidence of MB2 canal

was 86.36% in maxillary first molars and 29.4% in maxillary second molars. 77.19 %

of maxillary first molars and 90% of maxillary second molars had an unfilled MB2

canal. 72.7% of maxillary first molars and 88.8% of maxillary second molars showed

significant periapical radiolucencies in unfilled MB2 canals. So Conclusion was MB2

canals were present in majority of cases and most of the unfilled MB2 canals showed

evidence of periapical radiolucencies.

Atool Chandra Bhuyan et al. (2014)21

conducted an in vitro study to evaluate the

Root canal configuration of permanent maxillary first molar in Khasi population of

Meghalaya. Sixty (60) permanent maxillary first molars collected from patients of

Khasi population of Meghalaya were studied using canal staining and clearing


Page 16

technique. Observations of the number of roots, root canal configuration, lateral canal,

apical delta, and presence of the additional type of canals were made. Results

concluded that In Khasi population of Meghalaya, the most prevalent root canal

configuration in the mesiobuccal root is Type IV followed by Type I and Type II.

MB2 canals are present in more than 65% cases. In palatal and distobuccal roots,

Type I configuration is present in most cases. Racial divergence may be responsible

for such variations.

Rohan Gupta et al.(2017)22

conducted an in vitro study by Efficacy of cone beam

computed tomography in the detection of MB2 canals in the mesiobuccal roots of

maxillary first molars. Numerous researches have been done on the permanent

maxillary first molars for the presence of an extra canal, especially the mesiobuccal

roots for the presence of MB2 canals. Cone beam computed tomography (CBCT) has

been used recently in the detection of these canals. Selected sixty extracted maxillary

first molars were placed in the skull base, and CBCT scans were done for evaluating

the presence of MB2 canals in the mesiobuccal root. Sectioning of the roots at 3, 5,

and 7 mm from the tip was performed and further examined under the microscope for

the presence of the MB2 canals. Evaluations were done by two evaluators

independently. CBCT was found to be a reliable tool for the detection of MB2 canal

in maxillary first molar teeth when compared to gold standard sectioning technique.

Quing et al. (2010)23

conducted an in vitro study to evaluate root and canal

morphology of permanent maxillary first molars in a Chinese population using

cone-beam computed tomography scanning. The study included 775 cone-beam

computed tomography images of maxillary first molars; 627 of the subjects had

unilateral qualifying molars and 74 had bilateral qualifying molars. The following


Page 17

observations were made: (1) frequency of root and canal numbers, (2) frequency of

additional canals in the mesiobuccal root by sex, age, and tooth position, and (3)

unilateral and bilateral occurrence of additional canals in the mesiobuccal root.

They concluded that Cone-beam computed tomography scanning is an effective

method for studying external and internal dental morphology. These data may

facilitate successful endodontic treatment.

Buhrley LJ et al. (2002)24

conducted an in vivo study to determine the Effect of

magnification on locating the MB2 canal in maxillary molars. The purpose of this

study was to determine if the surgical operating microscope and/or dental loupes

could enhance the practitioner's ability to locate the second mesiobuccal canal (MB2)

canal of maxillary molars in an in vivo, clinical setting. The participating endodontists

documented 312 cases of root canal therapy on maxillary first and second molars.

Participants that used the microscope or dental loupes located the MB2 canal with a

frequency of 57.4% and 55.3%, respectively. Those using no magnification located

the MB2 canal with a frequency of 18.2%.

Sultan Al‑Shehri et al. (2017)25

conducted an in vivo study by to evaluate Root and

canal configuration of the maxillary first molar in a Saudi sub population. A cone-

beam computed tomography Study. A total of 351 CBCT images of the maxillary first

molars of 207 Saudi patients wereexamined. The number of root canals, root canal

configuration (Vertucci’s classification), and prevalence of fusion were

investigated.The results concluded that the majority had three roots and four canals.

The additional fourth canal was located in the MBR, and Type IV was the most


Page 18

prevalent. CBCT is an appropriate imaging modality that helps assess complex root

canal morphology of human teeth.

Thomas Gerhard Wolf et al. (2016)26

conducted an in vitro study by Root Canal

Morphology and Configuration of 118 Mandibular First Molars by Means of Micro–

Computed Tomography. The root canal configuration, foramina, and accessory canals

frequency of 118 mandibular first molars were investigated by means of micro–

computed tomography and 3-dimensional software imaging. A 4-digit system

describes the root canal configuration from the coronal to apical thirds and the main

foramina number. The results concluded that the root canal configuration of

mandibular first molars varies strongly. According to our expectations, both the

mesial and distal roots showed a high number of morphologic diversifications. The

root canal system of the mesial root showed more root canal configuration variations,

connecting and accessory canals than the distal root.

R.Zhang et al. (2011)27

conducted an in vivo study to identify the morphology of

maxillary permanent molar teeth in a Chinese subpopulation by using CBCT. Overall,

299 maxillary first and 210 maxillary second molar teeth were examined in vivo by

CBCT. The number of roots, the number of canals per root, the canal configuration

and the presence of additional mesiobuccal canals were recorded. The results

concluded that mesiobucccal roots of maxillary molar teeth had more variation in

their canal system than the distobuccal or palatal roots. The root canal configuration

of the maxillary second molars was more variable than that of the first molars. CBCT

can enhance detection and mapping of the mesiobuccal root-canal system with the

potential to improve the quality of root canal treatment.


Page 19

Mothanna Alrahabi et al. (2018)28

conducted an in vitro study to evaluate

Evaluation of root canal morphology of maxillary molars using cone beam computed

tomography. The objective of this study was to analyze root canals morphology and

existence of extra canals in maxillary molars in Saudi subpopulation. Freshly

extracted maxillary first molars (n=100) were included in this study. All teeth were

examined for morphology of roots, root canals and apical foramen by Cone Beam

Computed Tomography (CBCT). The root canals configuration was classified using

Vertucci’s classification. The results concluded that the occurrence of second canal in

the mesiobuccal root of upper first molar is >70%. The mesiobuccal roots are more

likely to have Vertucci’s type I or II configuration (>76%).

Claudia Rezende Gomes Alves et al. (2018)29

conducted an in vivo study to evaluate

Second Mesiobuccal Root Canal of Maxillary First Molars in a Brazilian Population

in High-Resolution Cone-Beam Computed Tomography. Three radiologists examined

414 high-resolution CBCTs. Of these, the CBCTs of 287 patients who had at least one

maxillary first molar were selected, making a total of 362 teeth. Prevalence and its

relation with gender and age of the patients, side of the tooth, and Vertucci’s

classification were analyzed. It was concluded that the prevalence of the MB2 canal in

maxillary first molars in this Brazilian population examined with high-resolution

CBTCs is 68.23%, being more prevalent in young patients. Gender and the side

examined are no factors for determining the presence of MB2.

Meraj Fallah Abed et al. (2013)30

conducted an in vivo study on Usage of Cone-

Beam Computed Tomography (CBCT) to Evaluate Root and Canal Morphology of

maxillary First Molar. Frequency identify of root and canal morphology of the first


Page 20

maxilla molars by Vertucci & Weine classification method by Cone-Beam Computed

Tomography (CBCT). Number of 522 CBCT were evaluated that number of 200

CBCT (119 of the first maxillary molar) had the experimental conditions and the

others were eliminated due to lack of condition. The results concluded that the

frequency of three and two roots of first molar was 94.1% and 5.9%, respectively.

Type of mesiobuccal three roots of first molar in Vertucci classification were Type I,

Type II and Type V with 27.7%, 31.3% and 34.8% frequency respectively. One and

two canals were observed in the mesiobuccal roots in high frequency.

Methodology

Page 21

METHODOLOGY

The present Study was conducted in Department of Conservative dentistry and

Endodontics, Maratha Mandal`s Dental College and research centre Belgaum.

SOURCE OF DATA:

1) Type of Study : An in vitro study

Source: The study was conducted in Department of Conservative Dentistry and

Endodontics, MMNGH Institute of Dental Sciences and Research centre,

Belagavi, using 75 extracted human permanent maxillary first molars, collected

from the department of oral and maxillofacial surgery.

METHOD OF COLLECTION OF DATA:

Maxillary first permanent molars with fully developed and mature root apices

Exclusion criteria.

1) Root fracture.

2) Root canal treated teeth

3) Root resorption

4) Radicular caries

5) Open apices

6) Calcification

Methodology

Page 22

Inclusion criteria:

Materials and armamentarium used are (Fig 1);

75 extracted teeth.(Maxillary first molars)

3% Sodium hypochlorite.

Hydrogen peroxide.

Hand piece.

Round carbide bur.

Endo Z bur no.3

16 DG explorer.

Air rotor.

Disposable syringes.

Ultrasonic scaler tips.

No 10 K File.

Normal saline

METHODOLOGY

Permanent maxillary first molars with matured root apices were selected for this

research. The collected teeth were cleaned with ultrasonic scaler to remove the

surface debris and stored in hydrogen peroxide for one hour.

Access opening of the collected samples were done with endo access bur

(Endo Z bur). Roof of the pulp chamber was completely removed and pulp chamber

was irrigated with 3% sodium hypochlorite for 60 seconds followed by normal saline.

MB2 canal orifices were located with DG 16 explorer and instrumented with no 10 K

file to check the patency (Fig 2).

Methodology

Page 23

75 samples having MB2 canal were selected for the study. Samples were embeded in

a square shaped template made up of wax measuring 5X5 cm. Each template will had

3 samples embeded in it, with crowns exposed.There were 25 templates in total with 3

teeth embeded in each.The templates were identified with letters A-Y and samples

identified by letters A1-A3,B1-B3….Y1-Y3 respectively(Fig 3).

All the templates embeded with teeth were subjected to 3D imaging by

CBCT(CARESTREAM 9300 MACHINE) at 90m slice thickness with tube voltage

70kv, tube current of 80 mA,and exposure time of 14 seconds. Images of axial,

coronal and sagittal sections were taken of mesiobuccal roots (Fig 4).

Categorisation of root canal configuration of MB root was done according to

Weine’s classification after obtaining 3D CBCT images (Fig 5).

Wiene’s classification of root canal configuration is as follows.

TYPE I-Single canal from pulp to apex.

TYPE II-Two canals leaving from the chamber and merging to form a single canal

short of the apex.

TYPE III-Two separate and distinct canals from chamber to apex.

TYPE IV-One canal leaving the chamber and dividing into two separate and distinct

canals.

Methodology

Page 24

Results obtained were subjected to statistical analysis using Chi square test to

check frequency and percentage of MB2 canal configuration of maxillary first molar

and conclusion was drawn based on results.

This study was intended to evaluate root morphology and canal configuration

of MB root of maxillary first molar by means of CBCT.The MB root of maxillary first

molar were subjected to CBCT analysis.The root canal configuration were

catogarized as per Weine’s classification.This would be helpful for the clinicians for

complete understanding the morphology of maxillary first molar and overcome the

complications related to it.

Sample size estimation

Page 25

SAMPLE SIZE OF ESTIMATION

Sample size;

The following formula was used for sample size calculation.

Formula; n= Z2pq

d2

p- Percentage

z- Confidence level

d- Precision(error)

q- Frequency

75 samples having MB2 canal were selected for the study. Samples were

embeded in a square shaped template made up of wax measuring 5X5 cm. All the

templates embeded with teeth were subjected to 3D imaging by CBCT. Categorisation

of root canal configuration of MB root was done according to Weine’s classification

after obtaining 3D CBCT images.

Results

Page 26

RESULTS

Table: Incidence of MB2 canal configuration in study samples

MB 2 canal configuration No of samples % of samples

Type I 6 8.00

Type II 36 48.00

Type III 28 37.33

Type IV 5 6.67

Total 75 100.00

Results

Page 27

Graph; Incidence of MB2 canal configuration in study samples

Graph; Incidence of MB2 canal configuration in study samples

Type I

8.00%

Type II

48.00% Type III

37.33%

Type IV

6.67%

8.00

48.00

37.33

6.67

0.0

10.0

20.0

30.0

40.0

50.0

Type I Type II Type III Type IV

Per

cen

tage

Discussion

Page 28

DISCUSSION

Each human tooth has its unique root canal anatomy and has been studied

in details. For example, mesiobuccal root of maxillary 1st molar has been reported to

have two distinct canals. The first molar is the earliest permanent tooth to appear in

the oral cavity exposing it for decay and in need of endodontic treatment1.

Anatomy, Location and Importance of MB2.

The maxillary first molar always has four canals, the access cavity has a

rhomboid shape, with the corners corresponding to the four orifices (MB-1, MB-2,

DB ,and P).Mesiobuccal canal is the narrowest of the three canals, flattened in

mesiodistal direction at cervix but becomes round as it reaches apically. Sometimes

isthmus is present between mesiobuccal canals, it should be cleaned properly for

success of the treatment .Mesiobuccal canals show curvature sometimes which is not

visible radiographically. So, care should be taken while doing endodontic therapy2,3

.

Three dimensional visualization of root canal system is the key for efficient cleaning,

shaping and achieving predictable success in root canal treatment.The root canal

treatment failure in maxillary first molar is often due to presence of second canal in

mesiobuccal root, which may remain undetected. The incidence of two canals in the

mesial root of the maxillary first molar has been well established by several authors,

Weine observed 37.5%, Pineda 13%, Vertucci 37%11

.Percentage of incidence of MB2

canal in maxillary first molar is given in table 1.

Discussion

Page 29

Investigators Sample size Methods Percentage

Weine et al 1969 208 Section 37.5%

Pineda &Kuttler 262 Radiograph 13%

Vertucci 100 Section 37%

Sultan Al-Shehri 300 Radiograph 56%

Dunya al-Bazzaz 180 Radiograph 58%

Neeraj Surathu 60 CBCT 86%

According to Pineda and Kuttler,study based on the incidence of MB2 canal it

was stated that presence of MB2 canal is a rule rather than exception.

Several methods have been presented to locate the MB2 canal. Foremost was a

modification of the access preparation to a rhomboidal shape for maxillary molars as

compared to the classical triangular outline. This provides better visibility and

accessibility. The MB2 orifice openings are usually found mesial to an imaginary line

between the MB1 and palatal orifices, and commonly, about 2-3 mm palatal to the

MB1 orifice.13

(Fig 6).

The effective way for exploration of MB2 canal clinically is to move mesially

from the mesiobuccal canal toward the palatal direction(Weine et al. 1969). The

orifice for the MB2 canal usually lies palatal to the mesiobuccal canal toward the

palatal canal.11

Discussion

Page 30

Methods of detection of additional canals.

It is important the clinician has a strong conviction that MB2 system is present in

all maxillary molars. In conjunction with dental operating microscope, a rhomboid

access,and the use of specific instruments, other aids can occasionally be used to

enhance the visualization of MB2 systems. They include the“champagne or bubble

test” with warmed 2.6%NaOCl, staining the chamber with 1%methylene blue, the use

of sharp explorers,looking for bleeding signs, and obliquely angled preoperative

radiograph19.

(Fig 7)

Role of CBCT in detecting additional canals.

The radiographic image produced is a two-dimensional (2D) representation of

a three-dimensional (3D) object. The interpretation of 2D “shadows” of 3D objects

such as complex anatomy, root canal morphology, and surrounding structures is

difficult and can contribute to nonhealing of endodontic cases. To overcome this

drawback, which may also be encountered in several fields of dentistry, 3D imaging

techniques have become essential. Cone-beam CT (CBCT)scanning has been used in

the field of endodontics since 1990.13

The use of CBCT images is an important clinical tool in diagnosis and

endodontic treatment. This test allows evaluating periapical lesions, internal and

external resorption, verifying the morphology of the root canal, evaluating fractures,

pre-surgical planning, and also verifying relationship with other important anatomical

structures. The ability to reduce or eliminate overlapping of adjacent structures makes

CBCT a superior technique compared to conventional periapical radiographs.14,15,16

Discussion

Page 31

The study done by Pablo Betancourt on CBCT technique for location of the

MB2 canal of maxillary first molar stated that unlike CT scans, CBCT has reduced

time and uses lower irradiation doses. Their field of view is limited, but the spatial

resolution is good in all planes.These devices give the dental surgeon high-quality 3D

diagnostic images of the maxillofacial region and from the acquired data as well. An

advantage of the CBCT is that the images can be studied by using different

representations (multiplanar reformation, 3-D surface rendering). They can be

rotated in any spatial plane without superposition of the anatomic structures.17

The aim of this study was to evaluate the root canal morphology of

mesiobuccal root of maxillary permanent first molar having mesiobuccal second root

canal(MB2) using CBCT and to categorise the root canal configuration of

mesiobuccal root of maxillary first molar having MB2 root canal as per Frankline S

Weine’s classification. In vitro investigations have been enforced because of their

superiority in comparison with the intrinsic limitations of in vivo investigations.

Nevertheless, both in vivo and in vitro research can provide significant information to

the clinician.18,19

75 samples having MB2 canal were selected for the study. Samples were

embeded in a square shaped template made up of wax measuring 5X5 cm. Each

template will had 3 samples embeded in it, with crowns exposed.There were 25

templates in total with 3 teeth embeded in each. All the templates embeded with teeth

were subjected to 3D imaging by CBCT(CARESTREAM 9300 MACHINE) at 90m

slice thickness with tube voltage 70kv, tube current of 80 mA,and exposure time of 14

seconds. Images of axial, coronal and sagittal sections were taken of mesiobuccal

roots.20,21,29

Discussion

Page 32

Categorisation of root canal configuration of MB root was done according to Weine’s

classification after obtaining 3D CBCT images.30

Wiene’s classification of root canal configuration is as follows.



short of the apex.


TYPE IV-One canal leaving the chamber and dividing into two separate and

distinct canals.

CBCT Images as per Weine’s classification (Fig 5 and Fig 8).

Results obtained were subjected to statistical analysis to check frequency and

percentage of MB2 canal configuration of maxillary first molar.

Discussion

Page 33

Frequency and percentage of MB2 canal configuration of maxillary first molar is

given in Table 2. Table 2: Incidence of MB2 canal configuration in study samples

MB 2 canal configuration No of samples % of samples .

Type I 6 8.00

Type II 36 48.00

Type III 28 37.33

Type IV 5 6.67

Total 75 100.00

In the present study the type II canal configuration is more, followed by type II,

and is less for type IV.

Discussion

Page 34

Configuration of the root canal(s) of mesiobuccal roots of maxillary first molars

according to Weine’s classification by different investigators.

In comparison to earlier studies done by Weine’s and Carina, the incidence of

Type I is 0.8%,significance increase in Type II 48% and Type III 37%,less for Type

IV 0.6%.So there is lots of difference in the studies. Hence further investigation are

required with large sample size.

Investigators Method Sample Size

Weine’s

Classification

1.Weine In 1969 Tooth Sectioning. 208

Type I- 48.5%.

Type II- 37.5%

Type III- 14%

Type IV -

2.Carina Maria Lyra

In 2015

CBCT 100

Type I 57%

Type II 35%

Type III -

Type IV -

Conclusion

Page 35

CONCLUSION

Within the limitations of this study, it can be concluded that Morphologic

variations in human teeth are quite common. The occurrence of second mesiobuccal

canal in the maxillary 1st molar root was > 70%.

Advanced technologies such as CBCT provides detailed 3D image of the root

canal which is helpful in understanding the morphology of root canal thoroughly.

Categorising the root canal morphology of mesiobuccal root as per Weine’s

classification by using CBCT sensitize the operator about the location, morphology

and possible complications related to MB2 canal.

The mesiobuccal roots were more likely to have Weines’s type II or type III

canal configuration. Every effort should be done to locate, clean and fill the MB2

canals to avoid the possible complications.

Summary

Page 36

SUMMARY

The purpose of this study was to to evaluate the root canal morphology of

mesiobuccal root of maxillary permanent first molar having mesiobuccal second root

canal(MB2) using CBCT and to categorise the root canal configuration of

mesiobuccal root of maxillary first molar having MB2 root canal as per Frankline S

Weine’s classification. 75 samples having MB2 canal were selected for the study.

Samples were embeded in a square shaped templet made up of wax measuring 5X5

cm. Each templet has 3 samples embeded in it, with crowns exposed.

There were 25 templetes in total with 3 teeth embeded in each. The templetes

were identified with letters A-Y and samples identified by letters A1-A3,B1

B3….Y1-Y3 respectively. All the templetes embeded with teeth were subjected to 3D

imaging by CBCT (CARESTREAM 9300 MACHINE) at 90m slice thickness with

tube voltage 70kv, tube current of 80 mA, and exposure of time14 seconds. Images of

axial, coronal and sagittal sections were taken of mesiobuccal roots. Categorisation of

root canal configuration of MB root was done according to Weine’s classification

after obtaining 3D CBCT images. Wiene’s classification of root canal configuration is

as follows.



short of the apex.


TYPE IV-One canal leaving the chamber and dividing into two separate and

distinct canals.

Summary

Page 37

The values collected were analysed using Chi-square test.

Results; In the present study the type II canal configuration for Type I is 0.8%,

significance increase in Type II 48% and Type III 37%,less for Type IV 0.6%. Within

the limitations of this study, it can be concluded that the use of CBCT is an important

diagnostic tool in endodontic treatment. The ability to reduce or eliminate overlapping

of adjacent structures makes CBCT a superior technique compared to conventional

periapical radiographs. The mesiobuccal roots were more likely to have Weines’s

type II or III canal configuration. very effort should be done to locate, clean and fill

the MB2 canals to avoid the possible complications.

Bibliography

Page 38

BIBLIOGRAPHY

1. Emmanuel Jo Nogueira Leal Silva,Yuri Nejaim. Evaluation of Root Canal

Configuration of Maxillary Molars in a Brazilian Population Using Cone-beam

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Extracted Permanent Maxillary First Molars Among a Sulaimani-Iraq

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CONSENT FORM

Page 43

DEPARTMENT OF CONSERVATIVE DENTISTRY

AND ENDODODONTICS

INFORMED CONSENT FORM

This informed consent form is for the subjects visiting the out-patient Department of

Conservative Dentistry and Endodontics at Maratha Mandal’s Nathajirao G.Halgekar

Institute of Dental Sciences and Research Center, Belagavi, Karnataka and who are willing

to participate in the research project entitled: “Evaluation of Root canal Morphology

And Configuration of Mesio buccal root of Maxillary First molar having Mesio

buccal second root canal by means of Cone-beam Computed Tomography-An in vitro

study”.

This Statement of Consent consists of two parts:

Information Sheet (to share information about unused samples with you)

Certificate of Consent (to record your agreement) You will be given a copy of the

full Statement of Consent

Date:

Name of principal Research guide: Dr. Hemant Vagarali

Name of principal investigator: Dr.Deepa Astekar

Name of the institution: Maratha Mandal’s Nathajirao G.Halgekar Institute

of Dental Sciences and Research Center, Belagavi, Karnataka.

CONSENT FORM

Page 44

Part I: Information sheet

Introduction:

I, Dr. Deepa Astekar, am a post graduate student in the Department of Conservative

Dentistry and Endodontics at Maratha Mandal’s Nathajirao G.Halgekar Institute of

Dental Sciences and Research Center, Belagavi, Karnataka. I am conducting a research

project titled: “Evaluation of Root canal Morphology And Configuration of Mesio

buccal root of Maxillary First molar having Mesio buccal second root canal by means

of Cone-beam Computed Tomography-An in vitro study.”

I request you to give me your permission to use the extracted tooth for the research work.

Purpose of the research: To evaluate the root canal morphology of mesiobuccal root of

maxillary permanent first molar having mesiobuccal second root canal(MB2) using CBCT

and To categorise the root canal configuration of mesiobuccal root of maxillary first molar

having MB2 root canal as per Frank line S Weine’s classification.

Type of research intervention:

In-vitro study on the extracted samples

Voluntary participation:

Your decision whether or not to allow us use the extracted teeth is voluntary. You are

entitled to refuse the use of sample for the research.

Reimbursements:

You are not waiving any legal claims, rights, or remedies because of your participation in

this research study.

Confidentiality:

Any information that is obtained in connection with this study and that can be identified

with you will remain confidential. Only I and members of the research staff will

CONSENT FORM

Page 45

have access to information about the research. At the conclusion of the study, the

interpretation will be reported as group results only. The outcome of the study will be

shared in research circles through scientific presentations /publications for the

purpose of advancement of knowledge.

If you are not able to understand any statements related to the consent and

research, you can ask questions about any part of the information provided above, if

you wish to. Adequate time will be taken to explain you the same.

Sincerely,

CONSENT FORM

Page 46

Part II. Certificate of Consent for organ/ sample storage

If any of the extracted teeth, I have provided for this research project is unused or leftover

when the project is completed (Tick one choice from each of the following boxes)

I wish my teeth samples to be destroyed immediately.

I want my teeth samples to be destroyed after years.

I give permission for teeth samples to be stored indefinitely

AND (if the sample is to be stored)

I give permission for my teeth samples to be stored and used in future research but only

on the same subject as the current research project: : “Evaluation of Root canal

Morphology And Configuration of Mesio buccal root of Maxillary First molar

having Mesio buccal second root canal by means of Cone-beam Computed

Tomography-An in vitro study.”

I give my permission for my teeth samples to be stored and used in future

research of any type which has been properly approved.

I give permission for my teeth samples to be stored and used in future research except for

research: “Evaluation of Root canal Morphology And Configuration of Mesio buccal

root of Maxillary First molar having Mesio buccal second root canal by means of

Cone-beam Computed Tomography-An in vitro study.”

AND

I want my identity to be removed from my teeth samples.

I want my identity to be kept with my teeth samples.

CONSENT FORM

Page 47

I have read the information, or it has been read to me. I have had the opportunity to

ask questions about it and my questions have been answered to my satisfaction. I

consent voluntarily to have my samples stored in the manner and for the purpose

indicated above.

Name of Participant:

Signature of Participant:

Date:

CONSENT FORM

Page 48

If illiterate,

I have witnessed the accurate reading of the consent form to the

potential participant, and the individual has had the opportunity to ask questions. I confirm

that the individual has given consent freely.

Thumb print of

Name of witness

Participant

Signature of witness

Date

Statement by the researcher/person taking consent: I have accurately read out the

information sheet to the potential participant, and to the best of my ability made sure that

the participant understands that the following will be done:

Use of the extracted teeth for the study titled: “Evaluation of Root canal Morphology

And Configuration of Mesio buccal root of Maxillary First molar having Mesio

buccal second root canal by means of Cone-beam Computed Tomography-An in

vitro study.”

I confirm that the participant was given an opportunity to ask questions about the nature

and manner of storage of the samples, and all the questions asked by the participant

have been answered correctly and to the best of my ability. I confirm that the

individual has not been coerced into giving consent, and the consent has been given

freely and voluntarily.

Ethical committee clearance letter

Page 49

Ethical committee clearance letter

Proforma prototype

Page 50

PROFORMA PROTOTYPE

CONSERVATIVE DENTISTRY AND ENDODONTICS

MARATHA MANDAL’s NATHAJIRAO G.HALGEKAR INSTITUE OF

DENTAL SCIENCES AND RESEARCH CENTRE, BELGAUM

STUDY SHEETS

Title: Evaluation of Root canal Morphology And Configuration of Mesio buccal root

of Maxillary First molar having Mesio buccal second root canal by means of Cone-

beam Computed Tomography-An in vitro study.

MB 2 canal configuration No of samples % of samples .

Type I

Type II

Type III

Type IV

Total

Master chart

Page 51

MASTER CHART

MB 2 canal

configuration

No of samples

% of samples .

Type I A2,B1,H1,J3,K2,Y1. 8.00

Type II

A1,B3,D1,D2,D3,E3,F1,F2,G3,H2,I1,I2,

J1,J2,L1,L2,M1,M2,N1,N3,O1,O2,P3,Q1,

Q2,R2,R3,S3,T1,T2,T3,U3,VI,V3,W1,W2,

48.00

Type III

A3,B2,C1,C3,E1,E2,F3,G1,G2,I3,K1,K3,

L3,N2,O3,P1,P2,Q3,S2,U1,U2,V2,W3,X1,

X2,X3,Y2,Y3.

37.33

Type IV C2,H3,M2,R1,S1. 6.67

Total 75 100.00

Figures

Page 52

PHOTOS

Fig-1 Armamentarium used for the study.

Fig-2

Fig2-MB2 canal orifices instrumented with 10 no K File

Figures

Page 53

Fig3-The templates

Fig4- CBCT 3D images

Figures

Page 54

Type I Type II

Type III Type IV

Fig5-CBCT 3D images according to Weine’s classification

Fig -6 Location of MB2 canal

Figures

Page 55

Fig7-Other aids to detect of additional canals.

AXIAL CORONAL SAGITAL

Fig8- Axial, Coronal and Sagittal CBCT images

DR. DEEPA ASTEKAR Dissertation - 52.172.27.147:8080

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