Vol 79, No 1 (2020)
Original article
Published online: 2019-05-06

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The role of clinical examination in the detection of permanent maxillary molars with two palatal roots

T. Hitij1, I. Štamfelj12
Pubmed: 31063199
Folia Morphol 2020;79(1):127-133.

Abstract

Background: The aim of the study was to determine whether the presence of two palatal roots (2PR) in permanent maxillary molars (PMMs) could be predicted by observing dental morphological traits during the clinical examination.

Materials and methods: A total of 18 second and 26 third PMMs with 2PR were examined from the collection of extracted teeth. The reference sample of 44 extracted PMMs with one palatal root was selected such that pairs of morphologically matching PMMs with one and 2PR were formed. The external morphology of these tooth pairs was examined under a stereomicroscope and distinguishing traits were registered. The Fisher’s exact test was applied to examine differences between second and third PMMs. Additionally, the external morphology of 17 PMM with 2PR in 15 patients was analysed retrospectively.

Results: Extracted PMMs with 2PR possessed the following distinguishing morphological traits: crown wider on the palatal half (55.3%), double Carabelli cusps (23.7%), pronounced palatal indentation of the crown (20.5%), thick palatal enamel extension (16.3%), palato-radicular groove (11.6%) and palatal enamel pearl (2.3%). Differences between second and third PMMs were not statistically significant (p > 0.05). At least one distinguishing trait was present in 63.4% and 94.1% of extracted and clinically evaluated PMMs with 2PR, respectively. Omega-shaped deformation of the dental arch may be the first clinically observable clue to this root constellation.

Conclusions: Clinical examination of tooth morphology and shape of the dental arch is essential for the detection PMMs with 2PR.

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References

  1. Ahmed HMA, Abbott PV. Accessory roots in maxillary molar teeth: a review and endodontic considerations. Aust Dent J. 2012; 57(2): 123–131; quiz 248.
  2. Baratto-Filho F, Fariniuk LF, Ferreira EL, et al. Clinical and macroscopic study of maxillary molars with two palatal roots. Int Endod J. 2002; 35(9): 796–801.
  3. Benenati FW. Maxillary second molar with two palatal canals and a palatogingival groove. J Endod. 1985; 11(7): 308–310.
  4. Bolk L. Das Carabellische Höckerchen. Schweiz Vjschr Zahnheilk. 1915; 25: 1–24.
  5. Carlsen O, Alexandersen V. Radix mesiolingualis and radix distolingualis in a collection of permanent maxillary molars. Acta Odontol Scand. 2000; 58(5): 229–236.
  6. Chan HL, Oh TJ, Bashutski J, et al. Cervical enamel projections in unusual locations: a case report and mini-review. J Periodontol. 2010; 81(5): 789–795.
  7. Christie WH, Peikoff MD, Fogel HM. Maxillary molars with two palatal roots: A retrospective clinical study. J Endodontics. 1991; 17(2): 80–84.
  8. Di Fiore PM. Complications of surgical crown lengthening for a maxillary molar with four roots: A clinical report. J Prosthet Dent. 1999; 82(3): 266–269.
  9. Friedman S, Stabholz A, Rotstein I. Endodontic management of molars with developmental anomalies. Int Endod J. 1986; 19(6): 267–276.
  10. Gašperšič D. The enamel extension and the course of cemento-enamel junction in permanent molars [in Slovene]. Zobozdrav Vestn. 1984; 39: 147–154.
  11. Gaspersić D. [The prevalence, location and composition of enamel pearls in permanent molars]. Zobozdrav Vestn. 1985; 40(1-5): 33–38.
  12. Goon WW, Carpenter WM, Brace NM, et al. Complex facial radicular groove in a maxillary lateral incisor. J Endod. 1991; 17(5): 244–248.
  13. Gu Y, Wang W, Ni L. Four-rooted permanent maxillary first and second molars in a northwestern Chinese population. Arch Oral Biol. 2015; 60(6): 811–817.
  14. Gu YC. A micro-computed tomographic analysis of maxillary lateral incisors with radicular grooves. J Endod. 2011; 37(6): 789–792.
  15. Grammatopoulos E. Gemination or fusion? Br Dent J. 2007; 203(3): 119–120.
  16. Kim Y, Lee SJ, Woo J. Morphology of maxillary first and second molars analyzed by cone-beam computed tomography in a korean population: variations in the number of roots and canals and the incidence of fusion. J Endod. 2012; 38(8): 1063–1068.
  17. Moskow BS, Canut PM. Studies on root enamel (2). Enamel pearls. A review of their morphology, localization, nomenclature, occurrence, classification, histogenesis and incidence. J Clin Periodontol. 1990; 17(5): 275–281.
  18. Nayak G, Aeran H, Singh I. Radix mesiolingualis and radix distolingualis: a case report of a tooth with an unusual morphology. Restor Dent Endod. 2016; 41(4): 322–331.
  19. Neelakantan P, Subbarao C, Ahuja R, et al. Cone-beam computed tomography study of root and canal morphology of maxillary first and second molars in an Indian population. J Endod. 2010; 36(10): 1622–1627.
  20. Peikoff MD, Christie WH, Fogel HM. The maxillary second molar: variations in the number of roots and canals. Int Endod J. 1996; 29(6): 365–369.
  21. Peikoff MD, Perry JB, Chapnick LA. Endodontic failure attributable to a complex radicular lingual groove. J Endod. 1985; 11(12): 573–577.
  22. Peikoff MD, Trott JR. An endodontic failure caused by an unusual anatomical anomaly. J Endod. 1977; 3(9): 356–359.
  23. Plotino G, Tocci L, Grande NM, et al. Symmetry of root and root canal morphology of maxillary and mandibular molars in a white population: a cone-beam computed tomography study in vivo. J Endod. 2013; 39(12): 1545–1548.
  24. Risnes S. The prevalence, location, and size of enamel pearls on human molars. Scand J Dent Res. 1974; 82(6): 403–412.
  25. Risnes S. The prevalence and distribution of cervical enamel projections reaching into the bifurcation on human molars. Scand J Dent Res. 1974; 82(6): 413–419.
  26. Schulze C. Anomalien und Missbildungen der menschlichen Zähne [in German]. Berlin: Quintessenz Verlags. 1987: 129–149.
  27. Shah DY, Jadhav GR. Endodontic management of a maxillary molar with formation supradentalis: A case report. J Conserv Dent. 2014; 17(5): 481–482.
  28. Shojaeian S, Ghoddusi J, Hajian S. A case report of maxillary second molar with two palatal root canals and a furcal enamel pearl. Iran Endod J. 2013; 8(1): 37–39.
  29. Šutalo J. Pojava prekobrojnih kanala u palatinalnom korijenu prvog gornjeg kutnjaka [in Croatian]. Acta Stom Croat. 1985; 19(1): 35–40.
  30. Tian XM, Yang XW, Qian L, et al. Analysis of the Root and Canal Morphologies in Maxillary First and Second Molars in a Chinese Population Using Cone-beam Computed Tomography. J Endod. 2016; 42(5): 696–701.
  31. Turner CG, Nichol CR, Scott GR. Scoring procedures for key morphological traits of the permanent dentition: The Arizona State University dental anthropology system. In: Kelley MA, Larsen CS (eds.). Advances in dental anthropology. Wiley-Liss, New York 1991: 13–31.
  32. Versiani MA, Pécora JD, de Sousa-Neto MD. Root and root canal morphology of four-rooted maxillary second molars: a micro-computed tomography study. J Endod. 2012; 38(7): 977–982.
  33. Woelfel JB, Scheid RC. Dental anatomy. Its relevance to dentistry. 6th ed. Lippincott Williams & Wilkins, Baltimore 2002: 208.
  34. Yang Bo, Lu Q, Bai Qx, et al. [Evaluation of the prevalence of the maxillary molars with two palatal roots by cone-beam CT]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2013; 48(6): 359–362.
  35. Zhang W, Tang Y, Liu C, et al. Root and root canal variations of the human maxillary and mandibular third molars in a Chinese population: A micro-computed tomographic study. Arch Oral Biol. 2018; 95: 134–140.