Clinical Research

Root Canal Morphology of Permanent Maxillary Teeth in the Han Nationality in Chinese Guanzhong Area: A New Modified Root Canal Staining Technique
Xi-Li Weng, MD,* Shi-Bin Yu, DDS, PhD,* Shou-Liang Zhao, DDS, PhD,† Han-Guo Wang, DDS, PhD,* Tong Mu, MD,‡ Rong-Yin Tang, MD,* and Xue-Dong Zhou, DDS, PhD§
Abstract
Introduction: The purpose of this study was to investigate the canal morphology of 504 maxillary permanent teeth of subjects of Han nationality in Chinese Guanzhong area. Methods: Maxillary permanent teeth were randomly collected in Guanzhong area. After regular preparation, the teeth were immersed into ink without preparing access cavities and then put into hyperbaric oxygen chamber (0.6 Mpa) for 2 hours to let the ink penetrate into root canal from apical foramen, apical deltas and foramen of lateral canals under stable positive pressure. After demineralization and clearing, the following observations were made: (1) number of root canals, (2) root canal configuration by using Vertucci’s classification, (3) presence of lateral canals, and (4) frequency of apical deltas. Results: All the teeth were well-stained, and the fine details were well-revealed. Apical deltas (12.2%–83.3%) and lateral canals (13.7%–68.8%) could be frequently found in all types of maxillary teeth. Most of central incisors (95.8%), lateral incisors (91.4%), and canines (75.4%) displayed type I canal configuration, whereas most of first premolars (87.3%) and second premolars (72.3%) possessed 2 canals with type II, IV, or VI canal configuration. The majority of distobuccal roots and palatal roots of first molars (88.9%, 97.8%), second molars (92.0%, 94.0%), and third molars (87.5%, 91.6%) possessed type I canal configuration. The prevalence of mesiobuccal roots with type I configuration was 66.7% in maxillary first molars, 82% in second molars, and 62.5% in third molars. Conclusions: The modified technique of canal staining can effectively reveal detailed root canal system. The canal configuration of maxillary teeth in subjects of Han nationality in Chinese Guanzhong area is consistent with previous reports in other races. (J Endod 2009;35:651–656)

T

he study of root canal anatomy has endodontic and anthropologic significance (1–3). It is of great importance to be familiar with variations in tooth anatomy, especially the anatomy of root canal system (4), which determines the result of dental treatment to some extent. Many previous investigations have examined the configurations of root canal systems. Several methods have been used, such as direct observation with the aid of operating microscope (5), macroscopic transverse sections (6–8), radiographs both in vivo and in vitro (9), micro–computed tomography scanning combined with 3-dimensional reconstruction (10–12), and creating cleared teeth (4, 13–18). It has been proved that the method of canal staining and root clearing was excellent for 3-dimensional evaluation of root canal morphology (2, 4, 13, 15). The traditional technique goes as follows. First, access cavity is made in crown, and pulp tissue is removed. Second, ink is injected into root canal system, and sometimes ink penetration can be assisted by a negative pressure from vacuum suction applied apically. Then the tooth is decalcified, dehydrated, and finally rendered transparent. There are at least 2 shortcomings in this traditional technique. First, preparing access cavity will destroy the morphology of crown, especially the roof of pulp chamber. Information of pulp chamber is lost in this way. Second, once the ink penetrates through the main apical foramen, the negative pressure will decrease abruptly. Then the lower negative pressure might be not enough to help examine the fine details, such as lateral canals and apical deltas, especially at the apical third of root canal. As the biggest nationality in China, the Han nationality makes up approximately 91.59% of the total Chinese population. Guanzhong area is at the center of China. The purpose of this study was to modify the traditional technique of canal staining and to evaluate the canal morphology of maxillary permanent teeth of the Chinese Han population by this new technique.

Materials and Methods
Five hundred four extracted maxillary permanent teeth were randomly obtained from general dentists in Guanzhong area of Shaanxi Province. The gender and age of patients were not known. The teeth were divided into 8 groups by anatomic characteristics. The 8 groups evaluated were maxillary central incisors, lateral incisors, canines, first premolars, second premolars, first molars, second molars, and third molars. The teeth were washed under tap water immediately after extraction and stored in 3% hydrogen peroxide solution until the collection was complete. Thereafter the samples were placed in 3.25% sodium hypochlorite (Xi’an Chemicals Factory, Xi’an, China) for 1 hour to remove adherent soft tissue. Then the remaining calculus was

Key Words
Morphology, permanent teeth, root canal configuration

From the *School of Stomatology, the Fourth Military Medical University, Xi’an; †School of Stomatology, Tongji University, Shanghai; ‡Department of Stomatology, Chinese MeiTan General Hospital, Beijing; and §West China College of Stomatology, SiChuan University, Chengdu, China. Drs Weng and Yu contributed equally to this work. Address requests for reprints to Professor Shou-Liang Zhao, School of Stomatology, TongJi University, Conservative Dentistry, No 399 YanChang Midroad, Shanghai 200072, China. E-mail address: slzhao_tj@yahoo.com.cn. 0099-2399/$0 - see front matter Copyright ª 2009 American Association of Endodontists. doi:10.1016/j.joen.2009.02.010

JOE — Volume 35, Number 5, May 2009

Root Canal Morphology of Permanent Maxillary Teeth

651

Without preparing access cavities. Representative canal configurations of root canals in this study. apical deltas and foramen of lateral canals under positive pressure. The ink penetrated into root canal system from apical foramen. and (G) type VIII (3). (D) type IV (2).Clinical Research Figure 1. The set pressure was 0. China) and put into hyperbaric oxygen chamber (DWC450-1150. After being washed under tap water. (C) type III (1-2-1). Shanghai Yangyuan Medical Oxygen Chamber Factory. (B) type II (2-1). Beijing. the teeth were immersed into 50% Chinese ink (Yidege Brand. May 2009 .6 Mpa. JOE — Volume 35. The teeth were then washed under tap water for 2 hours and dried overnight. Beijing Ink Factory. (E) type V (1-2). the teeth were demineralized by immersion in 5% nitric acid (Xi’an Chemicals Factory) for 7 days at Weng et al. (A) Type I (1). (F) type VI (2-1-2). removed by scaling. China) for 2 hours. Number 5. 652 Shanghai.

The transparent specimens were examined by unaided eyes. May 2009 Root Canal Morphology of Permanent Maxillary Teeth . dried. Tianjin. B) lateral canal. (3) presence of lateral canals. 653 JOE — Volume 35. and (4) frequency of apical deltas. Finally. (D. The acid solution was changed every day. 95%. and dehydrated by using ascending concentrations of ethyl alcohol (75%. room temperature. Number 5. The samples were washed under running tap water for 3 hours. (C) canal isthmus. (2) root canal configuration in each root by using Vertucci’s classification without additional modifications. E) apical deltas.Clinical Research Figure 2. and 100%) for 12 hours each. the dehydrated teeth were rendered transparent by immersion in methyl salicylate (Tianjin Basifu Chemical Factory. and (F–H) intercanal communications. China) for 2 days. (A. and the following observations were made: (1) number of root canals (defined as root canal orifices in the pulp chamber) per tooth. Representative canal showing fine details of root canals in this study. 85%.

These results were significantly higher than those of previous studies in which the traditional techniques were used. and Type II (2-1) 3 (4. III.0%).3) — — 5 (11. of root canals per tooth Type of teeth Central incisors Lateral incisors Canines First premolars Second premolars First molars Second molars Third molars No.8%).3% of maxillary first premolars had apical deltas in Jordanian population. 82% in second molars.7% in maxillary first molars. and 62.0) 3 (6. with high prevalence in first premolars (51.0%.8) 64 (91.4) — 2 (4.2) — Type VI (2-1-2) — — — 1 (1.3% in Thai maxillary molars (19).1) 50 (76.0) 21 (22.3) 5 — — — — — 2 (4.2) 1 (4.4) 1 (1. of teeth 71 70 65 95 65 45 50 43 1 68 (95.8) — — 4 (21.86% in Jordanian mesiobuccal root of maxillary first molars (20). second premolars (68.7) 40 (88.7%).0) 19 (44. In 12.2) — 3 (6. 18).7%). PR.0) 47 (94.4) 6 (6. expense.8) 4 (8.7%–25.2) the teeth were immersed into ink without preparing access cavities and then put into hyperbaric oxygen chamber. or 5 canals per tooth No.6) — — — — — — — — — 1 (5.7) 18 (27. 654 Weng et al. most of maxillary central incisors (95. Lateral canals could be found in all types of maxillary teeth (13. observing dimensions.2%–83.9) 13 (20. The results of the evaluation of the root canal systems are presented in Tables 1–3. which will be valuable for the research of pulp chamber in the future.9) 44 (97. Furthermore.8%).3) — 3 (3. and third molars (87. lateral incisors (91.6) 6 (12. the modified cleared teeth technique has advantages in some aspects. 2. IV.8) 68 (97.4%). Furthermore. 3). The majority of distobuccal roots and palatal roots of first molars (88.3) 47 (72.8%).0) 46 (92. JOE — Volume 35.0) 1 (2. 97.3) — — — Type V (1-2) — 3 (4. with frequency from 12. In the past several years. especially the third molars.2) — Type IV (2) — — 2 (3. palatal roots of first molars (97. Most of maxillary first premolars (87.7%–68. or VI canal configuration.7%).1%–13. lateral canals can be found in all types of maxillary teeth (13.0) 1 (1.7) — 4 (8.1) 61 (64. and fused roots of third molars (60. Number and percentage of canal system types in maxillary teeth Type I (1-1) Central incisors Lateral incisors Canines First premolars Second premolars MBR of first molars DBR of first molars PR of first molars MBR of second molars DBR of second molars PR of second molars MBR of third molars DBR of third molars PR of third molars FR of third molars 68 (95.6) 3 — — — — — 36 (80.0) 43 (86. whereas all the maxillary second premolars that possessed 1 canal showed type I canal configuration.9) 12 (12.9) 4 (8. 1 and 2).3%. the number of canals was variable.0) Type III (1-2-1) — 1 (1. For premolars.4%–22.8%).0) 1 (4.9) 15 (23.3) 1 (4. Discussion In the present study.2) 2 (2.2) 2 (2. the pulp chamber was intact. and the fine details could be seen clearly (Figs.7) 30 (66.1%). 91.8%). mesiobuccal root.6%) possessed type I configuration.4) 1 (2.5%.5) 3 (3. In the present study.0) — 5 (20.2) 4 — — — — — 7 (15.7%-68. distobuccal root.5% in third molars.9) — — 3 (6. FR. For molars. Two recent studies on Chinese population showed that the prevalence of apical deltas ranged from 2. Number and percentage of maxillary teeth with 1.4) 49 (75.2) 2 (8. effect of operation/skill on results.2% in Burmese maxillary molars (13).4%. second molars (92. such as tooth integrality.5) 21 (87. whereas Awawdeh et al (16) reported that 4. apical deltas and foramen of lateral canals under stable positive pressure (Fig. in the present study.9%. 94.6) 2 (4.3%) and second premolars (72. 91.2) — 4 (8.0) 15 (62. respectively). After regular preparation of the selected teeth. fused root.1) 24 (36. some modification was made on the traditional technique of canal staining. 7. Apical deltas were frequently seen in roots of all 8 groups.6) 12 (63.2) 1 (4. The results suggested that the penetration of ink was enough to show the fine details of the root canal system. and result integrality and accuracy. TABLE 2.8%.0) 7 (16. and 28. and canines (76.0) — Results All the teeth were well-stained and cleared. palatal root.0) — — 2 (8.8) 41 (82.2) 22 (33. Compared with previous techniques used in studies of root canal morphology (Table 4). 7.5) MBR.4%).2) — — 3 (6. In the present study.3%) possessed 2 canals and type II. second premolars (68.0) — 1 (4. and 75. lateral incisors (97. with high prevalence in maxillary first premolars (51. 3.9) — 1 (2. DBR. canines (75.8%). apical deltas were frequently seen in the roots of all groups (12. the canal configuration was more variable.1) 83 (87. or V canal configuration was displayed.9) 3 (6.1% in maxillary teeth (17.7) — — 12 (27.3) Type VII (1-2-1-2) — — — — — — — — — — — — — — — Type VIII (3) — — — — — — — — — — — — 2 (10. The ink penetrated into root canal system from apical foramen. May 2009 .2% to 83.8%). most of central incisors (95.7%). Number 5. and fused roots of third molars (60.Clinical Research TABLE 1.5) 22 (91. 4.3) 18 (27. A study on Turkish population (15) showed that the prevalence of apical deltas ranged from 1%–38% in maxillary permanent teeth.3%).9%) had a single canal and mainly type I configuration (95. In the present study. The prevalence of mesiobuccal roots with a single canal with type I configuration was 66.8%). the prevalence of lateral canals was variable in different reports.4%.9) 2 3 (4.7% of maxillary first premolars type I.

2) 28 (38.9) 9 (37. lateral canals. 22). JOE — Volume 35. Oral Surg Oral Med Oral Pathol 1984.0%) was higher than in previous reports (13. 2004BA720A23.1) 7 (13. Ng YL. 23. Hong-zhi Xia and Dr. J Endod 2000.3) 4 (16. the prevalence of mesiobuccal roots with a single canal (types I. 24) (Table 5). Sempira HN. DBR. 19.83%–100%) of previous studies (13.2) 30 (60. The variation appeared to be genetically determined (25).7) 10 (35. Acknowledgments The authors thank Dr. Diagram about traditional cleared teeth technique and new modified cleared teeth technique. of roots Central incisors Lateral incisors Canines First premolars Second premolars MBR of first molars DBR of first molars PR of first molars MBR of second molars DBR of second molars PR of second molars MBR of third molars DBR of third molars PR of third molars FR of third molars 71 70 65 95 65 45 45 45 50 50 50 24 24 24 19 No. 3-dimension. computed tomography. Alavi A. 3. second molars (94. 17. Ink enters into root canal system from prepared crown access cavity. References 1.8) 10 (22. Int Endod J 2002.2) 20 (35.3%) and second premolars (72. In the present study. J Endod 1988.4) 32 (44. Number 5.9) 20 (39.0%). which was lower than those (100%) of previous reports with traditional techniques of root staining (13. mesiobuccal root.14:325–9.5) 29 (60. 2-dimension.58:589–99.Clinical Research TABLE 3.8) 19 (35. 25–29). Weine FS.7) 15 (30. 2D. Hartwell GR. All these results proved that this new modified technique is valuable. PR.8) 31 (58. second molars (92. Grant No. IV.3) 52 (29. (B) New modified cleared teeth technique. Number and percentage of lateral canals and apical deltas No. 5.0) 25 (80.3) 29 (50. foramen of lateral canals. Walker RT. This new modified technique of canal staining is better than the traditional one at least in this aspect. 2.6) 20 (83.2%) and second molars (86. and complicated root canal system. 17–19. Gerstein H. Figure 3. Most of first premolars (87. and apical deltas under stable positive pressure. The majority of distobuccal roots of first molars (88.0) 17 (60.0) 13 (41. 4. Vertucci FJ.4) 30 (37.28:419–25. or VI canal configuration. III. Root and canal morphology of Thai mandibular molars. Gulabivala K. Many previous studies have shown that tooth morphology varies in different times. Comparison of different techniques used in studies of root canal morphology Operating microscope Tooth destruction Patient participation Observing dimensions Expense Effect of operation/skill on results Result integrality and accuracy No Yes 2D High Great Good Radiographs in vivo No Yes 2D Low Great Good Radiographs in vitro No No 2D Low Great Good Transverse sections Yes No 2D Low Great Better Micro-CT scanning No No 3D High Little Better Traditional cleared teeth Yes No 3D Low Little Better Modified cleared teeth No No 3D Low Little Better CT. Oral Surg Oral Med Oral Pathol 1969.0%) displayed type I canal configuration. Opasanon A. fused root. Canal configuration in the mesiobuccal root of the maxillary first molar and its endodontic significance. Zhen Zhou of General Hospital of Tibet Military Command for technical TABLE 4. 21. 17. nationalities. May 2009 Root Canal Morphology of Permanent Maxillary Teeth 655 . This study was supported by 10th Five-Year Plan of National Key Technologies R&D Program (in China).4) 6 (13.26:673–4. 22).7) Apical deltas 9 (12. ink enters into root canal system from apical foramen.7) MBR.5%) possessed type I configuration. 3D. palatal root. assistance. FR.3%) possessed 2 canals and mainly had type II. Healey HJ.9) 45 (56. distobuccal root.35:56–62.9%).2) 49 (43. It is the stable positive pressure at apical foramen during ink penetration that helps to reveal the fine apical deltas. and third molars (87. Root form and canal anatomy of mandibular second molars in a Southern Chinese population. Sometimes ink penetration can be assisted by negative pressure from vacuum suction applied apically. and V) in maxillary first molars (82. of canals 74 72 80 178 112 53 48 45 57 51 50 31 24 24 28 Lateral canals 24 (32.5) 92 (51. (A) Traditional cleared teeth technique. Evanson L. and areas (3. Without preparing access cavities.5) 6 (25.8) 9 (18. Root canal anatomy of the human permanent teeth. 19. 22). Frequency of second mesiobuccal canals in maxillary molars as determined by use of an operating microscope: a clinical study. 21.7) 77 (68. which also falls within the range (77. which was consistent with previous studies (17.

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