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A Comparative Evaluation of the Root Canal Morphology of Primary Molars Using Cone Beam Computed Tomography and the Clearing Technique: An in vitro Study

Year 2025, Volume: 35 Issue: 3, 189 - 196, 24.07.2025
https://doi.org/10.17567/currresdentsci.1475072

Abstract

Objective: This study aims to compare the accuracy of cone beam computed tomography (CBCT) and the clearing technique in evaluating the root canal morphology of human primary molars, crucial for successful endodontic treatment.
Materials and Methods: Eighty extracted primary molars (n=20) were divided into four groups: Group I= mandibular first, Group II= mandibular second , Group III= maxillary first, Group IV= maxillary second. CBCT images were captured prior to subjecting the teeth to the clearing technique. Root number, canal types according to Vertucci’s classification, and accessory canal prevalence were evaluated. Findings from both techniques were compared, and the agreement between the two was evaluated using the kappa coefficient and chi-square (χ2) test with SPSS 22.0 software for Windows.
Results: Mandibular primary molars exhibited two roots 100%, maxillary primary molars typically had two roots, with a fusion rate of 65% between distobuccal and palatal roots. Root canal configurations varied, with Types IV and I being common in mesial canals, Type V and I in distal canals, and Type I in palatal canals. Significant agreement was found between CBCT and clearing technique in detecting root canals in the mesial, distal, and palatal canals (p = 0.001). Accessory canals were most frequently observed in mesial canals and furcation areas. Significant agreement was found between CBCT and clearing technique in detecting accessory canals in mesial, distal, palatal canals and furcation areas of primary molars (p = 0.001).
Conclusions: The study emphasizes primary molar root canal variations, highlighting accessory canals. CBCT's comparable accuracy to the gold standard enhances diagnosis and treatment.

Ethical Statement

This study was approved by the Marmara University School of Medicine Clinical Research Ethics Committee on 21.04.2021 with protocol number 09.2021.425.

References

  • 1. Cleghorn BM, Boorberg NB, Christie WH. Primary human teeth and their root canal systems. Endod Top 2012;23(1):6–33. DOI: 10.1111/ etp.12000)
  • 2. Demiriz L, Bodrumlu EH, Icen M. Evaluation of root canal morphology of human primary mandibular second molars by using cone beam computed tomography. Niger J Clin Pract. 2018 Apr;21(4):462-467. doi: 10.4103/njcp.njcp_85_17. PMID: 29607858.
  • 3. Vertucci FJ (2005) Root canal morphology and its relationship to endodontic procedures. Endodontic Topics 10,3–29
  • 4. Ahmed HMA, Musale PK, El Shahawy OI, Dummer PMH. Application of a new system for classifying tooth, root and canal morphology in the primary dentition. Int Endod J. 2020 Jan;53(1):27-35. doi: 10.1111/iej.13199. Epub 2019 Oct 1. PMID: 31390075.
  • 5. Dammaschke T, Witt M, Ott K, Schäfer E (2004) Scanning electron microscopic investigation of incidence, location, and size of accessory foramina in primary and permanent molars. Quintessence International 35, 699–705.
  • 6. Waterhouse PJ, Whitworth JM, Camp JH, Fuks AB (2011) Pediatric endodontics: endodontic treatment for the primary and young permanent dentition. In: K Hargreaves, S Cohen, eds. Pathways of the Pulp, 10th edn. St. Louis: Mosby Elsevier, pp 808–57.
  • 7. Camp JH (2008) Diagnosis dilemmas in vital pulp therapy:treatment for the toothache is changing, especially inyoung, immature teeth.Pediatric Dentistry30, 197–205.
  • 8. Katge, Farhin; Dixit, Uma B. A cone-beam computed tomographic study of root and root canal morphology of primary maxillary and mandibular second molars in Indian Children: An in vitro study. Journal of Indian Society of Pedodontics and Preventive Dentistry 40(2):p 171-179, Apr–Jun 2022.
  • 9. Ahmed HMA. A critical analysis of laboratory and clinical research methods to study root and canal anatomy. Int Endod J. 2022 Apr;55 Suppl 2:229-280. doi: 10.1111/iej.13702. Epub 2022 Mar 31. PMID: 35124829.
  • 10. Gaurav V, Srivastava N, Rana V, Adlakha VK. A study of root canal morphology of human primary incisors and molars using cone beam computerized tomography: an in vitro study. J Indian Soc Pedod Prev Dent. 2013 Oct-Dec;31(4):254-9. doi: 10.4103/0970-4388.121827. PMID: 24262400.
  • 11. Sharma U, Gulati A, Gill N. An investigation of accessory canals in primary molars - an analytical study. Int J Paediatr Dent. 2016 Mar;26(2):149-56. doi: 10.1111/ipd.12178. Epub 2015 Jul 4. PMID: 26146865.
  • 12. Rahmati A, Khoshbin E, Shokri A, Yalfani H. Cone-beam computed tomography assessment of the root canal morphology of primary molars. BMC Oral Health. 2023 Sep 25;23(1):692. doi: 10.1186/s12903-023-03414-z. PMID: 37749546; PMCID: PMC10521415.
  • 13. Lee KW, Kim Y, Perinpanayagam H, Lee JK, Yoo YJ, Lim SM, Chang SW, Ha BH, Zhu Q, Kum KY. Comparison of alternative image reformatting techniques in micro-computed tomography and tooth clearing for detailed canal morphology. J Endod. 2014 Mar;40(3):417-22. doi: 10.1016/j.joen.2013.09.014. Epub 2013 Oct 25. PMID: 24565663.
  • 14. Ordinola-Zapata R, Bramante CM, Versiani MA, Moldauer BI, Topham G, Gutmann JL, Nuñez A, Duarte MA, Abella F. Comparative accuracy of the Clearing Technique, CBCT and Micro-CT methods in studying the mesial root canal configuration of mandibular first molars. Int Endod J. 2017 Jan;50(1):90-96. doi: 10.1111/iej.12593. Epub 2016 Jan 19. PMID: 26659613.
  • 15. Zoremchhingi, a,; Joseph, T.b; Varma, B.c; Mungara, J.d. A study of root canal morphology of human primary molars using computerised tomography: An in vitro study. Journal of Indian Society of Pedodontics and Preventive Dentistry 23(1):p 7-12, Jan–Mar 2005. | DOI: 10.4103/0970-4388.16019
  • 16. Wang, Yin-Lin & Chang, Hsiao-Hua & Kuo, Ching-I & Chen, Ssu-Kuang & Guo, ming-kuang & Huang, Guay-Fen & Lin, C.-S. (2013). A study on the root canal morphology of primary molars by high-resolution computed tomography. Journal of Dental Sciences. 8. 321–327. 10.1016/j.jds.2013.04.002.
  • 17. Ozcan G, Sekerci AE, Cantekin K, Aydinbelge M, Dogan S. Evaluation of root canal morphology of human primary molars by using CBCT and comprehensive review of the literature. Acta Odontol Scand. 2016;74(4):250-8. doi: 10.3109/00016357.2015.1104721. Epub 2015 Nov 2. PMID: 26523502.
  • 18. Katge F, Wakpanjar MM. Root canal morphology of primary molars by clearing technique: An in vitro study. J Indian Soc Pedod Prev Dent. 2018 Apr-Jun;36(2):151-157. doi: 10.4103/JISPPD.JISPPD_237_16. PMID: 29970632.
  • 19. Teixeira TF, da Silva AMP, Coutinho TMC, Marceliano EFV, Dos Santos Miranda ARL, Ferreira DC, Provenzano JC, Marceliano-Alves MFV. Deciduous Molars Complexity Anatomy Reveled by Computed Microtomography. Eur J Dent. 2023 Sep 20. doi: 10.1055/s-0043-1772566. Epub ahead of print. PMID: 37729937.
  • 20. Mahesh, R.1,; Nivedhitha, M. S.2. Root canal morphology of primary mandibular second molar: A systematic review. Saudi Endodontic Journal 10(1):p 1-6, Jan–Apr 2020. | DOI: 10.4103/sej.sej_18_19
  • 21. Neelakantan P, Subbarao C, Subbarao CV. Comparative evaluation of modified canal staining and clearing technique, cone-beam computed tomography, peripheral quantitative computed tomography, spiral computed tomography, and plain and contrast medium-enhanced digital radiography in studying root canal morphology. J Endod. 2010 Sep;36(9):1547-51. doi: 10.1016/j.joen.2010.05.008. Epub 2010 Jul 15. PMID: 20728725.
  • 22. Berscheid M (2015) Presence of accessory canals in the furcation region of primary molars. Master of Dentistry Thesis. University of Manitoba, Canada.
  • 23. Dr. Wakpanjar Mayur, M., Dr. Katge Farhin, Dr. Vamsi Krishna, C and Dr. Shivasharan Pooja, 2017. “A comparison between clearing technique and cone beam computed tomography for detection of accessory canals in primary molars: An in vitro study”, International Journal of Current Research, 9, (07), 54152-24156.
  • 24. Poornima P, Subba Reddy VV. Comparison of digital radiography, decalcification, and histologic sectioning in the detection of accessory canals in furcation areas of human primary molars. J Indian Soc Pedod Prev Dent. 2008 Jun;26(2):49-52. doi: 10.4103/0970-4388.41615. PMID: 18603727.
  • 25. Ringelstein D, Seow WK. The prevalence of furcation foramina in primary molars. Pediatr Dent. 1989 Sep;11(3):198-202. PMID: 2638005.
  • 26. Yoshida H, Yakushiji M, Sugihara A, Tanaka K, Taguchi M (1975) Accessory canals at floor of the pulp chamber of primary molars (author’s transl). Shikwa Gakuho 75, 5805
  • 27. Paras LG, Rapp R, Piesco NP, Zeichner SJ, Zullo TG (1993) An investigation of accessory canals in furcation areas of human primary molars: part 2. Latex perfusion studies of the internal and external furcation areas to demonstrate accessory canals. Journal of Clinical Pediatric Dentistry 17, 71–7.
  • 28. El Hachem C, Kaloustian MK, Nehme W, Ghosn N, Abou Chedid JC. Three-dimensional modeling and measurements of root canal anatomy in second primary mandibular molars: a case series micro CT study. Eur Arch Paediatr Dent. 2019 Oct;20(5):457-465. doi: 10.1007/s40368-019-00426-8. Epub 2019 Mar 4. PMID: 30830644.
  • 29. Ana Victória Lopes Bandeira, Marina de Deus Moura de Lima and Cacilda Castelo Branco Lima et al. Topography of Primary Molar Pulp Chamber Floor: A Scanning Electron Microscopy and Micro-Computed Tomography Analysis. Pesqui. bras. odontopediatria clín. integr.. 2021. Vol. 21. DOI: 10.1590/pboci.2021.150.

Year 2025, Volume: 35 Issue: 3, 189 - 196, 24.07.2025
https://doi.org/10.17567/currresdentsci.1475072

Abstract

References

  • 1. Cleghorn BM, Boorberg NB, Christie WH. Primary human teeth and their root canal systems. Endod Top 2012;23(1):6–33. DOI: 10.1111/ etp.12000)
  • 2. Demiriz L, Bodrumlu EH, Icen M. Evaluation of root canal morphology of human primary mandibular second molars by using cone beam computed tomography. Niger J Clin Pract. 2018 Apr;21(4):462-467. doi: 10.4103/njcp.njcp_85_17. PMID: 29607858.
  • 3. Vertucci FJ (2005) Root canal morphology and its relationship to endodontic procedures. Endodontic Topics 10,3–29
  • 4. Ahmed HMA, Musale PK, El Shahawy OI, Dummer PMH. Application of a new system for classifying tooth, root and canal morphology in the primary dentition. Int Endod J. 2020 Jan;53(1):27-35. doi: 10.1111/iej.13199. Epub 2019 Oct 1. PMID: 31390075.
  • 5. Dammaschke T, Witt M, Ott K, Schäfer E (2004) Scanning electron microscopic investigation of incidence, location, and size of accessory foramina in primary and permanent molars. Quintessence International 35, 699–705.
  • 6. Waterhouse PJ, Whitworth JM, Camp JH, Fuks AB (2011) Pediatric endodontics: endodontic treatment for the primary and young permanent dentition. In: K Hargreaves, S Cohen, eds. Pathways of the Pulp, 10th edn. St. Louis: Mosby Elsevier, pp 808–57.
  • 7. Camp JH (2008) Diagnosis dilemmas in vital pulp therapy:treatment for the toothache is changing, especially inyoung, immature teeth.Pediatric Dentistry30, 197–205.
  • 8. Katge, Farhin; Dixit, Uma B. A cone-beam computed tomographic study of root and root canal morphology of primary maxillary and mandibular second molars in Indian Children: An in vitro study. Journal of Indian Society of Pedodontics and Preventive Dentistry 40(2):p 171-179, Apr–Jun 2022.
  • 9. Ahmed HMA. A critical analysis of laboratory and clinical research methods to study root and canal anatomy. Int Endod J. 2022 Apr;55 Suppl 2:229-280. doi: 10.1111/iej.13702. Epub 2022 Mar 31. PMID: 35124829.
  • 10. Gaurav V, Srivastava N, Rana V, Adlakha VK. A study of root canal morphology of human primary incisors and molars using cone beam computerized tomography: an in vitro study. J Indian Soc Pedod Prev Dent. 2013 Oct-Dec;31(4):254-9. doi: 10.4103/0970-4388.121827. PMID: 24262400.
  • 11. Sharma U, Gulati A, Gill N. An investigation of accessory canals in primary molars - an analytical study. Int J Paediatr Dent. 2016 Mar;26(2):149-56. doi: 10.1111/ipd.12178. Epub 2015 Jul 4. PMID: 26146865.
  • 12. Rahmati A, Khoshbin E, Shokri A, Yalfani H. Cone-beam computed tomography assessment of the root canal morphology of primary molars. BMC Oral Health. 2023 Sep 25;23(1):692. doi: 10.1186/s12903-023-03414-z. PMID: 37749546; PMCID: PMC10521415.
  • 13. Lee KW, Kim Y, Perinpanayagam H, Lee JK, Yoo YJ, Lim SM, Chang SW, Ha BH, Zhu Q, Kum KY. Comparison of alternative image reformatting techniques in micro-computed tomography and tooth clearing for detailed canal morphology. J Endod. 2014 Mar;40(3):417-22. doi: 10.1016/j.joen.2013.09.014. Epub 2013 Oct 25. PMID: 24565663.
  • 14. Ordinola-Zapata R, Bramante CM, Versiani MA, Moldauer BI, Topham G, Gutmann JL, Nuñez A, Duarte MA, Abella F. Comparative accuracy of the Clearing Technique, CBCT and Micro-CT methods in studying the mesial root canal configuration of mandibular first molars. Int Endod J. 2017 Jan;50(1):90-96. doi: 10.1111/iej.12593. Epub 2016 Jan 19. PMID: 26659613.
  • 15. Zoremchhingi, a,; Joseph, T.b; Varma, B.c; Mungara, J.d. A study of root canal morphology of human primary molars using computerised tomography: An in vitro study. Journal of Indian Society of Pedodontics and Preventive Dentistry 23(1):p 7-12, Jan–Mar 2005. | DOI: 10.4103/0970-4388.16019
  • 16. Wang, Yin-Lin & Chang, Hsiao-Hua & Kuo, Ching-I & Chen, Ssu-Kuang & Guo, ming-kuang & Huang, Guay-Fen & Lin, C.-S. (2013). A study on the root canal morphology of primary molars by high-resolution computed tomography. Journal of Dental Sciences. 8. 321–327. 10.1016/j.jds.2013.04.002.
  • 17. Ozcan G, Sekerci AE, Cantekin K, Aydinbelge M, Dogan S. Evaluation of root canal morphology of human primary molars by using CBCT and comprehensive review of the literature. Acta Odontol Scand. 2016;74(4):250-8. doi: 10.3109/00016357.2015.1104721. Epub 2015 Nov 2. PMID: 26523502.
  • 18. Katge F, Wakpanjar MM. Root canal morphology of primary molars by clearing technique: An in vitro study. J Indian Soc Pedod Prev Dent. 2018 Apr-Jun;36(2):151-157. doi: 10.4103/JISPPD.JISPPD_237_16. PMID: 29970632.
  • 19. Teixeira TF, da Silva AMP, Coutinho TMC, Marceliano EFV, Dos Santos Miranda ARL, Ferreira DC, Provenzano JC, Marceliano-Alves MFV. Deciduous Molars Complexity Anatomy Reveled by Computed Microtomography. Eur J Dent. 2023 Sep 20. doi: 10.1055/s-0043-1772566. Epub ahead of print. PMID: 37729937.
  • 20. Mahesh, R.1,; Nivedhitha, M. S.2. Root canal morphology of primary mandibular second molar: A systematic review. Saudi Endodontic Journal 10(1):p 1-6, Jan–Apr 2020. | DOI: 10.4103/sej.sej_18_19
  • 21. Neelakantan P, Subbarao C, Subbarao CV. Comparative evaluation of modified canal staining and clearing technique, cone-beam computed tomography, peripheral quantitative computed tomography, spiral computed tomography, and plain and contrast medium-enhanced digital radiography in studying root canal morphology. J Endod. 2010 Sep;36(9):1547-51. doi: 10.1016/j.joen.2010.05.008. Epub 2010 Jul 15. PMID: 20728725.
  • 22. Berscheid M (2015) Presence of accessory canals in the furcation region of primary molars. Master of Dentistry Thesis. University of Manitoba, Canada.
  • 23. Dr. Wakpanjar Mayur, M., Dr. Katge Farhin, Dr. Vamsi Krishna, C and Dr. Shivasharan Pooja, 2017. “A comparison between clearing technique and cone beam computed tomography for detection of accessory canals in primary molars: An in vitro study”, International Journal of Current Research, 9, (07), 54152-24156.
  • 24. Poornima P, Subba Reddy VV. Comparison of digital radiography, decalcification, and histologic sectioning in the detection of accessory canals in furcation areas of human primary molars. J Indian Soc Pedod Prev Dent. 2008 Jun;26(2):49-52. doi: 10.4103/0970-4388.41615. PMID: 18603727.
  • 25. Ringelstein D, Seow WK. The prevalence of furcation foramina in primary molars. Pediatr Dent. 1989 Sep;11(3):198-202. PMID: 2638005.
  • 26. Yoshida H, Yakushiji M, Sugihara A, Tanaka K, Taguchi M (1975) Accessory canals at floor of the pulp chamber of primary molars (author’s transl). Shikwa Gakuho 75, 5805
  • 27. Paras LG, Rapp R, Piesco NP, Zeichner SJ, Zullo TG (1993) An investigation of accessory canals in furcation areas of human primary molars: part 2. Latex perfusion studies of the internal and external furcation areas to demonstrate accessory canals. Journal of Clinical Pediatric Dentistry 17, 71–7.
  • 28. El Hachem C, Kaloustian MK, Nehme W, Ghosn N, Abou Chedid JC. Three-dimensional modeling and measurements of root canal anatomy in second primary mandibular molars: a case series micro CT study. Eur Arch Paediatr Dent. 2019 Oct;20(5):457-465. doi: 10.1007/s40368-019-00426-8. Epub 2019 Mar 4. PMID: 30830644.
  • 29. Ana Victória Lopes Bandeira, Marina de Deus Moura de Lima and Cacilda Castelo Branco Lima et al. Topography of Primary Molar Pulp Chamber Floor: A Scanning Electron Microscopy and Micro-Computed Tomography Analysis. Pesqui. bras. odontopediatria clín. integr.. 2021. Vol. 21. DOI: 10.1590/pboci.2021.150.
There are 29 citations in total.

Details

Primary Language English
Subjects Dentistry (Other)
Journal Section Research Articles
Authors

Sevgi Yaşar 0000-0002-6661-2830

Ali Menteş 0000-0002-2778-6803

Publication Date July 24, 2025
Submission Date May 1, 2024
Acceptance Date May 28, 2024
Published in Issue Year 2025 Volume: 35 Issue: 3

Cite

AMA Yaşar S, Menteş A. A Comparative Evaluation of the Root Canal Morphology of Primary Molars Using Cone Beam Computed Tomography and the Clearing Technique: An in vitro Study. Current Research in Dental Sciences. July 2025;35(3):189-196. doi:10.17567/currresdentsci.1475072

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