Top

Clinical Oral Investigations

Published in:

01-06-2021 | Digital Volume Tomography | Original Article

Prevalence and morphological characteristics of disto-lingual roots in mandibular first molars: a cone beam CT study with diagnostic and therapeutic implications

Authors: Dominic King Lun Ho, Janet H. L. Wong, Georgios Pelekos, Ke Deng, Maurizio S. Tonetti

Published in: Clinical Oral Investigations | Issue 6/2021

Abstract

Objectives

High prevalence of disto-lingual roots (DLR) at the mandibular molar in Chinese can complicate the management of periodontitis. This study assessed the prevalence and morphological features of mandibular first molar DLR and furcation entrances in a Hong Kong population by analysis of cone beam computed tomography (CBCT).

Materials and methods

CBCT including the mandibular 1st molar region were identified from the Prince Philip Dental Hospital archive and analyzed by a single investigator. Morphologic features and location of DLR were studied and presented as 95% confidence intervals.

Results

A total of 398 CBCTs with 716 mandibular first molars were analyzed. The prevalence of DLRs in mandibular first molars on subject based was 20.1% (95% C.I. 16.2–24%). DLR was located 44.5° ± 8.9° (95% C.I. 42.8–46.1°) to the mid-lingual of the mandibular first molar, with a bucco-lingual width 3.3 mm ± 0.5 mm (95% C.I. 3.2–3.4 mm). The mesial furcation entrance was located 4.0 mm ± 0.9 mm (95% C.I. 3.8–4.2 mm) apical to the cemento-enamel junction (CEJ) while the distal was 5.2 mm ± 1.3 mm (95% C.I. 5.0–5.4 mm) from the CEJ. The surface area of the DLR was 106.9 mm² ± 41.2 mm² (95% C.I. 98.9–114.8 mm²).

Conclusions

Chinese population has a high prevalence of DLRs. The present information is critical for understanding the morphological features of DLR and guide diagnosis and treatment of stage III periodontitis as well as for secondary prevention and supportive care of stage II periodontitis.

Clinical relevance

Little is known about the location and morphology of disto-lingual roots of mandibular 1st molars, yet they are frequently present in patients with Chinese ethnic background, thus complicating diagnosis and treatment. The present study utilized CBCT to analyze the prevalence and morphological features of the mandibular first molar DLR and furcation entrance. It is the first study reporting on the position of the DLR, degree of separation of the furcation, and the surface area of the DLR.

Heitz-Mayfield LJA, Trombelli L, Heitz F, Needleman I, Moles D (2002) A systematic review of the effect of surgical debridement vs. non-surgical debridement for the treatment of chronic periodontitis. J Clin Periodontol 29:92–102CrossRef

Axelsson P, Nyström B, Lindhe J (2004) The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults: results after 30 years of maintenance. J Clin Periodontol 31(9):749–757CrossRef

Cobb CM (2002) Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin Periodontol 29:22–32CrossRef

Aimetti M (2014) Nonsurgical periodontal treatment. Int J Esthetic Dent 9(2):251–267

Badersten A, Nilveus R, Egelberg J (1984) Effect of nonsurgical periodontal therapy. J Clin Periodontol 11(1):63–76CrossRef

Loos B, Claffey N, Egelberg J (1988) Clinical and microbiological effects of root debridement in periodontal furcation pockets. J Clin Periodontol 15(7):453–463CrossRef

Nordland P, Garrett S, Kiger R, Vanooteghem R, Hutchens LH, Egelberg J (1987) The effect of plaque control and root debridement in molar teeth. J Clin Periodontol 14(4):231–236CrossRef

Fleischer HC, Mellonig JT, Brayer WK, Gray JL, Barnett JD (1989) Scaling and root planing efficacy in multirooted teeth. J Periodontol 60(7):402–409CrossRef

Chiu BM, Zee KY, Corbet EF, Holmgren CJ (1991) Periodontal implications of furcation entrance dimensions in Chinese first permanent molars. J Periodontol 62(5):308–311CrossRef

10.

Lang NP, Cumming BR, Löe H (1973) Toothbrushing frequency as it relates to plaque development and gingival health. J Periodontol 44(7):396–405CrossRef

11.

Tonetti MS, Greenwell H, Kornman KS (2018) Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol 89:S159–S172CrossRef

12.

Hamp SE, Nyman S, Lindhe J (1975) Periodontal treatment of multi rooted teeth. Results after 5 years. J Clin Periodontol 2(3):126–135CrossRef

13.

Tarnow D, Fletcher P (1984) Classification of the vertical component of furcation involvement. J Periodontol 55(5):283–284CrossRef

14.

Papapanou PN, Tonetti MS (2000) Diagnosis and epidemiology of periodontal osseous lesions. Periodontol 22(1):8–21CrossRef

15.

Nibali L, Zavattini A, Nagata K, Di Iorio A, Lin GH, Needleman I, Donos N (2016) Tooth loss in molars with and without furcation involvement–a systematic review and meta-analysis. J Clin Periodontol 43(2):156–166CrossRef

16.

Huynh-Ba G, Kuonen P, Hofer D, Schmid J, Lang NP, Salvi GE (2009) The effect of periodontal therapy on the survival rate and incidence of complications of multirooted teeth with furcation involvement after an observation period of at least 5 years: a systematic review. J Clin Periodontol 36(2):164–176CrossRef

17.

Bower RC (1979) Furcation morphology relative to periodontal treatment: furcation entrance architecture. J Periodontol 50(1):23–27CrossRef

18.

Tonetti MS, Christiansen AL, Cortellini P (2017) Vertical subclassification predicts survival of molars with class II furcation involvement during supportive periodontal care. J Clin Periodontol 44(11):1140–1144CrossRef

19.

Gher MW Jr, Dunlap RW (1985) Linear variation of the root surface area of the maxillary first molar. J Periodontol 56(1):39–33CrossRef

20.

Jackson Lu HK (1992) Topographical characteristics of root trunk length related to guided tissue regeneration. J Periodontol 63(3):215–219CrossRef

21.

Roussa E (1998) Anatomic characteristics of the furcation and root surfaces of molar teeth and their significance in the clinical management of marginal periodontitis. Clin Anat 11(3):177–186CrossRef

22.

Hou GL, Tsai CC (1987) Relationship between periodontal furcation involvement and molar cervical enamel projections. J Periodontol 58(10):715–721CrossRef

23.

Walker RT (1985) Three-rooted lower first permanent molars in Hong Kong Chinese. Br Dent J 159:298–299CrossRef

24.

Yew SC, Chan K (1993) A retrospective study of endodontically treated mandibular first molars in a Chinese population. J Endod 19(9):471–473CrossRef

25.

Huang RY, Lin CD, Lee MS, Yeh CL, Shen EC, Chiang CY et al (2007) Mandibular disto-lingual root: a consideration in periodontal therapy. J Periodontol 78(8):1485–1490CrossRef

26.

Curzon ME (1973) Three-rooted mandibular permanent molars in English Caucasians. J Dent Res 52(1):181CrossRef

27.

Pecora JD (1992) Three-rooted mandibular molars in patients of Mongolian, Caucasian and Negro origin. Braz Dent J 3(2):113–117

28.

Sperber GH, Moreau JL (1998) Study of the number of roots and canals in Senegalese first permanent mandibular molars. Int Endod J 31(2):117–122CrossRef

29.

Tu MG, Tsai CC, Jou MJ, Chen WL, Chang YF, Chen SY, Cheng HW (2007) Prevalence of three-rooted mandibular first molars among Taiwanese individuals. J Endod 33(10):1163–1166CrossRef

30.

De Moor RJG, Deroose CAJG, Calberson FLG (2004) The radix entomolaris in mandibular first molars: an endodontic challenge. Int Endod J 37(11):789–799CrossRef

31.

Jayasinghe RD, Li TKL (2007) Three-rooted first permanent mandibular molars in a Hong Kong Chinese population: a computed tomographic study. Hong Kong Dent J 4(2):90–93

32.

Müller HP, Eger T (1999) Furcation diagnosis. J Clin Periodontol 26(8):485–498CrossRef

33.

Hou GL, Chen SF, Wu YM, Tsai CC (1994) The topography of the furcation entrance in Chinese molars: furcation entrance dimensions. J Clin Periodontol 21(7):451–456CrossRef

34.

Carnevale G, Pontoriero R, Di Febo G (1998) Long-term effects of root-resective therapy in furcation-involved molars: a 10-year longitudinal study. J Clin Periodontol 25(3):209–214CrossRef

35.

Dannewitz B, Krieger JK, Hüsing J, Eickholz P (2006) Loss of molars in periodontally treated patients: a retrospective analysis five years or more after active periodontal treatment. J Clin Periodontol 33(1):53–61CrossRef

36.

Eickholz P, Pretzl B, Holle R, Kim TS (2006) Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. III. Class II furcations after 10 years. J Periodontol 77(1):88–94CrossRef

37.

Chandra SS, Chandra S, Shankar P, Indira R (2011) Prevalence of radix entomolaris in mandibular permanent first molars: a study in a South Indian population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112(3):e77–e82CrossRef

Title: Prevalence and morphological characteristics of disto-lingual roots in mandibular first molars: a cone beam CT study with diagnostic and therapeutic implications
Authors: Dominic King Lun Ho
Janet H. L. Wong
Georgios Pelekos
Ke Deng
Maurizio S. Tonetti
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Keywords: Digital Volume Tomography
Digital Volume Tomography
Published in: Clinical Oral Investigations / Issue 6/2021
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-020-03733-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prevalence and morphological characteristics of disto-lingual roots in mandibular first molars: a cone beam CT study with diagnostic and therapeutic implications

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 6/2021

Single-component orthodontic adhesives: comparison of the clinical and in vitro performance

The immunohistochemical profile of basal cell nevus syndrome–associated and sporadic odontogenic keratocysts: a systematic review and meta-analysis

Objective assessment of simulated non-carious cervical lesion by tridimensional digital scanning

Effect of ionizing radiation and cariogenic biofilm challenge on root-dentin caries

The use of host defense peptides in root canal therapy in rats

Facilitators and barriers to home-based toothbrushing practices by parents of young children to reduce tooth decay: a systematic review