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Root canal morphology of mandibular incisors in Jordanian population

Article in International Endodontic Journal · December 2006

DOI: 10.1111/j.1365-2591.2006.01159.x · Source: PubMed

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 doi:10.1111/j.1365-2591.2006.01159.x

Root canal morphology of mandibular incisors in a

Jordanian population

A. A. Al-Qudah & L. A. Awawdeh

Faculty of Dentistry, Department of Restorative Dentistry, Jordan University of Science and Technology, Irbid, Jordan

Abstract (i) number and type of root canals; (ii) presence and
location of lateral canals and intercanal communica-
Al-Qudah AA, Awawdeh LA. Root canal morphology of
tions; (iii) location of apical foramina; and (iv) fre-
mandibular incisors in a Jordanian population. International
quency of apical deltas.
Endodontic Journal, 39, 873–877, 2006.
Results The majority of mandibular incisors had a
Aim To investigate the root canal morphology of single canal (73.8% of teeth possessed a Type I canal
mandibular incisors in a Jordanian population using a system). Although 26.2% of the roots possessed two
canal staining and tooth-clearing technique. canals, only 8.7% had two separate apical foramina.
Methodology Four hundred and fifty extracted Conclusions The prevalence of two canals in this
mandibular incisors were collected from dental clinics group of mandibular incisors was 26.2% and is within
within north Jordan. Following pulp tissue removal and the range of previous studies performed on populations
staining of the canal systems, the teeth were decalcified of different racial origin.
with 5% nitric acid, dehydrated with ascending con-
Keywords: mandibular incisors, morphology, root
centrations of alcohol and rendered clear by immersion
canal.
in methyl salicylate. Cleared teeth were examined
by eye and the following features were evaluated: Received 19 February 2006; accepted 27 April 2006

plane, and exposed radiographs. They reported two

Introduction
canals in 40.5% of mandibular incisors. Later, Vertucci
A clear knowledge of the anatomy of root canal systems (1974) used the clearing technique to study the root
is an essential prerequisite to carrying out root canal canal morphology of 300 extracted mandibular anter-
preparation. Many of the problems encountered during ior teeth. Two canals were found in 30% of mandibular
root canal treatment occur because of inadequate central incisors and in 25% of mandibular lateral
understanding of the pulp space anatomy. This applies incisors. Mauger et al. (1998) evaluated the canal
to mandibular incisor teeth as many dentists fail to morphology at different root levels in one hundred
recognize the presence of a second canal. mandibular incisors and reported that 98–100% of the
Current knowledge of pulp space anatomy is based teeth had one canal in the area 1–3 mm from the apex.
on research findings and individual case reports. Many There is a lack of consistency in the reported
studies have examined the root canal systems of prevalence of second canals in mandibular incisors
mandibular incisors. Rankine-Wilson & Henry (1965) (Vertucci 1974, Kaffe et al. 1985, Walker 1988,
filled the root canals of mandibular anterior teeth with Mauger et al. 1998, Sert et al. 2004). The differences
radio-opaque material, sectioned them in a horizontal may be related to study design (in vivo versus ex vivo),
technique of canal identification (radiographic exam-
ination, sectioning and clearing) or to racial diver-
Correspondence: Dr Aladdin Al-Qudah, Faculty of Dentistry,
Department of Restorative Dentistry, Jordan University of
gence. Many studies have reported that root canal
Science and Technology, PO Box 3030, 22110 Irbid, Jordan systems vary according to race (Walker 1988, Haddad
(Fax: +962 2 7095115; e-mail: [email protected]). et al. 1999, Weine et al. 1999, Sert & Bayirli 2004).

ª 2006 International Endodontic Journal International Endodontic Journal, 39, 873–877, 2006 873
 Root canal morphology of mandibular incisors Al-Qudah & Awawdeh

Descriptions of the frequently occurring root canal quency of apical deltas. The canal configurations were
systems of permanent teeth are based largely on studies categorized into the first five types of Vertucci’s
conducted in Europe and North America, and relate to classification (2005) as follows:
teeth of mainly Caucasoid origin. These descriptions Type I. A single canal is present from the pulp
may not be fully applicable to teeth of non-Caucasoid chamber to the apex.
origin. There are no published reports on the root canal Type II. Two separate canals leave the pulp chamber,
anatomy of mandibular incisors in Jordan or other but join to form one canal to the site of exiting.
Middle Eastern countries. Jordan is in the Middle East Type III. One canal leaves the pulp chamber, divides
with an estimated population of 5.8 million. Approxi- into two within the root, and then merges to exit in one
mately, 92% of people living in Jordan are Jordanian canal.
and 98% are Arabs. Type IV. Two separate and distinct canals are present
The purpose of this study was to examine the root from the pulp chamber to the apex.
canal morphology of mandibular incisors in a Jorda- Type V. Single canal leaving the pulp chamber but
nian population using a canal staining and root dividing into two separate canals with two separate
clearing technique. apical foramina.
The five canal configurations are shown in Fig. 1.
Materials and methods
Results
Four hundred and fifty extracted mandibular incisors
were randomly collected from general dental clinics Results are summarized in Tables 1–3. All teeth had
within north Jordan. The gender and age of patients one root. Table 1 shows the number and percentage of
was not known and no attempt was made to differen- each canal type in the mandibular incisor teeth. Of 450
tiate between central and lateral incisors. The teeth teeth, 332 (73.8%) had a single canal. Although
were placed in 3.25% sodium hypochlorite (Hypex 26.2% of the roots possessed two separate canals, only
Bleach, Jordan Chemical industries Co., Amman, Jor- 8.7 had two separate apical foramina (Types IV and V).
dan) for 1 h, after which any remaining soft tissue or Figure 2 shows transparent teeth specimens, demon-
calculus was removed by scaling. Access cavities were strating the five canal configurations observed.
prepared and the pulp tissue removed by immersion in
3.25% sodium hypochlorite overnight, before place-
ment in an ultrasonic bath. The teeth were then rinsed
in running tap water for 2 h and dried overnight. An
endodontic irrigation syringe with gauge 27 needle (BU
Kwang Medical Inc., Seoul, Korea) was used to inject
Indian ink (Sanford rotring GmbH, Hamburg,
Germany) into the root canal system. The root apex
was then immediately placed over small vacuum holes,
connected to a central suction system, until the ink
exited at the apical foramen.
Type l Type ll Type lll
The teeth were demineralized by immersion in 5%
nitric acid for 4 days at room temperature (21 C). The
acid solution was changed every day. The teeth were
washed under the running tap water for 4 h, dried and
dehydrated using ascending concentrations of ethyl
alcohol (70%, 96% and 99%) for 12 h each. Finally,
the dehydrated teeth were placed in methyl salicylate,
which rendered them transparent after about 2 h.
The transparent specimens were examined by the
naked eye, and the following observations were made: Type lV Type V
(i) number and type of root canals; (ii) presence and
location of lateral canals and intercanal communica- Figure 1 Classification of root canal morphology (Vertucci
tions; (iii) location of apical foramina; and (iv) fre- 2005).

874 International Endodontic Journal, 39, 873–877, 2006 ª 2006 International Endodontic Journal
 Al-Qudah & Awawdeh Root canal morphology of mandibular incisors

Table 1 Number and percentage of canal system types in

mandibular incisors (n ¼ 450)
Type of root canal

Type I Type II Type III Type IV Type V

No. (%) 332 (73.8) 49 (10.9) 30 (6.7) 23 (5.1) 16 (3.6)

Table 2 Number and percentage of roots with lateral canals

and intercanal communications (n ¼ 450)
Position of lateral canals
Roots with Intercanal
Lateral canals Coronal Middle Apical communication

No. 28 (6.2) 4 (0.9) 6 (1.3) 18 (4.0) 83 (18.4)

(%)
Figure 3 A lateral canal in the apical third of the root.

Table 3 Number and frequency of roots with central and

lateral foramina and roots with apical deltas (n ¼ 450) Table 3 describes the frequency of roots with cen-
trally and laterally located foramina as well as
Position of apical foramina
frequency of apical deltas. More than half of the roots
Central Lateral Apical deltas (52.2%) had centrally located foramina. Apical deltas
No. (%) 235 (52.2) 215 (47.8) 8 (1.8) were observed in only eight teeth (1.8%).

Discussion
A variety of techniques have been used to study root
canal morphology including radiographic examination
(Kaffe et al. 1985), root sectioning (Mauger et al. 1998)
and staining and clearing techniques (Robertson et al.
1980). It has been reported that fine details of the root
canal system can be visualized by staining and clearing
(Gulabivala et al. 2002) and this method was used in
the present study.
The literature on mandibular incisors reveals that
11–68% of mandibular incisors possess two canals,
although many merge into one canal in the apical 1–
3 mm of the root (Madeira & Hetem 1973, Vertucci
1974, Kartal & Yanikoglu 1992, Miyashita et al. 1997,
Figure 2 Canal configurations observed in this study. From
Mauger et al. 1998, Sert et al. 2004). Vertucci (1974)
left to right: Types I, II, III, IV and V. examined the root canal morphology of 300 mandib-
ular anterior teeth and reported a second canal in
27.5% of mandibular incisors. Miyashita et al. (1997)
Table 2 shows the number and percentage of lateral reported that 12.4% of mandibular incisors contained
canals and intercanal communications as well as two canals, but only 3% had two foramina. Sert et al.
position of lateral canals. Lateral canals were present (2004) noted that two canals were present in 68% of
in only 6.2% of roots. There was an increasing mandibular central incisors. The differences between
prevalence of lateral canals towards the apical third these morphology studies may be related to variations
of the root with approximately 64% occurring in the of examination methods, classification systems, sample
apical part of the roots. A lateral canal in the apical sizes and ethnic background of tooth sources.
third of the root is clearly shown in Fig. 3. Intercanal This study examined the root canal morphology of
communications were found in 83 teeth (18.4%). extracted mandibular incisors collected from dental

ª 2006 International Endodontic Journal International Endodontic Journal, 39, 873–877, 2006 875
 Root canal morphology of mandibular incisors Al-Qudah & Awawdeh

clinics within north Jordan. Therefore, the sample may the average position of apical constriction relative to
not be fully representative of the Jordanian population. root apex. If the position of the foramen is more apical
However, root canal morphology may not vary in a than previously reported, then the position of the apical
young nation of the same ethnic origin. Therefore, the constriction and working length determination may
data presented in this paper is expected to apply to the vary accordingly.
Jordanian population.
It was found that 73.8% of the mandibular incisors
Conclusions
possessed a single root canal. Although two canals
were found in 26.2% of teeth, 67% of these canals Overall, 26.2% of mandibular incisors in this north
joined and exited in a single foramen. Only 8.7% of Jordanian population had two canals. In the teeth with
canals in the teeth exited in two separate foramina two canals, the Type II canal system was the most
(Types IV and V). Therefore, the frequency of two prevalent and Type V was the least prevalent.
canals in the present study was within the range of The high percentage of intercanal communications
previous reports. and centrally located apical foramina is of clinical
The results of this investigation indicate that two relevance.
canals occur in about one-fourth (26.2%) of mandib-
ular incisors. This proportion is not found clinically by
Acknowledgements
practitioners during root canal treatment (Neo & Chee
1990). This is due to failure of the dentist to recognize The authors wish to thank Blackwell publishing Ltd. for
the presence of the second canal and the need for access giving permission to reprint the first five canal config-
cavities to have appropriate inciso-gingival extension to urations in Fig. 8 of the following Ref. ‘Vertucci
facilitate the location of lingual canals. (2005)’.
Of the teeth with two canals, the Type II configura-
tion was most prevalent, followed by Types III, IV and V.
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