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Microcomputed tomography analysis of the


root canal morphology of single-rooted
mandibular canines
Article in International Endodontic Journal January 2013
DOI: 10.1111/iej.12061 Source: PubMed

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University of So Paulo

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doi:10.1111/iej.12061

Microcomputed tomography analysis of the root


canal morphology of single-rooted mandibular
canines

cora & M. D. Sousa-Neto


M. A. Versiani, J. D. Pe
Department of Restorative Dentistry, Faculty of Dentistry, University of S~
ao Paulo, Ribeir~
ao Preto, Brazil

Abstract
 cora JD, Sousa-Neto MD. MicroVersiani MA, Pe
computed tomography analysis of the root canal morphology
of single-rooted mandibular canines. International Endodontic
Journal.

Aim To investigate the anatomy of single-rooted mandibular canine teeth using microcomputed tomography
(lCT).
Methodology One hundred straight single-rooted
human mandibular canines were selected from a pool
of extracted teeth and evaluated using lCT. The anatomy of each tooth (length of the roots, presence of
accessory canals and apical deltas, position and major
diameter of the apical foramen and distance between
anatomical landmarks) as well as the two- and threedimensional morphological aspects of the canal (area,
perimeter, form factor, roundness, major and minor
diameter, volume, surface area and structure model
index) were evaluated. The results of the morphological analysis in each canal third were compared statistically using Friedmans test (a = 0.05).
Results The length of the roots ranged from 12.53
to 18.08 mm. Thirty-one specimens had no accessory

Introduction
The main role of laboratory-based studies is to develop
well-controlled conditions that are able to reliably
compare certain factors. The main confounding factor
of ex vivo studies is the anatomy of the root canal sys-

Correspondence: Manoel D. Sousa Neto, Rua Celia de Oliveira


Meirelles 350, 14024-070 Ribeir~ao Preto, SP, Brazil (Tel./
Fax: +55-16-3603-6783; e-mail: sousanet@forp.usp.br).

canals. The location of the apical foramen varied considerably. The mean distance from the root apex to
the major apical foramen was 0.27  0.25 mm, and
the major diameter of the major apical foramen ranged from 0.16 to 0.72 mm. Mean major and minor
diameters of the canal 1 mm short of the foramen
were 0.43 and 0.31 mm, respectively. Overall, the
mean area, perimeter, form factor, roundness, major
and minor diameters, volume, surface area and
structure model index (SMI) were 0.85  0.31 mm2,
3.69  0.88 mm, 0.70  0.09, 0.59  0.11, 1.36
 0.36 mm and 0.72  0.14 mm, 13.33  4.98
mm3, 63.5  16.4 mm2 and 3.35  0.64, respectively, with significant statistical difference between
thirds (P < 0.05).
Conclusions The anatomy and morphology of the
root canal of single-rooted canines varied widely in
different levels of the root.
Keywords: mandibular canine,
tomography, root canal anatomy.

microcomputed

Received 3 October 2012; accepted 1 January 2013

tem under investigation. Consequently, the results


might demonstrate the effect of canal anatomy rather
than the variable of interest (De-Deus 2012). Generally, the most common method for sample selection in
endodontic research has been radiography. However,
the accuracy of radiography in assessing the morphology of the root canal system is reduced because it provides only a two-dimensional image of a threedimensional structure (Pascon et al. 2009). Additionally, root canal anatomy has been evaluated using
clearing techniques, longitudinal and transverse cross-

2013 International Endodontic Journal. Published by Blackwell Publishing Ltd

International Endodontic Journal

Root canal anatomy of mandibular canine Versiani et al.

sectioning and scanning electron microscope (Vertucci


1984). However, these methods are invasive and,
therefore, cannot accurately reflect the morphology of
the object being studied (Versiani et al. 2011a).
In recent years, microcomputed tomography (lCT)
has gained increasing significance in the study of
hard tissues in endodontics as it offers a reproducible
technique that can be applied quantitatively as well
as qualitatively for the three-dimensional assessment
of the root canal system (Peters et al. 2001, Versiani
et al. 2011a, b, 2012). Consequently, this method
might improve the matching of teeth to enhance the
internal validity of ex vivo experiments.
In endodontic research, different groups of teeth
have been used. Amongst them, the single-rooted
mandibular canine has been extensively used for testing materials and techniques (Sp
angberg 1990).
Although its morphology has been investigated previously (De-Deus 1975, Vertucci 1984, Pecora et al.
1993), no research has been undertaken to evaluate
its anatomy in detail using high-resolution computed
tomography. Thus, considering that a thorough
understanding of the variations in root canal morphology of single-rooted canine is essential for its
experimental use in endodontic research, as well as
for overcoming problems related with shaping and
cleaning procedures, the purpose of this ex vivo study
was to investigate the root canal anatomy of
extracted single-rooted human mandibular canine
teeth using microcomputed tomography.

Materials and methods


After ethics committee approval, one hundred straight
single-rooted human mandibular canine teeth with
fully formed apices and a single root canal were randomly selected from a pool of extracted teeth, decoronated, and stored in labelled individual plastic vials
containing 0.1% thymol solution. After being washed
in running water for 24 h, each tooth was dried,
mounted on a custom attachment and scanned in a
lCT scanner (SkyScan 1174v2; Bruker-microCT,
Kontich, Belgium) at an isotropic resolution of 19.6 lm.
Images of each specimen were reconstructed from
the apex to the level of the cemento-enamel junction
with dedicated software (NRecon v. 1.6.3; BrukermicroCT), providing axial cross sections of the inner
structure of the samples. For each tooth, evaluation
was performed for the full canal length (approximately 790 slices) totalling up to 79 035 slices. DataViewer v. 1.4.4 software (Bruker-microCT) was used

International Endodontic Journal

to evaluate the length of the roots, the presence of


accessory canals and apical deltas, the position of the
major apical foramen and distance between several
anatomical landmarks at the apex. The major diameter of the major apical foramen as well as the buccolingual and mesio-distal diameters of the root canal
1 mm short of the apical foramen was also measured.
CTAn v. 1.12 software (Bruker-microCT) was used for
the two-dimensional (area, perimeter, form factor,
roundness, major diameter and minor diameter) and
three-dimensional (volume, surface area and structure
model index) evaluation of the root canal.
Area and perimeter were calculated using the Pratt
algorithm (Pratt 1991). The cross-sectional appearance, round- or more ribbon-shaped, was expressed as
roundness and form factor. Roundness of a discreet
two-dimensional object is defined as 4.A/(p.[dmax]2),
where A is the area and dmax is the major diameter.
The value of roundness ranges from 0 to 1, with 1 signifying a circle. The form factor is calculated by the
equation (4.p.A)/P2, where A and P are object area
and perimeter, respectively. Elongation of individual
objects results in smaller values of form factor. The
major diameter was defined as the distance between
the two most distant pixels in that object. The minor
diameter was defined as longest chord through the
object that can be drawn in the direction orthogonal to
that of the major diameter. Volume was calculated as
the volume of binarized objects within the volume of
interest. For the measurement of the surface area of the
three-dimensional multilayer data set, two components
to surface measured in a two-dimensional plane were
used; first the perimeters of the binarized objects on
each cross-sectional level and second the vertical surfaces exposed by pixel differences between adjacent
cross sections. Structure model index (SMI) involves a
measurement of surface convexity in a three-dimensional
structure.
SMI
is
derived
as
6.((S.V)/S2), where S is the object surface area before
dilation and S is the change in surface area caused by
dilation. V is the initial, undilated object volume. An
ideal plate, cylinder and sphere have SMI values of 0, 3
and 4, respectively (Hildebrand & R
uegsegger 1997).
CTVox v. 2.4 and CTVol v. 2.2.1 software (Bruker-microCT) were used for visualization and qualitative evaluation of the specimens.
The results of two- and three-dimensional analyses
of each third of the root canal were compared statistically using Friedmans test with the significance level
set as 5%. Data analysis was performed with SPSS
v. 17.0 for Windows (SPSS Inc, Chicago, IL, USA).

2013 International Endodontic Journal. Published by Blackwell Publishing Ltd

Versiani et al. Root canal anatomy of mandibular canine

Figure 1 Frontal and lateral views of three-dimensional models of the root canals of 100 single-rooted mandibular canines.

Results
Three-dimensional reconstruction of the internal
anatomy revealed that all specimens had only one
main root canal (Fig. 1). The length of the roots
measured from the apex to the cemento-enamel junction at the buccal aspect of the root ranged from
12.53 to 18.08 mm (15.57  1.20 mm). Thirty-one
specimens had no accessory canals (Fig. 2a), and
four specimens had a lateral canal in the middle
third (Fig. 2b). No accessory canals were observed in
the cervical third of the samples, and apical deltas
were observed in six specimens (Fig. 2c). In 62
canines, the number of accessory canals in the apical
third ranged from 1 to 3, in a total of 112 canals
(Fig. 2d).

The location of the major apical foramen varied


considerably, tending to the disto-buccal (26%), distal
(24%) and buccal (22%) aspects of the root. In five
specimens, the apical foramen coincided with the anatomical apex, but the position of the foramen also
occurred at the lingual (12%) and disto-lingual (11%)
aspects of the root.
Mean sizes and distances ( SD) between reference
landmarks at the apex are shown in Fig. 3. The perpendicular distance from the root apex to the major
apical foramen ranged from 0 to 1.06 mm (0.27 
0.25 mm). The major diameter of the major apical
foramen was 0.42  0.13 mm, ranging from 0.16 to
0.72 mm. The bucco-lingual diameter of the root
canal 1 mm short of the apical foramen ranged from
0.26 to 0.52 mm (mean of 0.43 mm) and was longer

2013 International Endodontic Journal. Published by Blackwell Publishing Ltd

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Root canal anatomy of mandibular canine Versiani et al.

(a)

(b)

(c)

(d)

Figure 2 Representative three-dimensional models of the internal anatomy of four single-rooted mandibular canines showing
(a) no accessory canals, (b) one lateral canal in the middle third of the root, (c) apical delta and (d) one accessory canal in the
apical third of the root.

(a)

(c)

(b)

Figure 3 Three-dimensional reconstruction of the apical third of a single-rooted mandibular canine. (a) Lateral view of the
apex showing the apical foramen located at the distal aspect of the root and its mean perpendicular distance from the anatomical apex; (b) detail of the apex showing the apical foramen; (c) higher magnification (outlined area in b) showing the mean
( SD) size of the apical foramen (in black), the bucco-lingual (in yellow) and the mesio-distal (in blue) mean diameters of the
root canal 1 mm short of the apical foramen.

than its mesio-distal diameter that ranged from 0.19


to 0.41 mm (mean of 0.31 mm).
The results of two- (area, perimeter, form factor,
roundness, and major and minor diameter) and
three-dimensional (volume, surface area, and SMI)
analysis are detailed in Tables 1 and 2, respectively.
Significant statistical difference between cervical, middle and apical thirds was observed in all analysed
data (P < 0.05). In the apical third, area, perimeter,
major diameter, minor diameter, volume and surface
area were significantly lower, whilst form factor,
roundness and SMI were significantly higher than in
the middle and cervical thirds (P < 0.05). Figure 4
shows the two-dimensional configuration of the root
canal demonstrating that its cross-sectional appearance varied in different levels of the root in a same
tooth, including round, oval, flat and irregular
shapes.

International Endodontic Journal

Discussion
Knowledge of root canal anatomy and its variations is
a basic requirement for successful root canal treatment (Vertucci 2005). The significance of canal anatomy has been emphasized by studies demonstrating
that variations in canal geometry before cleaning and
shaping had a greater effect on the changes that
occurred during preparation than did the instrumentation techniques (Peters et al. 2001). The main
purpose of this study was to evaluate mandibular
canines with a single root canal that extended from
the pulp chamber to the apex (type I) (Vertucci 1974).
It has been reported that the prevalence of type I root
canal configuration in mandibular canines ranged
from 78% to 98% of the sample (Vertucci 1984,
Pecora et al. 1993), but occasionally, it may have two
roots and two canals (Versiani et al. 2011a).

2013 International Endodontic Journal. Published by Blackwell Publishing Ltd

Versiani et al. Root canal anatomy of mandibular canine

Table 1 Morphometric bidimensional data (mean  standard deviation, n = 100)

Area (mm )
Perimeter (mm)
Form factor
Roundness
Major diameter (mm)
Minor diameter (mm)

Cervical

Range








0.392.90
3.139.37
0.280.86
0.170.85
1.163.81
0.451.51

1.62
5.79
0.62
0.47
2.23
1.01

0.56
1.28
0.15
0.16
0.59
0.24

Middle

Range








0.121.54
1.337.50
0.330.88
0.210.88
0.442.80
0.381.06

0.71
3.55
0.71
0.62
1.26
0.74

0.30
1.09
0.13
0.15
0.45
0.14

Apical

Range








0.040.47
0.763.07
0.460.89
0.390.87
0.261.12
0.190.62

0.20
1.70
0.78
0.68
0.59
0.40

0.10
0.46
0.08
0.09
0.17
0.09

Total

Range








0.221.92
1.786.39
0.440.86
0.290.84
0.672.52
0.400.99

0.85
3.69
0.70
0.59
1.36
0.72

0.31
0.88
0.09
0.11
0.36
0.14

Table 2 Morphometric three-dimensional data (mean  standard deviation, n = 100)

Volume (mm )
Surface area (mm2)
SMI

Cervical

Range

Middle

Range

Apical

Range

Total

Range

8.54  3.23
35.7  8.8
2.20  0.52

2.0117.07
16.657.1
0.523.13

3.64  1.61
20.9  7.1
2.33  0.51

0.547.82
6.547.5
0.823.76

1.03  0.52
9.9  3.1
2.54  0.34

0.192.56
3.818.7
1.213.11

13.33  4.98
63.5  16.4
3.35  0.64

3.1624.64
26.4111.9
0.763.61

SMI, structure model index.

Although canines are the longest teeth in the


mouth, an enormous variation in its size and shape
has been reported (Pecora et al. 1993, Woelfel
& Scheid 2002). In the present study, the length of
the roots ranged from 12.53 to 18.08 mm
(15.57  1.20 mm). These results are similar to
Woelfel and Scheid (2002) who reported a mean
length of 15.9 mm (9.522.2 mm) on 316 mandibular canines.
An accessory canal has been defined as any branch
of the main pulp canal or chamber that communicates with the external surface of the root, whilst an
apical delta is the presence of multiple accessory
canals at or near the apex (American Association of
Endodontists 2012). In the present study, 69% of the
sample had accessory canals located at the middle
(n = 4) and apical thirds (n = 65). Apical deltas were
observed only in 6% of the sample. De-Deus (1975)
investigated the frequency, location and direction of
the accessory canals in 1140 human teeth using
clearing technique. He found that only three out of
44 mandibular canines (6.8%) had one or two accessory canals. Using the same method, Vertucci (1984)
evaluated one hundred mandibular canines and
found apical deltas in six teeth and accessory canals
in 30% of the sample, located at the cervical (n = 1),
middle (n = 5) and apical (n = 24) thirds. Such differences could be explained through differences in sample
origin or racial factors, as well as the evaluation methods. However, these results confirm the evidence that,
in mandibular canines, accessory canals are most
prevalent in the apical third (Vertucci 1984).
The classic concept of apical root anatomy is based
on three anatomical and histological landmarks: the

Figure 4 Three-dimensional reconstruction of the pulp cavity of four single-rooted mandibular canines showing the
variations in the two-dimensional configuration of the root
canal in different levels of the root.

apical constriction, the cemento-dentinal junction and


the apical foramen (Kuttler 1955). Although, theoretically, it is desirable to prepare the canal to the apical
constriction (Ricucci & Langeland 1998), this landmark presents morphological variations that make its
identification unpredictable (Dummer et al. 1984). In
the present study, the traditional single constriction
was observed in 52% of the sample. This result is supported by previous studies on different groups of

2013 International Endodontic Journal. Published by Blackwell Publishing Ltd

International Endodontic Journal

Root canal anatomy of mandibular canine Versiani et al.

teeth, using microscopy (Dummer et al. 1984) and


micro-CT (Meder-Cowherd et al. 2011), in which different types of apical constriction were observed.
In the present study, the distance from the apex to
the major foramen ranged from 0 to 1.06 mm
(0.27  0.25 mm), and the eccentric placement of
the major foramen was recognized in almost all specimens (95%), often lying on the buccal aspect of the
root, as previously observed (Kuttler 1955, Chapman
1969, Burch & Hulen 1972, De-Deus 1975, Dummer
et al. 1984, Blaskovic-Subat et al. 1992, Pecora et al.
1993, Vertucci 2005, Martos et al. 2009, 2010). In
the literature, the mean distance between the major
apical foramen and the anatomical root apex in mandibular canines has been reported to be 0.35 mm
(Green 1956), 0.47  0.35 mm (Dummer et al.
1984), and 0.42  0.32 mm (Martos et al. 2009),
which were higher than the present results. These
dissimilarities are probably related to sample origin,
racial factors and the evaluation methods. Radiographically, an apical foramen located buccally or
lingually is superimposed over the root structure,
making it difficult to view the exit point of the instrument (Nekoofar et al. 2006, Martos et al. 2009,
2010). Therefore, the displacement of the major
foramen has the potential to cause an incorrect measurement of the canal and might result in over-instrumentation during root canal preparation (Kuttler
1955, De-Deus 1975, Dummer et al. 1984, Wu et al.
2000, Nekoofar et al. 2006).
The location of the cemento-dentinal junction varies considerably. In general, it is located approximately 1 mm from the major foramen and may not
coincide with the apical constriction (Nekoofar et al.
2006). Its diameter also varies extensively and was
determined to be 298 lm for canines (Ponce & Vilar
Fernandez 2003). In the present study, the mean
bucco-lingual and mesio-distal diameters of the root
canal 1 mm from the apical foramen were 0.43 and
0.31 mm, respectively. These results are in accordance with Wu et al. (2000) who also investigated
canal diameters in the apical region of mandibular
canines and found that the mean bucco-lingual and
mesio-distal diameters 1 mm short of the major foramen were 0.47 and 0.36 mm, respectively. These
results have definite implications for shaping and
cleaning procedures because only the mesio-distal
diameter is evident on radiographs. Besides, it shows
that the size of the root canal 1 mm short of the
major foramen in mandibular canines is similar to
the diameter of size 3545 K-files.

International Endodontic Journal

The diameter of the major apical foramen has been


thought to be the most important factor that influences the performance of electronic apex locators for
measuring working length (Nekoofar et al. 2006). In
the present study, the mean size of the major apical
foramen was similar to the tip of a size 40 K-file
(0.42  0.13 mm), but ranged from 0.16 to 0.72 mm.
Green (1956) also studied the anatomy of the root
apex of 50 mandibular canine and found the apical
diameter similar to a size 30 K-file. Considering that
the sample was collected at random, this variation
might be related to the physiological and pathological
conditions of the teeth at the time of extraction (Martos et al. 2009, 2010).
Overall, the qualitative evaluation (Fig. 1) showed
that the root canal of mandibular canines were wider
mesiodistally than buccolingually. This condition was
more evident in the cervical third in comparison with
the middle and apical thirds. The area, perimeter,
volume and surface area results reflected this morphological feature because they were significantly higher
in the cervical than in the middle and apical thirds.
Unfortunately, these results cannot be compared with
others as there is no information on this subject in
the literature to date. Thus, the clinical relevance of
such findings is still to be determined. However, these
morphological parameters should be taken into consideration when selecting a sample in laboratorybased studies because variations in canal geometry
have been considered to affect the results of such
studies (Peters et al. 2001).
Canals may have different shapes in cross section
in different levels of the root in a same tooth (Wu
et al. 2000). Recesses in flat-, irregular- or ovalshaped canals may not be included in a round preparation created by rotation of instruments, and thus,
they remain unprepared (Wu et al. 2000, Vertucci
2005, Versiani et al. 2011b). In the present study,
the cross-sectional appearance was evaluated using
two morphometric parameters: form factor and
roundness. Overall, the results showed that whilst
form factor diminished from the apical to the cervical
third, the roundness increased. It means that the root
canal at the apical third was more round or slightly
oval in shape in comparison with the middle and
cervical thirds. It is interesting to note that the results
of this study were no different from those obtained
with conventional methods (Wu et al. 2000). Nonetheless, algorithms used in lCT evaluation allow a
description of the shape of the root canal mathematically. In this way, the most important data regarding

2013 International Endodontic Journal. Published by Blackwell Publishing Ltd

Versiani et al. Root canal anatomy of mandibular canine

the cross-sectional appearance of the root canals


were its variation. The minimum and maximum values of roundness and form factor in all thirds were
similar, despite the significance difference of the
means observed between the thirds. It means that
the same canal may have different cross-sectional
forms throughout the root.
The SMI describes the plate- or cylinder-like geometry of an object (Hildebrand & R
uegsegger 1997)
and has been used to assess root canal geometry
(Peters et al. 2000, Versiani et al. 2011a,b, 2012).
The SMI is determined by an infinitesimal enlargement of the surface, whilst the change in volume is
related to changes of surface area, that is, to the convexity of the structure. These three-dimensional data
are impossible to achieve using conventional techniques such as radiographs or grinding. If a perfect
plate is enlarged, the surface area does not change,
yielding an SMI of zero. However, if a rod is
expanded, the surface area increases with the volume
and the SMI is normed so that perfect rods are
assigned SMI score of 3 (Peters et al. 2000). Overall,
the mean SMI ranged from 2.20 to 2.54, which indicates that the root canal systems had a conical frustum-like geometry. However, a large discrepancy
between the minimum and maximum values of SMI
in all thirds was also observed (0.523.61). If these
dissimilarities of the morphological parameters in
each third were not taken into consideration during
the sample selection in ex vivo studies, it might compromise the results.
Ex vivo experiments have been frequently used to
evaluate materials and techniques in dentistry. In
endodontics, a variety of teeth have been used in laboratory-based experiments including maxillary central
incisors, premolars, molars and canines. The reproduction of the clinical situation might be regarded as
the major advantage of the use of extracted human
teeth. On the other hand, the wide range of variations
in three-dimensional root canal morphology makes
standardization difficult (H
ulsmann et al. 2005). Thus,
if selection bias is not taken into account when the
sample is selected, then certain conclusions drawn
might be incorrect. On the basis of lCT data, it
should be possible to further improve sample selection
using established morphological parameters to provide
a consistent baseline. As the state of current knowledge on root canal anatomy advances rapidly, the
clarification of the purposes of sample selection protocols may assist investigators in the field to arrive at
meaningful conclusions (De-Deus 2012).

Conclusions
The anatomy and morphology of the root canal of
single-rooted canine varied widely in different levels
of the root. In summary:
1. The mean length of mandibular canine roots was
15.57  1.20 mm;
2. No accessory canals were observed in the cervical
third, and apical deltas were observed only in 6%
of the sample;
3. The location of the major apical foramen varied
considerably, tending to the buccal aspect of the
root;
4. The mean distance from the root apex to the
major apical foramen was 0.27  0.25 mm;
5. The mean size of the major apical foramen was
0.42  0.13 mm;
6. In the apical third, area, perimeter, major diameter, minor diameter, volume and surface area were
significantly lower, whilst form factor, roundness
and SMI were significantly higher than in the middle and cervical thirds.

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