An investigation of accessory canals in

primary molars - an analytical study

Urvashi Sharma, Anubha Gulati, & Namrata Gill

ijpd 2016;26:149-156

Dr. Jasmine Kaur

1st yr P.G

INTRODUCTION

The root canal morphology of primary molars is complex.

There are many factors that may complicate paediatric
endodontic treatment like short, narrow, tortuous pulp
canal, continued root resorption and proximity to the
underlying permanent successors.
Also, apart from an accessible primary canal, there could
be inaccessible accessory canals in the furcation areas.
These inaccessible accessory canal could establish pulpalperiodontal connections leading to infection and
subsequent bone loss in the area.
The prevalence of accessory canals varies from 9% to
94%.

AIM
The purpose of this study is

To evaluate the number, anatomical

morphology and patency of the accessory
canals in carious primary molar teeth using
radiovisiography, scanning electron
microscope and serial histological design
sectioning under light microscope.

MATERIAL AND METHOD

Thirty carious molars with no involvment of pulpal
floor and advanced root resorption were taken for the
study.
The organic debris was removed from extracted teeth
by immersing them in 3% hydrogen peroxide followed
by 3% sodium hypochlorite for 10 minutes.

Radiovisiography (phase 1)

The number of accessory canals was recorded under

RVG (RVG- MAX70), operating at 70kvp, 8mA with an
equivalent filteration rate of >2mm aluminium.
Three observers independently observed in dimly lit
room and recorded the number of furcation canals.
After a week, each of the three observers again recorded
the same but randomly provided teeth under same
conditions
Inter observer variability was checked with Cronbachs
alpha and kappa.
The values of both were over 0.8 each, thereby showing
insignificant variability.

Scanning electron microscope(phase 2)

The same teeth were then sectioned.
Sectioning is done horizontally 2mm coronal to the floor
of pulp chamber and 2mm below the external furcation
using a diamond disc.
The specimens were immersed in 3% hydrogen peroxide
followed by 2.5% sodium hypochlorite for 5 minutes.
The sections were dehydrated in fresh samples of
ascending grades of alcohol (15%, 20%, 30%, 50%,
70%, 80%, 90% and two changes of absolute alcohol)
for 15-20 minutes.

After the second wash in absolute alcohol, the specimens

were dried in a desicator for 24 hours.
These specimens were then mounted on labelled
aluminium stubs and placed in vaccum chamber of a
gold coating unit(JEOL JFC- 1100 Fine Coat Ion
Sputter).
The specimens were sputtered with 200-300 gold
under vaccum and analyzed for the presence, shape and
size of accessory canals under SEM (SEM-JOEL JSM6100 Scanning Microscope), with minimum
magnification of 15x at 10kv and maximum
magnification of 3300x at 15kv.

acessory canals observed under RVG (Phase 1)

accessory canals observed under SEM(Phase 2)

Decalcification And Serial Sectioning (Phase 3)

The specimens were cleaned by stirring them in a
solution of 0.2% iodine and 0.4% potassium iodide in 10
parts of water for 30-40 sec followed by washing in
distilled water.
The specimens were decalcified in 10% nitric acid for
1.5 days, then they were processed and embedded in
paraffin wax.
Serial sectioning of 4-5 m thickness of each specimen
were made and stained with haematoxylin and eosin.
The sections were then studied under light microscope
(Eclipse 50i) by a single observer at magnification of
100x and 400x for presence and patency of accessory
canals.

Accessory canals observed under light microscope (Phase 3)

RESULTS

The average number of accessory canals observed was

presented as mean + SD with a range and median.
In phase 1 i.e RVG, out of 30,13 primary molars showed
accessory canals with two molars showing maximum of
3 accessory canals each.
In phase 2 i.e SEM, 22 out of 30 primary molars showed
accessory canals with one molar showing maximum of
13 accessory canals.
In phase 3, i.e Decalcification, out of 28 primary molars,
18 primary molars showed accessory canals with one
molar showing maximum of 11 accessory canals.
Wilcoxon signed-rank test was used to compare the
number of accessory canals.

 The shapes of accessory canals with percentile are as

follows:
oval - 35.9%
round - 30.4%
irregular - 33.7%

Shape

Frequen
cy

Percenta
ge

Size in
microns
Mean + SD

49.71 +
42.434

Oval

33

35.9

Min.

irregular

31

33.7

Max.

225

Round

28

30.4

Percentile

25

19.00

total

92

100.0

Percentile

50

40.00

percentile

75

63.00

Frequencies for shape and size of accessory canals

 In

decalcification and sectioning, 18 teeth showed 47

accessory canals.

29

accessory canals were seen out of these 47 accessory

canals on the external furcation extending to varying
depths in dentin.

The
Of

remaining 18 canals were seen in deeper sections.

the 29 canals seen on external furcation, only two

patent canals were observed.

DISCUSSION
A failure

of endodontic treatment could be due to :- improper case selection.

- limitations of technique.
- root resorption.
- missed canals.
- over extended or inadequate obturation.
- failure to provide an adequate coronal seal.
Accessory canals could be result of :- incomplete fusion of tongue like extensions of
epithelial
diaphragm dividing the root trunk.
- entrapment of ectopic periodontal blood vessels.
- failure of formation of Hertwigs root sheath formation
during early root formation.

 In

this study only furcation canals were studied.

These

canals form pulpal-peridontal connections,

transmitting infection from pulp to peridontium and vice
versa.

This

study showed prevalence of 34.3%with a maximum

of three canals in two teeth under RVG.

Under SEM it showed prevalence of 73.3% with

maximum of 13 canals in one tooth.

 Narrowing

of accessory canals is also observed with

increasing depth into the dentin, this could be result of
formation of tertiary dentin forming `blind` and
`enclosed` canals.
A measure of diameters was also determined under SEM,
which showed a range of 1 to 225.
Under light microscope prevalence of 64.3% was
observed.
Following decalcification and sectioning, most accessory
canals were seen on external furcation & the remaining
canals were observed only in deeper sections.

 Age

and chronic infection could be possible reasons for a

lesser number of patent canals observed in this study.
Transmission of infection in the inter radicular area of
primary molars is not only due to accessory canals but also
it could be due to:- thin pulpal floor.
- increased width of dentinal tubules in primary teeth
compared to permanent teeth.
During endodontic treatment, a material which seals the
pulpal floor would be more advantageous than a material
which flows into the canals.
This would prevent the flow of medicaments from pulp
chamber to the periodontium restricting the pulpal
periodontal infections.

CONCLUSION
The number and anatomic morphology was best
visualised under SEM followed by sectioning and then
RVG.
2. The patency of accessory canals could only be
determined by histological sectioning under light
microscope.
3. Total 73.3% accessory canals were observed under
SEM but only 7% canals were found to be patent under
light microscope.
4. It is suggested that accessory canals in primary molars
is not necessarily the cause of endodontic failure.
1.

REFERENCES
Gutmann

JL. Prevalence, location, and patency of accessory

canals in the furcation region of permanent molars. J
Periodontal 1978; 49:21-26.
Dammaschke T, Witt M, Ott K et al. Scanning electron
microscopic investigation of incidence, location, and size of
accessory foramina in primary and permanent molars.
Quintessence Int 2004; 35: 699-705.
Paras LC, Rapp R, Piesco NP et al. An investigation of
accessory canals in furcation areas of human primary molars:
part 2. Latex pertusion studies of the internal and external
furcation areas to demonstrate accessory canals. J Clin
Pediatr Dent 1993b;17:71-77.

 Sasso

WS, Romani NF, Villa N. Considerations of some types

of dentin and their importance in pathology. I, Reparative
dentin. Rev Fac Odontol Sao Paulo 1996; 4: 191-203.
Ringlestein D, Secw WK. The prevalence of furcation
foramina in primary molars. Pediatr Dent 1989; 11: 198-202.
Neimann RW, Dickinson GL. Jackson CR et al. Dye ingress
in molars. Furcation to chamber floor. J Endod 1993; 19: 293296.
Taylor B. Response of the pulp and to dental caries in primary
molars. J Int Assoc Dent Child 1971; 2: 3.
Lopes-Silva AM, Lage-Marques JL. Evaluation of the
permeability of the furcation area of deciduous molars
conditioned with Er:YAG laser and cyanoacrylate. Psequi
Odontol Bras 2003; 17: 212-216.