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Research Article | DOI: https://doi.org/10.31579/2690-1919/412
1 Postgraduate Dental Student, Restorative and Esthetic Dentistry Department, Faculty of Dentistry, Sana’a University, Sana’a, Yemen.
2 Assistant professor of Endodontics, Department of Restorative and Esthetic Dentistry, Sana’a University, Republic of Yemen.
3 Associate professor of Restorative Dentistry. Fixed Prosthodontics, Restorative and Esthetic Dentistry Department, Faculty of Dentistry, Thamar University, Yemen.
4 Professor of Restorative Dentistry, Dental Implant Consultant, Restorative and Esthetic Dentistry Department, Faculty of Dentistry, Sana’a University, Sana’a, Yemen.
5 Lecturer of Dental Radiology Department, Faculty of Dentistry, Baghdad University.
*Corresponding Author: Abdulwahab Ismail Al-Kholani, Professor of Restorative Dentistry, Dental Implant Consultant, Restorative and Esthetic Dentistry Department, Faculty of Dentistry, Sana’a University, Sana’a, Yemen.
Citation: Ali Al-kinani MA, Al-Shameri BHH, Mohsen Ali Al-Hamzi, Al-kholani AI, Amaal M. Alnesairy, et al, (2024), Root and Canal Morphology of Permanent Maxillary and Mandibular Canines in a Sample of Yemeni Population Using Cone Beam Computed Tomography, J Clinical Research and Reports, 16(5); DOI:10.31579/2690-1919/412
Copyright: © 2024, Abdulwahab Ismail Al-Kholani. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 18 September 2024 | Accepted: 30 September 2024 | Published: 07 October 2024
Keywords: cone-beam computed tomography; maxillary canine; mandibular canine; root morphology; yemeni population
Aims and Objective: This study aimed to investigate the external and internal morphological characteristics, including crown shape, root curvature, canal diameter, and root canal configuration, of maxillary and mandibular canine teeth in a Yemeni population using cone-beam computedtomography (CBCT).
Materials and Methods: A total of 400 CBCT images (200 maxillary, 200 mandibular) were analyzed from 400 Yemeni subjects (averageage 34).
Results: All maxillary canineshad a single root, while 4% of mandibular canineshad two roots (slightly higherin females, but not significantly). Maxillary canines were markedly larger in males (p = 0.001). Most maxillary canines(98.5%) had a single root canal, while 16.5% of mandibular canines had two (significantly higher in males). Using the Vertucci classification, root canal configuration analysis showed that maxillary canineswere predominantly Type I, while mandibular canines displayed more variation.
Conclusion: This study provides insights into the morphological characteristics of Yemeni canine teeth. Gender is a significant factor in canine dimensions, with males having larger teeth.
Successful endodontic treatments require a comprehensive understanding of root canal system (RCS) morphology. Lack of familiarity with anatomical variations can lead to incomplete cleaning, shaping, and filling, resulting in treatment failure. [1]
Canine teeth play a crucial role in dental occlusion, mastication, and esthetics. Understanding their external and internal morphology is ess ential for various clinical procedures, including root canal treatment, tooth extraction, and prosthetic rehabilitation. Anatomical variations in the number of roots and root canal morphology can significantly impact the complexity and success of endodontic and surgical interventions. [4, 5]
Previous studies have investigated the external and internal morphology of canine teeth in different populations using various imaging techniques. These studies have reported variations in the number of roots, root canal configurations, and anatomical dimensions across different ethnic and geographic groups. [6, 7]
Cone-beam computed tomography (CBCT) has become an invaluable tool in dental research and clinical practice. It provides high-resolution three-dimensional (3D) images, allowing for detailed analysis of tooth morphology. [8, 9]
To the best of our knowledge, no studies have investigated the external and internal morphological characteristics of maxillary and mandibular canine teeth in a Yemeni population using CBCT imaging. This study aimed to analyze the morphology, including the number and type of roots, as well as the anatomical dimensions of maxillary and mandibular canine teeth in a sample of the Yemeni population using CBCT.
Study Design and Sample Selection
This cross-sectional study utilized CBCT images of Yemeni subjects. A total of 400 CBCT images were analyzed, with 200 each for maxillary and mandibular canines. The study population consisted of 400 Yemeni individuals aged 18-50, with an equal distribution of males and females for each jaw.
Inclusion criteria:
• Yemeni individuals aged 18-50 years
• Complete set of permanent dentition
• No previous dental treatments or abnormalities in canine teeth
• High-quality CBCT images without artifacts or distortions
Exclusion criteria:
• Pathological conditions or developmental anomalies in canine teeth
• Poor image quality or significant artifacts in CBCT images
The study was approved by the Institutional Review Board, and informed consent was obtained from all participants.
CBCT Image Acquisition and Analysis
All CBCT images were acquired using a standardized protocol with a Planmeca ProMax 3D Mid machine. Scans were performed with an 8x8 cm field of view, a 0.2 mm voxel size, and a 12-second exposure time.
Two experienced oral and maxillofacial radiologists analyzed the CBCT images using Planmeca Romexis software. The number and type of roots, as well as the anatomical dimensions (crown length, root length, and total length) of the maxillary and mandibular canine teeth, were assessed and recorded.
Statistical Analysis
Data were analyzed using SPSS software. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were calculated. The Chi-square test was used to compare the number of roots between genders, and the independent t-test was used to compare anatomical dimensions between male and female subjects. A p-value of less than 0.05 was considered statistically significant.
Root Anatomy of Maxillary and Mandibular Canines
Root Number:
• Maxillary canines: All maxillary canines examined had a single root.
• Mandibular canines: 96% were single rooted, while 4% had two roots. There was a slightly higher incidence of two-rooted mandibular canines in females compared to males, but this difference was not statistically significant (p > 0.05). (Table 1)
Anatomical Dimensions:
• Maxillary canines:
The average anatomical length of the maxillary canine crown was 8.3 mm, and the root was 16.8 mm.
The total average length was 25.1 mm.
Male patients had significantly longer maxillary canines than female patients (p = 0.001). (Table 2)
Mandibular canines:
Single-rooted mandibular canines had an average root length of 15.5 mm, crown length of 7.8 mm, and total length of 23.3 mm. (Table 3)
oTwo-rooted mandibular canines had an average root length of 12.5 mm per root, crown length of 9.4 mm, and total length of 21.9 mm. (Table 3)
Male individuals had significantly larger mandibular canines than female individuals (p = 0.001). (Table 4)
Root Canals:
• Maxillary canines: 98.5% had a single root canal, while 1.5% had two. There was no significant difference between males and females. (Table 5)
• Mandibular canines: 83.5% had a single root canal, while 16.5% had two. Males had a significantly higher prevalence of two-canal mandibular canines compared to females (p = 0.04). (Table 5)
Root Canal Configurations:
• Maxillary canines: The most common configuration was Type I (98.5%), followed by Type III (1%) and Type VII (0.5%). No significant differences were observed between males and females. (Table 6)
• Mandibular canines: The most common configuration was Type I (83.5%), followed by Type III (11%). Significant differences were found between genders, with Type I and Type V being more prevalent in females and Type III being more common in males. (Table 6)
Bilateral Symmetry:
• Maxillary canines: There was 100% bilateral symmetry for the number of roots, 99% for the number of root canals, and 99% for canal configurations. (Table 7)
• Mandibular canines: There was 98% bilateral symmetry for the number of roots, 97% for the number of root canals, and 95% for canal configurations. (Table 7)
Overall, maxillary canines consistently exhibited a single root and a single root canal, while mandibular canines showed more variation in root and canal anatomy.
| Root canal | Male (100) | Female (100) | Total | CI 95% | ||||
| N | % | N | % | N | % | Max | Man | |
| One root | 97 | 48.5% | 95 | 47.5% | 192 | 96.0% | 2.5 | 0.1 |
| Two roots | 3 | 1.5% | 5 | 2.5% | 8 | 4.0% | ||
| OR | 0.6 | |||||||
| *χ2 = 0.5 p= 0.5 | ||||||||
Table 1. Number of roots in the mandibular canines.
| Gender | Root length | Crown length | Total length | |||
| N | Mean ±SD | N | Mean ±SD | N | Mean ±SD | |
| Male | 100 | 17.7±1.8 | 100 | 8.4±1.0 | 200 | 26.2±1.9 |
| Female | 100 | 15.8±2.1 | 100 | 8.1±0.7 | 200 | 23.9±2.2 |
| (male+ female) | 200 | 16.8 | 200 | 8.3 | 200 | 25.1 |
| P Value | 0.001 | 0.006 | 0.001 | |||
Table 2: The cumulative mean tooth length of maxillary canine (root & crown)of the female and male.
| variable | Average length | Root | Crown | Total (root+ crown) |
| One root | N=192 | 15.5 | 7.8 | 23.3 |
| Two roots | N=8 | L+B=12.5 | 9.4 | 21.9 |
Table 3: The average lengthof mandibular canines with one and two roots
| Variable | Male | Female | P | ||
| N | Mean ±SD | N | Mean ±SD | ||
| Root length | 97 | 16.2±1.6 | 95 | 14.8±2.2 | 0.001 |
| Root length (L)* | 3 | 11.8±2.3 | 5 | 13.3±0.4 | 0.4 |
| Root length (B)* | 3 | 11.8±2.3 | 5 | 13.2±0.4 | 0.4 |
| Crown length | 100 | 7.9±0.9 | 100 | 7.7±0.9 | 0.1 |
| Total length | 97 | 24.0±1.9 | 95 | 22.5±2.5 | 0.001 |
| Total lengthof teeth has two roots | 3 | 21.6±2.5 | 5 | 22.5±0.7 | 0.6 |
*L: lingual root / *B: buccal root
Table 4. The cumulative mean tooth lengthof the mandibular canine (root& crown) of the femaleand male.
| Variable | Root canal | Male (100) | Female (100) | Total (200) | CI 95% | P value | ||||
| N | % | N | % | N | % | Max | Man | 0.6 | ||
Maxillary canines | One canal | 98 | 49.0% | 99 | 49.5% | 197 | 98.5% | 22.6 | 0.2 | |
| Two canals | 2 | 1.0% | 1 | 0.5% | 3 | 1.5% | ||||
Mandibular canines | One canal | 78 | 39.0% | 89 | 44.5% | 167 | 83.5% | 5.0 | 1.04 | 0.04 |
| Two canals | 22 | 11.0% | 11 | 5.5% | 33 | 16.5% | ||||
Table 5. Distribution of number of canals in permanent maxillary and mandibular canines
| Variable | Gender | Type I | Type II | Type III | Type V | Type VII | P value | |||||
| N | % | N | % | N | % | N | % | N | % | 0.6 | ||
Maxillary canines | Male (100) | 98 | 49.0% | … | … | 1 | 0.5% | … | … | 1 | 0.5% | |
| Female (100) | 99 | 49.5% | … | … | 1 | 0.5% | … | … | 0 | 0.0% | ||
| Total | 197 | 98.5% | … | … | 2 | 1.0% | … | … | 1 | 0.5% | ||
Mandibular canines | Male (100) | 78 | 39% | 2 | 1.0% | 17 | 8.5% | 3 | 1.5% | … | … | 0.04 |
| Female (100) | 89 | 44.5% | 1 | 0.5% | 5 | 2.5% | 5 | 2.5% | … | … | ||
| Total | 167 | 83.5% | 3 | 1.5% | 22 | 11.0% | 8 | 4% | … | … | ||
Table 6. Distribution of root canal configuration in permanent maxillary and mandibular canines.
Variable | Maxillary canines | Mandibular canines | ||||
| Right (n=100) | Left (n=100) | Number of symmetrical teeth | Right (n=100) | Left (n=100) | Number of symmetrical teeth | |
| One root | 100 | 100 | 200 | 97 | 95 | 190 |
| Two roots | ----------- | ----------- | ------ | 3 | 5 | 6 |
| Total | 100 | 100 | 200 | 100 | 100 | 196 |
| Total symmetry n (%) | 100% | 98% | ||||
| One root canal | 98 | 99 | 196 | 85 | 82 | 164 |
| Two root canals | 2 | 1 | 2 | 15 | 18 | 30 |
| Total | 100 | 100 | 198 | 100 | 100 | 194 |
| Total symmetry n (%) | 99% | 97% | ||||
| Vertucci type I | 98 | 99 | 196 | 85 | 82 | 164 |
| Vertucci type II | … | … | … | 1 | 2 | 2 |
| Vertucci typeIII | 1 | 1` | 2 | 9 | 12 | 18 |
| Vertucci type V | …….. | ……… | ……. | 3 | 5 | 6 |
| Vertucci typeVII | 1 | ………. | 0 | … | … | … |
| Total | 100 | 100 | 198 | 100 | 100 | 190 |
| Total symmetry n (%) | 99% | 95% | ||||
Table 7. Bilateral symmetryof maxillary and mandibular canines.
A comprehensive understanding of root canal morphology is paramount for the successful outcome of endodontic treatment. However, dentists must be vigilant in identifying less common root canal variations to ensure proper treatment. The failure to locate and treat all root canals can lead to negative treatment outcomes [10].
Since the late 19th century, various techniques have been employed to study dental root canal anatomy, including replication [11], histopathological analysis [12], radiography [13], microscopy [14], and micro-computed tomography (micro-CT) [15]. While these methods have provided valuable insights, they often involve invasive procedures that can alter the true morphology.
To overcome the limitations of previous techniques, cone-beam computed tomography (CBCT) has emerged as a non-invasive, three-dimensional imaging modality for evaluating external and internal dental anatomy. CBCT offers accurate, isotropic imaging that allows for precise visualization and measurement of anatomical features, unlike traditional medical CT scans [16]. The increasing use of CBCT in clinical practice has facilitated a better understanding of normal and atypical root canal morphology, which is crucial for improving the success of endodontic treatments [17].
The primary objective of this study was to investigate the morphology and canal anatomy of the roots of maxillary and mandibular permanent canines in a sample of the Yemeni population using an in vivo CBCT method.
This study found a 4% incidence of double roots in lower canines, which is consistent with the 4.7% rate reported in an Iranian population [18]. However, this rate is higher than those reported in several other populations, such as Iraqi (2.17%), Saudi (0.2%, 2.88%, and 1.6%), Moscow (0.2%), Turkish (3.1% and 3.4%), Brazilian (1.7%), Chinese (0.7%), South Asian Indian (0%), Chongqing (0.8%), Malaysian (1.21%), Iranian (1.3% and 1.6%), and Syrian (2.15%) [19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 7, 31]. In contrast, the rate is lower than the 12.08% reported in the Iranian population [32] and the 5.2% reported in the Pakistani population [33], as well as the 5.8% found in a Serbian population [34]. The variations in the incidence of double roots in lower canines across different populations could be attributed to genetic, racial, and geographical factors.
Regarding the maxillary canines, the present study did not find any instances of two-rooted maxillary canines, which is consistent with several previous studies conducted in various populations worldwide, including the USA by Green, UK, Mexico, Brazil, Vertucci in the USA, South Africa, Moscow, Turkey, and Iran [36, 37, 38, 13, 39, 23, 25, 22].
The present study found that gender had no significant effect on the distribution of root numbers in the maxillary and mandibular canines among the Yemeni population. This finding is consistent with studies conducted on Saudi Arabian populations [40, 20, 21]. Similar results were also reported in a Malaysian subpopulation [30]. In contrast, studies on Iranian and Turkish populations have reported statistically significant differences in the number of roots between gender [7, 25]. The variations in gender-based differences across different populations suggest that root canal morphology of canines may be influenced by genetic, racial, and geographical factors.
The prevalence of two canals in mandibular canines in this study was found to be 16.5%, which is higher than the values reported in several previous studies. Pineda and Kuttler [13] found a prevalence of 13.5%, Pecora et al. [26] reported 7.8%, Han et al. [41] found 6.3%, Kayaoğlu et al. [24] reported 6.1%, Mağat found 9.4% [42], Okumus and Kanyılmaz reported 7.2% [43], Büyükbayram et al. found 15.8% [44], Soleymani et al. found 11.6% [7], Almohaimede et al. reported 9.94% [21], and Mashyakhy found 9.3% [40]. However, the prevalence found in the present study was lower than that reported by Rahimi et al. (20.48%) [33], Vertucci (22%) [39], Aminsobhani et al. (28.2%) [18], Sert et al. (24%) [12], Naseri (18.4%) [31], and Amardeep et al. (20.4%) [45].
Regarding the maxillary canines, the present study found that 98.5% had a single canal, and only 1.5% had two canals. These findings are consistent with the results reported by Mashyakhy in a Saudi population (99% with one canal, 1% with two canals) [40] and Almohaimede et al. in a Saudi population (98.1% had one canal, 1.9% had two canals) [21]. However, these results differ from those in Malaysian and Iranian populations, where 100% of the maxillary canines had a single canal [30, 46]. The study by Naseri et al. in an Iranian population reported a higher frequency of two root canals in maxillary canines (34.9%), which is significantly different from the present findings [31]. This variation could be attributed to ethnic and genetic differences.
In this study, the prevalence of two canals in both maxillary and mandibular canine teeth was higher in males than females. This finding is consistent with the observations made by Sert and Bayirli [12], Altunsoy et al. [6], and Soleymani et al. [7], who also reported a higher incidence of two-canal canines in male subjects. In contrast, Kayaoğlu et al. [24] reported that canines with two canals were more often found in females than in males. This discrepancy in findings across different studies may be attributed to variations in study populations, sample sizes, and the diagnostic techniques employed. The average anatomical length of the maxillary canine crown was 8.3 mm in this study, which is not consistent with previous reports, which have stated the average maxillary canine crown length to be 10 mm [47] and 9.61 mm [45]. The average root length of the maxillary canine in the current study was 16.8 mm, which is in closer agreement with the previously reported averages of 17 mm [47] and 16.82 mm [45]. The total average length of the maxillary canine (crown and root) in the present study was 25.1 mm, which is shorter than the international average records of 26.5 mm [48] and 27.31 mm [49]. This discrepancy may be attributed to potential population-specific variations in tooth dimensions.
Regarding the mandibular canine, the average crown length in the present study was 7.8 mm, which is shorter than the 11 mm reported by Ash and Nelson [47]. The average root length of the mandibular canine was 15.5 mm, and the root was significantly longer in males than in females. These findings are consistent with the studies by Versiani et al. [50], Amardeep et al. [45], Soleymani et al. [7], and Doumani et al. [32], who also observed gender-related differences in mandibular canine root lengths.
The present study also revealed that the average tooth length of the evaluated maxillary and mandibular canines among Yemeni males was significantly longer than that in females. This observation is in line with the findings reported by Kulkarni et al. [51]. Based on Vertucci's classification, 83.5% of the mandibular canines were found to have a Type I canal configuration, followed by Type III (11%), Type V (4%), and Type II (1.5%). Our results agree with those reported in a previous investigation in a Saudi subpopulation by Mashyakhy [40] and Almohaimede et al. [21], in a Turkish population [25], and in an Iranian population [31], where most canal configurations were Type I followed by Type III and Type V. However, another study in a Saudi subpopulation by Al Dahman et al. [20] and Vertucci's study [39] found that the second most commonly occurring canal pattern was Type II followed by Type III. In another study in a Saudi population [22], it was recorded that Type I canal configuration was found in most mandibular canines (95.8%), followed by Type III (1.9%) and Type II (1.1%). Type IV canal pattern in mandibular canines was not observed in this study, whereas several studies showed this configuration pattern in lower canines [39, 13, 12, 26].
This study, conducted through CBCT imaging of a Yemeni population, offers significant insights into the external and internal morphological characteristics of maxillary and mandibular canine teeth. Our findings reveal that gender plays a substantial role in determining the anatomical dimensions of both maxillary and mandibular canines, with males exhibiting larger canine dimensions than females. Regarding root canal anatomy, the maxillary canine was predominantly found to have a single root canal, with a low prevalence of two-canal configurations. In contrast, the mandibular canine exhibited a higher occurrence of two-canal configurations, especially in male individuals.
An analysis based on Vertucci's classification revealed that the majority of maxillary canines had a Type I root canal configuration, with no significant gender-related differences. However, the distribution of root canal types in mandibular canines differed significantly between males and females. These results hold important clinical implications for various dental procedures and contribute to a deeper understanding of dental anatomy within the Yemeni population.
This study provides valuable insights into the external and internal morphological characteristics of maxillary and mandibular canine teeth in a Yemeni population using CBCT imaging. The findings suggest that gender is an influential factor in the anatomical dimensions of both maxillary and mandibular canine teeth, with male subjects exhibiting larger canine dimensions compared to their female counterparts The theory of maxillary canines had a single root canal, with a low prevalence of two-canal anatomy. In contrast, the mandibular canines exhibited a higher occurrence of two-canal configurations, particularly in male individuals.
The analysis of root canal configurations based on Vertucci's classification revealed that the majority of maxillary canines had a Type I configuration, with no significant gender-related differences. However, the distribution of root canal types in mandibular
Limitations:
• Sample size: A larger sample is needed for broader generalizability.
• Age range: Expanding the age range can explore age-related variations.
• Other factors: Systemic diseases, medications, and dental trauma should be considered.
• CBCT limitations: Image resolution can be inadequate for small or calcified canals.
• Comparative studies: Compare with other populations for global variations.
• Developmental aspects: Investigate root canal development over time.
• Correlation with dental problems: Explore the relationship between morphology and dental issues.
• Advanced imaging: Use micro-CT for higher-resolution images.
• Clinical implications: Study the impact of morphology on endodontic treatment outcomes.
The authors declare that they received no funding for this research.
The authors declare that they have no conflicts of interest.
• Manar Abdulsalam Ali Al-kinani: Primary investigator, data analysis, manuscript writing
• Other authors: Data collection, analysis, interpretation, manuscript review
• Supervisor: Professor Abdulwahab Al-kholani study conception, guidance, oversight, manuscript review
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