New Root Canal Classification System

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Knowledge of root and root canal morphology is a prerequisite for effective non-surgical and surgical endodontic treatments. The external and internal morphological features of roots are variable and complex, and several classifications have been proposed to define the various types of canal configurations that occur commonly. More recently, improvements in non-destructive digital image systems, such as cone-beam and micro-computed tomography, as well as the use of magnification in clinical practice, have increased the number of reports on complex root canal anatomy. Importantly, using
these newer techniques, it has become apparent that it is not possible to classify many root canal configurations using the existing systems. The purpose of this article is to introduce a new classification system that can be adapted to categorize root and root canal configurations in an accurate, simple and reliable manner that can be used in research, clinical practice and training.

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New Root Canal Classification System

  1. 1. Dr Hany M. A. Ahmed Department of Conservative Dentistry, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia Dr Marco A. Versiani Department of Restorative Dentistry, Dental School of Ribeirão Preto, University of São Paulo, Brazil Dr Gustavo De-Deus Department of Endodontics, School of Dentistry, Federal Fluminense University, Rio de Janeiro, Brazil Dr Paul M. H. Dummer School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
  2. 2. Introduction Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International “A thorough understanding of the complexity of the root canal system is essential for understanding the principles and problems of shaping and cleaning, for determining the apical limits and dimensions of canal preparations, and for performing successful microsurgical procedures”
  3. 3. Introduction Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International CARABELLI (1842) MUHLREITER (1870) BLACK (1890) GYSI (1892) PREISWERCK (1901) FISHER (1907) DEWEY (1916)FASOLI (1913) HESS (1917) PUCCI & REIG (1944) DE DEUS (1960) Data generated from classical studies demonstrated that the complexity of the internal and external anatomy of teeth required the creation of a classification system.
  4. 4. Introduction Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Weine et al. (1969) were the first authors to categorize root canal configurations within a single root. Oral Surg Oral Med Oral Pathol. 1969 Sep;28(3):419-25 Type I (1-1) Type II (2-1) Type III (2-2) Type IV (1-2) Later, Weine (1982) added an additional type to his system. Using Roman numbers, configurations were classified into 3 types according to the pattern of division of the main root canal along its course from the pulp chamber to the root apex.
  5. 5. Introduction Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Oral Surg Oral Med Oral Pathol. 1974 Sep;38(3):456-64. In 1974, Vertucci et al. identified more complex canal systems in the study of 200 maxillary second premolars using the clearing technique
  6. 6. Introduction Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Oral Surg Oral Med Oral Pathol. 1974 Sep;38(3):456-64. Using Roman numbers, authors reported a total of 8 configuration types according to the pattern of division of the main root canal along its course from the pulp chamber to the root apex
  7. 7. Introduction Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Despite these efforts to systematically describe the diversity of canal configurations, additional types of canal morphologies have been reported in different populations.
  8. 8. Introduction Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Recently, based on previous reports and anatomical studies using micro-CT technology, Versiani & Ordinola-Zapata (2015) were able to identify 37 types of root canal configuration.
  9. 9. Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International In summary, the most used classification systems are unable to categorize the diversity of root canal configurations as reported in the literature. Introduction
  10. 10. Aim Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Therefore, the purpose of this work is to present a practical system that allows students/trainees, clinicians and researchers to classify root and root canal configurations using any diagnostic method, regardless of their accuracy and reliability.
  11. 11. Methodology Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International • Root canal curvature (Schneider 1971, Pruett et al. 1997) • Canal bifurcation and root fusion (Vertucci 2005) • Accessory canals and apical ramifications (De Deus 1975) • Dens invaginatus (Oehlers 1957) • C-shaped canals (Melton et al. 1991, Fan et al. 2004, Kato et al. 2014) • Taurodontism (Shaw 1928, Jafarzadeh et al. 2008) • Supernumerary roots (Christie et al. 1991, Carlsen & Alexandersen 2000, Song et al. 2010) • And others Exclusion Criteria Literature already has many comprehensive classifications categorizing several morphological aspects and developmental anomalies of the teeth. Therefore, this proposal system does not include the following anatomical variations in the root and root canal system: Despite such information could be useful, the benefits of any new system must be the simplicity, so that it can be adopted universally!
  12. 12. Classification System Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International This system includes codes for 3 components: TN Tooth Number RNumber of Roots O-C-F Root Canal Configuration The canal configuration is identified according to the number of... Orifice(s) Canal System Foramen (Foramina) Tooth number can be written using any numbering system (e.g. universal numbering system, Palmer Notation Numbering System or the FDI World Dental Federation System)
  13. 13. Classification System Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International TN Tooth Number RNumber of Roots O-C-F Root Canal Configuration The canal configuration (O- C-F) is represented by the continuous course of the Root Canal from the Orifice... Orifice(s) Canal System Foramen (Foramina) ...to the Foramen . 1 2 1 Canal Configuration = 1-2-1
  14. 14. Classification System Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Application in Single-Rooted Teeth
  15. 15. Classification System : Application in Single-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Code for Single-Rooted Teeth TN1 O-C-F
  16. 16. Classification System: Application in Single-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 411 1-2-1 • Tooth Number: 41 (mandibular right central incisor) • 1 Root • Canal configuration (O-C-F) identified as 1-2-1
  17. 17. Classification System: Application in Single-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 441 1-2-3 • Tooth Number: 44 (mandibular right first premolar) • 1 Root • Canal configuration (O-C-F) identified as 1-2-3
  18. 18. Classification System: Application in Single-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 341 1-2 • Tooth Number: 34 (mandibular left first premolar) • 1 Root • Canal configuration (O-C-F) identified as 1-2
  19. 19. Classification System: Application in Single-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 211 1 * If the numbers of Orifice (O), Canal (C) and Foramen (F) are the same, then a single code is used. • Tooth Number: 21 (maxillary left central incisor) • 1 Root • Canal configuration (O-C-F) identified as 1-1-1
  20. 20. Classification System: Application in Single-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 151 2 • Tooth Number: 15 (maxillary right second premolar) • 1 Root • Canal configuration (O-C-F) identified as 2-2-2 * If the numbers of Orifice (O), Canal (C) and Foramen (F) are the same, then a single code is used.
  21. 21. Classification System: Application in Single-Rooted Teeth - Summary Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 1111 1152 1341-2 1411-2-1 1441-2-3
  22. 22. Classification System Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Application in Double-Rooted Teeth
  23. 23. Classification System Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International The code for double-rooted teeth includes the identification of both roots TN R1 R22 O-C-F O-C-F Code for Double-Rooted Teeth * If the numbers of Orifice (O), Canal (C) and Foramen (F) are the same, then a single code is used
  24. 24. Classification System: Application in Double-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 14 B P 2 Buccal Root • Tooth Number: 14 (maxillary right first premolar) • 2 Roots: B (Buccal) and P (Palatal) • Canal configuration in both roots: 1-1-1 Palatal Root 1 1 Acessory Canal
  25. 25. Classification System: Application in Double-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 24 B P 2 Buccal Root Palatal Root 1-2-1-2 1 • Tooth Number: 24 (maxillary left first premolar) • 2 Roots: B (Buccal) and P (Palatal) • Canal configuration in the B root: 1-2-1-2 • Canal configuration in the P root: 1-1-1
  26. 26. Classification System: Application in Double-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 33 B L 2 Buccal Root Lingual Root 1 11 If the root canals have a common configuration coronal to canal bifurcation... …then, canal configuration common to both roots is written before the identification of the roots • Tooth Number: 33 (mandibular left canine) • 2 Roots: B (Buccal) and L (Lingual) • Canal configuration in both roots: 1-1-1
  27. 27. Classification System: Application in Double-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 21 M D 2 Mesial Root Distal Root 1 11 Common configuration Acessory Canals • Tooth Number: 21 (maxillary left central incisor) • 2 Roots: M (Mesial) and D (Distal) • Canal configuration in both roots: 1-1-1
  28. 28. Classification System: Application in Double-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 44 B L 2 Buccal Root Lingual Root 1-2 11 Acessory Canal Common configuration • Tooth Number: 44 (mandibular right first premolar) • 2 Roots: M (Mesial) and L (Lingual) • Canal configuration in the B root: 1-2 • Canal configuration in the L root: 1-1
  29. 29. Classification System: Application in Double-Rooted Teeth - Summary Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 214B1P1 224B1-2-1-2P1 2211M1D1 2331B1L1 2441B1-2L1
  30. 30. Classification System Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Application in Multiple-Rooted Teeth
  31. 31. Classification System Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International The code for multiple-rooted teeth includes the identification of more than 2 roots TN R1 R2 Rn n O-C-F O-C-F Code for Multiple-Rooted Teeth O-C-F * If the numbers of Orifice (O), Canal (C) and Foramen (F) are the same, then a single code is used
  32. 32. Classification System: Application in Multiple-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 16 MB DB P 3 1 1 1 MB Root DB Root P Root • Tooth Number: 16 (maxillary right first molar) • 3 Roots: MB (mesiobuccal), DB (distobuccal) and P (Palatal) • Canal configuration in all roots: 1-1-1
  33. 33. Classification System: Application in Multiple-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 26 MB DB P 3 2-1 1 1 MB Root DB Root P Root • Tooth Number: 26 (maxillary left first molar) • 3 Roots: MB (mesiobuccal), DB (distobuccal) and P (Palatal) • Canal configuration in the MB root: 2-1 • Canal configuration in the DB and P roots: 1- 1-1
  34. 34. Classification System: Application in Multiple-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 27 MB DB MP DP 4 2-1 1 1 MB Root DB Root DP Root 1 MP Root • Tooth Number: 27 (maxillary left second molar) • 4 Roots: MB (mesiobuccal), DB (distobuccal) MP (mesiopalatal) and DP (distopalatal) • Canal configuration in the MB root: 2-1 • Canal configuration in the DB, MP, and DP roots: 1-1-1
  35. 35. Classification System: Application in Multiple-Rooted Teeth Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 47 M DB DL 3 2 1 1 DB Root DL Root M Root • Tooth Number: 47 (mandibular right second molar) • 3 Roots: M (mesial), DB (distobuccal) and DL (distolingual) • Canal configuration in the M root: 2-2-2 • Canal configuration in the DB and DL roots: 1- 1-1
  36. 36. Classification System: Application in Multiple-Rooted Teeth - Summary Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 316 MB1 DB1 P1 326 MB2-1 DB1 P1 427 MB2-1 DB1 MP1 DP1 347 M2 DB1 DL1
  37. 37. Classification System Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International Application in Different Teeth
  38. 38. Classification System: Application Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 1121 1311-2-1-2 1411-2-3-1 1421-2-1-2-1 1321-2-1 Single-rooted teeth Double-rooted teeth Multiple-rooted teeth
  39. 39. Classification System: Application Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 324 MB1 DB1 P1 1431-2 1341-2 1441-2-1 1252-1-2 Single-rooted teeth Double-rooted teeth Multiple-rooted teeth
  40. 40. Classification System: Application Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International 327 MB1 DB1 P1 316 MB3-1-2-1 DB1 P1 326 MB2-1-3 DB1 P1 337 M2-1-2 DB1 DL1 Single-rooted teeth Double-rooted teeth Multiple-rooted teeth
  41. 41. Conclusion Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. International The new proposed classification attempts to provide a simple, accurate and practical system that allows students, dental practitioners and researchers to classify root and root canal configurations. It provides detailed information on the tooth number, number of roots and root canal configuration types, whilst excluding developmental anomalies and minor canal anatomy to pave the way for simplicity and universal adoption.

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