Introduction. Evidence of second canal in permanent mandibular incisors is frequently questioned in dentistry. The difference in evidence between the two teeth is an interesting argument across different countries and ethnicities. So the aim of the systematic review was to investigate the evidence of second canal between permanent mandibular central and lateral incisors in China. Materials and Methods. The papers were selected from the electronic databases and hand searching according to inclusion and exclusion criteria. All qualified studies were judged by the reviewers. The selected studies were checked with Joanna Briggs Institute Critical Appraisal tool for prevalence studies. Finally, three studies were selected for the review and meta-analyses. The proportion of the second canal with its confidence interval and forest plot for the meta-analyses were calculated. Results. The evidences of second canal in permanent mandibular central and lateral incisors in China were 5.6% and 14.1%. Only one study reported bilateral symmetry of the second canal as 58.7% and 76.1% in the two types of teeth. Out of all canal anatomies, Vertucci’s type ΙΙΙ was dominant comprising 4.1% and 11.2% together with other second-canal types comprising 1.4% and 3% in permanent mandibular central and lateral incisors. When the proportions were meta-analyzed, mandibular central incisors had been less numerous OR = 0.35 [0.31, 0.40], 0.33[0.28, 0.39], and 0.42 [0.22, 0.79] in the evidence of second canal, of Type ΙΙΙ, and of other types except Type ΙΙΙ than mandibular lateral incisors in China. Out of all second-canal anatomies, Type ΙΙΙ presented 72.5% and 78.9% along with other second-canal types comprising 24.3% and 21.1% in the two teeth in China. Discussion. There was the evidence of second canal which deviated toward the permanent mandibular lateral incisor also in case of bilateral symmetry, the prevalence of Vertucci’s Type ΙΙΙ, and other second-canal types out of all canal anatomies.

Introduction. Missed canal is one of the common reasons for nonsurgical endodontic retreatments. The missed canals were frequently associated with periapical pathology. The aim of this systematic review was to find the diagnostic accuracy of CBCT for detection of the second canal of the root canal system of permanent teeth. Materials and Methods. The articles were selected from seven electronic databases according to selection criteria. All eligible studies were judged by the reviewers. The selected studies were checked with the QUADAS-2 tool for risk of bias and applicability concerns. Finally, 12 studies were selected for qualitative and quantitative analyses. The summary estimates of sensitivities and specificities and SROC curves were calculated and drawn by RevMan 5.3 and MetaDTA software. Results. Summary estimates of CBCT for detection of second canal anatomy in permanent teeth were 94% sensitivity and 93.1% specificity. 96.6% sensitivity of MB2 was followed by 88.8% sensitivity of maxillary and mandibular premolars and 81% that of mandibular molars. The specificity of 97.6% for premolars was trialed by 85% specificity of mandibular molars and MB2. For permanent mandibular canines, 67% sensitivity and 100% specificity were estimated. CBCT showed more agreement with detecting the second canal with micro-CT, estimating 100% sensitivity and 95.6% specificity. The highest prevalence of the second canal comprised the highest sensitivity of 99.1% and lowest specificity of 77.5%. After the exclusion of case-control studies, a 3% drop of sensitivity from the summary estimate was observed. Multiple spectrum of the second canal had 8.6% higher sensitivity and 4.4% lower specificity than single spectrum. Conclusion. CBCT is informative for detecting the second canal. Clinicians should keep in mind that the accuracy can vary in different types of teeth, with the prevalence of second canal across different populations, and with the spectrum of second canal anatomy in spite of the reviewers having postulated overestimation of the findings.

Introduction. Although numerous amounts of high-level evidence were present, they solely emphasized the tooth-level prevalence of three-rooted permanent mandibular first molar. Global patient-level prevalence and bilateral symmetrical distribution of this type of teeth were needed to be tackled across the world. The research question was “What is the global prevalence of three-rooted permanent mandibular first molars?” Materials and Methods. In vivo epidemiological studies undergone with Cone Beam Computed Tomography (CBCT) were eligible. The proportions of the prevalence of three-rooted permanent mandibular first molars were presented in the forest plots by random effect model. The calculation was performed with MetaXL version 5.3. Subgroup analysis, sensitivity analysis, and publication bias method were also calculated. Results. Seventy-two studies from 31 countries were selected for both qualitative and quantitative analyses. 26302 patients and 37994 permanent mandibular first molars were included in the analysis. 9% of permanent mandibular first molars all over the world demonstrated 3 roots. These three-rooted teeth were found in 10% of the world population, more than 45% of which revealed bilateral symmetry of that anatomy. Right-side dominance and no sexual dimorphism were seen in the distribution of three-rooted permanent mandibular first molars. Global tooth-level prevalence of Radix Entomolaris and Radix Paramolaris was 12% and 0.1%, respectively. Conclusion. The prevalence of three-rooted permanent mandibular first molars (PMFMs) was influenced by different geographical locations across the world and also by widespread habitation of the Mongoloid descent. The authors postulate that globalization, together with blending among ethnicities, may have a great impact on the reduction or accentuation of the anatomical significance in some populations.

Introduction. Incomplete understanding of the root canal system leads to endodontic failure. Missed canal was the fourth most common endodontic failure, which needed retreatment. There were a few studies on internal morphology of posterior teeth of Myanmar population. However, there was no report on root canal anatomy of anterior teeth. So, the aim of the in vitro study was to investigate root canal anatomy of Myanmar permanent mandibular incisors in Mandalay Region by the staining and clearing method. Materials and Methods. A total of 96 teeth from the tertiary hospitals and one academic department in Mandalay Region were selected according to inclusion and exclusion criteria. Then, they were cleaned, drilled, stained with Indian ink, and decalcified with 5% nitric acid for 3 days. After that, they were dehydrated with ascending concentration of ethanol (80% overnight, 90% for 1 hour, and full strength for three hours). Finally, they were clarified with 98% methyl salicylate and investigated by calibrated observer in case of Vertucci’s classification, allocation of apical foramen, and the detailed anatomy. Result. Almost 70% of the teeth had type Ι followed by 21.8% type ΙΙΙ, 4% 1-2-1-2-1 and type ΙΙ, and 1-3-2 and 2-3-1 comprised 1% each. Nearly 70% of apical foramen at central allocation of the root and 14% of detailed anatomy were seen in the sample teeth. Conclusion. Most of the sampled Myanmar teeth comprised one canal and one foramen followed by type ΙΙΙ. However, unusual anatomies, such as 1-2-1-2-1, 1-3-2, and 2-3-1, were also seen. Contrastively, proportions of central location of apical foramen and of detailed anatomy were differed from the former reports. This study summarized that 3 in 10 mandibular incisors comprised the evidence of second or third canal configuration. Three types of intercanal calcifications, fusiform, islet, and bead, were additionally explored.

Introduction. Growing body of evidences showed different grades in prevalence of bifid mandibular canals. Because the previous reviews focused solely on patient-level occurrence, hemi-mandible-level prevalence, bilateral symmetry, length, and diameter of bifid mandibular canals were required to be estimated collectively. The research question of this meta-analysis was “What is the prevalence of bifid mandibular canal among patients seeking computed tomography examinations”? Materials and Methods. In vivo, computed tomography, and cross-sectional studies were eligible. Studies, with less than 100 subjects or anatomic site restriction or controlled class of bifid mandibular canal, were excluded. Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies was used to assess methodological quality of all included studies. Random effect meta-analyses for proportion of bifid mandibular canal were done. Results. 40 studies met the inclusion criteria. All studies were selected for both systematic review and meta-analyses. Totally, 17714 patients and 31973 hemi-mandibles were included. All eligible studies showed moderate risk of bias on average. Resulting from the random effect model, more than 20% of patients seeking computed tomographic examinations had bifid mandibular canals (BMCs) which penetrated into slightly more than 14% of hemi-mandibles. Of the patients having bifid mandibular canals (BMCs), nearly 23% exhibited such anatomy on both sides of their mandibles. Estimated mean length and diameter of the accessory canals of bifid mandibular canals were 12.17 mm and 1.54 mm, respectively. Conclusion. The geographical locations, classifications, reliability test, and voxel size of computed tomography were all implicated in the prevalence of bifid mandibular canals along with gender and laterality, although considerable heterogeneity and bias were detected.