Application of a new system for classifying root and canal anatomy in studies involving micro‐computed tomography and cone beam computed tomography: Explanation and elaboration

Abstract

Adequate knowledge and accurate characterization of root and canal anatomy is an essential prerequisite for successful root canal treatment and endodontic surgery. Over the years, an ever‐increasing body of knowledge related to root and canal anatomy of the human dentition has accumulated. To correct deficiencies in existing systems, a new coding system for classifying root and canal morphology, accessory canals and anomalies has been introduced. In recent years, micro‐computed tomography (micro‐CT) and cone beam computed tomography (CBCT) have been used extensively to study the details of root and canal anatomy in extracted teeth and within clinical settings. This review aims to discuss the application of the new coding system in studies using micro‐CT and CBCT, provide a detailed guide for appropriate characterization of root and canal anatomy and to discuss several controversial issues that may appear as potential limitations for proper characterization of roots and canals.

Application of a new system for classifying root and canal anatomy in clinical practice – Explanation and elaboration

“…A recent review has provided a detailed description for the application of the new coding system when undertaking laboratory-based microCT studies and in vivo studies using CBCT with an emphasis on the basic concepts to be followed ( 14 ). Owing to the differences in methods of identification and interpretation of the root canals in research studies compared to clinical practice, and the importance of proper identification of root canals during different phases of root canal treatment procedures in addition to record keeping and legal concerns ( 16 - 18 ), this review aims to provide a detailed description for the use of the new coding system during the various phases of clinical management from pre-operative radiographic interpretation to root canal filling and follow-up.…”

“…The basic concepts of the new coding system have been described previously ( 9 - 12 ), and a recent review has explained and elaborated the application of the new system in research studies involving microCT and CBCT ( 14 ). In general, the basic principles of the new coding system can be applied in a similar manner (such as the tooth number when using any of the numbering systems), number of roots and canal configuration) regardless of the diagnostic assessment method or setting (experimental or clinical) ( Fig.…”

“…8 ). A new coding to classify accessory canals has been introduced ( 10 ), and further explained when applied in studies involving microCT and CBCT ( 14 ). In clinical practice (pre-operative stage), the operator can consider the possibility of the presence of this minor anatomy in the initial codes as shown in Figure 8 .…”

“…The basic concepts and guidelines for using the new coding system in CBCT clinical studies have been described recently ( 14 ), which can also be applied for case reports. In order to provide a consistent interpretation of the root canal configuration, the observer will have to determine the most apical position of the CEJ (cervical line) and level of the pulp floor in single and multi-rooted teeth, respectively, in order to determine the location of the canal orifice before writing the code of the tooth of interest (Figs.…”

“…14 ). Accessory canals are not usually observed in CBCT studies; however, some accessory canals can be large enough to be identified on CBCT images ( 14 ), especially when the 2D radiographic image has a lateral radiolucency indicating the possibility of its presence; this may become evident after root canal filling.…”