Publications by authors named "Joe Ben Itzhak"

18 Publications

  • Page 1 of 1

A Rare Case of Multiple Internal Root Resorption after the Delayed Treatment of a Traumatic Injury: A Case Report.

J Contemp Dent Pract 2021 Feb 1;22(2):194-198. Epub 2021 Feb 1.

Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel HaShomer, Israel.

Aim: The objective of this case report was to present a rare case of simultaneous multiple internal root resorption (IRR) in four mandibular incisors and discuss the possible etiology and suitable armamentarium for its treatment based on different morphological considerations.

Background: IRR in permanent dentition is a rare pathological condition and its etiology is not yet fully understood. Very few cases of multiple IRR were reported. This is the first reported case of multiple IRR due to traumatic injury.

Case Description: A 23-year-old man suffered trauma to his mandible after falling from a trampoline. His mandibular incisors suffered subluxation injuries and his orthodontic fixed retainer got detached. He delayed treatment and visited our clinic 4.5 months after the incident. Clinical and radiographic examination revealed four mandibular incisors with almost identical IRR defects at the apical third of the roots. The patient was then treated with four non-surgical root canal treatments using various endodontic instruments and techniques. Fifteen-month post-trauma, he showed no evidence of pathology at the follow-up examination.

Conclusion: Delayed treatment of dental trauma might cause multiple IRR, and the presence of an orthodontic fixed retainer can distribute surface forces and result in uniform IRR defects.

Clinical Significance: The combination of the self-adjusting file (SAF) and the XP-endo finisher is recommended for chemomechanical preparation of IRR defects in oval canals, especially at the apical third.
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February 2021

Use of Cone-beam Computed Tomography as a Critical Component in the Diagnosis of an Infected Nasopalatine Duct Cyst Mimicking Chronic Apical Abscess: A Case Report.

J Endod 2021 Jul 24;47(7):1177-1181. Epub 2021 Apr 24.

Department of Endodontics, Israel Defense Forces Medical Corps, Tel Hashomer, Israel.

Nasopalatine duct cysts (NPDCs) and other nonodontogenic lesions of the oral cavity may mimic odontogenic pathoses. We present a case of a 22-year-old man with a history of dental trauma and a lesion displaying the typical clinical and radiographic signs of a chronic apical abscess- a buccal sinus tract that was traced to a radiolucent area in the periapex of a maxillary central incisor. A comprehensive diagnostic process that included a cone-beam computed tomographic scan and a histopathologic examination of the lesion after complete enucleation led to the final diagnosis of an infected NPDC. The adjacent tooth was vital at the 1-year posttreatment follow-up, and a radiograph demonstrated complete healing of the periradicular structures. This case demonstrates the ability of NPDCs to present clinical and radiographic signs similar to apical inflammatory lesions and the need for a meticulous diagnostic process in order to avoid unnecessary endodontic intervention. The article also discusses the differential diagnoses of nonodontogenic lesions in the premaxillary area.
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http://dx.doi.org/10.1016/j.joen.2021.04.018DOI Listing
July 2021

Accuracy and stability of electronic apex locator length measurements in root canals with wide apical foramen: an ex vivo study.

BDJ Open 2020 Nov 17;6(1):22. Epub 2020 Nov 17.

Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Derech Sheba 2, 52621, Ramat Gan, Israel.

The aim of the current study was to determine the accuracy of electronic apex locator (EAL) measurements when using files of different sizes in roots with wide apical foramina while considering a new parameter of stability of EAL reading. Ten teeth with straight roots were subjected to a sequential widening of the apical foramen to 0.6, 0.7, and 0.8 mm. The roots were embedded after each enlargement stage in an alginate mold and subjected to EAL readings. Measurements were done using sequential K-file sizes and the self-adjusting file (SAF). Measurement stability was introduced as a new additional parameter. As the difference between the file size used and the apical diameter of the canal decreases, the results obtained were more accurate and stable. The stability and accuracy of the measurements coincided with each other in a statistically significant manner. Within the limitations of the present ex vivo study, it may be concluded that in straight canals with wide apical foramina of 0.6-0.8 mm, both SS K-files which fit snugly to the walls of apical foramen and the SAF file may offer both accurate and stable EAL measurements.
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http://dx.doi.org/10.1038/s41405-020-00052-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670426PMC
November 2020

Radicular Grooves and Complex Root Morphologies of Mandibular Premolars Among Israeli Population.

J Endod 2020 Sep 10;46(9):1241-1247. Epub 2020 Jun 10.

Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel.

Introduction: Mandibular premolars usually have one root and one root canal. Different studies found that up to 30% of mandibular premolars have more than one root canal, and up to 24% of mandibular premolars have C-shape canals. The purpose of this study was to investigate the root anatomy and the prevalence of complex root canal morphology in mandibular premolars in Israeli population.

Methods: A total of 1020 Israeli patients' cone-beam computed tomography scans were screened and evaluated. A total of 1835 mandibular first premolars and 1678 mandibular second premolars were examined. Irregular root anatomy and different root canal morphologies were recorded and analyzed.

Results: The overall prevalence of complex root morphology (types II-VIII) in mandibular first and second premolars was 21% and 2.8%, respectively. The bilateral prevalence of complex root morphology in mandibular first and second premolars was 46% and 29%, respectively. The prevalence of radicular grooves in mandibular first and second premolars with complex root morphology was 48% and 36%, respectively. No significant difference was found according to gender or the side of occurrence. However, complex root canal morphology was significantly found in mandibular premolars with radicular grooves.

Conclusions: Complex root canal morphology frequently occurs in mandibular first premolars in the population of Israel. Radicular groove existence in mandibular first and second premolars is significantly related to complex root canal morphology.
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http://dx.doi.org/10.1016/j.joen.2020.05.013DOI Listing
September 2020

Age-dependent root canal instrumentation techniques: a comprehensive narrative review.

Restor Dent Endod 2020 May 4;45(2):e21. Epub 2020 Mar 4.

Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel.

The aim of this article was to review age-dependent clinical recommendations for appropriate root canal instrumentation techniques. A comprehensive narrative review of canal morphology, the structural characteristics of dentin, and endodontic outcomes at different ages was undertaken instead of a systematic review. An electronic literature search was carried out, including the Medline (Ovid), PubMed, and Web of Science databases. The searches used controlled vocabulary and free-text terms, as follows: 'age-related root canal treatment,' 'age-related instrumentation,' 'age-related chemo-mechanical preparation,' 'age-related endodontic clinical recommendations,' 'root canal instrumentation at different ages,' 'geriatric root canal treatment,' and 'pediatric root canal treatment.' Due to the lack of literature with practical age-based clinical recommendations for an appropriate root canal instrumentation technique, a narrative review was conducted to suggest a clinical algorithm for choosing the most appropriate instrumentation technique during root canal treatment. Based on the evidence found through the narrative review, an age-related clinical algorithm for choosing appropriate instrumentation during root canal treatment was proposed. Age affects the morphology of the root canal system and the structural characteristics of dentin. The clinician's awareness of root canal morphology and dentin characteristics can influence the choice of instruments for root canal treatment.
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http://dx.doi.org/10.5395/rde.2020.45.e21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239687PMC
May 2020

Cone-beam Computed Tomography as a Noninvasive Assistance Tool for Oral Cutaneous Sinus Tract Diagnosis: A Case Series.

J Endod 2019 Jul 17;45(7):950-956. Epub 2019 May 17.

Department of Endodontics, Israel Defense Forces Medical Corps, Tel Hashomer, Israel.

An oral cutaneous sinus tract is a relatively uncommon condition that is generally associated with long-standing periapical inflammation. The traditional process of oral cutaneous sinus tract diagnosis is an invasive method based on the insertion of a lacrimal probe or wire. The present article describes the use of cone-beam computed tomographic imaging as a noninvasive assistant tool for the verification of the odontogenic origin.
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http://dx.doi.org/10.1016/j.joen.2019.03.017DOI Listing
July 2019

Ludwig Angina after First Aid Treatment: Possible Etiologies and Prevention-Case Report.

J Endod 2019 Jan 13;45(1):79-82. Epub 2018 Nov 13.

Department of Endodontics, Israel Defense Forces Medical Corps, Tel Hashomer, Israel.

Ludwig angina is a life-threatening type of soft tissue cellulitis involving 3 compartments on the floor of the mouth including the submental, sublingual, and submandibular spaces bilaterally. Prevention, early recognition, and treatment of Ludwig angina are critical because this is a clinical diagnosis with unpredictable progression. This article describes a rare case of Ludwig angina that evolved from an odontogenic infection and the specific microbiology and clinical course and discusses possible etiologies and prevention.
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http://dx.doi.org/10.1016/j.joen.2018.10.001DOI Listing
January 2019

CBCT analyses of advanced cervical resorption aid in selection of treatment modalities: a retrospective analysis.

Clin Oral Investig 2019 Apr 26;23(4):1635-1640. Epub 2018 Aug 26.

Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel.

Objectives: The selection of treatment for advanced (classes 3 and 4) invasive cervical resorption (ICR) based on a two-dimensional periapical radiograph is challenging. The purpose of the present study is to describe different treatment approaches for advanced invasive cervical resorption based on cone-beam computed tomography evaluation.

Materials And Methods: All cases of advanced ICR based on CBCT evaluation in our endodontic department between 2011 and 2016 were included in the study. The dimension, circumferential, and coronal-cervical locations of the entry point of the resorption tissue into the tooth were evaluated. The selected treatment approach for each case was documented, and all the data were summarized and analyzed.

Results: Twenty-three cases of advanced ICR were included in the study. Approximately, 74% were diagnosed in stage 4, and 26% were diagnosed in stage 3. The narrow entry point was identified in 43% (10 cases), while in 57% (13) of cases, the entry point was wide. Circumferentially, 70% (16) were located on the proximal side. Coronal-cervically, 43% (10) were located more than 1.5 mm above the crestal bone. All narrow entry point cases were treated using a minimally invasive technique, while different treatment approaches were chosen for cases with a wide entry point.

Conclusions: The present study proposes different treatment approaches for advanced ICR based on CBCT. The CBCT evaluation of the entry point may facilitate choosing the appropriate treatment approach for advanced ICR cases.

Clinical Relevance: The description of different treatment approaches for advanced invasive cervical resorption based on cone-beam computed tomography evaluation enables the clinician to choose the optimal treatment approach for each advanced ICR case.
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http://dx.doi.org/10.1007/s00784-018-2592-xDOI Listing
April 2019

External invasive resorption: Possible coexisting factors and demographic and clinical characteristics.

Aust Endod J 2019 Aug 20;45(2):141-145. Epub 2018 Aug 20.

Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel.

The purpose of this retrospective study was to identify the coexisting factors for EIR and to characterise EIR clinically and demographically. All cases of EIR that were referred to the endodontic department between 2011 to 2016 and diagnosed by an endodontist were evaluated. Demographic and clinical characteristics were collected and evaluated. Thirty-eight cases of EIR diagnosed between 2011 and 2016 were included in the study. Seventy-one percent of EIR cases were misdiagnosed by general practitioners. The most affected teeth were the maxillary central incisors (29% of cases) and mandibular molars (26%). Sixty-eight percent of EIR cases were diagnosed in teeth with clinically normal pulp. Pulp necrosis was observed mainly in the advanced stages (class 3 and class 4) of EIR (75%) and in teeth with a history of trauma (63%). Histories of previous trauma and orthodontic treatment were reported in 29% and 23% of cases, respectively.
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http://dx.doi.org/10.1111/aej.12292DOI Listing
August 2019

External invasive resorption: Case report of a rapidly progressive process in an impacted maxillary canine during orthodontic treatment.

Aust Endod J 2019 Aug 16;45(2):259-264. Epub 2018 Aug 16.

Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Ramat Gan, Israel.

External invasive resorption (EIR) is a type of external resorption that can involve the coronal, middle and apical parts of the root in its advanced stages and results in progressive loss of tooth structure. Common potential predisposing factors for EIR are orthodontic treatment and trauma. The EIR progression rate has not been described previously. This case report describes rapidly progressive EIR in an impacted maxillary canine after surgical exposure and application of directional orthodontic traction over 8 months. The article discusses the etiologies of EIR, the possible reasons for EIR and its rapid progression in the presented case and proposes a new theory of the connection between EIR and tooth impaction.
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http://dx.doi.org/10.1111/aej.12293DOI Listing
August 2019

Relationship between Root Apices and the Mandibular Canal: A Cone-beam Computed Tomographic Comparison of 3 Populations.

J Endod 2018 Apr 14;44(4):555-558. Epub 2018 Feb 14.

Department of Endodontics, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel; Private Practice, Ramat Gan, Israel.

Introduction: This study aimed to investigate the difference in the location of the inferior alveolar nerve (IAN) in relation to the apices of mandibular molars in 3 different populations using cone-beam computed tomographic (CBCT) imaging and to assess the proportion of teeth in close proximity (a distance of 1 mm or less) to the IAN.

Methods: Random CBCT images (N = 1224, Israel = 408, South Korea = 416, and India = 400) were examined. The shortest distance to the mandibular canal was measured by imaging software.

Results: The mean distance was 4.81 ± 2.15 mm. The mean distances for Israel, South Korea, and India were 4.60 ± 2.37 mm, 5.45 ± 2.13 mm, and 4.35 ± 1.76 mm, respectively. The distance in samples obtained from South Korea was significantly larger than the distance in samples obtained from Israel and India (P < .05). Samples from Israel exhibited close proximity in 6.6% of samples versus 3% in samples from India and 0.7% of samples from South Korea, a statistically significant difference (P < .05).

Conclusions: Although variation in tooth morphology in different populations was widely researched, the variation in the location of the IAN in relation to tooth apices of different populations was not addressed in the literature. Our study reveals that a difference in the distance of the apices to the IAN exists between populations as well as a difference in the proportion of teeth in close proximity to the IAN.
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http://dx.doi.org/10.1016/j.joen.2017.12.020DOI Listing
April 2018

Root Canal Morphology Evaluation of Central and Lateral Mandibular Incisors Using Cone-beam Computed Tomography in an Israeli Population.

J Endod 2018 Jan 21;44(1):51-55. Epub 2017 Oct 21.

Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel.

Introduction: Central and lateral mandibular incisors usually have 1 root canal. The purpose of this study was to investigate the prevalence of additional root canals in central and lateral mandibular incisors and to investigate the prevalence of oval and long oval canals in the cervical, middle, and apical thirds of cases with 1 root canal.

Methods: A total of 1016 Israeli patients' cone-beam computed tomography scans were screened and evaluated. A total of 1472 central mandibular incisors and 1508 lateral mandibular incisors were examined. The root canal morphology and cross-sectional shape were recorded and analyzed.

Results: The overall prevalence of more than 1 root canal in mandibular central and mandibular lateral respectively was 40.5% and 37.9%. The bilateral incidence of more than 1 root canal in mandibular central and mandibular lateral respectively was 69.8% and 68.7%. The root canal separation in type II to type V central and lateral mandibular incisors was found in the middle third of the root in 81.5% and 79.0%, respectively. The septum was smaller than 1 mm in 37% of central mandibular incisors and one-third of lateral mandibular incisors. In central and lateral incisors with 1 root canal, long oval canals were found in the middle third of the root of central and lateral mandibular incisors in 36.8% and 48.9%, respectively.

Conclusion: The occurrence of more than 1 root canal in central and lateral mandibular incisors is approximately 40% (type III was the predominant canal type). In central and lateral incisors with 1 root canal, long oval canals are common.
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http://dx.doi.org/10.1016/j.joen.2017.08.012DOI Listing
January 2018

Minimally Invasive Treatment of Class 4 Invasive Cervical Resorption with Internal Approach: A Case Series.

J Endod 2017 Nov 19;43(11):1901-1908. Epub 2017 Jul 19.

Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel.

Invasive cervical resorption (ICR) is a type of external resorption that can involve the coronal, middle, and apical parts of the root in its advanced stages. The diagnosis and treatment of ICR depend on the extent of the resorption into the dentin. The treatment of advanced ICR is challenging, and these teeth have poor prognoses. This article describes 4 cases of class 4 ICR diagnosed by using cone-beam computed tomography and treated with a minimally invasive internal approach with sodium hypochlorite irrigation and calcium hydroxide dressing. All cases were followed for at least 3 years.
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http://dx.doi.org/10.1016/j.joen.2017.04.026DOI Listing
November 2017

Successful orthograde treatment of dens invaginatus Type 3 with a main C-shaped canal based on cone-beam computed tomography evaluation.

J Conserv Dent 2016 Nov-Dec;19(6):587-590

Department of Endodontics, Israel Defense Forces Medical Corps, Tel Hashomer, Israel.

Dens invaginatus is a rare anatomic variation that is found primarily in maxillary lateral incisors. The management of dens invaginatus is challenging for clinicians; diagnosing the type of malformation, choosing the most appropriate treatment, and carrying out treatment are complicated by the intricate root system of these teeth. The following case report describes the diagnosis and treatment planning of dens invaginatus Type 3 after cone-beam computed tomography evaluation.
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http://dx.doi.org/10.4103/0972-0707.194034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5146779PMC
December 2016

C-shaped canals-prevalence and root canal configuration by cone beam computed tomography evaluation in first and second mandibular molars-a cross-sectional study.

Clin Oral Investig 2017 Jul 14;21(6):2039-2044. Epub 2016 Nov 14.

Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel.

Objectives: C-shaped root canal configuration is an unusual root canal morphology and one of the most often anatomical variations in root canal systems of second mandibular molars. The purpose of this study was to assess the prevalence, symmetry and configuration of C-shaped canals in first and second mandibular molars in an Israeli population using cone beam computed tomography (CBCT).

Materials And Methods: One thousand twenty Israel patients' CBCT scans were screened and evaluated. First and second mandibular molars with C-shaped canals were identified. Prevalence configuration along the root and symmetry were analyzed, and new radicular groove classification was proposed.

Results: Total of 1465 mandibular second molars and 1229 mandibular first molars were evaluated. The overall prevalence of C-shaped canals in first and second mandibular molars was 0.16 and 4.6%, respectively. No significant difference was found by gender or side of occurrence. The unilateral prevalence of C-shaped canals in mandibular second molars was 55%. C-shaped canal configuration changed along the root in 63% of the cases.

Conclusions: The prevalence of C-shaped canals in first and second mandibular molars in the Israeli population is low in comparison to other subpopulations. Clinicians should be aware of the possible asymmetry, different configuration along the root, and the location of danger zone of this anatomic variation during clinical work.

Clinical Relevance: CBCT is an efficient three dimensional radiographic examination for evaluation of C-shape root canal configuration. CBCT may help the clinicians during clinical work for considering appropriate cleaning, shaping, and obturation technique according to the characteristic of C-shape root canal configuration.
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http://dx.doi.org/10.1007/s00784-016-1993-yDOI Listing
July 2017

Use of Cone-beam Computed Tomography during Retreatment of a 2-rooted Maxillary Central Incisor: Case Report of a Complex Diagnosis and Treatment.

J Endod 2015 Dec 23;41(12):2064-7. Epub 2015 Oct 23.

Department of Endodontics, Israel Defense Forces, Medical Corps, Tel Hashomer, Israel.

A double-rooted maxillary incisor is an extremely rare anatomic variation. Only a few case reports describe this abnormal anatomy. In recent decades, cone-beam computed tomographic (CBCT) imaging has become more common for endodontic purposes. This case report describes the retreatment of double-rooted maxillary central incisors using CBCT imaging. In 2012, a 20-year-old man was referred to our department because of asymptomatic periapical lesions in teeth #8, #9, and #10. During the evaluation of a periapical radiograph, a rare anatomic variation, in the form of an additional root of tooth #9, was detected, and it was impossible to decide about the source of the lesion between teeth #9 and #10. During retreatment, after gutta-percha removal, CBCT imaging was performed; this allowed proper treatment of the additional root and a final diagnosis of normal periapical tissue of tooth #10 with no treatment needed. The 18-month follow-up revealed a healing lesion in tooth #9 and normal periapical tissue in tooth #10. During the treatment of teeth with an anatomic variation, CBCT imaging can serve as an auxiliary tool for 3-dimensional evaluation that influences treatment steps and techniques. CBCT scanning can be very useful in assessing the actual location of a periapical lesion, which influences diagnosis and treatment planning.
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http://dx.doi.org/10.1016/j.joen.2014.04.016DOI Listing
December 2015

Self-adjusting file (SAF) separation in clinical use: A preliminary survey among experienced SAF users regarding prevalence and retrieval methods.

J Conserv Dent 2015 May-Jun;18(3):200-4

Department of Endodontics, Dental School, University of Athens, Athens, Greece.

Context: The self-adjusting file (SAFs) is reported to be resistant to file separation in laboratory tests. No information is currently available regarding SAF separation during clinical use.

Aim: To conduct preliminary clinical survey among experienced SAF users in order to establish the prevalence of SAF separation during clinical use and to study how were such cases treated.

Materials And Methods: A questionnaire was sent to experienced SAF users to make inquiries regarding incidence of SAF separation and how were such events treated. Only responses from operators who had used 50 SAFs or more were included in the present study. Fisher's exact test was used to compare file separation occurrence.

Results: A total of 2517 SAFs had been used by these operators, and 15 cases of file separation were reported (0.6%). Twelve of these 15 separated files could be retrieved within a few minutes using Hedström files, with no additional dentine removal required. In the three cases in which the separated files could not be retrieved, the separated file segment was successfully bypassed.

Conclusions: The SAF might separate during clinical use, but the incidence of such an event was low. In most such cases, the separated file segment was easily and quickly retrieved without additional removal of dentin.
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http://dx.doi.org/10.4103/0972-0707.157247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450524PMC
June 2015

Prevalence of 3- and 4-rooted first and second mandibular molars in the Israeli population.

J Endod 2015 Mar 18;41(3):338-42. Epub 2014 Dec 18.

Department of Endodontics, Israel Defense Forces Medical Corps, Tel Hashomer, Israel.

Introduction: Three-rooted mandibular molars are 1 of the anatomic variations of mandibular molars. The location of the additional root is distolingual (radix entomolaris) or mesiobuccal (radix paramolaris). The purpose of this retrospective study was to assess the prevalence of 3- and 4-rooted mandibular first and second molars in the Israeli population and to classify them according to dimension, curvature, and location of separation from the main root.

Methods: A total of 1020 Israel patients' cone-beam computed tomographic scans were screened and evaluated. The incidence of 3- and 4-rooted first and second mandibular molars were recorded and analyzed. One thousand four hundred sixty-five mandibular second molars and 1,229 mandibular first molars were evaluated.

Results: The overall incidence of patients with 3-rooted mandibular first and second molars was 2.6% and 1.78%, respectively. The bilateral incidence of 3-rooted mandibular first and second molars was 26%. The incidence of 4-rooted mandibular second molar was 0.55%. No significant difference was found regarding sex or side of occurrence.

Conclusions: The occurrence of 3-rooted mandibular first molars in the Israeli population was rare, but clinicians should be aware of the special characteristic of this anatomic variation to modify accordingly the form of pulp chamber opening and choose appropriate instrumentation.
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http://dx.doi.org/10.1016/j.joen.2014.11.006DOI Listing
March 2015
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