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Evaluation of the internal anatomy of paramolar tubercles using cone-beam computed tomography

  • G. ColakogluEmail author
  • I. Kaya Buyukbayram
  • M. A. Elcin
  • M. Kazak
  • H. Sezer
Original Article
  • 25 Downloads

Abstract

Purpose

To evaluate the internal anatomy of paramolar tubercles (PTs) on molars, determine the existence of root canals in these structures that either communicate with or are isolated from the main root canals of teeth, and analyze the prevalence of root fusion and a C-shaped canal configuration using cone-beam computed tomography (CBCT).

Materials and methods

Twenty-six molars with PTs from the study group and 664 molars without PTs from the control group were evaluated using CBCT. The locations and sizes of tubercles were noted. The existence of root canals in PTs was detected. All teeth were evaluated according to the presence or absence of root fusion and a C-shaped canal configuration. Statistical analyses were performed with Pearson Chi square and Fisher’s exact tests (p < 0.05).

Results

Eleven (42.3%) PTs with their own canals communicated with the main root canals of teeth, and 10 of 11 PTs (90.9%) were larger than 4 mm in size. No PT possessed its own canal independent from the other canals. Teeth with PTs tended to have more root fusions than teeth without PTs. A statistically significant correlation was observed between PTs and the C-shaped canal configuration (p < 0.01). Maxillary second molars with PTs were the major teeth showing variations in the internal morphology.

Conclusions

PTs are an uncommon anatomical variation that is specific to the coronal and radicular morphology. Therefore, clinicians should be aware of its unpredictable and complex internal anatomy, particularly in cases requiring endodontic treatment. CBCT is recommended for teeth with PTs, particularly maxillary second molars, to improve the prognosis of the teeth.

Keywords

Paramolar tubercle C-shaped canal configuration Root fusion Cone-beam computed tomography 

Notes

Acknowledgements

All authors disclose no actual or potential conflicts of interest, including any financial, personal, or other relationship with other people or organizations that could inappropriately influence this work.

Author Contributions

GC: Planning of the study, evaluation of CBCT images, writing of the study. IKB: Planning of the study, evaluation of CBCT images, language editing. MAE: Evaluation of CBCT images, language editing. MK: Planning of the study, language editing. HS: Statistical analysis.

References

  1. 1.
    Appadurai R, Lingeshwar D, Missier MS, Maila SV (2018) Permanent mandibular protostylid: a rare developmental anomaly and its overview. Indian J Dent Res 29(2):244CrossRefGoogle Scholar
  2. 2.
    Arunkumar KV, Deepa D (2016) Rare presentation of accessory tubercles on permanent maxillary second molar. J Dent Allied Sci 5(1):43CrossRefGoogle Scholar
  3. 3.
    Bhattacharya P, Sinha R (2016) Dual cusped protostylid: case report and clinical significance. J Indian Acad Oral Med Radiol 28(3):281CrossRefGoogle Scholar
  4. 4.
    Bolk L (1916) Problems of human dentition. Am J Anat 19:91–148CrossRefGoogle Scholar
  5. 5.
    Dahlberg AA (1945) The paramolar tubercle (Bolk). Am J Phys Anthropol 3:97–103CrossRefGoogle Scholar
  6. 6.
    Desai VD, Gaurav I, Das S, Kumar MS (2014) Paramolar complex—the microdental variations: case series with review of literature. Ann Bioanthropol 2(2):65CrossRefGoogle Scholar
  7. 7.
    Garg S, Mishra N, Goel A, Tikku AP, Bharti R (2018) Endodontic management of a rare anamoly of paramolar tubercle fused with maxillary second molar using CBCT: a case report. IOSR J Dent Med Sci 17(7):52–55Google Scholar
  8. 8.
    Ghafoor S (2018) Unilateral protostylid on buccal surface of permanent maxillary first molar: a rare finding. JPDA 27(03):157Google Scholar
  9. 9.
    Hanihara K (1961) Criteria for classification of crown characters of the human deciduous dentition. Zinriugaku Zassi 69:27–45Google Scholar
  10. 10.
    Ikeda H, Suda H (2012) Iatrogenic pulp exposure in paramolar tubercles carries the risk of pulp or tooth loss. Int J Dent Case Rep 2(5):66–72Google Scholar
  11. 11.
    Jafarzadeh H, Wu YN (2007) The C-shaped root canal configuration: a review. J Endod 33(5):517–523CrossRefGoogle Scholar
  12. 12.
    Jain P, Ananthnarayan K, Ballal S, Natanasabapathy V (2014) Endodontic management of maxillary second molars fused with paramolar tubercles diagnosed by cone beam computed tomography—two case reports. J Dent (Tehran, Iran) 11(6):726Google Scholar
  13. 13.
    Jo HH, Min JB, Hwang HK (2016) Analysis of C-shaped root canal configuration in maxillary molars in a Korean population using cone-beam computed tomography. Restor Dent Endod 41(1):55–62CrossRefGoogle Scholar
  14. 14.
    Kazak M, Colakoglu G, Elcin MA, Somturk E, Gunal S (2017) Examination of paramolar tubercles in turkish population using cone beam computed tomography. Int J Morphol 35(4):1416–1421CrossRefGoogle Scholar
  15. 15.
    Kustaloglu OA (1962) Paramolar structures of the upper denititon. J Dent Res 41:75–83CrossRefGoogle Scholar
  16. 16.
    Lakshman AR, Kannepady SK, Kalkur C (2014) Parastyle: report of two rare cases. Front Clin Med 1:1–4Google Scholar
  17. 17.
    Lopamudra D, Shekar KS, Chandra R, Moinuddin MMK, Prasad K, Priya S (2016) Endodontic management by cone beam computed tomography and vista scan of maxillary second molar with parastyle—a case report. WebmedCentral Dent 7(6):WMC005134Google Scholar
  18. 18.
    Mull JP, Manjunath MK (2013) Paramolar tubercle in endodontics: an overview, case report and specimen study. J Pierre Fauchard Acad (India Section) 27:124–128CrossRefGoogle Scholar
  19. 19.
    Narsapur S, Choudhari S (2017) Bilateral protostylids and parastyles associated with hypodontia of maxillary lateral incisor: report of two rare clinical cases. J Indian Acad Oral Med Radiol 29(1):78–78CrossRefGoogle Scholar
  20. 20.
    Nayak G, Shetty S, Singh I (2013) Paramolar tubercle: a diversity in canal configuration identified with the aid of spiral computed tomography. Eur J Dent 7(1):139PubMedPubMedCentralGoogle Scholar
  21. 21.
    Ohishi K, Ohishi M, Takahashi A, Kido JI, Uemura S, Nagata T (1999) Examination of the roots of paramolar tuberoles with computed tomography: report of 3 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 88(4):479–483CrossRefGoogle Scholar
  22. 22.
    Patel S, Durack C, Abella F et al (2014) European society of endodontology position statement: the use of CBCT in endodontics. Int Endod J 47(6):502–504CrossRefGoogle Scholar
  23. 23.
    Scott GR, Turner CG II, Townsend GC, Martinón-Torres M (2018) The anthropology of modern human teeth: dental morphology and its variation in recent and fossil Homo sapiens. Cambridge University Press, Cambridge, p 79CrossRefGoogle Scholar
  24. 24.
    Scriven G, Roger J, Brook A et al (2018) Frequency of occurrence and degree of expression of the parastyle in several modern human populations. Dent Anthropol J 31(1):3–9CrossRefGoogle Scholar
  25. 25.
    Sharma S, Tyagi S, Kumar V (2018) Paramolar tubercle-Bolk cusp: a case report. J Oral Res Rev 10(2):76CrossRefGoogle Scholar
  26. 26.
    Şekerci AE, Özcan G (2015) Paramolar tubercle: report of five cases with clinical considerations. Dent Sci Cases 1(3):199–203Google Scholar
  27. 27.
    Turner CG 2nd, Nichol CR, Scott GR (1991) Scoring procedures for key morphological traits of the permanent dentition: The Arizona State University dental anthropology system. In: Nelly MA, Larsen CS (eds) Advances in dental anthropology. Wiley-Liss, New YorkGoogle Scholar
  28. 28.
    Turner RA, Harris EF (2004) Maxillary second premolars with paramolar tubercles. Dent Anthropol 17(3):75–78CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial Radiology, Faculty of DentistryIstanbul Aydin UniversityIstanbulTurkey
  2. 2.Department of Endodontics, Faculty of DentistryIstanbul Aydin UniversityIstanbulTurkey
  3. 3.Department of Restorative Dentistry, School of Dental MedicineBahcesehir UniversityIstanbulTurkey
  4. 4.Department of Biostatistics, Faculty of MedicineIstanbul Aydin UniversityIstanbulTurkey

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