0099-2399/97/2302-0101 $03.

00/0 JOURNALOF ENDOOONTICS Copyright 1997 by The American Association of Endodontists

Printed in U.S.A. VOL. 23, No. 2, FEBRUARY1997

3D Reconstruction of Two C-Shape Mandibular Molars

Kleoniki Lyroudia, Georgios Samakovitis, Ioannis Pitas, Theodoros Lambrianidis, Ioannis Molyvdas, and Georgios Mikrogeorgis

Two mandibular second molars, with an indication of C-shape morphology were processed for 3-D reconstruction. After serial cross sectioning, photographs of the sections were digitized and by using surface representation, 3D reconstruction was achieved. The first molar as the 3D reconstruction showed was single rooted with one C-shaped root canal with two foramens, while the second one was double rooted with two root canals, one Cshaped and one thin, having a common foramen.

The root canal morphology of mandibular molars is of great interest and has been discussed in a number of articles (1, 2, 3). It has been reported that 2.7 to 8% of the mandibular second molars present a C-shaped canal (1, 2). Recently two different methods (3) have been used for the study of the root canal configuration of these teeth and three evaluation criteria were used to describe mandibular second molars. These are: a. The continuous C-shaped canal b. The semicolon canal c. Two discrete and separate canals (3). This classification was first used by Weine et al. (1969) for the study of maxillary molars and was applied some years later to the classification of mandibular molars (4). A number of clinical studies (1, 2) also evaluated the pulp chamber configuration of the mandibular second molars. A new method, the 3D reconstructing method, was used in this study. The purpose of this work was the computerized 3D reconstruction of C-shaped canal morphology of two second mandibular molars. M A T E R I A L S AND M E T H O D S Two mandibular second molars that were extracted because of caries were used in this study. The teeth were put in a 5% NaOC1 solution for 24 h and then cleaned under running water. They were allowed to bench dry and embedded in a two phase polyester resin to make serial cross sections with a special microtome (Isomet-Buehler). Forty-eight h after embedding the specimens were trimmed to a convenient size for cutting and were stabilized on a piece of resin with dental modelling wax. Serial cross sections were taken from each tooth. The thickness of the sections was 1 mm. Nineteen

sections were obtained from the first tooth and 20 from the second. Each section was photographed using a stereoscopic microscope (Stemy SV8 Zeiss, West Germany). The photographs were digitized with a resolution of 300 dpi using an image scanner Epson 6000. The grey scale used was 0 to 255. To increase the visual image quality a contrast enhancement method was used. Proper alignment was done automatically or with some user interaction using image processing techniques (5). After that, a heuristic contour-following algorithm was incorporated to store object contours as a list of points to make contour manipulation easier (6). The outputs were images of the external boundary of the teeth and the root canal tracks. Three dimensional surface representation was used in this project to reconstruct the outer surface of the tooth, the inner surface of the pulp chamber, and the root canals. The surfaces between successive object contours were formed using triangles. Before triangulation correspondence between contours in successive slices was established. The whole procedure of triangulation was described in detail in our previous work (7). The final representation was accomplished through color addition and shading of the previous wireframe model. This so-called rendering is one of the most important parts of the 3D representation because through proper lighting, color, and texture, a better 3D reconstruction can be achieved. The materials used were purple glass for the outer surface and yellow mate for the pulp chamber.

RESULTS By using this method of computerized 3D reconstruction we were able to see clearly the morphology of root canals of the two mandibular second molars. The first one was single rooted (Fig. l) and there was only one root canal (Fig. 2) with a continuous C-shape morphology (Fig. 3) without any separation. At the apical third of the root canal there was a bifurcation and it was clear that the tooth had two apical foramens (Fig. 4). The second tooth was double rooted (Fig. 5) with two root canals (Fig. 6). One was C-shaped and the other was a thin typical one. By using 3D reconstruction we were able to see that these two root canals were connected in the apical third (Fig. 7) and finally ended by the same foramen. From another point of view it is clearly seen that at the coronal third of the root the separation of the thin root canal began giving the appearance of a huge triangle at that position (Fig. 8).

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FIG 1. Cross sections of a mandibular second molar. Both the root and the root canal have a C-shape. The dentin of the two roots is separated and connected by cementum. Fr~ 3. 3D reconstruction of the same mandibular second molar. The structure and the double apical foramen are clearly seen.

FIG 4.3D reconstruction of the same tooth seen from another point of view. FtG 2, Digitization of the photograph seen on Fig. 1 and the corresponding contours,

DISCUSSION 3D reconstruction may be a useful and interesting method for the study of the canal configuration of the C-shape teeth and in general for the teeth with morphological anomalies. Melton et al. (1991) by taking only one thin section from each of the three levels of the root (cervical, middle, and apical third) were able to develop a general idea of the root canal structure but

were not able to form a reconstruction of the whole tooth. The work of Cooke and Cox (1979) although of great interest is mainly a clinical investigation. By using the two phase polyester resin the present study was able to take serial cross sections of the whole tooth including crown sections. This methodology has helped us to reconstruct the structure of the whole tooth and pulp chamber. This method does not have the disadvantages of the resin casts method used by Melton et al (1991), which are failure of the resin

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FIG 5. Cross section of the second C-shape molar. The existence of two roots and two root canals is obvious.

FIG 7. 3D reconstruction of the second C-shape molar. The first root canal is thin and at the coronal part of it has the form of a triangle, whereas the second one has C-shape form.

FiG 6. Digitization of the photograph seen on Figure 5 and the corresponding contours.

FIG 8.3D reconstruction of the same tooth seen from another point of view. The two root canals have a common apical foramen.

to flow into all canal ramifications or tearing in thin areas. The main disadvantages of the present method are the thick sections (1 mm) used and the missing of some dental material by the whole cutting procedure. By taking serial sections we were able to see that although the

tooth looked single rooted the root dentin of the first tooth was clearly separated and connected by cementum and had a shape C in correspondence with the configuration of its root canal (Fig. 1). This type could be easily assigned to category I of Melton et al. (199 l). The second tooth could be assigned to category II of Melton et al. (1991) because it had two discrete root canals at the coronal third that became a continuous C-shape at the apical third (Fig. 7).

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2. Weine FS, Pasiewicz RA, Rice RT. Canal configuration of the mandibular second molar using a clinically oriented in vitro method. J Endodon 1988; 14:207-13. 3. Melton DS, Krell KV, Fuller MW. Anatomical and histological features of C-shaped canals in mandibular second molars. J Endodon 1991;17:384-8. 4. Weine FS, Healey HJ, Gerstein H, Evanson L. Canal configuration in the mesiobuccal root of the maxillary first molar and its endodontic significance. Oral Surg 1969;28:419-25. 5. Russ JC. Computer-assisted microscopy: the measurement and analysis of images. New York: Plenum Press, 1990. 6. Pitas I. Digital image processing algorithms. London: Prentice Hall, 1993;223-52. 7. Lyroudia K, PalakJdJs K, Manthos A, Nikolaidis N, Pitas I, Foroglou C. Computerized reconstruction of TEM examined pulpal blood vessels and nerves. Endod Dent Traumatol 1994; 11:189 -95.

Lyroudia Kleoniki is an assistant Professor in the Department of Dental Pathology and Therapeutics, School of Dentistry; Samakovitis Georgios is an electrical Engineer; Pitas Ioannis is a Professor in the Department of Infermatics; Lambrianidis Theodoros is an assistant Professor in the Department of Dental Pathology and Therapeutics; Molyvdas Ioannis is an assistant Professor in the Department of Dental Pathology and Therapeutics; and Mikrogeorgis Georgios is a Dentist, Aristotelian University of Thessaloniki, Greece. Address requests for reprints to Lyroudia Kleoniki, 23, Papafi Str., 54638 Thessaloniki, Greece.

References
1. Cooke HG, Cox FL. C-shaped canal configurations in mandibular molars. J Am Dent Assoc 1979;99:836-9.

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