El Hachem C, Kaloustian M K, Nehme W, Ghosn N, Abou Chedid J C
Department of Pediatric Dentistry, Faculty of Dentistry, Saint Joseph University, Beirut, Lebanon.
Department of Endodontics, Faculty of Dentistry, Saint Joseph University, Beirut, Lebanon.
Eur Arch Paediatr Dent. 2019 Oct;20(5):457-465. doi: 10.1007/s40368-019-00426-8. Epub 2019 Mar 4.
This study aimed at establishing a comprehensive specification of the root canal anatomy of second primary mandibular molars using micro computed tomography (CT).
10 s primary molars from Caucasian young patients were selected for this purpose. Micro CT imaging with a high resolution of 20 microns was performed to observe the roots and canals according to specific criteria. The Vertucci canal configuration, the presence of lateral canals and their location, the presence of an isthmus and its location, were first observed. Then, the length of the canals, their diameter in the mesio-distal and vestibulo-lingual direction, the dentinal thickness and the direction of the minimal dentinal thickness were measured.
The mean working length was not significantly different between the canals (p = 0.710). The bucco-lingual diameter was significantly higher when the tooth had a single distal canal at the coronal (p < 0.001), middle (p < 0.001) and apical (p = 0.012) levels. The root dentin thickness on the distal wall of the mesial root and the mesial wall of the distal roots were reduced, respectively, from the coronal to the apical thirds.
The results obtained in this case series report clearly show a complex, sometimes unpredictable, anatomy with dangerous areas where dentin is extremely thin. The plethoric presence of anastomoses, large bands of isthmus, lateral canals at all levels induces the need for the development of instruments specific to pulpectomies on primary teeth.
本研究旨在利用微型计算机断层扫描(CT)建立下颌第二乳磨牙根管解剖结构的综合规范。
为此选择了10颗来自白种年轻患者的乳磨牙。采用20微米高分辨率的微型CT成像,根据特定标准观察牙根和根管。首先观察韦尔图奇根管形态、侧支根管的存在及其位置、峡部的存在及其位置。然后,测量根管长度、其在近远中方向和前庭舌侧方向的直径、牙本质厚度以及最小牙本质厚度的方向。
各根管之间的平均工作长度无显著差异(p = 0.710)。当牙齿在冠部(p < 0.001)、中部(p < 0.001)和根尖部(p = 0.012)有单一远中根管时,颊舌径显著更高。近中根远中壁和远中根近中壁的牙根牙本质厚度分别从冠部到根尖三分之一逐渐减小。
本病例系列报告中获得的结果清楚地表明,其解剖结构复杂,有时不可预测,存在牙本质极薄的危险区域。大量的吻合支、宽大的峡部带以及各级侧支根管的存在,促使有必要开发专门用于乳牙牙髓摘除术的器械。