Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.
Faculty of Dentistry, Universidad Andres Bello, Santiago, Chile.
Int Endod J. 2022 Jun;55(6):672-684. doi: 10.1111/iej.13740. Epub 2022 Apr 10.
To describe the radicular dentine thickness in mandibular first premolars presenting C-shaped root canals, to identify the canal walls with less thickness as potential danger zones. In addition, to describe the internal and external anatomical characteristics of these teeth and associate them with the dentine thickness.
A total of 70 mandibular first premolars presenting C-shaped root canals were examined. Their internal morphology was analysed using Vertucci's and Fan's criteria, and their external morphology was analysed using the ASUDAS score. Besides, the dentine thickness around the root canals was two/three-dimensionally determined at five root planes and quantified in the distal and the mesial aspects.
According to Fan's, ASUDAS, and Vertucci's classifications, the most common canal configurations were category C3, grade 3, and type V, respectively. In Vertucci's type III anatomy, the mesial root wall of the lingual canal showed significantly less dentine thickness than the distal wall in the middle plane (p = .031). Similarly, in Vertucci's type V anatomy, significantly less dentine thickness was observed in the mesial root wall of the buccal and lingual canals in the middle plane (p < .001) and the buccal canal in the middle-apical plane (p = .014) than the distal root wall of these canals. In teeth with ASUDAS grade 3 and 4 scores, significantly less dentine thickness was observed in the mesial in comparison with the distal root wall of these canals. These differences were demonstrated in the middle and middle-apical planes (p < .001) of grade 3 teeth and the middle-apical plane (p < .001) of grade 4 teeth. In these root planes, the Ver1-AS3 and VerV-AS3 combinations presented a 4-times greater risk of presenting walls with a critical dentine thickness of 0.6 mm (odds ratio [OR] = 4, p = .025) than the combinations Ver1-AS2, VerV-AS2, VerV-AS4, and VerIII-AS3.
The root canal system configuration of mandibular first premolars with C-shaped canals showed a wide range of anatomical variations. The lowest dentine thickness was located in the mesial wall of the canals in the middle and apical root thirds of Vertucci's type III and V anatomies and in teeth with deep radicular grooves scored as ASUDAS grades 3 and 4. In the middle and middle-apical planes, the presence of the combinations Ver1-AS3 and VerV-AS3 showed a high risk of presenting a critical dentine thickness of 0.6 mm. Therefore, these root canal walls with less dentine thickness represent potential instrumentation danger zones in mandibular first premolars with C-shaped canals.
描述下颌第一前磨牙 C 形根管的根分叉处牙本质厚度,确定牙本质较薄的根管壁为潜在的危险区域。此外,描述这些牙齿的内部和外部解剖特征,并将其与牙本质厚度相关联。
共检查了 70 颗下颌第一前磨牙,这些牙齿具有 C 形根管。使用 Vertucci 和 Fan 的标准分析其内部形态,使用 ASUDAS 评分分析其外部形态。此外,在五个根面平面上对根管周围的牙本质厚度进行二维/三维确定,并在远中和近中方面进行定量。
根据 Fan、ASUDAS 和 Vertucci 的分类,最常见的根管构型分别为 C3 型、3 级和 V 型。在 Vertucci Ⅲ型解剖中,中平面的近中舌根管壁的牙本质厚度明显小于远中壁(p = 0.031)。同样,在 Vertucci Ⅴ型解剖中,中平面的近中颊和舌根管以及中根尖平面的颊根管的牙本质厚度明显小于这些根管的远中根壁(p < 0.001)。在 ASUDAS 分级为 3 级和 4 级的牙齿中,与这些根管的远中根壁相比,近中根壁的牙本质厚度明显减少。这些差异在中平面(p < 0.001)和中根尖平面(p < 0.001)的 3 级牙齿和中根尖平面(p < 0.001)的 4 级牙齿中表现出来。在这些根面平面中,Ver1-AS3 和 VerV-AS3 组合发生具有临界牙本质厚度为 0.6 mm 的危险根管壁的风险是 Ver1-AS2、VerV-AS2、VerV-AS4 和 VerIII-AS3 组合的 4 倍(比值比 [OR] = 4,p = 0.025)。
下颌第一前磨牙 C 形根管系统的根管构型表现出广泛的解剖变异。在 Vertucci Ⅲ型和Ⅴ型解剖的中根和根尖三分之一以及根沟深度为 ASUDAS 分级 3 和 4 的牙齿中,牙本质最薄的部位位于根管的近中壁。在中平面和中根尖平面中,Ver1-AS3 和 VerV-AS3 组合的存在显示出具有临界牙本质厚度为 0.6 mm 的危险根管壁的高风险。因此,这些牙本质较薄的根管壁代表下颌第一前磨牙 C 形根管潜在的器械危险区域。