RESUMO
Describir la morfología del sistema de canales radiculares del primer molar maxilar en una población chilena mediante exámenes de tomografía computarizada Cone-Beam (CBCT). Se realizó un estudio observacional descriptivo en el cual se utilizaron los exámenes CBCT de pacientes que fueron atendidos en un Centro de Radiología Maxilofacial privado durante el período comprendido entre Enero y Diciembre del año 2018 en la ciudad de Temuco, Chile, los cuales fueron observados de manera independiente por dos investigadores previamente calibrados. Se observaron 199 exámenes CBCT. En la raíz mesiobucal,predominaron las morfologías tipo II, I y IV de Vertucci respectivamente, mientras que en la raíz distobucal y palatina predominó la morfología tipo I. El canal MB2 estuvo presente en el 62,3 % de los casos, con una prevalencia significativamente mayor en pacientes jóvenes. En la mayoría de los primeros molares maxilares de los habitantes de la ciudad de Temuco se observaron tres raíces separadas y la presencia de cuatro canales. Se determinó una alta frecuencia del canal MB2 en la raíz MB.
SUMMARY: The objective of this study was to describe the morphology of the root canal system of the maxillary first molar in a Chilean population through Cone-Beam computed tomography (CBCT) examinations. A descriptive observational study was carried out in which the CBCT examinations of patients who were treated in a private maxillofacial radiology center during the period between January and December 2018 in Temuco, Chile, were used which were observed independently by two previously calibrated researchers. In this analysis 199 CBCT exams were observed. In the mesiobuccal root, Type II, I and IV morphologies predominated respectively, while in the distobuccal and palatal root, Type I morphology predominated. The MB2 canal was present in 62.3 % of cases, with a higher prevalence in young patients. Three separate roots and the presence of four canals were observed in most of the maxillary first molars of the patients in Temuco. A high frequency of the MB2 canal was determined in the root MB.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Cavidade Pulpar/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Dente Molar/diagnóstico por imagem , Chile , Distribuição por Idade , Cavidade Pulpar/anatomia & histologia , Maxila , Dente Molar/anatomia & histologiaRESUMO
The objective of this study was to investigate the complex anatomy of mesiobuccal roots, supporting and complementing commonly applied clearing technique, using access cavity modification and the pulpal groove deepening method. Three hundred and ninety eight extracted intact human maxillary first molars were included in this study. Firstly, modified rhomboidal shape access cavities were prepared then, the developmental groove between the mesiobuccal and the palatal canals was deepened 1 mm with a round slow speed bur. Indian ink was injected into both the canal orifices of mesiobuccal roots and into the groove between mesiobuccal and palatal canals, using a 22 gauge syringe. Then the clearing technique was applied. The incidence of one canal was 30.90 %, two canals was 62.07 %, three canals was 7.03 %. In twenty five (6.28 %) of the mesiobuccal roots, 8 root canal types, which are not included in Vertucci's classification, were seen. All these root canal types had three root canals. The establishment of adequate access and deepening of the pulp chamber floor increased the probability of locating the third canal in the mesiobuccal root of maxillary first molars.
El objetivo de este estudio fue investigar la compleja anatomía de las raíces mesiovestibulares, apoyando y complementando la técnica de limpieza aplicada comúnmente, usando la modificación de la cavidad de acceso y el método de profundización del surco pulpar. En este estudio se incluyeron 398 primeros molares maxilares, extraídos intactos. Se prepararon las cavidades de acceso con la forma romboidal modificada, el surco de desarrollo entre los conductos mesiovestibular y palatino se profundizó 1 mm con una fresa redonda de velocidad lenta. Se inyectó tinta china en los forámenes del canal de las raíces mesiovestibulares y en el surco entre los conductos mesiovestibular y palatino utilizando una jeringa de calibre 22. Luego se aplicó la técnica de limpieza. La incidencia de un canal fue del 30,90 %, dos canales del 62,07 % y tres canales del 7,03 %. En 25 casos (6,28 %) de las raíces mesiobucales, se observaron 8 tipos de conductos radiculares, que no están incluidos en la clasificación de Vertucci. Todos estos tipos de conductos tenían tres conductos radiculares. La determinación de un acceso adecuado y la profundización del piso de la cámara de pulpa aumentó la probabilidad de localizar el tercer canal en la raíz mesiovestibular de los primeros molares superiores.
Assuntos
Humanos , Cavidade Pulpar/anatomia & histologia , Dente Molar/anatomia & histologiaRESUMO
INTRODUCTION: The second canal of the mesiobuccal root (MB2) of the maxillary first molars (MFM) is difficult to detect in conventional radiographs and can be a major cause of failure in endodontic treatments. The aim of this study was to investigate the prevalence and anatomy of the MB2 by using high-resolution cone-beam computed tomography (CBCT). METHODS AND MATERIALS: Three radiologists examined 414 high-resolution CBCTs. Of these, the CBCTs of 287 patients (mean age 49.43±16.76) who had at least one MFM were selected, making a total of 362 teeth. Prevalence and its relation with gender and age of the patients, side of the tooth, and Vertucci's classification were analyzed. Data were statistically analyzed (P<0.05). RESULTS: A total of 68.23% of the teeth exhibited the MB2. The presence of the MB2 was equivalent in both genders and significantly higher in younger patients. There was no correlation between the presence of the MB2 in relation to both the sides of the MFM and the FOV size. Smaller FOV recognized higher Vertucci's grades. CONCLUSIONS: It was concluded that the prevalence of the MB2 canal in maxillary first molars in this Brazilian population examined with high-resolution CBTCs is 68.23%, being more prevalent in young patients. Gender and the side examined are no factors for determining the presence of MB2. Although the both FOVs of the high-resolution CBTCs (FOV 8 and 5) detect the MB2 canal, smaller FOV (FOV 5) is more accurate in the analysis of the internal anatomy of such root canals, according to the Vertucci´s classification.
RESUMO
El objetivo fue describir la configuración interna del sistema canalicular de la raíz mesiobucal (MB) del primer molar maxilar, identificando el número de canales junto a la frecuencia, ubicación y tipos de itsmo a 1, 3 y 5 mm del ápice. Esta investigación fue aprobado por el comité de ética. Se realizó un estudio descriptivo ex vivo de corte transversal. Molares extraídos fueron limpiados, desinfectados y fijados en formalina al 10 %. Se identificó la raíz MB y se obtuvieron cortes transversales (3) a 1, 3 y 5 mm desde apical a coronal, identificadas como secciones A, B y C. Ciento cincuenta secciones fueron teñidas con azul de metileno y observadas bajo microscopio óptico, tanto en la superficie apical como coronal, y analizadas mediante el programa ImageJ. Se obtuvieron estadísticas descriptivas (media ± DE), y mediante las prueba ANOVA y chi-cuadrado de Pearson se compararon las secciones a diferentes niveles. Se observaron un total de 445 canales radiculares, 289 correspondieron a canales accesorios. El 41,6 % fueron canales mesiobucales secundarios (MB2) y 5,1 % un tercer canal accesorio. Se observaron con mayor frecuencia istmos Tipo I (48), seguidos de Tipo IV (26); los Tipos II, III y V no superaron el 15 %. De acuerdo con la prueba de chi-cuadrado de Pearson, existen diferencias significativas entre los tipos istmos y distancia del ápice (p> 0,001). La incidencia del Tipo I fue mayor cerca del ápice, con un descenso hacia los 3,0 mm. Se observó una compleja morfología del sistema canalicular apical en la raíz MB, que explica su baja tasa de éxito cuando son tratados con endodoncia. Las variaciones anatómicas, tales como MB2 o más canales accesorios e istmos deben ser considerados en la planificación y realización del tratamiento de endodoncia convencional o cirugía apical, con el fin de lograr procedimientos más exitosos. Se recomienda que las apicectomías se extiendan por lo menos a 3,3 mm del ápice.
The aim was to describe the internal configuration of the canalicular system of the mesiobuccal root (MB) of the maxillary first permanent molar, identifying the number of canals and isthmus frequency, location, and types at 1, 3 and 5 mm from the apex. This research was approved by the ethics committee. A descriptive ex vivo cross-sectional study was conducted. Extracted molars were cleaned, disinfected and fixed in 10% buffered formalin. The non-instrumented MB root was identified and 3 cross sections at 1, 3 and 5 mm from apical to coronal identified as A, B and C were obtained. 150 sections were stained with methylene blue and observed under microscope, in both apical and coronal surface using the ImageJ program. Descriptive statistics (Mean±SD) was obtained, and ANOVA and Pearson chi-square tests were used to compare the sections at different levels. A total of 445 root canals were observed, 289 corresponded to accessory canals. 41.6% were secondary mesiobuccal canal (MB2) and 5.1% a third accessory canal. The isthmus observed were Type I (48), followed by Type IV (26); Types II, III and V did not exceed 15%. According to the Pearson chi-square test, there are significant differences between the isthmus types and distance of the apex (p> 0.001). The incidence of Type I was greater near the apex, with a decline towards 3.0 mm. A complex morphology of the apical maxillary MB root system was found, and explains their low success rate when treated endodontically. Anatomical variations such as MB2, accessory canals and isthmus should be considered when planning and conducting endodontic treatment or apical surgery, in order to achieve more successful procedures. It is recommended that apicectomies extend at least 3.3 mm from the apex.
Assuntos
Humanos , Masculino , Feminino , Adulto , Cavidade Pulpar/anatomia & histologia , Maxila/anatomia & histologia , Dente Molar/anatomia & histologia , Raiz Dentária/anatomia & histologia , Análise de VariânciaRESUMO
La incidencia de dos conductos en la raíz distovestibular en un primer molar maxilar es una variación anatómica poco frecuente del sistema de conductos. Los investigadores han demostrado múltiples forámenes, conductos adicionales, furcaciones, deltas, conexiones entre conductos, conductos en forma de C y conductos accesorios. Este reporte de caso clínico presenta el tratamiento de un primer molar maxilar con dos conductos en la raíz ovestibular. Se muestra clínicamente la presencia dedos conductos distovestibulares tipo 2-1, los cuales se instrumentaron manualmente con técnica corono- apical con limas K-Flexofi le de 25 mm y se obturaron con la técnica de condensación lateral, con conos de gutapercha, conos accesorios número FF, F y cemento Sealapex. Después del tratamiento se selló el diente con cemento temporal y se refirió para realizar la restauración defi nitiva...
The presence of two canals in the distobuccal root of a maxillary fi rst molar is a rare anatomical variation of the canal systems. Investigators have shown multiple foramina, additional canals, furcations, deltas, intercanal connections, C-shaped canals, and accessory canals. This clinical case reports the clinical treatment of a maxillary fi rst molar with two canals in the distobuccal root. We present a clinical case involving the presence of the two 2-1-type distobuccal canals. Manual instrumentation was performed using the crown-down technique with the aid of 25 mm K-fl exofi le fi les. The canals were fi lled using the lateral condensation technique and gutta-percha cones, FF and F accessory cones, and Sealapex cement. Following the treatment, the tooth was sealed with temporary cement and the patient was referred for fi nal restoration. The aim of this paper is to examine the anatomical variations that can occur in the root canal system and the technologies that can be used to correctly identify the location of additional canals.
Assuntos
Humanos , Masculino , Adulto , Cavidade Pulpar/anatomia & histologia , Maxila , Dente Molar/anatomia & histologia , Raiz Dentária/anatomia & histologia , Cavidade Pulpar , Guta-Percha/química , México , Dente Molar , Obturação do Canal Radicular/métodos , Odontometria/métodos , Tratamento do Canal Radicular/métodosRESUMO
Introduction:The knowledge on the complex anatomy of the maxillary first molar and location of extra canals are essential for diagnosis and endodontic treatment success. Objective:The purpose of this study was to report a clinical case showing a varied number of root canals in maxillary molars with the aid of the operating microscope (OM). Case report: The endodontic retreatment of the right maxillary first molar with unusual anatomical variation was performed, displaying three canals in the mesiobuccal root (MB), a root canal in the distobuccal root (DV) and a root canal in the palatal root (P). To remove the resin core inside pulp chamber with and without the aid of dental operating microscope, a high-speed drill and ultrasonic tip (diamond round) was used, respectively, for the refinement of the pulp chamber walls. The dental operating microscopewas used during the access surgery, location, negotiation of canals and checking of the completion of all stages of the retreatment. Subsequently, the cleaning, shaping and filling of the root canal system was completed. The presence of three canals in the mesiobuccal root, one in the distobuccal root and one in the palatal root was found. Conclusion: Variations in the number of canals could be confirmed during the surgery access in endodontic retreatment cases with the aid of dental operating microscope.
RESUMO
Introduction: Knowledge on variations in the root canal system is essential for a successful endodontic treatment. Objective: To present a case of identification of root canals in the maxillary left first molar,including the fourth root canal in the mesiobuccal root, using cone beam computed tomography (CBCT). Conclusion: The CBCT system proved to be relevant in providing important information on the root canal system for the planning of endodontic treatment in cases of persistent infection or access difficulties.