“Tehlikeli Bölge” Gerçekten Tehlikeli mi?– Endodonik Bakış Açısı

Abstract

Amaç: Çalışmanın amacı konik ışınlı bilgisayarlı tomografi (KIBT) kullanarak tehlikeli bölgenin (TB) dentin kalınlığını belirlemede panoramik radyografinin doğruluğunu değerlendirmek ve mandibular azı dişlerinin dentin kalınlıklarını farklı seviyelerde incelemektir. Gereç ve Yöntem: Çalışma için 250 mandibular azı dişi seçildi. Panoramik radyografide dentin kalınlıkları ölçüldü. KIBT görüntüsünde mesiobukkal (MB), meziolingual (ML) ve distal köklerin dentin kalınlıkları ölçüldü. Referans noktası mandibular molarların furkasyonunun 3 mm, 4 mm ve 5 mm altı olarak belirlendi. İstatistiksel analiz yapıldı. Bulgular: CBCT ve panoramik arasındaki fark MB için 0,5 mm, ML için 0,48 mm ve distal için 0,43 mm idi. 3 mm ve 5 mm arasındaki dentin kalınlığındaki fark istatistiksel olarak anlamlı değildir (P>.05), oysa 4 mm furkasyon seviyesi her bir kök kanalı için 3 mm ve 5 mm'de önemli ölçüde daha düşüktü. Bu çalışma, panoramik radyografide tehlike bölgesinde 0,5 mm distorsiyon oluştuğunu göstermiştir. Sonuç: Çalışmamız panoramik radyografide 1 mm'den az olan dentin kalınlığının distorsiyon nedeniyle perforasyona daha yatkın olduğunu göstermiştir. Dentin kalınlığı furkasyonun 4 mm altında en düşük seviyedeydi. Sonuçlarımız, periapikal radyografinin bulunmadığı kliniklerde veya kurumlarda klinisyenlere yol gösterici olacaktır.

Keywords

• Konik ışınlı bilgisayarlı tomografi
• Panoramik radyografi
• Mandibular molar
• Endodonti
• Kök kanal şekillendirmesi

Is “Danger Zone” Really Dangerous? - An Endodontic Perspective

Abstract

Aim: To evaluate the accuracy of panoramic radiography in determining dentin thickness of danger zone (DZ) using cone-beam computed tomography (CBCT) imaging to examine the dentin thicknesses of the mandibular molars at different levels. Materials and Methods: For the study, 250 mandibular molars were selected. Dentine thicknesses were measured on panoramic radiography. On the CBCT view, dentine thicknesses of mesiobuccal (MB), mesiolingual (ML), and distal roots were measured. The reference point was determined as 3 mm, 4 mm, and 5 mm below the furcation of mandibular molars. Statistical analysis was performed. Results: The discrepancy between CBCT and panoramic was 0.5 mm for MB, 0.48 mm for ML, and 0.43 mm for distal. The difference in the dentin thickness between 3 mm and 5 mm is not statistically significant(P>.05), whereas the 4 mm furcation level was significantly lower in either 3 mm and 5 mm for each root canal. This study showed that 0.5 mm distortion occurred in the danger zone on panoramic radiography. Conclusion: Our study showed that the dentin thickness of less than 1 mm in panoramic radiography is more prone to perforation because of distortion. The dentin thickness was lowest at 4 mm below the furcation. Our results can be a guide the clinicians in clinics or institutions where periapical radiography is not available.

Keywords

• Cone-beam computed tomography
• Panoramic radiography
• Mandibular molar
• Endodontics
• Root canal preparation

References

1. Abou-Rass M, Frank AL, Glick DH. (1980). The anticurvature filing method to prepare the curved root canal. Journal of American Dental Assocciation, 101, 792-794.
2. Akhlaghi NM, Kahali R, Abtahi A, et al. (2010). Comparison of dentine removal using V‐taper and K‐Flexofile instruments. International Endodontic Journal, 43, 1029-1036.
3. Asgary S, Nikneshan S, Akbarzadeh-Bagheban A, et al. (2016). Evaluation of diagnostic accuracy and dimensional measurements by using CBCT in mandibular first molars. Journal of Clinical and Experimental Dentistry, 8:1-8.
4. Azimi VF, Samadi I, Saffarzadeh A, et al. (2020). Comparison of dentinal wall thickness in the furcation area (danger zone) in the first and second mesiobuccal canals in the maxillary first and second molars using cone-beam computed tomography. European Endodontic Journal, 5(2), 81.
5. Bland J M, Altman D. (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 327:307-310.
6. Cerqueira NM, Louzada VG, Silva-Sousa YTC. (2021). Effect of canal preparation with XP-endo Shaper and ProTaper Next on root canal geometry and dentin thickness of mandibular premolars with radicular grooves and two canals: a micro-CT study. Clinical Oral Investigations, 25, 5505–5512.
7. De‐Deus G, Rodrigues EA, Belladonna FG, Simões‐Carvalho M, et al. (2019). Anatomical danger zone reconsidered: a micro‐CT study on dentine thickness in mandibular molars. International Endodontic Journal, 52,1501-1507.
8. De-Deus G, Rodrigues EA, Lee JK, et al. (2021). Root groove depth and inter-orifice canal distance as anatomical predictive factors for danger zone in the mesial root of mandibular first molars. Clinical Oral Investigations, 25(6), 3641-3649.

9. Espir CG, Nascimento CA, Guerreiro-Tanomaru JM, et al. (2018). Radiographic and micro-computed tomography classification of root canal morphology and dentin thickness of mandibular incisors. Journal of Conservative Dentistry, 21:57-62.
10. Estrela C, Pécora JD, Estrela CR, et al. Common operative procedural errors and clinical factors associated with root canal treatment. Braz Dent J 2017;28:179-190.
11. Garala M, Kuttler S, Hardigan P, et al. (2003). A comparison of the minimum canal wall thickness remaining following preparation using two nickel-titanium rotary systems. Internatonal Endodontic Journal, 36, 636–642.
12. Gerke O. (2020) Reporting standards for a Bland–Altman agreement analysis: A review of methodological reviews. Diagnostics, 10(5), 334.
13. Harris SP, Bowles WR, Fok A, et al. (2013). An anatomic investigation of the mandibular first molar using micro-computed tomography. Journal of Endodontics, 39,1374–1378.
14. Hiebert BM, Abramovitch K, Rice D, et al. (2017). Prevalence of second mesiobuccal canals in maxillary first molars detected using cone-beam computed tomography, direct occlusal access, and coronal plane grinding. Journal of Endodontics, 43, 1711-1715.
15. Júnior ASA, Cavenago BC, Ordinola-Zapata R, et al. (2014). The effect of larger apical preparations in the danger zone of lower molars prepared using the Mtwo and Reciproc systems Journal of Endodontics, 40, 1855-1859.
16. Kessler JR, Peters DD, Lorton L. (1983). Comparison of the relative risk of molar root perforations using various endodontic instrumentation techniques. Journal of Endodontics, 9,439-447.
17. Lazzaretti DN, Camargo BA, Della Bona A, et al. (2006) Influence of different methods of cervical flaring on establishment of working length. Journal of Applied Oral Science,14351,-354.
18. Lim SS, Stock CJ. (1987). The risk of perforation in the curved canal: anticurvature filling compared with step-back technique. International Endodontic Journal, 20,33-39.
19. Liu W, Wu B. (2016) Root canal surface strain and canal center transportation induced by 3 different nickel-titanium rotary instrument systems. Journal of Endodontics, 42, 299-303.
20. Mattos CT, Cruz CV, da Matta TCS, et al. (2014). Reliability of upper airway linear, area, and volumetric measurements in cone-beam computed tomography. American Journal of Orthodontics and Dentofacial Orthopedics, 145,188-197.
21. Miguéns-Vila R, Martín-Biedma B, De-Deus G, et al. (2021). Micro–computed Tomographic Evaluation of Dentinal Microcracks after Preparation of Curved Root Canals with ProTaper Gold, WaveOne Gold, and ProTaper Next Instruments. Journal of Endodontics, 47(2), 309-314.
22. Nardi C, Calistri L, Grazzini G, et al. (2008). Is Panoramic Radiography an Accurate Imaging Technique for the Detection of Endodontically Treated Asymptomatic Apical Periodontitis? Journal of Endodontics, 44, 1500-1508.
23. Olivier JG, García-Font M, Gonzalez-Sanchez JA, et al. (2016). Danger zone analysis using cone-beam computed tomography after apical enlargement with K3 and K3XF in a manikin model. Journal of Clinical and Experimental Dentistry, 8, 361-367.
24. Peters OA, Koka RS. Preparation of coronal and radicular spaces. In: Ingle JI, Bakland LK, Baumgartner JC, eds. Endodontics, 6th edn; pp. 2008:887– 991. Ontario: BC Decker Inc.
25. Rahmel S, Schulze RK. (2019). Accuracy in detecting artificial root resorption in panoramic radiography versus tomosynthetic panoramic radiographs. Journal of Endodontics, 45(5), 634-639.
26. Raiden G, Koss S, Costa L, et al. (2001). Radiographic measurement of residual root thickness in premolars with post preparation. Journal of Endodontics, 27, 296-298.
27. Sauáia TS, Gomes BPFA, Pinheiro ET, et al (2010). Thickness of dentine in mesial roots of mandibular molars with different lengths. International Endodontic Journal, 43, 555-559.
28. Silva EJNL, Pacheco PT, Pires F, et al. (2017). Microcomputed tomographic evaluation of canal transportation and centering ability of ProTaper Next and Twisted File Adaptive systems. International Endodontic Journal,50,694-699.
29. Silva LR, de Lima KL, et al. (2020). Dentin thickness as a risk factor for vertical root fracture in endodontically treated teeth: a case-control study. Clinical Oral Investigation,1-7
30. Sousa K, Andrade-Junior CV, Silva JM, et al. (2015). Comparison of the effects of Triple Gates and Gates-Glidden burs on cervical dentin thickness and root canal area by using cone-beam computed tomography. Journal of Applied Oral Science, 23, 164–168.
31. Xu J, He J, Yang Q, et al. (2017) Accuracy of cone-beam computed tomography in measuring dentin thickness and its potential of predicting the remaining dentin thickness after removing fractured instruments. Journal of Endodontics, 43,1522-1527.