Mandibular molar dişlerde kanal duvarı kalınlığının dental volümetrik tomografi ile değerlendirilmesi

Yıl 2021, , 14 - 18, 01.01.2021

Erinc Önem , Güniz Baksi Şen , R. Irmak Turhal Bilge Hakan Şen

https://doi.org/10.17214/gaziaot.739408

Öz

Amaç: Bu çalışmanın amacı, mandibular 1. ve 2. molar dişlere ait kanalların interradiküler bölgeye olan uzaklığını dental volümetrik tomografi (DVT) üzerinde ölçmektir.

Gereç ve Yöntem: Seksen hastaya ait mandibular DVT görüntülerindeki 50 adet 1. molar ve 50 adet 2. molar diş retrospektif olarak incelendi. Aksiyel kesitlerde bifurkasyon seviyesinin 2 mm altından, tüm kanalların dış sınırından interradiküler bölgeye olan en kısa mesafe kanal duvar kalınlığı ölçülerek kaydedildi. Ölçümler 2 radyolog tarafından yapıldı ve her alan için aritmetik ortalama alındı. Gruplar arasındaki farklar iki yönlü varyans analizi kullanılarak karşılaştırıldı. İkili karşılaştırmalar için ise Tukey HSD testi kullanıldı (p=0.05).

Bulgular: Mandibular 1. ve 2. molar diş kanallarına ait ölçümler grup olarak değerlendirildiğinde aralarındaki farkın istatistiksel olarak anlamlı olduğu gözlendi (p=0.009). Buna göre, 1. molar dişlerin kanalları interradiküler bölgeye, 2. molar dişlere göre daha yakındı. Kanal duvarı kalınlıkları, her bir molar grubunun kendi içerisinde birbirleriyle ikili olarak karşılaştırıldığında, meziobukkal (MB) kanalın en düşük değere sahip olduğu gözlendi (p<0.05). Distal kanalın bifurkasyona uzaklığı MB ve meziolingual (ML) kanallardan daha fazlaydı (p=0.000). Distobukkal (DB) ve distolingual (DL) kanallar arasında ise herhangi bir istatistiksel fark saptanmadı (p>0.05).

Sonuç: Mandibular 1. molar dişlerin kanallarının interradiküler bölgeye ortalama uzaklıkları, 2. molar dişlere göre daha azdı. Tüm mandibular molar dişlerdeki kanalların interradiküler bölgeye ortalama uzaklık değerleri açısından sıralanışları MB<ML<DL<DB<D şeklindedir. Buna göre, strip perforasyon ve vertikal kırık gibi komplikasyonları önlemek için yüksek açılı ve çaplı döner aletlerin kullanımından kaçınılmalıdır.

Anahtar Kelimeler

endodonti, mandibula, molar, kök kanal tedavisi

Evaluation of root canal wall thickness of mandibular molar teeth by dental volumetric tomography

Öz

Objective: This study aims to measure the distance between the root canals and inter-radicular region of mandibular 1st and 2nd molars using dental volumetric tomography (DVT).

Materials and Method: Mandibular DVT images of 50 first-molar teeth and 50 second-molar teeth of 80 patients were examined retrospectively. The shortest distance from the root canal wall to the inter-radicular region was measured at 2 mm below the bifurcation level at axial sections. Measurements were made by 2 radiologists, and arithmetic means were calculated for each area. The differences between the groups were analyzed with two-way ANOVA. Besides, Tukey HSD test was used for pairwise comparisons (p=0.05).

Results: The root canals of the 1st molar teeth were closer to the inter-radicular region than those of the 2nd molar teeth (p=0.009). When the thickness of root canal walls of different types of molars was compared pairwise, the mesiobuccal canal had the lowest measurement (p<0.05). The distance of the distal canal to the bifurcation area was higher than that of the mesiobuccal and mesiolingual canals (p=0.000). There was no statistically significant difference between the distobuccal and distolingual canals (p>0.05).

Conclusion: The root canals of the 1st molar teeth were closer to the inter-radicular region than those of the 2nd molar teeth. Measurements of different root canals of the 1st and 2nd molar teeth revealed differences in thickness. Overall, the order was MB<ML<DL<DB<D. Accordingly, over-instrumentation should be avoided particularly in mesial canals to avoid complications such as strip perforation and vertical fracture.

Anahtar Kelimeler

endodontics, mandible, molar, root canal therapy

Kaynakça

• Berutti E, Fedon G. Thickness of cementum/dentin in mesial roots of mandibular first molars. J Endod 1992;11:545-8.
• Abou-Rass M, Frank AL, Glick DH. The anticurvature filing method to prepare the curved root canal. J Am Dent Assoc 1980;5:792-4.
• Mahran AH, AboEl-Fotouh MM. Comparison of effects of ProTaper, HeroShaper, and Gates Glidden Burs on cervical dentin thickness and root canal volume by using multislice computed tomography. J Endod 2008;34:1219-22.
• Sousa K, Andrade-Junior CV, Silva JM, Duarte MA, De-Deus G, Silva EJ. Comparison of the effects of TripleGates and Gates-Glidden burs on cervical dentin thickness and root canal area by using cone beam computed tomography. J Appl Oral Sci 2015;23:164-8.
• Ramanathan S, Solete P. Cone-beam Computed Tomography Evaluation of Root Canal Preparation using Various Rotary Instruments: An in vitro Study. J Contemp Dent Pract 2015;16:869-72.
• Shantiaee Y, Dianat O, Paymanpour P, Nahvi G, Ketabi MA, Kolahi Ahari G, et al. Alterations of the danger zone after preparation of curved root canals using WaveOne with reverse rotation or reciprocation movements. Iran Endod J 2015;10:156–61.
• Raiden G, Koss S, Costa L, Hernández JL. Radiographic measurement of residual root thickness in premolars with post preparation. J Endod 2001;27:296-8.
• Sauáia TS, Gomes BP, Pinheiro ET, Zaia AA, Ferraz CC, Souza-Filho FJ, et al. Thickness of dentine in mesial roots of mandibular molars with different lengths. Int Endod J 2010;43:555-9.
• Harris SP, Bowles WR, Fok A, McClanahan SB. An anatomic investigation of the mandibular first molar using micro-computed tomography. J Endod 2013;39:1374-8.
• Kessler JR, Peters DD, Lorton L. Comparison of the relative risk of molar root perforations using various endodontic instrumentation techniques. J Endod 1983;9:439-47.
• Montgomer S. Root canal wall thickness of mandibular molars after biomechanical preparation. J Endod 1985;11:257-63.
• Isom TL, Marshall JG, Baumgartner JC. Evaluation of root thickness in curved canals after flaring. J Endod 1995;21:368-71.
• Garala M, Kuttler S, Hardigan P, Steiner-Carmi R, Dorn S. A comparison of the minimum canal wall thickness remaining following preparation using two nickel-titanium rotary systems. Int Endod J 2003;36:636-42.
• Garcia Filho PF, Letra A, Menezes R, Carmo AM. Danger zone in mandibular molars before instrumentation: an in vitro study. J Appl Oral Sci 2003;11:324-6.
• Zuckerman O, Katz A, Pilo R, Tamse A, Fuss Z. Residual dentin thickness in mesial roots of mandibular molars prepared with Lightspeed rotary instruments and Gates-Glidden reamers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:351-5.
• Wu MK, van der Sluis LW, Wesselink PR. The risk of furcal perforation in mandibular molars using Gates-Glidden drills with anticurvature pressure. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:378-82.
• Leite Pinto SS, Lins RX, Videira Marceliano-Alves MF, Guimarães MDS, Da Fonseca BA, Radetic AE, et al. The internal anatomy of danger zone of mandibular molars: A cone-beam computed tomography study. J Conserv Dent 2018;21:481-484.
• Dwivedi S, Dwivedi CD, Mittal N. Correlation of root dentin thickness and length of roots in mesial roots of mandibular molars. J Endod 2014;40:1435-8.
• Zhou G, Leng D, Li M, Zhou Y, Zhang C, Sun C, et al. Root dentine thickness of danger zone in mesial roots of mandibular first molars. BMC Oral Health 2020;20:43.
• Lim SS, Stock CJ. The risk of perforation in the curved canal: anticurvature filing compared with the stepback technique. Int Endod J 1987;20:33-9.
• Nelson SJ, Ash Jr MM. The Permanent Mandibular Molars In: Nelson SJ editor. Wheeler’s dental anatomy, physiology, and occlusion. 9th ed. St. Louis, MO, Saunders Elsevier; 2010. p.190, p.200.
• Mohammadzadeh Akhlaghi N, Khalilak Z, Vatanpour M, Mohammadi S, Pirmoradi S, Fazlyab M, et al. Root Canal Anatomy and Morphology of Mandibular First Molars in a Selected Iranian Population: An In Vitro Study. Iran Endod J 2017;12:87-91.
• Duarte MA, Bernardes RA, Ordinola-Zapata R, Vasconcelos BC, Bramante CM, Moraes IG. Effects of Gates-Glidden, LA Axxess and orifice shaper burs on the cervical dentin thickness and root canal area of mandibular molars. Braz Dent J 2011;22:28-31.