Dentin Thickness of the Danger Zone in the Mesial Roots of the Mandibular Molars: A Cone Beam Computed Tomography Analysis.

BACKGROUND: Mandibular first molars appear to be the most commonly tooth subjected to a root canal treatment, therefore a better understanding of the anatomy critical zones for resistance of this teeth may decrease the treatment's failure rate. So, this study was conducted to evaluate the dentin thickness of the danger zone in mesial roots of mandibular first molars using cone beam computed tomography in an Iranian population. METHODS: In this cross-sectional study, 210 Cone Beam Computed Tomography acquisition of the mandibular first molars were collected from a radiology center in Qazvin. The dentin thickness of the mesial roots (mesiobuccal and mesiolingual canals) was measured from the furcation to 5 mm below. The relationship between the dentin thickness in the danger zone and parameters, like age, gender, placement side, root length, the curvature of the canal, canal type, presence of middle mesial canal, and distance between the orifices of the mesial canals was investigated. Frequency, mean and standard deviation for variables were calculated, and data analysis was done by SPSS using simple and multiple linear regression and Pearson correlation coefficient. Also, two-sample t-test was used to compare mesiobuccal and mesiolingual on two sides. The significant level was also considered at (p < 0.05). RESULTS: The average minimum thickness of danger zone dentin was found to be 0.885 ± 0.259 mm in the mesiobuccal canal and 0.906 ± 0.206 mm in the mesiolingualcanal. Also, the minimum thickness of dentin in the mesiobuccal and mesiolingual canals in the range of 0 to 1 mm from the furcation was more than in other areas. There was no significant relationship between the minimum dentin thickness of the danger zone with gender, placement side, root length, canal type, and mesial canal entrance distance. But with increasing age, the thickness of dentin in the danger zone in the mesiolingualcanal increased significantly (p = 0.008). It was also observed that with the increase in the curvature of the canal, the thickness of the dentin in the danger zone in the mesiobuccal canal decreased (moderately curved (p = 0.008), severely curved (p = 0.046)). In addition, the thickness of the dentin in the mesiobuccal and mesiolingual canal was less in the samples with the middle mesial canal (p = 0.047, 0.044). CONCLUSIONS: Less dentin thickness in the danger zone in the mesial roots of mesiolingual mandibular first molars was seen in younger patients in mesiolingual canal, with a greater degree of canal curvature in the mesiobuccal canal and teeth with a middle mesial canal. Therefore, it is suggested that large taper instruments should be used with more precision to prevent complications.

Anatomical localization of posterior superior alveolar artery: A retrospective study by cone-beam computed tomography.

BACKGROUND: Familiarity with the anatomy of the arteries in the sinus wall is essential to prevent the perforation of the sinus membrane and bleeding during dental implant surgery. OBJECTIVES: The aim of the study was to evaluate the anatomical position of the posterior superior alveolar artery (PSAA), using cone-beam computed tomography (CBCT). MATERIAL AND METHODS: A total of 245 CBCT scans met the eligibility criteria for this cross-sectional study. The vertical distance from the lower border of the artery to the lower border of the sinus floor, the diameter of the artery, and the type of artery (intrasinusoidal, intraosseous or superficial) in the first and second premolar and molar regions were measured. The data was analyzed with the t tests, the one-way analysis of variance (ANOVA) and the χ2 tests. RESULTS: The maxillary PSAA was recognized in 187 (76.3%) scans. The mean distance between the artery and the floor of the sinus was 6.87 ±3.68 mm. The mean diameter of the artery was 1.37 ±0.61 mm. The greatest mean diameter of the artery was observed in the second premolar region, and the smallest in the first molar region. As many as 63.6% of the arteries were intraosseous, 28.9% intrasinusoidal, and 7.5% superficial. CONCLUSIONS: Due to the high prevalence of the intraosseous type, in most cases of sinus lift surgery there is an increased possibility of PSAA damage. As the largest diameter of the artery was observed in the second premolar region, the possibility of severe bleeding during sinus lift surgery in this area is increased. The average distance between the artery and the floor of the sinus was approx. 7 mm. Consequently, it is recommended that the lower border of the sinus access window should be as high as 7 mm to the floor of the sinus.