Variabilidad morfológica clínica del sistema de conductos de la raíz mesial de los primeros molares mandibulares: análisis de 150 casos / Morphological-clinical variability of the duct system of the mesial root of the mandibular first molars. Analysis of 150 cases

Introducción: El conocimiento de la complejidad del espacio radicular es esencial para el éxito del tratamiento endodóncico. La raíz mesial del primer molar inferior presenta como variante anatómica la existencia de un istmo entre los conductos mesiovestibular y mesiolingual que puede pasar desapercibido o que puede ser trabajado como un conducto suplementario. Objetivo. Clasificar y mostrar el aspecto in vivo de las diferentes morfologías que puede presentar la raíz mesial del primer molar mandibular desde el punto de vista clínico y radiográfico, teniendo presente la permeabilidad del istmo. Material y método. Muestra de 150 primeros molares mandibulares fueron catalogados según los siguientes parámetros: exploración visual de la cámara y aspectos radiográficos durante el tratamiento endodóncico. Resultados. El 82% de los casos evidenció la presencia de dos conductos sin istmo canalizable, aunque visible(istmo rudimentario) en el 40% de los caos. El resto de la muestra (18%) presentó un istmo canalizable (tener conducto) siendo clasificados según el punto de su permeabilización en: lingual (6,7%), vestibular (6%), intermedio (4%) y más de un punto de permeabilidad (1,3%). Conclusiones. La identificación visual de un surco que relaciona los conductos mesiovestibular y mesiolingula obliga al clínico a buscar un espacio por el que permeabilizar, limpiar y obturar el istmo como si de un tercer conducto se tratara. La canalización del istmo se comprueba en la radiografía de conductometría y no en la radiografía final, ya que la superposición del material de obturación hace que no se evidencie frecuentemente la presencia de los tres conductos (AU)

Introduction. The knowledge about the complex anatomy of the radicular space is essential for the success of the endodontic treatment. The mesial root of the permanent mandibular first molar shows isthmus between the mesiobuccal and mesiolingual canals, with different morphologies, that can go unnoticed. Objective. Sort and show in vivo the clinical appearance of different morphologies that may have mesial root of the permanent mandibular first molar in radiographic images and photographs taken during the root canal treatment, taking into account the permeability of the isthmus. Material and methods. 150 mandibular first molar were classified according to visual exploration of the chamber and radiographic images during endodontic treatment. Results. The 82% of total showed the presence of two canals without isthmus channeling, but visible (rudimentary isthmus) in 40% of cases. The rest of the sample (18%) had as isthmus ducted (third canal) being classified according to the permeabilization point: lingual (6,7%), buccal (6%), intermediate (4%) and permeability of more than one point (1,3%). Conclusions. Visual identification of a path that links the mesiobuccal and mesiolingual canals obliges the practitioner to look for a space in order to get patency, cleaning, shaping and filing the isthmus as if it were at third canal. Cahnneling the isthmus is usually found in the working length radiograph and not on the final radiograph as the superposition of the filling material does not often show evidence of the presence of three canals (AU)

Cutting efficiency evaluation of Quantec Series 2000 orifice openers with computed tomography (CT)

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Introduction: Orifice openers or orifice shapers are used to shape the coronal part of the root canals during endodontic treatment. Objectives: The aim of this work was to analyse the cutting efficiency of Quantec Series 2000 system orificeshapers by means of computerised tomography (CT). Materials and methods: Mandibular molars were selected,preoperative CT was performed and the cross-sections and surface area of the root canals were measured. Followingaccess opening and preparation of the coronal part of the canals with Quantec Series 2000 orifice shapers, a further CT was obtained of all the teeth, the previous measurements were repeated and the two sets of measurements were compared. Results: Although the canals suffered modifications due to the action of the instruments, they remainedcentred and retained their original morphology; the changes were greater in the most coronal part of the canals.Conclusions: the orifice shapers of the system under study kept the canals centred on their original position, so they do not present great aggressiveness during endodontic treatment; the canals that were initially the widest were those that showed the greatest modification; the CT system employed in the study showed itself to be an effective, noninvasive system for studying the changes that had taken place inside the root canals (AU)

Diagnostic performance of radiovisiography in combination with a diagnosis assisting program versus conventional radiography and radiovisiography in basic mode and with magnification

Objective. To evaluate and compare the diagnostic efficiency of a digital radiographic system (RadioVisioGraphy –RVG-) in combination with a diagnostic assisting program (Logicon) with RVG in basic mode, magnification and conventional radiography (Kodak).Study design. A study was made of 384 proximal surfaces corresponding to 192 posterior teeth. The diagnostictechniques employed comprised Kodak DF-58 Ultraspeed X-rays and a Trophy RVG system used in normal mode,magnification, combination with a caries diagnosis assisting program by Logicon; Kodak DF-58 Ultraspeed radiographs were used. The same X-ray source was used in all cases. The images obtained were compared to histological sections of the teeth used. These were brewed by abrasion and observed using a light microscope. A single operator made all observations. Sensitivity, specificity, the positive and negative predictive values, and the probability ratiowere calculated.Results. Application of the Logicon program increased sensitivity, specially in lesions with caries extending into the dentin. In contrast, conventional radiography yielded a higher specificity and positive predictive value. The negative predictive values were similar for both tecniques.Conclusions. The RVG digital radiography and the Logicon assistance program was effective in diagnosing caries (AU)

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