Résumé
Objective @#To explore the influence of a contracted endodontic access cavity on the risk of canal transportation in the danger zone of the mesial root canal of mandibular first molars (MFMs) using a one-curve preparation system, and to provide an experimental basis for the clinical selection of a better pulp approach.@*Methods@#Twenty MFMs extracted for severe periodontal disease that met the inclusion criteria, including intact coronal roots, mesial roots with two separate root canals, mesiobuccal canal (MB) and mesiolingual canal (ML), and a curvature of 0° to 20°, were selected. Subsequently, these MFMs were randomly divided into two groups based on the endodontic access design, including the traditional endodontic access cavity (TEC) group and the contracted endodontic access cavity (CEC) group. In the TEC group, the pulp chamber roof of the tooth was completely removed, while in the CEC group, the pulp chamber roof and peri-cervical dentin were preserved as much as possible. Then, the One Curve single file was adopted to conduct root canal preparation. Next, cone beam computed tomography (CBCT) was performed on extracted teeth before and after preparation, and the measurement sections were located at 0-7.0 mm below the root bifurcation of the mesial root canal at 1 mm intervals. The minimum wall thickness on the mesial and distal aspect of the root canal was measured in each section.@* Results @# ① Prepreparation CT measurements of 20 MFMs showed that the danger zone in the range 0-4 mm under root bifurcation, a mean thickness of 1.18 mm on the mesial aspect of the MB root canal and 1.08 mm on the distal aspect. The mean thickness of the ML root canal was 1.28 mm on the mesial aspect and 1.07 mm on the distal aspect. ② Compared with that of the traditional endodontic access cavity, no significant difference in the decrease of wall thickness was observed in the danger zone of mesial root canal of MFMs in the contracted endodontic access cavity (t = 1.319，P = 0.19). ③ In the mesiobuccal canal, compared with the apical transportation of the traditional endodontic access cavity, which tends to be more mesial side, the apical transportation of contracted endodontic access cavity tends to the distal side. In the mesiolingual canal, both apical transportation groups tended to be on the distal side. @*Conclusion @# When using the One Curve file, compared with traditional endodontic access, the contracted endodontic access cavity based on the minimally invasive concept does not increase the risk that the mesial root canal of mandibular first molars is transported.
Résumé
Objective @# To analyze the morphology and incidence of middle mesial canal (MM) and isthmus in the mandibular first permanent molar by cone-beam computed tomography (CBCT).@*Methods@# Statistical analysis was performed on images from patients who underwent CBCT examination in the Department of Radiology at Stomatological Hospital, Southern Medical University. Samples exhibiting root canal treatment, root resorption and calcification were excluded. Data regarding sex, age, the presence or absence of isthmus and MM, and the number of roots and root canals were recorded.@*Results @#Of the 217 mandibular first molar samples, 8 (3.7%) had an MM, and 2 (0.9%) had an independent apical foramen. The overall incidence rate of isthmus was 57.1%; this rate was 50.7% in the cervical third of the root canal, 17.5% in the middle third, and 13.4% in the apical third. The incidence rate of isthmus was 61.8% on the left side, 52.3% on the right side, 58.7% in males, and 55.8% in females. No significant difference was found between the left and right sides or between females and males (P > 0.05). The incidence rate of isthmus in people under 60 was greater than 50% but was significantly lower in people older than 60.@*Conclusion@#Only a very small proportion of MMs have an independent apical foramen in the mandibular first molar. The incidence of isthmus in the mesial root of the mandibular first permanent molar is high, and isthmus usually occurs in the cervical third of the root canal. During root canal treatment or apical surgery, attention should be given to the physical and chemical preparation of the isthmus.
Résumé
Objective:To investigate the clinical incidence of the three mesial root canals of mandibular first molars. Methods: Incidence and morphology of the three mesial root canals of mandibular first molars were determined by probing the fissure or grooves between the mesiobuccal and mesiolingual root canal orifices and X-ray analysis. Results: Of the 222 mandibular first molars, 13 of the molars had three mesial root canals. The incidence rate was 5.85 %. Conclusion: Although the incidence rate of the three mesial root canals of mandibular first molars was very low, the dental operative microscope was helpful for the diagnosis.