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AN ANALYSIS OF MANDIBULAR DENTAL ANATOMY USING CBCT FROM AN ENDODONTIC PATIENT POPULATION AT TEMPLE UNIVERSITY SCHOOL OF DENTISTRY
Hu, Wen Wu
Hu, Wen Wu
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2024-08
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Oral Biology
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http://dx.doi.org/10.34944/dspace/10620
Abstract
Introduction: Cone-beam computed tomography (CBCT) uses a cone-beam technique to produce a three-dimensional view of the scan and provides clinicians with tremendous information of the anatomy in question. CBCT overcomes the disadvantages of viewing overlapping anatomies and geometric distortion of two-dimensional x-rays (Forsberg, 1994). Most classic endodontic literatures, for example, Vertucci, Phillips et al., and Frankle et al., analyzed human extracted teeth or 2-dimensional (2-D) x-rays to study the root or dental anatomy (Vertucci, 1984; Philips 1992; Frankle, 1990). However, the limitations are small sample size, damage from tooth clearing method, and overlapping anatomy and distortion from 2-D x-rays. In the present study, we use CBCT to study mandibular anatomy. The advantages of the present study include studying the clinical cases (not the extracted teeth) using 3-D images.
Purpose: This study aims to analyze CBCT collection counts over time and mandibular canines, premolars, molars root/canal morphology including: 1) the root morphology and canal morphology; 2) the location and size of mental foramen; 3) distance of inferior alveolar nerve (IAN) to molar root apexes; 4) buccal bone thickness to mandibular canines, premolars, first and second molars root apexes; and 5) previous treatment failure in presence of missed canals. The results of this study will help clinicians better understand root/canal anatomy and mandibular landmarks, and aid in forming proper endodontic diagnosis, treatment planning, and rendering of treatment.
Materials and Methods: Retrospective data was collected from CBCT scans taken using the Carestream 8100 3-D limited field of view unit in the Temple University School of Dentistry Graduate Endodontics Clinic from January 2021 to February 2024. CBCT prescription forms and patients’ electronic health records (Axium) were reviewed, the reasons for taking CBCT were analyzed. Then 50 CBCT scans containing mandibular canines, premolars, and molars were randomly selected. A total of 125 teeth were subjected to anatomical analysis.The CBCT measurements include the following: 1) Canal morphology based on Vertucci’s classification; c-shaped canal for first and second molars. 2) The location/size of mental foramen and its distance to root apexes of first and second premolars, and first molars, respectively. 3) Distance from IAN to first and second molar root apexes. 4) Distance from buccal plate to root apexes of mandibular canines, premolars, and first and second molars. 5) Previous treatment failure in presence of missing canals. All above measurements were done by Carestream CS 3D imaging software. Patient clinical data were collected from Axium at Temple University School of Dentistry. This project was approved by Temple University Institutional Review Board (IRB protocol number 30589).
Results: The total amount of CBCT scans counted were 1695. Most common reason for a scan is retreatment pre-op and most common tooth type is mandibular first molar. The mental foramen was found to align with the apex of mandibular second premolar 64% of time with an average direct distance of 6.3 mm to the root apex. The distance of IAN is closer to mandibular second molar root apexes than mandibular first molar root apexes. The buccal plate thickness is on average thinner on mandibular canines and premolars than mandibular molars. Treatment failure in presence of missing canals is around 17-35% for mandibular molars.
Conclusion: CBCT provided an accurate way to visualize canal/root configurations and measure critical mandibular anatomical landmarks to known structures. Clinicians can use the results of this research to help form endodontic diagnosis, treatment plan, and render of treatment.
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