Clinical application of cone beam computed tomography combined with micro-ultrasound technique in treating three mesial canals in mandibular first molars

doi:10.7518/hxkq.2017.04.008

Abstract

Abstract:

Objective The aim of this study is to investigate the influence of cone beam computed tomography (CBCT) and micro-ultrasound technique for the treatment of three mesial canals in mandibular first molars. The three mesial canals according to Pomeranz’s classification were characterized. Methods A total of 75 permanent mandibular first molars for root canal treatment were randomly selected from patients belonging to the age group of 14-60 years. After preparing the access cavity and locating the main canals, the middle mesial canal orifices in all teeth were determined with an endodontic explorer under direct vision (StageⅠ), under magnification with the aid of micro-ultrasound (Stage Ⅱ), and with the combined use of CBCT and micro-ultrasound to remove the dentin wall and calcifications (Stage Ⅲ). Results Middle mesial canals were detected in 4.0%, 18.7%, and 22.7% of the teeth in StagesⅠ-Ⅲ, respectively. Statistical analysis showed significant differences (P<0.05) between StagesⅠand Ⅱ with regard to middle mesial canal detection. The number of Stage Ⅲ was more than that of Stage Ⅱ. The difference between the two stages was no significant. Among the 17 middle mesial canals, “confluent”, “fin” and “independent” anatomies were 52.9%, 35.3%, and 11.8%. Conclusion When used with adjunctive aids, including CBCT, micro-ultrasound facilitates dental clinicians in the location and treatment of middle mesial canals.

Key words: mandibular first molar, three mesial canals, ultrasound, cone beam computed tomography

CLC Number:

R781.05

Lili Yang, Yan Zhang, Shijun Zhao, Shuai Zhang, Na Wang, Jie Xu, Shue Hu, Zhiyuan Xu. Clinical application of cone beam computed tomography combined with micro-ultrasound technique in treating three mesial canals in mandibular first molars[J]. West China Journal of Stomatology, 2017, 35(4): 384-388.

Figures/Tables 4

References 20

[1]	de Paula AF, Brito-Júnior M, Quintino AC, et al. Three in-dependent mesial canals in a mandibular molar: four-year followup of a case using cone beam computed tomography[J]. Case Rep Dent, 2013, 2013:891849.
[2]	Sharma P, Shekhar R, Sharma A. Endodontic management of mandibular first molar with six canals using CBCT-report of a case[J]. J Clin Diagn Res, 2016, 10(8):ZJ12-ZJ13.
[3]	Abuabara A, Baratto-Filho F, Aguiar Anele J, et al.Efficacy of clinical and radiological methods to identify second mesio-buccal canals in maxillary first molars[J]. Acta Odontol Scand, 2013, 71(1):205-209.
[4]	Pomeranz HH, Eidelman DL, Goldberg MG.Treatment con-siderations of the middle mesial canal of mandibular first and second molars[J]. J Endod, 1981, 7(12):565-568.
[5]	Susin L, Liu Y, Yoon JC, et al.Canal and isthmus debride-ment efficacies of two irrigant agitation techniques in a closed system[J]. Int Endod J, 2010, 43(12):1077-1090.
[6]	Azim AA, Deutsch AS, Solomon CS.Prevalence of middle mesial canals in mandibular molars after guided troughing under high magnification: an in vivo investigation[J]. J En-dod, 2015, 41(2):164-168.
[7]	吴俊, 樊明文, 范兵, 等. 下颌第一磨牙近中根根管形态的研究[J]. 口腔医学研究, 2010, 26(5):747-749.
	Wu J, Fan MW, Fan B, et al.Root canal morphology of single-mesial-rooted of the mandibular first molar[J]. J Oral Sci Res, 2010, 26(5):747-749.
[8]	Kim SY, Kim BS, Woo J, et al.Morphology of mandibular first molars analyzed by cone-beam computed tomography in a korean population: variations in the number of roots and canals[J]. J Endod, 2013, 39(12):1516-1521.
[9]	Ballullaya SV, Vemuri S, Kumar PR.Variable permanent mandibular first molar: review of literature[J]. J Conserv Dent, 2013, 16(2):99-110.
[10]	Nosrat A, Deschenes RJ, Tordik PA, et al.Middle mesial canals in mandibular molars: incidence and related factors[J]. J Endod, 2015, 41(1):28-32.
[11]	von Arx T, Steiner RG, Tay FR. Apical surgery: endoscopic findings at the resection level of 168 consecutively treated roots[J]. Int Endod J, 2011, 44(4):290-302.
[12]	Venskutonis T, Plotino G, Juodzbalys G, et al.The impo-rtance of cone-beam computed tomography in the manage-ment of endodontic problems: a review of the literature[J]. J Endod, 2014, 40(12):1895-1901.
[13]	López FU, Kopper PM, Cucco C, et al.Accuracy of cone-beam computed tomography and periapical radiography in apical periodontitis diagnosis[J]. J Endod, 2014, 40(12): 2057-2060.
[14]	Safi Y, Aghdasi MM, Ezoddini-Ardakani F, et al.Effect of metal artifacts on detection of vertical root fractures using two cone beam computed tomography systems[J]. Iran En-dod J, 2015, 10(3):193-198.
[15]	Karapinar-Kazandag M, Basrani BR, Friedman S.The ope-rating microscope enhances detection and negotiation of accessory mesial canals in mandibular molars[J]. J Endod, 2010, 36(8):1289-1294.
[16]	Chauhan R, Tikku A, Chandra A.Detection of residual obturation material after root canal retreatment with three different techniques using a dental operating microscope and a stereomicroscope: an in vitro comparative evaluation[J]. J Conserv Dent, 2012, 15(3):218.
[17]	Schmidt BS, Zaccara IM, Reis Só MV, et al.Influence of operating microscope in the sealing of cervical perforations[J]. J Conserv Dent, 2016, 19(2):152-156.
[18]	Srinivasan R, Ravishanker P.Management of middle mesial canal under dental operating microscope[J]. Med J Armed Forces India, 2015, 71(Suppl 2):S502-S505.
[19]	Neelakantan P, Subbarao C, Subbarao CV.Comparative evaluation of modified canal staining and clearing technique, cone-beam computed tomography, peripheral quantitative computed tomography, spiral computed tomography, and plain and contrast medium-enhanced digital radiography in studying root canal morphology[J]. J Endod, 2010, 36(9):1547-1551.
[20]	Corcoran J, Apicella MJ, Mines P.The effect of operator experience in locating additional canals in maxillary molars[J]. J Endod, 2007, 33(1):15-17.