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

Abstract

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.

Keywords

• cone beam computed tomography
• danger zone
• dentin thickness