Root Apex Of Molar Research Articles

Correlating the clinical assessment of impacted mandibular third molars with panoramic radiograph and intraoral periapical radiograph.

Aims And Objectives:This study was conducted to compare the clinical assessment of impacted third molars of mandible with panaromic radiograph (OPG) and intraoral periapical radiograph (IOPA) and to assess the efficacy of IOPA and. Moreover, we corroborated the OPG and IOPA findings of impacted mandiblar third molar root apex to inferior alveolar canal.Materials and Methods:A total of 200 patients with pericoronitis were examined who were indicated for surgical extraction, among which 50 patients were selected for the study. All the patients underwent a radiographic survey with a digital OPG and IOPA of impacted mandibular third molars, along with clinical survey for anatomic relationship, type of impaction, space available, position in relation to second molar, number of roots, root curvature, and proximity of nerve canal. The data was subjected to statistical analysis. The Statistical Package for Social Sciences version 4.0.1 software was used for analyzing the collected data.Results:The study revealed that IOPA was more accurate in determining a majority of the factors affecting the third molar surgery, including relationship of the external oblique ridge (IOPA vs OPG = 96%:90%), anteroposterior relation with ramus (IOPA vs OPG = 70%:66%), vertical depth of impaction (IOPA vs OPG = 72%:68%), number of roots (P = 0.013), morphology of roots (IOPA vs OPG = 96%:90%); however, OPG was found to be accurate in evaluating the type of impaction (IOPA vs OPG = 88%:94%), canal relation, along with root of impacted molar (IOPA vs OPG = 74%:86%).Conclusion:To conclude, although IOPA has a marginal angle over OPG in assessing various parameters, only the number of roots have a greater accuracy (P < 0.0013) in IOPA than with OPG. However, the OPG is the better choice to be considered when the patient is associated with trismus.

Proximity of the mandibular molar root apex from the buccal bone surface: a cone-beam computed tomographic study.

ObjectivesThe purpose of this study was to evaluate the proximity of the mandibular molar apex to the buccal bone surface in order to provide anatomic information for apical surgery.Materials and MethodsCone-beam computed tomography (CBCT) images of 127 mandibular first molars and 153 mandibular second molars were analyzed from 160 patients' records. The distance was measured from the buccal bone surface to the root apex and the apical 3.0 mm on the cross-sectional view of CBCT.ResultsThe second molar apex and apical 3 mm were located significantly deeper relative to the buccal bone surface compared with the first molar (p < 0.01). For the mandibular second molars, the distance from the buccal bone surface to the root apex was significantly shorter in patients over 70 years of age (p < 0.05). Furthermore, this distance was significantly shorter when the first molar was missing compared to nonmissing cases (p < 0.05). For the mandibular first molars, the distance to the distal root apex of one distal-rooted tooth was significantly greater than the distance to the disto-buccal root apex (p < 0.01). In mandibular second molar, the distance to the apex of C-shaped roots was significantly greater than the distance to the mesial root apex of non-C-shaped roots (p < 0.01).ConclusionsFor apical surgery in mandibular molars, the distance from the buccal bone surface to the apex and apical 3 mm is significantly affected by the location, patient age, an adjacent missing anterior tooth, and root configuration.

Proximity of the Mandibular Canal to Teeth and Cortical Bone

IntroductionThe proximity of the inferior alveolar canal to the mandibular molar roots may pose a risk of injury during various dental surgeries. The purpose of this study was to evaluate age-related and gender-related changes by using cone-beam computed tomography images between the roots of the second molars, mandibular cortex, and the inferior alveolar canal. MethodsOne hundred fifty-five patients (68 men, 87 women), 20 years and older, who had previous cone-beam computed tomography scans were enrolled in this study. The patients were subcategorized by gender and age (group I, <21 years; group II, 21–40 years; and group III, >40 years). Distance between the mandibular canal (MC) and the second molar distal root apex as well as the 3 mandibular cortical regions (inferior cortex, buccal cortex, and lingual cortex) were measured. ResultsIn men, the second molar root apex to the MC distance was significantly shorter in group I than in group III (P < .01). In women, the second molar root apex to the MC distance was significantly shorter in group I than in group II and group III (P < .05). In both men and women, the buccal cortex of the mandible to the MC distance was significantly shorter on the right side compared with the left side (P < .01). ConclusionsOur study shows that age, gender, and region have an influence on the location of the MC in the second molar area.

Validity of the vertical tube-shift method in determining the relationship between the mandibular third molar roots and the inferior alveolar nerve canal.

ObjectivesTo assess the validity of the vertical tube-shift method using intraoral periapical radiography (IOPAR) for determining the relationship between the mandibular third molar roots and the inferior alveolar nerve (IAN) canal in comparison with cone-beam computed tomography (CBCT).Materials and MethodsFifty impacted mandibular third molars were analyzed using the IOPAR vertical tube-shift method and CBCT. The relationship of the IAN canal to the impacted mandibular third molar was recorded as buccal, lingual or in line with the apex and was compared with CBCT findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the vertical tube-shift method in depicting the relationship (buccal/lingual/in line with the apex) of the IAN canal to the third molar root apex was calculated.ResultsThe sensitivity and specificity PPV and NPV of the IOPAR vertical tube-shift technique was found to be highest for a lingual relationship (100%) followed by buccal (94.4%, 92.3%, 97.1%, and 85.7%) and in line with the apex relationship (88.9%, 95.0%, 80.0%, and 97.4%) of the IAN canal with the third molar root apex, respectively. A statistically significant association was observed between the IOPAR vertical tube-shift method and the CBCT with a P-value <0.01.ConclusionThe vertical tube-shift method can be used as an effective diagnostic tool in assessing the relationship of the IAN canal to the third molar root apex with high sensitivity, specificity, PPV, and NPV.

Assessment of the relationship between maxillary sinus floor and maxillary posterior teeth root apices using spiral CT scan

The purpose of this study is to investigate the relationship between the roots of the maxillary posterior teeth and the maxillary sinus using spiral computed tomography, and measured the distances between the roots of the maxillary posterior teeth and the sinus floor. Materials and Methods: The sample of the present study was a total of 120 Iraqi subject (60 males & 60 females) aged (20-60) years old, who admitted to spiral Computed Tomography scan unit in AL-Zahraa hospital in AL-Kut city to have Computed Tomography scan of the brain and paranasal sinuses who had complaints of headaches or with suspicion of sinusitis but without pathological findings in maxillary sinuses. From November 2012 to April 2013, CT sagittal reconstructed images were used in this study, Images were classified according to the relation between the root apices and the maxillary sinus floor into type1: Root apices below the sinus floor, type 2: Root apices in cosines floor. Vertical distance were measured between the deepest point of the maxillary sinus floor and the root apices of the maxillary first and second premolars and first, second molar contact with the sinus floor) and type 3: Root apices penetrate or inside the r using built-in measurement tools. Means, standard deviations and minimum and maximum values were calculated for all right and left premolars and molars. t-tests were used to compare measurements between left and right sides and between female and male patients. Results: The distance between sinus floor and root apex was longest for the first premolar palatal root apex and shortest for the second molar mesoibuccal root apex for both right and left sides. No statistically significant differences were found between the right and left side measurements or between females and males patients. Conclusion: There was no significant difference in vertical relation of maxillary posterior teeth to floor of maxillary sinus between male and female and between right and left side. The mesiobuccal root of the maxillary 2nd molar was closest to the maxillary sinus floor and palatal root of 1st premolar

Maxillary Sinus and Posterior Teeth: Accessing Close Relationship by Cone-beam Computed Tomographic Scanning in a Brazilian Population

IntroductionThis study aimed to evaluate the close proximity established between the maxillary sinus floor and posterior teeth roots apices by using cone-beam computed tomographic scanning. MethodsThe relationship of maxillary sinuses and posterior teeth roots, which were divided into 2 groups, was analyzed using i-CAT Vision software (Imaging Sciences, Hatfield, PA). Group 1 included all root apices found in close contact with the maxillary sinus floor without sinus floor elevation, whereas group 2 included all root apices that were protruded within the sinus producing an elevation of the bony cortical. ResultsA total of 100 maxillary sinuses and 601 roots apices were evaluated. Group 1 presented 130 of 601 (21.6%) roots and group 2 presented 86 of 601 (14.3%) roots. ConclusionsThe second molar mesiobuccal root apex is frequently found in close proximity with the sinus floor, and the relation between these anatomic structures should be considered in order to prevent an iatrogenic procedure and minimize the risks from an infectious disease within the sinus.

Spatial Relationship between Mandibular Third Molars and Inferior Alveolar Nerve using a Volume Rendering Software

Precise localization of the third molars in relation to the inferior alveolar nerve canal is critical from a clinical point of view and strongly affects the surgical treatment outcome. Recently, by using threedimensional modeling software, the relationship of third molar root apices and inferior alveolar nerve canal can be better understood. In this study, the spatial relationship of two surgical sites of 19 impacted third molars with close relationship to the inferior alveolar nerve canal is described by using imaging data from a cone beam computed tomography system. This study aimed to investigate the ability of three-dimensional modeling of tooth-nerve relationship using the data imported to Amira 5.2.2 imaging software.

Anatomical differences in lower third molars visualized by 2D and 3D X-ray imaging: clinical outcomes after extraction

The purpose of this study was to evaluate the relationship between third molars and the inferior alveolar canal using panoramic radiographs and cone beam computed tomography (CBCT) scans and to assess clinical outcomes after third molar removal retrospectively. The degree of superimposition, buccolingual position (buccal, central, and lingual) and physical relationship (separation, contact, and involved) were measured using CBCT scanning. Post-extraction complications were recorded. Based on radiographic evaluation, 45.9% of third molar roots were inside the inferior alveolar canal, 21.3% were in contact with the inferior alveolar canal, and 32.8% were separated from the canal. The frequency at which the mandibular canal was separated from the root apex was significantly higher when the canal was in the buccal position (80.0%) than in the central (20.0%) and lingual positions (0.0%). Although on panoramic radiographs all third molars were directly superimposed on the inferior alveolar canal, CBCT showed direct contact or canal involvement in 67.2% and separation of the canal from the root apex in 32.8%. Complications occurred in nine patients: eight had third molar root apices inside or in contact with the inferior alveolar canal. The prevalence of post-extraction complications correlated with the absence of cortication around the inferior alveolar canal.

An Experimental Study of Arch Perimeter and Arch Width Increase with Mandibular Expansion: A Finite Element Method

The objective of this study was to estimate the increase in arch perimeter associated with mandibular lateral expansion, To estimate the increase in intermolar width with mandibular lateral expansion and to find out the changes of tooth inclination with mandibular expansion. The mandibular bone with dentition of indian skeletal specimen was obtained. The computer tomogram (CT) slices of the mandible were taken. Finite element model (FEM): Numerical representation of the geometry was created by dividing the geometry into finite number of elements and the elements were connected together with nodes at the junction. The result of the study showed when 10° of lateral expansion was applied to the lower buccal segment at the center of rotation found at 4.3 mm below the root apex of first molar, a space of 1.3 mm between the canine and first premolar, and thus an increase in arch perimeter of 2.6 mm. The tip of the mesiolingual cusp of the first molar moved 4.2 mm laterally, resulting in a change in intermolar width by 8.4 mm. Three-dimensional simulation showed that 1 mm of intermolar expansion increased the arch perimeter by 0.30 mm. As the finite element method evolves and scientists are able to more clearly define physical properties of biological tissues, more accurate information can be generated at the level that other analytical methods cannot fully provide data.This result would be of value clinically for prediction of the effects of mandibular expansion.

Transverse, vertical, and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: A randomized clinical trial

Introduction The purpose of this study was to compare the transverse, vertical, and anteroposterior skeletal and dental changes in adolescents receiving expansion treatment with tooth-borne and bone-anchored expanders. Immediate and long-term changes were measured on cone-beam computed tomography (CBCT) images. Methods Sixty-two patients needing maxillary expansion were randomly allocated to 1 of 3 groups: traditional hyrax tooth-borne expander, bone-anchored expander, and control. CBCT images were taken at baseline, immediately after expansion, after removal of the appliance (6 months), and just before fixed bonding (12 months). Repeated measures multivariate analysis of variance (MANOVA) was applied to the distances and angles measured to determine the statistical significance in the immediate and long time periods. Bonferroni post-hoc tests were used to identify significant differences between the treatment groups. Results Immediately after expansion, the subjects in the tooth-borne expander group had significantly more expansion at the crown level of the maxillary first premolars (P = 0.003). Dental crown expansion was greater than apical expansion and skeletal expansion with both appliances. The control group showed little change (growth) over the 6-month interval. At 12 months, no group had a statistically significant difference in angle changes, suggesting symmetric expansion. Both treatment groups had significant long-term expansion at the level of the maxillary first molar crown and root apex, first premolar crown and root, alveolus in the first molar and premolar regions, and central incisor root. Tooth-borne expansion resulted in significantly more long-term expansion at the maxillary premolar crown and root than did bone-borne expansion. Conclusions Both expanders showed similar results. The greatest changes were seen in the transverse dimension; changes in the vertical and anteroposterior dimensions were negligible. Dental expansion was also greater than skeletal expansion. The purpose of this study was to compare the transverse, vertical, and anteroposterior skeletal and dental changes in adolescents receiving expansion treatment with tooth-borne and bone-anchored expanders. Immediate and long-term changes were measured on cone-beam computed tomography (CBCT) images. Sixty-two patients needing maxillary expansion were randomly allocated to 1 of 3 groups: traditional hyrax tooth-borne expander, bone-anchored expander, and control. CBCT images were taken at baseline, immediately after expansion, after removal of the appliance (6 months), and just before fixed bonding (12 months). Repeated measures multivariate analysis of variance (MANOVA) was applied to the distances and angles measured to determine the statistical significance in the immediate and long time periods. Bonferroni post-hoc tests were used to identify significant differences between the treatment groups. Immediately after expansion, the subjects in the tooth-borne expander group had significantly more expansion at the crown level of the maxillary first premolars (P = 0.003). Dental crown expansion was greater than apical expansion and skeletal expansion with both appliances. The control group showed little change (growth) over the 6-month interval. At 12 months, no group had a statistically significant difference in angle changes, suggesting symmetric expansion. Both treatment groups had significant long-term expansion at the level of the maxillary first molar crown and root apex, first premolar crown and root, alveolus in the first molar and premolar regions, and central incisor root. Tooth-borne expansion resulted in significantly more long-term expansion at the maxillary premolar crown and root than did bone-borne expansion. Both expanders showed similar results. The greatest changes were seen in the transverse dimension; changes in the vertical and anteroposterior dimensions were negligible. Dental expansion was also greater than skeletal expansion.

Transverse, vertical, and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: A randomized clinical trial

The purpose of this study was to compare the transverse, vertical, and anteroposterior skeletal and dental changes in adolescents receiving expansion treatment with tooth-borne and bone-anchored expanders. Immediate and long-term changes were measured on cone-beam computed tomography (CBCT) images. Sixty-two patients needing maxillary expansion were randomly allocated to 1 of 3 groups: traditional hyrax tooth-borne expander, bone-anchored expander, and control. CBCT images were taken at baseline, immediately after expansion, after removal of the appliance (6 months), and just before fixed bonding (12 months). Repeated measures multivariate analysis of variance (MANOVA) was applied to the distances and angles measured to determine the statistical significance in the immediate and long time periods. Bonferroni post-hoc tests were used to identify significant differences between the treatment groups. Immediately after expansion, the subjects in the tooth-borne expander group had significantly more expansion at the crown level of the maxillary first premolars (P = 0.003). Dental crown expansion was greater than apical expansion and skeletal expansion with both appliances. The control group showed little change (growth) over the 6-month interval. At 12 months, no group had a statistically significant difference in angle changes, suggesting symmetric expansion. Both treatment groups had significant long-term expansion at the level of the maxillary first molar crown and root apex, first premolar crown and root, alveolus in the first molar and premolar regions, and central incisor root. Tooth-borne expansion resulted in significantly more long-term expansion at the maxillary premolar crown and root than did bone-borne expansion. Both expanders showed similar results. The greatest changes were seen in the transverse dimension; changes in the vertical and anteroposterior dimensions were negligible. Dental expansion was also greater than skeletal expansion.

Assessment of the Relationship Between Impacted Mandibular Third Molars and Inferior Alveolar Nerve With Dental 3-Dimensional Computed Tomography

The purpose of this study was to assess the capacity of dental 3-dimensional computed tomography (3D-CT; limited cone-beam CT) to predict the exposure and injury of the inferior alveolar nerve (IAN) after mandibular third molar extractions. This study was a retrospective case series of patients who presented for extraction of mandibular third molars. Subjects eligible for study enrollment were those who underwent preoperative dental 3D-CT because the mandibular third molars were determined to be extremely close to the IAN on panoramic radiogram. The predictive variable was the anatomic relation of the IAN and third molar apices and was a binary variable, contact or noncontact. The primary outcome variable was IAN exposure, and the secondary outcome variable was IAN injury. From January 2006 to August 2007, 1,853 mandibular third molars in 1,539 patients were extracted. Among them, dental 3D-CT was performed on 53 third molars in 47 patients. The mandibular third molars were judged to make contact with the mandibular canal on dental 3D-CT images in 35 cases (66%). Intraoperative IAN exposure was observed in 17 (49%) contact cases and 2 (11%) noncontact cases on dental 3D-CT images. Of 53 cases extracted after dental 3D-CT examinations, IAN injury occurred in 8 cases (15%). IAN exposure led to IAN injury in 36.8% of cases, whereas IAN injury occurred in only 2.9% of cases without IAN exposure. Although the incidence of IAN injury in the molar-canal contact cases was 23%, all 8 cases with IAN injury (100%) were included in these contact cases. When viewing the anatomic relation between the IAN and mandibular third molar root apices using dental 3D-CT, contact of the 2 anatomic structures results in an increased risk for IAN exposure or injury.

In Vitro Radiographic Determination of Distances from Working Length Files to Root Ends Comparing Kodak RVG 6000, Schick CDR, and Kodak Insight Film

Previous studies suggest that digital and film-based radiography are similar for endodontic measurements. This study compared the accuracy and acceptability of measured distances from the tips of size #10 and #15 files to molar root apices in cadaver jaw sections using the newly developed Kodak RVG 6000, and the Schick CDR digital systems to digitized Kodak film. Standardized images were taken of files placed 0.5 to 1.5 mm short of true radiographic lengths. Images were imported into Adobe PhotoShop 7.0, thereby blinding observers who measured distances from files to root apices and assessed images for clarity (acceptability). Repeated measures ANOVA and Tukey-Kramer post hoc tests demonstrated that Kodak RVG 6000 images with enhanced contrast produced significantly less measurement error than unenhanced contrast Schick CDR images (p < 0.05) and significantly higher acceptability ratings than all other systems (all p < 0.002). Among these conditions, the newly developed Kodak RVG 6000 system provided the best overall images.

Atypical Facial Pain: the Consistency of Ipsilateral Maxillary Area Tenderness and Elevated Temperature

A consistent zone of ipsilateral tenderness adjacent to the maxillary molar root apices often is present in patients with atypical facial pain. The author performed bilateral palpation and recorded the temperature of this area on 18 consecutive patients with facial pain. He found tenderness and increased temperature on the involved side of the face in 15 and 17 patients, respectively. In two control groups of 10 patients without pain and 10 TMD patients, he observed no significant association between maxillary tenderness and increased temperature.

Patterns of innervation of the maxillary first molar: A dissection study

Human maxillae were dissected with the aim of tracing nerves from maxillary first molar root apices to their parent superior alveolar nerve branches. The contribution of the posterior, middle, and anterior superior alveolar nerves to the innervation of the first molar was assessed. The posterior superior alveolar nerve was found to contribute innervation 100% of the time; the middle superior alveolar nerve, when present, contributed innervation 28% of the time. The anterior superior alveolar nerve did not supply any innervation to the first molar.

An unusual case of lingual displacement of a mandibular third molar root apex

A complication of mandibular third molar surgery is reported in which lingual displacement of a third molar root occurred in association with the presence of a natural perforation of the lingual plate. The displacement was aggravated by the insertion of mylohyoid muscle fibers into the root itself. Histologic evidence is presented to support the finding of this unusual tissue relationship.