A micro‐CT analysis of radicular dentine thickness in mandibular first premolars presenting C‐shaped root canals: Identification of potential danger zones

Abstract

Aim To describe the radicular dentine thickness in mandibular first premolars presenting C‐shaped root canals, to identify the canal walls with less thickness as potential danger zones. In addition, to describe the internal and external anatomical characteristics of these teeth and associate them with the dentine thickness. Methodology A total of 70 mandibular first premolars presenting C‐shaped root canals were examined. Their internal morphology was analysed using Vertucci’s and Fan’s criteria, and their external morphology was analysed using the ASUDAS score. Besides, the dentine thickness around the root canals was two/three‐dimensionally determined at five root planes and quantified in the distal and the mesial aspects. Results According to Fan’s, ASUDAS, and Vertucci’s classifications, the most common canal configurations were category C3, grade 3, and type V, respectively. In Vertucci's type III anatomy, the mesial root wall of the lingual canal showed significantly less dentine thickness than the distal wall in the middle plane (p = .031). Similarly, in Vertucci's type V anatomy, significantly less dentine thickness was observed in the mesial root wall of the buccal and lingual canals in the middle plane (p < .001) and the buccal canal in the middle‐apical plane (p = .014) than the distal root wall of these canals. In teeth with ASUDAS grade 3 and 4 scores, significantly less dentine thickness was observed in the mesial in comparison with the distal root wall of these canals. These differences were demonstrated in the middle and middle‐apical planes (p < .001) of grade 3 teeth and the middle‐apical plane (p < .001) of grade 4 teeth. In these root planes, the Ver1‐AS3 and VerV‐AS3 combinations presented a 4‐times greater risk of presenting walls with a critical dentine thickness of 0.6 mm (odds ratio [OR] = 4, p = .025) than the combinations Ver1‐AS2, VerV‐AS2, VerV‐AS4, and VerIII‐AS3. Conclusions The root canal system configuration of mandibular first premolars with C‐shaped canals showed a wide range of anatomical variations. The lowest dentine thickness was located in the mesial wall of the canals in the middle and apical root thirds of Vertucci’s type III and V anatomies and in teeth with deep radicular grooves scored as ASUDAS grades 3 and 4. In the middle and middle‐apical planes, the presence of the combinations Ver1‐AS3 and VerV‐AS3 showed a high risk of presenting a critical dentine thickness of 0.6 mm. Therefore, these root canal walls with less dentine thickness represent potential instrumentation danger zones in mandibular first premolars with C‐shaped canals.

Prevalence and morphology of different root canal systems in mandibular premolars: a cross‐sectional observational study

“…Mandibular premolars have been shown to possess highly variable root canal anatomy and morphology in two-dimensional in vitro radiographic studies, [1][2][3] threedimensional in vitro methodologies (diaphanization, cross-sectional investigations and micro-computed tomography (micro-CT) analysis), [4][5][6][7][8][9][10][11][12][13][14] and in vivo techniques such as cone-beam computed tomography (CBCT). [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] An important morphological variation is the Cshaped root canal system, which has been characterized as one or more irregularly shaped canals in a semilunar configuration, connected by an isthmus, fin or transverse anastomosis that might span a variable length of the canal system, and appears to be strongly correlated with the presence of a radicular groove (RG).…”

“…Mandibular premolars have been shown to possess highly variable root canal anatomy and morphology in two‐dimensional in vitro radiographic studies, 1–3 three‐dimensional in vitro methodologies (diaphanization, cross‐sectional investigations and micro‐computed tomography (micro‐CT) analysis), 4–14 and in vivo techniques such as cone‐beam computed tomography (CBCT) 15–29 …”