Root apex and its positioning in CT scans. Published paper.
Three Dimensional mapping of the root apex: distances between apexes and anatomical structures and external cortical plates. Paper published in Revista Brazilian Oral Research, with colleagues Amjad Abu Hasna and Frederico Canato Marinho.
Connected subjects: root apex cone beam tomography in endodontics.
Translated excerpt:
SUMMARY
The knowledge of the position of the root apices in relation to the adjacent anatomical structures and bone plates is of importance for the clinician, for a better planning of the endodontic treatment, and consequently more safety in the procedures. Our study aimed to map the position of the dental arch apices in relation to the anatomical structures maxillary sinus and mandibular canal and in relation to the buccal and lingual bone plates, through the study of Cone-Beam Computed Tomography, and to analyze the risks of endodontic overinstrumentation in relation to these aspects. The results show a significant percentage of apices in close relationship with the structures cited, warn about the risks of invasive endodontic treatments given the proximity of the apices of certain dental groups with relevant structures, and recommend the use of CT technology for endodontic planning in cases of doubt regarding apical positioning.
Teeth may present different positions in the dental arch, which may lead, consequently, to a positioning of their root apices in regions that require greater attention by the clinician, both in diagnosis and in the planning and execution of endodontic treatment. This proximity occurs both in relation to relevant anatomical structures, such as the maxillary sinus and mandibular canal, and in relation to the external bone cortices, buccal or lingual, and when present in teeth with indication for endodontic treatment, represents a risk of complications and accidents, widely reported in the literature, due to physical injury, chemical and biological injury, paresthesia related to physical or chemical injury of the inferior alveolar nerve by intracanal medication, filling material or endodontic instruments, chemical injury of the maxillary sinus, periapical and muscular tissues by extravasation of chemical substances, and the dissemination of infection to tissues by microorganisms originating from the root canal. Such events range from events of minor severity and spontaneous resolution, to accidents of greater severity and surgical resolution.
Furthermore, contemporary endodontic treatments are largely performed beyond the limits of the root canal, by means of maneuvers known as apical patency or foraminal widening. Such treatments, due to their invasive potential to periapical tissues, are capable of increasing the above risks.
For the examination of tooth apices, the most accessible resource is the radiographic examination, which does not offer an adequate estimate of the apical anatomical position. The most suitable resource is cone beam computed tomography (CBCT), as it allows three-dimensional observation of the dental anatomy and its relationship with the entire adjacent anatomical region, eliminating anatomical overlaps and image distortions. However, CBCT is still a resource little used in clinical practice and the indication of this exam as a routine resource in endodontic diagnosis is not definitely established by the literature.
Root apex
