Measurement of Buccal Bone Plate Thickness Using C
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RESEARCH ARTICLES
Measurement of Buccal Bone Plate Thickness Using Computed Tomography in Maxillary Tooth
Guangchun Jin, Youcheng Yang*
Abstract: The distance from the apex to the buccal bone plate was measured from the computed tomography (CT) images of 1,806 teeth from 66 patients who were treated in the department of Oral & Maxillofacial Surgery at Dental Hospital affiliated to Binzhou Medical College in order to evaluate their accessibility during apical surgery. An image analyzer program (Image-Pro Plus, Ver. 4.0, Media Cybernetics, U. S. A.), optic lens, and digital caliper (Mitoutoyo Co, Tokyo, Japan) were used. The distance between the apex to either the buccal bone plate or the lingual bone plate was measured from the axial CT images for each tooth. The measurements were averaged and divided according to gender. In the maxilla, the largest distances from the second molar mesio-buccal and disto-buccal root to the buccal bone plate were 4.63mm and 3.61mm, respectively. The other measurements were < 3mm. In particular, the anterior teeth were all < 2mm. The average distances from the palatal apex in the maxillary first molar and the second molar to the buccal bone plate were 10.69mm and 10.17mm, respectively. The average distances from the palatal apex to the palatal bone plate in the maxillary first and second molars were 3.15mm and 3.08mm, respectively. Sometimes the lingual approach, bony lid approach or replantation needs to be made when there is a surgical need in the second molar and the disto-lingual root of maxillary molars because the normal buccal bone approach and retrograde filling would not be feasible. When it comes to diagnosis, the axial CT images were quite helpful in determining the spatial relationship between the apex and surrounding bone compared with the conventional radiographs, which means that it would be ideal to take a CT for each apical surgery case.
Key words: apical surgery; computed tomography; buccal bone plate; surgical approach
The appropriate method for accessing and securing the surgical field is very important for accurate apical surgery. Manipulating the surgical instruments and securing the surgical field are limited in many ways during apical surgery, which is performed in a cramped space and in a bleeding situation. From a clinical point of view, the thickness of the buccal bone plate is always of concern. Obtaining good surgical accessibility becomes increasingly difficult particularly when the buccal bone plate is thick such as in the mandibular molars or palatal roots of the maxillary molars. If a large amount of buccal bone plate needs to be sacrificed in order to reach the apex by boring through the thick buccal bone plate, the overall prognosis for the tooth can become poor even after successful apical surgery. Moreover, the root canal isthmus can still remain open even when the apex is reached reasonably but retrograde filling is not performed appropriately. The same problems are also encountered in the palatal root of the maxillary molars that is remote from the buccal bone plate ......
RESEARCH ARTICLES
Measurement of Buccal Bone Plate Thickness Using Computed Tomography in Maxillary Tooth
Guangchun Jin, Youcheng Yang*
Abstract: The distance from the apex to the buccal bone plate was measured from the computed tomography (CT) images of 1,806 teeth from 66 patients who were treated in the department of Oral & Maxillofacial Surgery at Dental Hospital affiliated to Binzhou Medical College in order to evaluate their accessibility during apical surgery. An image analyzer program (Image-Pro Plus, Ver. 4.0, Media Cybernetics, U. S. A.), optic lens, and digital caliper (Mitoutoyo Co, Tokyo, Japan) were used. The distance between the apex to either the buccal bone plate or the lingual bone plate was measured from the axial CT images for each tooth. The measurements were averaged and divided according to gender. In the maxilla, the largest distances from the second molar mesio-buccal and disto-buccal root to the buccal bone plate were 4.63mm and 3.61mm, respectively. The other measurements were < 3mm. In particular, the anterior teeth were all < 2mm. The average distances from the palatal apex in the maxillary first molar and the second molar to the buccal bone plate were 10.69mm and 10.17mm, respectively. The average distances from the palatal apex to the palatal bone plate in the maxillary first and second molars were 3.15mm and 3.08mm, respectively. Sometimes the lingual approach, bony lid approach or replantation needs to be made when there is a surgical need in the second molar and the disto-lingual root of maxillary molars because the normal buccal bone approach and retrograde filling would not be feasible. When it comes to diagnosis, the axial CT images were quite helpful in determining the spatial relationship between the apex and surrounding bone compared with the conventional radiographs, which means that it would be ideal to take a CT for each apical surgery case.
Key words: apical surgery; computed tomography; buccal bone plate; surgical approach
The appropriate method for accessing and securing the surgical field is very important for accurate apical surgery. Manipulating the surgical instruments and securing the surgical field are limited in many ways during apical surgery, which is performed in a cramped space and in a bleeding situation. From a clinical point of view, the thickness of the buccal bone plate is always of concern. Obtaining good surgical accessibility becomes increasingly difficult particularly when the buccal bone plate is thick such as in the mandibular molars or palatal roots of the maxillary molars. If a large amount of buccal bone plate needs to be sacrificed in order to reach the apex by boring through the thick buccal bone plate, the overall prognosis for the tooth can become poor even after successful apical surgery. Moreover, the root canal isthmus can still remain open even when the apex is reached reasonably but retrograde filling is not performed appropriately. The same problems are also encountered in the palatal root of the maxillary molars that is remote from the buccal bone plate ......
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