下颌前牙根管系统的解剖形态及其与三根型下颌第一恒磨牙关系的研究

doi:10.13591/j.cnki.kqyx.2025.01.009

摘要/Abstract

摘要：

目的通过CBCT揭示下颌前牙根管系统的解剖形态及其与三根型下颌第一恒磨牙的关系。方法采集200例患者的CBCT图像数据,观察下颌前牙根管系统的形态(按Vertucci分类进行记录)并测量牙根长度及牙颈部唇舌径;观测三根型下颌第一恒磨牙的发生情况。计算左/右侧下颌前牙双根管和三根型下颌第一磨牙的共同发生率,以及双侧同牙位同时出现双根管或远舌根的共同发生率。Spearman相关性分析检验下颌前牙双根管与三根型下颌第一磨牙的发生是否存在关联,并分析双侧相关性。结果下颌中切牙、侧切牙及尖牙双根管的发生率分别为10.4%、18.6%和6.5%;双侧同牙位双根管共同发生率分别为5.7%、11.1%和3.0%,双侧相关系数rho分别为0.487、0.505和0.440(P<0.01);双根管的发生率未见性别及双侧差异(P>0.05)。三根型下颌第一磨牙发生率为24.6%,未发现性别差异(P>0.05),右侧发生率(29.0%)显著高于左侧(20.3%)(P<0.05);双侧共同发生率17.4%,并呈中度相关(rho=0.666,P<0.01)。同侧共同出现三根型下颌第一磨牙与前牙双根管的发生率仅为2.6%~7.6%,相关性分析提示两者无显著相关性(P>0.05)。结论下颌前牙中,侧切牙的双根管发生率最高。三根型下颌第一磨牙与下颌前牙双根管的发生没有显著相关性。

关键词: 下颌前牙, 三根型下颌第一恒磨牙, 根管系统, 锥形束CT

Abstract:

Objective To study the root canal morphology of permanent mandibular anterior teeth and explore its correlation with the occurrence of three-rooted mandibular molars using cone beam computed tomographic (CBCT) imaging. Methods CBCT image data of 200 subjects were randomly collected from dental clinics. The root canal morphology of the mandibular anterior teeth was identified and classified by Vertucci’s classification, and the root length and labio-lingual dimension at the tooth neck level were measured. The occurrence of three-rooted mandibular first molars was examined as well. The concurrence rates of double-canaled anterior teeth and three-rooted mandibular first molars at each side, and concurrence rates of bilateral double-canaled anterior teeth and three-rooted mandibular first molars were calculated. Spearman correlation tests were applied to analyze the correlation between the double-canaled anterior teeth and three-rooted mandibular first molars, as well as the bilateral antimetric teeth. Results The incidence of double-canaled system was 10.4%, 18.6% and 6.5% in mandibular central incisors, lateral incisors and canines, respectively; the bilateral concurrence rates were 5.7%, 11.1% and 3.0%, respectively, and Spearman correlation coefficients (rho) were 0.487, 0.505 and 0.440 (P<0.01), respectively; gender difference and side difference were not detected (P>0.05). The frequency of three-rooted mandibular first molars was 24.6%; gender difference was not detected (P>0.05), while the incidence was significantly higher at the right side (29.0%) than the left side (20.3%)(P<0.05). The bilateral concurrence rate was 17.4%, and a moderate correlation was detected (rho=0.666, P<0.01). The concurrence rates between the double-canaled anterior teeth and three-rooted mandibular first molars at each side were very low (2.6%-7.6%), and Spearman correlation tests demonstrated that no correlation (P>0.05) could be detected between them. Conclusion The lateral incisors exhibited the highest incidence of two root canals among the mandibular anterior teeth. Additionally, there was no significant correlation between three-rooted mandibular first molars and double-canaled mandibular anterior teeth.

Key words: mandibular anterior teeth, three-rooted mandibular first molar, root canal system, cone beam computed tomography

中图分类号:

R781.05

朱鹏, 顾永春, 吴易涵, 徐小明. 下颌前牙根管系统的解剖形态及其与三根型下颌第一恒磨牙关系的研究[J]. 口腔医学, 2025, 45(1): 58-63.

ZHU Peng, GU Yongchun, WU Yihan, XU Xiaoming. The root canal morphology of mandibular anterior teeth and its correlation with the occurrence of three-rooted mandibular first molars[J]. Stomatology, 2025, 45(1): 58-63.

图/表 11

图1

图2

图3

表1

表2

表3

表4

表5

表6

表7

图4

参考文献 27

[1]	Vertucci FJ. Root canal anatomy of the mandibular anterior teeth[J]. J Am Dent Assoc, 1974, 89(2): 369-371. doi: 10.14219/jada.archive.1974.0391 pmid: 4527223
[2]	Chen M, Wang H, Tsauo C, et al. Micro-computed tomography analysis of root canal morphology and thickness of crown and root of mandibular incisors in Chinese population[J]. Clin Oral Investig, 2022, 26(1): 901-910.
[3]	Baxter S, Jablonski M, Hülsmann M. Cone-beam-computed-tomography of the symmetry of root canal anatomy in mandibular incisors[J]. J Oral Sci, 2020, 62(2): 180-183. doi: 10.2334/josnusd.19-0113 pmid: 32224571
[4]	Han T, Ma Y, Yang L, et al. A study of the root canal morphology of mandibular anterior teeth using cone-beam computed tomography in a Chinese subpopulation[J]. J Endod, 2014, 40(9): 1309-1314. doi: 10.1016/j.joen.2014.05.008 pmid: 25043332
[5]	Jiang CF, Pei F, Wu YH, et al. Investigation of three-rooted deciduous mandibular second molars in a Chinese population using cone-beam computed tomography[J]. BMC Oral Health, 2022, 22(1): 329.
[6]	Qiao X, Zhu HL, Yan YJ, et al. Prevalence of middle mesial canal and Radix entomolaris of mandibular first permanent molars in a western Chinese population: An in vivo cone-beam computed tomographic study[J]. BMC Oral Health, 2020, 20(1): 224.
[7]	Gu YC, Lu Q, Wang HG, et al. Root canal morphology of permanent three-rooted mandibular first molars: Part Ⅰ-Pulp floor and root canal system[J]. J Endod, 2010, 36(6): 990-994.
[8]	顾永春, 倪龙兴. X线投照角度对诊断下颌第一恒磨牙远舌根变异的作用[J]. 实用口腔医学杂志, 2013, 29(1): 94-96.
[9]	Tredoux S, Warren N, Buchanan GD. Root and canal configura-tions of mandibular first molars in a South African subpopulation[J]. J Oral Sci, 2021, 63(3): 252-256.
[10]	Kantilieraki E, Delantoni A, Angelopoulos C, et al. Evaluation of root and root canal morphology of mandibular first and second molars in a Greek population: A CBCT study[J]. Eur Endod J, 2019, 4(2): 62-68.
[11]	Shigefuji R, Serikawa M, Usami A. Observation of mandibular second molar roots and root canal morphology using dental cone-beam computed tomography[J]. Anat Cell Biol, 2022, 55(2): 155-160. doi: 10.5115/acb.22.050 pmid: 35773218
[12]	Martins JNR, Gu YC, Marques D, et al. Differences on the root and root canal morphologies between Asian and white ethnic groups analyzed by cone-beam computed tomography[J]. J Endod, 2018, 44(7): 1096-1104. doi: S0099-2399(18)30239-5 pmid: 29861062
[13]	Wu YC, Cheng WC, Chung MP, et al. Complicated root canal morphology of mandibular lateral incisors is associated with the presence of distolingual root in mandibular first molars: A cone-beam computed tomographic study in a Taiwanese population[J]. J Endod, 2018, 44(1): 73-79.e1.
[14]	Wu YC, Cheng WC, Weng PW, et al. The presence of distolingual root in mandibular first molars is correlated with complicated root canal morphology of mandibular central incisors: A cone-beam computed tomographic study in a Taiwanese population[J]. J Endod, 2018, 44(5): 711-716.e1.
[15]	Yeung AWK, Jacobs R, Bornstein MM. Novel low-dose protocols using cone beam computed tomography in dental medicine: A review focusing on indications, limitations, and future possibilities[J]. Clin Oral Investig, 2019, 23(6): 2573-2581.
[16]	Patel S, Brown J, Pimentel T, et al. Cone beam computed tomography in Endodontics—A review of the literature[J]. Int Endod J, 2019, 52(8): 1138-1152. doi: 10.1111/iej.13115 pmid: 30868610
[17]	Bai BB, Tang Y, Wu YH, et al. Ex vivo detection of mandibular incisors’ root canal morphology using cone-beam computed tomography with 4 different voxel sizes and micro-computed tomography[J]. BMC Oral Health, 2023, 23(1): 656.
[18]	Lin ZT, Hu QG, Wang TM, et al. Use of CBCT to investigate the root canal morphology of mandibular incisors[J]. Surg Radiol Anat, 2014, 36(9): 877-882. doi: 10.1007/s00276-014-1267-9 pmid: 24515289
[19]	Liu J, Luo J, Dou L, et al. CBCT study of root and canal morphology of permanent mandibular incisors in a Chinese population[J]. Acta Odontol Scand, 2014, 72(1): 26-30. doi: 10.3109/00016357.2013.775337 pmid: 24255962
[20]	Yang ZY, Lu KK, Wang F, et al. Cone-beam computed tomography study of the root and canal morphology of mandibular permanent anterior teeth in a Chongqing population[J]. Ther Clin Risk Manag, 2015, 12: 19-25.
[21]	赵莹, 董颖韬, 王晓燕, 等. 4674颗下颌前牙根管构型的锥形束CT分析[J]. 北京大学学报(医学版), 2014, 46(1): 95-99.
[22]	Candeiro GTM, Monteiro Dodt Teixeira IM, Olimpio Barbosa DA, et al. Vertucci’s root canal configuration of 14 413 mandibular anterior teeth in a Brazilian population: A prevalence study using cone-beam computed tomography[J]. J Endod, 2021, 47(3): 404-408. doi: 10.1016/j.joen.2020.12.001 pmid: 33326836
[23]	Mahmood TR. Assessment of root canal morphology of mandibular permanent anterior teeth in an Iraqi subpopulation by cone-beam computed tomography[J]. J Dent Sci, 2021, 16(4): 1182-1190. doi: 10.1016/j.jds.2021.02.010 pmid: 34484586
[24]	Kabak YS, Abbott PV. Endodontic treatment of mandibular incisors with two root canals: Report of two cases[J]. Aust Endod J, 2007, 33(1): 27-31. doi: 10.1111/j.1747-4477.2007.00054.x pmid: 17461838
[25]	Gu YC, Lu Q, Wang P, et al. Root canal morphology of permanent three-rooted mandibular first molars: Part Ⅱ-Measurement of root canal curvatures[J]. J Endod, 2010, 36(8): 1341-1346.
[26]	Ishii N, Sakuma A, Makino Y, et al. Incidence of three-rooted mandibular first molars among contemporary Japanese individuals determined using multidetector computed tomography[J]. Leg Med, 2016, 22: 9-12.
[27]	Jang JK, Peters OA, Lee W, et al. Incidence of three roots and/or four root canals in the permanent mandibular first molars in a Korean sub-population[J]. Clin Oral Investig, 2013, 17(1): 105-111.

项目	中切牙		侧切牙		尖牙
项目	根长	牙颈部唇舌径	根长	牙颈部唇舌径	根长	牙颈部唇舌径
左右侧
左侧	11.4±1.3	5.4±0.5	12.6±1.4	6.0±0.7	14.8±1.7	7.6±0.8
右侧	11.3±1.2	5.4±0.5	12.6±1.2	6.0±0.5	14.6±1.7	7.5±0.7
性别
男	11.7±1.3	5.6±0.4	12.8±1.3	6.1±0.5	15.1±1.9	7.9±0.8
女	11.0±1.0^**	5.3±0.4^**	12.3±1.2^**	5.9±0.7^**	14.3±1.4^**	7.2±0.5^**

项目	中切牙		侧切牙		尖牙
项目	单根管	双根管	单根管	双根管	单根管	双根管
左右侧
左侧	90.8	9.2	82.9	17.1	95.0	5.0
右侧	88.4	11.6	79.9	20.1	92.0	8.0
性别
男	89.9	10.1	79.9	20.1	95.5	4.5
女	89.2	10.8	82.9	17.1	91.5	8.5
合计	89.4	10.4	81.4	18.6	93.5	6.5

根管类型	中切牙	侧切牙	尖牙
1-1	352(89.6)	324(81.4)	374(93.5)
2-1	4(1.0)	21(5.3)	3(0.8)
1-2-1	19(4.8)	35(8.8)	12(3.0)
2-2	1(0.3)	2(0.5)	4(1.0)
1-2	17(4.3)	15(3.7)	7(1.7)
2-1-2	0(0)	1(0.3)	0(0)
合计	393(100.0)	398(100.0)	400(100.0)

项目	下颌中切牙			下颌侧切牙			下颌尖牙
项目	左侧双根管	左侧单根管	合计	左侧双根管	左侧单根管	合计	左侧双根管	左侧单根管	合计
右侧双根管	11	12	23	22	18	40	6	10	16
右侧单根管	7	163	170	12	146	158	4	180	184
合计	18	175	193	34	164	198	10	190	200
rho		0.487			0.505			0.440
P		0.000			0.000			0.000

下颌第一磨牙	男性			女性			合计
下颌第一磨牙	左侧三根	左侧双根	合计	左侧三根	左侧双根	合计	左侧三根	左侧双根	合计
右侧三根	15	10	25	16	9	25	31	19	50
右侧双根	2	67	69	2	57	59	4	124	128
合计	17	77	94	18	66	84	35	143	178
rho	0.655			0.675			0.666
P	0.000			0.000			0.000