Foi encontrado também neste estudo o número de canais principais e ramificações, em cada uma das raízes dos segundos molares superiores nos diversos níveis (Tabela 8). Esses dados mostraram que a nível apical a raiz mésio-vestibular sempre mostrou uma frequência maior do número de canais como se pode observar pela mediana na referida tabela.
6.2.3.3 Área mm2
A área dos canais radiculares aumentou gradualmente a cada milímetro que se distanciava da região apical. Os dados apresentados confirmam que a raiz mésio-vestibular é mais complexa e a raiz disto-vestibular apresenta-se num formato mais paralelo. Na análise comparativa sempre foi confirmada a diferença entre as três raízes.
A presença dessa diversificação de canais e ramificações principalmente em molares, acaba criando uma dificuldade enorme ao acessá-los em termos de clínica, se ainda associarmos idade do paciente, deposição de dentina reparadora que muitas vezes cobrem
82 Discussão
parcialmente a embocadura do canal mésio-vestibular e mésio-palatino quando estão presentes (VERTUCCI, 2005).
PETERS, SCHONENBERGER e LAIB, em 2001 relataram que os procedimentos de limpeza por meio de irrigações, tiveram maior influência no sucesso do tratamento endodôntico, do que as técnicas de instrumentação em si. Além disso, há relatos da existência de curvaturas acentuadas e uma elevada incidência de calcificações na porção coronal do canal mésio-vestibular (ALAVI et al., 2002; PARK et al., 2009a). Portanto, a remoção da dentina ou calcificações, utilizando-se brocas de alta ou baixa rotação para localizar os canais, pode conduzir à perfuração da parede na região de furca ou parede mesial. Em substituição a esses instrumentos rotatórios, a maioria destas obstruções pode ser eliminada com pontas ultrassônicas (ALAVI et al., 2002; VERTUCCI, F. J., 2005) ou pontas inativas diamantadas. Essa falta de acesso e a dificuldade de limpar e desinfetar todo o sistema de canais radiculares pode ter um efeito direto sobre o tratamento endodôntico (WOLCOTT et al., 2005).
Naturalmente se levarmos todas essas dificuldades para a clínica, o problema se torna maior. Cabe a nós profissionais nos preocuparmos primeiramente com o canal mésio- vestibular e mésio-palatino, caso existam, terão sua embocadura a nível de câmara pulpar. Em segundo lugar instrumentar adequadamente os dois canais mesias da melhor maneira possível, para que não sirvam de fonte alimentadora a demais canais inacessíveis ou mesmo ramificações que sempre estarão presentes a nível radicular.
O presente estudo forneceu uma análise profunda e abrangente da anatomia do sistema de canais radiculares dos segundos molares superiores, confirmando a elevada incidência de canais mésio-palatinos nas raízes mésio-vestibulares e as inúmeras ramificações nas mais variadas direções, permitindo a reprodução fiel das raízes, através dos meios quantitativos da microCT, que podem servir como complemento valioso para o estudo em profundidade, da morfologia radicular.
7 Conclusão
7 Conclusão7 Conclusão
Conclusão 85
7 CONCLUSÃO
7.1 O que mais prevaleceu no presente estudo foi o tipo V segundo Vertucci, com 26% para a raiz mesial e tipo I com 98% para as raízes distal e palatina.
7.2 O diâmetro maior (V-P) da raiz mésio-vestibular ao nível de 1mm do ápice foi de 0,24mm, para a raiz disto-vestibular 0,25mm e para a raiz palatina 0,29mm.
7.3 O diâmetro menor (M-D) da raiz mésio-vestibular a nível de 1mm do ápice foi de 0,23mm, para a raiz disto-vestibular 0,24mm e para a raiz palatina 0,32mm.
7.4 O número de canais e uma enorme diversificação de ramificações sempre foi maior na raiz mésio-vestibular.
7.5 A área dos canais radiculares e ramificações encontradas nos diferentes níveis aumentou gradualmente a cada milímetro no sentido ápico-cervical nas três raízes estudadas avaliadas.
Referências
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Anexos
AnexosAnexos
Anexos 99
Anexos 101 Anexo 2 [System] Scanner=Skyscan1174 Instrument SN=09G02060 Hardware=C Secure mode=OFF Software=Version 3. 2 (build 2) Home Directory=C:\SkyScan Tube=Hamamatsu 100/250 Camera=Princeton Instruments Camera Pixel Size (um)= 12.56 Camera X/Y Ratio=1.0073 [Acquisition]
Data Directory=C:\RESULTS\JP longo microCT\teste bnt\Tese Marcela\Dente60 Filename Prefix=Dente 60_
Source Voltage (kV)= 80 Source Current (uA)= 124 Filter=Al 1.0 mm Object to Source (mm)=121.000 Camera to Source (mm)=165.000 Number Of Files= 0 Number Of Rows= 1336 Number Of Columns= 2000 Optical Axis (line)= 690
Image Pixel Size (um)= 18.1020 Image Format=TIFF
Depth (bits)=16
Data Offset (bytes)= 264 Horizontal overlap (pixel)=0 Camera horizontal position=Center Visual Camera=OFF
Screen LUT=0 Exposure (ms)= 400 Rotation Step (deg)=0.300 Frame Averaging=On (4) Scanning position=116.475 mm
Suggested beam-hardening correction=10 Suggested HU-Calibration=238000 Number of connected scans=1 Use 360 Rotation=NO
Rotation Direction=CC
Scanning Trajectory=ROUND
102 Anexos
Camera Offset=OFF
Scanning Start Angle=197.400
Study Date and Time=Aug 12, 2012 15:19:18 Scan duration=00:33:41
[Reconstruction]
Reconstruction Program=NRecon Program Version=Version: 1.6.6.0
Program Home Directory=C:\Users\Skyscan\Downloads\nreconLocal Reconstruction engine=NReconServer
Engine version=Version: 1.6.6 Reconstruction from batch=Yes
Reconstruction servers= SKYSCAN-PC Option for additional F4F float format=OFF Reconstruction mode=Standard
Dataset Origin=Skyscan1174 Dataset Prefix=Dente 60_
Dataset Directory=C:\RESULTS\JP longo microCT\teste bnt\Tese Marcela\Dente 60 Output Directory=C:\RESULTS\JP longo microCT\teste bnt\Tese Marcela\Dente 60\Dente 60__Rec
Time and Date=Aug 13, 2012 01:12:40 First Section=58
Last Section=1334
Reconstruction duration per slice (seconds)=2.583399
Total reconstruction time (1277 slices) in seconds=3299.000000 Postalignment=0.00
Section to Section Step=1 Sections Count=1277 Result File Type=JPG
Result File Header Length (bytes)=Unknown: compressed JPG format (100%) Result Image Width (pixels)=960
Result Image Height (pixels)=884 Pixel Size (um)=18.10413
Reconstruction Angular Range (deg)=197.70 Use 180+=OFF
Angular Step (deg)=0.3000 Smoothing=2
Smoothing kernel=0 (Asymmetrical boxcar) Ring Artifact Correction=9
Draw Scales=OFF
Object Bigger than FOV=OFF Reconstruction from ROI=ON ROI Top (pixels)=1273 ROI Bottom (pixels)=387
Anexos 103
ROI Left (pixels)=565 ROI Right (pixels)=1528 ROI reference length=2000
Filter cutoff relative to Nyquisit frequency=100 Filter type=0
Filter type meaning(1)=0: Hamming (Ramp in case of optical scanner); 1: Hann; 2: Ramp; 3: Almost Ramp;
Filter type meaning(2)=11: Cosine; 12: Shepp-Logan; [100,200]: Generalized Hamming, alpha=(iFilter-100)/100
Undersampling factor=1
Threshold for defect pixel mask (%)=0 Beam Hardening Correction (%)=46 CS Static Rotation (deg)=0.00
Minimum for CS to Image Conversion=0.000000 Maximum for CS to Image Conversion=0.072600 HU Calibration=OFF
BMP LUT=0
Cone-beam Angle Horiz.(deg)=17.019047 Cone-beam Angle Vert.(deg)=11.415150
Anexos 105
ANEXO 3