Accessory Canals in the Region of Ramification of Multirooted Teeth

Akcesorni kanali u području korijenske ramifikacije molara najsuptilniji su dio ukupnog endodontskog prostora. Oni povezuju pulpu i parodont jer kroz njih prolaze krvne žile, živci i vezivno tkivo. Svrha ovog istraživanja bila je da se ustanovi njihova učestalost kod prvih donjih trajnih molara. U istraživanju smo se koristili s 26 ekstrahiranih prvih trajnih donjih molara kod kojih smo dijamantnim kolutom odvojili područje korijenske ramifikacije od ostalog dijela zuba. Nakon čišćenja 5%-tnim NaOCl od organskog materijala i dehidracije, uzorci su napareni zlatom i promatrani pod elektronskim mikroskopom (SAM) a nalazi fotografirani. Na svim uzorcima pronašli smo akcesorne kanale. Najčešće je nađeno 3 do 4 velika akcesorna kanala promjera od 50 do 150 pm koji su povezivali dno pulpne komore s izvanjskom površinom korijenske ramifikacije. Međutim, kod nekoliko zuba takvih je akcesornih kanala bilo i do 10. Također je na svim uzorcima nađen velik broj malih akcesornih kanalića promjera 10 do 30 pm za koje, međutim, nismo mogli ustanoviti koji od njih čine ogranke većih akcesornih kanala, a koji su hvatište snopova vezivnih vlakana parodonta. Otvori nekih manjih akcesornih kanalića bili su djelomično zatvoreni mineraliziranom supstancijom nalik na cement, ali ta pojava nije bila ni u kakvoj korelaciji sa starošću zuba. Osobito značenje ovi akcesorni kanali dobivaju kada nastupi oboljenje ili pulpe ili regionalnog parodonta jer omogućuju infekciji i upali da se kroz njih proširi s jednog na drugo tkivo. Također se ne smije zanemariti njihov utjecaj na tijek i krajnji ishod i parodontološke i endodontske terapije.Accessory canals in the region o f molar root ramification are the finest part o f the entire endodontic area. They connect the pulp and the periodontium, with blood vessels, nerves and connective tissue passing through them. The aim o f this study was to assess their frequency in the first lower permanent molars. Twenty-six extracted first lower permanent molars were used in the study. A diamond ring was used to separate the region o f root ramification from the rest o f the tooth. After cleaning from organic material with 5% NaOCl and dehydration, the specimens were gold-evaporated, observed under an electron microscope (SAM) and photos o f the findings were taken.Accessory canals were found in all specimens. Most frequently, 3-4 large accessory canals o f 50-150 (im in diameter, connecting the pulp chamber bed with the external surface o f root ramification, were observed. In several teeth, however, there were as many as up to 10 such accessory canals. A ll specimens observed also had a great number o f small accessory canals o f 10-30 fxm in diameter, but it was impossible to determine which o f them were branches o f large accessory canals and which represented the grip o f clusters o f periodontal connective fibers. Openings o f some smaller accessory canals were partially closed by a cement-like mineralized substance, but there was no correlation between this phenomenon and age o f the tooth. These accessory canals gain greatly in importance when a disease o f the pulp or regional periodontium occurs, allowing the infection and inflammation to spread through them from one tissue to another. Neither their effect on the course and eventual outcome o f both periodontal and endodontic therapy should be neglected