Avaliação do risco de perfuração radicular em planejamento digitais para endodontia guiada em dentes anteriores superiores

Abstract

Objective: To evaluate the risk of root perforation in maxillary anterior teeth subjected to digital planning for guided endodontics, based on the remaining dentin thickness and the drill deviation parameters reported in the literature. Materials and Methods: This study used cone-beam computed tomography (CBCT) images of 72 human maxillary anterior teeth distributed into three groups: 24 maxillary central incisors (MCI), 24 maxillary lateral incisors (MLI), and 24 maxillary canines (MC). The images were imported into the digital planning software Blue Sky Plan®, in which virtual guided endodontic planning was performed by simulating drill positioning toward the root canal. The remaining dentin thickness was measured at the cervical, middle, and apical thirds of each tooth, considering the shortest distance between the virtual drill path and the external root surface. The obtained values were analyzed in association with drill deviation parameters reported in the literature for guided endodontics to develop a root perforation risk classification for maxillary anterior teeth. High risk was defined as minimum dentin thickness values lower than 0.5 mm, moderate risk as values between 0.5 and 1.0 mm, and low risk as values greater than 1.0 mm. Results: A progressive reduction in remaining dentin thickness was observed from the cervical to the apical direction in all dental groups evaluated, with statistically significant differences among root thirds (p < 0.05). Maxillary lateral incisors exhibited the lowest remaining dentin thickness values, particularly in the apical third. Conclusion: According to the risk classification, maxillary central incisors, maxillary lateral incisors, and maxillary canines were predominantly classified as low risk in the cervical and middle thirds and moderate risk in the apical third. None of the evaluated teeth was classified as high risk for root perforation.