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Table of Contents   
ORIGINAL RESEARCH  
Year : 2013  |  Volume : 24  |  Issue : 2  |  Page : 206-210
Topography of the pulp chamber in the maxillary primary molars of a Tunisian children


1 Department of Fundamental and Mixt Sciences, Laboratory of Dental Anatomy, Faculty of Medicine, University of Monastir, Tunisia
2 Laboratory of Histology and Embryology, Faculty of Medicine, University of Monastir, Tunisia
3 Department of Paediatric Dentistry and Prevention, Faculty of Medicine, University of Monastir, Tunisia
4 Department of Preventive Medicine and Community, Faculty of Medicine, University of Monastir, Tunisia

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Date of Submission27-Aug-2011
Date of Decision01-Mar-2012
Date of Acceptance01-Aug-2012
Date of Web Publication20-Aug-2013
 

   Abstract 

Background: Knowledge of the variations in pulp chamber topography is very useful to the dentist while performing endodontic access cavity in primary teeth.
Aim: To determine the horizontal crown dimensions and the pulp chamber topography of shedding maxillary primary molars in a sample of Tunisian children.
Materials and Methods: Forty two maxillary primary molars (24 first and 18 second molars) were used. Teeth were ultrasonically cleaned before taking morphometric measurements of the buccolingual and mesiodistal sizes. Statistical student test was used comparing the mean sizes.
Results: All the crown measurements were higher in the second molar. While the buccolingual dimension of the pulp chamber was higher in the second molar, the mesiodistal sizes were equivalent among the teeth. The thickest walls were in the buccal side of the first molar and in the mesial side of the second one. The ratio of several measurements indicate that the pulp cavity is more vestibularly and distally located in the second molar.
Conclusion: Mesiodistal dimension of the pulp cavity is not proportional to that of the dental crown. Endodontic access cavity have to be shifted to the distal and vestibular sides from the first to the second upper molar.

Keywords: Anatomy, deciduous tooth, dental pulp cavity

How to cite this article:
Baccouche C, Ghoul-Mazgar S, Baaziz A, Said F, Salem KB. Topography of the pulp chamber in the maxillary primary molars of a Tunisian children. Indian J Dent Res 2013;24:206-10

How to cite this URL:
Baccouche C, Ghoul-Mazgar S, Baaziz A, Said F, Salem KB. Topography of the pulp chamber in the maxillary primary molars of a Tunisian children. Indian J Dent Res [serial online] 2013 [cited 2020 May 28];24:206-10. Available from: http://www.ijdr.in/text.asp?2013/24/2/206/116682
Due to the anthropological, forensic, and clinical significances, determination of the pulp chamber topography and the size of dental crowns appear to be an important tool in our practice. However, little is known about the pulp chamber topography in deciduous teeth [1],[2] and comparing the different sizes of the primary teeth crowns reported in the literature; it appears that these dimensions are very controversial in the previous studies. [3],[4] Such variation in crown dimensions could be attributed either to anthropological reasons or to methodological discrepancies.

From the anthropological perspective, several studies have explored the genetic and environmental influences on the tooth dimensions underlining racial differences [5] and variation in commonly used anthropological scoring systems. [6] Moreover, exploring the influence of the sex on the tooth dimensions, dimorphism seems to be very low in primary teeth [4] and the crown and pulp morphology are different according to the type, the stage of development and the physiology of teeth. [2]

Regarding the methods used to explore primary teeth dimensions, most studies utilised indirect methods such as the radiographic approach, [7],[8] measurements on dental plaster models [3],[9] or the three-dimensional reconstructed images using micro-CT. [2] Although these methods of measurements offer reliable intraoral records, they have some inconveniences such as the risk of exposing patients to over radiation, the superimposition of structures deforming images or the difficulty to introduce a digital caliper between teeth on a dental plaster model. Moreover, considering the methods used in the literature, the majority of these studies explored no more than the mesiodistal size of the teeth and little is known about the other dimensions.

The size of primary teeth in the current Tunisian population has not been studied before and because of the variability in the methods described in the literature, we propose a direct approach determining the crown and pulp chamber dimensions of maxillary primary molars under a stereomicroscope.


   Materials and Methods Top


Sample collection

The study sample consisted of forty two maxillary primary molars. Teeth were collected from children aged between 9 and 12 years. Molars included in this study were clinically mobile and showed root resorption without agenesis of the succedaneous permanent tooth on radiography. Teeth with caries, restoration or fractures were excluded from the study. Two groups were defined: maxillary first molars (n = 24) and maxillary second molars (n = 18).

Preparation of the molars

Before the observation on light microscopy, teeth were cleaned and they were ultrasonically treated during 15 minutes in alcoholic baths at 20°C (ultrasonic cleaner CP104) to eliminate the remaining pulpal tissue.

Morphometric analysis

Measurements were taken with W-PI 10×/23 accurate micrometric ocular at a magnification of 1.25 under a stereomicroscope (Zeiss Stemi 2000-C).

Eight direct measures were recorded for all the teeth [Figure 1] and the criteria for each measurement were defined as follows:
Figure 1: Schematic summary of the different morphological measurements of the pulp chamber and the crown of the maxillary primary molars in the horizontal plane: (a) maxillary primary second molar. (b) maxillary first molar

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  • The greatest buccolingual measurement of the crown (A): The greatest measure of the crown in the buccolingual axis.
  • The greatest mesiodistal measurement of the crown (B): The greatest measure between the mesial and the distal surfaces perpendicular to the buccolingual axis.
  • The greatest buccolingual measurement of the pulp cavity (a): The greatest measure of the pulp cavity included in A.
  • The greatest mesiodistal measurement of the pulp cavity (b): The greatest measure of the pulp cavity included in B.
  • The thickness of the buccal wall of the crown (V): The distance between the external surface of the crown and the pulp cavity included in A from the buccal side of the molar.
  • The thickness of the lingual wall of the crown (L): The distance between the external surface of the crown and the pulp cavity included in A from the lingual side of the molar.
  • The thickness of the mesial wall of the crown (M): The distance between the external surface of the crown and the pulp cavity included in B from the mesial side of the molar.
  • The thickness of the distal wall of the crown (D): The distance between the external surface of the crown and the pulp cavity included in B from the distal side of the molar.
Statistical procedures

After the conversion of the measurements in millimetres, a statistical analysis was performed using the SPSS program. Descriptive statistics, means, and standard deviation were obtained for each group of molars. Then, they were compared inter the different groups using (t test). Results were considered to be significant when P ≤ 0.05.


   Results Top


Average measurements of the crowns

[Table 1] reflects the mean values and the standard deviation of the greatest buccolingual and mesiodistal crown measurements recorded in each group of the studied molars. In fact, for the two groups of molars, the sizes of the crown were significantly greater (P ≤ 10−3 ) in the buccolingual axis (7. 16 mm for the first molar and 8.15 mm for the second one) than in the mesiodistal axis (5.48 mm for the first molar and 7.01 mm for the second one), however, the second molar present in general the greatest measurements.
Table 1: Means (mm), standard deviation of the greatest buccolingual and mesiodistal diameter of the crown

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Morphological features of the pulp chambers in the first and the second maxillary primary molars

The sizes of the pulp chambers were larger in the buccolingual than in the mesiodistal axis for each molar [Table 2]. The greatest dimension of the pulp chamber "a" was significantly higher (P ≤ 10−3 ) in the second molar (4.05 ± 0.1) compared to the first molar (3.61 ± 0.1). However, there was no significant difference between the molars when comparing the greatest dimensions in the mesiodistal axis "b" (P = 0.28). The pulp chamber of the primary second molar is more developed in the buccolingual axis, but its mesiodistal size is equivalent to that of the first molar.
Table 2: Means (mm), standard deviation of the pulp chamber diameter in the buccolingual and mesiodistal axis

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Topography of the pulp chambers in the first and the second maxillary primary molars

The dentin thickness average was calculated and it revealed that the thickest wall was recorded in the buccal side of the first molar (1.97 ± 0.1) and in the mesial side of the second molars (2.41 ± 0.2) [Table 3]. A Comparison between the two groups of molars showed that the dentin thickness was higher in all the surfaces of the second molars (P ≤ 0.01).
Table 3: Means (mm), standard deviation of buccal, lingual, mesial and distal dentin thickness of molars

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A comparison of the ratio V/L among the molars indicated that the buccal dentinal thickness was significantly lower than the lingual dentinal thickness in the second molar compared to the first one (P ≤ 0.05) with an average means of 1.19 ± 0.07 and 1.11 ± 0.06 respectively in the first and second molars. Moreover, the ratio V + a/A was significantly lower in the second teeth (0.76 ± 0.01) compared to the first one (0.78 ± 0.2) (P = 0.05), indicating that the pulp cavity in the second primary molar is more vestibularly located than the first one.

Concerning the mesiodistal axis, the ratio (D + b/B) was significantly lower (P ≤ 0.05) in the second molar compared to the first one with means of 0.65 ± 0.03 and 0.70 ± 0.03 respectively in the second and the first one, indicating that the pulp cavity of the second primary molar is more distally located than the first tooth.


   Discussion Top


As the classical description of the maximum mesiodistal crown diameter is defined as the greatest distance between the contact points of the proximal surfaces and as the buccolingual crown diameter is the greatest distance at a right angle to the mesiodistal measurement, it seems that all these measurements are related to the contact points and to the neighbouring adjacent teeth. Considering the variability in the shape of deciduous teeth, the dynamism of the eruption process and the possible dental disharmonies, other markers should be considered for the measurement of crown dimensions. In this study, instead of the classical crown measures, we used the crown's buccolingual axis to determine the crown and the pulp dimensions. Even if such method limits the comparison of our data to those of the literature, the odontometric information noted in our study should be reliable in adapting preformed stainless steel crowns for these children and the comparison of the results in-between teeth seems to be more adequate. Our results were also analysed independently of the patient's sex and introducing this factor might reveal other specific differences in the crown and pulp dimensions as suggested by previous studies. [3],[7],[9] However, examples are not enough to examine the effect of the gender.

Crown dimensions

Our approach using direct measurements on a stereomicroscope revealed small dimensions of the studied crowns compared to those of the literature. [3],[9] This difference could be attributed either (i) to the physiological usury of the interproximal contact points described in the primary molars regarding their physiological stage of development, or (ii) to the ethnic feature of the Tunisian children. We also noticed that the buccolingual measurements of the crown were particularly greater than the mesiodistal ones for each tooth and that comparing the molars, the mesiodistal and the buccolingual sizes were significantly greater in the maxillary second molar (P ≤ 10−3 ). Such data confirms the results in previous studies describing a greater significant correlation between these dimensions in the maxillary second molar than in the first one. [3] The buccolingual difference between the molars could be attributed to a morphological shape developed earlier in this axis of the tooth to allow the development of the external dental morphologic trait defined as tubercle of Carabelli. This tubercle is found on the mesiolingual surface of the maxillary primary second molars and not in the first one. [10] The odontometric information recorded in this study should be reliable in adapting preformed stainless steel crowns for Tunisian children.

Pulp chamber dimensions

Surprisingly, although endodontic treatments are well-described in the literature, [11],[12],[13],[14] little is known about the pulp chamber dimensions of the maxillary primary molars. [5] While there was no significant difference in the mesiodistal dimension "b" (P = 0.28) between the molars, our study showed that the greatest dimension of the pulp chamber was significantly higher in the buccolingual axis in the second molar compared to the first molar (P ≤ 10−3 ). If we consider that the pulp circumference mimics the crown contour, such feature reminds the morphological character noticed in the crown of the second molars and could in part be attributed to the tubercle of Carabelli. This could also explain the noticed data described in previous studies showing that primary second molars are more accessible for endodontic treatment than the first ones. [15] However, in the mesiodistal axis, the pulp chamber dimensions seem to be regulated by other factors than the crown circumference.

Dentin thickness

Previous reports on dentinal thickness generally used measurements on tooth sides. [16],[17] Our results presented in [Table 3] confirm the previous data showing an increase of the dentin thickness in all the surfaces of the second molar compared to the first one. [17] In the first molar, the thickest wall was located in the buccal side of the tooth. This could be attributed to the prominent Zuckerkandl tubercle located in the cervical mesiobuccal side of the tooth. [18] Curiously, in the second molar the thickest wall was mesially and not lingually located regarding the tubercle of Carabelli. This data could be attributed to the dentinogenesis process that could be more important mesially according to the occlusal solicitations existing in this side. In fact, the occlusal solicitations are limited in the other sides of this terminal molar. However, comparing the ratios V/L of the dentinal thickness, it appears that the buccal dentinal thickness was significantly lower than the lingual dentinal thickness in the second molar compared to the first one (P ≤ 0.05). Besides, in the mesiodistal axis, a ratio analysis showed that the distal thickness of the crown seems to be more reduced comparatively to the mesial one in the second molar than in the first one (P ≤ 0.05), confirming the previous noticed data that the thickest wall of the second molar is mesially located.

Pulp topography

Reports on the topographic relationship between the contour of the crown and the pulp chamber in deciduous teeth have mostly used radiographs [7] or micro-CT systems. [2] The present study revealed that there was no significant difference in the mesiodistal sizes of the pulp cavity between the molars (P ≥ 0.05) while the greatest dimension of the pulp chamber (a) was significantly higher in the buccolingual axis (P ≤ 0.05) in the second molar (4.05 ± 0.1) compared to the first molar (3.61 ± 0.1). Considering the analysis of the dentin thickness, it appears that the pulp cavity is more vestibularly and distally located in the second molar than in the first one. Such data suggest that during the preparation of cavities in maxillary primary molars, the paediatric dentist should not consider the mesiodistal dimension of the crown to predict the dimension of the pulp cavity but he should consider shifting the eventual endodontic access to the distal and vestibular sides of the second molar in order to preserve the dentinal wall thickness.

In conclusion, an analysis of the measurements revealed that in the maxillary primary second molar, while all the crown dimensions and the buccolingual size of the pulp chamber were more important compared to the first molar, there was no significant difference in the mesiodistal size of the pulp chamber and the pulp cavity was more vestibularly and distally located in the second molar. In addition, this morphometric study revealed small dimensions of the crown compared to those of the literature and it should be compared to molars of earlier stages of development to better evaluate the apposition and the resorption processes responsible for the final topography of the pulp cavity and to appreciate the usury of proximal surfaces.

 
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Correspondence Address:
Chiraz Baccouche
Department of Fundamental and Mixt Sciences, Laboratory of Dental Anatomy, Faculty of Medicine, University of Monastir
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.116682

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    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]

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