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ORIGINAL ARTICLE
Year : 2008  |  Volume : 20  |  Issue : 2  |  Page : 49-53 Table of Contents   

An intraoral periapical radiographic study of nutrient canals as a diagnostic aid in systemic diseases and pathological conditions


Department of Oral Medicine and Radiology, College of Dental Sciences, Davangere-577 004, Karnataka, India

Correspondence Address:
Vanaja G Reddy
Post Graduate student, Dept. of Oral Medicine and Radiology, College of Dental Sciences, Davangere-577004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.44364

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   Abstract 

Objectives: To correlate the prevalence of nutrient canals in healthy dentulous with healthy edentulous, diabetes mellitus, hypertension and periodontally compromised patients. Methods: Study was conducted on 500 subjects in the age group of 21-70 years. They were clinically and radiographically examined using intraoral periapical radiographs, and were statistically analyzed. Results: On Comparing with control group, prevalence of nutrient canals was observed to be highly significant in diabetes (27%, P<0.001), significant in edentulous (22%, P<0.01), hypertensive (21%, P<0.01) and periodontitis (17%, P<0.05) groups. Highly significant age wise prevalence was observed in edentulous and periodontitis groups and a significant increase in diabetes and hypertensive groups. Interpretation and Conclusion: Significant correlation was observed in diabetes, edentulous, hypertensive and periodontitis groups, when compared with healthy subjects. Increase in prevalence of nutrient canals on mandibular anterior IOPAR can be used as an adjunct diagnostic aid in systemic diseases like diabetes, hypertension and periodontitis.

Keywords: Diabetes mellitus, edentulous, hypertension, nutrient canals, periodontitis


How to cite this article:
Reddy VG, Ali I M, Shashikanth M C. An intraoral periapical radiographic study of nutrient canals as a diagnostic aid in systemic diseases and pathological conditions. J Indian Acad Oral Med Radiol 2008;20:49-53

How to cite this URL:
Reddy VG, Ali I M, Shashikanth M C. An intraoral periapical radiographic study of nutrient canals as a diagnostic aid in systemic diseases and pathological conditions. J Indian Acad Oral Med Radiol [serial online] 2008 [cited 2020 Jan 26];20:49-53. Available from: http://www.jiaomr.in/text.asp?2008/20/2/49/44364


   Introduction Top


Radiographs are an important diagnostic aid and are routinely used for investigating the diseases of teeth and bone. Certain radiographic findings can be of significance if evaluated, one such finding is the presence of nutrient canals. Nutrient canals are spaces in bones and are considered to be channels that conduit blood vessels and nerves. [1] They are observed more frequently in the mandibular anterior region as radiolucent lines [2] situated interproximal and inferior to the teeth, and they usually have a vertical rather than horizontal direction with varying width. [1],[2] Very little effort has been made to correlate the radiographic appearance of nutrient canals with, diabetes mellitus, hypertension, periodontal diseases, rickets, tuberculosis, calcium deficiency, disuse atrophy and coarctation of aorta. [3] There remain many unanswered questions regarding the clinical significance and relationship if any between the presence of nutrient canals and various pathologic conditions, and why they appear in some case and not in others. [4] Hence, present study was undertaken primarily to know the prevalence of nutrient canals in healthy dentulous, edentulous, diabetes, hypertensive and periodontitis and to determine if any correlation exists between them, and also to determine whether the presence of nutrient canals can be used as a clue for the detection of hypertensive and diabetic patients.


   Materials and Methods Top


Study sample consisted of 500 subjects of either sex, between the age group of 21and 70 years, attending the out patient department. Selections of subjects was based on the following criteria and were divided into 5 groups:

Group-I (Control group) - consisted of subjects without radiographic or clinical evidence of periodontitis and without any systemic illness.

Group-II (Healthy edentulous) - consisted of subjects with complete edentulous maxillary and mandibular arches, with the minimum period of edentulousness being at least 1 year, and without any systemic illness.

Group-III (Diabetic group) - consisted of known diabetes mellitus patients with the minimum duration of at least 1 year and without any other systemic illness. Moderate to severe cases of periodontal involvement were excluded.

Group-IV (Hypertensive group) - consisted of known hypertensive patients, with the minimum duration of at least 1 year, and without any other systemic illness. Moderate to severe cases of periodontal involvement were excluded.

Group-V (Periodontitis group) - consisted of patients with clinical and radiographic evidence of periodontitis like periodontal pockets, mobility, gingival recession, pus exudation and without any systemic illness.

Selected subjects were clinically evaluated and later radiographic procedures were carried out. Mandibular anterior region was selected as the site of study, due to higher frequency of occurrence of nutrient canals in this region. Radiographs were later evaluated for presence or absence of mandibular anterior teeth, presence or absence of radiolucent lines (nutrient canals) running vertically either in interdental area or in the periapical region and the total number of radiolucent lines present were recorded as nutrient canals (NC).


   Results Top


Prevalence of nutrient canals in control group and other assigned groups [[Table 1], Graph 1]: The prevalence of NC in group I, II, III, IV and V were 47, 69, 74, 68 and 64%, respectively. Group II, III, IV and V showed a statistically significant value on comparison with group I.

Average number of nutrient canals [[Table 2], Graph 2]: In group I, number of NC varied from 1 canal to as many as 3 canals with the mean number of 0.81.0. In group II, it varied from 1 canal to as many as 5 canals, with mean number of 1.81.5. In group III, number of NC varied from 1 canal to as many as 4 canals, with a mean number of 1.61.2. In group IV, it varied from 1 canal to as many as 5 canals, with a mean number of 1.51.4. In group V, it varied from 1 canal to as many as 5 canals, with a mean number of 1.41.4. On comparison of group II, group III, group IV individually with group I to Mann-Whitney test it showed a highly statistically significant results whereas group V showed statistically significant result.[Additional file 1],[Additional file 2],[Additional file 3]

Age wise prevalence of nutrient canals [Table 3]: The age wise prevalence of NC in the control group distributed over the 5 age group (years) showed a statistically high significant correlation. Peak prevalence in the age group of 41-60 years was observed.

Prevalence of nutrient canals in relation to the duration of disease [[Table 4], Graph 3]:

Peak prevalence of NC was seen in 1-10 years of the duration of disease.


   Discussion Top


Diagnostic radiography plays a vital role in bringing to the fore the underlying pathologic conditions in dentistry like caries, periapical changes and periodontal changes, as well as gross manifestations of osseous changes in the mandible and maxilla. It has been recognized for many years that wide variations exist in the radiographic appearance of identical anatomic structures. [1] Of all the anatomic landmarks encountered on radiographic examination, NC remain the most enigmatic in their presence as well as absence. A number of studies [1],[2],[3],[4],[5],[6],[7] has been carried out to ascertain their role of NC in both health and disease. Predominance of NC in the anterior mandibular region was attributed to the following facts:

  1. Thin alveolar process
  2. Horizontally arranged trabeculae
  3. Decreased bony support of cortical and cancellous bone
  4. More prone to irritation from calculus and trauma. [1],[3],[4]


Diabetes group when compared with control showed a statistically significant percentage difference of 22%, with Z value of 3.23 and P -value of <.01. This percentage increase in presence of NC is in accordance with other studies. [4],[8],[9],[10] The reason attributed to this higher prevalence of NC is to the fact that, the anatomic structure of the anterior mandible in edentulous subjects is quiet different from that of dentulous subjects and high incidence of NC in edentulous subjects may be associated with resorption of the alveolar bone following tooth loss and the thickness of the remaining alveolar bone. [4],[10],[11]

The edentulous bony areas have thinner cortical plates and lace like supporting pattern of the cancellous bone, which can be recorded more minutely radiographically than the dentition regions where the tooth root and lamina dura are super imposed over a great percentage of the alveolar bone, and also may be attributed to the fact that their appearance is more pronounced in areas of advanced resorption of the alveolar bone, but this appearance is due the ability of the roentgenograph to record the thinner bony structures more clearly. [4],[7]

An increase in prevalence of NC in diabetic patients was attributed to the fact that, the deficiency of insulin has mitogenic action on the endothelial cells which would lead to collateral vessel formation. Also the process of atherosclerosis can be seen leading to narrowing of blood vessel lumen. So, this collateral vessel formation may act as a compensatory mechanism which leads to increased prevalence of NC, which was in accordance with other studies. [3],[4],[12]

An increase in prevalence of NC in hypertensive patients in our study was in accordance with other studies [1],[3],[4] which may be attributed to the principal effects of hypertension i.e., dilatation of arterioles, hypertrophy and hyperplasia of the arterial walls and atherosclerosis. [3] In atherosclerosis, along with thickening of arterial walls, there is narrowing of the lumen which may lead to opening of more collaterals to compensate the blood supply. Thus, either dilatation of the vessel wall or opening of more collaterals or both of these changes may be responsible for the increased prevalence of NC in these patients. [3]

In periodontitis, the incidence of NC and the number of observable canals increased as the radiographic evidence of bone resorption became more severe. Nutrient canals were more likely to appear in cases in which the alveolar bone was 'above average' in density with small diminutive trabecular spaces. Cause appears to be associated with the presence of periodontal disease that brings about a sclerotic changes in the trabecular bone pattern and also NC appear more pronounced due to the ability of radiographs to record the thinner bony structures more clearly, which was in accordance with other studies. [4],[5],[13]

A higher percentage of the prevalence of NC extending beyond the root apex has been observed more obviously than that of those found between the roots. This findings confirms well with the established anatomic description of blood supply to the mandibular anterior region. [4],[5],[13],[14],[15]

An increased incidence of periodontal disease was observed in patients of advanced age. [6],[16] The incidence of NC and the number of observable canals increased as the radiographic evidence of bone resorption became more severe. Nutrient canals were more likely to appear in cases in which the alveolar bone was 'above average' in density with small diminutive trabecular spaces. Cause appears to be associated with the presence of periodontal disease that brings about a sclerotic change in the trabecular bone pattern and also in advanced periodontal disease NC appear more pronounced due to the ability of radiographs to record the thinner bony structures more clearly. [4]

In the current study, the sex wise prevalence of NC showed no significance in any of the groups.

Highly significant correlation was seen in relation to the duration of the disease with a P -value of <.001 for the three groups indicating a statistically highly significant correlation. The reason for the sudden decrease in the prevalence of NC as the duration of disease increased in case of hypertension can be postulated to the fact that it may be due to the calcification of blood vessels (terminal stage of arteriosclerosis) in patients with long standing hypertension, leading to the disappearance of NC. Arteriosclerosis occurs not only in hypertensive patients, but also in the aged, diabetes, and in persons with periodontal disease. In case of group II, group III and group IV - atherosclerosis can be attributed to this trend.


   Conclusion Top


The statistically significant findings from this study can be used to recommend that increased prevalence of nutrient canals (NC) can act as an adjunct diagnostic marker for detection of underlying systemic diseases like diabetes mellitus, hypertension etc. But a larger sample of individual groups is needed to have an in depth knowledge of the small variations according to age, sex, duration and frequency which might help to make better diagnosis and better treatment decisions. Findings of the study could be used as a diagnostic marker for further investigations, so as to bring forth the underlying systemic conditions, if any, and helping the patient in his/her over all health and treatment planning of such diseases.

 
   References Top

1.Patni VM, Merchant GJ, Dhooria HS. Incidence of nutrient canals in hypertensive patients: A radiographic study. Oral Surg Oral Med Oral Pathol 1985;59:206-11.  Back to cited text no. 1  [PUBMED]  
2.White SC, Pharaoh MJ, editors. Oral radiology, Principles and interpretations. 5 th ed. St. Louis: Mosby; 2004. p. 184-5.  Back to cited text no. 2    
3.Patel JR, Wuehrman AH. A radiographic study of nutrient canals. Oral Surg Oral Med Oral Pathol 1976;42:693-701.  Back to cited text no. 3    
4.Kishi K, Nagaoka T, Gotoh T, Imai K, Fujiki Y. Radiographic study of mandibular nutrient canals. Oral Surg Oral Med Oral Pathol 1982;54:118-22.  Back to cited text no. 4    
5.Britt GN. A study of human mandibular nutrient canals. Oral Surg 1977;44:635-45.  Back to cited text no. 5    
6.Bilge OM, Harorli AB, Yilmaz AB. Radiographic study of mandibular nutrient canals. Ann Dent 1992;51:17-21.  Back to cited text no. 6    
7.Lovett DW. Nutrient canals: A roentgenographic study. J Am Dent Assoc 1948;37:671-6.  Back to cited text no. 7    
8.Guptha, Mehta, Sahu, editors. Dental radiology. A.I.T.B.S. Publishers and Distributors; 1996. p. 30.  Back to cited text no. 8    
9.Goodman-Topper ED, Chosack A. Radiographic appearance of nutrient canals in the region of the erupting permanent maxillary cuspid. Oral Surg Oral Med Oral Pathol 1989;67:606-10.  Back to cited text no. 9    
10.Bilge OM, Harorli AB, Yilmaz AB. Radiographic study of mandibular nutrient canals. Ann Dent 1992;51:17-21.  Back to cited text no. 10    
11.Sweet AP. A statistical analysis of the incidence of nutrient channels and foramina in five hundred periapical full mouth radiodontic examinations. J Am Dent Assoc 1942;28:427-42.  Back to cited text no. 11    
12.Edwards CR, Boucher IA, editors. Davidson's principles and practice of medicine. 16 th ed. ELBS; 1991. p. 316-26.  Back to cited text no. 12    
13.Ryder WB. The significance of "Circulatory canals" in Roentgenograms of the alveolar process. Am J Ortho Surg 1942;28:640-51.  Back to cited text no. 13    
14.Stafne EC, Gibilisco JA, editor. Oral radiographic diagnosis. 5 th ed. W.B. Saunders Company; 1985. p. 3-4.  Back to cited text no. 14    
15.Ennis LM. Roentgenographic variations of the maxillary sinus and the nutrient canals of the maxilla and the mandible. In: Ivy RH, Thoma KH, editors. Dental roentgenology. 2 nd ed. Lea and Febiger; 1931. p. 173-93.  Back to cited text no. 15    
16.Van der Velden U. Effect of age on the periodontium. J Clinical Periodontol 1984;11:281-94.  Back to cited text no. 16    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]

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