Computed tomographic anatomy of the mandibular first and second molars and their surrounding structures in the spread of odontogenic infection

Objectives The purposes of this study were to analyze the CT anatomy of the mandibular first and second molars in uninfected subjects and to clarify the pathway of odontogenic infection originating from the mandibular first and second molars. Methods CT anatomies, especially for bucco-lingual aspects and the surrounding soft tissues, were investigated in 100 uninfected subjects and 17 infected patients. Results At the level of bifurcation, disappearance of the cortical plates was frequently observed on the buccal and lingual sides of the first molars, and it was reduced on the buccal side in the second molar. In the first molar, the bony width was thinner on the buccal than the lingual side. The lingual cortices were thinner in the second molar. All medial pterygoid and 88% of masseter muscles were situated posteriorly, without horizontally overlapping the second molar, whereas the mylohyoid muscle (MhM) overlapped horizontally with the first and second molars. The MhM was positioned superior to the root apices in 10 and 39% of first and second molars, respectively. All patients with first molar infection showed involvement of buccal structures, and one showed lingual side involvement. In contrast, six of nine patients with second molar infection showed involvement on the lingual side. Conclusions Infection originating from the second molar was more likely to spread to the lingual side than infection originating from the first molar. CT anatomy surrounding the causal teeth supported the spread pathways of mandibular first and second molar infection.