Radiographic Features of the Gubernaculum Tract in Impacted Teeth
-
Samare Mortazavi
,
Mahrokh Imanimoghaddam
,
Arefe Delkhosh
,
Amirhosein Kordi Karimabadi
,
Toktam Poorebrahim
Abstract
Introduction: The gubernaculum tract (GT) is a fibrous canal extending from the dental follicle to the alveolar crest, playing a crucial role in tooth eruption. This structure is not visible on conventional radiographs but can be reliably detected using cone-beam computed tomography (CBCT). This study aimed to evaluate the radiographic characteristics of the GT in impacted teeth using CBCT imaging. Materials and Methods: In this cross-sectional study, CBCT scans of 85 patients (41 males, 44 females) with impacted teeth, referred to Mashhad Dental School between December 2020 and December 2022, were evaluated. The mean age was 21.4 ± 11.06 years (range: 8–48 years). The presence, dimensions, morphology, and attachment patterns of the GT were assessed in coronal and sagittal planes. Data were analyzed using Chi-square and Mann-Whitney U tests (α = 0.05). Results: The GT was detectable in 36.7% of impacted teeth, with significantly higher visibility in males (P = 0.015). Canines were the most commonly affected teeth. The most frequent causes of impaction were abnormal eruption angle and tooth displacement. The GT most commonly showed central attachment in mesio-distal (64%) and bucco-lingual (76%) dimensions and occlusal attachment in the occluso-cervical direction (52%). Rectangular morphology was predominant (57%). Mean GT length and width were approximately 3.1–3.3 mm in both planes. Conclusion: CBCT enables detailed visualization of the gubernaculum tract in impacted teeth. The presence and characteristics of the GT may serve as predictive indicators for eruption disturbances and assist in treatment planning decisions. Keywords: Cone-beam computed tomography; Tooth; Impacted; Tooth eruption; Gubernaculum dentis; Dental follicle.
1. Ferreira DCA, Fumes AC, Consolaro A, Nelson-Filho P, de Queiroz AM, De Rossi A. Gubernacular cord and canal – does these anatomical structures play a role in dental eruption? RSBO Revista Sul-Brasileira de Odontologia. 2013;10(2):167-71.
2. Cerqueira TS, Correia KVD. Study and evaluation of the gubernacular canal by means of cone beam computed tomography. Stomatologija. 2020;22(3):86-91.
3. Cahill DR. Histological changes in the bony crypt and gubernacular canal of erupting permanent premolars during deciduous premolar exfoliation in beagles. J Dent Res. 1974;53(4):786-91.
4. Oda M, Nishida I, Habu M, Takahashi O, Tabe S, Tsurushima H, et al. Imaging peculiarities of gubernaculum tracts in molars as accessional teeth on CT. Clin Exp Dent Res. 2021;7(6):1205-14.
5. Zengin AZ, Rizeli L, Sumer AP. Detection and characteristics of the gubernacular tract in supernumerary teeth on cone beam computed tomography. Oral Radiol. 2023;39(2):292-300.
6. Oda M, Miyamoto I, Nishida I, Tanaka T, Kito S, Seta Y, et al. A spatial association between odontomas and the gubernaculum tracts. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121(1):91-5.
7. Koc N, Boyacioglu Dogru H, Cagirankaya LB, Dural S, van der Stelt PF. CBCT assessment of gubernacular canals in relation to eruption disturbance and pathologic condition associated with impacted/unerupted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019;127(2):175-84.
8. Kamarthi N, Gupta D, Gotur SP. Radiographic demonstration of association of gubernaculum dentis (gubernaculum tract) in odontogenic cysts and tumors – a CBCT finding. Indian J Radiol Imaging. 2020;30(3):340-3.
9. Gaeta-Araujo H, da Silva MB, Tirapelli C, Freitas DQ, de Oliveira-Santos C. Detection of the gubernacular canal and its attachment to the dental follicle may indicate an abnormal eruption status. Angle Orthod. 2019;89(5):781-7.
10. Al-Abdallah M, AlHadidi A, Hammad M, Dar-Odeh N. What factors affect the severity of permanent tooth impaction? BMC Oral Health. 2018;18(1):184.
11. Ten Cate AR. Oral histology: development, structure, and function. 5th ed. St. Louis: Mosby; 1998.
12. Marks SC Jr, Cahill DR. Experimental study in the dog of the non-active role of the tooth in the eruptive process. Arch Oral Biol. 1984;29(4):311-22.
13. Van Hassel HJ, McMinn RG. Pressure differential favouring tooth eruption in the dog. Arch Oral Biol. 1972;17(1):183-90.
14. Craddock HL, Youngson CC. Eruptive tooth movement – the current state of knowledge. Br Dent J. 2004;197(7):385-91.
15. Becktor KB, Nolting D, Becktor JP, Kjaer I. Immunohistochemical localization of epithelial rests of Malassez in human periodontal membrane. Eur J Orthod. 2007;29(4):350-3.
16. Rabea AA. Recent advances in understanding theories of eruption (evidence based review article). Future Dental Journal. 2018;4(2):189-96.
17. Kaczor-Urbanowicz K, Zadurska M, Czochrowska E. Impacted teeth: an interdisciplinary perspective. Adv Clin Exp Med. 2016;25(3):575-85.
18. Chu FC, Li TK, Lui VK, Newsome PR, Chow RL, Cheung LK. Prevalence of impacted teeth and associated pathologies – a radiographic study of the Hong Kong Chinese population. Hong Kong Med J. 2003;9(3):158-63.
19. Wolf J, Dym H. Office-based procedures for unusual impactions. Atlas Oral Maxillofac Surg Clin North Am. 2013;21(2):211-20.
20. Shiller WR. Positional changes in mesio-angular impacted mandibular third molars during a year. J Am Dent Assoc. 1979;99(3):460-4.
21. Frank CA. Treatment options for impacted teeth. J Am Dent Assoc. 2000;131(5):623-32.
22. Polat HB, Ozan F, Kara I, Ozdemir H, Ay S. Prevalence of commonly found pathoses associated with mandibular impacted third molars based on panoramic radiographs in Turkish population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(6):e41-7.
23. Raghoebar GM, Boering G, Vissink A, Stegenga B. Eruption disturbances of permanent molars: a review. J Oral Pathol Med. 1991;20(4):159-63.
24. Sajnani AK. Permanent maxillary canines – review of eruption pattern and local etiological factors leading to impaction. J Investig Clin Dent. 2015;6(1):1-7.
25. Palma C, Coelho A, Gonzalez Y, Cahuana A. Failure of eruption of first and second permanent molars. J Clin Pediatr Dent. 2003;27(3):239-45.
26. Isola G, Cicciù M, Fiorillo L, Matarese G. Association between odontoma and impacted teeth. J Craniofac Surg. 2017;28(3):755-8.
27. Van Buggenhout G, Bailleul-Forestier I. Mesiodens. Eur J Med Genet. 2008;51(2):178-81.
28. Russell KA, Folwarczna MA. Mesiodens – diagnosis and management of a common supernumerary tooth. J Can Dent Assoc. 2003;69(6):362-6.
29. Flores MA-OX, Onetto JA-O. How does orofacial trauma in children affect the developing dentition? Long-term treatment and associated complications. Dent Traumatol. 2019;35(4-5):256-64.
30. Posadzy M, Desimpel J, Vanhoenacker F. Cone beam CT of the musculoskeletal system: clinical applications. Insights Imaging. 2018;9(1):35-45.
31. Scarfe WC, Farman AG. What is cone-beam CT and how does it work? Dent Clin North Am. 2008;52(4):707-30.
32. Klintstrom E, Smedby O, Moreno R, Brismar TB. Trabecular bone structure parameters from 3D image processing of clinical multi-slice and cone-beam computed tomography data. Skeletal Radiol. 2014;43(2):197-204.
33. Haridas H, Mohan A, Papisetti S, Ealla KK. Computed tomography: will the slices reveal the truth. J Int Soc Prev Community Dent. 2016;6(Suppl 2):S85-92.
34. Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc. 2006;72(1):75-80.
35. Tyndall DA, Brooks SL. Selection criteria for dental implant site imaging: a position paper of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(5):630-7.
36. Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J. 2007;40(10):818-30.
37. Chaudhry A, Sobti G. Imaging characteristics of gubernacular tract on CBCT – a pictorial review. Oral Radiol. 2021;37(3):355-65.
38. Oda M, Nishida I, Habu M, Takahashi O, Tsurushima H, Otani T, et al. Overview of radiological studies on visualization of gubernaculum tracts of permanent teeth. J Clin Med. 2021;10(14):3054.
39. Elsayed LK, El Khateeb SM, Alzahrani SA, Al SS, Ba-Hattab R. Case report: an association of the gubernacular canal, supernumerary tooth and odontoma with an impacted canine on cone-beam computed tomography. F1000Res. 2020;9:1204.
40. Chaudhry A, Sobti G. Visualization of gubernacular tract of transmigrated canine on CBCT. J Evol Med Dent Sci. 2019;8(45):3637-41.
41. Oda M, Nishida I, Miyamoto I, Habu M, Yoshiga D, Kodama M, et al. Characteristics of the gubernaculum tracts in mesiodens and maxillary anterior teeth with delayed eruption on MDCT and CBCT. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(4):511-6.
42. Nishida I, Oda M, Tanaka T, Kito S, Seta Y, Yada N, et al. Detection and imaging characteristics of the gubernacular tract in children on cone beam and multidetector computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120(2):e109-17.
43. Wood NK, Goaz PW. Differential diagnosis of oral and maxillofacial lesions. 5th ed. St Louis: Mosby; 1997. p. 137-42.
44. Siotou K, Kouskouki MP, Christopoulou I, Tsolakis AI, Tsolakis IA. Frequency and local etiological factors of impaction of permanent teeth among 1400 patients in a Greek population. Dent J (Basel). 2022;10(8):150.
45. Betts A, Camilleri GE. A review of 47 cases of unerupted maxillary incisors. Int J Paediatr Dent. 1999;9(4):285-92.
2. Cerqueira TS, Correia KVD. Study and evaluation of the gubernacular canal by means of cone beam computed tomography. Stomatologija. 2020;22(3):86-91.
3. Cahill DR. Histological changes in the bony crypt and gubernacular canal of erupting permanent premolars during deciduous premolar exfoliation in beagles. J Dent Res. 1974;53(4):786-91.
4. Oda M, Nishida I, Habu M, Takahashi O, Tabe S, Tsurushima H, et al. Imaging peculiarities of gubernaculum tracts in molars as accessional teeth on CT. Clin Exp Dent Res. 2021;7(6):1205-14.
5. Zengin AZ, Rizeli L, Sumer AP. Detection and characteristics of the gubernacular tract in supernumerary teeth on cone beam computed tomography. Oral Radiol. 2023;39(2):292-300.
6. Oda M, Miyamoto I, Nishida I, Tanaka T, Kito S, Seta Y, et al. A spatial association between odontomas and the gubernaculum tracts. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121(1):91-5.
7. Koc N, Boyacioglu Dogru H, Cagirankaya LB, Dural S, van der Stelt PF. CBCT assessment of gubernacular canals in relation to eruption disturbance and pathologic condition associated with impacted/unerupted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019;127(2):175-84.
8. Kamarthi N, Gupta D, Gotur SP. Radiographic demonstration of association of gubernaculum dentis (gubernaculum tract) in odontogenic cysts and tumors – a CBCT finding. Indian J Radiol Imaging. 2020;30(3):340-3.
9. Gaeta-Araujo H, da Silva MB, Tirapelli C, Freitas DQ, de Oliveira-Santos C. Detection of the gubernacular canal and its attachment to the dental follicle may indicate an abnormal eruption status. Angle Orthod. 2019;89(5):781-7.
10. Al-Abdallah M, AlHadidi A, Hammad M, Dar-Odeh N. What factors affect the severity of permanent tooth impaction? BMC Oral Health. 2018;18(1):184.
11. Ten Cate AR. Oral histology: development, structure, and function. 5th ed. St. Louis: Mosby; 1998.
12. Marks SC Jr, Cahill DR. Experimental study in the dog of the non-active role of the tooth in the eruptive process. Arch Oral Biol. 1984;29(4):311-22.
13. Van Hassel HJ, McMinn RG. Pressure differential favouring tooth eruption in the dog. Arch Oral Biol. 1972;17(1):183-90.
14. Craddock HL, Youngson CC. Eruptive tooth movement – the current state of knowledge. Br Dent J. 2004;197(7):385-91.
15. Becktor KB, Nolting D, Becktor JP, Kjaer I. Immunohistochemical localization of epithelial rests of Malassez in human periodontal membrane. Eur J Orthod. 2007;29(4):350-3.
16. Rabea AA. Recent advances in understanding theories of eruption (evidence based review article). Future Dental Journal. 2018;4(2):189-96.
17. Kaczor-Urbanowicz K, Zadurska M, Czochrowska E. Impacted teeth: an interdisciplinary perspective. Adv Clin Exp Med. 2016;25(3):575-85.
18. Chu FC, Li TK, Lui VK, Newsome PR, Chow RL, Cheung LK. Prevalence of impacted teeth and associated pathologies – a radiographic study of the Hong Kong Chinese population. Hong Kong Med J. 2003;9(3):158-63.
19. Wolf J, Dym H. Office-based procedures for unusual impactions. Atlas Oral Maxillofac Surg Clin North Am. 2013;21(2):211-20.
20. Shiller WR. Positional changes in mesio-angular impacted mandibular third molars during a year. J Am Dent Assoc. 1979;99(3):460-4.
21. Frank CA. Treatment options for impacted teeth. J Am Dent Assoc. 2000;131(5):623-32.
22. Polat HB, Ozan F, Kara I, Ozdemir H, Ay S. Prevalence of commonly found pathoses associated with mandibular impacted third molars based on panoramic radiographs in Turkish population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(6):e41-7.
23. Raghoebar GM, Boering G, Vissink A, Stegenga B. Eruption disturbances of permanent molars: a review. J Oral Pathol Med. 1991;20(4):159-63.
24. Sajnani AK. Permanent maxillary canines – review of eruption pattern and local etiological factors leading to impaction. J Investig Clin Dent. 2015;6(1):1-7.
25. Palma C, Coelho A, Gonzalez Y, Cahuana A. Failure of eruption of first and second permanent molars. J Clin Pediatr Dent. 2003;27(3):239-45.
26. Isola G, Cicciù M, Fiorillo L, Matarese G. Association between odontoma and impacted teeth. J Craniofac Surg. 2017;28(3):755-8.
27. Van Buggenhout G, Bailleul-Forestier I. Mesiodens. Eur J Med Genet. 2008;51(2):178-81.
28. Russell KA, Folwarczna MA. Mesiodens – diagnosis and management of a common supernumerary tooth. J Can Dent Assoc. 2003;69(6):362-6.
29. Flores MA-OX, Onetto JA-O. How does orofacial trauma in children affect the developing dentition? Long-term treatment and associated complications. Dent Traumatol. 2019;35(4-5):256-64.
30. Posadzy M, Desimpel J, Vanhoenacker F. Cone beam CT of the musculoskeletal system: clinical applications. Insights Imaging. 2018;9(1):35-45.
31. Scarfe WC, Farman AG. What is cone-beam CT and how does it work? Dent Clin North Am. 2008;52(4):707-30.
32. Klintstrom E, Smedby O, Moreno R, Brismar TB. Trabecular bone structure parameters from 3D image processing of clinical multi-slice and cone-beam computed tomography data. Skeletal Radiol. 2014;43(2):197-204.
33. Haridas H, Mohan A, Papisetti S, Ealla KK. Computed tomography: will the slices reveal the truth. J Int Soc Prev Community Dent. 2016;6(Suppl 2):S85-92.
34. Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc. 2006;72(1):75-80.
35. Tyndall DA, Brooks SL. Selection criteria for dental implant site imaging: a position paper of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(5):630-7.
36. Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J. 2007;40(10):818-30.
37. Chaudhry A, Sobti G. Imaging characteristics of gubernacular tract on CBCT – a pictorial review. Oral Radiol. 2021;37(3):355-65.
38. Oda M, Nishida I, Habu M, Takahashi O, Tsurushima H, Otani T, et al. Overview of radiological studies on visualization of gubernaculum tracts of permanent teeth. J Clin Med. 2021;10(14):3054.
39. Elsayed LK, El Khateeb SM, Alzahrani SA, Al SS, Ba-Hattab R. Case report: an association of the gubernacular canal, supernumerary tooth and odontoma with an impacted canine on cone-beam computed tomography. F1000Res. 2020;9:1204.
40. Chaudhry A, Sobti G. Visualization of gubernacular tract of transmigrated canine on CBCT. J Evol Med Dent Sci. 2019;8(45):3637-41.
41. Oda M, Nishida I, Miyamoto I, Habu M, Yoshiga D, Kodama M, et al. Characteristics of the gubernaculum tracts in mesiodens and maxillary anterior teeth with delayed eruption on MDCT and CBCT. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(4):511-6.
42. Nishida I, Oda M, Tanaka T, Kito S, Seta Y, Yada N, et al. Detection and imaging characteristics of the gubernacular tract in children on cone beam and multidetector computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120(2):e109-17.
43. Wood NK, Goaz PW. Differential diagnosis of oral and maxillofacial lesions. 5th ed. St Louis: Mosby; 1997. p. 137-42.
44. Siotou K, Kouskouki MP, Christopoulou I, Tsolakis AI, Tsolakis IA. Frequency and local etiological factors of impaction of permanent teeth among 1400 patients in a Greek population. Dent J (Basel). 2022;10(8):150.
45. Betts A, Camilleri GE. A review of 47 cases of unerupted maxillary incisors. Int J Paediatr Dent. 1999;9(4):285-92.
| Files | ||
| Issue | Vol 12, No 4 (Autumn 2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Cone-beam computed tomography; Tooth; Impacted; Tooth eruption; Gubernaculum dentis; Dental follicle. | ||
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How to Cite
1.
Mortazavi S, Imanimoghaddam M, Delkhosh A, Kordi Karimabadi A, Poorebrahim T. Radiographic Features of the Gubernaculum Tract in Impacted Teeth. J Craniomaxillofac Res. 2026;12(4):254-260.
