Canal gubernacular: papel no processo eruptivo, aspectos imaginológicos e associações com lesões patológicas

Abstract

The gubernacular canal (GC) is an anatomical structure that has received limited attention from dental professionals. It is hypothesized that this structure may play a critical role in the tooth eruption process by serving as a pathway for erupting teeth. It is posited that alterations in the GC could lead to disturbances in this process. Additionally, the GC has been found to be closely associated with certain odontogenic cysts and tumors, suggesting its potential involvement in the etiology of these lesions and its relevance as an ancillary factor in the diagnosis of related pathologies. The objective of this review was to compile and synthesize information regarding the imaging characteristics of the GC, its function in the eruption process, and its possible association with odontogenic lesions. A comprehensive search was conducted across the PubMed, Embase, Lilacs, and Scielo databases utilizing the keywords “gubernacular canal,” “gubernacular cord,” “gubernaculum dentis,” “gubernacular tract,” “gubernaculum tract,” “gubernaculum cord,” and “gubernaculum canal.” Two independent reviewers evaluated the titles, abstracts, and full texts. The initial search yielded 480 articles, of which 15 were included based on established eligibility criteria. Inclusion criteria encompassed case reports and scientific research without restrictions regarding publication year or language. Exclusion criteria consisted of articles with only abstracts available, studies lacking full texts, animal studies, bibliographic and systematic reviews, research not primarily focused on the characterization of the GC, and studies outside the scope of dentistry. The selected studies evaluated a total of 2,400 individuals and 4,812 teeth. Among the 15 articles, 14 utilized computed tomography, while 1 performed histological analysis. The prevalence of the GC in computed tomography scans ranged from 3.7% to 98.9%. Notably, the prevalence of the GC was higher in teeth exhibiting normal eruption patterns compared to those with eruption disorders. From the studies reviewed, it is evident that the GC is frequently underdiagnosed in two-dimensional imaging modalities, underscoring the significance of tomographic evaluation. When examining its relationship with tooth eruption, the GC was found to be more prevalent in teeth with normal eruption patterns than in impacted or delayed-erupting teeth. Furthermore, the GC is present in molars, indicating its existence beyond permanent teeth that have deciduous predecessors. In terms of its association with lesions, the GC appears to be a valuable asset in the differential diagnosis of odontogenic lesions, as it is predominantly associated with these conditions rather than with non-odontogenic lesions.