Dynamic spatial relationships between the greater palatine canal and dental landmarks across age and gender groups: A CBCT cohort study.

BACKGROUND: The relationship of the greater palatine canal (GPC) to dentoalveolar landmarks and how this relationship changes with demographic factors are of critical importance for surgical interventions. We aimed to evaluate the relationship between the GPC and maxillary molars using multiple dentoalveolar landmarks, and to investigate the influence of age, gender, and tooth type using cone-beam computed tomography (CBCT). STUDY DESIGN: A total of 1156 maxillary molars (649 first, 507 second) were analyzed. This CBCT-based cohort study included patients allocated to age groups: 18-35 years, 36-65 years, and >65 years. Distances between the GPC and the occlusal plane (OP-GPC), cementoenamel junction (CEJ-GPC), and root apices were measured. The horizontal relationship between GPC and apices (superior, adjacent, and inferior positions), as well as canal morphology, was assessed. Linear mixed-effects models, generalized estimating equations, and Pearson's chi-square were used. RESULTS: Second molars demonstrated significantly shorter OP-GPC, CEJ-GPC, and apex-GPC distances compared to first molars (p<0.05). Females exhibited reduced vertical distances (p<0.05). CEJ-GPC distances increased with age, while OP-GPC decreased with age (p<0.05). The superior position was more common in older age groups (p<0.05). GPC morphology remained stable across age and gender (p>0.05). CONCLUSIONS: The spatial relationship between the GPC and maxillary molars is dynamic rather than fixed, and varies systematically with age and gender. Second molars present reduced anatomical safety margins. The CEJ-GPC distance tended to be greater in those over 35 than in those under 35. This study highlights the importance of individualized, CBCT-supported assessment based on demographic factors to ensure safe surgical procedures.