Palatal Root Research Articles

Relationship between crown and root canal anatomy of four-rooted maxillary molar teeth.

This study aimed to determine the prevalence of four-rooted teeth and the corresponding crown, root and canal morphology in maxillary molars. Cone-beam computed tomographic images for 1200 patients were examined, and 1799 maxillary first molar (MFM) and 2123 maxillary second molar (MSM) teeth were evaluated. Statistical analyses were performed at a 5% significance level. Only three MFMs (0.17%) and 30 maxillary MSMs (1.41%) were four-rooted. The most common four-root type was the double palatal root. A higher proportion of four-rooted teeth were observed in men (P<0.05), and a high percentage of root fusion was seen in these teeth. The palatal half of the crown was wider in teeth with double palatal roots. Although rarely encountered, the diagnosis and proper treatment of these teeth are very important for endodontic success.

Effect of Alternative Palatal Root Access Technique on Fracture Resistance of Root Canal Treated Maxillary Fourth Premolar Teeth in Dogs.

A biomechanical study was performed to identify the effect of different treatment methods for difficult to instrument palatal roots on the fracture resistance of root canal treated maxillary fourth premolar teeth in dogs. Forty maxillary fourth premolar teeth with surrounding alveolar bone were harvested from beagle cadavers. Inclusion criteria included maxillary fourth premolars with no evidence of disease and similar distal root canal volumes on radiographic evaluation. The teeth were randomly divided into a control group and three treatment groups based on the endodontic treatment technique for the palatal root. The control group had a single 2 mm transcoronal access on the mesiobuccal aspect of the tooth to allow instrumentation of both the mesiobuccal and palatal root through a single small access. Alternative treatment modalities that are described for difficult to instrument palatal roots investigated in this study included enlarging the transcoronal mesiobuccal access to 4 mm, making an additional access directly over the palatal root (2 mm), and hemisection with extraction of the palatal root. All teeth had the same distal root access size (2 mm) and relative location. After access, all teeth were filed, shaped, obturated, and restored in the same fashion. Axial compression testing was performed at an angle of 60 degrees to the long axis of the tooth using a universal materials testing machine. The maximum force prior to fracture was determined for each tooth based on a force vs. deflection curve. The mean maximum force prior to fracture for all teeth was 831 N. No significant difference in mean fracture resistance was identified between the control group and treatment groups or between the different treatment groups themselves. Thus, when faced with a difficult to instrument palatal root, the treatment method chosen should be based on operator preference and experience.

Prevalence of Apical Periodontitis by Cone Beam Computed Tomography: A Cross Sectional Study

Objective: This study aimed to assess the prevalence of apical periodontics (AP) from a sample of Iraqi adult population by using cone beam computed tomography (CBCT) images. Methods: Two hundred and fifty-one CBCT images (116 male and 135 female) were obtained, 6738 teeth were examined of these patients who attended for dental treatment from January 2017 to June 2018 in the B&amp;R private dental clinic in Sulaimani, Kurdistan region/Iraq. Apical periodontitis was divided according to tooth types (anatomical) in both upper and lower jaw, root canal treatment (RCT) and non-root canal treatment (Non-RCT), affected root by AP, and quality of RCT. Pearson’s chi-square test was used to determine the level of significance (p&lt;0.05). Results: Apical periodontitis was found in 294 teeth from 6738 examined teeth, of these, 59.9% of AP incidence was linked to RCT. The percentage of periapical lesions was not significantly different between male and female patients. Among RCT teeth, maxillary teeth were found to be most susceptible to AP (61.92%) compared to mandibular teeth (38.07%). Mesiobuccal root of upper first molar and mesial root of lower first molar were most commonly affected with AP (12.4%). The most reported defects where under filling, followed by missed canal, and pulpotomy which were 32%, 20% and 18 % respectively. Missed upper second mesiobuccal canal presented with a higher percentage of AP (40.6%) and palatal roots of maxillary molars showed the least AP (2.7%). Conclusions: The prevalence of AP was low on population level; however, the prevalence of AP was high in inadequate endodontically treated teeth and increased in teeth with complex anatomy.

Autotransplantation of third molar for oro-antral communication closure: case report with evidence of sinus elevation after healing

Background Oro-antral communication is a complication due to the extraction of the posterior teeth of the upper arch. Small lesions are able to spontaneously close, but larger diameter lesions require a surgical treatment. Methods A compromised upper first molar had to be extract determining an oro-antral communication (OAC). Several techniques have been described for the management of OACs, but none of these techniques guarantees bone healing or immediate rehabilitation. In the case of the present report an autotransplantation of the ipsilateral third molar was performed for closing the communication and rehabilitate the extracted tooth. Results The transplantation of the third molar determined the immediate closure of the oroantral communication without resorting to more invasive surgical procedures. The 1,5 years follow up showed the bone healing and the complete oro-antral communication closure. During healing, the palatal root, that was invading the sinus, caused a vertical bone augmentation making a sinus lifting. Conclusions When a donor tooth is available, the autogenous transplantation could be used to manage the closure of oro-antral communication due to its high regenerative potential.

Targeted Endodontic Microsurgery: Implications of the Greater Palatine Artery

IntroductionTargeted Endodontic Microsurgery (TEMS) combines trephine burs and 3D-printed guides to make flapless maxillary palatal root-end surgery possible. This study assessed the location of the greater palatine artery (GPA), the relationship of the GPA to maxillary molar root ends, and the feasibility of flapless palatal-approach TEMS. MethodsThree endodontists analyzed 250 cone-beam computed tomographic images of maxillary molars for (1) transition morphology between the hard palate and the alveolar process adjacent to first and second molars as an indication of the most likely location of the GPA, (2) the superior-inferior relationship between the GPA and root ends, and (3) the feasibility of palatal-approach TEMS. ResultsPalatal transition morphology included 20% Spine, 72% Bridge, and 8% Smooth. GPA position as related to palatal root ends was classified as 34% superior, 40% adjacent, and 21% inferior. Five percent of classifications were undefined. TEMS was deemed feasible for 47% of maxillary first molars and 52% of second molars, and was significantly more feasible with GPAs superior to palatal root ends. Reasons for infeasibility included GPA proximity and unfavorable resection angle or level. Maxillary first molar palatal roots were 11.13 ± 2.68 mm from the greater palatine foramen (GPF) and 2.37 ± 1.46 mm from the GPA. Second molar palatal roots were 4.94 ± 2.55 mm from the GPF and 2.53 ± 1.77 mm from the GPA. ConclusionsPalatal transition morphology and GPA position adjacent to maxillary molars, as manifested in cone-beam computed tomographic coronal views, suggested maxillary palatal root TEMS could be accomplished with a 2-mm safety margin in 47% of first molars and 52% of second molars. Historical paradigms that do not consider flapless palatal surgical approaches may need to be revised.

Preserving the Neurovascular Bundle in Targeted Endodontic Microsurgery: A Case Series

Endodontic microsurgery encompasses the use of microscopy, specialized instruments, and advanced imaging with cone-beam computed tomographic (CBCT) imaging. This treatment modality results in high clinical success rates and facilitates the enucleation of osteolytic lesions, the resection of apical root canal complexities harboring persistent bacterial biofilms, and the evaluation of possible root defects and fractures. However, there is the risk of injury to important anatomic structures, particularly when treating posterior teeth. Neurovascular bundles are among these structures at risk for injury. Fortunately, high-resolution CBCT scans can be used to detect these structures that are known to have a high anatomic variability. In addition, CBCT information can be combined with high-resolution intraoral scans to plan, design, and fabricate surgical guides to be used in a targeted endodontic microsurgery (TEMS) approach. We report 3 cases with previous endodontic treatment having persistent apical periodontitis that were treated with TEMS to avoid damage to the neurovascular bundles at risk of injury. In the first case, the palatal root of tooth #14 was adjacent to the greater palatine artery. In the second case, the mental nerve exited through 2 separate foramina close to the predictive osteotomy site for the mesial root of tooth #19. In the third case, the posterior superior alveolar artery was in close proximity to the mesiobuccal root of tooth #14. Collectively, these cases illustrate the diagnostic value of CBCT imaging for detecting neurovascular bundles and the use of TEMS to mitigate the risk of injury to these important structures. Thus, the combination of CBCT imaging and TEMS can potentially minimize the risk of intraoperative complications and postoperative sequelae while increasing the predictability of endodontic microsurgeries in complex cases.

A 3D finite element analysis of maxillary molar distalization using unilateral zygoma gear and asymmetric headgear.

The aims of this study were (a) to evaluate the displacement and stress distribution in the maxillary dentition associated with the use of two different unilateral distalization appliances-unilateral zygoma gear (UZG) appliance and asymmetric headgear (AHG)-in non-growing patients; and (b) to assess the effects of fully erupted maxillary third molars on the distalization of the first molar with both appliances by using three-dimensional finite element analysis. Two 3D models of the maxilla were created: one with third molars and one without. Next, two distalizing appliances (UZG and AHG) were added to each model to create four models. Distalization forces were applied, and the resultant displacements were recorded at the mesiobuccal and distolingual cusps and palatal root apex of each molar and the incisal edge root apex of the central incisors. The resulting von Mises stress distributions were evaluated. With the UZG, the first molar showed greater root distalization than the crown in the model with the third molar, whereas the model without the third molar showed distalization and distal tipping of the first molar. With the AHG, the first molar showed a large amount of distal tipping in the model without a third molar. However, this tipping was less than that in the model with third molars. The presence of completely erupted third molars decreased the amount of uncontrolled distal tipping in both appliances. UZG can be considered as an effective option for maxillary molar distalization.

Selective Retreatment and Sinus Lift: An Alternative Approach to Surgically Manage the Palatal Roots of Maxillary Molars

Endodontic microsurgery on the palatal root of maxillary molars presents a clinical challenge because of the root position and approximation from the maxillary sinus floor. Attempting a buccal or a palatal approach to address the root is associated with limited accessibility and visibility as well as the risk of injury to the maxillary sinus membrane and/or the greater palatine nerves and vessels. If all the maxillary molar roots require surgical intervention, two flaps may even be needed, which can make the procedure technically more difficult and lengthier. This case report presents 2 clinical cases in which apicoectomy was needed on the palatal roots of maxillary molars. The treatment includes selective nonsurgical retreatment of the palatal root and obturation using a root repair material followed by a surgical intervention from a buccal approach to treat the buccal roots, sinus lift using piezosurgery, and root resection of the palatal root. The approach was successful in both cases without any untoward events. We monitored the radiographic changes using cone-beam computed tomographic imaging immediately after the surgery and at multiple follow-up appointments. The cone-beam computed tomographic images revealed healing of the periapical disease around all the roots up to 14 and 24 months and apical repositioning of the maxillary sinus floor.

Alveolar bone response to maxillary incisor retraction using stable skeletal structures as a reference.

To evaluate alveolar bone change in relation to root position change after maxillary incisor retraction via cone-beam computed tomography (CBCT) using stable skeletal structures as a reference. A total of 17 subjects (age 24.7 ± 4.4 years) who required retraction of the maxillary incisors were included. Labial and palatal alveolar bone changes and root change were assessed from preretraction and 3 months postretraction CBCT images. The reference planes were based on stable skeletal structures. The Kruskal-Wallis test and Wilcoxon signed-rank test were used to compare changes within and between groups, as appropriate. Spearman rank correlations were used to identify the parameters that correlated with alveolar bone change. The significance level was set at .05. The labial alveolar bone change after maxillary incisor retraction was statistically significant (P < .05), and the bone remodeling/tooth movement (B/T) ratio was 1:1. However, the palatal bone remained unchanged (P > .05). The change in inclination was significantly related to labial alveolar bone change. Using stable skeletal structures as a reference, the change in labial alveolar bone followed tooth movement in an almost 1:1 B/T ratio. Palatal alveolar bone did not remodel following maxillary incisor retraction. The change in inclination was associated with alveolar bone change.

Root Canal Treatment of the Maxillary Second Molar with an Root Canal Treatment of the Maxillary Second Molar with an Unusual Morphology: A Case Report Unusual Morphology: A Case Report

Four rooted maxillary second molar is a rare condition. A research of 1,200 maxillary second molars found only 0.4% of the sample with this condition. In a tooth with two palatal roots, one of them is the normal palatal root, while the other is a supernumerary structure which can be found mesiolingually (radix mesiolingualis) or distolingually (radix distolingualis). Objective: to describes a successful root canal treatment of a maxillary second molar with radix mesiolingualis. Final restoration using a short fiber-reinforced composite as the bottom structure under the onlay composite direct restoration. Case report: A 39-year old female patient complained of pain continuously for the past two weeks in her right maxillary second molar (tooth #17). Clinical examination revealed a deep mesioocclusal caries lesion and presence of extra cusps on the palatal surface of the crown. Conclusion: Crown with extra cusps relatively larger compared to a normal crown. It could be indicated the additional palatal roots. Those variations could be identified by clinical and radiographic examination, while more accurate assessment with CBCT imaging. The right material was required to support function and strengthen the tooth after root canal treatment.

A CBCT BASED DIGITAL ANALYSIS OF SHAPING ABILITY OF MAX WIRE®ALLOY FILE IN THE TREATMENT OF LARGE AND CURVED ROOT CANALS

Aim: To evaluate the limits of the shaping ability of MaxWire® alloy file in the treatment of pre-created large and curved root canals with different apical sizes by using cone-beam computed tomography (CBCT). Materials and methods: Forty-five permanent maxillary first molars with moderately curved palatal roots (20°-30°) were divided into three groups, and large root canals were created with apical diameter #35 (Group 1), #40 (Group 2) or #50 (Group 3) by using BioRace NiTi System. Then, they were reshaped with the MaxWire alloy file, XP-endo Shaper®. Canals were scanned before and after instrumentation by using the CBCT scanner. Canal transportation (CT), centering ratio (CR), % increased prepared area (PA), and % increased prepared outline (PO) at 2, 3, and 4 mm from the apex were calculated. Data were statistically analyzed at P < 0.05. Results: There was a significant difference in the mean increase in PO in all apical sizes and all three levels. At both 3 mm and 4 mm levels the maximum PA and PO were achieved in apical size 35, while at 2 mm level the maximum values were obtained in apical size 40. There was no statistically significant difference in CT and CR within groups at 2 mm distance from the apex. Conclusion: Max Wire alloy technology of this novel instrument makes it possible to clean and touch the dentin walls of large and curved root canals. Small FOV and small voxel size of CBCT could also be used in shaping ability studies in endodontics.

Effect of Fiber Posts on Stress Distribution of Endodontically Treated Upper Premolars: Finite Element Analysis.

By means of a finite element method (FEM), the present study evaluated the effect of fiber post (FP) placement on the stress distribution occurring in endodontically treated upper first premolars (UFPs) with mesial–occlusal–distal (MOD) nanohybrid composite restorations under subcritical static load. FEM models were created to simulate four different clinical situations involving endodontically treated UFPs with MOD cavities restored with one of the following: composite resin; composite and one FP in the palatal root; composite and one FP in the buccal root; or composite and two FPs. As control, the model of an intact UFP was included. A simulated load of 150 N was applied. Stress distribution was observed on each model surface, on the mid buccal–palatal plane, and on two horizontal planes (at cervical and root-furcation levels); the maximum Von Mises stress values were calculated. All analyses were replicated three times, using the mechanical parameters from three different nanohybrid resin composite restorative materials. In the presence of FPs, the maximum stress values recorded on dentin (in cervical and root-furcation areas) appeared slightly reduced, compared to the endodontically treated tooth restored with no post; in the same areas, the overall Von Mises maps revealed more favorable stress distributions. FPs in maxillary premolars with MOD cavities can lead to a positive redistribution of potentially dangerous stress concentrations away from the cervical and the root-furcation dentin.

Endodontic management in a rare variant of maxillary third molar with two palatal roots and root canals: a case report

The maxillary molars especially the third molars have the most complicated root canal system in permanent dentition There are many variations in root canal number system and configuration in maxillary molars It is imperative and paramount for the clinician to seek out every possible aberration of root canal anatomy for all teeth undergoing treatment This paper relates a case of a maxillary right third molar with a canal configuration rarely reported in the literature The tooth had four roots with four root canals two separate palatal roots mesiopalatal and distopalatal with their own distinct canals and orifices The mesiobuccal and distobuccal roots had normal anatomy This paper escalates the complexity of maxillary molar variation and is intended to brace clinician rsquo s awareness of the rare morphology of root canal system

Evaluation of the Relationship Between Maxillary Sinus Wall and Maxillary Canines and Posterior Teeth Using Cone-Beam Computed Tomography

BackgroundThe proximity between the maxillary sinus and dental roots may impede orthodontic tooth movement. This study aimed to explore the relationship between the maxillary sinus wall (MSW) and maxillary canines and posterior teeth using cone-beam computed tomography (CBCT).Material/MethodsCBCT images (317) were examined for whether the mesial, distal, buccal, and palatal surfaces of the examined root contacted the MSW, and the contact distance of each root surface with the MSW was measured. The effects of age and sex were analyzed using logistic regression and linear regression analyses.ResultsThe highest contact ratios with the MSW (ranging from 62.0% to 73.2%) were observed at the palatal root surfaces of the first molar mesiobuccal and distobuccal roots (1M MB and DB), the buccal root surface of the first molar palatal roots (1M P), and the mesial and buccal root surfaces of the second molars (2M), followed by the distal root surface of the second premolars (2PM) and the mesial root surfaces of the 1M MB and P (ranging from 49.2% to 59.3%). At these root surfaces, the contact ratios decreased with age (P<0.05), but the lowest still reached a range of 29.4% to 57.9% in the 30- to 47-year-old group.ConclusionsThe 2PM distal root surface, the 1M MB mesial and palatal root surfaces, the 1M DB palatal root surface, and the 1M P and 2M mesial and buccal root surfaces most frequently contacted the MSW. Clinicians should observe the contact of root surfaces with the MSW, even in aged patients.

Evaluation of the Cleaning Efficiency of 2 Shape, Hyflex EDM and Pro Taper GOLD Systems Using Digital Image Morphometric Analysis (An in Vitro Study)

Aim of the Study: To measure and compare the cleaning efficiency of 2 Shape, Hyflex EDM and Protaper GOLD rotary systems in removing debris and compare the percentage of remaining debris at three different levels of root canal by using digital image morphometric analysis. Material and Method: Total 60 freshly extracted human maxillary first molar with single straight palatal roots were selected were disinfected in a solution of 1% Thymol for 1 day then the palatal roots were sectioned at a length of 12 mm from the apex and randomly divided into three groups of twenty teeth : Group A: Was prepared by 2 Shape file system (Full rotary technique). Group B: Was prepared by Hyflex EDM file system (Full rotary technique). Group C: Was prepared by Protaper GOLD system (Full rotary technique) . All systems were used according to the manufacture instructions and roots prepared to an apical preparation corresponding to size 40 K-file. Sodium hypochlorite (3%) was used as an irrigant for all groups. Conclusions: 2 Shape system was significantly less effective than Hyflex EDM and Protaper GOLD systems in eliminating debris from root canals at all levels. There were no differences in the cleaning efficiency between Hyflex EDM and Protaper GOLD systems at all levels of root canals.

Mucosal Fenestration After 2% Chlorhexidine Extrusion Used in Substitution of Sodium Hypochlorite: A Case Report

This report describes a case of sodium hypochlorite (NaOCl) and chlorhexidine (CHX) extrusion through the apical foramen, causing acute pain, swelling and mucosal fenestration. A 62-year-old woman was referred for endodontic treatment in the first left maxillary premolar with a diagnosis of necrotic pulp. After the root canal irrigation with 2.5% NaOCl, the patient felt a burning sensation and pain. Discrete swelling and redness were noted in the patient’s face at the end of the session. Antibiotic and corticosteroids were prescribed. In the next appointment, 2% CHX was used, but another episode of extrusion occurred, with a sudden acute pain and intense swelling within a few minutes after the injection. After 2 weeks, the patient exhibited a left-side facial swelling extending anterior and inferior to the left zygomatic arch and superior to the body of the mandible. Oral antibiotic and anti-inflammatory drugs were administered. After 10 days, the swelling had completely diminished, but a mucosal fenestration and tooth mobility were verified. A cone beam CT was requested and showed a periapical lesion involving both buccal and palatal roots. After a prosthetic evaluation, the tooth extraction was indicated. One week after tooth removal, the mucosa was completely healed.

Antibacterial effect of a hyperosmotic solution containing sorbate and ethanol on Enterococcus faecalis in planktonic form and as biofilm: an in vitro study

The antibacterial effect of a hyperosmotic solution containing sorbate and ethanol on E. faecalis in planktonic state and in biofilm was evaluated. Three hyperosmotic solutions (HS-A, HS-B y HS-C) were obtained from different formulations of potassium sorbate and sodium chloride, which were tested as antimicrobials against planktonic forms of E. faecalis, in McFarland standards from 0.5 to 7, using the sedimentation technique and colony forming units (CFU) count. Afterwards an E. faecalis biofilm was produced in the palatal roots of upper first molars, by a static method in 21 days; subsequently they were prepared biomechanically by the Universal Protaper system, using the hyperosmotic solution B as an irrigant to evaluate the bacterial load reduction. One pre-instrumentation sample and one post-instrumentation sample were taken, and then were processed and cultivated to count CFU. Consecutively, roots were observed by scanning electron microscopy. The hyperosmotic solution had an important antibacterial effect when used against E. faecalis in planktonic state; solutions HS-A and HS-B were effective in eliminating E. faecalis up to 7 McFarland, while a statistical difference (p˂0.001) was observed in reducing the bacterial load in the biofilm, based on the log10 CFU count. The final solution tested seemed not to harm the dentinal structure and was capable of causing morphological changes to the bacterial cell consistent with a hyperosmotic shock. Thus, the solutions tested could be an option to be considered as irrigating agents; nonetheless further research is required regarding its biocompatibility.

Controlling incisor torque with completely customized lingual appliances.

PurposeTo test the null hypothesis of no significant deviation between the center of rotation (CROT) and the center of resistance (CRES) during space closure in Angle class II division 2 subjects achieved using a completely customized lingual appliance (CCLA) in combination with class II elastics and elastic chains.MethodsThis retrospective study included 29 patients (male/female 11/18; mean age 15.6 [13–27] years) with inclusion criteria of an Angle class II/2 occlusion of least of half of a cusp, maxillary dental arch spacing, completed CCLA treatment (WIN, DW Lingual Systems, Bad Essen, Germany) in one center with a standardized archwire sequence and use of class II elastics and elastic chains only. Maxillary incisor root inclination was assessed by X‑ray superimpositions of the maxilla at the beginning (T1) and the end (T3) of CCLA treatment. Using Keynote software (Apple®, Cupertino, CA, USA), the incisor’s CROT was assessed with the point of intersection of the incisor axes (T1; T3) following vertical correction of overbite changes. CRES was defined at 36% of the incisor’s apex–incisal edge distance.ResultsThe null hypothesis was rejected: the mean CROT − CRES difference was 52.6% (p < 0.001). The mean CROT was located at 88.6% (min–max 51–100%) of the incisor’s apex–incisal edge distance. Although 6.9% of CROT were located between the CRES and the alveolar crest, the vast majority (93.1%) were assessed between the alveolar crest and the incisal edge, or beyond.ConclusionCCLAs can create upper incisor palatal root torque even in cases in which lingually oriented forces applied incisally to the center of resistance of the upper incisors counteract these intended root movements.

Microcomputed tomography evaluation of contamination with endodontic obturation material remnants in teeth with different root canal anatomy after post space preparation

Statement of problemWhether the amount of the endodontic obturation material remnants in a root canal prepared for a post is related to variations in the anatomic shape of the canal or whether it varies in different parts of the post space is unclear. PurposeThe purpose of this in vitro study was to estimate the extent of root canal contamination with remnants of the obturation material after post space preparation in relation to the anatomic shape of the root canals by means of microcomputed tomography. Material and methodsFifty freshly extracted teeth were divided into 5 test groups with respect to the root anatomy of different tooth types. The root canals were shaped and obturated with gutta percha. The space for the glass fiber post was prepared with standardized drills, and all specimens were scanned by microcomputed tomography. The areas of residual obturation material on the root canal walls in the coronal and apical parts of the prepared post space were estimated by using a 3D visualization software program. Parametric and nonparametric dispersive analysis (analysis of variance and Kruskal-Wallis) and Wilcoxon tests were used for statistical data evaluation (α=.05). ResultsThe estimates of the root canal surface areas contaminated with residual obturation material after post space preparation were significantly larger in premolars (P≤.01), as compared with mandibular incisors and with the palatal roots of maxillary first molars. The contamination areas in different parts of the root canal (apical and coronal) reported significant differences within and between the test groups. ConclusionsThe extent of root canal contamination with remnants of endodontic obturation material after post space preparation was related to the anatomic shape of the roots and varied in the coronal and apical parts of the prepared post space.

Influence of the Intracanal Material and Metal Artifact Reduction Tool in the Detection of the Second Mesiobuccal Canal in Cone-beam Computed Tomographic Examinations

IntroductionThe aim of this study was to evaluate the influence of different intracanal materials and the metallic artifact reduction (MAR) tool of cone-beam computed tomographic (CBCT) imaging on the detection of the second mesiobuccal (MB2) canal in maxillary first molars. MethodsForty maxillary first molars were selected; half of them had the MB2 canal in the mesiobuccal root confirmed by micro–computed tomographic imaging. All teeth were instrumented, except for the MB2 canal, and filled with gutta-percha, which was passively inserted up to the working length. Each tooth was individually inserted into a dry human skull, and CBCT scans were performed using the OP300 device (Instrumentarium Dental, Tuusula, Finland) with and without the use of the MAR tool. For each scanned tooth, the following intracanal materials were used in the palatal root: gutta-percha, silver palladium, nickel chromium, and cobalt chromium. Five examiners assessed the images for the detection of the MB2 canal using a 5-point scale. The weighted kappa test was applied to evaluate intra- and interexaminer reproducibility. The diagnostic values (sensitivity, specificity, and area under the receiver operating characteristic curve) were calculated in the different groups and compared using 2-way analysis of variance and the Tukey post hoc test. ResultsThe intra- and interobserver agreement ranges for the different conditions were studied. The diagnostic values were not significantly different (P > .05) regardless of the intracanal material and the use of the MAR tool. ConclusionsThe presence of different intracanal materials and MAR activation does not influence CBCT-based detection of MB2 canals.