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An ex vivo comparison of digital radiography and cone-beam and micro computed tomography in the detection of the number of canals in the mesiobuccal roots of maxillary molars. Domark Jeffrey D,Hatton John F,Benison Roxanne P,Hildebolt Charles F Journal of endodontics INTRODUCTION:The purpose of this study was to compare digital periapical and cone-beam computed tomography (CBCT) images to determine the number of canals in the mesiobuccal root of maxillary molars and to compare these counts with micro computed tomography (μCT), which was also used to determine canal configuration. METHODS:Digital periapical (RVG 6100), CBCT (9000 3D), and μCT images (the reference standard) were obtained of 18 hemi-maxillas. With periapical and CBCT images, 2 endodontists independently counted the number of canals in each molar and repeated the counts 2 weeks later. Teeth were extracted and scanned with μCT, and 2 additional endodontists, by consensus, determined the number and configuration of canals. The Friedman test was used to test for differences. RESULTS:In mesiobuccal roots, 2 canals were present in 100% of maxillary first molars (13 of 13) and 57% of second molars (8 of 14), and 69% (9 of 13) and 100% (8 of 8) of these exited as 2 or more foramina. There was no difference in canal counts for original and repeat reads by the 2 observers with periapical (P = .06) and with CBCT (P = .88) and no difference when CBCT counts were compared with μCT counts (P = .52); however, when periapical counts were compared with μCT counts, there was a significant difference (P = .04). CONCLUSIONS:For cadaver maxillary molars, μCT canal counts were significantly different from digital periapical radiograph counts but not different from Carestream9000 3D CBCT counts. 10.1016/j.joen.2013.01.010
Three root canals in the mesiobuccal root of maxillary molars: case reports and literature review. Ahmad Ibrahim Ali,Al-Jadaa Anas Journal of endodontics INTRODUCTION:The knowledge of root canal anatomy is essential to ensure a successful outcome of surgical and nonsurgical root canal treatment. The aims of this article were to present 2 cases of maxillary molars with 3 mesiobuccal root canals and to review the available literature on this anatomic variation. METHODS:The first case described a nonsurgical root canal treatment of tooth #16 in a 29-year-old man with the aid of a dental operating microscope. In the second case, an extracted maxillary right first molar was scanned by a micro-computed tomographic system and reconstructed 3-dimensionally using modeling software. RESULTS:In both cases, the mesiobuccal root had 3 canals (type 3-2 in case I and type 3-3 in case II), whereas the distobuccal and palatal roots had a single canal. The literature review showed that the overall incidence of 3-canaled mesiobuccal roots in maxillary molars ranged from 1.3%-2.4% and that the most common root canal configuration was type 3-2. CONCLUSIONS:Clinicians should always anticipate the presence of extra canals in maxillary molars and use all the available tools to locate and treat these. 10.1016/j.joen.2014.07.034
Symmetry of root and root canal morphology of maxillary and mandibular molars in a white population: a cone-beam computed tomography study in vivo. Plotino Gianluca,Tocci Luigi,Grande Nicola M,Testarelli Luca,Messineo Daniela,Ciotti Mario,Glassman Gary,D'ambrosio Ferdinando,Gambarini Gianluca Journal of endodontics INTRODUCTION:The aim of the present study was to use cone-beam computed tomography (CBCT) to analyze root canal anatomy and symmetry of maxillary and mandibular first and second molar teeth of a white population. METHODS:A total of 201 patients who required CBCT examinations as part of their dental diagnosis and treatment were enrolled in the present study. Overall, 596 healthy, untreated, well-developed maxillary and mandibular molar teeth (161 maxillary first molars, 157 maxillary second molars, 117 mandibular first molars, and 161 mandibular second molars) were examined by CBCT to establish the symmetry in root and canal anatomy between right and left sides in the same patient by evaluating the number of roots and root canals and the root canal configuration. RESULTS:Three separate roots with 3 separate canals was the normal anatomy of maxillary first and second molars. Most mandibular first and second molars had 2 separate roots, and the majority had 3 canals. In the present study, first molars, both maxillary and mandibular, exhibited greater asymmetry than the second molars. Maxillary first molars were found to be symmetrical in 71.1% of patients, whereas maxillary second molars were symmetrical in 79.6%. The remaining 28.9% and 20.4% of patients, respectively, showed asymmetry. Around 30% of the mandibular first molars and 20% of the mandibular second molars showed asymmetry. CONCLUSIONS:The results of the present study reported a percentage of symmetry that varied from 70%-81%. These variations in symmetry should be taken in high consideration when treating 2 opposite molars in the same patient, because their anatomy may be different in up to 30% of the cases. 10.1016/j.joen.2013.09.012
Evaluation of root canal configuration of maxillary molars in a Brazilian population using cone-beam computed tomographic imaging: an in vivo study. Silva Emmanuel João Nogueira Leal,Nejaim Yuri,Silva Amaro I V,Haiter-Neto Francisco,Zaia Alexandre A,Cohenca Nestor Journal of endodontics INTRODUCTION:The aim of this study was to analyze and characterize root canal morphology of maxillary molars of the Brazilian population using cone-beam computed tomographic (CBCT) imaging. METHODS:Patients referred for a CBCT radiographic examination for accurate diagnosis and treatment planning were enrolled in the study. A total of 620 healthy, untreated, fully developed maxillary first and second molars were included (314 first molars and 306 second molars). The following observations were recorded: (1) number of roots and their morphology, (2) number of canals per root, (3) fused roots, and (4) primary variations in the morphology of the root canal systems. RESULTS:First and second molars showed a higher prevalence of 3 separate roots, mesiobuccal, distobuccal, and palatal, with 1 canal in each root (52.87% and 45.09%, respectively). Two canals in the mesiobuccal roots represented 42.63% of teeth, whereas mesiobuccal roots of second molars presented 2 canals in 34.32%. The most common anatomic variation in the maxillary first molar was related to the root canal configuration of the mesiobuccal root, whereas the root canal system of the maxillary second molar teeth showed more anatomic variables. CONCLUSIONS:Mesiobuccal roots of maxillary molar teeth had more variation in their canal system than the distobuccal or palatal roots. The root canal configuration of the maxillary second molars was more variable than the first molars in a Brazilian population. CBCT imaging is a clinically useful tool for endodontic diagnosis and treatment planning. 10.1016/j.joen.2013.10.002
Prevalence Studies on Root Canal Anatomy Using Cone-beam Computed Tomographic Imaging: A Systematic Review. Martins Jorge N R,Marques Duarte,Silva Emmanuel João Nogueira Leal,Caramês João,Versiani Marco A Journal of endodontics INTRODUCTION:In the literature, several prevalence studies on root canal anatomy using cone-beam computed tomographic technology are currently available although their results remain disperse. This systematic review aimed to appraise and combine, under strict criteria conditions, selected prevalence studies in order to comprehend the distribution of root canal configuration types among different populations. METHODS:This systematic review was registered in PROSPERO. Six electronic databases were accessed, and the studies were selected according to a predefined inclusion/exclusion criteria. References of the collected studies and 3 peer-reviewed endodontic journals were hand searched. The authors of the selected studies were contacted for additional information. All eligible studies were submitted to a scientific merit evaluation by 2 evaluators independently, who also reached a final consensus for each study score using the Joanna Briggs Institute Critical Appraisal tool for prevalence studies. RESULTS:Fifty-two studies from 28 different countries including 102,610 teeth and presenting a Joanna Briggs Institute Critical Appraisal tool average score of 80.5% were included in this review. Overall, results showed a wide prevalence range of the second mesiobuccal canal in maxillary first and second molars but also a high prevalence of single-rooted configuration in maxillary first premolars and mandibular second molars and 3-rooted morphology in the mandibular first molar of Asian populations. CONCLUSIONS:The included studies showed a global tendency for a particular morphology in some groups of teeth, whereas others showed diversity in specific anatomic types among different populations. 10.1016/j.joen.2018.12.016
Evaluation of root and canal morphology of maxillary permanent first molars in a North American population by cone-beam computed tomography. Guo Jing,Vahidnia Arjang,Sedghizadeh Parish,Enciso Reyes Journal of endodontics INTRODUCTION:The purpose of this study was to evaluate the number of roots and canal morphology of maxillary permanent first molars in a North American population. METHODS:Three hundred seventeen cases with bilateral maxillary first molars were included. All images from cone-beam computed tomography were carefully reviewed by 2 endodontists. Frequency of number of roots, presence of an additional mesiobuccal canal (MB2), and Vertucci canal type for each root were tabulated. Age, gender, and ethnicity differences were calculated with the χ(2) test. The intra-rater reliability was assessed by using the Cohen kappa statistic. RESULTS:The fused root rate was 0.9%. The occurrence of 3-rooted maxillary first molars differed between left and right sides (P = .03). MB2 occurrence only showed statistically significant differences among age groups (P = .005). In the mesiobuccal roots, the most common Vertucci classifications of canal types were type IV (2-2, 41.9%), type I (1, 28.3%), and type II (2-1, 26.3%). There was a statistically significant difference in Vertucci classification of canal type among 5 ethnic groups (African American, Asian, Hispanic, Other, and Non-Hispanic white, P < .001). CONCLUSIONS:Cone-beam computed tomography facilitates the identification of root and canal configuration. The information gained about the tooth anatomy and canal morphology before treatment could potentially facilitate root canal therapy. 10.1016/j.joen.2014.02.002
Second canal in mesiobuccal root of maxillary molars is correlated with root third and patient age: a cone-beam computed tomographic study. Reis Adriana Gurgel de Araújo Rebouças,Grazziotin-Soares Renata,Barletta Fernando Branco,Fontanella Vania Regina Camargo,Mahl Celia Regina Winck Journal of endodontics INTRODUCTION:There is little evidence supporting the use of cone-beam computed tomographic (CBCT) scanning in root canal anatomy investigation. This study aimed to investigate the presence of second mesiobuccal canals (MB2) in different thirds of the mesiobuccal root of first and second maxillary molars using CBCT scanning and to correlate findings with patient sex and age. METHODS:A total of 100 male and female adult patients with healthy, untreated, well-developed maxillary molars were enrolled. A total of 343 teeth were analyzed in vivo using CBCT scanning: 79 right and 79 left maxillary first molars (1MR and 1ML) and 94 right and 91 left maxillary second molars (2MR and 2ML). Teeth with 3 roots were identified, and the presence of MB2 canals in different thirds was correlated with patient sex and age. RESULTS:Maxillary molars with 3 roots showed a high percentage of MB2 canals: 1MR, 86.1%; 1ML, 91.0%; 2MR, 87.5%; and 2ML, 79.3%. MB2 canals were less prevalent in the middle and apical thirds than in the coronal third. There were no significant associations between the overall presence of MB2 canals and patient sex. Older age (ie, 51-70 years) was associated with fewer canals in 1ML and 2ML. All age groups showed fewer MB2 canals in the apical versus the coronal third. CONCLUSIONS:The prevalence of MB2 canals decreases as the root canal approaches the apical third and as age increases. No association with sex was observed. CBCT scanning proved effective in mapping MB2 canals present in different thirds of the root. 10.1016/j.joen.2013.01.003
Root Canal Morphology and Configuration of 179 Maxillary First Molars by Means of Micro-computed Tomography: An Ex Vivo Study. Briseño-Marroquín Benjamín,Paqué Frank,Maier Karolin,Willershausen Brita,Wolf Thomas Gerhard Journal of endodontics INTRODUCTION:The objective of this study was to propose a root canal configuration description method and to investigate the root canal system morphology of the maxillary first molar by means of micro-computed tomographic imaging. METHODS:The root canal configuration, foramina, and accessory canal frequency of 179 maxillary first molars were investigated by means of micro-computed tomographic imaging and 3-dimensional software imaging. The root canal configuration and main foramina number are described from coronal to apical with a 4-digit system. RESULTS:The most frequent root canal configurations were 1-1-1/1 (45.8%), 2-2-2/2 (25.1%) and 2-2-1/1 (10.1%) in mesiobuccal roots and 1-1-1/1 in distobuccal (97.2%) and palatal (98.9%) roots. The first mesiobuccal (MB1) root canal had 1 accessory canal in 26.3% of the teeth, the distobuccal root canal had 12.3%, and the palatal root canal had 9.5%; in the second mesiobuccal root canal, there was rarely 1 accessory canal. There was 1 accessory canal in 26.3%, 12.3%, and 9.5% in the MB1, distobuccal, and palatal root canals, respectively. The MB1, distobuccal, and palatal root canals had 1 main foramen. The MB2 had 1 main foramen in 39.0% of the teeth and no main foramen in 61.0%. CONCLUSIONS:The root canal configuration of maxillary first molars is quite diversified. Contrary to our expectations in this research, the mesiobuccal root has predominantly 1 root canal entrance and only 1 main foramen. Anatomic variations including connecting and accessory canals occur in any third of root. 10.1016/j.joen.2015.09.007
Evaluation of the root and canal systems of maxillary molars in Taiwanese patients: A cone beam computed tomography study. Lin Yu-Hua,Lin Hsiu-Na,Chen Chien-Chih,Chen May-Show Biomedical journal BACKGROUND:This study evaluated variations in root canal configuration in the maxillary permanent molars of Taiwanese patients by analyzing patients' cone beam computed tomography (CBCT) images. Comparisons were made among these configurations and those previously reported. This information may serve as a basis for improving the success rate of endodontic treatment. METHODS:The root canal systems of 114 Taiwanese patients with bilateral maxillary first or second molars were examined using CBCT images. The number of roots, canals per root, and additional mesiobuccal (MB) canals, as well as the canal configuration were enumerated and recorded. RESULTS:Of the 196 maxillary first molars examined, three (1.5%) had a single root, two (1.0%) had two roots, and 191 (97.5%) had three separate roots. Out of all first molar roots examined, 44% of mesiobuccal (MB) roots had a single canal and the remainder had a second MB (MB2) canal. Of the 212 maxillary second molars examined, 16 (7.1%) had a single root, 51 (24.2%) had two roots, 143 (67.8%) had three roots, and two (0.9%) had four separate roots. For the MB roots, 92.3% of three-rooted maxillary second molars had a single canal and the remainder had an MB2 canal. In all three-rooted maxillary first and second molars, each of the distal and palatal roots had one canal. CONCLUSIONS:The root canal configurations of the MB roots of maxillary molars were more varied than those of the distobuccal and palatal roots, and the root canal configurations of maxillary second molars were more varied than those of the first molars. These findings demonstrate CBCT as a useful clinical tool for endodontic diagnosis and treatment planning. 10.1016/j.bj.2017.05.003
Assessment of the Second Mesiobuccal Root Canal in Maxillary First Molars: A Cone-beam Computed Tomographic Study. Zhang Yuerong,Xu Hai,Wang Dongmiao,Gu Yongchun,Wang Juan,Tu Shuzhen,Qiu Xiaohui,Zhang Fuyu,Luo Yao,Xu Shi,Bai Jianling,Simone Grandini,Zhang Guangdong Journal of endodontics INTRODUCTION:The purpose of this study was to investigate the incidence and location of the second mesiobuccal (MB2) root canal of the maxillary first molar and the relationship between the presence of an MB2 canal and the distribution of canal orifices on the pulpal floor with the aid of cone-beam computed tomographic (CBCT) technology. METHODS:A total of 1008 maxillary first molars (548 patients) were randomly selected and analyzed through CBCT imaging. The association between the incidence of MB2 canals and potential impacting factors including sex, side, age, and the distribution of the main root canal orifices on the pulpal floor was explored. The interorifice distances (ie, the length of a line between the center point of any 2 orifices) at the pulpal floor level were measured using Mimics 10.01 software (ImageWorks, Materialise, Belgium). RESULTS:The majority of 3-rooted maxillary first molars showed 2 root canals (85.4%) in the mesiobuccal root. The incidence of MB2 canals had no statistically significant difference between the left and right sides (P > .05) but had a significant association with the patients' sex and age (P < .05). Receiver operating characteristic curve analysis showed a high diagnostic accuracy (the area under the receiver operating characteristic curve = 0.92) of using the distance ratio of the interorifice distance between the main mesiobuccal and the palatal root canal orifices to the interorifice distance between the distobuccal and the palatal root canal orifices to predict the presence of an MB2 canal. A larger distance ratio (>1.26) indicated a highly probable existence of an MB2 canal. In this study, no molar presented an MB2 canal with a distance ratio of less than 1.16, whereas all molars with a ratio greater than 1.37 presented an MB2 canal without exception. A Bland-Altman scatterplot showed great agreement between the distances of the main mesiobuccal and the distobuccal canal orifices and the second mesiobuccal and the distobuccal canal orifices. CONCLUSIONS:Understanding the incidence of MB2 canals and the distribution pattern of canal orifices on the pulpal floor may help clinicians to quickly identify and locate MB2 canals. 10.1016/j.joen.2017.06.021
CBCT uses in clinical endodontics: the effect of CBCT on the ability to locate MB2 canals in maxillary molars. Parker J,Mol A,Rivera E M,Tawil P International endodontic journal AIM:To determine whether a CBCT volume can aid in the location of MB2 canals in maxillary molars. METHODOLOGY:This prospective clinical study involved 50 patients that needed RCT on a maxillary molar. The teeth where the MB2 was located upon access with the dental operating microscope received routine root canal treatment, and teeth where MB2 was not located had a CBCT volume made after instrumenting the located canals. At the second appointment, the clinician used the aid of the CBCT volume and troughing to attempt to locate MB2. RESULTS:The clinicians located MB2 upon initial access in 70% (n = 35) of teeth. In the remaining 15 teeth, CBCT and troughing located MB2 53% of the time in that group (8/15 teeth). Overall, MB2 was located in 86% of the 50 first and second maxillary molars (maxillary first molars 90% and maxillary second molars 73%). A total of 15 CBCT volumes were made, and of these teeth, 33% of MB2 canals (5/15 teeth) were visualized on the CBCT volume. CONCLUSIONS:This prospective clinical study showed that the effectiveness of using CBCT to locate additional MB2 canals in maxillary molars appears limited. The use of the dental operating microscope in conjunction with selective troughing and CBCT imaging allowed clinicians to locate 90% (maxillary first molars) and 73% (maxillary second molars) of MB2 canals. 10.1111/iej.12736
A Cone-beam Computed Tomographic Study of Root and Canal Morphology of Maxillary First and Second Permanent Molars in a Thai Population. Ratanajirasut Roserin,Panichuttra Anchana,Panmekiate Soontra Journal of endodontics INTRODUCTION:Understanding tooth anatomy is crucial for effective endodontic treatment. This study investigated the roots and root canal morphology of maxillary first and second permanent molars in a Thai population using cone-beam computed tomographic (CBCT) imaging. METHODS:This study evaluated 476 maxillary first molars and 457 maxillary second molars receiving CBCT examination and determined the number of roots and canal morphology according to Vertucci's classification, and the prevalence of a second mesiobuccal (MB2) canal in the mesiobuccal (MB) root was correlated with sex, age, and tooth side. RESULTS:Three roots were most commonly found in maxillary first and second molars. MB2 canals in the MB root were found in 63.6% and 29.4% of first and second molars, respectively. The most common canal morphology in the first molar MB roots was type I (36.4%) followed by type II (28.8%), and type IV (25.3%). The most common canal morphology in the second molar MB roots was type I (70.6%) followed by type II (14.6%) and type IV (7.5%). Bilateral MB2 canals in the MB roots were present in 80.93% and 82.59% of the first and second molars, respectively. There was a significant correlation between males and the prevalence of MB2 canals in first molars (P < .05). CONCLUSIONS:CBCT imaging is useful to determine root canal morphology. The prevalence of MB2 canals is approximately 60% and 30% in first and second molars, respectively. Furthermore, bilateral MB2 canals were commonly found. Our results can help endodontists to improve endodontic treatment outcomes. 10.1016/j.joen.2017.08.020
CBCT for the assessment of second mesiobuccal (MB2) canals in maxillary molar teeth: effect of voxel size and presence of root filling. Vizzotto M B,Silveira P F,Arús N A,Montagner F,Gomes B P F A,da Silveira H E D International endodontic journal AIM:To compare detection of the second mesiobuccal (MB2) canal in maxillary molar teeth using cone-beam computed tomography (CBCT) with different voxel sizes against conventional radiographic examination when the MB1 was unprepared, prepared and filled. METHODOLOGY:Radiographic examination and 0.2-, 0.25- and 0.3-mm CBCT (n = 89) were performed in 3 stages: S1, no first mesiobuccal (MB1) canal preparation or filling; S2, after MB1 preparation and filling; and S3, after MB1 root canal filling removal and canal repreparation. Images were analysed using the i-Cat software. After RE and CBCT acquisition in S3, all the samples were clarified to directly visualize the presence of the MB2 canal. All images were analysed by a blinded, previously calibrated examiner. Accuracy, specificity and sensitivity were compared using analysis of variance (P < 0.05 level of significance). RESULTS:MB2 root canals were detected in 67% of the samples. Overall, radiographic examination was associated with lower mean accuracy values for detecting MB2 than CBCT regardless of the MB1 condition. The MB1 root canal condition did not influence MB2 detection in 0.2-mm voxel images. The presence of root fillings in the MB1 canals reduced the detection of MB2 canals, especially in the 0.3- and 0.25-mm voxel-size images (P < 0.05). CONCLUSION:CBCT was associated with higher mean values of specificity and sensibility than radiographic examination for the detection of MB2 canals. When endodontic retreatment is necessary removal of the root filling prior to the CBCT examination eliminates artefacts, thereby permitting the use of the 0.3-mm voxel protocol that has good diagnostic performance and lower radiation dose. 10.1111/iej.12075
Worldwide Analyses of Maxillary First Molar Second Mesiobuccal Prevalence: A Multicenter Cone-beam Computed Tomographic Study. Martins Jorge N R,Alkhawas Moataz-Bellah A M,Altaki Zaher,Bellardini Gianmarco,Berti Luiza,Boveda Carlos,Chaniotis Antonis,Flynn Daniel,Gonzalez Jose Antonio,Kottoor Jojo,Marques Miguel Seruca,Monroe Adam,Ounsi Hani F,Parashos Peter,Plotino Gianluca,Ragnarsson Magnús F,Aguilar Ruben Rosas,Santiago Fábio,Seedat Hussein C,Vargas Walter,von Zuben Murilo,Zhang Yuerong,Gu Yongchun,Ginjeira António Journal of endodontics INTRODUCTION:Maxillary first molar second mesiobuccal (MB2) root canal prevalence may change among different populations. The aim of this study was to analyze the worldwide prevalence of the MB2 root canal and understand its possible relation with sex, age, side, and root configuration using in vivo cone-beam computed tomographic (CBCT) assessment. METHODS:Observers from 21 regions were calibrated to achieve a similar CBCT assessment methodology and instructed to collect data from 250 maxillary first molars in previously existing examinations. Intra- and interrater reliability tests were performed. The sample size included 5250 molars and was defined by way of a preliminary trial. Data collected included MB2 presence, sex, age, side, number of roots per tooth, and mesiobuccal root configuration. The z test for proportions in independent groups was used to analyze the differences among subgroups. P < .05 was considered significant. RESULTS:The worldwide CBCT-assessed MB2 prevalence was 73.8%, ranging from 48.0% in Venezuela to 97.6% in Belgium. The prevalence in males and females was 76.3% and 71.8%, respectively (P < .05). Significantly higher MB2 proportions were found in younger patients and 3-rooted molar configurations. The group intraclass correlation coefficient and the percentage of agreement for the MB2 presence were 0.95 and 0.91, respectively. The intrarater Cohen kappa value was above 0.61 for all observers. CONCLUSIONS:MB2 prevalence in the analyzed regions varied widely. The differences may be associated with specificities within each region but also patient demographics. Males, younger patients, and 3-rooted configurations were associated with higher MB2 proportions. 10.1016/j.joen.2018.07.027