Restorative Dentistry and Endodontics

The Korean Academy of Conservative Dentistry (대한치과보존학회)
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Apical periodontitis in mesiobuccal roots of maxillary molars: influence of anatomy and quality of root canal treatment, a CBCT study

  • Received : 2022.05.04
  • Accepted : 2022.07.26
  • Published : 2022.11.30
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Abstract

Objectives: This study aimed to evaluate the prevalence of apical periodontitis (AP) in the mesiobuccal roots of root canal-treated maxillary molars. Materials and Methods: One thousand cone-beam computed tomography images of the teeth were examined by 2 dental specialists in oral radiology and endodontics. The internal anatomy of the roots, Vertucci's classification, quality of root canal treatment, and presence of missed canals were evaluated; additionally, the correlation between these variables and AP was ascertained. Results: A total of 1,000 roots (692 first molars and 308 second molars) encompassing 1,549 canals were assessed, and the quality of the root canal filling in the majority (56.9%) of the canals was satisfactory. AP was observed in 54.4% of the teeth. A mesiolingual canal in the mesiobuccal root (MB2 canal) was observed in 54.9% of the images, and the majority (83.5%) of these canals were not filled. Significant associations were observed between the presence of an MB2 canal and the quality of the root canal filling and the presence of AP. Conclusions: AP was detected in more than half of the images. The MB2 canals were frequently missed or poorly filled.

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References

  1. American Association of Endodontists. Treatment standards. Available from: https://www.aae.org/specialty/wp-content/uploads/sites/2/2018/04/TreatmentStandards_Whitepaper.pdf (updated 2020; cited May 2, 2022).
  2. Yoo YJ, Perinpanayagam H, Oh S, Kim AR, Han SH, Kum KY. Endodontic biofilms: contemporary and future treatment options. Restor Dent Endod 2019;44:e7.
  3. Kulild JC, Peters DD. Incidence and configuration of canal systems in the mesiobuccal root of maxillary first and second molars. J Endod 1990;16:311-317. https://doi.org/10.1016/S0099-2399(06)81940-0
  4. Keskin C, Keles A, Versiani MA. Mesiobuccal and palatal interorifice distance may predict the presence of the second mesiobuccal canal in maxillary second molars with fused roots. J Endod 2021;47:585-591. https://doi.org/10.1016/j.joen.2021.01.003
  5. Martins JN, Kishen A, Marques D, Nogueira Leal Silva EJ, Carames J, Mata A, Versiani MA. Preferred reporting items for epidemiologic cross-sectional studies on root and root canal anatomy using cone-beam computed tomographic technology: a systematized assessment. J Endod 2020;46:915-935. https://doi.org/10.1016/j.joen.2020.03.020
  6. Martins JN, Alkhawas MA, Altaki Z, Bellardini G, Berti L, Boveda C, Chaniotis A, Flynn D, Gonzalez JA, Kottoor J, Marques MS, Monroe A, Ounsi HF, Parashos P, Plotino G, Ragnarsson MF, Aguilar RR, Santiago F, Seedat HC, Vargas W, von Zuben M, Zhang Y, Gu Y, Ginjeira A. Worldwide analyses of maxillary first molar second mesiobuccal prevalence: a multicenter cone-beam computed tomographic study. J Endod 2018;44:1641-1649.e1. https://doi.org/10.1016/j.joen.2018.07.027
  7. Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod 1990;16:498-504. https://doi.org/10.1016/S0099-2399(07)80180-4
  8. Saini HR, Tewari S, Sangwan P, Duhan J, Gupta A. Effect of different apical preparation sizes on outcome of primary endodontic treatment: a randomized controlled trial. J Endod 2012;38:1309-1315. https://doi.org/10.1016/j.joen.2012.06.024
  9. Song M, Kim HC, Lee W, Kim E. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod 2011;37:1516-1519. https://doi.org/10.1016/j.joen.2011.06.032
  10. do Carmo WD, Verner FS, Aguiar LM, Visconti MA, Ferreira MD, Lacerda MF, Junqueira RB. Missed canals in endodontically treated maxillary molars of a Brazilian subpopulation: prevalence and association with periapical lesion using cone-beam computed tomography. Clin Oral Investig 2021;25:2317-2323. https://doi.org/10.1007/s00784-020-03554-4
  11. Baruwa AO, Martins JN, Meirinhos J, Pereira B, Gouveia J, Quaresma SA, Monroe A, Ginjeira A. The influence of missed canals on the prevalence of periapical lesions in endodontically treated teeth: a cross-sectional study. J Endod 2020;46:34-39.e1. https://doi.org/10.1016/j.joen.2019.10.007
  12. Ricucci D, Siqueira JF Jr. Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. J Endod 2010;36:1277-1288. https://doi.org/10.1016/j.joen.2010.04.007
  13. Ricucci D, Siqueira JF Jr, Bate AL, Pitt Ford TR. Histologic investigation of root canal-treated teeth with apical periodontitis: a retrospective study from twenty-four patients. J Endod 2009;35:493-502. https://doi.org/10.1016/j.joen.2008.12.014
  14. Jang YE, Kim BS, Kim Y. Clinical factors associated with apical periodontitis visible on cone-beam computed tomography but missed with periapical radiographs: a retrospective clinical study. J Endod 2020;46:832-838.
  15. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589-599. https://doi.org/10.1016/0030-4220(84)90085-9
  16. Estrela C, Bueno MR, Azevedo BC, Azevedo JR, Pecora JD. A new periapical index based on cone beam computed tomography. J Endod 2008;34:1325-1331. https://doi.org/10.1016/j.joen.2008.08.013
  17. Tiburcio-Machado CS, Michelon C, Zanatta FB, Gomes MS, Marin JA, Bier CA. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J 2021;54:712-735. https://doi.org/10.1111/iej.13467
  18. Chauhan N, Mittal S, Tewari S, Sen J, Laller K. Association of apical periodontitis with cardiovascular disease via noninvasive assessment of endothelial function and subclinical atherosclerosis. J Endod 2019;45:681-690.
  19. Jakovljevic A, Sljivancanin Jakovljevic T, Duncan HF, Nagendrababu V, Jacimovic J, Aminoshariae A, Milasin J, Dummer PM. The association between apical periodontitis and adverse pregnancy outcomes: a systematic review. Int Endod J 2021;54:1527-1537. https://doi.org/10.1111/iej.13538
  20. Poornima L, Ravishankar P, Abbott PV, Subbiya A, PradeepKumar AR. Impact of root canal treatment on high-sensitivity C-reactive protein levels in systemically healthy adults with apical periodontitis - a preliminary prospective, longitudinal interventional study. Int Endod J 2021;54:501-508. https://doi.org/10.1111/iej.13444
  21. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105:1135-1143. https://doi.org/10.1161/hc0902.104353
  22. Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol 1998;8:1558-1564. https://doi.org/10.1007/s003300050586
  23. Parker JM, Mol A, Rivera EM, Tawil PZ. Cone-beam computed tomography uses in clinical endodontics: observer variability in detecting periapical lesions. J Endod 2017;43:184-187. https://doi.org/10.1016/j.joen.2016.10.007
  24. Beacham JT, Geist JR, Yu Q, Himel VT, Sabey KA. Accuracy of cone-beam computed tomographic image interpretation by endodontists and endodontic residents. J Endod 2018;44:571-575. https://doi.org/10.1016/j.joen.2017.12.012
  25. Martins JN, Marques D, Silva EJ, Carames J, Mata A, Versiani MA. Second mesiobuccal root canal in maxillary molars-a systematic review and meta-analysis of prevalence studies using cone beam computed tomography. Arch Oral Biol 2020;113:104589.
  26. Alacam T, Tinaz AC, Genc O, Kayaoglu G. Second mesiobuccal canal detection in maxillary first molars using microscopy and ultrasonics. Aust Endod J 2008;34:106-109. https://doi.org/10.1111/j.1747-4477.2007.00090.x
  27. Coelho MS, Parker JM, Tawil PZ. Second mesiobuccal canal treatment in a predoctoral dental clinic: a retrospective clinical study. J Dent Educ 2016;80:726-730. https://doi.org/10.1002/j.0022-0337.2016.80.6.tb06135.x
  28. Parker J, Mol A, Rivera EM, Tawil P. CBCT uses in clinical endodontics: the effect of CBCT on the ability to locate MB2 canals in maxillary molars. Int Endod J 2017;50:1109-1115. https://doi.org/10.1111/iej.12736
  29. Vizzotto MB, Silveira PF, Arus NA, Montagner F, Gomes BP, da Silveira HE. CBCT for the assessment of second mesiobuccal (MB2) canals in maxillary molar teeth: effect of voxel size and presence of root filling. Int Endod J 2013;46:870-876. https://doi.org/10.1111/iej.12075
  30. Costa FF, Pacheco-Yanes J, Siqueira JF Jr, Oliveira AC, Gazzaneo I, Amorim CA, Santos PH, Alves FR. Association between missed canals and apical periodontitis. Int Endod J 2019;52:400-406. https://doi.org/10.1111/iej.13022
  31. Burry JC, Stover S, Eichmiller F, Bhagavatula P. Outcomes of primary endodontic therapy provided by endodontic specialists compared with other providers. J Endod 2016;42:702-705. https://doi.org/10.1016/j.joen.2016.02.008
  32. Kruse C, Spin-Neto R, Evar Kraft DC, Vaeth M, Kirkevang LL. Diagnostic accuracy of cone beam computed tomography used for assessment of apical periodontitis: an ex vivo histopathological study on human cadavers. Int Endod J 2019;52:439-450. https://doi.org/10.1111/iej.13020
  33. Kruse C, Spin-Neto R, Wenzel A, Vaeth M, Kirkevang LL. Impact of cone beam computed tomography on periapical assessment and treatment planning five to eleven years after surgical endodontic retreatment. Int Endod J 2018;51:729-737. https://doi.org/10.1111/iej.12888
  34. Ahmed HM. A critical analysis of laboratory and clinical research methods to study root and canal anatomy. Int Endod J 2022;55 Supplement 2:229-280. https://doi.org/10.1111/iej.13702