Missed canals in endodontically treated maxillary molars of a Brazilian subpopulation: prevalence and association with periapical lesion using cone-beam computed tomography.

OBJECTIVES: To evaluate the prevalence of missed canals in endodontically treated maxillary molars through cone-beam computed tomography (CBCT) images and to verify their association with the presence of periapical lesions. MATERIAL AND METHODS: Three oral radiologists evaluated 633 maxillary molars in CBCT exams regarding number of roots, number of root canals, number of missed canals, anatomic identification of missed canals, presence of periapical lesions, and root location of the periapical lesions. Data were statistically analyzed at a 5% significance level. RESULTS: Descriptive statistical analysis showed that among 395 first molars, 218 had at least one missed canal, and 186 (46.5%) had a missed canal and periapical lesion simultaneously. Of these, 72.4% (134) of the missed canals were only mesiobuccal 2 (MB2). Among 238 s molars evaluated, 121 presented at least one missed canal, and 104 (43.6%) had a missed canal and periapical lesion simultaneously. Of these, 81.7% (85) of the missed canals were only MB2. The chi-squared test showed an association between the presence of missed canals and periapical lesions for 1st and 2nd maxillary molars. Teeth that presented a missed canal showed an odds ratio (OR) of 2.57 (p < 0.0001) of being associated with a periapical lesion. Missed canal occurrence was positively related to the number of root canals (z = 13.06, p < 0.0001), meaning when the number of root canals is higher, there is a higher probability of missed canal occurrence. According to the model calculated prediction, for a one-unit increase in the number of canals, the probability of missed canals increases by 4.22%. CONCLUSIONS: It was concluded that MB2 was the most frequently missed canal, associated with the presence of periapical lesions in endodontically treated maxillary molars. CLINICAL RELEVANCE: Professionals' negligence of anatomical root variations has been contributed to the high prevalence of missed canals, leading to failures in endodontic treatment. Their association with periapical lesion occurrence emphasizes the importance of correct detection and instrumentation of these canals.

The mandibular bone structure in children by fractal dimension and its correlation with pixel intensity values: a pilot study.

OBJECTIVES: To identify a normal pattern of mandibular trabecular bone in children based on the fractal dimension (FD), and its possible correlation with pixel intensity (PI) values, to facilitate the early diagnosis of possible diseases and/or future bone alterations. MATERIALS AND METHODS: The 50 panoramic images were selected and divided into two groups, according to the children's age: 8-9 (Group 1; n = 25) and 6-7 (Group 2; n = 25). For FD and PI analyses, three regions of interest (ROIs) were selected, and their mean values were evaluated for each ROI, according to each group, using the t test for independent samples and the model of generalized estimation equations (GEE). Subsequently, these mean values were correlated by the Pearson test. RESULTS: Comparing the groups, FD and PI did not differ from each other for any of the measured regions (p > 0.00). It was observed that in the mandible branch (ROI1), FD and PI means were 1.26 ± 0.01 and 81.0 ± 2.50, respectively. In the mandible angle (ROI2), the means were 1.21 ± 0.02 (FD) and 72.8 ± 2.13 (PI); and in the mandible, cortical (ROI3) values of FD = 1.03 ± 0.01 and PI = 91.3 ± 1.75 were obtained. There was no correlation between FD and PI in any of the analyzed ROI (r < 0.285). The FD means of ROI1 and ROI2 did not differ from each other (p = 0.053), but both were different from ROI3 (p < 0.00). All PI values differed from each other (p < 0.00). CONCLUSION: The bone trabeculate pattern in 6-9-year-old children presented FD between 1.01 and 1.29. Besides that, there was no significant correlation between FD and PI.

Middle mesial root canals in mandibular molars: prevalence and correlation to anatomical aspects based on CBCT imaging.

OBJECTIVES: To determine the prevalence of middle mesial root canal (MMC) in a Brazilian subpopulation, verify whether its presence is related to anatomical characteristics of the tooth, and propose a classification using cone-beam computed tomography (CBCT). METHODS: CBCT scans of 284 patients were evaluated by 2 radiologists to determine the presence of the MMC in mandibular first and second molars. Subsequently, the mesiodistal and buccolingual measurements of the mesial roots were obtained; the measurements between the root canals, and from MMC to the mesiobuccal canal and to the mesiolingual canal were also obtained. The MMC was classified according to its relationship with mesiobuccal and mesiolingual canals. The data were analyzed using χ2 and Fisher's exact test, multiple logistic regression analysis, Student's t-test, κ and intraclass correlation coefficient (p < 0.05). RESULTS: The intraexaminer agreements for the presence of the MMC and the measurements were considered almost perfect (0.953 and 0.999, respectively). Of 216 mandibular first molars, 11.1% had the MMC, and of 228 mandibular second molars, only 1.75% had the MMC. The presence was significant higher in the mandibular first molar (p < 0.0001). The buccolingual measurement and the measurement between mesiobuccal and mesiolingual canals were higher in teeth with MMC (p = 0.024 and p = 0.005, respectively). It was possible to classify the configuration of MCC into four types: independent (60.7%), confluent (14.3%), mesiolingual confluent (14.3%), and mesiobuccal confluent (10.7%). CONCLUSIONS: The prevalence of MMC is more pronounced in mandibular first molars and anatomical measurements, such as greater measurement between mesiobuccal and mesiolingual canals, may alert clinicians to its presence. It was found four types of configurations of MMC.

The prevalence and characteristics of external cervical resorption based on cone-beam computed tomographic imaging: a cross-sectional study.

Objectives: This study investigated the prevalence and characteristics of external cervical resorption (ECR) regarding sex, age, tooth, stages of progression, and portal of entry, using cone-beam computed tomography (CBCT) scans. Materials and Methods: CBCT scans of 1,313 patients from a Brazilian subpopulation comprising 883 female and 430 male patients (mean age, 55.2 years), acquired using a PreXion 3D CBCT unit, were evaluated. All permanent teeth included in the scans were evaluated for the presence of ECR according to the 3-dimensional classification and the portal of entry. The association between the presence of ECR and the factors studied was assessed using the χ2 test. Intra-observer agreement was analyzed with the kappa test (α = 0.05). Results: In total, 6,240 teeth were analyzed, of which 84 (1.35%) were affected by ECR. A significant association was found between the presence of ECR and sex, with a higher prevalence in male patients (p = 0.002). The most frequently affected teeth were the mandibular and maxillary central incisors. The most common height was the mid-third of the root. For the portal of entry, 44% of cases were on the proximal surfaces, 40.5% on the lingual/palatal surface and 15.5% on the buccal surface. Intra-observer agreement was excellent. Conclusions: The prevalence of ECR was 1.35%, with a higher prevalence in male patients and a wide age distribution. The mandibular and maxillary central incisors were the most commonly affected teeth, and cases of ECR most frequently showed a height into the mid-third of the root and proximal entry.