Palatal root surgery of a maxillary molar using a piezosurgery transantral approach with simultaneous sinus lift grafting: a case report.

AIM: To report a case involving transantral palatal root piezoelectric surgery followed by a sinus floor augmentation procedure with the purpose of minimizing and managing complications associated with sinus lining perforations and optimizing bone regeneration at the site of the surgical defect. SUMMARY: An asymptomatic 28-year-old male patient with the diagnosis of chronic apical periodontitis on a previously root filled right maxillary first molar (FDI tooth 16) and second premolar (No. 15) was managed by transantral apical surgery. Cone-beam computerized tomography (CBCT) revealed the position of the palatal root of the first molar within the maxillary sinus. The case highlights the management of the palatal root and the handling of a perforation of the Schneiderian membrane through a combination of piezosurgery and a sinus lift grafting procedure involving a second-generation of platelet concentrates. No postoperative complications were observed. Sinus bone augmentation after a 26-month recall period was confirmed by CBCT in the clinically asymptomatic teeth. KEY LEARNING POINTS: The selective bone tissue cutting and enhanced visibility obtained by piezoelectric surgery in comparison with current rotary techniques make this technology the preferred tool for apical surgery when the mucosal lining of the maxillary sinus could be compromised. The wound healing and physical properties of the platelet-rich fibrin membranes in combination with an allograft material can be considered as sinus bone graft options when a transantral approach is performed on a palatal root of a maxillary molar. A preoperative tomographic examination is essential for apical surgery using a transantral approach with sinus bone augmentation, because of the information obtained from the axial and coronal views on the CBCT scan.

Comparative accuracy of the Clearing Technique, CBCT and Micro-CT methods in studying the mesial root canal configuration of mandibular first molars.

AIMS: To compare the accuracy of the clearing technique and cone beam computed tomography (CBCT) in the assessment of root canal configurations using micro-computed tomography (micro-CT) imaging system as the reference standard. METHODOLOGY: Thirty-two mesial roots of mandibular first molars, selected on the basis of micro-CT scans (voxel size: 19.6 µm) and presenting several canal configurations, were evaluated using 2 CBCT scanners (voxels sizes: 120 µm and 150 µm) followed by the clearing technique. Two examiners analysed the data from each method and classified the anatomical configuration of the mesial canal according to Vertucci's system. Data were compared using Fisher's exact and chi-square tests. Reliability for each assessment was verified by the kappa test, and significance level was set at 5%. RESULTS: Kappa value indicated a high level of agreement between the examiners. Detection of type I configurations was significantly lower in cleared teeth (P < 0.05), whilst type II root canals were detected in all specimens by both tests (P > 0.05). In mesial roots with variable anatomical configurations, CBCT and the clearing method were significantly less accurate than the reference standard (P < 0.05). CONCLUSION: Within the tooth population studied, accuracy of identifying mesial root canal configuration was influenced greatly by the evaluation method and the type of anatomy. Detection of type I configurations in cleared teeth was significantly lower, whilst type II configurations were detected in all specimens by both methods. In mesial roots with variable anatomical configurations, neither CBCT nor clearing methods were accurate for detecting the actual root canal anatomy.

Micro-CT evaluation of C-shaped mandibular first premolars in a Brazilian subpopulation.

AIM: To describe morphometric aspects of the internal anatomy of C-shaped mandibular premolars from a Brazilian subpopulation using micro-CT analysis. METHODOLOGY: First mandibular premolars with radicular grooves (n = 123) were scanned using a micro-computed tomography system. After cross-section analysis, 83 specimens were identified with a C-shaped canal and selected for micro-CT analysis. Number and location of canals according to Vertucci's classification, distances between anatomic landmarks, occurrence of apical deltas, furcation canals, prevalence of C-shaped cross-sections at five levels as well as 2-dimensional analysis (Area, perimeter, roundness, aspect ratio, major and minor diameters) were performed for the more prevalent anatomical features. Data were compared statistically using Kruskal-Wallis tests (α = 0.05). RESULTS: The more prevalent anatomical types according to Vertucci's classification were Type I (13%), III (8%), V (37%) and VII (2%). Mean distances from the furcation to the cemento-enamel junction were in the range of 5.36-5.65 mm. Apical deltas and furcation canals were present in 36 (43%) and 27 (33%) specimens, respectively. C-shaped cross-sections were more prevalent at the middle (56%) and apical middle levels (81%). Overall, significant differences were found in the 2-dimensional analyses between single canals at the apical third and buccal and lingual canals of Vertucci's V classification (P < 0.05). CONCLUSIONS: In this Brazilian subpopulation, C-shaped canal configuration of the root canal system was found in 67% of extracted first mandibular premolars with radicular grooves. Vertucci's types I and V were the most prevalent anatomical variations. C-shaped cross-sections were more prevalent in the middle third, and the presence of apical deltas was the most common feature in the apical third.