ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Cone Beam Computed Tomography is accurate in identifying multiple canals in the mesiobuccal root of maxillary molars.
Clinical Question In maxillary molars, will cone-beam computed tomography compared to histologic exam, accurately identify multiple canals in the mesiobuccal root?
Clinical Bottom Line Cone Beam Computed Tomography is accurate in identifying multiple canals in the mesiobuccal root of maxillary molars.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20416435Blattner/201020 maxillary molarsPreclinical/laboratory study
Key resultsBlattner et al. concluded that “CBCT is a reliable method to detect the MB2 canal when compared with the gold standard of physical sectioning of the specimen.” They used human teeth mounted in modified pig maxillas to simulate human hard/soft tissues. Inter-examiner reliability was 90% for CBCT and 100% for sectioning. The incidence of MB2 canals was 58% by CBCT and 68% with sectioning.
#2) 23503712Silveira/201399 maxillary molarsPreclinical/laboratory study
Key resultsSilveira et al. concluded that CBCT “is an auxiliary way to detection and mapping of the MB2 canal in maxillary molars,” although it is "ineffective in determining negotiability"of the canal. Acrylic mounts were used to position the teeth before they were scanned by two different, which could reduce artifacts in the CBCT. The incidence of MB2 canals was 70%. The concordance index for CBCT scans to anatomic exam was 65-71% for first molars and 80% for second molars.
#3) 23791260Domark/201327 maxillary molarsPreclinical/laboratory study
Key resultsThe authors present micro CT as the reference standard for identifying canal anatomy. They used human cadaver hemi-maxillas for the study and found no significant difference between micro CT and CBCT. The incidence of MB2 canals found in this study was 100% and there was no significant difference for both inter-observer and intra-observer agreements.
Evidence Search cone beam computed tomography, maxillary molars, mesiobuccal canals
Comments on
The Evidence
There are no systematic reviews on this topic, however these studies agree that there was no significant difference between using CBCT versus their gold standard for accurately identifying the presence of multiple canals in maxillary molars. However, none of the studies found 100% of MB2 using CBCT. These studies did not complete clinical trials on live human patients. As a result, the accuracy of CBCT could be increased due to lack of artifact from patient movement and soft/hard tissues.
Applicability CBCT is a great diagnostic tool for teeth with complicated anatomy, e.g., MB2 in maxillary molars. It can also be useful in identifying the cause of failure in endodontic retreatment cases, e.g., missed MB2 canal.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords
ID# 2514
Date of submission: 08/18/2013spacer
E-mail cullenj@livemail.uthscsa.edu
Author James Cullen, DDS
Co-author(s) Ahmed Afify, DDS
Co-author(s) e-mail dr.a.afify@gmail.com
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
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