International Journal of Dentistry and Oral Science (IJDOS) / IJDOS-2377-8075-08-7024

Retreatment Of Root Canals In Maxillary Molars Due To Missing Second Mesiobuccal Canals And Its Association With Gender

Fathima Bareera Rezvi1, Adimulapu Hima Sandeep2*, Manjari Chaudhary3

1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai � 600 077, TN, India.
2 Senior Lecturer, Department of Conservative and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, Poonamallee High Road, Chennai - 600077, Tamil Nadu, India.
3 Senior Lecturer, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, India.

*Corresponding Author

Adimulapu Hima Sandeep,
Senior Lecturer, Department of Conservative and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, Poonamallee High Road, Chennai - 600077, Tamil Nadu, India.
E-mail: himas.sdc@saveetha.com

Received: May 28, 2021; Accepted: June 16, 2021; Published: July 04, 2021

Citation:Fathima Bareera Rezvi, Adimulapu Hima Sandeep, Manjari Chaudhary. Retreatment Of Root Canals In Maxillary Molars Due To Missing Second Mesiobuccal Canals And Its Association With Gender. Int J Dentistry Oral Sci. 2021;8(7):3035-3039.doi: dx.doi.org/10.19070/2377-8075-21000618

Copyright: Adimulapu Hima Sandeep�2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

Abstract

The knowledge of root canal morphology determines the success of endodontically treated teeth, especially the anatomy of the maxillary molars as its mesiobuccal root has two distinct canals. Majority of failures in maxillary molars result from missing the second mesiobuccal (MB2) canal, as it is present in 50% to 90% of maxillary molars. The aim of the study was to evaluate the association between retreatment of root canals in maxillary molars due to missing second mesiobuccal canal and gender. This study was conducted among patients visiting the outpatient department of a private dental college from June 2019 to March 2020. The data was formulated by reviewing the case sheets of patients and the data was statistically analysed using Statistical Package for Social Sciences (SPSS) software. The current study shows retreatment of root canals in maxillary molars due to missed second mesiobuccal canal was 9.7%. It was more prevalent in the right maxillary first molars (6.5%) compared to left maxillary first molars (3.2%) in which males (6.5%) had higher occurrence rate than females (3.2%). Pearson�s Chi Square value: 3.389, p value: 0.06 (>0.05). No significant association was found between gender and retreatment due to missed second mesiobuccal canal.

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1.Keywords
2.Introduction
6.Conclusion
8.References

Keywords

Maxillary Molar; Second Mesiobuccal Canal; Retreatment; Gender.

Introduction

Anatomical variations impose certain limitations to the chemicomechanical preparation of the root canal causing certain areas of the root canal to not be accessed by the instrument, leading to failure of cases. These anatomical variations are of utmost importance, especially in maxillary molars as they present a number of main canals. Previous studies have reported variations in palatal, mesiobuccal and distobuccal canals of maxillary molars [1-3]. Most often, these variations are seen in the mesiobuccal root when compared to the palatal root. This canal is known as the second mesiobuccal canal or MB2, as a simplified name [3]. In 1925, Hess was the first to report the presence of these canals [4]. When a root canal treatment becomes unsuccessful , the clinician is challenged to make a decision that solves the problem. Hence, a proper diagnosis is required to deal with the clinical management of the situation [5, 6]. In instances where the failure occurred due to short fillings in straight canals or under-instrumented roots, it can be managed easily [7, 8]. However, failure of treatment that occurs due to missed canals can be managed either by microsurgery or non-surgical root canal retreatment [9, 10].

It is essential to know the root and canal morphology of each tooth as the knowledge of this is important for the planning of endodontic treatment and its success [11]. The presence of a MB2 in maxillary molars is said to range from 50% to 90% of cases [3, 12]. The success of the treatment relies on detecting all canals that can then be disinfected, cleaned, shaped, and obturated [13-15]. Most of the failed root canal treatments are due to missed MB2 canals, in maxillary first second molar [16-19]. The mesiobuccal root of the maxillary first molar has led to more research [20], because it consists of an extra root canal, known as the MB2 canal [21]. In the maxillary first molars, the MB2 canal departs the chamber at a sharp mesial inclination, then bending distally, making its detection very challenging [22, 23]. The difficulty to detect the second mesiobuccal canal is one of the main reasons for endodontic failure in maxillary first molars [24, 25]. Endodontically retreated teeth were found to contain more undetected MB2 canals, suggesting that failure of endodontic treatment has occured due to missing out on the existing MB2 canals which eventually leads to a poorer prognosis of that tooth [26, 27].

When the MB2 canal is not found in the initial treatment, several retreatments are performed, aiming to address the cases of missed second mesiobuccal canals [28]. Therefore, the clinician should approach in the best possible manner [29], as it is important to access the proper location of MB2 canals and they are essential for the successful treatment of maxillary molars [30]. The clinician should be able to locate and manage these cases in the initial treatment and also choose the best option when the initial treatment fails.Previously our team has a rich experience in working on various research projects across multiple disciplines [31-45].

In our study we aim to evaluate the association between retreatment of root canals in maxillary molars due to missing second mesiobuccal canal and gender.

Materials And Methods

Study Setting

The present retrospective study was conducted in a University setting with an advantage of a wide range of availability of data. Ethical clearance for this study was obtained from the Institutional Ethical Committee - SDC/SIHEC/2020/DIASDATA/ 0619-0320. The population included in the study were 31 patients who underwent retreatment of root canal in maxillary molars due to missed MB2 canal at the Conservataive dentistry and Endodontics Department. Two examiners were involved in the study.

Study design

The study was designed based on the set inclusion criteria of patients from the out patient department who underwent retreatment of root canals in maxillary molars due to missed MB2 canal. Cases which did not fall under this inclusion criteria were excluded from the study.

Sampling

The study was based on non probability convenience sampling. To minimize the sampling bias, all the case sheets of patients who underwent retreatment of root canals in maxillary molars due to missed MB2 canal were reviewed and included.

Data Collection and Tabulation

This study is a retrospective study where the data was collected by reviewing the case records of the patients visiting the out patient department of a private dental college from June 2019 to March 2020. The collected data included the following parameters: Patients details: Name, Age, Gender, Patient identification number and the presence of retreatment of root canals in maxillary molars due to missed MB2 canal were recorded. A total of 86,000 case sheets and radiographs associated with the case sheets were reviewed and the data of 31 patients who underwent retreatment of root canals in maxillary molars due to missed MB2 canal was further analysed. Cross verification of the data was done by a reviewer.

Results And Discussion

This study shows that 9.7% of retreatment was due to missed MB2 canals. (Figure 1) Retreatment in right maxillary first molar (16) - 54.8%, right maxillary second molar (17) - 3.2%, left maxillary first molar (26) - 38.7%, left maxillary second molar (27) - 3.2%. (Figure 2) Retreatment due to a missed MB2 canal in the right maxillary first molar (16) is 6.5% and left maxillary first molar (26) is 3.2% respectively. (Figure 3) Retreatment was more prevalent in males, 71% than in females 29%. (Figure 4) Retreatment due to missed MB2 canal was more prevalent in males, 6.5% than in females. (Figure 5)

Based on the results of this study we can see that retreatment of root canals in maxillary molars due to missed MB2 is 9.7%. Similar studies were done by Wolcott et al.,(26)[46] Sempira et al.,[47] Baruwa et al., [48] Costa et al., [49] and Nascimento et al. [50]. Wolcott et al. [46] states that the incidence of second mesiobuccal canal in first maxillary molar retreatment was 67% and the incidence of second mesiobuccal canal in maxillary second molar retreatment was 44% when compared to initial treatment. Sempira et al. [47] stated in his study that two hundred maxillary first molars and maxillary second molars were evaluated with the help of a microscope, in which MB2 canal was present in 30% percent of all maxillary molars. When evaluated separately, 33.1% of the maxillary first molars and 24.3% of the maxillary second molars had MB2 canal. In a study by Costa et al. [49] 2294 teeth with evidence of root fillings were identified, out of which two hundred and eighty one teeth were assessed and 12% had at least one untreated missed canal. The mesiobuccal roots of maxillary first molars had the greatest frequency of untreated canals, with the second mesiobuccal canal being the most frequently missed canal. Six hundred eighteen endodontically treated teeth were evaluated and 59.3% root canals showed failure in a study conducted by Nascimento et al. [50]. Underfilling was the most frequent technical error for failure in all root canals, except for the second mesiobuccal root canal of maxillary molars which were missed in 78.4% of the cases. Baruwa et al. [48] states that the root presenting with the highest percentage of 62.8% of missed canals was the second mesiobuccal root of the maxillary first molar. Based on prevalence of retreatment of root canals and its association with gender, our study shows male predilection. 71% of males had retreatment when compared to females. Retreatment of root canals due to missed second mesiobuccal canal was also more prevalent in males (6.5%). This is in line with the studies conducted by [51-53] except [54], where Al-Rahabi states that his study had more female predilection than male predilection.

Loupes, microscopes, radiographs and cone beam computed tomography (CBCT) have been used for better access, detection and treatment of the second mesiobuccal canal of maxillary first molars [55, 56]. By using better access techniques, Weller et al [55] recorded a MB2 canal in 39% of his sample of maxillary first molars and 21.4% in the maxillary second molars. This technique helped to prepare a rhomboidal shape access and a thorough probing of the groove between the mesial and palatal canals with a sharp endodontic explorer [57]. MB2 is typically located under a layer of dentin that sits on the pulp floor, known as the �dentin shelf � [58] This needs to be removed in order to uncover the MB2 orifice.These techniques will eventually lead to higher endodontic quality treatment and better outcomes [59].Our institution is passionate about high quality evidence based research and has excelled in various fields [60-70].

The limitations of the study include small sample size, single centered study and cannot be generated into a larger population. For future scope, a larger sample size along with further diagnosis and treatment plan will be beneficial.

Figure 1. Bar chart represents the prevalence of retreatment due to missed MB2 canal in maxillary molars. X axis represents retreatment due to missed MB2 canals and Y axis represents the percentage of patients undergoing retreatment. The prevalence of retreatment in maxillary molars due to missed MB2 canal was less (9.7%) compared to the overall retreatment cases (90.3%).

Figure 2. Bar chart represents the prevalence of overall retreatment in various maxillary molars. X axis represents the various tooth numbers and Y axis represents the percentage of teeth undergoing overall retreatment. The prevalence of overall retreatment in maxillary molars was higher in tooth number 16 (54.8%) compared to others.

Figure 3. Bar chart represents the association between various teeth and retreatment due to missed MB2 canal compared to other reasons. X axis represents the various teeth and Y axis represents the number of teeth undergoing retreatment. [Pearson�s Chi Square value = 0.324a , df = 3, p value = 0.955 (>0.05), hence statistically not significant].The prevalence of retreatment due to missed MB2 canal was higher in tooth number 16 (6.5%) when compared to others and the difference was statistically not significant.

Figure 4. Bar chart represents the prevalence of overall retreatment among males and females. X axis represents the gender and Y axis represents the percentage of patients undergoing retreatment. The prevalence of overall retreatment was higher in males (71.0%) when compared to females (29.0%).

Figure 5. Bar chart represents the association between gender and retreatment due to missed MB2 canal compared to other reasons. X axis represents the gender and Y axis represents the number of patients undergoing retreatment. [Pearson�s Chi Square value = 0.030a , df = 1, p value = 0.863 (>0.05), hence statistically not significant] Retreatment due to missed MB2 canal was more in males (6.5%) when compared to females (3.2%) which shows the results are statistically not significant.

Conclusion

Within the limits of the study, we observed that retreatment of root canals in maxillary molars due to missed MB2 was 9.7% and it was more prevalent in the maxillary first molars. Incidence of overall retreatment and retreatment due to missed MB2 canals was more prevalent in males than in females.

Acknowledgement

We would like to thank Saveetha Dental College for providing us with the opportunity to review the case sheets.

Author�s Contribution

First author (Fathima Bareera Rezvi) performed the analysis, and interpretation and wrote the manuscript. Second author (Dr. Adimalapu Hima Sandeep) contributed to conception, data design analysis, interpretation and critically revised the manuscript. Third author (Dr. Manjary Chaudhary) participated in the study and revised the manuscript. All the authors have discussed the results and contributed to the final manuscript.

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