Worldwide Assessment of the Mandibular First Molar Second Distal Root and Root Canal: A Cross-sectional Study with Meta-analysis.

INTRODUCTION: This study assessed the prevalence of radix entomolaris and 2 canals at the distal aspect of mandibular first molars among different geographic regions by means of cone-beam computed tomographic imaging. METHODS: Precalibrated observers from 23 worldwide geographic locations followed a standardized screening protocol to assess 5750 cone-beam computed tomographic images of mandibular first molars (250 per region), gathering demographic data and recording the presence of radix entomolaris and a second canal at the distal aspect of teeth. Intra- and interrater reliability tests were conducted and comparisons among groups were performed using proportions and odds ratio forest plots. The significance level was set at 5%. RESULTS: The results of intra- and interrater tests were above 0.79. The prevalence of radix entomolaris varied from 0.9% in Venezuela (95% confidence interval [CI], 0%-1.9%) to 22.4% in China (95% CI, 17.2%-27.6%). Regarding the proportion of a second distal canal, it ranged from 16.4% in Venezuela (95% CI, 11.8%-21.0%) to 60.0% in Egypt (95% CI, 53.9%-66.1%). The East Asia subgroup was associated with a significantly higher prevalence of an extra distolingual root, whereas the American subgroup, the American native ethnic group, and elderly patients were linked to significantly lower percentages of a second canal at the distal aspect of teeth. No significant differences were noted between male or female patients. CONCLUSIONS: The overall worldwide prevalence rates of radix entomolaris and a second canal at the distal aspect of the mandibular first molar were 5.6% and 36.9%, respectively. The East Asia geographic region and Asian ethnic group had a higher prevalence of a second distal root.

Worldwide Prevalence of a Lingual Canal in Mandibular Premolars: A Multicenter Cross-sectional Study with Meta-analysis.

INTRODUCTION: The presence of multiple root canals is an important morphologic aspect of mandibular premolars. This study aimed to perform a worldwide analysis on the prevalence of a lingual canal in mandibular premolars and to evaluate its influence on patients' demographics in 23 countries using cone-beam computed tomographic images. METHODS: Observers from 23 countries were instructed to evaluate cone-beam computed tomographic images of 300 first and 300 second premolars (13,800 teeth) regarding the presence of a lingual canal, canal configuration, and data related to patients' ethnicity, age, and sex following a standardized screening methodology. Intra- and interrater evaluations were performed using the Cohen kappa test and intraclass correlation coefficient. Proportion and odds ratio forest plots were calculated in order to compare groups. Statistical significance was set at 5%. RESULTS: Both kappa and intraclass correlation coefficient values were above 0.60, and the percentage of agreement was 94.9% (first premolar) and 97.8% (second premolar). A significant statistical difference was observed between the worldwide proportion of a lingual canal in mandibular first (23.8%; range, 12.0%-32.7%) and second (5.3%; range, 1.0%-15.3%) premolars (P < .05). Asians and patients over 60 years old were associated with the lowest proportions of a lingual canal (P < .05), whereas Africans and younger groups were associated with the highest proportions (P < .05). The prevalence of a lingual canal in males (27.9%) was higher than females (20.0%) for the first premolar only (P < .05). Males were associated with 1.533 and 1.597 higher odds of presenting a lingual root canal in the first and second premolars, respectively. CONCLUSIONS: The worldwide proportion of a lingual root canal was 23.6% and 5.3% for the first and second premolars, respectively. Ethnicity, geographic region, age, and sex had an influence on the outcomes.

Clinical and radiographic evaluation of high viscosity bulk-fill resin composite restorations.

PURPOSE: To perform a clinical and radiographic evaluation comparing Filtek Bulk Fill high viscosity bulk-fill resins with Filtek Z350 XT nanoparticulate for 1 year. METHODS: 58 restorations were performed for each material (bulk-fill and nanoparticulate), for a total of 116 restorations. Among these, 42 Class I and 16 Class II restorations were performed for each group, in molars and premolars. Clinical evaluation was performed 7 days (baseline), 6 months and 1 year after restorations, using the World Dental Federation (FDI) criteria. Radiographs were obtained at 7 days and 1 year after the restoration was placed and the radiopacity was measured using Image J software at the same time interval. RESULTS: Of the 70 restorations available for evaluation at 1 year, the Mann-Whitney and Friedman tests showed no statistically significant difference for the FDI criteria analyzed. Greater radiopacity was observed for bulk-fill resin compared to nanoparticulate (two-way ANOVA, P= 0.022). This same test showed no difference in radiopacity between the groups in the two evaluation periods (P= 0.062). The high viscosity bulk-fill resin composite presented similar clinical performance to nanoparticulate resin in this evaluation period and higher radiopacity was observed for this material when compared to nanoparticulate resin, in both time periods. CLINICAL SIGNIFICANCE: The high viscosity bulk-fill resin composite showed similar performance to the nanoparticulate resin during the evaluation period of 1 year. Radiopacity showed high values for the bulk-fill resin when compared to nanoparticulate resin. The bulk-fill resin has potential to be used in posterior teeth.

Worldwide Analyses of Maxillary First Molar Second Mesiobuccal Prevalence: A Multicenter Cone-beam Computed Tomographic Study.

INTRODUCTION: Maxillary first molar second mesiobuccal (MB2) root canal prevalence may change among different populations. The aim of this study was to analyze the worldwide prevalence of the MB2 root canal and understand its possible relation with sex, age, side, and root configuration using in vivo cone-beam computed tomographic (CBCT) assessment. METHODS: Observers from 21 regions were calibrated to achieve a similar CBCT assessment methodology and instructed to collect data from 250 maxillary first molars in previously existing examinations. Intra- and interrater reliability tests were performed. The sample size included 5250 molars and was defined by way of a preliminary trial. Data collected included MB2 presence, sex, age, side, number of roots per tooth, and mesiobuccal root configuration. The z test for proportions in independent groups was used to analyze the differences among subgroups. P < .05 was considered significant. RESULTS: The worldwide CBCT-assessed MB2 prevalence was 73.8%, ranging from 48.0% in Venezuela to 97.6% in Belgium. The prevalence in males and females was 76.3% and 71.8%, respectively (P < .05). Significantly higher MB2 proportions were found in younger patients and 3-rooted molar configurations. The group intraclass correlation coefficient and the percentage of agreement for the MB2 presence were 0.95 and 0.91, respectively. The intrarater Cohen kappa value was above 0.61 for all observers. CONCLUSIONS: MB2 prevalence in the analyzed regions varied widely. The differences may be associated with specificities within each region but also patient demographics. Males, younger patients, and 3-rooted configurations were associated with higher MB2 proportions.

Effect of Fiber Post Cementation Timing on the Bond Strength of Resin Cements in Epoxy Resin-Obturated Canals.

This study evaluated the influence of timing after endodontic treatment and type of resin cement used on the bond strength of fiber posts to epoxy resin-obturated canals. A total of 80 bovine incisor roots were divided into four groups (n = 20). Glass fiber posts were cemented at two different times, immediately or 7 days after endodontic treatment, using either a dual-curing resin cement (RelyX ARC, 3M ESPE) or a self-adhesive resin cement (RelyX U200, 3M ESPE). Following post cementation, the samples were cross-sectioned into slices containing root dentin, cement, and fiber post at the cervical, mid, and apical root thirds. The push-out test was performed on a universal testing machine. Three-way analysis of variance for randomized blocks showed no significant effect within the triple interaction (P = .394) or between the double interactions cement-timing (P = .395), cement-root thirds (P = .996), and timing-root thirds (P = .331). The main factor cement revealed a significant effect, showing that regardless of the timing and root third, RelyX ARC provided significantly higher bond strength values than U200. Regardless of root third and timing, the dual-curing resin cement showed higher bond strength to root dentin when the canals were filled with epoxy resin-based cement.

Worldwide Prevalence of Mandibular Second Molar C-Shaped Morphologies Evaluated by Cone-Beam Computed Tomography.

INTRODUCTION: The aim of this study was to evaluate and compare the C-shaped mandibular second molar prevalence in different regions around the world with the aid of cone-beam computed tomography technology. METHODS: Nine field observers from 9 different geographic regions were calibrated. A total of 400 samples were collected in each region. The prevalence of C-shaped anatomy was calculated. The number of roots and the configuration of the C-shaped canals at 3 different axial levels were also evaluated. The z-test was used to analyze the difference between the means of each independent group. Intrarater reliability was also tested. RESULTS: A total of 3600 teeth from 2735 patients were included in this research; 499 teeth presented C-shaped root canal configuration, representing a global prevalence of 13.9%. China had a prevalence of 44.0%, which was significantly higher than any other region. The C-shape prevalence in women was 16.5%, which was significantly higher than the 10.4% prevalence found in men. No difference between sides (37 or 47) was evident in the global sample. CONCLUSIONS: Cone-beam computed tomography is a valuable tool to evaluate the C-shaped root canal configuration in vivo. In the present study, China presented the highest prevalence of C-shaped mandibular second molars when compared with other regions. Women exhibited a higher prevalence than men.