Restor Dent Endod.  2022 Aug;47(3):e33. 10.5395/rde.2022.47.e33.

Proximity of maxillary molar apexes to the cortical bone surface and the maxillary sinus

• Lee HS
• Kim D
• Kim SK

• KMID: 2548137
• DOI: http://doi.org/10.5395/rde.2022.47.e33

Abstract

Objectives
This study aimed to analyze the proximity of maxillary molar roots to their overlying cortical bone surfaces and the maxillary sinus.
Materials and Methods
Cone-beam computed tomographic images of 151 patients with completely erupted upper molars that had 3 separate roots were studied. The following distances were measured: from the root apex to the cortical plate and maxillary sinus floor, and from the apical 3-mm level of the root to the cortical plate. Differences between groups were analyzed with 1-way analysis of variance and the Scheffé post hoc test, the significance of differences between cone-beam computed tomography views with the paired t-test, and the significance of differences among age groups with linear regression analysis. The significance level was set at p < 0.05.
Results
The mesiobuccal and distobuccal root apexes of maxillary second molars were more distant from the buccal cortical plate than the maxillary first molars (p < 0.05). The apical 3-mm level of the mesiobuccal root of the first molar was closer to the buccal cortical bone than the second molar (p < 0.05). In the maxillary first molars, the thickness of the buccal cortical bone decreased in all roots with age (p < 0.05). In all root apexes of both molars, the difference in the vertical level between the maxillary sinus floor and the root apex increased with age (p < 0.05).
Conclusions
Awareness of the anatomical profile of maxillary molar apices in relation to the cortical bones and maxillary sinus will be beneficial for apical surgery.

Keyword

Maxillary molar; Proximity; Cortical plate; Maxillary sinus; Endodontic surgery

Figure

• 

  Figure 1 PRIRATE 2020 flowchart for the experimental design.CBCT, cone-beam computed tomography; KNUDH, Kyungpook National University Dental Hospital; IRB, Institutional Review Board; ANOVA, analysis of variance.

• 

  Figure 2 Measurements of root distance from the cortical bone. A. Measurements of the maxillary molar root apex from the axial view of cone-beam computed tomography (CBCT). B. Measurements at the apical 3-mm level of the root from the coronal view of CBCT.1MB, distance between the first molar mesiobuccal root and the buccal cortical plate; 1DB, distance between the first molar distobuccal root and the buccal cortical plate; 1PB, distance between the first molar palatal root and the buccal cortical plate; 1PP, distance between the first molar palatal root and the palatal cortical plate; 2MB, distance between the second molar mesiobuccal root and the buccal cortical plate; 2DB, distance between the second molar distobuccal root and the buccal cortical plate; 2PB, distance between the second molar palatal root and the buccal cortical plate; 2PP, distance between the second molar palatal root and the palatal cortical plate.

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  Figure 3 The vertical relationship between the maxillary molar apex and the maxillary sinus floor. (A) Type I, the root apex protruded into the sinus; (B) type II, the root apex was 0 mm from the sinus floor or was at the same vertical level as the sinus floor; and (C) type III, the root apex was below the sinus floor.a, level of root apex; s, level of maxillary sinus floor; d, level distance between root apex and sinus floor.

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