Camacho-Aparicio Liliana A, Borges-Yáñez S Aída, Estrada Daniel, Azcárraga Minerva, Jiménez Reneé, González-Plata-R Ricardo
Dental Public Health Department, División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Ciudad Universitaria, Av. Universidad 3000, Del. Coyoacán, C.P. 04510, México City, México.
J Clin Exp Dent. 2022 Jun 1;14(6):e471-e478. doi: 10.4317/jced.59347. eCollection 2022 Jun.
Several investigations have determined whether the use of a dental operating microscope (DOM) in combination with selective dentine removal with ultrasonic tips increases the percentage of location of the Mesiobuccal 2 (MB2) root canal in maxillary first molars (MFM). However, these studies did not report the performance of in vivo measurements with the comparison with a gold standard. The aim of this study was to determine the validity of the DOM and selective dentin removal with ultrasonic tips to locate the MB2 root canal in MFM using Cone Beam Computed Tomography (CBCT) as the gold standard.
The initial sample size was 91 patients, but 7 were excluded, so the sample size was 84 patients who signed the informed consent. Inclusion criteria: MFM indicated for root canal treatment. An expert blinded observer identified the MB2 in the CBCT. Two standardized examiners (Kappa=91%) performed the clinical assessment in three stages: Stage 1, canal location with an endodontic explorer and a mirror; Stage 2, use of DOM and Stage 3, use of DOM plus selective dentine removal with ultrasonic tips. The validity of each stage was calculated.
The prevalence of MB2 using CBCT was 79%, by clinical location was 68%. Sensitivity was 79%, 82%, 86% for stage 1, 2 and 3, respectively. Specificity and Positive Predictive Values were 100% for all methods. Negative Predictive Value was 56%, 60%, 67%, respectively. Positive Likelihood Ratio tends to infinity for all methods, Negative Likelihood Ratio= 0.21, 0.18 and 0.14 and Accuracy= 83%, 86% and 89%, respectively.
The use of DOM with selective dentine removal with ultrasonic tips is the most valid method for locating MB2 canal in MFM. There was an increase in the location of the MB2 root canal with the DOM and ultrasonic tips, which definitely help the clinician. Cone beam computed tomography, microscopy, second mesiobuccal canal, sensitivity and specificity, validity.
多项研究已确定，使用牙科手术显微镜（DOM）结合超声尖进行选择性牙本质去除，是否会提高上颌第一磨牙（MFM）近中颊根第二根管（MB2）的定位成功率。然而，这些研究并未报告与金标准相比的体内测量性能。本研究的目的是使用锥形束计算机断层扫描（CBCT）作为金标准，确定DOM和超声尖选择性牙本质去除在定位MFM中MB2根管方面的有效性。
初始样本量为91例患者，但排除了7例，因此样本量为84例签署知情同意书的患者。纳入标准：适用于根管治疗的MFM。一名不知情的专家观察者在CBCT中识别出MB2。两名标准化检查者（kappa = 91%）分三个阶段进行临床评估：第1阶段，使用牙髓探查器和镜子进行根管定位；第2阶段，使用DOM；第3阶段，使用DOM加超声尖进行选择性牙本质去除。计算每个阶段的有效性。
使用CBCT时MB2的患病率为79%，临床定位时为68%。第1、2和3阶段的敏感性分别为79%、82%、86%。所有方法的特异性和阳性预测值均为100%。阴性预测值分别为56%、60%、67%。所有方法的阳性似然比趋于无穷大，阴性似然比分别为0.21、0.18和0.14，准确性分别为83%、86%和89%。
使用DOM结合超声尖进行选择性牙本质去除是定位MFM中MB2根管最有效的方法。使用DOM和超声尖时，MB2根管的定位成功率有所提高，这无疑对临床医生有帮助。锥形束计算机断层扫描、显微镜检查、近中颊根第二根管、敏感性和特异性、有效性。
