Incidence of Middle Mesial Canals in Mandibular Molars during Root Canal Treatment and Non-Surgical Retreatment

Introduction Large scale clinical studies on the incidence of middle mesial canals (MMCs) in non-surgical root canal treatment and retreatment of mandibular molars are lacking. The primary aim of this observational study was to determine the incidence of MMCs in mandibular first and second molars that received root canal treatment (RCT) or non-surgical retreatment (NSRetx). The secondary aim was to determine factors associated with incidence of MMCs. Methods Included were 3,018 mandibular molars that received RCT (n=1,624) or NSRetx (n=1,394) by three Endodontists in a private practice. Demographic and procedural data were collected. Bivariate and multivariable (Poisson regression model) analyses were performed. Results Incidence of MMCs was 8.8% (n=267). While the bivariate analysis showed that NSRetx was significantly associated with incidence of MMCs, this association did not reach the threshold for statistical significance after controlling for all covariates (p=.07). Multivariable analysis on the entire cohort showed that incidence of MMCs was significantly associated with younger age (Risk Ratio [RR]: 1.62; 95% confidence interval [CI]: 1.28-2.06), male gender (RR: 1.48; 95%CI: 1.18-1.85), pre-operative CBCT (RR:1.48; 95%CI: 1.17-1.89), and first molar (RR: 2.30; 95% CI:1.74-3.05). Subgroup multivariable analyses revealed that incidence of MMCs was associated with male gender only in the RCT group (RR: 2.26; 95%CI: 1.55-3.30) but not in the NSRetx group (RR: 1.11; 95%CI: 0.82, 1.50); and with pre-operative CBCT only in the NSRetx group (RR: 1.78; 95%CI: 1.28, 2.50) but not in the RCT group (RR: 1.10; 95%CI: 0.71, 1.69). Associations with younger age and first molar remained unchanged. Conclusions Overall incidence of MMCs was 8.8%. Incidence of MMCs was significantly higher in younger patients and in mandibular first molars but was not associated with the type of treatment.