Effect of a metal artifact removal algorithm on visibility of the second mesiobuccal canal of maxillary molars on cone-beam computed tomography scans: multilevel mixed-effects ordered logistic regression

Objectives: This study aimed to assess the effect of a metal artifact removal (MAR) algorithm on the visibility of the second mesiobuccal canal (MB2) of maxillary molars on cone-beam computed tomography (CBCT) scans. Materials and Methods: This cross-sectional study evaluated 41 CBCT scans of patients retrieved from the radiology clinic's archives. The CBCT scans were saved with and without the MAR algorithm applied. The images were coded and evaluated by two endodontists to assess MB2 detection in maxillary molars and its visibility level using a 5-point Likert scale. Of the 164 samples, 32 were excluded from the study, and 132 teeth were examined. The Wilcoxon test was used to compare images with and without MAR with respect to MB2 visibility (alpha=0.05). Results: No significant difference existed between images with and without MAR regarding the visibility of MB2 of maxillary first and second molars in apical (OR= 0.96, 95% CI; 0.58–1.59), middle (OR= 1.01, 95% CI; 0.65 – 1.59) and coronal (OR= 1.02, 95% CI; 0.63-1.64) thirds of the root by adjusting the effect of other variables. Conclusion: According to the present results, the application of the MAR algorithm did not significantly change the visibility of MB2 in the maxillary first and second molars on CBCT scans.