ORIGINAL RESEARCH

https://doi.org/10.5005/jp-journals-10015-2567
World Journal of Dentistry
Volume 16 | Issue 1 | Year 2025

Topographic Analysis of Maxillary Molar Roots with Sinus Floor and Morphometric Evaluation of Alveolar Bone Using Cone Beam Computed Tomography

Shamali Gaikwad1https://orcid.org/0000-0002-0035-7021, Manjushri Waingade2https://orcid.org/0000-0002-1996-573X, Raghavendra S Medikeri3https://orcid.org/0000-0002-7879-8644

1,2Department of Oral Medicine and Radiology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India

3Department of Periodontology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India

Corresponding Author: Manjushri Waingade, Department of Oral Medicine and Radiology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India, Phone: +91 7875044983, e-mail: manju.waingade@gmail.com

Received: 10 December 2024; Accepted: 27 January 2025; Published on: 13 March 2025

ABSTRACT

Aim: The aim of this study was to evaluate the relationship of the roots of maxillary molars with the maxillary sinus (MS) floor and also to assess the buccal and palatal alveolar bone (AVB) dimensions of maxillary molars using cone beam computed tomography (CBCT).

Materials and methods: This retrospective observational study utilized CBCT scans of 96 individuals. A total of 384 posterior teeth, 192 first molars and 192 second molars, were evaluated to assess the relationship of maxillary molars with the MS floor, maximum buccal AVB width, maximum palatal bone width, vertical distance between furcation and MS floor, and tooth-ridge angle. Data were analyzed using the Chi-squared test, descriptive statistics, and bivariate correlation between two numerical variables.

Results: Type 1 was the most prevalent vertical relationship (37.5%), with a higher frequency for the first molar. Type 1H (35.15%) and Type 4H (30.98%) were the most prevalent horizontal relationships, with a higher frequency for Type 1H in second molars. No significant difference was found according to gender or side. There was a statistically significant difference in buccal and palatal AVB width, vertical distance, furcation distance, as well as tooth-ridge angle (p < 0.05).

Conclusion: The most common vertical and horizontal relationships were Type 1 and Type 1H, respectively. The mesiobuccal (MB) root of the second molar and the palatal root of the first molar were closer to the MS floor. The second molar had significantly more buccal and palatal horizontal bone width than the first molar.

Clinical significance: The study findings suggest that most of the teeth showed the root apex to be located in contact with the lowest border of the maxillary sinus floor (MSF). Thus, caution is necessary, as one root of the molar often projects into the sinus. Similarly, root apices within the alveolar recess of the MSF were placed more toward the buccal side with respect to the buccal root. Therefore, prior knowledge of anatomical structures surrounding teeth is necessary before proceeding with any surgical or implant procedures.

Keywords: Cone beam computed tomography, Cortical bone, Furcation defect, Maxillary bone, Maxillary sinus, Tooth apex

How to cite this article: Gaikwad S, Waingade M, Medikeri RS. Topographic Analysis of Maxillary Molar Roots with Sinus Floor and Morphometric Evaluation of Alveolar Bone Using Cone Beam Computed Tomography. World J Dent 2025;16(1):32–39.

Source of support: Nil

Conflict of interest: None

INTRODUCTION

The maxillary sinus (MS), also called the ”antrum of Highmore,” is the largest and the first of the paranasal sinuses to develop.1,4 The MS is a pyramid-shaped osseous cavity, the base being represented by the nasal antral wall and the tip lying in the zygomatic bone.5,7 The inferior wall of the MS is curved and is formed by the lower third of the medial wall and the bucco-alveolar wall. This floor extends between adjacent teeth or between individual roots in about half of the population, creating elevations in the antral surface (commonly referred to as ”hillocks”) or protrusions of root apices into the sinus.4,8,9

The anatomical relationship between the maxillary sinus floor (MSF) and maxillary posterior teeth is important, as there are many clinical implications for the protrusion of posterior roots into the MS.10,12 The first and second molar roots are most commonly seen in close proximity to the inferior wall of the MS, and occasionally the maxillary canine root also encroaches upon the sinus.1,4,13 Spread of maxillary molar and premolar periapical or periodontal infections to the MS or iatrogenic perforations of the MSF can lead to sinusitis. The complications caused by the projection of roots into the sinus include oroantral fistula (the extension of the root into the sinus following the extraction of the first and second molars) and the endoanteral syndrome (the progression and development of pulpal diseases into the sinus, causing sinusitis). The influence of root protrusion in the MSF may lead to tooth root resorption or tipping during orthodontic treatment.7,9,10,14,16

The topography of the MSF and its relationship with maxillary teeth roots depends on age, pneumatization size and grade, the position of teeth, state of dental retention, and genetics.5,17,18 The biological structures of different populations have different genetic features that can justify their distinct anatomic and topographic relations.6,19,20 Identifying the degree of the proximity, as well as the cortical thickness between the root apex and the inferior wall of the sinus, is of paramount importance for surgical procedures, and careful assessment of the anatomic relationship of maxillary sinuses with the roots of posterior teeth is essential for the diagnosis of maxillofacial pathologies and preoperative treatment plans.13,18 Clinicians conducting preprosthetic and preimplant surgical procedures in the posterior maxilla should take into consideration the amount of protrusion of teeth roots into the sinus and, consequently, the risk of pneumatization after extractions that will reduce the amount of available bone at the implant or denture site.3,8,18,21

The relationship between the roots of the maxillary posterior teeth and the MS can be assessed by various radiographic techniques. Two-dimensional techniques, such as panoramic radiographs, are commonly utilized in dental implant treatment, but due to the superimposition of anatomic structures, horizontal and vertical magnification (10–33%), and a lack of cross-sectional information, panoramic radiographs become unreliable for assessing the topographical relationship of anatomical structures.8,17,22,23 This unreliability of panoramic radiographs can be solved by three-dimensional (3D) cone beam computed tomography (CBCT) imaging, as it provides multiplanar thin-sliced views with no superimposition.6,7,15,17,23

The aim of this study was to investigate the proximity of roots of maxillary posterior teeth to the MS, measure the distance of maxillary posterior teeth roots and MSF, and measure the thickness of bone between the root and the alveolar bone (AVB) using CBCT.

MATERIALS AND METHODS

This was a retrospective observational study that involved CBCT scans of 96 individuals selected randomly from the archives of the Department of Oral Medicine and Radiology, Sinhgad Dental College and Hospital, Pune, from July 2021 to 2022. A total of 384 posterior teeth, 192 first molars, and 192 second molars were evaluated. The study protocol was reviewed and approved (SDCH/IEC/IN/OUT/2021/10) by the Institutional Review Board of the Ethics Committee. The study was conducted from August 2021 to November 2022.

Cone beam computed tomography scans of individuals aged 18 years or above who were referred to the Department for assessment of preimplant site or orthodontic treatment. CBCT images of completely erupted and healthy maxillary first and second molars with completely formed roots were included in the study. CBCT scans with any pathologies (sinusitis, polyps, etc.)/congenital anomalies associated with the MS, showing prosthetic restorations with maxillary molars, root canal-treated maxillary molars, subjects with chronic periodontitis showing horizontal/vertical bone loss with furcation or apical involvement with respect to maxillary molars, or subjects undergoing orthodontic treatment, and images of insufficient quality caused by metal artifacts, blurring, and motion artifacts were excluded.

The CBCT images were obtained using a Promax 3D unit (Planmeca, Helsinki, Finland), operating at 84 kVp, 9–14 mA, with a 0.16 mm voxel size, exposure time of 12 seconds, and a field of view of 8 × 8 cm2. CBCT images were obtained with a slice thickness of 0.2 mm. These images were evaluated with the software Romexis (Planmeca, viewer 4.3.0.R) on a 24-inch Nvidia Quadro FX 380 screen with 1280 × 1024 resolution in a quiet room with subdued ambient lighting. Appropriate background lighting and a color LCD computer screen were used for the processing of the scans. Each scan was analyzed by two investigators. To improve the intra- and interpersonal reliability, investigators were tested on 38 patients for intra- and interexaminer variability with an interval of 7 days before the study analysis in between each measurement. If the variability between the two examiners was found to be up to 10%, then the average was considered. However, for the variability of >10%, reassessment was carried out by another investigator. The original data were reoriented along the occlusal plane and set parallel to the floor plane, and cross-sectional images of CBCT were set up with the mesiodistal centerline of each root of maxillary molar teeth.

In the sagittal section of the first and second maxillary molars, the following parameters were analyzed:

Type 1: The apex of all roots is located in contact with or inferior to the lowest border of the MSF.

Type 2: The diverged buccal and palatal roots envelop the sinus.

Type 3: One or more roots are protruding into the MS.

A—Only the buccal root is protruding into the sinus.

B—Only the palatal root is protruding into the sinus.

C—All roots are protruding into the sinus.

D—A fused root is protruding into the sinus.

Type 4: All roots are leaning to the buccal or palatal side of the MS.

  1. Type 1H: Root apices with the alveolar recess of the MSF placed more toward the buccal side with respect to the buccal root.

  2. Type 2H: The alveolar recess of the MSF is placed between the buccal and palatal roots.

  3. Type 3H: The alveolar recess of the MSF is placed more toward the palatal side with respect to the palatal root.

  4. Type 4H: The alveolar recess of the MSF crosses over the roots without establishing a relationship with them.

  5. Type 5H: The alveolar recess of the MSF is toward the buccal and palatal sides, and may or may not extend between the roots.

Statistical Analysis

All data were subjected to statistical analysis using the Statistical Package for Social Sciences (SPSS v 26.0, IBM). The reliability of recording the same parameters among two examiners was assessed using Cohen’s kappa (κ). Descriptive statistics, such as frequencies and percentages for categorical data, and means and standard deviations for numerical data, have been depicted. The normality of numerical data was checked using the Shapiro–Wilk test, and as the data followed a normal curve, parametric tests were used for comparisons. The bivariate correlation between two numerical variables was checked using the correlation coefficient. Comparison of frequencies of categories of variables with groups was done using the Chi-squared test. For all the statistical tests, p < 0.05 was considered to be statistically significant, keeping α error at 5% and β error at 20%, thus giving power to the study as 80%.

RESULTS

In the present study, CBCT images of 47 males (49%) and 49 females (51%) with a mean age of 28.64 ± 10 years, aged 18–62 years, were analyzed.

The Cohen’s kappa (κ) used to assess the reliability of assessors was 0.785 (p < 0.001), indicating a strong level of agreement.

The present study revealed different types of vertical and horizontal relationships of maxillary first and second molars in relation to the MSF (Figs 1 and 2).

Fig. 1: Type of vertical relationship between maxillary molar roots and MS floor

Fig. 2: Type of horizontal relationship between maxillary molar roots and MS floor

The most common vertical relationship seen between the first and second molars and MSF was Type 1 (37.5%), and the difference was statistically significant (p < 0.01), with a higher frequency for Type 1 with the first molar. Also, Type 1 was most commonly seen on the right and left sides (34 and 40.62%) and in both males and females (38.26 and 36.70%), respectively. There was a statistically nonsignificant difference seen for the vertical relationship according to gender and side (Table 1).

Table 1: The frequency distribution of types of vertical relationship by type of tooth (first molar and second molar) with MSF
Vertical relationship of teeth with MS floor Tooth type Side Gender
1st molar 2nd molar Total Left Right Total Females Males Total
n % n % n % n % n % n % n % n % n %
Type 1 77 40 67 34.89 144 37.5 66 34 78 40.62 144 37.5 75 38.26 69 36.70 144 37.5
Type 2 50 26.04 5 2.60 55 14.32 26 13.54 29 15.10 55 14.32 21 10.71 34 18.08 55 14.32
Type 3A 20 10.41 30 15.62 50 13.02 28 14.58 22 11.45 50 13.02 28 14.28 22 11.70 50 13.02
Type 3B 8 4.16 4 2.08 12 3.12 10 5.20 2 1.045 12 3.12 4 2.04 8 4.25 12 3.12
Type 3C 14 7.29 24 12.5 38 9.89 17 8.85 21 10.93 38 9.89 23 11.73 15 7.97 38 9.89
Type 3D 0 0 2 1.04 2 0.52 1 0.52 1 0.52 2 0.52 2 1.02 0 0 2 0.52
Type 4 23 11.97 60 31.25 83 21.61 44 22.91 39 20.31 83 21.61 43 21.93 40 21.27 83 21.61
Total 192 100 192 100 384 100 192 100 192 100 384 100 196 100 188 100 384 100

n, number of teeth; %, percentage of teeth

The most common horizontal relationship seen between molars and MSF was Type 1H (35.15%) and Type 4H (30.98%). The first molar showed Type 4H (32.81%), and the second molar showed Type 1H (46.87%). There was a statistically significant difference seen for the horizontal relationship between the tooth types (p < 0.01), with a higher frequency for Type 1H with the second molar. On both the right and left sides, Type 1H was the most commonly seen relationship (34.89 and 35.41%), respectively, and in males and females (38.26 and 30.61%), respectively. There was a statistically nonsignificant difference seen for the horizontal relationship according to gender and side (Table 2).

Table 2: The frequency distribution of types of horizontal relationship by type of tooth (first molar and second molar) with MSF
Horizontal relationship of teeth with MS floor Tooth type Side Gender
1st molar 2nd molar Total Left Right Total Females Males Total
n % n % n % n % n % n % n % n % n %
Type 1H 45 23.43 90 46.87 135 35.15 67 34.89 68 35.41 135 35.15 75 38.26 60 30.61 135 35.15
Type 2H 49 25.52 4 2.08 53 13.80 23 11.97 30 15.62 53 13.54 20 10.20 33 16.83 53 13.80
Type 3H 18 9.37 12 6.25 30 7.81 19 9.89 11 5.72 30 7.81 12 6.12 18 9.18 30 7.81
Type 4H 63 32.81 56 29.16 119 30.98 63 32.81 56 29.16 119 51.82 64 32.65 55 28.06 119 30.98
Type 5H 17 8.85 30 15.62 47 12.23 20 10.41 27 14.06 47 12.23 25 12.75 22 11.22 47 12.23
Total 192 100 192 100 384 100 192 100 192 100 384 100 196 100 188 100 384 100

n, number of teeth; %, percentage of teeth

Table 3 shows the mean and standard deviation of each parameter measured on the cross-sectional images of CBCT for the first and second molars. The tooth-wise comparison showed statistical significance for the buccal AVB width at the midpoint and at the apex of the MB root, palatal AVB width at the midpoint, vertical distance/thickness between the MSF and apex of the MB root and palatal root, and vertical furcation distance (p < 0.05). The quadrant-wise internal angle between the long axis of the maxillary first and second molars and the long axis of the AVB was statistically significant (p < 0.05). There was no significant difference between tooth type, side, and gender for all other parameters (p > 0.05) (Figs 345).

Table 3: The frequency distribution of parameters measured on the cross-sectional images of CBCT
Parameter N Tooth type Quadrant Gender
Tooth Mean SD T value p-value Side Mean SD T value p-value Gender Mean SD T value p-value
Max buccal AVB width in midpoint of MB root 192 1 M 1.74 1.08 –6.39 0.000** R 2.18 1.12 1.48 0.139# M 2.01 0.99 –1.452 0.147#
192 2 M 2.46 1.12 L 2.02 1.20 F 2.18 1.30
Buccal horizontal bone width between MB root apex and buccal alveolar plate 192 1 M 3.77 1.99 –6.34 0.000** R 4.65 2.35 1.23 0.219# M 4.012 1.90 –4.006 0.000**
192 2 M 5.23 2.51 L 4.350 2.41 F 4.967 2.69
Max palatal AVB width in midpoint of palatal root 192 1 M 2.05 0.89 –2.28 0.023* R 2.09 0.97 –1.30 0.194# M 2.230 0.94 1.561 0.119#
192 2 M 2.26 0.94 L 2.22 0.87 F 2.08 0.90
Palatal horizontal bone width between palatal root apex and palatal alveolar plate 192 1 M 3.67 1.71 –1.30 0.194# R 3.83 1.71 0.44 0.657# M 3.69 1.83 –1.048 0.295#
192 2 M 3.91 1.94 L 3.75 1.95 F 3.89 1.82
Vertical distance between MB root and MS floor 192 1 M 0.97 2.48 3.01 0.003** R 0.62 2.41 0.04 0.966# M 0.72 2.18 0.894 0.372#
192 2 M 0.26 2.17 L 0.61 2.31 F 0.51 2.51
Vertical distance between palatal root apex and MS floor 192 1 M 0.99 2.31 –2.66 0.008** R 1.41 2.44 0.621 0.535# M 1.37 2.22 0.285 0.776#
192 2 M 1.67 2.71 L 1.25 2.64 F 1.29 2.82
Vertical furcation distance from furcation point of root to lowest point of MS floor 192 1 M 5.80 2.73 –4.39 0.000** R 6.62 2.57 1.675 0.095# M 6.26 2.64 –0.904 0.367#
192 2 M 6.98 2.53 L 6.16 2.79 F 6.51 2.74
Internal angle between long axis of teeth and long axis of AVB 192 1 M 11.64 4.76 –0.93 0.356# R 11.32 4.63 –2.257 0.025* M 12.21 4.83 1.437 0.151#
192 2 M 12.08 4.66 L 12.40 4.73 F 11.52 4.57

*<0.05; **– <0.005; #– >0.05; L, left; N, number of teeth; p-value, probability value; R, right; SD, standard deviation; T value, T test value

Fig. 3: The mean values of each parameter measured on the cross-sectional images of CBCT for molars according to tooth

Fig. 4: The mean values of each parameter measured on the cross-sectional images of CBCT for molar according to quadrant

Fig. 5: The mean values of each parameter measured on the cross-sectional images of CBCT for molar according to gender

The most common vertical and horizontal relationships were Type 1 and Type 1H, respectively. This suggests that most of the teeth showed the root apex to be located in contact with the lowest border of the MSF. Similarly, the root apices with the alveolar recess of the MSF were placed more toward the buccal side with respect to the buccal root.

The MB root of the second molar and the palatal root of the first molar were closer to the MSF. The second molar had significantly more buccal and palatal horizontal bone width than the first molar.

DISCUSSION

The close anatomical relationship between the MS and the root apices of the posterior teeth has a considerable impact on planning surgical and endodontic therapy.5,11,22,25 CBCT provides serial cross-sectional views in the axial, sagittal, and coronal planes. It can also be used to detect some finer structures, such as tiny septa on MSF or thin layers of bone plate between the root apex and the MSF.3,26,27 CBCT has a high resolution, a low dose of radiation, offers a financial advantage for the patient, and allows full 3D characterization of AVB.21,23,27,29

Different classifications for the vertical relationship between the root apex and MSF have been presented in the literature.1,8,12,14,21,24,26,30 These classifications are based on three types: that is, root apex in contact or not in contact with MSF and protruding into the MSF.1,8,13,21,24,26,30 Pagin et al.14 only studied the contacting type and detailed them into contacting by a point or an area. Choi et al.24 simplified classification depending on whether buccal, palatal, or fused roots are protruding into MSF as well as the leaning of roots to the buccal or palatal side of MSF.

In the present study, the classification given by Choi et al.24 was followed. Type 1 (the apex of all roots are located in contact with or not in contact with the MSF) was most commonly seen in first molars (40%) followed by second molars (34.89%). However, Choi et al.24 reported Type 3 (root protrusion into MSF) (44.4%) as the frequent relationship among molars in the Korean population. Meanwhile, Kwak et al.13 (54.5%) and Pagin et al.14 (21.6%) found Type 1 to be the most common vertical relationship in the Korean and Brazilian populations, respectively. Razumova et al.11 reported Type 2 as the most common in first and second molars in the Russian population. Sharan and Madjar8 concluded panoramic radiographs can be as 96% accurate in identifying the relation of the roots to the MS in the case of zero (the root is not in contact with the cortical borders of the sinus) and one scores (an inferiorly curving sinus floor, the root is in contact with the cortical borders of the sinus); when compared to the CT-scan images, but this percentage decreases with higher scores relations. In a study by Mattar et al.31 in the Saudi Arabian population, first molars showed a vertical relationship of 38% for score 3 (one or more root apex is projecting on the sinus cavity for a distance <2 mm). The difference between these studies may be attributed not only to methodological differences but also to the characteristics of ethnicity since the analyzed populations were diverse.

There was no significant correlation of gender and vertical relationship in the present study, which was in accordance with previous studies.6,26,27,32,33 But Haghanifar et al.12 and Ok et al.34 reported that no contact of root with MSF is a common relationship among females. Most of the studies reported there was no significant correlation between the side and vertical relationship, which was in accordance with the present study.6,18,27,33,35 Conversely, Chan et al.32 reported that no contact of root with MSF is a common relationship on the right side.

Estrela et al.19 proposed a classification for the horizontal relationship between MSF and roots of maxillary molars adapted from the criteria given by Kwak et al.13 where he added the probability of protrusion of root into MSF and the inferior position of root apex with MSF. In the current study, the classification given by Estrela et al.19 was followed. The most prevalent horizontal relationship observed in the present study was Type 1H (alveolar recess of the MSF was located between the buccal and palatal roots) in first molars (25–52%) followed by Type 2H (46.87%) in second molars. Whereas, Type 2H was the most prevalent relationship reported by Kang et al.,30 Estrela et al.,19 and Hameed et al.33 in Korean, Brazilian, and Saudi Arabian populations, respectively. There was no significant correlation of gender and side with a horizontal relationship in the present study, which was in accordance with previous studies.7,19,30,33

During immediate implant placement, determining the thickness of the cortical bone wall and the angulation of teeth may help to lower the rate of surgical complications and enable the surgeon to precisely choose the most effective surgical plan for ensuring specific long-term treatment outcomes.30,36,39

In the present study, both buccal and palatal bone thickness were reported to be higher in the region of the second molars than first molars. The buccal and palatal cortical bone thickness in second molars at the midpoint and at the apex was similar to those reported in previous studies.13,22,28 In the present study, buccal bone thickness was more than palatal bone, as reported in previous literature.10,22,28,40 Most studies have reported the buccal AVB to be thinnest on the maxillary first premolars.10,22,28,40 There was no significant correlation between gender and side with buccal and palatal bone thickness, which was in agreement with previous studies.28,40

The sagittal root angle, which measures the long axis as an immediate index for implant placement, is mainly used as the concept of restoration orientation.36,41,42 The roots of maxillary teeth are angled toward a common point about 4 inches away. The AVB angulation represents the root trajectory in relation to the occlusal plane.2 The sagittal root angle is defined as the angle between the long axis of the tooth and the long axis of the corresponding AVB in the sagittal plane.42 This angle corresponds to the AVB characteristics and plays a key role in determining implant position.22,28,41,42 In the present study, the internal angle for the first and second molars was found to be in close approximation with a study reported by Yoshimine et al.22 in the Japanese population. Few studies reported a positive correlation between internal angle and the maxillary premolars.22,28 In the present study, no significant difference was seen in the internal angle in relation to gender or side, which was in accordance with the study reported by Bulut and Şişman28 in the Turkish population.

It is essential to obtain data about the morphological characteristics of the residual alveolar ridge and the quantity of available bone before extracting it when planning an immediate implant operation.2,24,43,45 The vertical furcation distance at the first molar has been reported in a range of 3–9 mm, which is in accordance with the present study.5,16,24 The AVB height of the first molars was slightly shorter than that of the second molars, which was in accordance with the previous study.24 There were no significant differences in alveolar height measurements between the side and gender. However, Choi et al.24 reported that males had comparatively shorter distances as compared to females.

In the present study, the MB root of the second molar and the palatal root of the first molar were closer to MSF, which is in accordance with previous studies.5,14,19,21,22,26,28,46,47 The present study reported the vertical distance of the MB root apex with MSF for second molars and palatal root apex with MSF in the first molar to be similar to that reported in the literature (0.18–6 mm).10,11,15,20,26,30,40,46 Von Arx et al.48 revealed that premolars were closer to the sinus in men than in women, presumably because men have longer rooted and broader fully developed maxillary sinuses. Pei et al.27 showed that irrespective of side or plane, the molar roots were closer to the sinus in women than in men, but these differences were not statistically significant. However, in the present study, no statistically significant difference in vertical distance between root apex and MSF was seen according to side and gender.

This study highlights the role of comprehensive evaluation of bone morphology and the status of bone for effective implant placement, which includes the vertical and horizontal relationship of the maxillary molar roots to the MSF. These parameters, put together, are of paramount importance in facilitating the planning of surgical and implant procedures.

The most important limitation to be considered is that the method of classification used to identify the vertical and horizontal relationship of maxillary posterior teeth with the MSF is not standardized, so the comparison between different studies becomes very difficult. Also, because the sample size was drawn from a single location over a short period, the external validity is limited. More large-scale research is needed to better understand the relationship between the maxillary molar roots and the MS, as well as linear and angular parameters. A larger cohort study with data from a larger geographical area may be required to gain a better understanding of the factors that influence the relationship between the maxillary molar roots and the MS and linear and angular parameters, such as age and region.

CONCLUSION

Thus, the present study findings give a good opportunity to evaluate the parameters that are essential for the placement of implants, endodontic, surgical, and orthodontic treatment planning. This study emphasizes the importance of thoroughly analyzing the anatomical structures to avoid complications and obtain appropriate treatment results.

ORCID

Manjushri Waingade https://orcid.org/0000-0002-1996-573X

Shamali Gaikwad https://orcid.org/0000-0002-0035-7021

Raghavendra S Medikeri https://orcid.org/0000-0002-7879-8644

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