Prevalence of Unfilled MB2 Canals and Their Association with Apical Periodontitis: A CBCT-Based Cross-Sectional Study in a German Population

<b>Background/Objectives</b>: The presence of untreated second mesio-buccal canals (MB2) in maxillary first molars is usually associated with endodontic treatment failure. Previous CBCT-based investigations have evaluated the quality of root canal fillings and the prevalence of apical lesions in endodontically treated teeth. However, evidence specifically addressing untreated MB2 canals and their association with apical periodontitis remains limited. Therefore, the aim of this cross-sectional study was to evaluate the prevalence of unfilled MB2 canals in endodontically treated maxillary first molars and their association with apical periodontitis. <b>Methods</b>: CBCT scans of 75 patients from an endodontic practice were retrospectively analyzed. Maxillary first molars (teeth 16 and 26) were evaluated for the presence and filling status of root canals (MB1, MB2, palatal, distal) and the presence of periapical radiolucency using the CBCT periapical index. Two calibrated examiners independently assessed all images. The association between unfilled MB2 canals and apical periodontitis was analyzed using chi-square tests, and odds ratios with 95% confidence intervals were calculated. <b>Results</b>: The mean patient age was 53.4 ± 15.5 years (range: 14-80). An MB2 canal was present in 84% (63/75) of eligible teeth. Among teeth with an MB2 canal, only 20.6% (13/63) were endodontically filled, while 79.4% remained untreated. Apical periodontitis was observed in 65.3% (49/75) of all teeth. A significant association was found between unfilled MB2 canals and apical periodontitis (<i>p</i> < 0.001), with an odds ratio of 0.095 (95% CI: 0.022-0.402), indicating that filled MB2 canals significantly reduced the possible risk of periapical pathology. <b>Conclusions</b>: A high prevalence of unfilled MB2 canals was observed in this German population (79.4%). Furthermore, unfilled MB2 canals were strongly associated with apical periodontitis. Therefore, clinicians should utilize all available diagnostic tools, including CBCT and dental microscopes, to maximize MB2 canal identification and improve endodontic treatment outcomes.