Colin Dick 1

Background
The apices of maxillary premolar and molar roots may exhibit incomplete bone coverage, an anatomical variation that poses clinical implications during dental procedures such as extractions or endodontic treatments. Prior studies have suggested that the buccal bone plate may not entirely cover the root apices in certain regions, yet the prevalence and anatomical patterns of this finding remain underexplored. This study aimed to assess the frequency and characteristics of incomplete apical bone coverage (IABC) of maxillary premolar and molar roots using cone-beam computed tomography (CBCT).

Methods
A retrospective cross-sectional study was conducted using 400 CBCT scans from adult patients. Inclusion criteria focused on the presence of fully erupted maxillary premolars and molars with closed apices. Each root was evaluated in the sagittal and cross-sectional views for evidence of IABC, defined as a lack of overlying cortical bone on the apical third. The occurrence was analyzed across tooth type, root location (buccal or palatal), and sex. Descriptive and inferential statistics were employed to determine prevalence and associated factors.

Results
Out of 400 CBCT scans, 1,583 individual roots were assessed. IABC was identified in 45.7% of roots, with buccal roots of maxillary first premolars and mesiobuccal roots of first molars being most commonly affected. Palatal roots exhibited significantly lower prevalence. IABC was more frequent in males than females and was more often observed in the posterior maxilla. Additionally, right and left sides were comparably affected, with no significant lateral asymmetry. The findings suggest that IABC is a common anatomic feature in the maxillary posterior region.

Limitations
Limitations include the retrospective nature of the study and lack of clinical correlation with surgical or pathological outcomes. The study population may not be representative of all demographic groups, potentially affecting generalizability. Additionally, CBCT limitations such as resolution and artifact interference could affect detection accuracy.

Conclusions
Incomplete apical bone coverage is a prevalent finding in maxillary posterior teeth, particularly in buccal roots. Recognition of this anatomical variation is important for clinicians during treatment planning and surgical interventions to avoid complications. CBCT proves to be a valuable tool in identifying this feature preoperatively.

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