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Many endodontic treatment failures in maxillary molars result from missed second mesiobuccal (MB2) canals. An MB2 canal orifice is present in as many as 95% of maxillary molars, but these canals are not always located during endodontic procedures. Additional tools, such as cone-beam computed tomographic (CBCT) imaging, may be needed to locate these canals in maxillary molars. Hence, the aims of this study were to investigate the frequency of use of CBCT imaging during the treatment of maxillary molars and to evaluate the influence of its use on the detection of MB2 canals.Endodontic treatment records, digital intraoral radiographs (when present), and CBCT images from all maxillary first and second molars treated at the University of Washington, Seattle, WA, between 2010 and 2014 (N = 886) were reviewed. Statistical analysis was performed to assess differences between the groups.Overall, an MB2 canal was found in 55.8% of the maxillary molars studied, and CBCT imaging assisted in detecting 11.7% of these canals. CBCT imaging was used in 16.5% of the cases treated and was used significantly more for retreatment cases. CBCT imaging was used preoperatively in 5.6% of cases, and the data show that significantly more MB2 canals were located when a preoperative CBCT image was available. More MB2 canals were located in first molars without full-coverage crowns.The data show that CBCT imaging is a valuable tool in locating MB2 canals. Based on the results of his study, the use of CBCT imaging could be warranted when treating maxillary molars.This study evaluated the effectiveness of using cone-beam computed tomographic (CBCT) imaging in locating second mesiobuccal (MB2) canals in maxillary molars.Overall, an MB2 canal was found in 55.8% of the maxillary molars studied, and CBCT imaging assisted in detecting 11.7% of these canals.More MB2 canals were located when a preoperative CBCT image was taken.Significantly more MB2 canals were found when CBCT imaging was used during second molar retreatments.