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Objective: This study's objective is to analyze the prevalence as well as the configuration of second mesiobuccal (MB2) in maxillary 2nd molars and predict its existence based on mesiobuccal-palatal (MB-P) distance, MB-P/distobuccal-palatal (DB-P) distance ratio and mesiobuccal, distobuccal, and palatal orifice (MDP) angle with the help of cone-beam computed tomography. Materials and Methods: The presence and absence of MB2 are noted down in 300 maxillary 2nd molars. Canal configuration was observed from the orifice to the apex in the mesiobuccal root. Interorifice distances of MB-DB, MB-P, and DB-P were measured. MB-P and DB-P ratios have been computed. MDP angle was also measured. Then, MB2 existence and the above factors are correlated. Results: The prevalence of MB2 is increased as the values increase in MB-P distance (>5.25 mm), MB-P and DB-P ratio (>1.25), and MDP angle (>95°). Out of 150 MB2 teeth, Vertucci type 2, 4, and 8 Configurations are seen in 103 (68.6%), 46 (30.6%), and 1 (0.67%), respectively. Conclusions: This positive correlation between MB2 presence and these three factors helps clinicians to identify MB2 canals effectively. [ABSTRACT FROM AUTHOR]

Aim: To describe the management of the palato‐mesiobuccal (PMB) canal in maxillary second molars with fused roots using conventional techniques. Summary: Root canal treatment success hinges upon effectively addressing the intricate and variable anatomy of molar teeth. Failure to do so can lead to persistent infections and treatment failure. Recent advancements in imaging technologies have provided unparalleled insights into dental anatomy, especially in molars. Among these discoveries is the PMB canal, a unique anatomical variant recently reported for the first time in Endodontic literature. This canal, found in maxillary second molars with fused roots and originating from the coronal third of the palatal canal while traversing towards the mesiobuccal root presents challenges in clinical management due to its location. This article is the first to showcase the management of the PMB canal using conventional techniques. In the first case, a 38‐year‐old male patient presented with asymptomatic irreversible pulpitis in the maxillary second right molar. Following thorough instrumentation and irrigation, the presence of the PMB canal was discovered during root canal preparation. The canal was managed using rotary instruments and obturated successfully, resulting in a symptom‐free tooth at an 8‐year follow‐up. The second case illustrates a similar scenario in a 23‐year‐old female patient presenting with symptomatic irreversible pulpitis in tooth 17. The PMB canal was identified during treatment and managed using rotary nickel‐titanium instruments, leading to a favourable outcome at a 9‐year follow‐up. Key learning points: In fused roots of maxillary second molars, a PMB canal might be expected.Exploration of the buccal wall of the palatal canal under magnification after shaping procedures can reveal the PMB canal orifice in fused roots.Small tapers are suggested for the enlargement of the PMB canal.Continuous bleeding spots in the palatal canal might indicate a possible PMB canal orifice in vital cases.The use of an apex locator is suggested for the differential diagnosis of the PMB canal orifice from a perforation site. [ABSTRACT FROM AUTHOR]

Objective To explore the distribution and difference of bone thickness in the infrazygomatic crest (IZC) in adolescents at different eruption stages of the maxillary second molar and provide guidance for placement of orthodontic IZC miniscrew. Methods Cone beam CT scans of 110 adolescents with normal occlusion were assessed. According to the eruption stage of the maxillary second molar, the subjects were divided into 3 groups of S1 (44 cases), S2 (30 cases), and S3 (36 cases). The horizontal base plane (HB) in this study was defined as a horizontal axial section with the mesiobuccal cusps of the left maxillary first molar on. Two coronal slices of interest were selected which passing through the apex of mesiobuccal (MB) and distobuccal (DB) roots of the left maxillary first molar respectively. In both of the two coronal slices, the buccal bone thickness was measured at 13 (HB13), 15 (HB15), 17 (HB17) mm above the HB plane at a gingival inclination of 60°. The measurement differences of bone thickness between MB and DB, and among different heights were evaluated, and the differences among S1, S2, and S3 groups in each simulated paths were compared. Distributions of measurements were reported as colormaps. Results The IZC bone thickness of DB was thicker than MB at HB13 and HB15 in the 3 groups.The higher the insertion height, the smaller the bone thickness (P<0.05). Bone thickness decreased from S1 to S2 to S3 at HB13 and HB15. The maximum bone thickness (5.20 mm) was observed at HB13 in DB, and the minimum bone thicness (1.90 mm) was observed at HB17 in DB. Conclusion The thickest bone in IZC of the three groups located at HB13 in DB of the maxillary first molar, and the bone thickness decreases with the increase of the insertion height. The later the eruption stage of the maxillary second molar, the less bone thickness in the IZC region and the operation difficulty might increase. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Main objective of root canal therapy is to locate all the canals, cleaning and shaping, and obturation to obtain fluid tight seal. Failure to locate all canals can lead to the failure of root canal therapy. Variation of pulp aperture, among teeth with multiple roots, constitutes recurring issue during diagnosing and completing efficient endodontic procedures. Understanding normal anatomy features and associated likely modifications is critical in the effective execution of the dental procedure, since the inability to effectively treat simply one canal may end up into endodontic unsuccessful therapy. The paper covers a procedure whereby the root pattern and canals of the maxillary second molar were modified employing an operative microscope and verified with cone‐beam computed tomography (CBCT). Cone‐beam computed tomography revealed that the maxillary second molar containing two different palatal roots and canals and two distinct buccal roots and canals. This Research paper presents and investigates the morphological difference observed on the maxillary second molar in order to guarantee the effectiveness of root canal treatment examined utilizing imaging techniques like CBCT. [ABSTRACT FROM AUTHOR]

The maxillary second molar is a tooth that can have relationships with the maxillary sinus. The endodontic treatment may present difficulties (secondary and tertiary dentin deposits, narrowing of the canals, limited mouth opening), and the success of the treatment is dictated by the quality of the chemomechanical canal treatment and the canal obturation. It is essential to avoid accidents and incidents that can induce dental-origin conditions of the maxillary sinus. [ABSTRACT FROM AUTHOR]

Failure to locate a complete canal system affects the prognosis of root canal treatment. A missed root canal is one of the most common reasons for failed root canal treatment. The prevalence of the second mesiobuccal canal in the maxillary second molar is relatively high and has a variety of configurations. Therefore, knowledge of its morphology is required in clinical endodontics. This review presented the canal in terms of its prevalence, classification, anatomical features, and the method for locating the second mesiobuccal canal in the maxillary second molar. Root canal treatment requires knowledge of tooth morphology, appropriate access preparation, and a thorough examination of the tooth's interior. Thus, clinicians should carefully employ various methods for assessing the anatomy of the entire root canal system to prevent failure in locating the second mesiobuccal canal. This canal can be located by modifying the access cavity design and utilizing specific instruments to improve the second mesiobuccal canal system visualization. [ABSTRACT FROM AUTHOR]

Key Clinical Message Main objective of root canal therapy is to locate all the canals, cleaning and shaping, and obturation to obtain fluid tight seal. Failure to locate all canals can lead to the failure of root canal therapy. Abstract Variation of pulp aperture, among teeth with multiple roots, constitutes recurring issue during diagnosing and completing efficient endodontic procedures. Understanding normal anatomy features and associated likely modifications is critical in the effective execution of the dental procedure, since the inability to effectively treat simply one canal may end up into endodontic unsuccessful therapy. The paper covers a procedure whereby the root pattern and canals of the maxillary second molar were modified employing an operative microscope and verified with cone‐beam computed tomography (CBCT). Cone‐beam computed tomography revealed that the maxillary second molar containing two different palatal roots and canals and two distinct buccal roots and canals. This Research paper presents and investigates the morphological difference observed on the maxillary second molar in order to guarantee the effectiveness of root canal treatment examined utilizing imaging techniques like CBCT.

This study investigated the root and canal morphology of maxillary second molars in a Black South African population using high‐resolution cone‐beam computed tomography. In total, 386 maxillary second molar teeth were evaluated and described according to the classifications of Vertucci (with the additions of Sert and Bayirli), as well as Ahmed et al. Root number, fusions and canal morphology were recorded. Relationships between morphology, sex and age were assessed using Fisher's exact test (p < 0.05). Maxillary second molars were predominantly three‐rooted (96.1%), with root fusion observed in 14%. No relationships between sex, age and canal morphology were found. Additional canals were observed in 67.4% of mesiobuccal roots. The Ahmed et al. classification provided a better overall description of the morphology. In this population, maxillary second molar teeth exhibited a diversity of root and canal morphology. Complex variations may render endodontic management more difficult and increase the possibility of missed anatomy. [ABSTRACT FROM AUTHOR]

Copyright of Clinical Orthodontics is the property of Dental Press International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Key Clinical Message: Endodontists should be aware that some maxillary second molars can have more than three roots. If any unusual anatomical features are detected during dental radiography or endodontic procedures, it is necessary to conduct cone‐beam computed tomography (CBCT) scanning to prevent procedural mishaps. CBCT can provide three‐dimensional reconstructed images of the root canal system. With the help of CBCT, variations in tooth root number and root canal morphology, such as extra canals, apical ramifications, apical deltas, and lateral canals, can be identified. Knowledge of the variations is very important for the success of endodontic treatment. This report suggests that endodontists must not assume that a MSM has only three tooth roots, which is the most prevalent number. [ABSTRACT FROM AUTHOR]

This report aims to communicate the discovery of a novel anatomy in a 3-rooted maxillary second molar, named as palato-mesiobuccal canal. The tooth selected for this report was found incidentally as a result of a study on extracted maxillary molars that was being conducted for an unrelated purpose and involved hundreds of teeth. This 3-rooted maxillary second molar was scanned using a micro–computed tomography device set at a pixel size of 13.68 μm. The images were reconstructed with previously tested parameters resulting in the acquisition of 1655 axial cross-sections. Three-dimensional (3D) models of the internal and external anatomies were generated in Standard Tessellation Language (STL) format and were texturized to simulate the pulp tissue. The inner structure of the tooth was analyzed through the axial cross sections and the 3D volume was qualitatively evaluated. The analysis of the 3D models revealed that the maxillary second molar under examination has 3 independent roots and 4 root canals. Each root (mesiobuccal, distobuccal, and palatal) contains 1 canal, while the fourth canal follows a unique path, originating in the coronal third of the palatal canal and proceeding in a buccal direction ultimately exiting through an independent foramen at the apex of the mesiobuccal root, near the mesiobuccal canal. This brief communication reports the discovery of a novel anatomy in a 3-rooted maxillary second molar, named as palato-mesiobuccal canal, and provides important insights into the complexity of the root canal system in this group of teeth. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Clinicians should be aware of the variations in the number of roots and root canals and the peculiar or eccentric location of root canals. An intraoperative CBCT can be very useful in improved visualization of the anatomical variations. This case report describes the unusual location of the distobuccal root canal in a maxillary second molar with root fusion. On access opening, three distinct root canal orifices, the mesiobuccal canal, palatal canal, and a third orifice closer to the palatal canal, were seen, giving an illusion of an additional palatal canal. An attempt was made to search for the distobuccal canal in its usual position, leading to the gouging of the pulp chamber floor. An intraoperative limited field of view cone‐beam computed tomography (CBCT) revealed the root orifice adjacent to the palatal canal was the distobuccal canal. CBCT also revealed fusion of both the buccal and palatal roots in the root's coronal and middle third region, but they were not fused apically. [ABSTRACT FROM AUTHOR]

Background: The goal of the present research was to employ CBCT imaging to assess the root and canal anatomy of maxillary second molars in a population from the Hail province of Saudi. The effects of gender and side were taken into account. Methods: The investigation included a sample size of 499 completely developed right and left untreated maxillary second molars obtained from 250 Saudi people. The root morphology of each tooth was evaluated. The examination also included an analysis of the canal morphology for each tooth, utilizing Vertucci's categorization. The effect of genders as well as sides was recorded. Results were analyzed using the Chi-square test. Results: 464 teeth had three roots (93.0%), whereas 20 teeth (4.0%) had two roots. One root was recorded in 7 (1.4%) of the study sample, whilst 8 (1.6%) had four roots. Although there were no significant differences between the left and right sides (p = .075), gender had a significant influence on the number of roots (p = .030). 240 M (48.1%) had three canal orifices, and 247 (49.5%) had four root canal orifices. Eight molars (1.6%) had two canal orifices, while one and five canal orifices were found in 3 (0.6%) and one (0.2%), respectively. Gender had a significant impact on the number of root canal orifices (p = .039). The observed differences in the orifices of the root canals between the left and right sides were not statistically significant (p = .059). The prevalence of MB2 in maxillary second molars was found to be 49.7%. In the mesiobuccal root, the Vertucci type I configuration had the highest canal frequency (50.3%), followed by the Vertucci types II (14.4%), IV (13.8%), V (12.0%), and III (7.6%), and VI (1.8%). The prevalence of Vertucci type I canal configurations was found to be higher in the distobuccal root (99.4%) and palatal root (98.2%) of maxillary second molars. Conclusions: Significant variations in root canal anatomy were observed within the Saudi population. The majority of the subjects from Saudi Arabia in this study exhibited the presence of maxillary second molars with three roots. Approximately half of the sample under investigation exhibited the presence of the four canals.

Key Clinical Message Endodontists should be aware that some maxillary second molars can have more than three roots. If any unusual anatomical features are detected during dental radiography or endodontic procedures, it is necessary to conduct cone‐beam computed tomography (CBCT) scanning to prevent procedural mishaps. Abstract CBCT can provide three‐dimensional reconstructed images of the root canal system. With the help of CBCT, variations in tooth root number and root canal morphology, such as extra canals, apical ramifications, apical deltas, and lateral canals, can be identified. Knowledge of the variations is very important for the success of endodontic treatment. This report suggests that endodontists must not assume that a MSM has only three tooth roots, which is the most prevalent number.

Key Clinical Message Clinicians should be aware of the variations in the number of roots and root canals and the peculiar or eccentric location of root canals. An intraoperative CBCT can be very useful in improved visualization of the anatomical variations. Abstract This case report describes the unusual location of the distobuccal root canal in a maxillary second molar with root fusion. On access opening, three distinct root canal orifices, the mesiobuccal canal, palatal canal, and a third orifice closer to the palatal canal, were seen, giving an illusion of an additional palatal canal. An attempt was made to search for the distobuccal canal in its usual position, leading to the gouging of the pulp chamber floor. An intraoperative limited field of view cone‐beam computed tomography (CBCT) revealed the root orifice adjacent to the palatal canal was the distobuccal canal. CBCT also revealed fusion of both the buccal and palatal roots in the root's coronal and middle third region, but they were not fused apically.

Objective To study the diagnostic accuracy and the distance between the root of maxillary posterior tooth and the maxillary sinus using panoramic radiography and cone beam computer tomography; to provide basic information for clinicians to treat diseases in the maxillary posterior region. Methods Eighty patients were included in this study. A total of 671 specimens were measured for the distance between the root tip and the maxillary sinus floor in both imaging modalities. Results The roots that did not contact the sinus floor or contacted but did not project into the sinus cavity showed an agreement of 82% and 70% when using panoramic radiography. Forty-eight percent of the roots that projected into the sinus cavity in panoramic radiography showed protrusion into the sinus with cone beam computer tomography (CBCT). For panoramic radiography and CBCT showing root projections into the sinus cavity, the average distances were 2.19 ± 1.82 mm and 1.47 ± 1.01 mm, respectively. There was a significant difference between the two values (P ＜ 0.05). Conclusion Panoramic radiography is more accurate when roots of maxillary posterior teeth do not contact the sinus floor or contact it. However, it has a lower accuracy rate when the tooth roots protrude into the sinus.

Introduction. The success of endodontic treatment depends on the adequate biomechanical preparation and obturation of the entire root canal system. The untreated or poorly debrided/obturated root canals are among the most frequent causes of endodontic treatment failure. The endodontic treatment of maxillary molar has the highest failure rates due to the complexity of their root canal anatomy. The aim of the study is to present the endodontic treatment of maxillary second molar with two roots and two canals. Case report. The clinical case report presents the endodontic treatment of maxillary second molar with two roots and two canals in a patient, aged 32 years. After the analysis of preoperative diagnostic radiograph, opening the pulp chamber and access cavity preparation, two canal orifices were localized. After the biomechanical preparation, root canals were obturated with the Gutta-percha points and sealer during the same visit. Conclusion. Although maxillary second molar most commonly varies in terms of the number of root canals in the buccal roots, less common variations in anatomical and morphological traits, such as the presence of two roots and two canals, should be considered during endodontic treatment.

This article aims to focus on the brief knowledge about the anatomical and morphological variations of the root canal anatomy of the maxillary second molar. The present case report reveals the endodontic management of the four-rooted right maxillary second molar diagnosed with the help of cone-beam computed tomography (CBCT) imaging. The CBCT findings confirmed the presence of four roots (mesiobuccal, distobuccal, distopalatal, and mesiopalatal) and four root canals. This case report demonstrates the importance of CBCT which is a valuable tool for diagnosis and management of these complex root canal systems. [ABSTRACT FROM AUTHOR]

Objective: To assess the number of canals and morphological patterns of mesiobuccal root of maxillary second molars based on Vertucci's classification analyzed by Cone Beam Computed Tomography (CBCT) scans in our patients. Study Design: Retrospective Cross sectional analytical study. Place and Duration: At Operative Dentistry Department, Islamic International Dental Hospital, Islamabad from 1st September 2020 to 1st January 2021. Methodology: Cone-beam computed tomography (CBCT) scans (PLANMECA, Finland) were used with image size 13 x 9cm (651 x 651 x 451 cm³), voxel size 200μm to include maxillary anatomy with 96 KV radiation dose, exposure time of 12.527 seconds and current of 9 MA. Slice thickness of 0.200mm was recorded. Axial, coronal and sagittal planes were used to evaluate root canal anatomy of maxillary second molars. Number of canals and morphological patterns as per Vertucci's classification were recorded in mesiobuccal root of maxillary second molars. Results: Out of 200 cone-beam computed tomography (CBCT) scans, 316 maxillary second molars met the inclusion criteria. Mesiobuccal root of maxillary second molars having one canal were found in 78.48% and 2 canals in 21.52%. Maximum frequencies of canals in mesiobuccal root of maxillary second molars as per Vertucci's Classification were found to have type I i.e. 78.5% followed by type IV in 16.5% and type II in 5%. Conclusion: Number of canals is variable for the mesiobuccal root of maxillary second molar. Single canal and Vertucci's type I is the most common canal configuration type in mesiobuccal root of maxillary second molars. Significant difference was found between gender and Vertucci's classification in mesiobuccal root. [ABSTRACT FROM AUTHOR]

Abstract This report illustrates a rare case of a geminated maxillary right second molar tooth using CBCT in a 23‐year‐old man with severe pain. Nonsurgical endodontic treatment was performed, which gave rise to an asymptomatic tooth at the 12‐month follow‐up.

This report illustrates a rare case of a geminated maxillary right second molar tooth using CBCT in a 23-year-old man with severe pain. Nonsurgical endodontic treatment was performed, which gave rise to an asymptomatic tooth at the 12-month follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Maxillary molars may frequently require root canal therapy and can have complex anatomy. It is important to locate and treat the second mesiobuccal canal to significantly improve prognosis. Aim of the Study: The purpose of this study was to evaluate direct vision, dental operating microscope (DOM), selective dentin removal under DOM, and cone beam computed tomography (CBCT) in clinical detection of second mesiobuccal root canal (MB2) in maxillary molars. Materials and Methods: A total of 122 maxillary first and second molars indicated for root canal treatment were included in our study. Following access cavity preparation, the presence of MB2 canal orifice was assessed in four stages. Stage I: with direct vision. Stage II: under DOM, Stage III: after selective dentin removal under DOM and Stage IV: teeth in which MB2 canal was not identified by Stage III were further investigated with CBCT. The number of canals identified during each stage was analyzed statistically. Results: Clinical detection of MB2 canal in our study was 90%, with 93% in maxillary first molar and 86% in maxillary second molar. 64% MB2 canals were located at Stage I (direct vision) which improved to 84% at Stage II (under DOM) and 90% at Stage III (selective dentin removal under DOM). CBCT investigation (Stage IV) further improved the identification of MB2 canal leading to overall prevalence of 93%. Conclusion: The results of our study demonstrated that MB2 canal can be clinically detected in up to 90% of maxillary molars by the use of DOM and selective dentin removal. CBCT investigation is indicated when MB2 canals are not clinically detected.

Introduction: To assess the incidence and configuration of the second mesiobuccal (MB2) canal in maxillary first and second molars in an adult sub-population in London from cone beam computed tomography (CBCT) scans. Materials and methods: CBCT scans from the adult patient record database at a dental teaching hospital were selected and viewed using 3D viewing software. Each tooth was assessed, in 1 mm axial and 0.5 mm sagittal sections, to determine the presence of a MB2 canal and then categorised according to Weine's classification. Results: A total of 110 CBCT scans of 323 teeth (172 maxillary first molars and 151 maxillary second molars) from 57 male and 53 female patients were assessed. A MB2 canal was found in 60.5% of maxillary first molars but only 41.7% of maxillary second molars; when present, the most common configuration was two separate and distinct canals (Weine Type III) at 46.2% for maxillary first molars and 43.8% for maxillary second molars. Two separate canals merging to form one canal at the apex (Weine Type II) were found in 39.4% of maxillary first molars and 28.1% of maxillary second molars; whilst 14.4% of maxillary first molars and 26.6% of maxillary second molars had two or more canals at the apex (Weine Type IV). Conclusions: The high incidence of a MB2 canal in maxillary first and second molars was re-confirmed in this study and clinical strategies are needed to manage, especially, the most challenging Weine Type IV variety. CBCT has again proven to be an excellent imaging tool and useful for assessing complex root canal morphology. [ABSTRACT FROM AUTHOR]

Dental anatomy exhibits considerable variation with the presence of additional canals being a common occurrence. The upper second molar typically presents with three canals and three roots; however, variations such as the existence of an extra canal or a root can pose challenges during endodontic treatment. Maxillary molar is characterized by an additional canal located within the palatal root, often exhibiting complex configurations and variations in morphology. Access refinement is critical to gaining adequate visibility and facilitating instrumentation. Meticulous exploration of the pulp chamber floor and careful examination of radiographs from different angles are essential for accurate diagnosis. Careful negotiation and cleaning of the extra canal with appropriate files and irrigants are essential to remove pulp tissue and debris effectively. Furthermore, obturation of the canal space with biocompatible materials is crucial to ensure a three-dimensional seal and prevent bacterial ingress. Clinically, the inability to detect and treat the extra palatal canal can lead to persistent infection, incomplete debridement, and compromised treatment outcomes. This case report delves into the significance of this anatomical variation, diagnostic modalities, and effective management strategies., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Manik et al.)

Variations in the root canal anatomy can occur in any tooth, if not identified and treated accordingly; they may lead to endodontic treatment failure. A typical maxillary second molar usually has three separate roots with one canal in each. The present case report elucidates the successful endodontic treatment of a rare and unusual root canal anatomy of maxillary left second molar using cone-beam computed tomography as a diagnostic aid.

In this case report, we present a maxillary second molar variant, which had two palatal roots with two canals and two buccal roots with three canals, including a second mesiobuccal canal. A 44-year-old female patient complained about a tooth crown fracture and severe pain in her right maxillary second molar. A clinical intraoral inspection and radiography were carried out on the tooth, and a diagnosis of chronic apical periodontitis was made. Four roots (two buccal and two palatal) and five canals (three buccal and two palatal) were found. The anatomical variation of the tooth was further confirmed by cone-beam computed tomography, a cone-fit procedure, and a radiograph with a shifted projection angle. Root-canal treatment was performed under an endodontic microscope.

The present case highlights the endodontic management of a maxillary second molar with three roots and seven canals. Root canal treatment was performed for the maxillary second molar diagnosed with symptomatic irreversible pulpitis. During the procedure under magnification, extra canals were detected in the mesiobuccal root. Cone-beam computed tomography (CBCT) evaluation confirmed four canals in the mesiobuccal root with Vertucci's Type XXI (4-1) pattern. The distobuccal root exhibited two canals with Vertucci's Type III (1-2-1) configuration. The palatal canal was single and large. A 4 year follow-up revealed satisfactory clinical and radiographic findings. Magnification and CBCT allow us to explore possible anatomic variations with insights to tackle such situations clinically. [ABSTRACT FROM AUTHOR]

Adequate knowledge about anatomical variations and anatomy of tooth is mandatory for successful endodontic therapy. Usually maxillary second molars are having three roots with one palatal and two buccal roots, but molar with four roots is rare clinical condition with two palatal roots and two buccal roots. Keeping in the mind of conventional techniques like tracing, the dentinal map will aid in identifying the extra canals. In this case report, the patient was reported with the chief complaint of pain in the upper right back region and a diagnosis of symptomatic irreversible pulpitis with acute apical periodontitis in relation to 17 was made. Endodontic treatment was performed where extra canal was clinically located by tracing the dentinal map. Later the canals were biomechanically prepared in crown down manner and obturated using respective gutta-percha and AHplus sealer. Later CBCT was taken for the confirmation of 4 roots. [ABSTRACT FROM AUTHOR]

Introduction: Maxillary molars may frequently require root canal therapy and can have complex anatomy. It is important to locate and treat the second mesiobuccal canal to significantly improve prognosis.Aim Of the Study: The purpose of this study was to evaluate direct vision, dental operating microscope (DOM), selective dentin removal under DOM, and cone beam computed tomography (CBCT) in clinical detection of second mesiobuccal root canal (MB2) in maxillary molars.Materials and Methods: A total of 122 maxillary first and second molars indicated for root canal treatment were included in our study. Following access cavity preparation, the presence of MB2 canal orifice was assessed in four stages. Stage I: with direct vision. Stage II: under DOM, Stage III: after selective dentin removal under DOM and Stage IV: teeth in which MB2 canal was not identified by Stage III were further investigated with CBCT. The number of canals identified during each stage was analyzed statistically.Results: Clinical detection of MB2 canal in our study was 90%, with 93% in maxillary first molar and 86% in maxillary second molar. 64% MB2 canals were located at Stage I (direct vision) which improved to 84% at Stage II (under DOM) and 90% at Stage III (selective dentin removal under DOM). CBCT investigation (Stage IV) further improved the identification of MB2 canal leading to overall prevalence of 93%.Conclusion: The results of our study demonstrated that MB2 canal can be clinically detected in up to 90% of maxillary molars by the use of DOM and selective dentin removal. CBCT investigation is indicated when MB2 canals are not clinically detected. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the root and canal morphology of permanent maxillary first and second molars using cone-beam computed tomography (CBCT) imaging. Materials and Methods: This study evaluated the CBCT images of 480 maxillary first molars and 536 maxillary second molars from 268 patients who received CBCT scanning for various procedures. The number of roots, prevalence of the second mesiobuccal (MB2) canal in the mesiobuccal root, its association with gender, and the prevalence of bilateral MB2 canals were evaluated. Descriptive statistics was used to evaluate the prevalence, while Chi-square test was used to assess the association between the prevalence of MB2 canal and gender with a significance level set at P < 0.05 and P < 0.001. Results: Majority of maxillary first (97.7%) and second molars (80.0%) were presented with three roots. MB2 canals were found in 59.9% and 35.2% of maxillary first and second molars, respectively. The prevalence of MB2 canals among male patients was significantly higher in both maxillary first (P < 0.05) and second molars (P < 0.001). Bilateral MB2 canals were seen in 76.2% and 58.3% of maxillary first and second molars, respectively. Conclusions: MB2 canal was common among Malay ethnic with the prevalence of approximately 60% and 35% in maxillary first and second molars, respectively. Our findings will increase the knowledge and awareness of dental clinicians to be more vigilant in identifying the MB2 canal to ensure complete cleaning and obturation of all root canals during root canal treatment. [ABSTRACT FROM AUTHOR]

The first step in a successful endodontic treatment is to gain access to the pulp chamber and find all of the canals. To achieve this goal, practitioners need to be familiar with all possible variations of the root canal and have adequate information of the tooth needing treatment. The present case report describes an anatomical variant of the maxillary second molar with 6 canals, a variation that has not been previously reported. Helpful hints for detection of the unusual canal are presented, as well. [ABSTRACT FROM AUTHOR]

The objective of this article is to highlight the importance of having a thorough knowledge about the root canal anatomy and the possible anatomical variations in maxillary second molar. This case report presents the endodontic management of the left maxillary second molar with four roots and four canals. A cone-beam computed tomography (CBCT) imaging was performed to ascertain this complex root canal anatomy. The CBCT findings revealed that the distobuccal canal and the distopalatal canal of the left maxillary second molar exhibits Vertucci Type VI root canal anatomy. This case report demonstrates the usefulness of CBCT in the understanding of complex root canal anatomy of maxillary second molar and its potential use as an endodontic diagnostic tool.

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Having a thorough knowledge of root canal configuration is essential for a successful endodontic treatment. Clinicians should always pay attention to the unusual canal configuration so as to avoid missing extra canals. This paper describes a nonsurgical retreatment of a maxillary second molar with two missing root canals; diagnosed by cone-beam computed tomographic (CBCT) imaging. The tooth had three roots and five canals: a C-shaped buccal root fused by mesiobuccal (MB) and distobuccal (DB) roots with three canals (CBCT scanning showed that the second MB canal was closer to the palatal than the buccal side), a mesiopalatal root with one canal, and a distopalatal root with one canal. The purpose of this case report is to remind clinicians of the importance of anatomical variations, and thus, detection of extra canals. [ABSTRACT FROM AUTHOR]

Introduction: Objective: This study aimed to assess the possible variations in root canal anatomy and topography of the apices of first and second maxillary molars. Materials and methods: A total of 67 first and second maxillary permanent molars were collected. Access cavity was prepared and 2% methylene blue was injected. The teeth were demineralized by 5% nitric acid and cleared with methyl salicylate. Specimens were evaluated under stereomicroscopy and analyzed using the sample t-test. Results: Based on Vertucci’s classification, the mesiobuccal root of maxillary first molars was type I in 87.5% and type IV in 12.5% of the cases. The mesiobuccal root of second maxillary molars was type I in 60%, type II in 8.6%, type IV in 25.7% and type V in 5.7% of cases. In maxillary first and second molars, the distobuccal and palatal roots were type I in 100% of the cases. The distance of the apical constriction from the apical foramen was 0.21±0.09 mm, the distance from the apical constriction tothe anatomic apex was 0.44±0.19 mm and the distance of the apical foramen from the anatomic apex was 0.15±0.15 mm. The mean percentage of delta prevalence was 3.2% in both teeth. Conclusion: The mean distance of the apical foramen and apical constriction from the anatomic apex was less than 0.6 and 1.2 mm, respectively. In maxillary first and second molars, the mean distance of the apical constriction from the apical foramen and anatomic apex was 0.21 and 0.44, respectively and the mean distance of the apical foramen from the anatomic apex was 0.15 mm

Brief Background Recognition of variations in root canal anatomy is an essential prerequisite for successful endodontic diagnosis and treatment. Most of the endodontic failures result from missed canals. The maxillary second molar has the most complex root canal system, and a high percentage of treatment failures are due to the impossibility of locating, instrumenting and obturating the second mesiobuccal canal (MB2). There is lot of literature available regarding the incidence of MB2 in maxillary first molars but a very few studies are available regarding the incidence of MB2 in second molars. The present study evaluated the prevalence of the second mesiobuccal canal (MB2) in maxillary second and first molars using cone beam computed tomography. (CBCT) Material and Methods CBCT images of Maxillary first and second molars were collected from patients (n= 600) who had undergone CBCT imaging. The images were analyzed and the prevalence of MB2 canals were calculated. Results In total of 600 patients, 1,205 teeth were examined. The prevalence of the MB2 canal in maxillary first molar in males is 61.29% and in females it is 59.12% and for maxillary second molars the prevalence in males is 32.97% and in females it is 31.15%. Summary and Conclusions It is important for the clinician to know the high probability of finding the MB2 canal in the maxillary first and second molars, and the CBCT is a good diagnostic tool for its detection and exploration. The information gained about the tooth anatomy and canal prevalence before treatment could potentially facilitate root canal therapy. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Complexity of root canal system and variations in internal anatomy of teeth require careful analysis of preoperative cone beam computed tomography or multiangle radiographs to locate and identify possible extra roots or canals. A fourth canal in upper molars is expected, and much effort should be made when planning the endodontic treatment to avoid missing a canal. [ABSTRACT FROM AUTHOR]

The objective of this article is to highlight the importance of having a thorough knowledge about the root canal anatomy and the possible anatomical variations in maxillary second molar. This case report presents the endodontic management of the left maxillary second molar with four roots and four canals. A cone-beam computed tomography (CBCT) imaging was performed to ascertain this complex root canal anatomy. The CBCT findings revealed that the distobuccal canal and the distopalatal canal of the left maxillary second molar exhibits Vertucci Type VI root canal anatomy. This case report demonstrates the usefulness of CBCT in the understanding of complex root canal anatomy of maxillary second molar and its potential use as an endodontic diagnostic tool. [ABSTRACT FROM AUTHOR]

In this case report, we present a maxillary second molar variant, which had two palatal roots with two canals and two buccal roots with three canals, including a second mesiobuccal canal. A 44-year-old female patient complained about a tooth crown fracture and severe pain in her right maxillary second molar. A clinical intraoral inspection and radiography were carried out on the tooth, and a diagnosis of chronic apical periodontitis was made. Four roots (two buccal and two palatal) and five canals (three buccal and two palatal) were found. The anatomical variation of the tooth was further confirmed by cone-beam computed tomography, a cone-fit procedure, and a radiograph with a shifted projection angle. Root-canal treatment was performed under an endodontic microscope. [ABSTRACT FROM AUTHOR]

Introduction: This study sought to assess root canal morphology of maxillary second molars regarding age and gender in an Iranian population using cone-beam computed tomography (CBCT). Methods and Materials: Totally, 157 maxillary second molars of patients presenting to a radiology clinic were evaluated on CBCT scans. Tooth length, number of roots, root fusion, coronal and sagittal root deviation, number of canals per root, prevalence of second mesiobuccal canal, root canal morphology according to the Vertucci's classification and the correlation of these variables with age and gender were evaluated. Data were analyzed using the Mann Whitney U, Kruskal Wallis and Fisher's exact tests. Results: Of 157 teeth, 98 belonged to females and 59 to males. The mean tooth length was significantly greater in males than in females (P=0.002) and it was shorter in 50-60 years old group. The rate of root fusion was 18.6%. Distobuccal and palatal roots were mainly straight in both sagittal and coronal planes while mesiobuccal roots mostly had a distal-buccal deviation; 67.5% of the teeth had four canals. Number of canals was significantly correlated with gender and was higher in males (P<0.05). The most prevalent canal type was type VI in second mesiobuccal, and type V in palatal and distobuccal canals. The most common types in mesiobuccal canal were types I, VI and II, respectively. In the remaining two roots, type I was the most common. Conclusion: Root and canal morphology of the maxillary second molars in Iranian population showed features different from those in other populations. [ABSTRACT FROM AUTHOR]

Maxillary second molar impaction in the adjacent ectopic third molar is a rare condition that practitioners might face in the field of pediatric dentistry and orthodontics. The early diagnosis and extraction of the adjacent ectopic third molar have been advocated, and prior research has reported a high rate of spontaneous eruption following third molar removal. However, some challenges in the daily practice are that the early diagnosis of this type of tooth impaction is difficult with conventional radiographic examination, and sometimes the early surgical removal of the maxillary third molar must be postponed because of the risks of damaging the second molar. The objective of this study is to report a case series of five young patients with maxillary second molar impaction and to discuss the difficulty of early diagnosis with the conventional radiographic examination, and unpredictability of self-correction.

A thorough understanding of internal and external anatomy of various teeth is critical for a successful outcome of endodontic therapy. The aims of this paper were (1) to describe the clinical retreatment of a maxillary second molar with two palatal roots and (2) to review the available literature regarding this anatomical variation. A 45-year-old Saudi female presented for non-surgical retreatment of maxillary left second molar. Careful radiographic and clinical examinations revealed the presence of two buccal and two palatal roots each with a single root canal. Anatomical variations can occur in any tooth; therefore, the clinicians should always anticipate the occurrence of these variations and utilize all the available tools to diagnose and manage them

Procedural accidents during endodontic treatment often complicate the overall treatment plan of the patient. One of the most frequently encountered procedural accidents is fracture of endodontic instrument. Removal of fractured instrument from root canal is often a difficult procedure especially, when the fractured instrument extends beyond apex. This case report presents the management of a case involving the surgical removal of a broken endodontic file from the periapical region of the mesiobuccal root of a maxillary second molar.

Variation in the root and canal morphology of maxillary second molars is quite common. The most common configuration is three roots and three or four canals. But the presence of an additional palatal root is rather uncommon and has been reported to have an incidence of 1.4%. The extra root is located mesiolingual or distolingual to the primary palatal root. This is a unique case report that describes the successful endodontic management of a maxillary second molar with Radix Distolingualis (RDL). Identification of this variation was done through clinical examination, multi-angled radiographs, surgical operating microscope and an accurate assessment of this morphology was made with the help of Cone Beam Computed Tomography (CBCT) imaging. In addition, this article also discusses the literature review, guidelines for diagnosis and treatment of RDL.

مقدمه: یکی از بهترین روش‏ها برای بازسازی نواقص استخوانی در ناحیه دهان و دندان بیماران، استفاده از پیوند اتوژن است که هنوز به عنوان استاندارد طلایی جهت آگمنتاسیون نواحی دچار کمبود استخوان، در نظر گرفته می‏شود. مناطق داخل دهانی متعددی برای برداشت این گرفت استخوانی وجود دارد که توبروزیته ماگزیلا به دلیل دسترسی راحت‏تر و عوارض جراحی کمتر، محل مناسبی جهت برداشت مقادیر محدود استخوان می‏باشد. هدف از انجام این مطالعه، ارزیابی مشکلات پریودنتال مولر دوم ماگزیلاری پس از برداشتن پیوند استخوان از ناحیه توبروزیته بود. مواد و روش‏ها: ۱۵ بیمار مراجعه کننده به بخش جراحی و ایمپلنت دانشکده دندانپزشکی مشهد، با محدوده سنی ۲۰ تا ۴۰ سال، پس از بررسی شرایط ورود و خروج، وارد مطالعه شدند. برای هر بیمار شاخص‏های عمق پاکت، از دست دادن چسبندگی لثه، شاخص پلاک، شاخص لثه و خونریزی بعد از پروب کردن، در سه ناحیه شامل میددیستال، دیستوباکال و دیستولینگوال از هر دندان، در دو زمان قبل و ۶ ماه بعد از جراحی، اندازه گیری و ثبت شدند. در تحلیل داده ها از آزمون t زوجی، ویلکاکسون و مک نمار استفاده شد (05/0α=). یافته‏ها: میانگین عمق پاکت در دیستال مولر دوم ماگزیلا، در دوز مان قبل و ۶ ماه بعد از عمل، به میزان ۱۵/۴% کاهش یافته بود که این میزان کاهش، معنی‏دار بوده است (002/0P=). سه شاخص پلاک (002/0P=)، از دست دادن چسبندگی لثه 025/0=P و شاخص لثه ۰77/۰=P به صورت رتبه ای ارزیابی شدند که هر سه با گذشت زمان کاهش یافته بود. میزان خونریزی مشاهده شده در ۶ ماه پس از جراحی ۴/٢۱% کاهش داشت اما این میزان کاهش معنی‏دار نبود (۲۵۰/۰P=). نتیجه گیری: برداشتن گرفت استخوانی از ناحیه توبروزیته، منجر به ایجاد مشکلات پریودنتال برای مولر دوم ماگزیلاری مجاور این ناحیه، نخواهد شد و استخوان ساپورت کننده در دیستال آن، چنانچه در طی جراحی دچار صدمه شده باشد، دوباره بازسازی شده به طوری که عمق پاکت و عرض بیولوژیک نرمالی خواهیم داشت.