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cone beam – international magazine of cone beam dentistry

I case report _ CBCT in diagnosis _Introduction Besidesadequateknowledgeofrootcanalmorphol- ogy in general, it is of utmost importance to evaluate eachindividualcaseforaberrantanatomyandtoiden- tifyanymorphologicalvariationbeforeperformingand duringanendodonticprocedureonsuchteeth.Inclin- ical practice, conventional radiography with the assis- tanceofanoperatingmicroscopeisthemostcommon methodforevaluatingrootcanalanatomy.However,it has been shown that their use does not reveal all anatomicaldetails.Recentlyintroducedanddeveloped conebeamcomputedtomography(CBCT)fordentaluse hasprovedtobemoreaccurateindetectingrootcanal morphology,especiallyinmaxillaryposteriorteeth.One of the most unusual and rare aberrations of tooth anatomyisamaxillarysecondmolarwithtwoseparated palatalroots.Thisarticlepresentsthecaseofsuchapa- tient, who presented ten years after another such pa- tienthadbeenrecorded. _Case report A 26-year-old male patient sought treatment at the Department of Restorative Odontology and Endodontics at the University of Belgrade with the following chief symptoms, which had persisted for several weeks already: _spontaneous dull, mild and intermittent pain in the region of the left maxillary molar; _moderate sensation of pain when biting hard food. Additionalinformationwasacquiredfromfurther anamnesis: _Therewerenoothersymptoms,andnoirradiationof existing pain. _Thepatientrecalledthatarootcanaltherapyhadbeen performedonthesametoothseveralyearsbefore. _He also recalled that two teeth on the same side of the upper jaw had been extracted at least ten years before. Furthermore, clinical examination confirmed the following: _onlythesecondmolar,#27,withanextensiveamal- gam restoration, was present in the left maxilla; _moderate sensitivity on vertical percussion of the buccal cusps, and painful response to percussion of the mesiopalatal cusp; _no sensitivity on digital palpation on the vestibular or palatal side; _both hot–cold and electric vitality tests were nega- tive; _no pathological mobility of the tooth. The diagnostic periapical radiograph (bisecting angle technique) showed Diagnosis and management of a rare case of a maxillary second molar with two palatal roots Supported by conventional radiography and CBCT Author_ Ass. Prof. Katarina Beljic-Ivanovic, Serbia 26 I cone beam2_2015 Fig. 1_Straight-line access to all four root canals of tooth #27. Fig. 2_Intra-oral radiograph indicating all four root canals of tooth #27. Fig. 3_Obturated root canal orifices of tooth #27. Fig. 4_Intra-oral radiograph of tooth #27 lacking periapical information. Fig. 1 Fig. 2 Fig. 3 Fig. 4

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