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Dental Tribune Middle East & Africa Edition No. 5, 2015

endo tribuneDental Tribune Middle East & Africa Edition | September-October 2015 1D ENDO TRIBUNE TheWorld’sEndodonticNewspaper MiddleEast&AfricaEdition FKG Dentaire SA www.fkg.ch 3D efficiency_ mechanicalcleaninginareaspreviouslyimpossibletoreach Oval, caverns, double canal, C, 8, isthmus shape. > Page 4D Diagnosis and management of a rare case of a maxillary second molar with two palatal roots - Supported by conventional radiography and CBCT By Ass. Prof. Katarina Beljic-Ivanovic, Serbia B esides adequate knowl- edge of root canal mor- phology in general, it is of utmost importance to evaluate each individual case for aber- rant anatomy and to identify any morphological variation before performing and during an endo- dontic procedure on such teeth. In clinical practice, conventional radiography with the assistance of an operating microscope is the most common method for evaluating root canal anatomy. However, it has been shown that their use does not reveal all ana- tomical details. Recently intro- duced and developed cone beam computed tomography (CBCT) for dental use has proved to be more accurate in detecting root canal morphology, especially in maxillary posterior teeth. One of the most unusual and rare aberrations of tooth anatomy is a maxillary second molar with two separated palatal roots. This ar- ticle presents the case of such a patient, who presented ten years after another such patient had been recorded. Case report A 26-year-old male patient sought treatment at the Depart- ment of Restorative Odontology and Endodontics at the Universi- ty of Belgrade with the following chief symptoms, which had per- sisted for several weeks already: - spontaneous dull, mild and in- termittent pain in the region of the left maxillary molar; - moderate sensation of pain when biting hard food. Additional information was ac- quired from further anamnesis: - There were no other symp- toms, and no irradiation of exist- ing pain. - The patient recalled that a root canal therapy had been per- formed on the same tooth sev- eral years before. - He also recalled that two teeth on the same side of the upper jaw had been extracted at least ten years before. Furthermore, clinical examina- tion confirmed the following: - only the second molar, #27, with an extensive amalgam res- toration, was present in the left maxilla; - moderate sensitivity on vertical percussion of the buccal cusps, and painful response to percus- sion of the mesiopalatal cusp; - no sensitivity on digital palpa- tion on the vestibular or palatal side; - both hot–cold and electric vital- ity tests were negative; - no pathological mobility of the tooth. The diagnostic periapical ra- diograph (bisecting angle tech- nique) showed: - partly obturated palatal and mesiobuccal (MB) root canals and an unfilled distobuccal (DB) root canal; - slight radiolucency around the palatal root apex; no distinctive border towards the surrounding maxillary bone structure. The necessity of an endodontic retreatment of the tooth was ex- plained in detail to the patient, who accepted the suggested therapeutic procedure and the general schedule for further ap- pointments. Treatment procedure The old amalgam restoration and the phosphate cement base were completely removed, and the cavity walls were addition- ally prepared to enable clear visibility and straight-line access to all root canal orifices. The ori- fices of the palatal and MB root canals had been blocked with obturation material, presumably iodine phosphate cement and a gutta-percha cone. Approxi- mately 3 mm distal from the orifice of the obturated palatal root canal, another oval, crack- like orifice could be seen, with the appearance of a perforation. Further assessment of the pulp chamber floor was performed with 4.5 x magnifying loupes and the Endodontic Probe Orifice Opener (DENTSPLY Maillefer). Using the probe and a #10 K-file to negotiate the flat oval orifice, the presence of a second palatal (distopalatal, DP) root canal was detected. The orifice of the DB root canal was hidden under brownish de- posits of tertiary dentine, located about 2 mm distal from the ob- turated MB canal orifice and ap- proximately 2 mm buccal from the DP canal orifice. The DB canal orifice was negotiated and

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