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  Double vision - 2 palatals

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. -
From: Rajiv Patel
Sent: Saturday, February 25, 2006 9:44 AM
Subject: [roots] DOUBLE VISION - 2 PALATALS

Here's a case with all its challenges....
Thought for today: "If you think education is expensive, try ignorance" 
- Rajiv Patel

OUTSTANDING RAJIV....... Kendo A+ RAJIV Magnificent Job and Analysis. - Ben. Rajiv, Excellent presentation. Great work and result. Marga has showed us that this kind of anatomy has high possibility of being a tooth with a extra root for the MB2 and NOT a second P root - Thomas Rajiv, It seems curious that there would be pus draining from a tooth with a pre-op dx of irrev pulpitis..... did that stike you as curious? Nice case and nicely presented - Mark Mark, If you look at the diagnosis it includes both irreversible pulpitis and also acute apical (periradicular) periodontitis. Probably some roots had vital pulp and some not - Thomas Thank you all for your feedback, appreciate it truly.Here are the replies for Thomas and Mark Thank you Kendo and Ben Thomas based on the location of the canal and its direction, I feel this was a true Palatal canal as compared to being an MB2 canal which would be located more towards the Mesial and buccal aspect, in addition to the shape of the orifice for the 2 palatals. The surface anatomy of the tooth was also very peculiar - it was "one big tooth" Here's some literature of different configurations for maxillary 2nd molars Peikoff MD, Christie WH, Fogel HM. Int Endod J. 1996 Nov;29(6):365-9. The maxillary second molar: variations in the number of roots and canals. A retrospective study was undertaken of 520 completed endodontic treatment of maxillary second molar teeth which were selected from a specialty endodontic practice. Radiographs were reviewed and studied, a classification of anatomical root and canal variations was devised, and the frequency with which each variant occurred was recorded . There were six variants which occurred frequently enough to be considered as separate anatomic categories and their frequency of occurrence is illustrated. The six variants found in the study and their frequency of occurrence are as follows: (1) three separate roots and three separate canals ( 56.9%); (2) three separate roots and four canals (two in the mesiobuccal root) (22.7%); (3) three roots and canals whose mesiobuccal and distobuccal canals combine to form a common buccal with a separate palatal (9%); (4) two separate roots with a single canal in each ( 6.9%); (5) one main root and canal (3.1%); and (6) four separate roots and four separate canals including two palatal (1.4%). Mark, As per my pulp tests - it was clearly showing signs of Irreversible pulpitis, "The pus - was a MACROSCOPIC Diagnosis" of a Microscopic condition - Microabscesses which form - starting in the pulp horn areas and spread apically. As mentioned my presentation - the amount of Hyperemia in the pulp- was "almost scary" Please see attached Histologic representation from Seltzer and Bender's Dental Pulp text book. Hope that answers your question - Rajiv Patel Rajiv, Fantastic. I like the way you present it more than what you do actually on the tooth. I am making a software making your presentation as a model. so that for each patient I(we) can freely and easily make similar presentation of the patient needs can be given a hard copy like ken does - Vipin Hi Rajiv, Attached pics of an upper third molar (2 palatal roots) I extracted today. your presentation would have helped to do RCT on this tooth....luckily I didnt have to - venkat Venkat? what on earth are you talking about! you were lucky that you didn't have to help that patient? I don;t understand that. But I think Rajiv can incorporate your picture in to his presenttaion! :) - Vipin Patient was given options and he opted for extraction and I meant I was lucky he did so. - Venkat I agree with Vipin...upper third molar has a restricted access and visibility and extraction is always a better choice in my view - Sachin Nice....can you post some x-rays fo that tooth from various angles? Thanks, - Fred

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