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
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
(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
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