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Endo tips    Better Endo    Endo abstracts    Endo discussions

Uncovering the Mb2 canal- Courtesy ROOTS
The opinions within this web page are not ours. Authors have been credited
for the individual posts and images where they are. -

From: Dr. Glenn A. van As
Sent: Saturday, April 23, 2005 1:57 PM
To: 'roots
Subject: Uncovering the Mb2 canal , a journey documented

Here is the original story as posted on Dental Town

Hi folks:  so often I read about not finding MB2s in upper molars 
or not knowing where to look or how to uncover them.  I had a light 
day yesterday so I had a chance to fully document this case for you.  
Hopefully it helps to not only show where the MB2 is located, the 
angle it initially takes but also what the microscope can show for 
endo at high mag.

This was a 45 year old lady who has had intermittent lingering pain 
to cold and spontaneous pain on upper left 2nd molar with large resin 
in place.

I opened the tooth and found DB and Pal canals to be vital and easy 
to find because of bleeding. MB1 and MB2 were non vital and not easy 
to see at all. I used  an Ultrasonic tip to uncover the MB1 canal 
which was not on the same plane as the DB canal (Not a straight triangle) 
and so I assumed that there would be an MB2.  The tip used is called the
Carr Killer Ultrasonic tip ( and it was in the EMS mini 
endo unit.

Now to look for the MB2 canal I placed water on the floor of the pulp 
chamber and quite often you get a chance to read the dentin map which 
is subtle shades of the pulpal floor that allow you to see where the 
canal may be. Typically it involves shades of grey that lead to the 
canals.  In this case something was visible but not clear. Next thing 
to do is trough 2-3mm down following the dentin map and have another 
look.  There was the tell tale white line (tissue ) between the 
uncovered MB1 and the position where the MB2 would be which is Mesial 
to a line drawn between the MB and Palatal so almost always you have 
to remove some of the mesial wall of your access.  Its interesting to 
note how I had to trough 3mm down to get a good view, and also note the 
angle that the MB2 initally is entered at, USUALLY MESIAL AND LINGUAL 
to that of the MB1.

The MB1 and MB2 were completely separate even though the post op film 
was straight on and didnt separate them.  I can usually tell by irrigation.  
If you place bleach down the MB1 canal and the MB2 fills up as well, 
then suck back and see if the MB2 dries up.  This means there is a 
connection.  Of course you can also tell by putting two files into
both canals at the same time.  These two were separate portals of exit 
so it was good I found both.

My file system which really is unimportant is that I use K3 VTVT 
(alternating between 06 and 04 tapers changing the tip size each file 
as well so its called variable tip and variable taper).  This has been 
shown by John McSpadden to reduce file breakage.  Typical sequence is

Hand file 06- 20 to apex with Glyde
.12 , .10,. .08 tapered coronal shapers (17mm length) to open coronal 1/2
.04 #40
.06 #35
.04 #30
.06 #25
.04 #20
.)6 #15 (if needed)

Then taper back from there to gauge the apex with a file.
In this case MB1, MB2, and DB canals filled with 04 #35-#40 tips cut 
specifically with a gauge Palatal canal 06 35 tip

EWT sealer, System B downpack and Obtura backfill to obturate.
Note the nice accessory canals in the apical third on the DB and 
Palatal canals.
Time to complete case....7.5 mins including photos.........
Nah just kidding yah.......90 mins.

I hope that you find this interesting and this is pretty standard 
for me to find a 4th canal in a molar both maxillary and mandibular.
first and second molars. - Glenn

The photos are of the case and at the end is a crude drawing of the 
endo access and where the MB2 is located

Glen, Just wanted to let you know that I thought your MB2 explanation was very helpful. As a GP you don't always like to ask these questions, but your presentation was very much appreciated. Thank You for taking the extra time to document your procedure.- Stephen Wonderful documentation Glenn! You really are an artist! Congrats! - Liviu Thanks Liviu, I am trying to improve the level of my presentations so they look professional. I worked those images in an image editing program (not photoshop) and the beveled edges and drop shadow add to the overall look. I appreciate the kind words my friend. - Glenn Glenn, awesome ! - Fred

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