Locating the second mesiobuccal canal in maxillary molars: challenges and solutions

Abstract

The second mesiobuccal canal in mesiobuccal roots in maxillary molars is a common finding in root canal treatments. Failure on the location of these canals is associated with a high rate of unsuccessful treatments of maxillary molars. Its prevalence has been assessed in several in vitro and in vivo studies, presenting variations according to the methodology applied, along with the population of interest. While the anatomy of these teeth is well defined in micro-computed tomography studies, the clinical management is a great challenge for the practitioner. The use of a dental operating microscope has rendered a better clinical outcome when considering the location and treatment of this canal. On the other hand, cone-beam computed tomography use is still controversial in the efficacy of MB2 canal location. The association of a dental operating microscope with troughing performed with ultrasonic tips is an essential step in this location. Moreover, sodium fluorescein might be applied for root canal location. Due to the high rate of unsuccessful cases when the MB2 canal is not initially found, several cases are performed aiming to address the cases of missed MB2 canals. Therefore, the clinician should discuss the best possible approach, whether surgical or clinical. This article presents an overview of the importance of the MB2 canal on the outcomes of root canal treatments of maxillary molars. Solutions based in current literature will be presented accordingly.

Prevalence of mesiobuccal 2 canal in first maxillary molar: A retrospective radiographic study

“…2 The presence of such root canals was first reported by Hess in 1925. 3 Christie WH (1991) and Fogel HM (2017) reported variation in distobuccal root canal and palatal canals of maxillary molars. 4,5 According to Witherspoon DE (2013), 44% of retreatment in maxillary first molars is due to missed canals and 93% of these missed canals are identified in the mesiobuccal-2 root canal.…”

Prevalence of root canal system configurations in the brazilian population analyzed by cone-beam computed tomography – a systematic review

“…Regarding the maxillary molars, the MB2 canal's identification and clinical management are a great challenge for practitioners, and missing it may lead to unsuccessful endodontic treatments. 2,51 The present study identified a wide range of MB2 canal prevalence for both maxillary first (between 37.1% 25 and 88.5% 31 ) and second molars (between 21.8% 26 and 83.4% 31 ). Generally, there is a tendency for lower percentages of MB2 canals in maxillary second molars than in first molars, 5,8,52,53 but that condition was not markedly evident in the present review.…”

“…The use of a dental operating microscope and ultrasonic tips are highly recommended to effectively address this high prevalent MB2 root canal, mainly in cases where its orifice opening in the pulp chamber floor is not evident. 51,54 As for the mandibular molars in the Brazilian population, the two-rooted configuration with two root canals in the mesial root and a single canal in the distal root was the most common morphology in the present review. The most common root canal classifications in the mandibular first molar's mesial roots were Vertucci's Types II and IV, with the root canal orifice openings generally perceptible in the pulp chamber floor.…”

A Review Pemanfaatan Teknologi Sonikasi

“…Proses sonikasi diterapkan dalam farmasi, makanan, kosmetik, air, pelapis, tinta, cat, pengerjaan logam, perawatan kayu, pengerjaan logam(37), nanokomposit, pestisida, bahan bakar, produk kayu dan banyak industri lainnya. Sonikasi juga dapat digunakan untuk mempercepat pembubaran, dengan cara memecah interaksi antarmolekul serta menganalisis dinamika molekular dan kinetika reaksi pada pembelahan molekul (38).Ini sangat berguna ketika tidak memungkinkan untuk mengaduk sampel, seperti tabung NMRdan juga dapat digunakan sebagai penyedia energi (39) [19] , 2012-2016 oksidasi [20] 2017-2018 sonochemic al [21] , PCR [22] 2019> langsung (AS) [16] , Depolimerisasi [17] , Degradasi [18] , Tes triple negative praktis tidak termasuk PJI(64).…”