Wednesday, August 6, 2014

Anatomy

MB2 study data ranges from 50%-95% MB3 is 1-3% (source)

Brazil CBCT study - 86-91% MB2 PROVIDED dealing with a three rooted molar
Table 1. The Total Number of Teeth, Teeth with 3 Roots, and the Presence/Absence of MB2 Canals in 3-rooted First and Second Maxillary Molars
ToothTotal teeth
N
Teeth with 3 roots
n (%)
MB2 present
n (%)
MB2 absent
n (%)
Right maxillary first molars797968 (86.1)11 (13.9)
Left maxillary first molars797871 (91.0)7 (8.9)
Right maxillary second molars948877 (87.5)11 (12.5)
Left maxillary second molars918769 (79.3)18 (20.6)
Total343332285 (85.8)47 (14.1)

Table 2. The Prevalence of MB2 Canals According to Root Third Assuming have an MB2 (obviously)
ToothCoronal third
n (%)
Middle third
n (%)
Apical third
n (%)
Right maxillary first molars68 (100)65 (95.6)53 (77.9)
Left maxillary first molars71 (100)68 (95.8)54 (76.0)
Right maxillary second molars77 (100)75 (97.4)51 (66.2)
Left maxillary second molars69 (100)64 (92.7)47 (68.1)

8x scope 80% MB2 and 1% MB3 more of an isthmus study
This and the following photo are why I think there is so much variance in % of MB2 "found" in studies. Is it a fin, an isthmus, or an MB2?
In vivo study 1987 77% MB2 and 3% MB3 - Also has great definition of what they consider an MB2
So are the first and third ones MB2? or figure eight shaped single canals?

Jordan study 63% under 3.5x and 57% naked eye.  They also state in this study that max first molars have highest failure rate.  I am of opinion this is low as 3.5x is not a high mag.  I use 6x for everything and have used 2.5, 3.5.4.5, and 6.0 in my career and can say that the jump from 3.5 to 4.5 made a difference for me.  Here is a study proving increase in mag increases ability to locate MB2.

Endo program 70% - The results of this study demonstrate that it is imperative for any dentist performing root canal therapy on maxillary first molars to examine carefully the pulpal floor to locate all canals, especially the second mesiobuccal canal.

Coronal half microscope 1990 95% - 54% accessed with hand instruments, 32% with "bur" (seems something similar to munce) and 10% with scope.  Shows better techniques and equipment result in more found

Multiple methods 2009  67% have MB2 and of those 65.30% exhibited 1 foramen

Korean Population CBCT study     64% MB2 1.25% DB2   .25% single root and fused .73%

Hartwell and Bellizzi in vivo 1982 "A discrepancy was observed when 4 canal maxillary molar obturation was compared with the in vitro studies. Access prep should be reevaluated to facilitate the search and location of the 4th canal in maxillary molars.  It is almost axiomatic to accept the fact the root canal system of the MB root of the max molars frequently have more than one canal."  BINGO!!!

Tuesday, August 27, 2013

WF 72 20(17)-25 Categories here are race sex age then the numbers are MB2 present(cleansed and filled)-total

Categories of this blog are

Tooth vital - tooth necrotic

# teeth with MB2 present- able to cleanse and shape the MB2 - MB2 join MB1 - teeth I consider calcified that no MB2 was found - total # of 1st molar treated MB2 distance from MB1 - join MB1

13-12=25

20-17-8-1-25

NA

This tooth was VERY calcified! I found the palatal and used the piezo down to about 7mm from predicted apex but never could get a file to go more than 1mm or so in. Didn't hunt too aggressively for MB2 on this one.

CaOH
Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  
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Monday, July 29, 2013

WM 71 20(17)-24 Categories here are race sex age then the numbers are MB2 present(cleansed and filled)-total

Categories of this blog are

Tooth vital - tooth necrotic

# teeth with MB2 present- able to cleanse and shape the MB2 - MB2 join MB1 - teeth I consider calcified that no MB2 was found - total # of 1st molar treated

MB2 distance from MB1 - join MB1

13-11=24

20-17-8-0-24

2-3mm-no

Internal resorption
 
Classic view of an MB2 that does not join the MB1

 

Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  
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Wednesday, June 5, 2013

WF 57 19(16)-23 Categories here are race sex age then the numbers are MB2 present(cleansed and filled)-total

Categories of this blog are

Tooth vital - tooth necrotic

# teeth with MB2 present- able to cleanse and shape the MB2 - MB2 join MB1 - teeth I consider calcified that no MB2 was found - total # of 1st molar treated

MB2 distance from MB1 - join MB1

12-11=23

19-16-8-0-23

this was more of a fin than a true second canal-yes



Monday, March 11, 2013

WM 31 18(15)-22 Categories here are race sex age then the numbers are MB2 present(cleansed and filled)-total

Categories of this blog are

Tooth vital - tooth necrotic

# teeth with MB2 present- able to cleanse and shape the MB2 - MB2 join MB1 - teeth I consider calcified that no MB2 was found - total # of 1st molar treated

MB2 distance from MB1 - join MB1

11-11=22

18-15-7-0-22

1mm-no




Wednesday, February 20, 2013

WF 54 17(14)-21 Categories here are race sex age then the numbers are MB2 present(cleansed and filled)-total

 Categories of this blog are

Tooth vital - tooth necrotic

# teeth with MB2 present- able to cleanse and shape the MB2 - MB2 join MB1 - teeth I consider calcified that no MB2 was found - total # of 1st molar treated

MB2 distance from MB1 - join MB1

10-11=21

17-14-7-0-21

NA





Thursday, January 3, 2013

WF 47 Retreat MB2 present and join

Not tracking MB2 in retreat teeth as would likely give too high percentage of MB2 (more likely to fail if MB2 missed)

MB2 join MB. Could only get to length with 08 file twice, once at start of visit #2 and once near end of visit #2.  Can see faint line of sealer in canal at apex.  I originally thought MB2 missed as couldn't see on straight or angled PA.  Upon access found it was located so then left with hoping could get to apex and thoroughly clean.  Experienced instrument separation in MB2, which was able to retrieve with piezo but left root thin.  I know there is a perf and this will fail and need hemi-section and new crown now.

Completed in Wheaton.  First photo is  CaOH. Second is final fill

Tooth symptomatic
CaOH wait 4 weeks tooth felt good, despite not reaching apex
 
Reached apex and removed separated file but now seems to be strip perf

Perf seen now.  Also no blood until condensing g.p. and then bled=perf=may have mini fracture from condensing gp

WM 49 at time of failure

Eventually I will track this also.  This case was done in 3/10.  In future I will link to original post also.  RCT appears unsuccessful and obviously the tooth is not. The MB2 was missed in original treatment, even though it was quite large and easy to locate.  I do not believe I had a piezo at time had to remove these silver points which resulted in more tooth structure removed than would today.

Separate MB2. 

Thursday, November 1, 2012

WF 55 17(14)-20 Categories here are race sex age then the numbers are MB2 present(cleansed and filled)-total

Categories of this blog are

Tooth vital - tooth necrotic

# teeth with MB2 present- able to cleanse and shape the MB2 - MB2 join MB1 - teeth I consider calcified that no MB2 was found - total # of 1st molar treated

MB2 distance from MB1 - join MB1

10-10=20

17-14-7-0-20

1-2mm-no

Not sure on this one as far as MB1 length.  It appears MB2 and MB1 end at different lengths or I overfilled MB1 by .5-1mm (Kodak says .6mm) if i use the worst looking xray.

Here looks like MB1 continues around curve

Here looks like MB1 is OK or maybe long depending on how you look at it

Here looks like it's long

WF 54 16(13)-19 Categories here are race sex age then the numbers are MB2 present(cleansed and filled)-total

Categories of this blog are

Tooth vital - tooth necrotic

# teeth with MB2 present- able to cleanse and shape the MB2 - MB2 join MB1 - teeth I consider calcified that no MB2 was found - total # of 1st molar treated

MB2 distance from MB1 - join MB1

9-10=19

16-13-7-0-19


Can see join

Fracture not sure will be successful, especially long term

Wednesday, October 10, 2012

WM 84 15(12)-18 Categories here are race sex age then the numbers are MB2 present(cleansed and filled)-total


Categories of this blog are

Tooth vital - tooth necrotic

# teeth with MB2 present- able to cleanse and shape the MB2 - MB2 join MB1 - teeth I consider calcified that no MB2 was found - total # of 1st molar treated

MB2 distance from MB1 - join MB1

8-10=18

15-12-6-0-18
CaOH
Can see separate MB2


Monday, June 18, 2012

WM 51 14(11)-17 Categories here are race sex age then the numbers are MB2 present(cleansed and filled)-total

Categories of this blog are

Tooth vital - tooth necrotic

# teeth with MB2 present- able to cleanse and shape the MB2 - MB2 join MB1 - teeth I consider calcified that no MB2 was found - total # of 1st molar treated

MB2 distance from MB1 - join MB1

8-9=17

14-11-6-0-17

2mm or less and joined within the first 5mm from chamber floor. 



Can see the MB2 just makes the access of MB root look a little wider is all.

Wednesday, May 30, 2012

WM 69 13(10)-16 Categories here are race sex age then the numbers are MB2 present(cleansed and filled)-total

Categories of this blog are

Tooth vital - tooth necrotic

# teeth with MB2 present- able to cleanse and shape the MB2 - MB2 join MB1 - teeth I consider calcified that no MB2 was found - total # of 1st molar treated

MB2 distance from MB1 - join MB1

7-9=16

13-10-5-0-16

Pre-op



CaOH
Final no radiographic evidence of MB2
Troughed more with piezo today.  No MB2 present

Thanks to Dr. McCall for alerting me to cheap peizo's on ebay.  They work great and no more $100 down the drain for every time they break!!