The first maxillary molar is one of the most difficult teeth for endodontical treatment; it presents the highest failure rates due to the impossibility of locating and treating the second mesiobuccal canal (MB2). The aim of our work was study of second mesiobuccal canal in maxillary first molar and compare obtained data with literature sources for increasing the efficiency of treatment.
Materials and methods: The study involved 59 patients with exacerbation of chronic pulpitis or chronic periodontitis who were distributed according to age: 14-20 years, 21-30 years and 31-40 years. The average age was 31±2.98 years. Patients were investigated by operating dental microscope and computer tomograph with description of peculiarities of second mesiobuccal canal in maxillary first molar. A type of canal according to Vertucci was detected; general 76 teeth were described.
Results: The second mesiobuccal canal was found in 65 (85.5%) of the 76 maxillary molars and in 29 (38.1%) of these MB2 canals it was accessible to the apex. We have detected that patients with chronic pulpitis or chronic periodontitis have significant different undetected MB2 canal in group 14-20 years (7.1%) and 31-40 years (19.4%), p<0.05. Such differences between groups could be explained by the development of pulpal calcification with long term inflammatory processes.
Conclusion: First maxillary molar is possibly the most treated and least understood posterior tooth. Deep knowledge of anatomical and topological structure of the MB2 canal at the stage of diagnostics as well as during the course of endodontic treatment can help to decrease the percentage of unsuccessful treatment of the first molar. Clinicians need to be mindful of the possible presence of MB2 canal, which should motivate change in the routine practice of clinical endodontic treatment. Modifications in the endodontic access and detection techniques, as well as advancements in radiographic technique and magnification technology, aids in the location and treatment with the MB2 canal of the first maxillary molar.