(TC78) Endodontic and Periodontal Implications of Anatomical Variations in Maxillary Second Molars: A case report and review of the literature

Maxillary second molar anatomy variations have been studied, but one of the least commonly researched variations is the presence of four roots or extra canals with unusual locations like a mesial palatal canal. In an analysis of multiple population studies, across 3,013 maxillary second molars, only 0.86% had four roots. Though rare, four-rooted maxillary second molars have both endodontic and periodontal implications for treatment. Apical periodontitis has been found to occur in 98% of teeth with at least one missed root canal. In addition, a second palatal root introduces a fourth furcation, increasing the risk of periodontal disease and adding complexity to the periodontal treatment. Thus, it is important to correctly identify when a fourth root is present to improve treatment success rates. 

The purpose of this table clinic is to present three examples of maxillary second molars with anatomical variations that had endodontic and/or periodontal involvement as well as the therapy implemented. A focus will be placed on determining commonalities across these cases to create guidelines for the clinician to identify, diagnose, and treat unusual morphology using a clinical exam, 2-D, and 3-D radiographs. This knowledge will help the clinician to better recognize when they face similar cases as well as how to adapt treatment to best address this variation.