Management of maxillary second molars with two palatal roots: report of two cases

Abstract

Introduction: these case reports aim to highlight the importance of always considering the possible anatomical variations present in the dental organs that need root canal treatment. Despite the research dedicated to reporting the prevalence of these anatomical variations, variations in the number of palatine roots of maxillary molars are rarely accounted due to their extremely low incidence. Material and methods: this report presents two clinical cases in which maxillary molars with additional palatal roots are present. The first case was a 41-year-old woman, with no apparent pathological data, who had a previous access cavity but no radiographic signs of periapical pathology. Periodontal probing was normal. The pulpal diagnosis was previously initiated pulp therapy and the periapical diagnosis was healthy periapical tissues. During the inspection of the pulp chamber floor, the palatine canal was located more distally than normal, making the operator suspicious of the presence of an additional root canal. The access cavity was slightly enlarged in the mesio-palatine direction, which resulted in the location of a second palatal canal in an extra palatal root. The second case was a 28-year-old woman with a non-contributory medical history who presented pain upon thermal changes in the maxillary right second molar. The pulpal diagnosis was symptomatic irreversible pulpitis and the periapical diagnosis was symptomatic apical periodontitis. The access cavity had a quadrangular design and four root canals were located. One canal corresponded to a second palatal root canal in its own palatal root. After locating the extra palatine roots in these two cases, both could be negotiated, instrumented, and obturated. Results: during root canal treatment, types I and II of the palatal root classification system proposed by Chritie et al. for maxillary molars were identified. Conclusions: it is important to take into consideration these anatomical variations in the number and shape of the palatal roots of maxillary molars. Although its prevalence may be considered extremely low, such complex cases can be encountered in daily endodontic practice.