Amy Dukoff
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 HE
ABNORMALITIES of the mandibular second molar are often not fully taken
into account when root canal therapy is being considered. Usually,
non-surgical root canal therapy is thought of as a routine endodontic procedure.
On first glance at a radiograph of a mandibular second molar, the toooth
often appears normal in morphology. However, when the procedure begins,
very often the practitioner then realizes the extent of the difficulties
that he or she may have to overcome.
The mandibular second molar is typically compared
to the first mandibular molar. The differences are instructive.
First, they are smaller coronally than the first mandibular molar.
Second, they are more symmetrical than the first molar. Furthermore,
the second molar’s roots have a tendency to be close together while being
in a gradual curve. The first and second molars have similar access,
which is in the mesial aspect of the crown extending just slightly distal.
Of course, this access may have to be modified due to caries and coronal
structure. Both molars must resist the forces of mastication.
The second mandibular molars have some distinct
characteristics. They are extremely susceptible to vertical fracture.
Therefore, mesial-distal fractures if present have a very poor prognosis.
Furthermore, the C-shaped root system is an anatomical variation of second
molars. They can be seen with a fin or web connecting the root systems.
The C-shaped canal may not be easily detectable on radiographic interpretation.
In their article “C-Shaped Canal System in Mandibular Second Molars: Part
II-Radiographic Features,” in the December 2004 Journal of Endodontics,
Drs. Bing Fan, Gary Cheung, Mingwen Fan, James Gutmann, and Wei Fan, suggest
that with close scrutiny one may possibly predict the presence of the C-shaped
canal. The groove linking the canals may be so thin that one cannot
see it by inspecting the radiograph. It’s important to be critical
in looking at all second molar radiographs.
Achieving a successful result in root canal threapy
on second molars presents a challenge to all clinicians. It’s imperative
to be critical before beginning and understand the case before proceeding.
April-June 2005
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Achieving
a successful result in root canal therapy on second molars presents a challenge
to all clinicians.
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