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<< Back to 2004 Case List

November 2004 – Maxillary First Molar with a Wild MB Root

Fig. 1 - Oct. '02

This maxillary first molar was referred because of suspected pupal necrosis and distal pocketing to the furca. The periodontist felt that the tooth had a possibility of being retained if we could successfully get some bone fill as the result of endodontically related healing.. As you can tell by the fact that the radiographs were NON digital, this was performed a while ago.

The preoperative radiograph ( Fig.1) showed one of the most unusually shaped MB roots that I had ever seen. It literally made what appeared to be two 180 turns, perpendicular to the root axis.

I also noted that the 2nd molar had been extracted and that the third molar had been crowned with an exaggerated mesial contour, to try to close the contact. It was a valiant effort but the open contact continued to present a problem for the patient. This was mainly due to the mobility of the wisdom tooth caused by the short wisdom tooth roots and heavy occlusion. I told the periodontist that I would attempt treatment on this tooth but that I was unsure whether it would help the overall perio condition of the case.

Fig. 2 - Immediate Post Op.

The final film ( Fig.2 ) shows joined MB1 and MB2 canals a very unusual shaped apex. This case was done exclusively with hand files and reamers. Obturation was with Vertical acompaction of Warm Gutta Percha using the Schilder Technique.

Fig. 3 - Dec. '02.

Approximately 6 weeksmonths later, the patient had the case restored with a temporary crown. We were initially optimistic.

Fig. 4 - Jan. '03

In Jan. of 2003, I saw the patient again and determined that the tooth now had a CL III furcation involvement on the distal side (Fig.4 Gutta percha cone in pocket.). The prognosis was now only fair-poor.

Fig. 5 - DB root amp performed

The referring periodontist performed a DB root amp on this tooth. We hope to retain it for a while but the long term prognosis appears to be poor. Although a valiant attempt was made to salvage the tooth, I do not believe that it warrants further expensive attempts at restoration.

Although I was initially pleased to be able to negotiate and fill the MB root, factors beyond our control will probably result in eventual extraction.