MB2's... A Case of Ignorance is Definitely Not Bliss

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Now when I use the word ignorance in the title I certainly don't mean to infer any underlying insult. I only mean to bring up it's base meaning "to ignore". The days of saying to your patient or yourself for that matter, that the the elusive MB2 that you are hunting for in a maxillary 1st or 2nd molar, is non negotiable or calcified. Without the presence of an endodontic microscope or having the ability to run a 3D CBCT, I defy you to say either the canal is calcified or even not present. We all know the percentages are in the 60% to 75% range for 1st molars having an MB2 and 40% for a 2nd molar. My philosophy is if you find 3 canals you better look for 4. Most of the time they are there and it's the most common cause of failure of an upper molar. To think, " no worries I'll find it when I retreat or the specialist will find it" , then perhaps a referral would have been the appropriate option from the beginning. I know the dynamic of endo has changed over the years. From the GP doing his own endo to the GP employing an in office specialist. All fine if the case is in their comfort zone and the practitioner, specialist or GP has the armamentarium at their disposal. Remember a referral is not a admission of inability. It is a valuable TEAM decision on the part of a GP to provide the best care for their patient. In a metropolitan area such as NYC where specialists are close by, lack of a referral can be a sticky wicket when it comes to malpractice defense. This does come up in every case I am asked to review and defend. This is to inform and not to scare!

Now for a hint. Most of the time an MB2 orifice will appear obviously Palatal to but more importantly mesial to the MB orifice. Stay in darker dentin and use plenty of EDTA on the pulpal floor and for gods sake use a scope when excavating. A CBCT scan is certainly a good road map to have.

Happy MB2 hunting.

Note the MB2 obturated orifice almost equidistant between the MB and palatal

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