Maxillary Second Molar with Two Separated Palatal Roots: A Case Report

Background: The normal anatomy of the second maxillary molar consists of three roots: mesiobuccal root, distobuccal root, and palatal root. However, there are several variations in the anatomy of the root canal system of the second maxillary molar, such as the presence of four canals: two buccal and two palatal canals. Case Presentation: We present a rare case of 60-year-old male with no medical history presented with a deep carious lesion in the occluso-mesial surface of the left second maxillary molar. The preoperative diagnostic radiograph depicted periapical radiolucency surrounding the distobuccal root and a variation in the morphology of the number of roots and root canals: four roots, including two palatal roots. A diagnosis of symptomatic irreversible pulpitis and symptomatic apical periodontitis was reached. The canals were obturated with bioceramic sealer using the continuous wave compaction technique, and the tooth was sealed with temporary and then final restoration. Discussion: The root and root canal morphology of maxillary second molars are known to be more varied than that of maxillary first molars. Untreated or missed root canals can inevitably cause treatment failure; therefore, it is essential to utilize advanced technologies such as cone beam computed tomography (CBCT) and dental microscopes. Conclusion: Thorough knowledge of the root canal system and its frequent variations is necessary for successful root canal treatment. Future studies should focus on developing educational protocols to train clinicians to recognize and manage rare anatomical variations.