The patient came in with pain in the upper left posterior region. On examination, tooth #26 (maxillary left first molar) was found to be deeply carious, with decay extending into the pulp chamber. Radiographic and clinical findings confirmed the diagnosis: irreversible pulpitis with symptomatic apical periodontitis.
The treatment plan was clear root canal therapy, followed by a core build-up and crown.
During the first appointment, we accessed the pulp chamber under rubber dam isolation and located the usual three canals: Mesiobuccal (MB) Distobuccal (DB) Palatal (P)
We cleaned and shaped all three canals using rotary instrumentation, irrigated thoroughly with sodium hypochlorite and EDTA, and placed a calcium hydroxide dressing. The tooth was temporarily sealed, and the patient was recalled for obturation.
At the next visit, the canals were obturated successfully using gutta-percha and sealer. The patient left with a temporary restoration and instructions to monitor for any discomfort.
About a week later, the patient returned not with intense pain, but with persistent sensitivity in the same tooth. Everything looked fine radiographically. But something wasn’t right.
And that’s when we asked ourselves the golden question: Did we miss the MB2 canal?
We re-entered the tooth, this time under magnification and with focused exploration. Sure enough, we located the MB2 canal a commonly missed canal in maxillary molars that can lead to treatment failure if left untreated
Thankfully, the patient was asymptomatic during the procedure, so no anesthesia was required. The canal was cleaned, shaped, and irrigated, then obturated in the same sitting.
A composite core build-up was done immediately after, restoring the tooth’s structure.
Following this final intervention, the patient reported complete relief from sensitivity. A follow-up appointment has been scheduled for crown preparation, ensuring long-term success and protection of the tooth.
Never underestimate the complexity of root canal anatomy especially in maxillary molars. MB2 canals are present in up to 90% of maxillary first molars, but are often overlooked without proper magnification or attention. Even when a tooth is symptom-free post-obturation, follow-up is key patients often notice lingering symptoms that can indicate missed anatomy.
This case serves as a powerful reminder: in endodontics, attention to detail is everything. A missed canal can turn a successful RCT into a persistent problem but with the right tools, knowledge, and clinical intuition, even the most hidden canals can be brought to light.
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