The aims of this study were to assess the prevalence and configuration of the second mesiobuccal (MB2) canal in the mesiobuccal MB root of permanent maxillary first molars at different root levels in a Saudi sub-population using cone-beam computed tomography (CBCT) and to measure the inter-orifice distance between MB & MB2 at the pulpal floor level. Materials and Methods: This retrospective study was carried out on CBCT images of Saudi patients seen at King Abdul Aziz University. A total of 106 maxillary first molars were evaluated using a specialized software program (iCAT CBCT software). The prevalence of MB2, canal configuration and location of joining (apical-middle-coronal), if present was calculated. Also, the inter-orifice distance between both canals was measured at the level of the pulpal floor. Chi-square and one-way analysis of variance (ANOVA) were used. Results: The MB2 canal was found in 92 (86.8%) maxillary first molar teeth. The MB and MB2 canals were joined in 61 (58%) cases, where the location of joining was 14 (23%), 17 (27%), and 31 (50%) in the coronal, middle, and apical third, respectively. The mean interorifice distance between both canals at the level of the pulpal floor was 2.52±0.76 mm. Conclusion: The prevalence of MB2 canal in this Saudi sub-population was high. The prevalence decreased as the root canal approached the apical third. There was no correlation between the average distance and occurrence of canal joining. CBCT is useful in detecting and mapping the mesiobuccal root canal system, with a likelihood of enhancing the quality of root canal treatment.

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Introduction: Patient comfort during root canal treatment is immense for patient cooperation and endodontist efficiency. Establishing the high prevalence of failure of IANB injections in providing pulpal anaesthesia, will most likely support the investigation of supplemental techniques to ensure patient comfort. Objectives: The study aimed to evaluate the prevalence of failed Inferior Alveolar Nerve Block (IANB) injections in achieving pulpal anaesthesia in mandibular molars diagnosed with symptomatic irreversible pulpitis when administered alone. Methods: This study involved fifty patients, diagnosed with symptomatic irreversible pulpitis in their mandibular first and second molars. IANB injection using 2% lidocaine with 1:100,000 epinephrine was administered to anesthetize the acutely inflamed teeth before commencing root canal treatment. Lip and tongue numbness was checked subjectively after injection to ensure successful IANB injection. Objectively, cold test was performed after 15 minutes and pain level was recorded using Visual Analogue Scale (VAS). Success was defined as no pain response by (VAS) during cavity preparation, endodontic access, or initial instrumentation. Results: Although, majority of patient (96%) expressed surrounding soft tissue numbness, only 73% did not feel any pain during initiating root canal treatment. Conclusions: IANB injection alone is not enough to provide profound pulpal anaesthesia in acutely inflamed mandibular molars; therefore, supplemental injections are required to achieve patients comfort during treatment.

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