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Maxillary second molar
Maxillary second molar
Maxillary second molar
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Maxillary second molar
Maxillary second molars of permanent and primary teeth marked in red.
Identifiers
FMA290271
Anatomical terminology

The maxillary second molar is the tooth located distally (away from the midline of the face) from both the maxillary first molars of the mouth but mesial (toward the midline of the face) from both maxillary third molars. This is true only in permanent teeth. In deciduous (baby) teeth, the maxillary second molar is the last tooth in the mouth and does not have a third molar behind it. The function of this molar is similar to that of all molars in regard to grinding being the principal action during mastication, commonly known as chewing. There are usually four cusps on maxillary molars, two on the buccal (side nearest the cheek) and two palatal (side nearest the palate).

There are great differences between the deciduous (baby) maxillary molars and those of the permanent maxillary molars, even though their function are similar. The permanent maxillary molars are not considered to have any teeth that precede it. Despite being named molars, the deciduous molars are followed by permanent premolars. The deciduous maxillary second molar is the most likely deciduous tooth to have an oblique ridge.

In the universal system of notation, the deciduous maxillary second molars are designated by a letter written in uppercase. The right deciduous maxillary second molar is known as "A", and the left one is known as "J". The international notation has a different system of notation. Thus, the right deciduous maxillary second molar is known as "55", and the left one is known as "65".

In the universal system of notation, the permanent maxillary second molars are designated by a number. The right permanent maxillary second molar is known as "2", and the left one is known as "15". In the Palmer notation, a number is used in conjunction with a symbol designating in which quadrant the tooth is found. For this tooth, the left and right second molars would have the same number, "7", but the right one would have the symbol, "┘", underneath it, while the left one would have, "└". The international notation has a different numbering system than the previous two, and the right permanent maxillary second molar is known as "17", and the left one is known as "27".

References

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Maxillary second molar

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The maxillary second molar is a permanent posterior tooth in the human dentition, located in the maxillary arch distal to the first molar and mesial to the third molar (wisdom tooth). It typically erupts between 11 and 13 years of age and plays a key role in mastication by grinding and comminuting food particles. The tooth has a rhomboidal occlusal outline formed by four major cusps—mesiobuccal, distobuccal, mesiopalatal, and distopalatal—with the mesiopalatal cusp being the largest; an oblique ridge often connects the mesiopalatal to the distobuccal cusp. It usually possesses three roots (mesiobuccal, distobuccal, and palatal) that are less divergent and more parallel than those of the first molar, with average dimensions including a crown length of 7.7 mm, mesiodistal crown width of 9.7 mm, buccolingual crown width of 11.4 mm, total tooth length of 21.4 mm, and root lengths of 13.1 mm (mesiobuccal), 12.5 mm (distobuccal), and 13.7 mm (palatal). Compared to the , the second molar's crown is smaller in all s, particularly mesiodistally by about 1 , with a reduced distobuccal cusp that exposes more of the distal marginal ridge from the buccal view; it also lacks a fifth (distolingual) cusp. The buccolingual exceeds the mesiodistal by up to 2.3 , and the distal half of the crown is shorter occlusocervically than the mesial half. exhibit distal inclination and are often fused in the apical third, with the palatal root being the straightest and strongest; buccal roots are parallel and of similar length, shorter than the palatal by about 1 . The pulp chamber is typically rhomboid or in shape, narrowing apically. Notable anatomical variations include root fusion (reported in 8.8–85% of cases depending on , such as 55% in Caucasoids and up to 85% in Mongoloids) and internal canal configurations, with three canals being most common but a second mesiobuccal canal (MB2) present in 38–40% of teeth; the distobuccal root usually has one canal, while the palatal may rarely bifurcate (1.82–12.2%). These variations, along with occasional C-shaped canals (about 4.9%) or four-rooted forms (up to 1.2% in some groups), significantly impact endodontic and restorative procedures.

Identification

Notation systems

The maxillary second molar is identified using several standardized notation systems in dentistry, each designed to facilitate precise communication among professionals regardless of language or region. These systems assign unique identifiers to teeth based on their position in the dental arch, with the maxillary second molar specifically denoted in the permanent dentition. In the Universal Numbering System, adopted by the American Dental Association in 1975, permanent teeth are numbered sequentially from 1 to 32, starting at the upper right third molar and proceeding clockwise around the mouth as viewed by the dentist. The maxillary right second molar is designated as tooth #2, while the maxillary left second molar is tooth #15. The Palmer Notation, also known as the Zsigmondy-Palmer system, divides the mouth into four quadrants and numbers teeth from 1 (central incisor) to 8 (third molar) within each quadrant, using orientation symbols—such as a vertical line for the upper right (⏐7), a horizontal line for the upper left (7—), and brackets for the lower arches—to indicate position. For the maxillary second molar, this corresponds to the number 7 in the maxillary quadrants, with the appropriate symbol for right or left orientation. The , standardized as ISO 3950 and adopted internationally in 1970, employs a two-digit code where the first digit denotes the quadrant (1 for upper right, 2 for upper left, 3 for lower left, 4 for lower right) and the second digit indicates the tooth position from 1 () to 8 (third molar). Thus, the maxillary right second molar is 17, and the maxillary left second molar is 27. These systems trace their evolution to early 19th-century efforts for standardized recording, beginning with Zsigmondy's quadrant-based numbering introduced in , which influenced the Palmer modification in the late 1800s, and culminating in the FDI's two-digit in the 1970s to promote global uniformity. system predominates in for its simplicity in sequential numbering, Palmer remains common in the UK and countries for its quadrant symbols aiding quick visualization, and FDI is favored internationally for its compact, unambiguous format in records and research.

Location and nomenclature

The maxillary second molar is the seventh permanent tooth counting from the midline in each maxillary quadrant, located distal to the first molar and mesial to the third molar. In standard dental , it is referred to as the permanent maxillary second molar according to the Fédération Dentaire Internationale (FDI) system, where it is designated as tooth 17 in the upper right quadrant (quadrant 1) and tooth 27 in the upper left quadrant (quadrant 2); it is also commonly called the upper second molar or the "12-year molar" due to its typical eruption between approximately 11 and 13 years of age. This tooth is typically present bilaterally in both the left and right maxillary arches, exhibiting high symmetry between counterparts, though congenital absence () can occur, albeit rarely for second molars. It contributes to the posterior segment of the maxillary arch, forming a grinding unit alongside the adjacent first molar. For clinical identification, notation systems assign it numbers such as #2 (upper right) or #15 (upper left) in the Universal Numbering System.

Anatomy

Crown morphology

The crown of the permanent maxillary second molar presents a rhomboidal occlusal outline, often appearing as a twisted parallelogram or heart-shaped form due to its tapering lingual half, and is smaller in all dimensions than the maxillary first molar. The mesiodistal width averages approximately 9-10 mm (range 8.5-11.7 mm), while the buccolingual width is about 11 mm (range 9.9-14.3 mm), with the latter exceeding the former; crown height measures around 7 mm (range 6.1-9.4 mm). The occlusal surface typically features four main cusps in about 65% of cases (tetracuspid form), arranged in a pattern that supports efficient mastication: the mesiobuccal cusp is prominent and wide, the distobuccal cusp is smaller and less developed, the mesiopalatal (mesiolingual) cusp is the largest and longest, and the distopalatal (distolingual) cusp is the smallest and may be reduced or absent in the remaining 35% (tricuspid form). An oblique ridge, less prominent than in the first molar, connects the mesiopalatal to the distobuccal cusp, contributing to the crown's structural integrity. A fifth cusp () is typically absent, distinguishing it from the first molar. The buccal surface is characterized by two cusps separated by a developmental groove, with the occlusal plane sloping cervically toward the distal aspect for enhanced chewing efficiency. The lingual surface is narrower, particularly in its cervical third, and houses the two palatal cusps, often with a lingual groove if the distopalatal cusp is present. The mesial and distal surfaces include marginal ridges that bound the occlusal fissures, with the distal marginal ridge partially visible due to the reduced distobuccal cusp. Enamel on the crown is thicker on the occlusal surfaces compared to the sides, providing resistance to wear during mastication, and is generally thicker overall than in the first maxillary molar, with average thicknesses of 1.28 mm mesially and 1.43 mm distally. The texture features a smooth, hard outer layer that varies slightly in density, supporting the tooth's functional longevity.

Root structure

The maxillary second molar typically features three : a mesiobuccal , a distobuccal , and a palatal , with the palatal being the largest and longest while the two buccal are often divergent from each other. The emerge from a common trunk at the cemento-enamel junction (CEJ) and diverge apically, providing stability within the alveolar bone. Average lengths measure approximately 13.1 mm for the mesiobuccal , 12.5 mm for the distobuccal , and 13.7 mm for the palatal , resulting in an overall length of about 12-13 mm. The trunk extends for a mean of 4.32 ± 1.05 mm buccally before the trifurcation occurs. The buccal furcation entrance is positioned more apically, often near the junction of the cervical and middle thirds of the , compared to the more coronal palatal furcation. Root fusion occurs in approximately 25.8% of cases across pooled studies, most commonly involving the distobuccal and palatal , which can alter the external morphology and reduce the number of distinct to two or one in 5-12% of teeth. The palatal apex is typically blunt or rounded, while buccal apices are more pointed; open apices are occasionally observed but rare in fully developed teeth. The roots are enveloped by the periodontal ligament from the CEJ to the apex, facilitating attachment to the alveolar bone and nutrient exchange. Rare variants, such as a single fused root or supernumerary fourth root, occur in less than 3% of cases and are addressed in detail under root variations.

Internal anatomy

The pulp chamber of the maxillary second molar is typically rhomboidal in cross-section when viewed from the occlusal surface, positioned centrally beneath the occlusal table and featuring four distinct pulp horns corresponding to the four major cusps. The chamber floor commonly exhibits configurations such as Y-shaped or I-shaped, with orifices typically numbering three to four, consisting of one each for the mesiobuccal (MB), distobuccal (DB), and palatal roots, though an MB2 orifice is present in 20-40% of specimens depending on . The system generally comprises three canals, one within each , with studies reporting this configuration in 61.75% to 92.3% of cases; however, the mesiobuccal frequently harbors an additional MB2 canal, occurring in 20-35% of maxillary second molars—less prevalent than the 50-60% seen in first molars. Common configurations follow Vertucci types I (single canal throughout, ~26% in MB ), II (two separate canals merging apically, ~13%), and III (two separate canals throughout, ~20%), with the DB and palatal canals overwhelmingly type I (93.5% and 96.7%, respectively). Accessory canals, often termed lateral canals, arise in 10-15% of cases across the roots, with incidences of 18.7% in MB1, 8.9% in MB2, 11.3% in DB, and 14.6% in palatal; these are most frequent in the middle and apical thirds. Multiple apical occur in 5-10% of specimens, primarily as accessory openings alongside the main , contributing to complex apical anatomy. The palatal root may exhibit an apical delta, characterized by intricate branching and near the apex, though this is less prevalent than in the mesiobuccal root (prevalence ~10-20% in molars overall). Histologically, the pulp of the maxillary second molar consists of rich in fibroblasts, , undifferentiated mesenchymal cells, and immune cells such as macrophages and lymphocytes, forming four zonal layers from the periphery inward: the cell-rich zone, cell-poor zone, pulp proper, and layer. Blood supply derives from arterioles entering via the , forming a network that supports dentinogenesis, while innervation is provided by myelinated Aδ fibers (for sharp pain) and unmyelinated C fibers (for dull ache) from the maxillary division of the via superior alveolar branches, with denser sensory endings in the pulp-dentin interface.

Development and eruption

Chronology

The development of the maxillary second molar follows a well-defined chronological sequence, beginning with initiation at approximately 2.5 to 3 years of age. Enamel formation is typically completed between 7 and 8 years of age, marking the end of crown mineralization. Eruption of the maxillary second molar generally occurs between 12 and 14 years of age, with a mean age of 12 years. Root completion follows eruption, typically between 14 and 16 years of age, at which point approximately 75% of root formation has already occurred by the time of eruption. These timelines can be influenced by factors such as nutrition, genetics, and systemic health conditions. Population variations influence these timelines, with meta-analyses indicating slight delays in eruption age among certain ethnic groups, such as up to 13.45 years as a maximum in some Asian cohorts compared to earlier averages in European populations. Radiographic assessment using Nolla's developmental stages provides a standardized method to evaluate progress specific to the maxillary second molar, dividing formation into 10 stages from crypt formation (stage 1) to apical foramen closure (stage 10).

Occlusal development

The occlusal surface of the maxillary second molar develops through sequential dentinogenesis and , initiated by differentiation from mesenchymal cells in the during the late bell stage of tooth formation. Odontoblasts first deposit dentin matrix at the tips of future cusps, beginning with the palatal (lingual) cusp, followed by the buccal cusps, as guided by secondary enamel knots that act as signaling centers for epithelial folding and cusp patterning. This sequential activity ensures the formation of four primary cusps—mesiopalatal, distopalatal, mesiobuccal, and distobuccal—with the palatal cusps typically larger and more prominent, reflecting the tooth's overall morphology. As dentinogenesis advances apically from the cusp tips, ameloblasts from the inner enamel epithelium begin secreting enamel matrix, which mineralizes to form the hard outer layer of the occlusal surface. Fissure and groove formation occurs concurrently through the invagination of the between developing cusps, resulting in the central groove that separates the buccal and palatal halves, and the oblique ridge connecting the mesiobuccal and distopalatal cusps; these features mature as the crown completes around 7-8 years of age. The depth of pits and fissures established during this phase varies based on enamel deposition patterns, with narrower, deeper configurations increasing susceptibility to caries due to plaque accumulation in these vulnerable sites. Enamel maturation on the occlusal surface progresses in stages, transitioning from a soft, hypocalcified organic matrix secreted by ameloblasts to a fully mineralized structure through the removal of and proteins, achieving approximately 96% content by completion. This process, driven by ameloblast modulation and ion transport, solidifies the cuspal ridges and grooves, enhancing resistance to occlusal forces while the pit and morphology influences long-term durability. During emergence around 12-13 years, the matured occlusal features integrate with the adjacent first molar and second premolar, aligning the buccal cusps and oblique ridge to establish harmonious intercuspation in the . At the microscopic level, the occlusal reveals enamel prisms arranged in rods that extend perpendicularly from the dentinoenamel junction to the surface, with decussating patterns in the cuspal regions providing structural reinforcement unique to molars. Underlying this, dentinal tubules radiate outward from the pulp chamber toward the cusps in a slightly S-shaped , oriented to follow the incremental lines of dentin deposition and optimizing biomechanical support for the occlusal load.

Function

Role in mastication

The maxillary second molar contributes significantly to the grinding phase of mastication by complementing the adjacent first molar in the of food boluses, reducing particle size for easier and . Its occlusal surface features four cusps—mesiopalatal, mesiobuccal, distopalatal, and distobuccal—arranged to create oblique ridges and fossae that enhance shearing and crushing actions, making it particularly effective for processing tougher, fibrous food components such as and meats. During , the maxillary second molar helps to distribute biomechanical forces across the and prevent overload on . The palatal cusp, being the largest and most prominent, typically bears the primary contact during initial occlusal impacts, channeling forces toward the roots for stable support. Clinical studies demonstrate that loss of the maxillary second molar impairs overall masticatory , with unilateral extraction associated with a 25% reduction in posterior grinding performance and subjective perceptions of difficulty. Over time, age-related on the maxillary second molar intensifies due to cumulative masticatory stresses, resulting in flattened cusps and altered occlusal that gradually diminish its capacity for effective . From an evolutionary perspective, the robust, multi-cusped structure of the maxillary second molar represents an to the omnivorous human diet, facilitating the grinding of varied plant-based fibers and animal proteins that characterized ancestral patterns.

Occlusion

In normal Class I occlusion, the mesiobuccal cusp of the maxillary second molar aligns with the mesiobuccal groove of the opposing mandibular second molar, while the distobuccal cusp aligns with the distobuccal groove of the mandibular second molar, facilitating stable intercuspation and efficient load distribution during centric occlusion. The lingual cusps of the maxillary second molar typically rest within the central fossae of the mandibular second molar, with buccal cusps positioned slightly buccal to the mandibular buccal cusps, promoting balanced vertical support and preventing lateral tipping. During lateral excursions, working side contacts on the maxillary second molar involve the mesiolingual cusp engaging the buccal groove of the mandibular second molar, supporting efficient grinding motions, while balancing side contacts are minimal and primarily involve the distobuccal cusp to avoid interferences. The oblique ridge, spanning from the mesiolingual to the distobuccal cusp, plays a key role in guiding these movements by providing a stable pathway for opposing mandibular cusps, enhancing occlusal harmony and reducing eccentric wear. Canine guidance exerts a minimal direct influence on the maxillary second molar but indirectly supports posterior disclusion by elevating the mandible's path during excursions, thereby limiting heavy contacts on this tooth and preserving its integrity. In malocclusions, Class II relationships shift the mandibular second molar distally, causing the maxillary second molar's buccal cusps to contact lingual inclines or fossae prematurely, which alters force vectors and leads to accelerated wear on the distobuccal aspects. Similarly, Class III malocclusions position the mandibular second molar mesially, resulting in edge-to-edge or reverse cusp-groove alignments that promote uneven loading and premature occlusal wear on the mesiobuccal surfaces. Articulation dynamics further modulate these interactions; the Bennett angle, averaging 7.5 degrees, introduces a lateral shift during excursions that can cause the distobuccal cusp path of the maxillary second molar to traverse steeper inclines on the working side, potentially increasing protrusive interferences if exaggerated. Immediate side shift, typically 1-2 mm of lateral translation before condylar rotation, amplifies this effect on the maxillary second molar by altering the immediate contact trajectory, which may necessitate occlusal adjustments to mitigate non-working interferences.

Variations and anomalies

Root variations

The maxillary second molar typically exhibits a three-rooted configuration, consisting of mesiobuccal, distobuccal, and palatal , but deviations such as fusion, supernumerary roots, and altered shapes occur with notable frequency. Root fusion, particularly between the distobuccal and palatal roots, is one of the most prevalent variations, with reported incidences ranging from 10% to 57% across populations, often resulting in a fused distobuccal-palatal root alongside a separate mesiobuccal root. , characterized by an abrupt bend in the root, can accompany fusion, complicating extraction and endodontic access. Extra roots are less common, with four-rooted configurations occurring in about 2-5% of maxillary second molars, typically involving an additional mesiobuccal or palatal root; five-rooted forms are extremely rare and documented primarily in case reports. Single-rooted variants, often conical in shape, have an incidence of 0.5-3.1% in many populations, though some studies report rates up to 10% in certain cohorts such as Korean and Chinese. Asymmetry between contralateral maxillary second molars is observed in approximately 10-20% of cases based on cone-beam computed tomography (CBCT) analyses, manifesting as differences in number or fusion patterns. Population-specific differences are evident, with higher fusion rates—approaching 40%—in Asian groups compared to lower prevalences (around 14%) in African populations.

Cusp anomalies

The maxillary second molar typically features a four-cusp arrangement on its occlusal surface, consisting of the mesiobuccal, distobuccal, mesiopalatal, and distopalatal cusps, though variations in cusp number, , and morphology can occur due to developmental irregularities. Accessory cusps represent uncommon supernumerary structures that alter the standard crown morphology. The , an additional mesiolingual tubercle or cusp, is notably rare on the maxillary second molar, with an incidence of approximately 1.6%, in contrast to its much higher prevalence of around 46.5% on the first molar. Talon cusps, characterized by prominent accessory projections on the palatal surface, are exceptionally infrequent in permanent maxillary molars, occurring in less than 1% of cases, and are primarily documented through isolated case reports rather than population-level data. Cusp reduction anomalies often involve diminished or absence of primary cusps, potentially resulting in irregular occlusal grooves prone to or caries. The distopalatal cusp is particularly susceptible to or complete absence in the maxillary second molar, observed in up to 70% of cases where it is either nonexistent or significantly reduced, leading to a narrower lingual crown outline and open central grooves. This variation contributes to a more rhomboidal or heart-shaped occlusal form in affected teeth. Taurodontism, while primarily a and pulp chamber anomaly, can indirectly influence cusp development by altering overall crown proportions through an enlarged pulp chamber and shortened , with an incidence of approximately 4-12.7% in maxillary second molars. This condition may result in relatively broader cusps or compensatory morphological adjustments on the occlusal surface. Enamel pearls, ectopic enamel nodules typically located at root furcations, occasionally extend toward the crown base and disrupt cusp formation or furcation integrity, with a prevalence of 1.7-6.8% among permanent molars, most commonly affecting maxillary first and second molars. These cusp anomalies exhibit genetic associations, particularly with syndromes such as , where rates of dental developmental irregularities, including and cusp reductions, are elevated due to chromosomal influences on odontogenesis. In individuals with , hypoplastic cusps and other morphological variants occur at higher frequencies compared to the general population, often alongside microdontia affecting maxillary molars.

Clinical considerations

Endodontic treatment

Endodontic treatment of the maxillary second molar presents unique challenges due to its complex , which often includes a second mesiobuccal (MB2) canal in the mesiobuccal root and potential curvatures in the palatal canal. The typical canal configuration consists of three roots (mesiobuccal, distobuccal, and palatal) housing four canals, with the MB2 present in approximately 30–50% of cases. Access cavity preparation begins with an occlusal outline form that is generally triangular to expose the three primary orifices, but modifications to a trapezoidal or square shape may be necessary for enhanced visibility in cases with additional canals. Locating the MB2 involves troughing the floor of the pulp chamber along the mesiobuccal groove using a round bur or ultrasonic tips, starting from the orifice of the mesiobuccal (MB1) and extending toward the palatal , often requiring removal of a shelf or calcifications. This approach ensures straight-line access while preserving tooth structure, with the cavity extended mesially and distally as needed to avoid procedural errors like . Canal negotiation requires careful instrumentation to navigate the frequently curved palatal canal and the narrow, variable MB2, using hand files such as K-files or C-files for initial patency, followed by nickel-titanium (NiTi) rotary files in a crown-down technique. Cone-beam computed tomography (CBCT) guidance improves detection and negotiation success rates to approximately 85-90% for MB2 canals by providing three-dimensional visualization of canal morphology prior to treatment. Irrigation with and (EDTA) is alternated to enhance cleaning of these complex systems. Obturation techniques prioritize sealing the intricate canal network, with lateral compaction using and a resin-based sealer like AH Plus being a widely adopted method for achieving dense three-dimensional fills in the multiple canals. Common failures in obturation stem from missed MB2 canals, which can lead to incomplete and persistent apical periodontitis if not addressed. Retreatment considerations include nonsurgical removal of existing materials using rotary NiTi files and solvents like , particularly for posts in the palatal root, followed by re-instrumentation of missed canals. In cases of fused roots, which complicate access, apical may be indicated if orthograde retreatment fails, involving root-end resection and retrograde filling to seal persistent lesions. Technological aids such as the dental operating with 6-25x and illumination are essential for precise visualization during access, , and retreatment, significantly reducing the of missing canals. Recent advancements, including the GentleWave system utilizing multisonic ultracleaning, have demonstrated improved healing outcomes for apical periodontitis in molars with complex anatomies. Specialized NiTi file systems, like ProTaper or WaveOne, designed for molar variations, facilitate safer shaping of curved canals and improve overall treatment outcomes.

Pathologies and impaction

The maxillary second molar exhibits high susceptibility to dental caries, particularly on its occlusal surfaces, due to the presence of deep and complex fissures that facilitate plaque accumulation and bacterial retention. Studies indicate that occlusal caries frequencies in the second maxillary molar can reach up to 60.9%, often ranking it among the most affected alongside the first molar. Additionally, distal surface caries on the maxillary second molar is frequently associated with adjacent impacted third molars, attributed to poor access and food impaction in the interproximal area. Periodontal pathologies affecting the maxillary second molar often involve furcation areas, especially in teeth with fused roots, where developmental grooves can mimic or exacerbate furcation involvement, leading to localized bone loss and attachment breakdown. This configuration complicates thorough and increases the risk of progressive periodontitis if not addressed early. Impaction of the maxillary second molar occurs with a of 0% to 2.3%, making it a relatively rare anomaly compared to third molars, but it is commonly influenced by the position of the erupting third molar, which can cause mesial tilting or displacement of the second molar during its eruption phase around age 12-13. typically relies on panoramic radiographs to assess angulation, development, and spatial relationships with adjacent teeth. Extraction of the maxillary second molar is indicated in up to 2.9% of cases, often due to complications from proximity to impacted third molars, such as severe caries, resorption, or impaction-related disturbances; prophylactic removal of the third molar may be considered to prevent secondary issues in the second molar. Other associated pathologies include periapical abscesses arising from untreated root canals, with maxillary second molars showing a 43.28% of missed canals like the second mesiobuccal canal, which can lead to persistent infection if endodontic issues remain unresolved. Furthermore, impacted second molars may contribute to through inflammation around the partially erupted .

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