1 This was first described in the literature by Late Prof. L. Bolk2 of the Anatomical Institute of the University promotion information of Amsterdam in the year 1916. Dahlberg3 in 1945 introduced paleontologic nomenclature when he referred to this structure as ��parastyle�� when present in the upper molars and as ��protostylid�� when present in the lower molars. Parastyle may occur in both deciduous and permanent molars and are usually expressed on the buccal surface of the mesiobuccal cusp (paracone) of the upper molars. In rare instances, it is expressed on the distobuccal cusp (metacone) of the upper molars and the buccal surfaces of the upper premolars. Similarly, a double cusp formation is extremely rare.
4 With respect to size and shape, paramolar tubercles vary; the structure can be anything from a mere prominence of the buccal surface, separated from the rest of the tooth by a fossa or a groove, to a well-developed lobulated cusp, separated by a constriction and having the appearance of a fused supernumerary tooth. The lobulated tubercle is often associated with a root that is either rudimentary or fully formed.2,5 It is not always necessary that these tubercles contain pulp tissue. In cases where it is strongly pronounced this may be presumed. Root canals in tubercles are often connected with other canals;6 in other cases, they are isolated.7 Over the years, many authors have dealt with the problems of supernumerary features of molars. Their studies have mainly been restricted to their external morphology only without giving consideration to the internal anatomy of these superstructures.
Periapical radiographs have been of little significance in assessing the internal structure of the paramolar tubercle as it superimposes on the normal anatomy of the tooth. In these areas, spiral computed tomography (SCT) or volume acquisition CT has proved to be a useful diagnostic tool.8 This article reports a rare case of two well-developed lobulated cusps occurring on the buccal surface of maxillary right second molar (tooth # 2) that was examined through the use of SCT to ascertain the structure of the tubercles, including the root canal morphology and their relationship with associated tooth roots. Also in this article the etiology and the relevance of this structure with respect to different disciplines of dentistry has also been discussed.
CASE REPORT A 36-year-old male patient reported to the Department of Conservative Dentistry and Endodontic with a chief complaint of decayed teeth. The patient��s familial and medical history was noncontributory. On clinical examination, Entinostat in addition to carious teeth, two well-developed lobulated tubercles were found on the buccal surface of tooth # 2 (Figure 1A and 1B). The tubercles exhibited asymmetrical prominence; the mesial tubercles was less pronounced than the distal, while both being more or less expressed on the buccal surface of the mesiobuccal cusp of tooth # 2.