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Georgieva S, Borisova-Papancheva T, Zaneva-Hristova D. Atypical Root Canal System Anatomy in a Permanent Upper First Molar: A Case Report. Cureus 2025; 17:e80760. [PMID: 40248521 PMCID: PMC12004421 DOI: 10.7759/cureus.80760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2025] [Indexed: 04/19/2025] Open
Abstract
Root canal system variations can occur in each tooth group and significantly influence the outcome of the endodontic treatment. Upper first molars often present with some variations, mostly due to the presence of a second mesio-buccal root canal. Other types of atypical root canal system anatomy in upper first molars have also been reported but with a significantly smaller frequency. The aim of this article is to describe a clinical case of a C-shaped root canal configuration in a maxillary first molar - the diagnosis, preparation, irrigation, and final definitive obturation of the root canal system.
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Affiliation(s)
- Slavena Georgieva
- Department of Conservative Dentistry and Oral Pathology, Medical University of Varna, Varna, BGR
| | | | - Denitsa Zaneva-Hristova
- Department of Conservative Dentistry and Oral Pathology, Medical University of Varna, Varna, BGR
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2
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Liu M, Huang Y, Wu Y, Zhang Y, Zhang Z, Wu Q. Nonsurgical endodontic retreatment of C-shaped maxillary molars: case reports and review of literature. BMC Oral Health 2024; 24:1401. [PMID: 39563303 PMCID: PMC11575010 DOI: 10.1186/s12903-024-05155-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 11/06/2024] [Indexed: 11/21/2024] Open
Abstract
The root canal systems of maxillary first molar (MFM) and maxillary second molar (MSM) variations represent a clinical challenge for endodontists, especially the prevalence of fused C-shaped roots. Having a thorough knowledge of root canal configuration is an extremely important point for a successful root canal treatment to avoid missing extra canals. The aim of this article was to present 2 cases of maxillary molar with an unusual C-shaped configuration diagnosed during root canal retreatment/treatment and conduct a literature review of the MFM and MSM anatomy. Case 1 reports that three separate palatal root canals fused into a C-shaped configuration in the MFM, which with an enamel pearl in the furcation, was classified as Type D and first reported in MFM. Case 2 reflects the fusion of all three buccal canals of the MSM into a C-shaped configuration that finally formed an apical foramen with a supernumerary tooth, and the configuration was Type B. Evaluation at an 18-month and a 9-month recall revealed that two patients were symptom-free after the conduct of a non-surgical retreatment/treatment, and the X-ray revealed normal periapical tissue. In addition, the thickness of the Schneiderian membrane due to odontogenic maxillary sinusitis returns to normal after an effective retreatment in case 1. These reports serve to remind endodontists of the importance and complexity of anatomical variations, which should always be considered when formulating an effective root canal treatment plan. The combined use of cone-beam computerized tomography (CBCT) and a dental operating microscope (DOM) will be profitable to locate and identify extra canals when a periapical radiograph shows signs of an unusual canal morphology.
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Affiliation(s)
- Ming Liu
- Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, China
| | - Yanling Huang
- Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, China
| | - Yixuan Wu
- Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, China
- Xiamen Medical College, Xiamen, China
| | - Yi Zhang
- Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, China
| | - Zhisheng Zhang
- Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, China.
| | - Qianju Wu
- Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, China.
- Department of Prosthodontics, Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, 361000, China.
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Wahane KD, Bansod AV, Mattigatti S, Mahaparale R, Rote YB, Wanjari MB. Cone-Beam Computed Tomography (CBCT) Analysis of an Unusual Configuration of the Upper First Molar With a C-shaped Canal With Apically Fused Roots: A Case Report. Cureus 2023; 15:e36474. [PMID: 37090297 PMCID: PMC10115750 DOI: 10.7759/cureus.36474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Lack of identification of the root canal results in root canal treatment failure, one of the most frequent causes of root canal treatment failure. To successfully treat root canals, it is crucial to have a detailed understanding of root canal configuration, including distinguishing traits and anatomical differences. The root canal in the C form arrangement is among the most important anatomical variances. Because of its distinctive highlight, the existence of fins or webs linking the different root canals - the C-shaped form of root canal has proven challenging to detect and manage. Any molar region may have this root canal arrangement, including the mandibular first molar, first premolar, and maxillary molars. Above all, mandibular second molars are where it is most usually discovered. This report discusses the uncommon maxillary first molar with an apically merged root. The importance of comprehending canal variations, which are C-shaped root canals, should be critically evaluated in light of the rise in the root canal treatment failure rate for the upper molars.
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Affiliation(s)
- Kapil D Wahane
- Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to Be University (KIMSDU), Karad, IND
| | - Anand V Bansod
- Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to Be University (KIMSDU), Karad, IND
| | - Sudha Mattigatti
- Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to Be University (KIMSDU), Karad, IND
| | - Rushikesh Mahaparale
- Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to Be University (KIMSDU), Karad, IND
| | - Yuvraj B Rote
- Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to Be University (KIMSDU), Karad, IND
| | - Mayur B Wanjari
- Department of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Singh T, Kumari M, Kochhar R, Iqbal S. Prevalence of C-shaped canal and related variations in maxillary and mandibular second molars in the Indian Subpopulation: A cone-beam computed tomography analysis. J Conserv Dent 2022; 25:531-535. [PMID: 36506623 PMCID: PMC9733544 DOI: 10.4103/jcd.jcd_234_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/29/2022] [Accepted: 06/14/2022] [Indexed: 12/15/2022] Open
Abstract
Aim The aim of this study was to evaluate the prevalence and anatomical configuration of the C-shaped canal in permanent maxillary and mandibular second molars in the Greater Noida population by compiling the results of data that used cone-beam computed tomography (CBCT) analysis. Subjects and Methods CBCT images were taken from the archive in the department of oral medicine and radiology taken for diagnostic purposes referred by other departments in the dental college. Five hundred CBCT records of patients, between the age group of 15-40 years, containing maxillary second molars and mandibular second molars were selected and reviewed. Statistical Analysis Statistical analysis was done using the Chi-square test to find out the most common configuration of the C-shaped canal between maxillary and mandibular second molars. Results Hundred and ten out of 500 patients had C-shaped canals (22%). Among them, 58 teeth (52.7%) were continuous C-shaped canals, 41 teeth (37.3%) were semicolon-shaped canals and 11 teeth (10%) had separated canals. (Chi-square test value = 8.26, P = 0.024). Statistically significant difference was found in configuration types. Among the jaw type, 62 maxillary second molar presented with C-shaped canal (25.1%) and 48 mandibular second molar presented with C-shaped canal (18.9%) (Chi-square test value = 3.87, P = 0.276). However, the difference was statistically insignificant in relation to the jaw type. Conclusions Within the limitation of the study, we can conclude that the overall prevalence of C-shaped canals was 22% and the most common C-shaped canal configuration type was continuous (52.7%). However, no statistically significant difference was found in relation to jaw type.
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Affiliation(s)
- Tanisha Singh
- Department of Conservative Dentistry and Endodontics, ITS Dental College Hospital and Research Centre, Greater Noida, Uttar Pradesh, India,Address for correspondence: Dr. Tanisha Singh, Sector PI ITBP Housing Society Flat No. 313, Greater Noida, Uttar Pradesh, India. E-mail:
| | - Manju Kumari
- Department of Conservative Dentistry and Endodontics, ITS Dental College Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Rohit Kochhar
- Department of Conservative Dentistry and Endodontics, ITS Dental College Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Sana Iqbal
- Department of Conservative Dentistry and Endodontics, ITS Dental College Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
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Baghbani A, Bagherpour A, Ahmadis Z, Dehban A, Shahmohammadi R, Jafarzadeh H. The efficacy of five different techniques in identifying C-shaped canals in mandibular molars. AUST ENDOD J 2020; 47:170-177. [PMID: 33030295 DOI: 10.1111/aej.12445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 12/24/2022]
Abstract
Information regarding the canal anatomy especially in complex cases such as C-shaped canals is essential for a successful treatment. In this study, five different methods for identification of C-shaped canal configuration were compared. 108 extracted mandibular molars with fused roots were studied. Radiographic evaluation was carried out using periapical radiography and CBCT. After access cavity preparation, all specimens were evaluated by direct visual examination and then under dental operating microscope. Finally, the actual anatomy of each sample was determined by preparing horizontal cross sections of the roots (1 mm thick) and examining them under stereomicroscope as the gold standard. Among the techniques used, high-resolution CBCT manifested the highest accuracy, whereas periapical radiography had the lowest. All approaches can be useful in reaching a correct diagnosis. CBCT, especially the low-resolution modality, is an effective technique in the diagnosis of C-shaped anatomy.
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Affiliation(s)
- Atefeh Baghbani
- Department of Prosthodontics, Faculty of Dentistry, Bojnurd University of Medical Sciences, Bojnurd, Iran
| | - Ali Bagherpour
- Department of Oral and Maxillofacial Radiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Ahmadis
- Department of Prosthodontics, Faculty of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
| | - Arezou Dehban
- Department of Prosthodontics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Shahmohammadi
- Department of Endodontics, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
| | - Hamid Jafarzadeh
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Unusual Maxillary First Molars with C-Shaped Morphology on the Same Patient: Variation in Root Canal Anatomy. Case Rep Dent 2019; 2019:1857289. [PMID: 31772783 PMCID: PMC6854219 DOI: 10.1155/2019/1857289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 11/18/2022] Open
Abstract
A maxillary first molar should be considered a four-canal tooth until proved otherwise; however, a clinician should also be aware of the possibility of the presence of C-shaped root canal configuration with or without possibility of splitting into two or three canals. The two clinical cases reported in this paper describe the endodontic treatment of two maxillary first molars, on the same patient, with uncommon anatomy: the first case is about a maxillary first molar with only one C-shaped root and one oval canal with a large buccolingual diameter, a C1 type according to Fan's classification; the second case, about the contralateral maxillary first molar, is probably the first case documented of a maxillary first molar with a C-shaped root canal and C-shaped root with complete fusion of the three roots, having a C3 configuration.
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Mashyakhy M, Chourasia HR, Jabali A, Almutairi A, Gambarini G. Analysis of Fused Rooted Maxillary First and Second Molars with Merged and C-shaped Canal Configurations: Prevalence, Characteristics, and Correlations in a Saudi Arabian Population. J Endod 2019; 45:1209-1218. [DOI: 10.1016/j.joen.2019.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/25/2019] [Accepted: 06/25/2019] [Indexed: 11/26/2022]
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Liu J, Que KH, Xiao ZH, Wen W. Endodontic management of the maxillary first molars with two root canals: A case report and review of the literature. World J Clin Cases 2019; 7:79-88. [PMID: 30637256 PMCID: PMC6327126 DOI: 10.12998/wjcc.v7.i1.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/26/2018] [Accepted: 12/01/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.
CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively. Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography (CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope (DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition, each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.
CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.
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Affiliation(s)
- Jie Liu
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin 300070, China
| | - Ke-Hua Que
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin 300070, China
| | - Zuo-Hui Xiao
- Department of Geriatric Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
- Laboratory of Biomedical Materials, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Wen Wen
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin 300070, China
- Department of Stomatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China
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Evaluation of the root and canal systems of maxillary molars in Taiwanese patients: A cone beam computed tomography study. Biomed J 2017; 40:232-238. [PMID: 28918912 PMCID: PMC6136279 DOI: 10.1016/j.bj.2017.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/06/2017] [Accepted: 05/23/2017] [Indexed: 12/13/2022] Open
Abstract
Background This study evaluated variations in root canal configuration in the maxillary permanent molars of Taiwanese patients by analyzing patients' cone beam computed tomography (CBCT) images. Comparisons were made among these configurations and those previously reported. This information may serve as a basis for improving the success rate of endodontic treatment. Methods The root canal systems of 114 Taiwanese patients with bilateral maxillary first or second molars were examined using CBCT images. The number of roots, canals per root, and additional mesiobuccal (MB) canals, as well as the canal configuration were enumerated and recorded. Results Of the 196 maxillary first molars examined, three (1.5%) had a single root, two (1.0%) had two roots, and 191 (97.5%) had three separate roots. Out of all first molar roots examined, 44% of mesiobuccal (MB) roots had a single canal and the remainder had a second MB (MB2) canal. Of the 212 maxillary second molars examined, 16 (7.1%) had a single root, 51 (24.2%) had two roots, 143 (67.8%) had three roots, and two (0.9%) had four separate roots. For the MB roots, 92.3% of three-rooted maxillary second molars had a single canal and the remainder had an MB2 canal. In all three-rooted maxillary first and second molars, each of the distal and palatal roots had one canal. Conclusions The root canal configurations of the MB roots of maxillary molars were more varied than those of the distobuccal and palatal roots, and the root canal configurations of maxillary second molars were more varied than those of the first molars. These findings demonstrate CBCT as a useful clinical tool for endodontic diagnosis and treatment planning.
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Jo HH, Min JB, Hwang HK. Analysis of C-shaped root canal configuration in maxillary molars in a Korean population using cone-beam computed tomography. Restor Dent Endod 2016; 41:55-62. [PMID: 26877991 PMCID: PMC4751207 DOI: 10.5395/rde.2016.41.1.55] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/06/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the incidence of root fusion and C-shaped root canals in maxillary molars, and to classify the types of C-shaped canal by analyzing cone-beam computed tomography (CBCT) in a Korean population. MATERIALS AND METHODS Digitized CBCT images from 911 subjects were obtained in Chosun University Dental Hospital between February 2010 and July 2012 for orthodontic treatment. Among them, a total of selected 3,553 data of maxillary molars were analyzed retrospectively. Tomography sections in the axial, coronal, and sagittal planes were displayed by PiViewstar and Rapidia MPR software (Infinitt Co.). The incidence and types of root fusion and C-shaped root canals were evaluated and the incidence between the first and the second molar was compared using Chi-square test. RESULTS Root fusion was present in 3.2% of the first molars and 19.5% of the second molars, and fusion of mesiobuccal and palatal root was dominant. C-shaped root canals were present in 0.8% of the first molars and 2.7% of the second molars. The frequency of root fusion and C-shaped canal was significantly higher in the second molar than the first molar (p < 0.001). CONCLUSIONS In a Korean population, maxillary molars showed total 11.3% of root fusion and 1.8% of C-shaped root canals. Furthermore, root fusion and C-shaped root canals were seen more frequently in the maxillary second molars.
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Affiliation(s)
- Hyoung-Hoon Jo
- Department of Conservative Dentistry, School of Dentistry, Chosun University, Gwangju, Korea
| | - Jeong-Bum Min
- Department of Conservative Dentistry, School of Dentistry, Chosun University, Gwangju, Korea
| | - Ho-Keel Hwang
- Department of Conservative Dentistry, School of Dentistry, Chosun University, Gwangju, Korea
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Martins JNR, Mata A, Marques D, Anderson C, Caramês J. Prevalence and Characteristics of the Maxillary C-shaped Molar. J Endod 2016; 42:383-9. [PMID: 26806590 DOI: 10.1016/j.joen.2015.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/07/2015] [Accepted: 12/13/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The anatomy of the maxillary C-shaped molar has been the subject of several case reports although no true prevalence research has ever been conducted. The aim of this observational study was to evaluate and characterize the incidence of these morphologies using cone-beam computed tomographic (CBCT) technology. METHODS Patients having presurgical CBCT examination were selected. CBCT analysis was performed at 5 different axial levels, and the teeth were classified as maxillary molar C shapes according to the inclusion criteria for the present investigation. The prevalence of C-shaped anatomy was calculated. The z test for proportions in independent groups was used to analyze the differences between proportions. Intrarater reliability was also tested. RESULTS A total of 2227 teeth (928 upper first molars and 1299 upper second molars) from 895 patients were included in this research. Five different types of C-shaped molars were found, which included fusion between mesiobuccal and palatal roots (type A), mesiobuccal and distobuccal roots (type B), distobuccal and palatal roots (type C), 2 possible palatal roots (type D), and mesiobuccal and palatal roots connecting with an independent distobuccal root canal at apical or between distobuccal and palatal roots connecting with an independent mesiobuccal root canal at apical (type E). The global prevalence was 1.1% for first molars and 3.8% for second molars. Differences were observed between sex, teeth, and some types of C shapes at P < .05. CONCLUSIONS Maxillary C-shaped molars have low prevalence but high anatomic complexity. An understanding of their anatomic configuration and variations is important in ensuring that they are treated properly. Distinct differences exist between C-shaped configurations of upper and lower molars.
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Affiliation(s)
- Jorge N R Martins
- Department of School of Dental Medicine, Biomedical and Oral Sciences Research Unit (FCT Unit 4062), Evidence Based Dentistry Center, Lisbon University, Lisbon, Portugal; Private Practice, Lisbon, Portugal.
| | - António Mata
- Department of Biology, New York University, New York, New York; Department of Oral Biology, Biomedical and Oral Sciences Research Unit (FCT Unit 4062), Evidence Based Dentistry Center, Lisbon University, Lisbon, Portugal; Department of Oral Biology and Biochemistry Group, Biomedical and Oral Sciences Research Unit (FCT Unit 4062), Evidence Based Dentistry Center, Lisbon University, Lisbon, Portugal
| | - Duarte Marques
- Department of Anatomy and Physiology, Biomedical and Oral Sciences Research Unit (FCT Unit 4062), Evidence Based Dentistry Center, Lisbon University, Lisbon, Portugal; Department of Oral Biology and Biochemistry Group, Biomedical and Oral Sciences Research Unit (FCT Unit 4062), Evidence Based Dentistry Center, Lisbon University, Lisbon, Portugal
| | | | - João Caramês
- Department of Implantology, Biomedical and Oral Sciences Research Unit (FCT Unit 4062), Evidence Based Dentistry Center, Lisbon University, Lisbon, Portugal
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12
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Kim JW, Ji HJ, Cho KM, Kim SM, Park SH. A cone-beam computed tomographic study of C-shaped root and root canal in maxillary molars. ACTA ACUST UNITED AC 2015. [DOI: 10.14368/jdras.2015.31.2.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jin-Woo Kim
- Department of Conservative Dentistry, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Hyo-Jin Ji
- Department of Conservative Dentistry, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Kyung-Mo Cho
- Department of Conservative Dentistry, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Sung-Min Kim
- Hyundai Senior High School, Seoul, Republic of Korea
| | - Se-Hee Park
- Department of Conservative Dentistry, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
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Kato A, Ziegler A, Higuchi N, Nakata K, Nakamura H, Ohno N. Aetiology, incidence and morphology of the C-shaped root canal system and its impact on clinical endodontics. Int Endod J 2014; 47:1012-33. [PMID: 24483229 PMCID: PMC4258081 DOI: 10.1111/iej.12256] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/27/2014] [Indexed: 01/15/2023]
Abstract
The C-shaped root canal constitutes an unusual root morphology that can be found primarily in mandibular second permanent molars. Due to the complexity of their structure, C-shaped root canal systems may complicate endodontic interventions. A thorough understanding of root canal morphology is therefore imperative for proper diagnosis and successful treatment. This review aims to summarize current knowledge regarding C-shaped roots and root canals, from basic morphology to advanced endodontic procedures. To this end, a systematic search was conducted using the MEDLINE, BIOSIS, Cochrane Library, EMBASE, Google Scholar, Web of Science, PLoS and BioMed Central databases, and many rarely cited articles were included. Furthermore, four interactive 3D models of extracted teeth are introduced that will allow for a better understanding of the complex C-shaped root canal morphology. In addition, the present publication includes an embedded best-practice video showing an exemplary root canal procedure on a tooth with a pronounced C-shaped root canal. The survey of this unusual structure concludes with a number of suggestions concerning future research efforts.
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Affiliation(s)
- A Kato
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University, Aichi, Japan
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14
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Chhabra S, Yadav S, Talwar S. Analysis of C-shaped canal systems in mandibular second molars using surgical operating microscope and cone beam computed tomography: A clinical approach. J Conserv Dent 2014; 17:238-43. [PMID: 24944447 PMCID: PMC4056395 DOI: 10.4103/0972-0707.131785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/27/2014] [Accepted: 02/04/2014] [Indexed: 11/27/2022] Open
Abstract
Aims: The study was aimed to acquire better understanding of C-shaped canal systems in mandibular second molar teeth through a clinical approach using sophisticated techniques such as surgical operating microscope and cone beam computed tomography (CBCT). Materials and Methods: A total of 42 extracted mandibular second molar teeth with fused roots and longitudinal grooves were collected randomly from native Indian population. Pulp chamber floors of all specimens were examined under surgical operating microscope and classified into four types (Min's method). Subsequently, samples were subjected to CBCT scan after insertion of K-files size #10 or 15 into each canal orifice and evaluated using the cross-sectional and 3-dimensional images in consultation with dental radiologist so as to obtain more accurate results. Minimum distance between the external root surface on the groove and initial file placed in the canal was also measured at different levels and statistically analyzed. Results: Out of 42 teeth, maximum number of samples (15) belonged to Type-II category. A total of 100 files were inserted in 86 orifices of various types of specimens. Evaluation of the CBCT scan images of the teeth revealed that a total of 21 canals were missing completely or partially at different levels. The mean values for the minimum thickness were highest at coronal followed by middle and apical third levels in all the categories. Lowest values were obtained for teeth with Type-III category at all three levels. Conclusions: The present study revealed anatomical variations of C-shaped canal system in mandibular second molars. The prognosis of such complex canal anatomies can be improved by simultaneous employment of modern techniques such as surgical operating microscope and CBCT.
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Affiliation(s)
- Sanjay Chhabra
- Department of Conservative Dentistry & Endodontics, Army Dental Center (R&R), Delhi Cantonment, New Delhi, India
| | - Seema Yadav
- Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, New Delhi, India
| | - Sangeeta Talwar
- Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, New Delhi, India
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15
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Treatment of a Hypertaurodontic Maxillary Second Molar in a Patient with 10 Taurodonts: A Case Report. J Endod 2014; 40:140-4. [DOI: 10.1016/j.joen.2013.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 08/17/2013] [Accepted: 08/18/2013] [Indexed: 11/24/2022]
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16
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Silva EJNL, Nejaim Y, Silva AIV, Haiter-Neto F, Zaia AA, Cohenca N. Evaluation of root canal configuration of maxillary molars in a Brazilian population using cone-beam computed tomographic imaging: an in vivo study. J Endod 2013; 40:173-6. [PMID: 24461399 DOI: 10.1016/j.joen.2013.10.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/25/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The aim of this study was to analyze and characterize root canal morphology of maxillary molars of the Brazilian population using cone-beam computed tomographic (CBCT) imaging. METHODS Patients referred for a CBCT radiographic examination for accurate diagnosis and treatment planning were enrolled in the study. A total of 620 healthy, untreated, fully developed maxillary first and second molars were included (314 first molars and 306 second molars). The following observations were recorded: (1) number of roots and their morphology, (2) number of canals per root, (3) fused roots, and (4) primary variations in the morphology of the root canal systems. RESULTS First and second molars showed a higher prevalence of 3 separate roots, mesiobuccal, distobuccal, and palatal, with 1 canal in each root (52.87% and 45.09%, respectively). Two canals in the mesiobuccal roots represented 42.63% of teeth, whereas mesiobuccal roots of second molars presented 2 canals in 34.32%. The most common anatomic variation in the maxillary first molar was related to the root canal configuration of the mesiobuccal root, whereas the root canal system of the maxillary second molar teeth showed more anatomic variables. CONCLUSIONS Mesiobuccal roots of maxillary molar teeth had more variation in their canal system than the distobuccal or palatal roots. The root canal configuration of the maxillary second molars was more variable than the first molars in a Brazilian population. CBCT imaging is a clinically useful tool for endodontic diagnosis and treatment planning.
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Affiliation(s)
| | - Yuri Nejaim
- Department of Oral and Maxillofacial Surgery, Oral Radiology Division, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Amaro I V Silva
- Department of Oral and Maxillofacial Surgery, Oral Radiology Division, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Francisco Haiter-Neto
- Department of Oral and Maxillofacial Surgery, Oral Radiology Division, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Alexandre A Zaia
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Nestor Cohenca
- Department of Endodontics, School of Dentistry, University of Washington, Seattle, Washington
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17
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Shin Y, Kim Y, Roh BD. Maxillary first molar with an O-shaped root morphology: report of a case. Int J Oral Sci 2013; 5:242-4. [PMID: 24008268 PMCID: PMC3967315 DOI: 10.1038/ijos.2013.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/16/2013] [Indexed: 02/07/2023] Open
Abstract
This case report is to present a maxillary first molar with one O-shaped root, which is an extended C-shaped canal system. Patient with chronic apical periodontitis in maxillary left first molar underwent replantation because of difficulty in negotiating all canals. Periapical radiographs and cone-beam computed tomography (CBCT) were taken. All roots were connected and fused to one root, and all canals seemed to be connected to form an O-shape. The apical 3 mm of the root were resected and retrograde filled with resin-modified glass ionomer. Intentional replantation as an alternative treatment could be considered in a maxillary first molar having an unusual O-shaped root.
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Affiliation(s)
- Yooseok Shin
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
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18
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Martins JNR, Quaresma S, Quaresma MC, Frisbie-Teel J. C-shaped maxillary permanent first molar: a case report and literature review. J Endod 2013; 39:1649-53. [PMID: 24238466 DOI: 10.1016/j.joen.2013.06.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 05/14/2013] [Accepted: 06/29/2013] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The C-shaped configuration is rare in the upper first molar.The purpose of this article is to present 2 cases diagnosed during endodontic therapy and perform a literature review of this anatomy in the upper first molar. METHODS Endodontic therapy was performed by using a dental operating microscope and a cone-beam computed tomography analysis for better understanding of this anatomy. A literature search was conducted to identify and compare all the published cases of C-shaped upper first molar. RESULTS Before the cases reported in this article, only 5 cases were available in the published literature. Three different types of C-shaped configurations in the upper first molar have been presented. CONCLUSIONS The C-shaped maxillary first molar is a rare anatomic configuration. The use of the dental operating microscope may help in the endodontic therapy of these cases. Three types of C-shaped configurations have been reported; the fusion of the distobuccal root with the palatal root appears to be the most usual one.
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Affiliation(s)
- Jorge N R Martins
- Department of Endodontics, Instituto de Implantologia, Lisbon, Portugal.
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19
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Rahimi S, Ghasemi N. Maxillary first molar with two root canals. Sultan Qaboos Univ Med J 2013; 13:E346-9. [PMID: 23862051 DOI: 10.12816/0003251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 11/18/2012] [Accepted: 12/12/2012] [Indexed: 01/01/2023] Open
Abstract
Knowledge regarding the anatomic morphology of maxillary molars is absolutely essential for the success of endodontic treatment. The morphology of the permanent maxillary first molar has been reviewed extensively; however, the presence of two canals in a two-rooted maxillary first molar has rarely been reported in studies describing tooth and root canal anatomies. This case report presents a patient with a maxillary first molar with two roots and two root canals, who was referred to the Department of Endodontics, Tabriz University of Medical Sciences, Iran.
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Affiliation(s)
- Saeed Rahimi
- Dental and Periodontal Research Center, Department of Endodontics, Tabriz Dental School, Tabriz University of Medical Sciences, Tabriz, Iran
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20
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Shakouie S, Mokhtari H, Ghasemi N, Gholizadeh S. Two-rooted maxillary first molars with two canals: a case series. IRANIAN ENDODONTIC JOURNAL 2013; 8:29-32. [PMID: 23412400 PMCID: PMC3570973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 04/29/2012] [Accepted: 05/15/2012] [Indexed: 11/16/2022]
Abstract
Thorough understanding of the anatomic and internal morphology of a root canal system is absolutely essential for the success of endodontic treatment. Since permanent maxillary first molars have shown variation in internal anatomy, morphology, this tooth has been reviewed extensively. Presence of two canals in a two-rooted maxillary first molar has rarely been reported in studies describing tooth and root canal anatomies. In this report, three cases are presented, which involve the root canal treatment of maxillary first molars with fusion of the two buccal roots.
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Affiliation(s)
- Sahar Shakouie
- Department of Endodontics, Dental School, Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Mokhtari
- Department of Endodontics, Dental School, Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding author: Hadi Mokhtari, Department of Endodontics, Faculty of Dentistry, Golgasht Street, 5166614713, Tabriz, Iran. Tel: +98-914 3131992, Fax: +98-411 3346977, E-mail:
| | - Negin Ghasemi
- Department of Endodontics, Dental School, Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seddigheh Gholizadeh
- Department of Endodontics, Dental School, Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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21
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Seo DG, Gu Y, Yi YA, Lee SJ, Jeong JS, Lee Y, Chang SW, Lee JK, Park W, Kim KD, Kum KY. A biometric study of C-shaped root canal systems in mandibular second molars using cone-beam computed tomography. Int Endod J 2012; 45:807-14. [DOI: 10.1111/j.1365-2591.2012.02037.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shetty PP, Astekar MS, Jain A, Pandya M. Maxillary first molar with two palatal roots located under dental operating microscope. Clin Pract 2012; 2:e26. [PMID: 24765425 PMCID: PMC3981339 DOI: 10.4081/cp.2012.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 12/13/2011] [Accepted: 12/17/2011] [Indexed: 11/22/2022] Open
Abstract
An awareness and understanding of the presence of an additional root and unusual root canal morphology is essential as it determines the successful outcome of endodontic treatment. A thorough knowledge of basic root canal anatomy and its variation is necessary for successful completion of endodontic treatment. This report points to the importance of looking for additional roots and canals with the help of operating microscope. Finding additional roots and canals would enable clinician to successfully treat a case that would otherwise not be successful.
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Affiliation(s)
| | - Madhusudan S Astekar
- Department of Oral Pathology, Paher University, Pacific Dental College and Hospital, Udaipur, India
| | - Ankit Jain
- Department of Conservative and Endodontics
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23
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Kottoor J, Velmurugan N, Ballal S, Roy A. Four-rooted maxillary first molar having C-shaped palatal root canal morphology evaluated using cone-beam computerized tomography: a case report. ACTA ACUST UNITED AC 2011; 111:e41-5. [PMID: 21444221 DOI: 10.1016/j.tripleo.2010.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 12/15/2010] [Indexed: 11/20/2022]
Affiliation(s)
- Jojo Kottoor
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Chennai, India
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24
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Kottoor J, Velmurugan N, Surendran S. Endodontic management of a maxillary first molar with eight root canal systems evaluated using cone-beam computed tomography scanning: a case report. J Endod 2011; 37:715-9. [PMID: 21496678 DOI: 10.1016/j.joen.2011.01.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 01/11/2011] [Accepted: 01/15/2011] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Root canal treatment of maxillary molars presenting with complex root canal configurations can be diagnostically and technically challenging. METHODS Nonsurgical endodontic therapy of a left maxillary first molar with three roots and eight root canals was successfully performed. This unusual morphology was diagnosed using a dental operating microscope (DOM) and confirmed with the help of cone-beam computed tomography (CBCT) images. RESULTS CBCT axial images showed that both the mesiobuccal and distobuccal root contained a Sert and Bayirli type XV canal, whereas the palatal root showed a Vertucci type II canal configuration. CONCLUSIONS The use of a DOM and CBCT imaging in endodontically challenging cases can facilitate a better understanding of the complex root canal anatomy, which ultimately enables the clinician to explore the root canal system and clean, shape, and obturate it more efficiently.
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Affiliation(s)
- Jojo Kottoor
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Chennai Tamil Nadu, India.
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25
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Endodontic Management and Cone-beam Computed Tomography Evaluation of Seven Maxillary and Mandibular Molars with Single Roots and Single Canals in a Patient. J Endod 2011; 37:103-9. [DOI: 10.1016/j.joen.2010.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 09/03/2010] [Accepted: 09/19/2010] [Indexed: 11/19/2022]
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26
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Maxillary first molar with seven root canals diagnosed with cone-beam computed tomography scanning: a case report. J Endod 2010; 36:915-21. [PMID: 20416446 DOI: 10.1016/j.joen.2009.12.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 11/30/2009] [Accepted: 12/08/2009] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The purpose of this article was to emphasize the importance of having a thorough knowledge about the root canal anatomy. METHODS This case report presents the endodontic management of a maxillary first molar with three roots and seven canals. The clinical detection of the seven canals was made using a surgical operating microscope and confirmed using cone-beam computed tomography (CBCT) scanning. RESULTS CBCT axial images showed that both the palatal and distobuccal root have a Vertucci type II canal pattern, whereas the mesiobuccal root showed a Sert and Bayirli type XV canal configuration. CONCLUSION This report describes and discusses the variation in canal morphology of maxillary first molar and the use of latest adjuncts in successfully diagnosing and negotiating them.
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27
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Maxillary first molar with an unusual morphology: report of a rare case. ACTA ACUST UNITED AC 2008; 106:e62-5. [DOI: 10.1016/j.tripleo.2008.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 07/27/2008] [Indexed: 12/12/2022]
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28
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Jafarzadeh H, Wu YN. The C-shaped root canal configuration: a review. J Endod 2007; 33:517-523. [PMID: 17437864 DOI: 10.1016/j.joen.2007.01.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Revised: 12/25/2006] [Accepted: 01/02/2007] [Indexed: 11/30/2022]
Abstract
Recognition of unusual variations in the canal configuration is critical because it has been established that the root with a single tapering canal and apical foramen is the exception rather than the rule. The early recognition of these configurations facilitates cleaning, shaping, and obturation of the root canal system. "C" configuration, which is an important anatomic variation, presents a thin fin connecting the root canals. Because of the importance of its true diagnosis and treatment, a comprehensive review of published information and investigations about it in addition to approaches for its treatment is necessary.
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Affiliation(s)
- Hamid Jafarzadeh
- Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
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29
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Cleghorn BM, Christie WH, Dong CCS. Root and root canal morphology of the human permanent maxillary first molar: a literature review. J Endod 2006; 32:813-21. [PMID: 16934622 DOI: 10.1016/j.joen.2006.04.014] [Citation(s) in RCA: 205] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 04/27/2006] [Accepted: 04/30/2006] [Indexed: 01/28/2023]
Abstract
The objective of this study was to review the literature with respect to the root and canal systems in the maxillary first molar. Root anatomy studies were divided into laboratory studies (in vitro), clinical root canal system anatomy studies (in vivo) and clinical case reports of anomalies. Over 95% (95.9%) of maxillary first molars had three roots and 3.9% had two roots. The incidence of fusion of any two or three roots was approximately 5.2%. Conical and C-shaped roots and canals were rarely found (0.12%). This review contained the most data on the canal morphology of the mesiobuccal root with a total of 8399 teeth from 34 studies. The incidence of two canals in the mesiobuccal root was 56.8% and of one canal was 43.1% in a weighted average of all reported studies. The incidence of two canals in the mesiobuccal root was higher in laboratory studies (60.5%) compared to clinical studies (54.7%). Less variation was found in the distobuccal and palatal roots and the results were reported from fourteen studies consisting of 2576 teeth. One canal was found in the distobuccal root in 98.3% of teeth whereas the palatal root had one canal in over 99% of the teeth studied.
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Affiliation(s)
- Blaine M Cleghorn
- Department of Dental Clinical Sciences, Dalhousie University, Halifax, Nova Scotia.
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30
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Jin GC, Lee SJ, Roh BD. Anatomical study of C-shaped canals in mandibular second molars by analysis of computed tomography. J Endod 2006; 32:10-3. [PMID: 16410060 DOI: 10.1016/j.joen.2005.10.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to investigate the prevalence and configuration of the C-shaped canal using serial axial computed tomography images of the mandibular second molars that had not been restored severely or treated endodontically, and to compare the thickness of the remaining tooth structure from the center of the canal to the outer surface of the deepest groove area in C-shaped mandibular second molar to that of "danger zone of perforation" in normal mandibular second molar. This distance was measured at the cervical, middle, and apical third level each. From 220 teeth, C-shaped canals were found in 98 teeth (44.5%). Almost all the grooves were directed lingual (99%). The continuous C-shaped canal was the most frequently found (49%) and the separated canal was the least (17.4%). The thinnest remaining tooth structure in the groove area of the C-shaped mandibular second molar was not different from that of the danger zone of normal mandibular second molar at the three levels (p > 0.05).
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Abstract
AIM This case report presents an unusual C-shaped root canal system in a maxillary first molar tooth. SUMMARY Although C-shaped root canals are most frequently seen in the mandibular second molar, they may also appear in maxillary molars. A literature search revealed only a few case reports of C-shaped root canal systems in maxillary molars. The present case describes a C-shaped canal in the buccal root of a maxillary first molar. The endodontic access cavity displayed two canal orifices, one leading to the canal system in the buccal root, the other into the palatal root canal system. In the buccal root, what appeared to be the mesial and distal canals joined to form a single C-shaped canal. KEY LEARNING POINTS --Careful examination of radiographs and the internal anatomy of teeth is essential.-- The location and morphology of root canals should be identified at high magnification under the microscope.
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Affiliation(s)
- Z Yilmaz
- Department of Endodontics, Faculty of Dentisty, Hacettepe University, Ankara, Turkey.
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32
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Torabinejad M, Kutsenko D, Machnick TK, Ismail A, Newton CW. Levels of Evidence for the Outcome of Nonsurgical Endodontic Treatment. J Endod 2005; 31:637-46. [PMID: 16123698 DOI: 10.1097/01.don.0000153593.64951.14] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The purpose of this systematic review was (a) to search for clinical articles pertaining to success and failure of nonsurgical root canal therapy, and (b) to assign levels of evidence to these studies. Electronic and manual searches were conducted to identify studies published between January 1966 and September 2004 with information on the success and failure of nonsurgical root canal therapy. Articles were reviewed and graded for strength of level of evidence (LOE) from one (highest level) to five (lowest level). This review resulted in the identification of 306 clinical studies related to this topic area. Six articles were randomized controlled trials (RCTs, LOE 1). This search also identified 12 low-quality RCTs (LOE 2), 14 cohort studies (LOE 2), five case-control and eight cross sectional studies (LOE 3), four low-quality cohort studies (LOE 4), and five low-quality case-control studies (LOE 4). The majority (73) of the often-quoted "success and failure" studies were case series (LOE 4). The rest of the articles were descriptive epidemiological studies (42), case reports (114), expert opinions (18), literature reviews (4), and one meta-analysis. Based on these findings, it appears that a few high-level studies have been published in the past four decades related to the success and failure of nonsurgical root canal therapy. The data generated by this search can be used in future studies to specifically answer questions and test hypotheses relevant to the outcome of nonsurgical root canal treatment.
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Affiliation(s)
- Mahmoud Torabinejad
- Department of Endodontics of the School of Dentistry, Loma Linda University, Loma Linda, California 92350, USA.
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33
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Fan B, Cheung GSP, Fan M, Gutmann JL, Fan W. C-Shaped Canal System in Mandibular Second Molars: Part II—Radiographic Features. J Endod 2004; 30:904-8. [PMID: 15564875 DOI: 10.1097/01.don.0000136206.73115.93] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate the relation between the radiographic features of C-shaped mandibular second molars and the cross-sectional shapes of their root canal system. Fifty-eight extracted mandibular second molars with fused roots were collected from a native Chinese population. The teeth were scanned at 0.5-mm interval thickness by micro-computed tomography (microCT) and observed at 11 levels. The 54 teeth that possessed a C-shaped canal system were further examined. Their radiographic appearances were classified into three types according to discernible radiographic features. The results were subject to the Kruskal-Wallis statistical test. In these 54 molars, 16 teeth (29.63%) showed a type I radiographic image, 22 (40.74%) type II, and 16 (29.63%) type III. In the type I category, the C1 and C4 canal configurations were mostly found in the apical area. Categories C2 and C3 were the main configurations in the middle and apical areas in type II and III. The type III had more C2 canals in middle area than type II. These results suggested that it was possible to predict the presence and the configuration of C-shaped canal system by the radiographic appearance.
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Affiliation(s)
- Bing Fan
- Key Lab for Oral Biomedical Engineering of Ministry of Education, Endodontic Center, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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34
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Chai WL, Thong YL. Cross-sectional Morphology and Minimum Canal Wall Widths in C-shaped Roots of Mandibular Molars. J Endod 2004; 30:509-12. [PMID: 15220648 DOI: 10.1097/00004770-200407000-00012] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The cross-sectional canal morphology and minimum widths of buccal and lingual canal walls were studied in 20 mandibular molars with C-shaped roots and canal orifices. The roots were mounted in clear resin blocks and sectioned transversely at 1-mm intervals. A total of 154 cross-sections were evaluated with an image analyzer. Twelve different longitudinal canal configurations were identified. The most prevalent were types 1-2 and 1-2-1 with each type occurring in four roots. Evaluation of the cross-sectional morphology showed that the configurations were complete "C" (27%), incomplete C (64%), and non-C (9%). The mean value for the minimum width of the lingual canal wall was 0.58 +/- 0.21 mm and the buccal wall was 0.96 +/- 0.26 mm. This suggests that there is a higher risk of root perforation at the thinner lingual walls of C-shaped canals during shaping and post canal preparation procedures. Both buccal and lingual canal walls were frequently narrower at mesial locations.
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Affiliation(s)
- Wen Lin Chai
- General Dental Practice Unit, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.
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35
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Seo MS, Park DS. C-shaped root canals of mandibular second molars in a Korean population: clinical observation andin vitroanalysis. Int Endod J 2004; 37:139-44. [PMID: 14871181 DOI: 10.1111/j.0143-2885.2004.00772.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate the incidence and morphology of C-shaped root canals of the mandibular second molar in a Korean population. METHODOLOGY Through clinical observation, randomly selected 272 mandibular second molars of Korean patients were accessed and evaluated after taking radiographs for determination of working length. In an in vitro analysis, 96 extracted mandibular second molars of Korean patients were collected and embedded in resin using an Endodontic cube technique, and were sectioned at intervals of 1 mm. The specimens were then observed with a surgical microscope and were photographed. Canal configurations were assigned to one of three categories: Category I defined a C-shaped outline without any separation; Category II referred to those with canal configurations, where dentine separated one distinct canal from a buccal or lingual C-shaped canal; Category III had two or more discrete and separate canals. RESULTS In clinical observation, 89 of 272 teeth (32.7%) had C-shaped canals. Of the 96 teeth examined in vitro, 30 (31.3%) had C-shaped canals. Upon in vitro analysis, only 1 tooth at the subpulpal level and 10 teeth at the apical 1 mm level were categorized under Category III. CONCLUSION There was high prevalence of C-shaped root canals in the mandibular second molars of Koreans. C-shaped canals having semicolon and continuous shapes at the canal orifice have a high possibility of being divided into two or three canals in the apical region.
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Affiliation(s)
- M S Seo
- Department of Conservative Dentistry, Sungkyunkwan University School of Medicine, The Institute of Oral Health Science, Samsung Medical Center, Seoul, Korea
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36
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Abstract
AIM This clinical report presents the endodontic treatment of two maxillary first molars and the anatomical study of two additional maxillary first molars with a C-shaped distally located root canal system. This configuration is not a common finding. SUMMARY According to the endodontic literature, the C-shaped root canal is most frequently seen in the mandibular second molar. The occurrence of C-shapes in maxillary first molars, however, has only been described in a limited number of case reports. We observed this configuration in two out of 2175 root-filled maxillary first molars treated at the Department of Endodontology, Ghent University Hospital, during the last 10 years. In order to study and visualize this particular aberration, cross-sections in two additional two-rooted maxillary first molars were made. From these cross sections it can be concluded that the C-shaped canal configuration is the result of a fusion of the distobuccal and the palatal roots.
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Affiliation(s)
- R J G De Moor
- Department of Operative Dentistry and Endodontology, Dental School, Ghent University Hospital, Belgium
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37
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Abstract
AIM The aim of this clinical article is to describe the unusual anatomy that was detected in a maxillary first molar during routine endodontic treatment. SUMMARY Success in root canal treatment is achieved after thorough cleaning and shaping followed by the complete obturation of the root canal system. Such treatment may be performed in root canal systems that do not comply with the normal anatomical features described in standard textbooks. The present case describes root canal treatment in a maxillary first molar with two roots and a type IV canal configuration in the buccal root. KEY LEARNING POINTS Careful examination of radiographs and the internal anatomy of teeth is essential. Root canal treatment is likely to fail if the entire system is not debrided and filled. Anatomic variations can occur in any tooth.
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38
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Fava LR, Weinfeld I, Fabri FP, Pais CR. Four second molars with single roots and single canals in the same patient. Int Endod J 2000; 33:138-42. [PMID: 11307455 DOI: 10.1046/j.1365-2591.2000.00272.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE REPORT Studies on canal configuration have demonstrated a substantial variation in the number of roots and root canals in different teeth. Maxillary and mandibular molars may have three and two roots, respectively, and generally present with three of four root canals. This case describes the presence of one single root and one root canal in all second molars of the same patient.
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Affiliation(s)
- L R Fava
- Methodist University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
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39
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Affiliation(s)
- M Hülsmann
- Department of Operative Dentistry, Zentrum ZMK, University of Göttingen, Germany
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40
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Malagnino V, Gallottini L, Passariello P. Some unusual clinical cases on root anatomy of permanent maxillary molars. J Endod 1997; 23:127-8. [PMID: 9220744 DOI: 10.1016/s0099-2399(97)80260-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Three case reports are presented concerning permanent maxillary molars with fusion of two buccal roots. The morphology is peculiar because it is characterized by the mesiobuccal canal merging into the distobuccal canal in their apical one-third. A thorough review of the literature failed to reveal any previously reported description of permanent maxillary molars with this arrangement of canals, with the exception of a recently reported epidemiological study.
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Affiliation(s)
- V Malagnino
- Restorative Dentistry Department, University of Borne La Saplenza, Italy
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41
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Sabala CL, Benenati FW, Neas BR. Bilateral root or root canal aberrations in a dental school patient population. J Endod 1994; 20:38-42. [PMID: 8182385 DOI: 10.1016/s0099-2399(06)80025-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Clinicians have often noted that aberrant root morphology in a given tooth is also observed with varying degrees of frequency in the corresponding contralateral tooth. The purpose of this study was to determine the proportion of bilateral morphological root aberrations in a random sample of adult human dentition. Five hundred one dental records were selected from the retired record section at the University of Oklahoma College of Dentistry and their full-mouth radiographs were reviewed for aberrant root canal morphology. Bifurcation of the canal in mandibular first premolars was the most common finding (22.8% of patients), with 60% of these being bilateral. Maxillary anterior teeth had the least aberrations. It was observed that unusual root morphology is bilateral approximately 60% of the time. Therefore, the incidence of root or root canal abnormalities reported by the percentage of patients involved will always exceed the incidence of abnormalities reported by type of tooth (e.g. mandibular or canine) involved except for abnormalities which are found bilaterally in 100% of the patients studied. Radiographic interpretation appears to result in a lower incidence of anatomical aberrations than direct identification. The more rare the aberration, the more likely it is to be bilateral in occurrence.
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Affiliation(s)
- C L Sabala
- Department of Endodontics, University of Oklahoma College of Dentistry
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