C-shaped Root Research Articles

Endodontic management of maxillary permanent molar C-shaped morphology

Aim: Report on the successful endodontic management of 4 permanent maxillary molars with a C-shape configuration of the root canal system. Summary: Even though C-shaped anatomies are more commonly described in the mandibular molars, its occurrence in permanent maxillary molars has also been reported. Complexity of the root canal system may pose a difficulty in achieving proper chemo-mechanical debridement, and consequently jeopardize the success of endodontic therapy. Additional dedicated armamentarium can help the clinician recognize, assess, plan and better manage such complex configurations. Key learning points Although of rare prevalence, clinicians must be aware and recognize the possible existence of a C-shaped root canal configuration in both first and second permanent maxillary molars. This anatomy can be attributed to an embryologic alteration that leads to the non-division of roots during the root formation stage of tooth formation. Further studies on the prevalence of the C-shaped configuration in permanent maxillary molars may contribute to a better understanding and, consequently, proper management of this morphology. Specific tools, such as the dental operating microscope and specific ultrasonic tips, as well as additional means of enhancing chemical debridement, are essential for the correct management of these intricate anatomies and appear to positively impact outcome of root canal treatment.

Association between the presence of distolingual root in mandibular first molars and the presence of C-shaped mandibular second molars: a CBCT study in a Taiwanese population.

The purpose of this study was to assess the prevalence of C-shaped canals in permanent mandibular second molars (SMs) and to determine whether its appearance was associated with the presence of distolingual root (DLR) in permanent mandibular first molars (FMs). Three hundred and eighty patients were qualified for evaluation of their FMs and SMs using cone beam computed tomography. The prevalence, distribution pattern, external root morphology, and the internal root canal anatomy of the examined molars were recorded and analyzed. Furthermore, the association between the root canal configurations of SMs and the appearance of DLR in FMs was also assessed. The prevalence of SMs with C-shaped root canals was 44.7%. The most common root canal configuration type of the one-rooted SMs with C-shaped anatomy was C3 (45.6%), followed by C2 and C1. The frequency of C-shaped canals in SMs was 45.4% in Non-DLR group, 52.8% in unilateral DLR group, and 33.9% in bilateral DLR group, respectively. Moreover, the prevalence of C-shaped root canals in SMs with the presence of bilateral DLRs in FMs was significantly lowered. The association between the presence of DLR in FMs and C-shaped canal configurations in neighboring SMs was surveyed, and the prevalence of C-shaped root canals in SMs with the presence of bilateral DLRs in FMs was found to be significantly lowered.

Management of c-shape root canal configuration: Case reports

Unusual root canal anatomy always poses a diagnostic and treatment challenge.Therefore a thorough knowledge of root canal anatomical variations along with proper diagnosis, treatment planning and clinical expertise is the key to their successful management. The C‑shaped root canal configuration is one such aberrant canal anatomy, common in the mandibular second molar. It often goes undetected and due to the intricate root canal configuration, it is often difficult to negotiate, debride and obturate such canalsleading to failure of root canal treatment. This article presents management of four different C-shape root canal configurations using the cold lateral condensation and thermoplasticized obturation techniques. Understanding the anatomical presentations of this variation will enable the clinician to manage these cases effectively. Advanced irrigation and obturation techniques help in managing such anomalous canal configurations.

Cone Beam Computed Tomography (Cbct) and Endodontic Microscopic Assessment of C-Shaped Canal Systems in Mandibular Second Molars

By knowing the anatomy of the tooth including root canal, dentists also have gathered physiologically anomalous requirements for effective root canal treatment. An exceptional morphology is present in the root canal system known as the C-shaped root network. A substantial volume of evidence already has come out on C-shaped root canal systems. The analysis provides an extensive description of root through root canals in the form of C. Characteristics of this exceptional morphology were studied mainly focused on macroscopic, microscopic and functional measurements including odontogenetic tooth shape analyses. To trying to clarify the clinical nature of C-shaped root canals, we sought to isolate them both. In addition to summarizing existing experiences, another of the objectives of this investigation was to find evidence that supports our interpretation of the C shaped root canal network. In fact, new advances in 3D mapping techniques help clarify the reliable etiology of the physiology of the Cshaped root canal network. Studies of extreme scenarios such as C-shaped root anatomy or morphology with rectangle and squared channels will also help us gain the wide range with root morphologies found in man’s teeth which eventually result in better care outcomes for patients and dentists and their satisfaction.

Prevalence of C-Shaped Canals in Anterior and Posterior Teeth of Iranian Population Using Cone Beam Computed Tomography

Background: Lack of knowledge of root anatomy is the second most common reason for failed endodontic therapy. Therefore, acquiring knowledge about it leads to a more effective treatment. C-shaped canal is an anatomical variation that causes clinical challenges. The objective of this study is to determine the occurrence of the C-shaped roots in permanent anterior and posterior teeth of the Iranian population using CBCT (cone beam computed tomography) scans. Methods: This was a descriptive cross-sectional study. In this study, 1408 teeth were assessed. Cranex 3D Mid was used to prepare CBCT images. Each tooth was examined in axial sections, and five different levels were identified as coronal, medium, apical, 1/3, and 2/3. The canal shapes were classified into 5 categories based on modified Melton’s method. Data were analysed using the chi-square test at a significance level of 5%in SPSS version 24.0. Results: In total, of 1408 teeth which were evaluated, 7.81% (110) were confirmed to have C-shaped canals. The occurrence of the C-shaped canal was significantly higher in molars (P < 0.001). The occurrence of the C-shaped canal was significantly higher in mandibular teeth (10.04%) compared to maxillary teeth (5.81%) (P < 0.001). The most common C-shaped canal category was C1 (57.27%). The relationship of gender and age with the C-shaped canal occurrence was not statistically significant (P = 0.585, P = 0.562, respectively). Conclusions: CBCT is a useful tool to evaluate C-shaped root canal morphology. The high occurrence of the C-shaped canal in the Iranian population requires clinical awareness.

Mandibular molar C-shaped root canals in 5th millennium BC China

ObjectiveThe aim of this study was to analyze the occurrence and variations in C-shaped canals in ancient Chinese teeth and compare the differences of these features between ancient and age-matched modern populations. DesignApproximately 5000-year-old craniofacial bone remains were collected from the fossils of 38 individuals (total: 68 mandibular second molars) excavated from the Jiaojia site. The control group comprised of an equal number of randomly selected modern samples. We used cone-beam computed tomography to scan the mandible along the apex-crown axis and analyzed the canal morphology, based on Fan’s categorization criterion, at 2 mm, 5 mm, and 8 mm to the apical level. Grooves on the lingual and buccal sides were also recorded. ResultsThe proportion of C-shaped roots among ancient samples on the left and right sides were 48.57 % (17/35 teeth) and 54.55 % (18/33 teeth), respectively, and 51.47 % (35/68 teeth) in the total sample. Conversely, in the control group, 44.12 % (15/34) and 38.24 % (13/34) occurred on the left and right sides, respectively, and 41.18 % (28/68) in the total sample. Among the C-shaped canals from the Jiaojia site samples, the classification type changed between two adjacent levels in 84.31 % of samples. Approximately 35 (51.5 %) teeth had a fused root, 20 (29.41 %) had one shallow buccal and one deep lingual groove. The occurrence of C-shape variation was not significantly correlated with time (p＞0.05). ConclusionsThis study identified a high rate of C-shaped root canals among individuals of Jiaojia who lived approximately 5000 years ago.

Evaluation of root morphology of maxillary and mandibular second molars lost due to periodontitis.

Little is known about the anatomical characteristics of root morphology in molars lost due to periodontal reason. The aim of this study was to study root morphology in maxillary and mandibular molars lost due to periodontitis by investigating the frequency of root fusion, classifying fusion types, and measuring radicular groove depth by micro-computed tomography. Ninety-eight posterior teeth were collected from 87 Japanese patients during the study period. Of these, maxillary (N=36) and mandibular (N=22) second molars lost most frequently were assessed for root fusion and morphology. The 36 maxillary second molars included nine (25%) teeth with a single root, 14 (39%) with two roots, and 13 (36%) with three roots. Of the 23 maxillary second molars with fused (1 and 2) roots, there were 11 (48%), 2 (9%), 1 (4%), 1 (4%), 3 (13%), and 5 (22%) teeth with root types 1-6, respectively. The 22 mandibular second molars comprised 14 (64%) teeth with a single root, 7 (32%) with two roots, and one (4%) with three roots. Of the 14 mandibular second molars with a fused (1) root, 12 (86%) had a C-shaped root and two (14%) had a non-C-shaped root. We observed a higher frequency of root fusion in the present study compared with that reported by previous studies using randomly selected second molars.

C-shaped canals in mandibular molars of a Brazilian subpopulation: prevalence and root canal configuration using cone-beam computed tomography.

To assess C-shaped root canal configuration by identifying its prevalence and each configuration type proportion, according to tooth (mandibular first or second molar) and demographic characteristics in a Brazilian population, using cone-beam computed tomography (CBCT). Moreover, it was verified if there is a relationship between root canal configuration observed in two-dimensional reconstructions of CBCT and presence of C-shape. Mandibular jaw CBCT scans (184 males and 220 females, aged 15 to 80years), which presented 1464 mandibular molars (710 first molars and 754 second molars), were assessed. Teeth were evaluated for the presence and type of C-shaped root canals by observing the roots at five levels in CBCT axial reconstructions. Root canal configuration was assessed in panoramic reconstructions. Data were statistically analyzed at a significance level of 5%. Of the 1464 mandibular molars, 125 (8.5%) were classified as C-shaped. This variation was more prevalent in females (n = 107, 85.6%) and in second molars (n = 108, 86.4%). C1 (uninterrupted C-shaped canal) was the most prevalent type of C-shaped configuration (41.76%), while C5 (no canal lumen) was the least prevalent type (0.96%). Single root with single canal in panoramic reconstructions was the most predominant configuration for C-shaped teeth (n = 54, 43.2%). Fused roots presented 17.2 higher odds of being associated with C-shaped root canals than non-fused roots. C-shaped root canals were more prevalent in mandibular second molars and in females. Additionally, clinicians should bear in mind the greater possibility of C-shaped configuration in mandibular molars with fused roots. Mandibular molars with C-shaped canals present a clinical challenge. A higher C-shaped proportion was noted in radiographic fused root types, which had 17.2 higher odds of presenting such anatomy when compared to radiographic non-fused roots. Root radiographic features may help in diagnosis of complex C-shaped morphologies.

Root and Canal Morphology of Mandibular Second Molars in a Yemeni Population: A Cone-beam Computed Tomography.

Objective:This study aimed to identify and characterize root and canal morphology and the prevalence of C-shaped canals of mandibular second molars (MSMs) in a Yemeni population using cone-beam computed tomography (CBCT).Methods:Three-dimensional digital images of 500 MSMs with mature roots were taken from 250 Yemeni individuals and analyzed for the following features: number of roots, shape and type of roots, type of canal configuration in each root, prevalence of C-shaped canal, and primary variations in the morphology of root and canal systems. Chi square and Fisher’s exact tests were employed for statistical analysis.Results:89.6% of MSMs had two separate roots, 9% had two fused roots, 0.6% had three separate roots and 0.8% had one root. Mesial root was mostly ribbon-shaped (60.5%) and distal root was mostly kidney-shaped (50.7%). Type II and Type I canal configurations were the most frequent in mesial (56.9%) and distal (91.3%) roots, respectively. C-shaped canals were found in 9%. Six variants were found with variant 3 being the most common (71%).Conclusion:Yemeni MSMs are mainly two-rooted. The prevalence of three- and one-rooted MSMs was relatively low. Various canals configurations were found in MSMs among this sample of Yemeni population. The clinicians should consider C-shaped roots and canals when treating Yemeni MSMs and should be aware of their morphological variations to ensure successful root canal treatment. Although bilateral similarity of many anatomical features of MSMs was found, individual evaluation of each MSM is necessary while performing endodontic treatment on both sides.

ANALYSIS OF ROOT FRACTURE ASPECTS OF MANDIBULAR C-SHAPED ROOTS

ANALYSIS OF ROOT FRACTURE ASPECTS OF MANDIBULAR C-SHAPED ROOTS

Unusual Maxillary First Molars with C-Shaped Morphology on the Same Patient: Variation in Root Canal Anatomy

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.

A micro-computed tomographic study of remaining filling materials of two bioceramic sealers and epoxy resin sealer after retreatment.

ObjectiveThis study evaluated the presence of residual root canal filling material after retreatment using micro-computed tomography (micro-CT).Materials and MethodsExtracted human teeth (single- and double-rooted, n = 21/each; C-shaped, n = 15) were prepared with ProFile and randomly assigned to three subgroups for obturation with gutta-percha and three different sealers (EndoSeal MTA, EndoSequence BC sealer, and AH Plus). After 10 days, the filling material was removed and the root canals were instrumented one size up from the previous master apical file size. The teeth were scanned using micro-CT before and after retreatment. The percentage of remaining filling material after retreatment was calculated at the coronal, middle, and apical thirds. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni post hoc correction.ResultsThe tested sealers showed no significant differences in the percentage of remaining filling material in single- and double-rooted teeth, although EndoSeal MTA showed the highest value in C-shaped roots (p < 0.05). The percentage of remaining filling material of AH Plus and EndoSeal MTA was significantly higher in C-shaped roots than in single- or double-roots (p < 0.05), while that of BC sealer was similar across all root types. EndoSeal MTA showed the highest values at the apical thirds of single- and double-roots (p < 0.05); otherwise, no significant differences were observed among the coronal, middle, and apical thirds.ConclusionsWithin the limitations of this study, a large amount of EndoSeal MTA remained after retreatment, especially in C-shaped root canals.

Cone-beam computed tomography evaluation of C-shape canals and longitudinal grooves of mandibular first and second molar teeth

Aim: This study aims to evaluate the anatomical features and prevalence of C-shaped roots and longitudinal grooves in mandibular first and second permanent teeth using cone-beam computed tomography (CBCT).Material and Methods: CBCT records of first and second mandibular teeth from 839 patients who applied to the Department of Oral and Maxillofacial Radiology between 2011 and 2018 were used. The CBCT examination was performed at five different axial levels and the mandibular molars were classified as types of longitudinal groove and C-shape according to the Fan criteria. Differences between genders, age groups, left and right side and type of tooth were determined.Result: A total of 2903 teeth (1321 first molars and 1582 second molar) from 839 patients were included in the study. C-shaped canals were found in mandibular first molar teeth with a prevalence of 0.15%, while 4.1% in mandibular second molar teeth. Only two mandibular first molars exhibited C-shaped canal. Female patients had a higher prevalence than males. Longitudinal grooves were most commonly found lingual surface. Conclusions: The occurence of C-shaped canals in mandibular first and second molars among Turkish population was generally less than in other populations. CBCT is a valuable tool to evaluate the C-shaped root canal configuration in vivo. Keywords: Cone-beam computed tomography; C-shaped canal; mandibular molar

Evaluation of Root and Root Canal Morphology of Mandibular First and Second Molars in a Greek Population: A CBCT Study.

Objective:Τo study the number of roots, canal configurations, and frequency of morphological variations in mandibular first and second molars in a Greek population.Methods:This study examined 478 mandibular first molars and 524 mandibular second molars using a high-resolution cone-beam computed tomography (CBCT). The number of roots was recorded and the root canal configuration was categorized based on the classification by Vertucci. The presence and configuration of C-shaped root canals were recorded and they were classified according to the Fan classification. The symmetry between the right and the left side was also evaluated.Results:Among the mandibular first molars, 0.2% teeth were single-rooted, 96.4% were two-rooted, and 3.3% were three-rooted. In the mandibular second molars, 12.2%, 82.8%, and 4.9% were single-rooted, two-rooted, and three-rooted, respectively. In two-rooted mandibular first and second molars, the most frequent root canal pattern observed was Vertucci’s type II in the mesial root (69.8% and 64.1%, respectively) and Vertucci’s type I in the distal root (81.7% and 97.7%, respectively). Three-rooted molars showed one oval-shaped mesial root and two distal roots (56.2% in first molars, 65.4% in second molars), where each distal root contained a single root canal (type I), and the mesial root presented either type II (53.3%), IV (26.6%), I (13.3%), or V (6.6%) canal configurations. C-shaped canals were only detected in mandibular second molars (5.3% of teeth, 10.8% of individuals), and bilateral occurrence was observed in 24.5% patients. The most frequent root canal pattern was Fan’s C1 type at the orifice, followed by C3a and C3b in the coronal and middle third, which joined into a single canal (C4) apically.Conclusion:The characteristics of the root and root canal anatomy of the mandibular first and second molars of Greek individuals were similar to those observed in Caucasians. However, the higher incidence of third roots in mandibular molars in Greek individuals compared to Caucasians requires absolute clinical awareness.

Autotransplantation of Impacted Third Molar Using 3D Printing Technology: A Case Report

Here, we describe a case of autotransplantation of a mandibular horizontally impacted third molar using a 3-dimensional (3D) model based on limited cone-beam computed tomography (CBCT) images for diagnosis, 3D morphological evaluation, preoperative treatment planning, and surgical simulation. A 27-year-old woman visited this hospital for conservative treatment of the mandibular left second molar. Intraoral radiography and CBCT images revealed a C-shaped root canal in the mesial root, and compressive resorption of the distal root due to impingement of the crown of the horizontally impacted lower left third molar. Extraction was therefore planned. Multiple tooth-jaw bone 3D models for preoperative diagnosis were fabricated using a low-cost desktop 3D printer and surgical simulation of autotransplantation performed. The autotransplantation was then performed accordingly. Cone-beam computed tomography images and 3D models were extremely useful in obtaining a stereoscopic understanding of the morphology of the transplanted tooth and its surrounding anatomical structures. At the one-year postoperative recall, the patient was able chew with the transplanted tooth without pain, and no significant abnormalities were detected on intraoral radiographs, indicating a successful postoperative clinical course. Our experience of using 3D models fabricated based on CBCT images using a desktop 3D printer for preoperative diagnosis and surgical simulation suggests that this technique is useful in tooth autotransplantation.

Analysis of Cause of Endodontic Failure of C-Shaped Root Canals.

The purpose of this study was to analyze various characteristics and classification of C-shaped root canals and evaluate the causes of endodontic failure of C-shaped root canals by examining the resected root surface with an endodontic microscope and a scanning electron microscope (SEM). Forty-two teeth with C-shaped root canals were included in this study and had undergone intentional replantation surgery. Before surgery, periapical radiography and cone-beam computed tomography were taken. The root canal configuration was analyzed and classified according to Melton's classification at coronal and apical level. After injection of 1 : 100,000 epinephrine with 2% lidocaine, the tooth was carefully extracted. After the root-end resection, the resected root surface was examined using an operating microscope and SEM. Mandibular second molars were most frequently involved teeth (90.4%). The most frequently observed root canal configurations were C1 at the coronal level (45.2%) and C3 at the apical 3 mm level (45.2%). The most common cause of failure for a C-shaped root canal treatment was a leaky canal (45.2%), followed by an isthmus (23.8%), missing canal, overfilling, and iatrogenic problems. In conclusion, C-shaped root canals were most frequently found in mandibular second molars. The most common cause of failure was a leaky canal and isthmus.

Relationship of the Incidence of C-shaped Root Canal Configurations of Mandibular First Premolars with Distolingual Roots in Mandibular First Molars in a Taiwanese Population: A Cone-beam Computed Tomographic Study

IntroductionThe aim of this study was to determine the prevalence of C-shaped canal configurations (CSs) and radicular grooves (RGs) in permanent mandibular first premolars (MPs) and to investigate the relevance of such complexities with the presence of distolingual roots (DLRs) in permanent mandibular first molars (MMs). MethodsA total of 800 pairs of MPs and MMs were investigated using a cone-beam computed tomographic system (NewTom 5G; QR srl, Verona, Italy). The frequency and symmetry of DLRs in MMs along with the occurrence of RGs and CSs in examined MPs were evaluated. Multivariable logistic regression analysis was applied to examine the correlation between the CSs of MPs with the appearance of DLRs in MMs. ResultsIn the examined teeth, 23.0% of MMs had a DLR, whereas 16.6% of MPs had RGs and 12.5% of MPs had C-shaped canals. Although the most common canal configuration in MPs is the single canal (74.1%), the other 25.9% still possess complicated root canals. Of these MPs that have different canal configurations, 54.6% had 2 canals, whereas 44.4% had CSs. Specifically, the CS showed a high prevalence of C3 morphologies at 98.9% followed by C1 at 1.1%. A corresponding and increasing frequency was noted in CSs and RGs of MPs and MMs with DLRs (P < .001). After adjusting for related categoric variables, the adjusted odds ratios for CSs of MPs in the bilateral DLR group compared with the non-DLR group was 3.294 (P < .001). ConclusionsThis study showed an increased appearance of CSs in MPs when DLRs were present in MMs in the Taiwanese population.

Endodontic treatment of a hypertaurodontic mandibular left second molar in a patient with many taurodonts combined with multiple pulp stones

Taurodontism is a rare embryologic anomaly of teeth, defined by an apical displacement of the furcation of roots and enlarged pulp chambers. Taurodontism has been classified as hypo-, meso- or hypertaurodontism according to the severity of the anomaly. The aim of this case report was to illustrate a clinical case with multiple bilateral taurodonts and to describe the endodontic management of the hypertaurodontic mandibular left second molar with a C-shaped canal and extensive dental pulp calcifications. A healthy 20-year-old male patient was referred for the endodontic treatment of his lower left second molar. Cone beam computed tomography revealed a C-shaped root canal configuration and several dental pulp calcifications in this tooth. The endodontic treatment was performed in two appointments under an operating dental microscope. A panoramic radiograph, made during the 18months follow-up appointment, revealed nine other taurodontic molars, most of them associated with dental pulp calcifications.

Prevalence of C-shaped canal system in mandibular first and second molars in a Saudi population assessed via cone beam computed tomography: a retrospective study.

The purpose of this study was to determine the prevalence of the C-shaped root canal configuration, location of the longitudinal groove, sex differences, and unilateral/bilateral presence in mandibular first and second molars in a Saudi population using cone beam computed tomography (CBCT). CBCT images for the mandibular first and second molars of 487 patients (a total of 529 first molars and 681s molars) were evaluated. The teeth were assessed for the presence of C-shaped root canals according to Fan criteria. Subdivisions were also made according to sex, direction of the longitudinal groove, and unilateral/bilateral presence. Only one C-shaped mandibular first molar was observed (0.19%), whereas 62 second molars (9.1%) exhibited C-shaped anatomy. Unilateral presence of the C-shaped root canal system was more common (53.85%). Female patients had a higher prevalence than males. Longitudinal grooves were most commonly found on the root lingual surface (58.1%). The prevalence of the C-shaped canal configuration in a Saudi Arabian population was 0.19% in the mandibular first molar and 9.1% in the mandibular second molar. Longitudinal groove prevalence was highest on the lingual surface. Women had a significantly higher prevalence of the C-shaped canal configuration than men. Patients with unilateral presence of the C-shaped canal configuration were more common than those with bilateral presence. Tooth type, patient sex, and ethnicity can help clinicians predict the prevalence of the C-shaped canal system in mandibular molars.

根管治療が施された下顎樋状根歯のX線的, マイクロCTおよび組織学的観察 ―27年長期症例―

根管治療が施された下顎樋状根歯のX線的, マイクロCTおよび組織学的観察 ―27年長期症例―