Canals In Mandibular Second Molars Research Articles

Cone-beam computed tomographic analysis of canal convolution in mesial root of mandibular second molars and a proposed new classification

Aim: The aim is to evaluate the anatomical characteristics of mesiolingual and mesiobuccal canals in mandibular second molars particularly in terms of its exit direction, distance of confluence from the minor constriction, and the angle of confluence. Materials and Methods: The cone-beam computed tomography images of hundred mandibular second molars were analyzed. Endodontically treated teeth and those with anatomical variations such as C-shaped canal configuration were excluded from this study. The distance of the confluence from the minor constriction, angle of confluence, and the exit direction of the mesiobuccal and the mesiolingual canals were assessed. Data were analyzed using an independent t-test. Results: The course of the mesiobuccal and mesiolingual canals beyond the confluence was towards the center of the root. The average angle of confluence was 32.75°–35.28°. The average distance of confluence from the minor constriction was 2.19 to 2.68 mm. The mesiolingual canal was straighter whereas the mesiobuccal canal had a tortuous course. Considering the results of the present study, a new classification has been proposed for the root canal morphology of the mesial root of mandibular second molars. Conclusion: The variation in the morphology of mandibular second molars highlights that the mesiolingual canal presented a mild curvature through and beyond the confluence when compared to the mesiobuccal canal which exhibited a tortuous course through the confluence.

Cone-beam computed tomographic analysis of canal convolution in mesial root of mandibular second molars and a proposed new classification

Aim: The aim is to evaluate the anatomical characteristics of mesiolingual and mesiobuccal canals in mandibular second molars particularly in terms of its exit direction, distance of confluence from the minor constriction, and the angle of confluence. Materials and Methods: The cone-beam computed tomography images of hundred mandibular second molars were analyzed. Endodontically treated teeth and those with anatomical variations such as C-shaped canal configuration were excluded from this study. The distance of the confluence from the minor constriction, angle of confluence, and the exit direction of the mesiobuccal and the mesiolingual canals were assessed. Data were analyzed using an independent t-test. Results: The course of the mesiobuccal and mesiolingual canals beyond the confluence was towards the center of the root. The average angle of confluence was 32.75°–35.28°. The average distance of confluence from the minor constriction was 2.19 to 2.68 mm. The mesiolingual canal was straighter whereas the mesiobuccal canal had a tortuous course. Considering the results of the present study, a new classification has been proposed for the root canal morphology of the mesial root of mandibular second molars. Conclusion: The variation in the morphology of mandibular second molars highlights that the mesiolingual canal presented a mild curvature through and beyond the confluence when compared to the mesiobuccal canal which exhibited a tortuous course through the confluence.

Incidence of C-shaped canals in mandibular second molars in patients visiting Rehman College of Dentistry, Khyber Pakhtunkhwa (KPK), Pakistan

Objective: The objective of the study was to evaluate incidence of C-shaped canals in mandibular second molars using Cone Beam Computed Tomography. Study Design: Cross Sectional, Descriptive study. Place and Duration: This study was undertaken in Department of Radiology, Rehman College of Dentistry, Peshawar, from 15th June 2022 till 15th December 2022. Methodology: Cone Beam Computed Tomography scans of 60 patients of both genders between 18 and 60 years of age were studied for the presence of C-shaped canals in mandibular 2nd molars. Results were analyzed with the help of SPSS version 21. Chi-square was applied for comparison of male and female groups. Results: Cone Beam Computed Tomography scans of 60 patients of both genders between 18 and 60 years of age were studied for the presence of C-shaped canals in mandibular 2nd molars. Results were analyzed with the help of SPSS (version 21). Chi-square was applied for comparison of male and female groups (p > 0.05). Conclusion: Incidence of C-shaped canal is high in patients with mandibular 2nd molars. Endodontists need to be vigilant for the existence of C-shaped canals and proper imaging of these canals is essential for successful endodontic treatment. Keywords: Root Canal Therapy, Molar, C-Shaped Canals, Pulp, Cone Beam Computed Tomography, Endodontic. How to Cite This: Rehman AZ, Alam S, Khan IA, Arbab KN, Khalid MD, Askar H. Incidence of C-shaped canals in mandibular second molars in patients Visiting Rehman College of Dentistry, Khyber Pakhtunkhwa (KPK), Pakistan. Isra Med J. 2023; 15(2): 70-73. DOI: https://doi.org/10.55282/imj.oa1373

Endodontic Management of C-shaped Root Canal Configuration using Different Obturation Systems: Case Series

C-shaped canal is one of the most difficult situations with which the dentist is confronted during endodontic treatment of teeth. Recognition of unusual variation 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 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. The present case series reports the successful management of C-shaped canals in mandibular second molars using cone-beam computed tomography(CBCT), sonic irrigation activation and different thermoplasticized gutta percha obturating techniques.

Correlation between presence of radix entomolaris in mandibular first molars and C-shaped canals in mandibular second molars: a sample of CBCT scans in Taiwanese students

The anatomy of root canals is so complex that in many cases it is not sufficient to take an intraoral radiograph to diagnose the number and shape of root canals. Therefore, Cone Beam Computed Tomography (CBCT) facilitating diagnosis and treatment planning in endodontics is gaining more and more importance. Radix entomolaris is an extra root which is found in mandibular molars and located distolingually. C-shaped canal is most commonly found in mandibular second molars and can differ significantly in shape from the typical anatomy of lower molars. The aim of the study was to evaluate the correlation between presence of radix entomolaris in mandibular first molars and presence of C-shaped mandibular second molars in Taiwanese students based on CBCT scans. The material consisted of 19 CBCT examinations taken in the Department of Dental and Maxillofacial Radiodiagnostics of the … Among 19 CBCT examinations 5 cases of coexistence of additional root and C- shaped canals were found. Up to 80.0% of cases were bilateral. In the studied sample there was high coincidence of radix entomolaris in mandibular first molars and C-shaped mandibular second molars. Knowledge of this correlation will prevent diagnostic errors during endodontic and surgical treatment planning.

The C-shaped Canal System in Mandibular Molars of a Saudi Arabian Population: Prevalence and Root Canal Configurations Using Cone-Beam Computed Tomography.

Objectives: This retrospective study aimed to assess the prevalence of the C-shaped canal system in mandibular first and second molars in a Saudi Arabian population using cone-beam computed tomography (CBCT).Materials and Methods: The sample included 300 CBCT images from adults aged 18 to 80 years (38.7 ± 17.9) (150 females and 150 males). All images were analyzed to detect the C-shaped root canal according to Fan’s criteria. We also categorized our findings according to the gender and direction of the longitudinal groove. Data were reported as frequencies and percentages. The Chi-squared test was used to analyze proportional differences, with the significance level set at ≤0.05.Results: The C-shaped canals were observed in 146 mandibular first molars (24.33%) and 182 second molars (30.33%). Male patients had a significantly higher prevalence of C-shaped canals in mandibular second molars than females (P=0.003). The longitudinal groove was most typically detected on the root's lingual surface (53.35%).Conclusion: The incidence of the C-shaped canal in a Saudi Arabian population was 27.33% in the mandibular molars. The longitudinal groove was mostly on the lingual surface. Males showed a higher prevalence of the C-shaped canal than females.

Assessment of C-Shaped Canal Morphology in Mandibular and Maxillary Second Molars in an Iraqi Subpopulation Using Cone-Beam Computed Tomography

Endodontic treatment is basically dependent on knowledge of the root canal anatomy. The goal of this study was to use cone-beam computed tomography (CBCT) imaging to examine the C-shaped canal configuration of mandibular and maxillary second molars in an Iraqi subpopulation. The prevalence and configurations of C-shaped canals were evaluated in 368 mandibular second molars and 369 maxillary second molars using CBCT scans. The effects of gender, age, and unilateral/bilateral on the presence of C-shaped canals were investigated. Chi-square and Fisher's exact tests were used to determine the level of significance (p ≤ 0.05), and kappa value was used to check reliability of results of the research. In mandibular second molars, the prevalence of C-shaped canals was 17.4%. The prevalence was significantly higher in females (23%) than males (10.4%) using the chi-square test. There is no significant difference in the prevalence of C-shaped canal depending on age and tooth position. The C2 type was the most common (56.3%). This prevalence did not differ with gender, age, or tooth position. In maxillary second molars, C-shaped canals were present in 7.9%. Type I (subtype C) (fusion of 2 root canals MB-DB) was the most common type of fused root (65.5%). There is no significant difference in the prevalence of C-shaped canal depending on the type of fused root, age, and tooth position. The majority of C-shaped canals in mandibular second molars were bilateral in both genders, but unilateral presence was more common in maxillary second molars in both genders. Within the limits of this study, C-shaped canals were found to be more common in mandibular second molars than in maxillary second molars in an Iraqi subpopulation.

Frequency of Multiple Canals in Mandibular Premolars and its Correlation with Other Anatomical Variants (C Shaped Canals in Mandibular Second Molars): A Retrospective and Cross-sectional Study

Introduction: Recognition of variations in molar root morphology is critically important for dental procedures such as root canal treatment and apical surgery. Usage of CBCT enables systemic evaluation of teeth including the number of roots and canals, location of roots, etc. The aim of this study was to determine the frequency of multiple canals in mandibular first and second premolars and to evaluate correlations between other anatomical variants using Cone beam computed tomography (CBCT).
 Methodology: The protocol of this retrospective, cross-sectional study was approved by the Ethics Committee of Saveetha Dental Hospital, Chennai, India. Images of mandibular premolars were obtained from patients who had undergone CBCT scanning at the hospital between January 2018 and November 2020.Cross-sectional images in the axial, coronal, and sagittal planes were reconstructed using GALILEOS ComfortPLUS ( Sirona 3D)is an advanced CBCT that provides seamless workflow integration. Serial axial, coronal and sagittal-plane CBCT images were closely examined at 1.0-mm intervals from the canal orifice to the apex.
 Results: Using SPSS software (ver. 21; SPSS, Inc., Chicago, IL, USA), chi-squared test was performed for analyses of different parameters involved. Various anatomical variants such as distolingual roots of first molars, C shaped canals of second molars are highly correlated with different canal configurations of mandibular premolars.
 Conclusion: This retrospective study showed that different configurations of mandibular premolars canals was significantly correlated with the presence of Distolingual root (DLRs) in first molars, and C shaped canals in second molars. Understanding and identifying anatomical variants is important in comprehensive success of endodontic treatment.

Morphologic Characteristics of C-Shaped Root Canals in Mandibular Second Molars in a Raj Shashi (Bangladesh) Population-An In Vivo Study

Morphologic Characteristics of C-Shaped Root Canals in Mandibular Second Molars in a Raj Shashi (Bangladesh) Population-An In Vivo Study

Evaluation of C-shaped canals in mandibular second molars of a selected patient group using cone beam computed tomography: prevalence, configuration and radicular groove types.

The aim of the present study was to examine the prevalence, symmetry and configurations of C-shaped canals and radicular groove types in mandibular second molars according to age and sex in a Turkish sub-population using cone beam computed tomography (CBCT). In total, 674 CBCT images (368 females and 306 males, aged 18-76 years) of 1348 mandibular second molars were evaluated. The symmetry, configuration of C-shaped root canals, radicular groove types with age and sex were noted. One sample chi-square test and chi-square test were used to determine statistically significant differences. The statistical significance level was set at p < 0.05. Of the 1348 mandibular second molars evaluated, 10.7% had C-shaped root canals. C-shaped root canals appeared to be significantly more common in females than in males (p < 0.05). C1 (44.4%) was the most frequent configuration in the coronal third, and C2 (44.4%), and C4 (31.9%) were the most frequent configurations in middle and apical thirds, respectively. Type 2 (45.1%) was the most common radicular groove type (p < 0.05). The frequency of C-shaped root canals in mandibular second molars in a Turkish sub-population was considerably high (10.7%). CBCT can aid the detection of C-shaped canals and their configurations. Dentists should consider the possibility of C-shaped canals in root canal treatment of mandibular second molars, as these configurations have implications for biomechanical preparation and filling methods.

Deep-learning for predicting C-shaped canals in mandibular second molars on panoramic radiographs.

The aim of this study was to evaluate the use of a convolutional neural network (CNN) system for predicting C-shaped canals in mandibular second molars on panoramic radiographs. Panoramic and cone beam CT (CBCT) images obtained from June 2018 to May 2020 were screened and 1020 patients were selected. Our dataset of 2040 sound mandibular second molars comprised 887 C-shaped canals and 1153 non-C-shaped canals. To confirm the presence of a C-shaped canal, CBCT images were analyzed by a radiologist and set as the gold standard. A CNN-based deep-learning model for predicting C-shaped canals was built using Xception. The training and test sets were set to 80 to 20%, respectively. Diagnostic performance was evaluated using accuracy, sensitivity, specificity, and precision. Receiver-operating characteristics (ROC) curves were drawn, and the area under the curve (AUC) values were calculated. Further, gradient-weighted class activation maps (Grad-CAM) were generated to localize the anatomy that contributed to the predictions. The accuracy, sensitivity, specificity, and precision of the CNN model were 95.1, 92.7, 97.0, and 95.9%, respectively. Grad-CAM analysis showed that the CNN model mainly identified root canal shapes converging into the apex to predict the C-shaped canals, while the root furcation was predominantly used for predicting the non-C-shaped canals. The deep-learning system had significant accuracy in predicting C-shaped canals of mandibular second molars on panoramic radiographs.

Prevalence of C-shaped Canals and Three-rooted Mandibular Molars Using CBCT in a Selected Thai Population.

C-shaped canals and three rooted mandibular molars are challenging to treat. These anatomies are commonly found in mandibular molars, especially in the Mongoloid population. However, there is no report on these anatomies using cone-beam computed tomography on all three mandibular molars in Thais. The objectives of this study were to determine the prevalence of C-shaped canals and three-rooted mandibular molars in Thais and investigate whether there is a relationship between these morphology and gender. Three pre-calibrated observers independently determined the presence of each anatomy using a specific protocol in 753 molars from cone-beam computed tomographic images. The three observers randomly re-evaluated 20% of the samples to determine inter- and intra-observer agreement using Cohen's Kappa statistic. The relationship of these root canal anatomy with sex was analysed by the Chi-square test. The prevalence of C-shaped canals and three-rooted molars was 0.39% and 12.1%, 42.4% and 3.9%, and 16.6% and 9.1% in first, second, and third mandibular molars respectively. The inter-/intra-observer reliability of the results was extremely high. This cross-sectional study showed the prevalence of C-shaped canals in mandibular second molars was relatively high and should be considered normal root canal anatomy in Thais. The prevalence of three-rooted molars was highest in first molars and frequently found in third molars. Cone-beam computed tomography was a reliable technique to determine root canal anatomy.

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.

Frequency of non-single canals in mandibular premolars and correlations with other anatomical variants: an in vivo cone beam computed tomography study

BackgroundA knowledge regarding anatomical variants is important to achieve success in endodontic treatment. Root canal treatment of mandibular first premolars (PM1 s) is challenging due to the existence of numerous variations in canal configurations, including a C-shaped variant. We aim to determine the frequency and morphologic characteristics of non-single canals of mandibular first (PM1 s) and second (PM2 s) premolars in a Korean population using cone beam computed tomography (CBCT) and to evaluate correlations between non-single canals of PM1 s and other anatomical variants, such as distolingual roots (DLRs) in mandibular first molars (M1 s) and C-shaped canals in mandibular second molars (M2 s).MethodsA total of 971 PM1 s and 997 PM2 s from 500 patients were examined in vivo by CBCT. Root canal configurations and C-shaped canals were determined in accordance with the Vertucci classification and Fan classification, respectively. The correlation between non-single canals in PM1 s and DLRs in M1 s was evaluated using logistic regression analysis.ResultsPM2 s typically had one root (99.89%) with one canal (98.4%). Among PM1 s with non-single canals (21.2%), Vertucci type V (10.9%) and C-shaped (3.7%) canals were prevalent. Among C-shaped PM1 canals, the majority were Vertucci type V (77.8%); a C-shaped configuration (C2) was predominant mostly at the middle and/or apical third of the root. After adjusting for other variables (i.e., sex, age, and side), C-shaped canals in PM1 s was significantly correlated with the presence of DLRs in M1 s (odds ratio = 2.616; 95% confidence interval, 1.257–5.443; p = 0.010).ConclusionsThe presence of C-shaped PM1 canals was positively related to the presence of DLRs in M1 s. Although C-shaped canals in PM1 s are difficult to distinguish, this finding could aid clinicians in predicting C-shaped canal configurations in PM1 s of patients who exhibit DLRs in M1 s.

C-shaped root canals of mandibular second molars in a Korean population: a CBCT analysis.

ObjectivesThe purpose of this study was to investigate the C-shaped root canal anatomy of mandibular second molars in a Korean population.Materials and MethodsA total of 542 teeth were evaluated using cone-beam computed tomography (CBCT). The canal shapes were classified according to a modified version of Melton's method at the level where the pulp chamber floor became discernible.ResultsOf the 542 mandibular second molars, 215 (39.8%) had C-shaped canals, 330 (53%) had 3 canals, 17 (3.3%) had 2 canals, 12 (2.2%) had 4 canals, and 8 (1.7%) had 1 canal. The prevalence of C-shaped canals was 47.8% in females and 28.4% in males. Seventy-seven percent of the C-shaped canals showed a bilateral appearance. The prevalence of C-shaped canals showed no difference according to age or tooth position. Most teeth with a C-shaped canal system presented Melton's type II (45.6%) and type III (32.1%) configurations.ConclusionsThere was a high prevalence of C-shaped canals in the mandibular second molars of the Korean population studied. CBCT is expected to be useful for endodontic diagnosis and treatment planning of mandibular second molars.

Biometric Analysis of C-shaped Root Canals in Mandibular Second Molars Using Cone-Beam Computed Tomography.

The configuration of C-shaped root canals, root canal wall thickness and orientation of the thinnest area using CBCT in mandibular second molars were assessed. Seventy five CBCT scans were evaluated. Axial sections were evaluated to determine the configuration of C-shaped canals in the coronal, middle and apical regions. The root canal path from the orifice to the apex, the thinnest root canal wall and its orientation were all determined. Data were analyzed using one-way ANOVA and post hoc Tukey's test. The most common configurations were Melton's type I in the coronal and middle and types I and IV in the apical region. The mean thicknesses of the thinnest root canal wall were 1.94±0.43, 1.42±0.57 and 1.10±0.52 mm in the coronal, middle and apical regions, respectively. The lingual wall was the thinnest wall in the coronal, middle and apical regions and it was thinner in the apical than in the middle and coronal regions. The lingual wall was thinner in the middle third of the mesial root compared to the distal root (P<0.05). The lingual wall was the thinnest in C-shaped root canals of mandibular second molars of an Iranian population. Type, number and pathway of canals may vary from the orifice to the apex.

Use of cone-beam computed tomography in diagnosing and treating endodontic treatment failure: A case study

The use of cone-beam computed tomography (CBCT) as a complementary imaging modality applies to various clinical situations that with conventional two-dimensional radiographs alone may pose diagnostic challenges. These challenges include but are not limited to locating missed canals in endodontic retreatment and diagnosing the presence of lesions such as resorption, periapical bone defects, root fractures, and perforations. In this study, we present a case of an asymptomatic apical periodontitis that was incidentally found on a panoramic radiograph. Analyses based on panoramic and periapical radiographs and clinical examinations were insufficient for definitive diagnosis, which necessitated the use of CBCT. The CBCT scan allowed identification of the cause of the apical disease, an unfilled mesiolingual canal in previously root canal treated left mandibular second molar, as well as the extent of the lesion. We also explore the diagnostic challenges in using traditional two-dimensional radiographs only, the challenges in locating root canals in mandibular second molars, and risks and benefits in using CBCT.

C-shaped canals-prevalence and root canal configuration by cone beam computed tomography evaluation in first and second mandibular molars-a cross-sectional study.

C-shaped root canal configuration is an unusual root canal morphology and one of the most often anatomical variations in root canal systems of second mandibular molars. The purpose of this study was to assess the prevalence, symmetry and configuration of C-shaped canals in first and second mandibular molars in an Israeli population using cone beam computed tomography (CBCT). One thousand twenty Israel patients' CBCT scans were screened and evaluated. First and second mandibular molars with C-shaped canals were identified. Prevalence configuration along the root and symmetry were analyzed, and new radicular groove classification was proposed. Total of 1465 mandibular second molars and 1229 mandibular first molars were evaluated. The overall prevalence of C-shaped canals in first and second mandibular molars was 0.16 and 4.6%, respectively. No significant difference was found by gender or side of occurrence. The unilateral prevalence of C-shaped canals in mandibular second molars was 55%. C-shaped canal configuration changed along the root in 63% of the cases. The prevalence of C-shaped canals in first and second mandibular molars in the Israeli population is low in comparison to other subpopulations. Clinicians should be aware of the possible asymmetry, different configuration along the root, and the location of danger zone of this anatomic variation during clinical work. CBCT is an efficient three dimensional radiographic examination for evaluation of C-shape root canal configuration. CBCT may help the clinicians during clinical work for considering appropriate cleaning, shaping, and obturation technique according to the characteristic of C-shape root canal configuration.

In vitro study of the morphology of internal lower second molars

The mandibular molars are a group of teeth that have a complex internal morphology, and its fundamental knowledge is necessary. The second molar has two roots, one mesial and distal, but three canals are more commonly find: two in the mesial root and one in the distal root. Objective: To study through four criteria: radiographic, clinical, microscopic, and anatomy, the internal morphology of the mandibular second molars. Material and methods: This was a cross-sectional, in vitro, descriptive, observational study, in which 50 second molars were selected, having as exclusion criteria teeth destroyed by caries. Inclusion criteria comprised teeth with higid and semi-higid crowns Results: ��� of mandibular second molars had three canals. The round-shaped cross section was the most common throughout the cervical-apical extension of both mesial (59%) and distal (47%) canals. However, other possible configurations and number of canals can be found in second molars, as the presence of four (12%) or five canals (3%). 36.7% of the mesial canals and 29.4% of distal canals were flattened in the mesial-distal direction and elongated in buccolingual direction; the variation of the "C-shaped" canal was found in 4% of cases. Conclusion: The most frequent configuration and number of canals of mandibular second molars were, respectively, the round-shaped cross section configuration in the entire length of the canal, and three canals. However the professional should be aware that this morphology may vary as shown in each research phase. Therefore, to achieve clinical success, the professional should have the knowledge of the internal morphology of these teeth and their possible variations.

Endodontic Management of C-shaped Canals in Mandibular Second Molars

Endodontic Management of C-shaped Canals in Mandibular Second Molars