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      The Assessment of C-shaped Canal Prevalence in Mandibular Second Molars Using Endodontic Microscopy and Cone Beam Computed Tomography: An In Vivo Investigation

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          Abstract

          Background

          Understanding root canal anatomy variations, particularly C-shaped canals, is crucial for successful endodontic treatment. This study used clinical and radiographic methods to assess the prevalence and characteristics of C-shaped canals in mandibular second molars in Western Maharashtra.

          Materials and methods

          This prospective study was conducted in the western region of Maharashtra, India. The samples included patients requiring endodontic treatment for mandibular second molars. Clinical evaluation was conducted using a surgical endodontic microscope and cone beam computed tomography (CBCT) imaging. Inclusion and exclusion criteria ensured the selection of a focused and homogeneous sample. Data analysis included assessment of unilateral/bilateral occurrence, canal distribution, and cross-sectional characteristics.

          Results

          Out of 200 mandibular second molars, 7.5% exhibited C-shaped root canals, with no significant gender differences. Canal distribution varied across coronal, middle, and apical levels, with prevalent configurations being C1, C2, C3, and C4. No significant differences were observed in canal distribution based on root levels. No significant gender differences were found in the presence of grooves on the root surfaces.

          Conclusion

          This study provides valuable insights into the prevalence and characteristics of C-shaped canals in mandibular second molars in Western Maharashtra. Further research into histological and genetic aspects can enhance our understanding, leading to improved treatment strategies for complex root canal anatomy variations.

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          Most cited references64

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          Root canal anatomy of the human permanent teeth.

          Frank J Vertucci (1984)
          Two thousand four hundred human permanent teeth were decalcified, injected with dye, and cleared in order to determine the number of root canals and their different types, the ramifications of the main root canals, the location of apical foramina and transverse anastomoses, and the frequency of apical deltas.
          Article 0 comments Cited 258 times – based on 0 reviews     Review now
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            Root and canal morphology of Burmese mandibular molars.

            K Gulabivala, T H Aung, A Alavi … (2001)
            To study the root canal morphology of Burmese mandibular molars using a canal staining and tooth clearing technique. Mandibular molars (331) were collected from indigenous Burmese patients and designated; first (139), second (134), third (58) molars. Following pulp tissue removal and staining of the canal systems with Indian ink, the teeth were decalcified and rendered clear with methyl salicylate. Under magnification (x3), the following features were evaluated: (i) root number and morphology, (ii) number of canals per root, (iii) root canal configuration (Vertucci's classification), (iv) number of apical foramina per root, (v) number and location of lateral canals and (vi) the presence of intercanal communications. Most of the mandibular molars had two separate roots (90% in first molars, 58% in second molars, 53% in third molars) and three-rooted teeth were (10%) confined to first molars. C-shaped roots occurred in 22.4% of mandibular second molars and a further 14.9% had two fused roots. The majority (81-100%) of conical distal roots possessed a simple type I (single canal) configuration. Whilst the canal system of mesial roots was more complex: 52-85% contained two canals, of which type II (two orifices, one foramen) and type IV (two separate canals) were the most prevalent. A broad range of 6.5-70% had intercanal communications. Fused/single-rooted molars had a wide variety of canal system types but intercanal communications were rare except in C-shaped roots (33%) of second molars. The majority of roots of all molars contained one or two apical foramina (91-96%) and the apical third had the highest prevalence of lateral canals. There was a high prevalence of three-rooted mandibular first molars and C-shaped roots/canals in mandibular second molars from a Burmese population. Conical roots tend to have simple canal systems, whilst flatter/broader roots have more complex canal systems.
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              Outcome of primary root canal treatment: systematic review of the literature -- Part 2. Influence of clinical factors.

              Y-L Ng, V. Mann, S Rahbaran … (2008)
              (i) To carry out meta-analyses to quantify the influence of the clinical factors on the efficacy of primary root canal treatment and (ii) to identify the best treatment protocol based on the current evidence. The evidence for the effect of each clinical factor on the success rate (SR) of primary root canal treatment was gathered in three different ways: (i) intuitive synthesis of reported findings from individual studies; (ii) weighted pooled SR by each factor under investigation was estimated using random-effect meta-analysis; (iii) weighted effect of the factor under investigation on SR were estimated and expressed as odds ratio for the dichotomous outcomes (success or failure) using fixed- and random-effects meta-analysis. Statistical heterogeneity amongst the studies was assessed by Cochran's (Q) test. Potential sources of statistical heterogeneity were investigated by exploring clinical heterogeneity using meta-regression models which included study characteristics in the regression models. Out of the clinical factors investigated, pre-operative pulpal and periapical status were most frequently investigated, whilst the intra-operative factors were poorly studied in the 63 studies. Four factors were found to have a significant effect on the primary root canal treatment outcome, although the data heterogeneity was substantial, some of which could be explained by some of the study characteristics. Four conditions (pre-operative absence of periapical radiolucency, root filling with no voids, root filling extending to 2 mm within the radiographic apex and satisfactory coronal restoration) were found to improve the outcome of primary root canal treatment significantly. Root canal treatment should therefore aim at achieving and maintaining access to apical anatomy during chemo-mechanical debridement, obturating the canal with densely compacted material to the apical terminus without extrusion into the apical tissues and preventing re-infection with a good quality coronal restoration.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 9 June 2024
                Publication date (Electronic, collection): June 2024
                Volume: 16
                Issue: 6
                Electronic Location Identifier: e62026
                Affiliations
                [1 ] Department of Conservative Dentistry and Endodontics, DY Patil Dental School, Pune, IND
                [2 ] Department of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, USA
                [3 ] Department of Diagnostic Sciences, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, Newark, USA
                [4 ] Department of Endodontics, Mahatma Gandhi Vidyamandir's Karmaveer Bhausaheb Hiray Dental College and Hospital, Maharashtra University of Health Sciences, Nashik, IND
                [5 ] Department of Oral and Maxillofacial Radiology, Mahatma Gandhi Vidyamandir's Karmaveer Bhausaheb Hiray Dental College and Hospital, Maharashtra University of Health Sciences, Nashik, IND
                Author notes
                Article
                DOI: 10.7759/cureus.62026
                PMC ID: 11233462
                PubMed ID: 38989337
                SO-VID: f3a52a58-a399-47e8-acf0-bbc202917af2
                Copyright © Copyright © 2024, Shaikh et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 9 June 2024
                Categories
                Subject: Dentistry
                Subject: Radiology

                Keywords: ethnic groups,root canal variations,root canal configuration,endodontic treatment,root canal anatomy,cone-beam computed tomography (cbct),mandibular second molar,c-shaped canal
                Data availability:
                Keywords: ethnic groups, root canal variations, root canal configuration, endodontic treatment, root canal anatomy, cone-beam computed tomography (cbct), mandibular second molar, c-shaped canal

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