Endodontic management of a C-shaped maxillary first molar with three independent buccal root canals by using cone-beam computed tomography

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

Objectives

The purpose of this study was to investigate the C-shaped root canal anatomy of mandibular second molars in a Korean population.

Materials and Methods

A 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.

Results

Of 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.

Conclusions

There 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.

A C-Shaped Canal in a Maxillary Second Molar: Prexion 3D Cone-Beam Computed Tomography Analysis

OBJECTIVE

The aim of this study was to present an atypical case of a C-shaped root canal that was present in the vestibular root of a permanent maxillary second molar using PreXion 3-D cone-beam computed tomography (CBCT) as a diagnostic device.

MATERIALS AND METHODS

A 50-year-old female patient was referred for routine examination to a private diagnostic imaging clinic in Recife-Pernambuco. During the physical examination, the presence of an unusual C-shaped anatomy in the vestibular canal with a mesiodistal interconnection that extended from the apical to the cervical third was detected in axial slices acquired with a PreXion 3-D scanner.

RESULTS

Although C-shaped root canals are most frequently observed in the mandibular second molar, this case presented a rare finding in the permanent maxillary second molar.

CONCLUSIONS

PreXion 3-D CBCT has emerged as a new high-resolution imaging test technology, thus assisting with the diagnosis of anatomical variations such as C-shaped root canals. However, such imaging technology is not recommended for routine use.

Prevalence and Characteristics of the Maxillary C-shaped Molar

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.

Use of cone-beam computed tomography and three-dimensional modeling for assessment of anomalous pulp canal configuration: a case report

Three-dimensional (3D) reconstruction of cone-beam computed tomography (CBCT) scans appears to be a valuable method for assessing pulp canal configuration. The aim of this report is to describe endodontic treatment of a mandibular second premolar with aberrant pulp canal morphology detected by CBCT and confirmed by 3D modeling. An accessory canal was suspected during endodontic treatment of the mandibular left second premolar in a 21 year old woman with a chief complaint of pulsating pain. Axial cross-sectional CBCT scans revealed that the pulp canal divided into mesiobuccal, lingual, and buccal canals in the middle third and ended as four separate foramina. 3D modeling confirmed the anomalous configuration of the fused root with a deep lingual groove. Endodontic treatment of the tooth was completed in two appointments. The root canals were obturated using lateral compaction of gutta-percha and root canal sealer. The tooth remained asymptomatic and did not develop periapical pathology until 12 months postoperatively. CBCT and 3D modeling enable preoperative evaluation of aberrant root canal systems and facilitate endodontic treatment.

Endodontic management of a mandibular second molar with radix entomolaris: a case report

The presence of radix entomolaris (RE) in a mandibular first molar is a common occurrence in certain ethnic groups, but the presence of RE in a mandibular second molar is a rare occurrence. In the present case, RE was identified from preoperative radiographs and confirmed using cone-beam computed tomography (CBCT). The access cavity was modified to locate the RE. Cleaning and shaping were performed with nickel-titanium rotary instruments. Obturation was completed with gutta-percha cones using AH Plus (Dentsply Detrey GmbH) as sealer. From the CBCT axial images, the RE was determined to have a Type III curvature by the De Moor classification, Type B separate RE by the Carlsen and Alexandersen classification, and radiographically, a Type i image by the Wang classification. The presence of RE in the mandibular second molar makes it essential to anticipate and treat the distolingual root canal. This case report highlights the usefulness of CBCT for assessing RE in the mandibular second molar, which can help the clinician in making a confirmatory diagnosis and assessing the morphology of the root canal.