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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 81-84

Endodontic management of a mandibular second molar with C-shaped canals


1 Senior Lecturer, Department of Conservative Dentistry and Endodontics, Hazaribag College of Dental Sciences and Hospital, Hazaribagh, Jharkhand, India
2 Postgraduate Student, Department of Conservative Dentistry and Endodontics, Hazaribag College of Dental Sciences and Hospital, Hazaribagh, Jharkhand, India
3 Associate Professor, Department of Conservative Dentistry and Endodontics, Hazaribag College of Dental Sciences and Hospital, Hazaribagh, Jharkhand, India
4 Senior Lecturer, Department of Conservative Dentistry and Endodontics, Jaipur Dental College, Jaipur, Rajasthan, India

Date of Submission13-Aug-2021
Date of Acceptance27-Aug-2021
Date of Web Publication27-Sep-2021

Correspondence Address:
Dr. Deepak Kurup
Department of Conservative Dentistry and Endodontics, Hazaribag College of Dental Sciences and Hospital, Hazaribagh, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_30_21

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  Abstract 


The aim of this case report is to explain the etiology and management of C-shaped canals. An important anatomic variant in root canal morphology, the C configuration, presents as a thin fin connecting the canals with a predilection for mandibular second molars. Early recognition of the C-shape becomes imperative for its successful management. Newer diagnostic tools have facilitated a more precise diagnosis of this condition. Clinical and radiographic diagnoses can aid in the identification and negotiation of the fan-shaped areas. The inaccessible areas and unique canal patterns make provision of optimum treatment quality a highly challenging proposition. Successful endodontic therapy of this canal configuration can be achieved with rotary and hand instrumentation assisted with ultrasonics.

Keywords: Anatomic variant, C configuration, endodontic treatment


How to cite this article:
Mandal TK, Dubey D, Kurup D, Pandey NK, Verma K, Mahreen S. Endodontic management of a mandibular second molar with C-shaped canals. Int J Prev Clin Dent Res 2021;8:81-4

How to cite this URL:
Mandal TK, Dubey D, Kurup D, Pandey NK, Verma K, Mahreen S. Endodontic management of a mandibular second molar with C-shaped canals. Int J Prev Clin Dent Res [serial online] 2021 [cited 2021 Nov 29];8:81-4. Available from: https://www.ijpcdr.org/text.asp?2021/8/3/81/326830




  Introduction Top


C-shaped canals are generally seen in mandibular second molars that appear to have a single, large root. In this type of configuration, the floor of the chamber is lower than normal. The access penetration is quite deep. Place a file in the MB canal and then take an X-ray. The X-ray will show the file in the MB canal traversing obliquely across the tooth. It looks overwhelmingly like a perforation.

C-shaped canals normally have three canals. The mesiobuccal and distal canals are interconnected. This connection or “fin” holds tremendous amounts of tissue. The mesiolingual canal usually is separate. Therefore, we refer to this shape as a C-shaped canal. Sometimes, all three canals are connected in a “horseshoe” type ring. This is called a true C-shaped canal. A true C is less common than the regular C and often is seen in the third molars. In this case reported, we have shown the management of two different case reports depicting C-shaped canal configuration in the mandibular second molar.


  Case Report-1 Top


A 28-year-old female patient reported to the Department of Conservative Dentistry and Endodontics in Hazaribag College of Dental Sciences and Hospital with a chief complaint of spontaneous pain in the lower right back tooth. History revealed spontaneous pain with the right mandibular second molar for the past 15–20 days. Subjective symptoms included sensitivity to thermal stimuli and an increase in intensity of pain. The patient's medical history and dental history was noncontributory.

Clinical examination of the right mandibular second molar revealed the presence of a large carious lesion, which was sensitive to percussion. Periodontal probing around the tooth showed normal alveolar bone morphology, normal sulcular depth, absence of pockets, and mobility within physiological limits. Preoperative radiographs [Figure 1] revealed a disto-occlusal radiolucency approaching the pulp space and radiolucency was seen at the apex. Radiographs confirmed the presence of fused roots, which indicated the C-shape of the canals. From the sensibility tests and clinical and radiographic examination, a diagnosis of symptomatic irreversible pulpitis routine nonsurgical endodontic treatment was planned. Treatment plan was explained to the patient and consent was obtained.
Figure 1: Preoperativeradiograph

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Local anesthesia was administered (1.8 ml 2% lidocaine with 1: 200,000 epinephrine) to the patient. Under rubber dam, access opening was done. Working length was determined with #35 K-file and #40 K-file for mesial and distal canal, respectively, using an apex locator (CanalPro Coltene) and confirmed with radiograph. Biomechanical preparation was done with neoendo rotary file system till 25/4 in the mesial canal and 25/6 in the distal canal. Copious irrigation was done with 3% sodium hypochlorite, followed by normal saline. Canals were then dried with paper points and calcium hydroxide dressing was placed for 7 days.

In the next visit, the patient was asymptomatic. Calcium hydroxide dressing was removed from the root canal. The canal was dried with absorbent points (DENTSPLY Maillefer, Ballaigues, Switzerland), and obturation [Figure 2] was done with 25/4 and 25/6 thermoplasticized gutta percha cones with bio-C root canal sealer. The access cavity was restored using resin composite (GC EVER X).
Figure 2: Obturation

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  Case Report 2 Top


A 32-year-old male patient reported to the department of conservative dentistry and endodontics with a chief complaint of pain in the lower left back tooth. Medical history was noncontributory.

Intraoral examination revealed disto-occlusal caries with respect to #37 and tenderness to percussion. Radiographically [Figure 3], the tooth was conical in shape with fused mesial and distal root with a thin radiolucent line between them, with suspected C-shaped canal. Periapical radiolucency is suggestive of periapical abscess. Routine endodontic treatment was planned and explained to the patient. After working length determination, canal was prepared with Protaper rotary files (DENTSPLY Maillefer, Switzerland) up to F2, followed by circumferential filing with hand K-files (DENTSPLY Maillefer, Switzerland). Copious amount of 3% sodium hypochlorite was used for irrigation, which was activated using ultra X (ORIKAM, Switzerland), and calcium hydroxide dressing was given as an intracanal medicament. The patient was recalled after 2 weeks and was sign and symptom free; obturation [Figure 4] was then completed with thermoplasticized gutta percha and AH PLUS root canal sealer. Permanent access restoration was done with composite (Beautiful, Shofu).
Figure 3: Preoperativeradiograph

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Figure 4: Obturation

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  Discussion Top


C-shaped canal configuration is the most common variation reported in mandibular second molars. Anatomical irregularities, such as accessory or lateral canals or presence of an apical delta in a C-shaped canal makes it difficult to clean, shape and achieve three-dimensional seal.[1],[2],[3],[4] Internal irregularities such as fins and isthmus prevent through debridement with conventional instrumentation leading to endodontic failure. Thus, thorough chemicomechanical cleansing is vital in successful management of C-shaped canal.[5] The C-shaped canal configuration was observed more commonly in the Asian population, with higher prevalence in Koreans ranging from 31.3% to 45.5% and 0.6% to 41.27% in Chinese population.[3],[4],[5],[6],[7],[8] Mandibular second molars are most commonly associated with the presence of C-shaped canal configuration in 2.7%–45.5% of population.[4],[9],[10],[11] Majority of studies were carried out in the Chinese population regarding the presence of C-shaped canals, and mandibular premolars have shown C-shaped canals in 29.7% of cases. The C-shaped variation is also observed in maxillary third molars,[12] mandibular third molars,[12],[13] mandibular second premolars (1%),[14] and maxillary first molars (0.12%)[15] and having no correlation of C-shaped canal with that of gender, age, or tooth position.

Role of irrigant with agitation using ultrasonics, thus, becomes vital in debridement of such canals.[4] After NiTi rotary instrumentation, K-file could be passively introduced into the canal and instrumented toward the isthmus areas to facilitate its complete debridement.[16],[17],[18],[19],[20] Obturation of C-shaped canals is a critical task due to the various intricacies present within the root canal. Cold lateral condensation technique does not allow deeper condensation and penetration of obturating material in the intricacies.[4] Thermoplasticized gutta percha technique is proved to be advantageous in obturation of such aberrant root canal anatomy.

Rubber dam application was done with clamps sometimes obstruct the available working area, thus rubber dam may be stabilized using wedjets or tying floss to concern and adjacent teeth. Using small head hand piece, small length burs, bending hand files at a desirable angle, or flexi files may help in access and canal preparation.

Conclusively, to manage such difficult cases effectively, general dentists may refer the cases to the specialist whenever situation demands.[4] After NiTi rotary instrumentation, K-file could be passively introduced into the canal and instrumented toward the isthmus areas to facilitate its complete debridement.[16]


  Conclusion Top


The early recognition of these canal configurations facilitates cleaning, shaping, and obturation of the root canal system. It should be noted that using a radiograph showing files set to the canal terminus to diagnose and to determine canal morphology may not give the results expected. In some instances, it may be difficult to distinguish between C-shaped canal or one with single or three canals joining apically. Thus, it is necessary to confirm the diagnosis by exploring the access cavity.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Manning SA. Root canal anatomy of mandibular second molars. Part II. C-shaped canals. Int Endod J 1990;23:40-5.  Back to cited text no. 1
    
2.
Cheung GS, Yang J, Fan B. Morphometric study of the apical anatomy of C-shaped root canal systems in mandibular second molars. Int Endod J 2007;40:239-46.  Back to cited text no. 2
    
3.
Seo MS, Park DS. C-shaped root canals of mandibular second molars in a Korean population: Clinical observation and in vitro analysis. Int Endod J 2004;37:139-44.  Back to cited text no. 3
    
4.
Yang ZP, Yang SF, Lin YC, Shay JC, Chi CY. C-shaped root canals in mandibular second molars in a Chinese population. Endod Dent Traumatol 1988;4:160-3.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    
6.
Zhang R, Wang H, Tian YY, Yu X, Hu T, Dummer PM. Use of cone-beam computed tomography to evaluate root and canal morphology of mandibular molars in Chinese individuals. Int Endod J 2011;44:990-9.  Back to cited text no. 6
    
7.
Zheng Q, Zhang L, Zhou X, Wang Q, Wang Y, Tang L, et al. C-shaped root canal system in mandibular second molars in a Chinese population evaluated by cone-beam computed tomography. Int Endod J 2011;44:857-62.  Back to cited text no. 7
    
8.
Wang Y, Guo J, Yang HB, Han X, Yu Y. Incidence of C-shaped root canal systems in mandibular second molars in the native Chinese population by analysis of clinical methods. Int J Oral Sci 2012;4:161-5.  Back to cited text no. 8
    
9.
Manning SA. Root canal anatomy of mandibular second molars. Part I. Int Endod J 1990;23:34-9.  Back to cited text no. 9
    
10.
Rahimi S, Shahi S, Lotfi M, Zand V, Abdolrahimi M, Es'haghi R. Root canal configuration and the prevalence of C-shaped canals in mandibular second molars in an Iranian population. J Oral Sci 2008;50:9-13.  Back to cited text no. 10
    
11.
Weine FS. The C-shaped mandibular second molar: Incidence and other considerations. Members of the Arizona Endodontic Association. J Endod 1998;24:372-5.  Back to cited text no. 11
    
12.
Sidow SJ, West LA, Liewehr FR, Loushine RJ. Root canal morphology of human maxillary and mandibular third molars. J Endod 2000;26:675-8.  Back to cited text no. 12
    
13.
Kuzekanani M, Haghani J, Nosrati H. Root and canal morphology of mandibular third molars in an Iranian population. J Dent Res Dent Clin Dent Prospects 2012;6:85-8.  Back to cited text no. 13
    
14.
Yu X, Guo B, Li KZ, Zhang R, Tian YY, Wang H, et al. Cone-beam computed tomography study of root and canal morphology of mandibular premolars in a western Chinese population. BMC Med Imaging 2012;12:18.  Back to cited text no. 14
    
15.
Cleghorn BM, Christie WH, Dong CC. Root and root canal morphology of the human permanent maxillary first molar: A literature review. J Endod 2006;32:813-21.  Back to cited text no. 15
    
16.
Yin X, Cheung GS, Zhang C, Masuda YM, Kimura Y, Matsumoto K. Micro-computed tomographic comparison of nickel-titanium rotary versus traditional instruments in C-shaped root canal system. J Endod 2010;36:708-12.  Back to cited text no. 16
    
17.
Ruddle CJ. Three-dimensional obturation of the root canal system. Dent Today 1992;11:28, 30-3, 39.  Back to cited text no. 17
    
18.
Walid N. The use of two pluggers for the obturation of an uncommon C-shaped canal. J Endod 2000;26:422-4.  Back to cited text no. 18
    
19.
Khan S, Chatra L, Prashanth SK, Veena KM, Rao PK. Pathogenesis of oral submucous fibrosis. J Cancer Res Ther 2012;8:199-203.  Back to cited text no. 19
    
20.
Yoithapprabhunath TR, Maheswaran T, Dineshshankar J, Anusushanth A, Sindhuja P, Sitra G. Pathogenesis and therapeutic intervention of oral submucous fibrosis. J Pharm Bioallied Sci 2013;5:S85-8.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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  In this article
   Abstract
  Introduction
  Case Report-1
  Case Report 2
  Discussion
  Conclusion
   References
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