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Case Report
Dilemmas pertaining to three canals in the mesiobuccal root of a maxillary second molar: a case report
Ankit Arora, Shashi Rashmi Acharya, Muliya Vidya Saraswathi, Padmaja Sharma, Amber Ather
Restor Dent Endod 2013;38(3):172-177.   Published online August 23, 2013
DOI: https://doi.org/10.5395/rde.2013.38.3.172
AbstractAbstract PDFPubReaderePub

The mesiobuccal root of the maxillary molars is well known to pose a hindrance during endodontic therapy. Presented here is a case of a maxillary left second molar where three canals were located in its mesiobuccal root with the use of visual and diagnostic aids. Difficulties encountered during the process of unveiling the tooth's internal anatomy were discussed. The dilemmas encountered pertained to the root canal configuration, the nomenclature of the extra canals, and the justification for the presence of a third canal. The root canal configuration of 3-2-1 was confirmed for the mesiobuccal root using information gained from clinical, radiographic, and multi-detector computed tomography (MDCT) scan findings. This case demonstrates the need for efforts to locate extra canals in the mesiobuccal root of the maxillary molars as their internal anatomy remains a mystery.

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Original Articles
Cross-sectional morphology and minimum canal wall widths in C-shaped root of mandibular molars
Byung-Chul Song, Yong-Bum Cho
J Korean Acad Conserv Dent 2007;32(1):37-46.   Published online January 31, 2007
DOI: https://doi.org/10.5395/JKACD.2007.32.1.037
AbstractAbstract PDFPubReaderePub

The C-shaped canal system is an anatomical variation mostly seen in mandibular second molars, although it can also occur in maxillary and other mandibular molars. The main anatomical feature of C-shaped canals is the presence of fins or web connecting the individual root canals. The complexity of C-shaped canals prevents these canals from being cleaned, shaped, and obturated effectively during root canal therapy, and sometimes it leads to an iatrogenic perforation from the extravagant preparation.

The purpose of this study was to provide further knowledge of the anatomical configuration and the minimal thickness of dentinal wall according to the level of the root.

Thirty extracted mandibular second molars with fused roots and longitudinal grooves on lingual or buccal surface of the root were collected from a native Korean population. The photo images and radiographs from buccal, lingual, apical direction were taken. After access cavity was prepared, teeth were placed in 5.25% sodium hypochlorite solution for 2 hours to dissolve the organic tissue of the root surface and from the root canal system. After bench dried and all the teeth were embedded in a self-curing resin. Each block was sectioned using a microtome (Accutom-50, Struers, Denmark) at interval of 1 mm. The sectioned surface photograph was taken using a digital camera (Coolpix 995, Nikon, Japan) connected to the microscope. 197 images were evaluated for canal configurations and the minimal thickness of dentinal wall between canal and external wall using' Root Thickness Gauge Program' designed with Visual Basic.

The results were as follows:

1. At the orifice level of all teeth, the most frequent observed configuration was Melton's Type C I (73%), however the patterns were changed to type C II and C III when the sections were observed at the apical third. On the other hand, the type C III was observed at the orifice level of only 2 teeth but this type could be seen at apical region of the rest of the teeth.

2. The C-shaped canal showed continuous and semi-colon shape at the orifice level, but at the apical portion of the canal there was high possibility of having 2 or 3 canals.

3. Lingual wall was thinner than buccal wall at coronal, middle, apical thirds of root but there was no statistical differences.

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The effect of C-factor and volume on microleakage of composite resin restorations with enamel margins
Bong-Joo Koo, Dong-Hoon Shin
J Korean Acad Conserv Dent 2006;31(6):452-459.   Published online November 30, 2006
DOI: https://doi.org/10.5395/JKACD.2006.31.6.452
AbstractAbstract PDFPubReaderePub

Competition will usually develop between the opposing walls as the restorative resin shrinks during polymerization. Magnitude of this phenomenon may be depended upon cavity configuration and volume.

The purpose of this sturdy was to evaluate the effect of cavity configuration and volume on microleakage of composite resin restoration that has margins on the enamel site only.

The labial enamel of forty bovine teeth was ground using a model trimmer to expose a flat enamel surface. Four groups with cylindrical cavities were defined, according to volume and configuration factor (Depth × Diameter / C-factor) - Group I: 1.5 mm × 2.0 mm / 4.0, Group II: 1.5 mm × 6.0 mm / 2.0, Group III: 2.0 mm × 1.72 mm / 5.62, Group IV: 2.0 mm × 5.23 mm / 2.54.

After treating with fifth-generation one-bottle adhesive - BC Plus™ (Vericom, AnYang, Korea), cavities were bulk filled with microhybrid composite resin - Denfill™ (Vericom). Teeth were stored in distilled water for one day at room temperature and were finished and polished with Sof-Lex system. Specimens were thermocycled 500 times between 5℃ and 55℃ for 30 second at each temperature.

Teeth were isolated with two layers of nail varnish except the restoration surface and 1 mm surrounding margins. Electrical conductivity (µA) was recorded in distilled water by electrochemical method. Microleakage scores were compared and analyzed using two-way ANOVA at 95% level.

The results were as follows:

1. Small cavity volume showed lower microleakage score than large one, however, there was no statistically significant difference.

2. There was no relationship between cavity configuration and microleakage.

Factors of cavity configuration and volume did not affect on microleakage of resin restorations with enamel margins only.

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Effect of rotational speed of Protaper™ rotary file on the change of root canal configuration
Min-Chul Seo, Yoon-Jeong Jeon, In-Chol Kang, Dong-Jun Kim, Yun-Chan Hwang, In-Nam Hwang, Won-Mann Oh
J Korean Acad Conserv Dent 2006;31(3):179-185.   Published online May 31, 2006
DOI: https://doi.org/10.5395/JKACD.2006.31.3.179
AbstractAbstract PDFPubReaderePub

This study was conducted to evaluate canal configuration after shaping by ProTaper™ with various rotational speed in J-shaped simulated resin canals.

Forty simulated root canals were divided into 4 groups, and instrumented using by ProTaper™ at the rotational speed of 250, 300, 350 and 400 rpm. Pre-instrumented and post-instrumented images were taken by a scanner and those were superimposed. Outer canal width, inner canal width, total canal width, and amount of transportation from original axis were measured at 1, 2, 3, 4, 5, 6, 7 and 8 mm from apex. Instrumentation time, instrument deformation and fracture were recorded. Data were analyzed by means of one-way ANOVA followed by Scheffe's test.

The results were as follows

Regardless of rotational speed, at the 1~2 mm from the apex, axis of canal was transported to outer side of a curvature, and at 3~6 mm from the apex, to inner side of a curvature. Amounts of transportation from original axis were not significantly different among experimental groups except at 5 and 6 mm from the apex.

Instrumentation time of 350 and 400 rpm was significantly less than that of 250 and 300 rpm (p < 0.01).

In conclusion, the rotational speed of ProTaper™ files in the range of 250~400 rpm does not affect the change of canal configuration, and high rotational speed reduces the instrumentation time. However, appearance of separation and distortion of Ni-Ti rotary files can occur in high rotational speed.

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Effect of canal tapering in teeth of various apical size & cross-sectional configuration on microleakage
Jung-Hee Kim, Kyung-Ha Lee, Se-Joon Lee, Mi-Kyung Yu, Kwang-Won Lee
J Korean Acad Conserv Dent 2005;30(2):95-101.   Published online March 31, 2005
DOI: https://doi.org/10.5395/JKACD.2005.30.2.095
AbstractAbstract PDFPubReaderePub

The aim of this study was to evaluate the microleakage of teeth according to root canal preparation with & without apical enlargement in various size of apical foramen. 60 extracted one canal roots were cross-cutted at 5 mm from root apex and divided into two groups according to their apical foramen size of large (L) and small (S). Each group was subdivided into two groups accordance with their cross-sectional configuration at 5 mm from apex, round (R) and ovoid (O); SR Group, SO Group, LR Group, LO Group. Each group was shaped in .02 taper by Quantec series Nickel-Titanium (NiTi) rotary file, obturated by lateral condensation method. Leakage was measured using a fluid transport model under 40 cmH2O pressure. After the leakage test, blocks which had showed the leakage retreated with .04 taper and .06 taper and evaluated the degree of fluid filtration in each group. The data was analysed statistically using chi-square test and fisher's exact test.

The results obtained were as follows:

1. Significant difference in leakage was found in groups which had different apical foramen size in .02 taper instrumentation (p < 0.05), but not in .04 taper instrumentation (p > 0.05).

2. The difference in microleakage according to the shape of canal was not evident at 5 mm from apex (p > 0.05).

3. There was correlation between .02 taper instrumentation and .04 taper instrumentation in LR group , LO group (p < 0.05).

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Effect of surface defects and cross-sectional configuration on the fatigue fracture of NiTi rotary files under cyclic loading
Yu-Mi Shin, Eui-Sung Kim, Kwang-Man Kim, Kee-Yeon Kum
J Korean Acad Conserv Dent 2004;29(3):267-272.   Published online May 31, 2004
DOI: https://doi.org/10.5395/JKACD.2004.29.3.267
AbstractAbstract PDFPubReaderePub

The purpose of this in vitro study was to evaluate the effect of surface defects and cross-sectional configuration of NiTi rotary files on the fatigue life under cyclic loading. Three NiTi rotary files (K3™, ProFile®, and HERO 642®) with #30/.04 taper were evaluated. Each rotary file was divided into 2 subgroups: control (no surface defects) and experimental group (artificial surface defects). A total of six groups of each 10 were tested. The NiTi rotary files were rotated at 300rpm using the apparatus which simulated curved canal (40 degree of curvature) until they fracture. The number of cycles to fracture was calculated and the fractured surfaces were observed with a scanning electron microscope. The data were analyzed statistically. The results showed that experimental groups with surface defects had lower number of cycles to fracture than control group but there was only a statistical significance between control and experimental group in the K3™ (p<0.05). There was no strong correlation between the cross-sectional configuration area and fracture resistance under experimental conditions. Several of fractured files demonstrated characteristic patterns of brittle fracture consistent with the propagation of pre-existing cracks.

This data indicate that surface defects of NiTi rotary files may significantly decrease fatigue life and it may be one possible factor for early fracture of NiTi rotary files in clinical practice.

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The canal system in the mesiobuccal root of the maxillary first molar
Dong-Hyun Cho, Ho-Young Choi, Sang-Hyuk Park, Gi-Woon Choi
J Korean Acad Conserv Dent 2003;28(3):232-240.   Published online May 31, 2003
DOI: https://doi.org/10.5395/JKACD.2003.28.3.232
AbstractAbstract PDFPubReaderePub

This study is to investigate the canal system in the mesiobuccal root of the maxillry first molar.

61 maxillary first molars were randomly selected. Serial transverse sections were made perpendicular to the long axis of the mesiobuccal root. Each section was placed in 3% sodium hypochlorite for 24 hours and rinsed in water and dried. The resected surface was stained with 2% methylene blue dye and examined with stereomicroscope.

Canal configuration analysis showed that 36.1% of the specimen classified as type I, 16.4% as type II, 37.7% as type III and 9.8% as type IV.

Type II canal was merged in one canal within 1 to 4mm of the apex. 40% of type II canal converged at 2mm of the apex.

Type IV canal was divided into two canal within 2 to 4mm of the apex. 66.6% of type IV canal branched off at 2mm of the apex.

None of the sections had more than two main root canal.

48.4% of the sections in 3mm with two canals contained an isthmusand more than 70% with two canals has isthmus at 4 to 5mm sections.

63.9% of the mesiobuccal root of maxillary first molar had two canaland 76.5% of sections with two canals in 5 MM had an isthmus. Because of this complexity the clinician should always search for extra canal carefullyand root canal system, including an isthmus, should be cleaned and shaped completelyand obturated three dimensionally for successful endodontic treatment.

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