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Research Articles
Predictor factors of 1-rooted mandibular second molars on complicated root and canal anatomies of other mandibular teeth
Hakan Aydın, Hatice Harorlı
Restor Dent Endod 2024;49(1):e2.   Published online January 3, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e2
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to determine the effects of 1-rooted mandibular second molar (MnSM) teeth on root canal anatomy complexities of the mandibular central incisor (MnCI), mandibular lateral incisor (MnLI), mandibular canine (MnCn), mandibular first premolar (MnFP), mandibular second premolar (MnSP), and mandibular first molar (MnFM) teeth.

Materials and Methods

Cone-beam computed tomography images of 600 patients with full lower dentition were examined. Individuals with 1-rooted MnSMs were determined, and the complexity of root canal anatomy of other teeth was compared with individuals without 1-rooted MnSMs (Group-1; subjects with at least one 1-rooted MnSM, Group-2; subjects with more than a single root in both MnSMs). A second canal in MnCIs, MnLIs, MnCns, MnFPs, and MnSPs indicated a complicated root canal. The presence of a third root in MnFMs was recorded as complicated.

Results

The prevalence of 1-rooted MnSMs was 12.2%, with the C-shaped root type being the most prevalent (9%). There were fewer complicated root canals in MnCIs (p = 0.02), MnLIs (p < 0.001), and MnFPs (p < 0.001) in Group 1. The other teeth showed no difference between the groups (p > 0.05). According to logistic regression analysis, 1-rooted right MnSMs had a negative effect on having complex canal systems of MnLIs and MnFPs. Left MnSMs were explanatory variables on left MnLIs and both MnFPs.

Conclusions

In individuals with single-rooted MnSMs, a less complicated root canal system was observed in all teeth except the MnFMs.

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Shape and anatomical relationship of the mental foramen to the mandibular premolars in an Indian sub-population: a retrospective CBCT analysis
Komal Sheth, Kulvinder Singh Banga, Ajinkya M. Pawar, James L. Gutmann, Hyeon-Cheol Kim
Restor Dent Endod 2022;47(1):e1.   Published online December 13, 2021
DOI: https://doi.org/10.5395/rde.2022.47.e1
AbstractAbstract PDFPubReaderePub
Objectives

This study assessed the shape and anatomical relationship of the mental foramen (MF) to mandibular posterior teeth in an Indian sub-population.

Materials and Methods

In total, 475 existing cone-beam computed tomography records exhibiting 950 MFs and including the bilateral presence of mandibular premolars and first molars were assessed. Images were evaluated 3-dimensionally to ascertain the position, shape, and anatomical proximity of MFs to mandibular teeth. The position and shape of MFs were measured and calculated. The Pythagorean theorem was used to calculate the distance between the root apex of the mandibular teeth and the MF.

Results

MFs exhibited a predominantly round shape (left: 67% and right: 65%) followed by oval (left: 30% and right: 31%) in both males and females and in different age groups. The root apices of mandibular second premolars (left: 71% and right: 62%) were closest to the MF, followed by distal to the first premolars and mesial to the second premolars. The mean vertical distance between the MF and the nearest tooth apex calculated on sagittal sections was 2.20 mm on the right side and 2.32 mm on the left side; no significant difference was found according to sex or age. The distance between the apices of the teeth and the MF was ≥ 4 mm (left; 4.09 ± 1.27 mm and right; 4.01 ± 1.15 mm).

Conclusions

These findings highlight the need for clinicians to be aware of the location of the MF in treatment planning and while performing non-surgical and surgical endodontic procedures.

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The prevalence of radix molaris in the mandibular first molars of a Saudi subpopulation based on cone-beam computed tomography
Hassan AL-Alawi, Saad Al-Nazhan, Nassr Al-Maflehi, Mazen A. Aldosimani, Mohammed Nabil Zahid, Ghadeer N. Shihabi
Restor Dent Endod 2020;45(1):e1.   Published online November 14, 2019
DOI: https://doi.org/10.5395/rde.2020.45.e1
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to determine the incidence of radix molaris (RM) (entomolaris and paramolaris) in the mandibular first permanent molars of a sample Saudi Arabian subpopulation using cone-beam computed tomography (CBCT).

Materials and Methods

A total of 884 CBCT images of 427 male and 457 female Saudi citizens (age 16 to 70 years) were collected from the radiology department archives of 4 dental centers. A total of 450 CBCT images of 741 mature mandibular first molars that met the inclusion criteria were reviewed. The images were viewed at high resolution by 3 examiners and were analyzed with Planmeca Romexis software (version 5.2).

Results

Thirty-three (4.5%) mandibular first permanent molars had RM, mostly on the distal side. The incidence of radix entomolaris (EM) was 4.3%, while that of radix paramolaris was 0.3%. The RM roots had one canal and occurred more unilaterally. No significant difference in root configuration was found between males and females (p > 0.05). Types I and III EM root canal configurations were most common, while type B was the only RP configuration observed.

Conclusions

The incidence of RM in the mandibular first molars of this Saudi subpopulation was 4.5%. Identification of the supernumerary root can avoid missing the canal associated with the root during root canal treatment.

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C-shaped root canals of mandibular second molars in a Korean population: a CBCT analysis
Hee-Sun Kim, Daun Jung, Ho Lee, Yoon-Sic Han, Sohee Oh, Hye-Young Sim
Restor Dent Endod 2018;43(4):e42.   Published online November 1, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e42
AbstractAbstract PDFPubReaderePub
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.

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CBCT study of mandibular first molars with a distolingual root in Koreans
Hee-Ho Kim, Hyoung-Hoon Jo, Jeong-Bum Min, Ho-Keel Hwang
Restor Dent Endod 2018;43(3):e33.   Published online July 30, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e33
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to investigate the prevalence of a separate distolingual root and to measure the thickness of the buccal cortical bone in mandibular first molars in Koreans using cone-beam computed tomography (CBCT) images.

Materials and Methods

High-quality CBCT data from 432 patients were analyzed in this study. The prevalence of a separate distolingual root of the mandibular first molar was investigated. The distance from the distobuccal and distolingual root apices to the outer surface of the buccal cortical bone was measured. We also evaluated the thickness of the buccal cortical bone.

Results

The prevalence of a separate distolingual root (2 separate distal roots with 1 canal in each root; 2R2C) was 23.26%. In mandibular first molars with 2R2C, the distance from the distobuccal root apex to the outer surface of the buccal cortical bone was 5.51 mm. Furthermore, the distance from the distolingual root apex to the outer surface of the buccal cortical bone was 12.09 mm. In mandibular first molars with 2R2C morphology, the thickness of the buccal cortical bone at the distobuccal root apex of the mandibular first molar was 3.30 mm. The buccal cortical bone at the distobuccal root apex was significantly thicker in the right side (3.38 mm) than the left side (3.09 mm) (p < 0.05).

Conclusions

A separate distolingual root is not rare in mandibular first molars in the Korean population. Anatomic and morphologic knowledge of the mandibular first molar can be useful in treatment planning, including surgical endodontic treatment.

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Case Report
Mandibular bone necrosis after use of paraformaldehyde-containing paste
Chi-hwan Lee, Yoorina Choi, Sujung Park
Restor Dent Endod 2016;41(4):332-337.   Published online November 8, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.332
AbstractAbstract PDFPubReaderePub

Paraformaldehyde has been used in the past as a pulpotomy agent. However, it has a severe cytotoxic effect and may cause alveolar bone necrosis. Depulpin, a devitalizing agent containing 49% paraformaldehyde, is no longer used frequently due to its severe side effects. In the two cases described in the present study, Depulpin was used as a devitalizing agent during root canal treatment. It caused a gradual loss of sensibility in adjacent teeth, gingival necrosis, and osteomyelitis. This case report demonstrates the serious side effects of using a paraformaldehyde-containing paste as a devitalizing agent for pulp, particularly mandibular bone necrosis.

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Research Articles
Healing outcomes of root canal treatment for C-shaped mandibular second molars: a retrospective analysis
Hye-Ra Ahn, Young-Mi Moon, Sung-Ok Hong, Min-Seock Seo
Restor Dent Endod 2016;41(4):262-270.   Published online August 29, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.262
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the healing rate of non-surgical endodontic treatment between C-shaped and non-C-shaped mandibular second molars.

Materials and Methods

Clinical records and radiological images of patients who had undergone endodontic treatment on mandibular second molars between 2007 and 2014 were screened. The periapical index scoring system was applied to compare healing outcomes. Information about preoperative and postoperative factors as well as the demographic data of the patients was acquired and evaluated using chi-square and multinomial logistic regression tests.

Results

The total healing rate was 68.4%. Healing rates for the mandibular second molar were 70.9% in C-shaped canals (n = 79) and 66.6% in non-C-shaped ones (n = 117). The difference was not statistically significant.

Conclusions

The presence of a C-shaped canal in the mandibular second molar did not have a significantly negative effect on healing after treatment. Instead, proper pulpal diagnosis and final restoration were indicated as having significantly greater influence on the healing outcomes of C-shaped and non-C-shaped canals, respectively.

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Proximity of the mandibular molar root apex from the buccal bone surface: a cone-beam computed tomographic study
Dokyung Kim, Jung-Hong Ha, Myoung-Uk Jin, Young-Kyung Kim, Sung Kyo Kim
Restor Dent Endod 2016;41(3):182-188.   Published online July 14, 2016
DOI: https://doi.org/10.5395/rde.2016.41.3.182
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to evaluate the proximity of the mandibular molar apex to the buccal bone surface in order to provide anatomic information for apical surgery.

Materials and Methods

Cone-beam computed tomography (CBCT) images of 127 mandibular first molars and 153 mandibular second molars were analyzed from 160 patients' records. The distance was measured from the buccal bone surface to the root apex and the apical 3.0 mm on the cross-sectional view of CBCT.

Results

The second molar apex and apical 3 mm were located significantly deeper relative to the buccal bone surface compared with the first molar (p < 0.01). For the mandibular second molars, the distance from the buccal bone surface to the root apex was significantly shorter in patients over 70 years of age (p < 0.05). Furthermore, this distance was significantly shorter when the first molar was missing compared to nonmissing cases (p < 0.05). For the mandibular first molars, the distance to the distal root apex of one distal-rooted tooth was significantly greater than the distance to the disto-buccal root apex (p < 0.01). In mandibular second molar, the distance to the apex of C-shaped roots was significantly greater than the distance to the mesial root apex of non-C-shaped roots (p < 0.01).

Conclusions

For apical surgery in mandibular molars, the distance from the buccal bone surface to the apex and apical 3 mm is significantly affected by the location, patient age, an adjacent missing anterior tooth, and root configuration.

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Case Reports
Endodontic treatment of a C-shaped mandibular second premolar with four root canals and three apical foramina: a case report
Thikamphaa Bertrand, Sahng Gyoon Kim
Restor Dent Endod 2016;41(1):68-73.   Published online January 19, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.68
AbstractAbstract PDFPubReaderePub

This case report describes a unique C-shaped mandibular second premolar with four canals and three apical foramina and its endodontic management with the aid of cone-beam computer tomography (CBCT). C-shaped root canal morphology with four canals was identified under a dental operating microscope. A CBCT scan was taken to evaluate the aberrant root canal anatomy and devise a better instrumentation strategy based on the anatomy. All canals were instrumented to have a 0.05 taper using 1.0 mm step-back filing with appropriate apical sizes determined from the CBCT scan images and filled using a warm vertical compaction technique. A C-shaped mandibular second premolar with multiple canals is an anatomically rare case for clinicians, yet its endodontic treatment may require a careful instrumentation strategy due to the difficulty in disinfecting the canals in the thin root area without compromising the root structure.

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Use of cone-beam computed tomography and three-dimensional modeling for assessment of anomalous pulp canal configuration: a case report
Alper Sinanoglu, Dilek Helvacioglu-Yigit, Ibrahim Mutlu
Restor Dent Endod 2015;40(2):161-165.   Published online December 4, 2014
DOI: https://doi.org/10.5395/rde.2015.40.2.161
AbstractAbstract PDFPubReaderePub

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.

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Endodontic treatment of a mandibular first molar with 8 canals: a case report
Ankit Arora, Shashi Rashmi Acharya, Padmaja Sharma
Restor Dent Endod 2015;40(1):75-78.   Published online October 13, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.75
AbstractAbstract PDFPubReaderePub

Presented here is a case where 8 canals were located in a mandibular first molar. A patient with continuing pain in mandibular left first molar even after completion of biomechanical preparation was referred by a dentist. Following basic laws of the pulp chamber floor anatomy, 8 canals were located in three steps with 4 canals in each root. In both of the roots, 4 separate canals commenced which joined into two canals and exited as two separate foramina. At 6 mon follow-up visit, the tooth was found to be asymptomatic and revealed normal radiographic periapical area. The case stresses on the fact that understanding the laws of pulp chamber anatomy and complying with them while attempting to locate additional canals can prevent missing canals.

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Asymmetry in mesial root number and morphology in mandibular second molars: a case report
Gurudutt Nayak, Shashit Shetty, Rhitu Shekhar
Restor Dent Endod 2014;39(1):45-50.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.45
AbstractAbstract PDFPubReaderePub

Ambiguity in the root morphology of the mandibular second molars is quite common. The most common root canal configuration is 2 roots and 3 canals, nonetheless other possibilities may still exist. The presence of accessory roots is an interesting example of anatomic root variation. While the presence of radix entomolaris or radix paramolaris is regarded as a typical clinical finding of a three-rooted mandibular second permanent molar, the occurrence of an additional mesial root is rather uncommon and represents a possibility of deviation from the regular norms. This case report describes successful endodontic management of a three-rooted mandibular second molar presenting with an unusual accessory mesial root, which was identified with the aid of multiangled radiographs and cone-beam computed tomography imaging. This article also discusses the prevalence, etiology, morphological variations, clinical approach to diagnosis, and significance of supernumerary roots in contemporary clinical dentistry.

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Research Article
An evaluation of canal curvature at the apical one third in type II mesial canals of mandibular molars
Hye-Rim Yun, Dong-Kyun Lee, Ho-Keel Hwang
Restor Dent Endod 2012;37(2):104-109.   Published online May 18, 2012
DOI: https://doi.org/10.5395/rde.2012.37.2.104
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to evaluate the buccolingual curvature at the apical one third in type II mesial canals of mandibular molars using the radius and angle of curvature.

Materials and Methods

Total 100 mandibular molars were selected. Following an endodontic access in the teeth, their distal roots were removed. #15 H- or K-files (Dentsply Maillefer) were inserted into the mesiobuccal and mesiolingual canals of the teeth. Radiographs of the teeth were taken for the proximal view. Among them, type II canals were selected and divided into two subgroups, IIa and IIb. In type IIa, two separate canals merged into one canal before reaching the apex and in type IIb, two separate canals merged into one canal within the apical foramen. The radius and angle of curvature of specimens were examined.

Results

In type II, mean radius of curvature in mesiolingual and mesiobuccal canals were 2.82 mm and 3.58 mm, respectively. The radius of the curvature of mesiolingual canals were significantly smaller than that of mesiobuccal canals in type II, and especially in type IIa. However, there were no statistically significant differences in radius of curvature between mesiobuccal and mesiolingual canals in type IIb and there were no significant differences in angle of curvature between type IIa and IIb.

Conclusion

In this study, type II mesial canals of mandibular molars showed severe curvature in the proximal view. Especially, mesiolingual canals of type IIa had more abrupt curvature than mesiobuccal canals at the apical one third.

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Basic Research
A retrospective study of the intentionally replanted mandibular second molars with C-shaped root canal configurations
Won-Jun Shon, Kee-Yeon Kum, Seung-Ho Baek, Woo-Cheol Lee
J Korean Acad Conserv Dent 2011;36(1):19-25.   Published online January 31, 2011
DOI: https://doi.org/10.5395/JKACD.2011.36.1.19
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this retrospective study was to evaluate the success rate of intentionally replanted mandibular second molar with C-shaped canal configurations and to access the impact of preoperative periapical lesion on the success of intentional replantation procedure.

Materials and Methods

This retrospective chart review study evaluated 52 intentionally replanted mandibular second molar teeth treated at Seoul National University Dental Hospital Department of Conservative Dentistry from January 2005 to December 2007. Seventeen teeth were lost for the follow-up, and another 6 teeth did not meet inclusion criteria of C-shaped root canal configurations. Healing outcome such as success, uncertain healing, and failure after follow-up was evaluated by clinical criteria and radiographs.

Results

The overall success rate was 72.4% for the 29 intentionally replanted C-shaped mandibular second molars. The success rate of replanted teeth with preoperative periapical lesions was similar to that of replanted teeth which have no periapical lesions.

Conclusions

Therefore, root canal treatment failure on C-shaped mandibular second molar can be predictably treated by intentional replantation regardless of the presence of periapical lesion.

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Case Report
Root canal treatment of a mandibular second premolar with three separate root canals
Seok-Ryun Lee, Seol-Hee Shin, Sung-Ok Hong, Chang-Kyu Song, Hoon-Sang Chang, Kyung-San Min
J Korean Acad Conserv Dent 2010;35(4):302-305.   Published online July 31, 2010
DOI: https://doi.org/10.5395/JKACD.2010.35.4.302
AbstractAbstract PDFPubReaderePub

Mandibular premolars show a wide variety of root canal anatomy. Especially, the occurrence of three canals with three separate foramina in mandibular second premolars is very rare. This case report describes the root canal treatment of an unusual morphological configuration of the root canal system and supplements previous reports of the existence of such configuration in mandibular second premolar.

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Original Articles
A retrospective study on incidence of C-shaped canals in mandibular second molars
Hee-Sun Kim
J Korean Acad Conserv Dent 2009;34(4):346-349.   Published online July 31, 2009
DOI: https://doi.org/10.5395/JKACD.2009.34.4.346
AbstractAbstract PDFPubReaderePub

Mandibular second molars have many variations in canal configuration. Technical modifications in cleaning, shaping and obturation are required. The purpose of this study was to investigate the root canal anatomy of mandibular second molars. 86 teeth of 85 patients were accessed and evaluated with taking radiographs for working length determination. 27 teeth(31.4%) had C-shaped canals, 43 teeth(50%) had 3 canals, 11 teeth(12.7%) had 4 canals, 5 teeth(5.8%) had 2 canals. Incidence of C-shaped canal was 31.7% in male and 31.1% in female. 30.9% of left mandibular second molar and 31.8% of right mandibular second molar showed C-shaped canals.

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Morphology of the apical root canal system in Korean mandibular first molar
Hyeon Jeong, Sang-jin Park, Sang-Hyuk Park, Gi-Woon Choi
J Korean Acad Conserv Dent 2009;34(2):137-144.   Published online March 31, 2009
DOI: https://doi.org/10.5395/JKACD.2009.34.2.137
AbstractAbstract PDFPubReaderePub

The aim of this study was to investigate the shapes and diameters of the physiological foramen and anatomy of the root canal at 3mm from apex in mandibular first molars.

Sixty mandibular first molars were randomly selected. The apical anatomy of 60 mandibular first molars was investigated by means of a stereomicroscope (60x magnification).

The results were as follows;

1. There was a high percentage of two physiological foramina in mesial (61.67%) and one foramen in distal(71.66%) roots of mandibular first molars.

2.There was a high frequency of accessory foramina in mesial roots with one foramen (26.07%).

3. The diameters of physiological foramen was as follows:

0.329mm in single mesial foramen

0.266mm in mesiobuccal foramen and 0.246mm in mesiolingual foramen

0.375mm in single distal foramen

0.291mm in distobuccal foramen and 0.237mm in distolingual foramen

4. The most common physiological foramen shape was oval (69.93%).

5. The incidence of isthmus in mesial root at 3mm from apex was 55%. The 3mm-sections contained a complete isthmus 31.66% and a partial isthmus 23.34%.

6. 3mm from the apex, the most common canal shape was oval (50.64%).

Knowledge of the apical anatomy of mandibular first molar would be necessary for success of surgical and nonsurgical endodontic treatment.

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A study on the C-shaped root canal system of mandibular second molar
Dong-Gyun Lee, Jun-Mo Park, Ho-Keel Hwang
J Korean Acad Conserv Dent 2007;32(4):335-342.   Published online July 31, 2007
DOI: https://doi.org/10.5395/JKACD.2007.32.4.335
AbstractAbstract PDFPubReaderePub

C-shaped canals are known to present a complex canal anatomy with numerous fins connecting individual canals, thus requiring supplementary effort to accomplish a successful root canal treatment. This study examined the frequency of the C-shaped mandibular second molars and interrelation between the clinical records and radiographs to recognize them treated in the Department of Conservative Dentistry of the Chosun University Dental Hospital during a six-year period (1998 - 2004). This study reviewed the clinical records of 227 patients who underwent root canal treatment of the mandibular second molars. After opening the chamber, those cases with C-shaped orifices in the pulpal floor were selected, and the C-shaped root canal types were classified according to Melton's criteria. Three experienced dentists evaluated the radiographs of the C-shaped mandibular second molar on a viewer using a magnifying glass in order to determine if the root apex was fused or separated, the distal root canal was either centered or mesial shifted in the distal root, and if there was bilateral symmetry in a panorama. In conclusion, there is a high frequency of C-shaped mandibular second molars in Koreans. Simultaneous interpretation of the root shape and distal root canal using the preoperative, working length and post-treatment radiographs is important for diagnosing a C-shaped mandibular second molar.

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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 influence of different access cavity designs on the fracture strength in endodontically treated mandibular anterior teeth
Young-Gyun Lee, Hye-Jin Shin, Se-Hee Park, Kyung-Mo Cho, Jin-Woo Kim
J Korean Acad Conserv Dent 2004;29(6):515-519.   Published online November 30, 2004
DOI: https://doi.org/10.5395/JKACD.2004.29.6.515
AbstractAbstract PDFPubReaderePub

Straight access cavity design allows the operator to locate all canals, helps in proper cleaning and shaping, ultimately facilitates the obturation of the canal system. However, change in the fracture strength according to the access cavity designs was not clearly demonstrated yet. The purpose of this study was to determine the influence of different access cavity designs on the fracture strength in endodontically treated mandibular anterior teeth.

Recently extracted mandibular anterior teeth that have no caries, cervical abrasion, and fracture were divided into three groups (Group 1 : conventional lingual access cavity, Group 2 : straight access cavity, Group 3 : extended straight access cavity) according to the cavity designs. After conventional endodontic treatment, cavities were filled with resin core material. Compressive loads parallel to the long axis of the teeth were applied at a crosshead speed of 2mm/min until the fracture occurred. The fracture strength analyzed with ANOVA and the Scheffe test at the 95% confidence level.

The results of this study were as follows :

1. The mean fracture strength decrease in following sequence Group 1 (558.90 ± 77.40 N), Group 2 (494.07 ± 123.98 N) and Group 3 (267.33 ± 27.02 N).

2. There was significant difference between Group 3 and other groups (P = 0.00).

Considering advantage of direct access to apical third and results of this study, straight access cavity is recommended for access cavity form of the mandibular anterior teeth.

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