Management of C-Shaped Root Canals Configuration-A Report of Five Cases
ABSTRACT: A thorough knowledge of the root canal configuration, including the morphology of teeth involved in root canal treatment is fundamental for effective endodontic treatment. This case report discusses successful management of five cases of c-shaped canal configuration.
Key words: Mandibular second molar, C‑shaped canals, Management.
INTRODUCTION: A thorough knowledge of the root canal configuration, including the morphology of teeth associated with root canal treatment is fundamental for effective endodontic treatment. EOS 44
The C-shaped canal anatomy was first reported by Cooke and Cox (1979) in mandibular second molar. It is named accordingly owing to the C-shaped cross-sectional anatomical configuration of the root and root canal EOS 47.
The primary etiology of the C – shaped canal is a failure of Hertwig’s epithelial root sheath to fuse on buccal or lingual root surface.EOS 40
The incidence of C‑shaped root canal configuration reported among (2.7% to 44.5%) in mandibular second molars followed by maxillary molars (0.92%) and maxillary second molar (4.9%) .EOS 48
This case report discusses successful management of five cases of c-shaped canal configuration.
CASE 1
A 45 year old female patient presented at the Department of Conservative Dentistry & Endodontics with the complaint of pain in relation to 47. On clinical examination the tooth revealed deep caries in relation to 47. The medical history was no significant.The canal morphology confirmed the presence of a single root with multiple canal (figure 1). Access was prepared after adequate anesthesia with rubber dam. A two orifice was located in the middle of the floor of the pulp chamber (figure 2). Working length was determined (figure 3) and canal was prepared by crown down technique. Copious irrigation was carried out with 5.25% Sodium hypochlorite and normal saline. The canals were thoroughly dried and obturation was done using number 25 Gutta-percha and AH Plus sealer (Dentsply, Maillefer,Ballaigues, Switzerland) (Figure 4and5).
Case 2
A 25 year old female patient presented to the Department of Conservative Dentistry and Endodontics with the chief complaint of pain in relation to her mandibular right second molar. The medical history was no significant. Intra oral examination revealed carious 47 with pain on percussion. The radiograph showed pulpal involvement with fused mesial and distal roots(figure 1).Tooth diagnosed with with acute apical periodontitis. (Figure 2). ). Access was prepared after adequate anesthesia with rubber dam and one mesial orifice & A broad C-shaped distal orifice (Figure 2).The working length determined.(figure 3).The cleaning and shaping was performed with Hero Shaper rotary files (Micro Mega, Besançon, France). Copious irrigation was carried out with 5.25% Sodium hypochlorite and normal saline.The obturation was done using 4% cone and AH plus sealer (Dentsply, Maillefer,Ballaigues, Switzerland)( Figure 4and 5).
CASE 3
A female patient aged 28 years presented to the Department of Conservative Dentistry & Endodontics with the chief complaint of pain in the lower left back tooth region .On Clinical examination revealed extensive caries.On radiographic examination revealed fused roots (figure1). On Intra oral examination revealed carious tooth 37 with pulp involvement. Access cavity was prepared after LA given. After pulp extirpation, The pulpal floor demonstrated two orifice one mesial and one distal was located in the center of the pulp chamber([Figure 2). Cleaning and shaping was done using Revo-s rotary files (Micro Mega, Besançon, France) up to F1. Copious irrigation was carried out with 5.25% Sodium hypochlorite and normal saline. The obturation was done using master cone with AH‑Plus sealer (Dentsply Maillefer, USA) (Figure 4and5).
CASE 4
A 36 year old female patient reported to the Department of Conservative Dentistry & Endodontics with a complaint of pain of her lower left back tooth region. The medical history was noncontributory. Intra oral examination revealed mesioproximal caries on tooth 37 with necrotic pulp and slight pain on percussion.(Figure1) The access cavity was prepared under local anesthesia. The pulpal floor demonstrated mesial or distal orifice and a broad C-shaped middle orifice look like semicolon sort morphology. (Figure 2).Cleaning and shaping of the canal was done with hand K3 rotary files (Sybronendo,Mexico)The anticurvature filing method was performed to avoid the strip perforation. Copious amount of 5.25% sodium hypochlorite was used for irrigation.Working length was determined (Figure 3). The obturation was done using master cone with AH‑Plus sealer (Dentsply Maillefer Company, USA) (Figure 4and5).
CASE 5
A 33 year old female patient presented to the Department of Conservative Dentistry and Endodontics with a complaint of pain in the lower right back tooth region. Her Medical history was noncontributory. Radiographically distoproximal radiolucency was seen involving pulp .The radiograph also showed a single conical root.(Figure 1). Access was prepared after adequate anesthesia with rubber dam and one single orifice was located in the center of the pulp chamber [Figure 2]. The pulp chamber was irrigated with 5.25% sodium hypochlorite. Working length was determined [Figure 3]. Cleaning and shaping was done with rotary ProTaper rotary files (Dentsply,Maillefer, Ballaigues, Switzerland) The obturation was done using F3 cone with AH‑Plus endodontic sealer (Dentsply Maillefer) (Figure 4and5).
DISCUSSION
The awareness of internal dental anatomy and variations of the root canal system of multirooted teeth represents a challenge to diagnosis and treatment. The preoperative knowledge of possible anatomic variations is important for the achievements of the endodontic treatment.eos 44 eos 40 below
Numerous classifications of C-shaped canals configuration have been pro¬posed to make the diagnosis and treatment planning easier.
Melton et al in 1991 divided the C-shaped canals into three types .
Melton et al in 1991 proposed the following classification based on the different configurations of the orifices in C-shaped canal systems eos 31
Type I – continuous C-shaped canal.
Type II – semicolon in which a C-shaped canal is present buccally or lingually, separated from another distinctive canal with a dentine wall.
Type III – Separate canals are present eos 5.C-SHAPED 40S ,C-SHAPED 21
Melton in 1991 (17)divided the C-shaped canals into three types. Type I: The continuous C-shaped canal. Type II:The semicolon shaped canal. Type III: Two discrete and separate canals.
Fan et al. revised Melton’s classification and divided the C-shaped canals into three types distinguished the following categories:
Type I- The shape is a continuous
Type II-The canal shape resembles a semicolon resulting from a break in the C outline.
Type III- Two or three separate canals.
Type IV- One round or oval canal in the cross -section.
Type V- No canal lumen can be foundEOS 3 C-SHAPED 41
The presented case report 5 can be assigned to type 1melton classificationThe Second case report can be assigned to type 2 of Melton's classification. C-shaped 34.
Management of the C-shaped canals intend be combined with additional measures for complete debridement and thorough cleaning of the intricate root canal anatomy.EOS 20
Gain access to cavity design modif ication may be essential to find and negotiate the complete root canal system. Calcifications in the pulp chamber should be negotiated with ultrasonic tips to reveal the canal anatomy completely EOS 45
Cir¬cumferential filing must be done to ensure maximum tissue removal and attention should be taken to avoid strip perforation.EOS 42
Therefore, the anti-curvature filing was done in all the cases
Copi¬ous irrigation with 5. 25 % ( NaOCl) sodium hypochlorite should be done to debride the intricacies of the C-shaped canal. Irrigant should be acti¬-vated by means of ultrasonics.cs401 C-SHAPED 40,EOS20
Complete Obturation of the C-shaped canal is difficult to achieve. Lateral compaction with sealer and heated spreaders or use of thermoplasticised gutta percha is indicated.EOS 46
This studies five cases of C- shaped canal configuration which were diagnosed and managed successfully.
CONCLUSION
• The successful endodontic management require thorough knowledge about atypical root canal systems. The significant care should be taken during biomechanical preparation and obturation of C-shaped root canals for achieving success in root canal therapy ,along side with good prognosis.