Management of C-shaped canal system
21/08/2023
Fellow
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A thorough knowledge of the root canal anatomy and its variations is required for achieving success in root canal therapy, along with diagnosis, treatment planning and clinical expertise, One such variation of the root canal system is the C-shaped canal configuration.
It is termed so because of the C-shaped cross-sectional anatomical configuration of the root and root canal, This condition was described for the first time in literature by Cooke and Cox in 1979, Though most commonly found in mandibular second molars
the C-shaped canal configuration may also occur in mandibular premolars , maxillary molars and mandibular third molars
The C-shaped canal configuration presents with variations in both the number and location of the canal(s), as the canal(s) courses from the coronal to the apical third
The complexity of this canal configuration proves to be a challenge with respect to debridement and obturation and possibly the prognosis during root canal therapy.
Recognition of a C-shaped canal configuration before treatment can facilitate effective management, which will prevent irreparable damage that may put the tooth in severe jeopardy.
The main cause of a C-shaped root is due to the failure of the Hertwig’s epithelial root sheath to fuse on the lingual or buccal root surface .
The roots of molars with C-shaped canals may be conical and fused. For these characteristics, studies suggested that C-shaped root canals could be recognized based on preoperative radiographs .
C-shaped canals normally have three canals. The MB and distal canals are interconnected. The ML 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.
Fig. 1
Classification of C shaped canals
Fig. 2
Case 1
C1, Type 1
A- Access Cavity
B- Cone fitting
C- Final Obturation Resembles C- Shape
Fig. 3
Down packing and back filling
Fig. 4
Notice apical delta after obturation
Fig. 5
CASE 2
C2 , Type III
Access Cavity & Pre-OP Xray
Fig. 6
Working length determination
Fig. 7
A- Injecting BC Sealer
B- Cone Fitting
Fig. 8
Cone fitting and clinical X-ray
Fig. 9
Down packing
Fig. 10
Final obturation and X-ray
Fig. 11
CASE 3
C3 , Type I
Access Cavity “ with 3 main canal orifices & we can see the isthmus between them clearly “
Fig. 12
Down packing
Fig. 13
Final obturation
Fig. 14
CASE 4
C3, Type I
Access Cavity
Fig. 15
Down packing
Fig. 16
Final obturation
Fig. 17
CASE 5
C4
A- Pre-OP Xray
B- Cone Fitting
C- Down-Packing
D- Obturation
E- Negative
Conclusions
- The C-shaped root canal configuration has an ethnic predilection and a high prevalence rate in mandibular second molars.
-The C-shaped anatomy represents an important and challenging anatomical variation during negotiation, debridement and obturation, Understanding the anatomical presentations of this variation will enable the clinician to manage these cases effectively.
Bibliography
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Melton DC, Krell KV, Fuller MW. Histological Anatomical and features of C-shaped canals in mandibular second molars. J Endod 1991; 17: 384-388.
Sabala CL, Benenati FW, Neas BR. Bilateral root or root canal aberra- tions in a dental school patient population. J Endod 1994; 20: 38-42
Haddad GY, Nehme WB, Ounsi HF. Diagnosis, classification, and frequency of C-shaped canals in mandibular ?second molars in the Lebanese population. J Endod 1999; 25: 268-271.
Sidow SJ, West LA, Liewehr FR, Loushine RJ. Root canal morphology of human maxillary and mandibular third molars. J Endod 2000; 26: 675-678
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Fan B, Cheung GS, Fan M, Gutmann JL, Bian Z. C-shaped canal system in mandibular second molars: Part I: Anatomical features. J Endod 2004; 30: 899-903.
