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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 3  »  C-shaped root canal configuration in maxillary first molars
C-shaped root canal configuration in maxillary first molars
Introduction - Case report 1.



R. J. G. De Moor
Department of Operative Dentistry and Endodontology, Dental School, Ghent University Hospital, Ghent University, Gent, Belgium.

Key learning points.

  • C-shaped root canal morphotypes may occur in the distal portion of the pulp chamber in maxillary first molars.
  • The C-shape results from a fusion of the distobuccal and palatal roots.
  • The C-shape may extend to the apical third of the fused roots.

Introduction.
The literature describes various root canal morphotypes in maxillary molars. The most common finding is the prevalence of two canals in the mesiobuccal root (Fogel et al. 1994). In addition, aberrations such as one (Carlsen et al. 1992), four (Christie et al. 1991) and five (Fahid & Taintor 1988) roots with a corresponding number of root canals have been discussed. Case reports with four (Benenati 1985), five (Wong 1991, Jacobsen & Nii 1994) and six root canals (Martinez-Berna & Ruiz-Badanelli 1983, Bond et al. 1988) have also been presented.
However, the C-shaped root canal configuration in a two-rooted maxillary first molar has only been reported in a limited number of case reports (Newton & McDonald 1984, Dankner et al. 1990). Apparently, this type of canal configuration in the maxillary first molar has not yet been described in studies describing tooth anatomy and root canal anatomy on the basis of extracted teeth and/or using cross-sections.
The present report describes root canal treatment in two maxillary first molars with Cshaped canal systems. This particular aberration is also demonstrated by means of crosssections in two additional two-rooted maxillary first molars.

Report 1.
A 44-year-old Caucasian female patient was referred by the otorhinolaryngologist (ORL) for treatment of her maxillary left first molar. The tooth had been periodically percussion sensitive for 5 years. After clinical and radiographic examination by the ORL, the diagnosis of maxillary sinusitis was excluded. Radiographic examination (Fig. 1) revealed radiopaque material in the pulp chamber with little evidence of root canal preparation or filling. After removal of the coronal amalgam, the paste in the pulp chamber was removed and the chamber cleaned ultrasonically and rinsed with a 2.5% sodium hypochlorite solution. The pulp chamber floor was then explored to locate the canal orifices, which had not been opened. Two mesial orifices were found, as well as a broad distal semilunar orifice (Fig. 2).

preoperative periapical radiograph of the maxillary left first molar
Figure 1. Case 1: preoperative periapical radiograph of the maxillary left first molar.

access opening after removal of the amalgam filling and cleaning of the pulp chamber floor
Figure 2. Case 1: access opening after removal of the amalgam filling and cleaning of the pulp chamber floor. Two orifices in the mesiobuccal root and a semilunar opening connecting the palatal with the distobuccal canal can be seen.

The two mesial canals were preflared with a ProFile Orifice Shaper (O.S.) number 3 and shaped with ProFiles .04 and .06 taper (Dentsply Maillefer, Baillaigues, Switzerland) to a size 25 with the crown-down technique to an estimated 3 mm from the radiographic apex. The distal canal was flared with Gates Glidden drills (numbers 4–3–2) and initially prepared with Flexofiles (Dentsply Maillefer) to 3 mm from the radiographic apex. Working length determination was performed radiographically with two size 25 files in the mesial canals and a size 30 file in the palatal orifice of the C-shaped canal and a size 20 in the distobuccal orifice (Fig. 3a). The two files in the C-shaped canal appeared to join and were connected by an isthmus, separating the two files. The mesial canals were then further prepared with ProFiles .04 and .06 taper up to 1 mm from the radiographic apex to size 25 –.06 taper. An apical stop was created with a size 30 Flexofile (Dentsply Maillefer). The distal C-shaped canal was debrided up to 1 mm from the radiographic apex with Flexofiles to a size 35 and the preparation was refined with Hedström files (Dentsply Maillefer). An interappointment dressing of calcium hydroxide (Control Stabilized Calcium Hydroxide, La Maison Dentaire, Balzers, Switzerland) was sealed in the pulp chamber with Cavit (ESPE, Seefeld, Germany) and covered with Fuji Cap II (GC., Tokyo, Japan) as a coronal temporary filling.

root length determination radiograph with four endodontic instruments
Figure 3. Case 1: a) root length determination radiograph with four endodontic instruments (two in the mesiobuccal root and two in the distal root); b) radiograph of the obturated canal system.

aarrow indicating the radiographic outline of the combined palatal and distobuccal canals and roots, that were not discernible at any point in treatment, despite different angulations of the X-ray beams
Figure 4. Case 1: a,b) radiographs of the obturated canal system 6 months and 1 year after completion of the root canal treatment (arrow indicating the radiographic outline of the combined palatal and distobuccal canals and roots, that were not discernible at any point in treatment, despite different angulations of the X-ray beams).

The patient returned after 10 days for completion of the treatment. The tooth was asymptomatic and isolation and access were made without anaesthesia. Instrumentation was repeated with Flexofiles and the canals were thoroughly rinsed with 2.5% sodium hypochlorite. The canals were obturated with AH-26 (De Trey, Dentsply, Konstanz, Germany) root canal sealer and four gutta-percha master cones, using cold lateral condensation with accessory cones up to 3 mm from the apical constriction followed by thermo-mechanical condensation with Gutta-Condensers (Dentsply Maillefer) (hybrid gutta-percha condensation, De Moor & De Boever 2000) (Fig. 3b). The access cavity was sealed with Fuji Cap II and the occlusion was adjusted.
At the 6-month (Fig. 4a) and 1-year recall examinations (Fig. 4b), the tooth remained asymptomatic and the apical response was normal on the radiograph.
There was no opportunity to verify whether this particular root canal configuration was present bilaterally (Sabala et al. 1994).