Rare occurrence of c‑shaped root canal configuration in mandibular first molar Dr Ahmed Abdulrahman Almalaq, Hail Dental Center, Hail City, Saudi Arabia. Dr_ahmed933@yahoo.com
Dr Saad Al‑Nazhan, Department of Restorative Dental Science, Division of Endodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
Abstract The occurrence of C-shaped root canal configuration in mandibular first molar is rare. The present case has an unusual C-shaped root canal configuration for both the appearances of the canal orifices and the configuration along the roots. Use of cone-beam computed tomography, rotary and hand instrumentation assisted with sonic and ultrasonic activation of irrigation solution is very important for effective management of this anomalous canal configuration. Modifications in the obturation techniques will ensure a three-dimensional fill of the canal system. Clinician should expect to encounter unusual features when performing endodontic treatment. Key words: Cone-beam computed tomography, C-shaped canal, mandibular first molar, root canal configuration, root canal treatment
Republished from the Saudi Endodontic Journal Volume 7 / Issue 3 September - December 2017
The knowledge of root canal anatomy plays a major role on the influence of the outcome of endodontic treatment. A thorough biomechanical cleaning and shaping of the root canal system, followed by hermetic seal of entire root canal space should be achieved for successful treatment. However, unexpected complex canal anatomy presents clinical challenges and difficulties that might jeopardized the main goal of such therapy. 1 Therefore, clinician should recognize the variations in the root canal systems and its characteristic features in different races when performing endodontic treatment. The mandibular first molars erupt at the age of 6–7 years and apical closure is usually completed by 8–9 years. The completion of canal differentiation commences about 3–6 years after root completion. 2 Any disturbances in this differ-
Dental News, Volume XXIV, Number III, 2017
entiation can result in variations in canal anatomy. One such variation of the root canal system is the C-shaped canal configuration. 3 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. 4 C-shape root canal configuration in molars is an anatomical variation that make diagnosis and treatment more difficult. The occurrence of C-shaped root canal configuration is very rare in mandibular first molars. 5 Out of 125 samples of mandibular first molars from an Indian population; only one sample had C-shaped canal. Demirbuga et al., 6 reported an incidence of 0.85% of C-shaped canals in mandibular first molars of the Turkish population. The aim of this paper was to report a management of an unusual and rare case of C-shaped canal in mandibular first molar.
Case report A 48-year-old Saudi female was complaining from pain with cold and biting about 3 weeks ago on the right mandibular first molar (#46). She went to primary health care center where root canal treatment was initiated for the tooth then referred to Hail Dental Center, Hail, Saudi Arabia to continue the treatment. The patient is a hypothyroidism “controlled” and according to American Society of Anesthesiologists (ASA) classification, she is class ASA II. 7 The patient chief complaint was “I have pain with biting on lower right side.” Clinical examination revealed no extra or intraoral soft tissue abnormalities; the probing depth was within normal measures, and the affected tooth has responded to percussion test. Preoperative radiographs revealed widening of the periodontal ligament of the distal root [Figure 1a]. The case was diagnosed as previously initiated and symptomatic apical periodontitis.