Endodontic Management of C-shaped Canals in Mandibular Second Molars

Abstract

Aim: C shaped canal, a common root canal variation in mandibular molars mandates thorough identification and management, when present. Of the several known configurations of C-shaped canals, one often seen is the root canal form having an elongated ribbon shaped arc that continues uninterrupted till the apex. Occasionally, the apical exit of these canals may not be constricted and obturating such teeth three dimensionally is an operational challenge. Here, in this report, management of C shaped canals using mineral trioxide aggregate (MTA) is described. Case Presentation: Two cases of mandibular second molars having C-shaped canal configuration and wide apical openings were diagnosed using basic diagnostic criteria in a routine clinical setting. The canals were thoroughly cleaned and shaped using stainless steel hand files and 5.25% NaOCl irrigation. Mineral trioxide aggregate (MTA) was carried into the canal in increments and the canal obturated partially or completely with MTA. Access cavities were sealed with bonded resin restorations. Six month recall showed both cases to be clinically asymptomatic. Discussion: C-shaped root canals are frequently observed anatomic variations in mandibular molars. Owing to the complex and variable presentation of C canals, a clinician often faces several challenges during their diagnosis and treatment. Basic measures required for confirming the presence of these anatomic variations include intense exploration of the access cavity under adequate magnification coupled with high quality preoperative and intra treatment radiographs. MTA, a well known tricalcium silicate cement, has unique physiochemical and biological characteristics. Because of its anti bacterial and bio inductive properties combined with excellent marginal adaptation, it provides a superior seal and has successfully emerged as a suitable alternative barrier material to Gutta percha. Conclusion: Diagnosis and treatment of C shaped canals is highly challenging owing to its variable presentation. Detection of C shaped canals in routine clinical setting is possible using high quality radiographs and precise clinical assessment. MTA can be successfully used to create an apical barrier in C canals with wide apical foramina.