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Morphological Variations of the Root Canal System in C-Shaped Roots of the Mandibular Second Molar in a Japanese Population

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Morphological Variations of the Root Canal System in C-Shaped Roots of the Mandibular Second Molar in a Japanese Population Int J Oral-Med Sci 13(3):81-88, 2015 81 Original Article Morphological Variations of the Root Canal System in C-shaped Roots of the Mandibular Second Molar in a Japanese Population Makoto Suzuki,1 Yasuhisa Tsujimoto,2 and Shintaro Kondo3 1Nihon University Graduate Schoolof Dentistry at Matsudo, Endodontics, Matsudo, Chiba 271-8587, Japan Departments of 2Endodontics, 3Anatomy, Nihon University Schoolof Dentistry at Matsudo, Matsudo, Chiba 271-8587, Japan Article History Abstract Received ઈ November 2014 Morphologicalvariationsof the root canalsystem of C-shaped roots in mandibularsecond Accepted ઋ December 2014 molars of young Japanese patients (aged 20 to 29 years old) were analyzed by using multi- detector row computed tomography (MDCT) in order to clarify the entire picture from the orifice to the apex. CT images were reconstructed so that the axialimage was inclined perpendicular to the long axis of teeth. C-shaped roots were more frequently found in females (54.0%) than in males (36.7%) (p<0.01). One root canal was most frequently Keywords : found on the coronalside, and the root canalnumbers increased to the apex. Thus, in many C-shaped root canal, cases at the coronallevelthecanalformed letter?C@ , but it ramified into increasingly multi-detector row computed tomog- smaller canals towards the apex. The complex configuration of the root canals may be raphy, root canaltreatment, related to various degree of fusion in the roots. The results of this study might be used for Mongoloid, sinodonty understanding the nature of C-shaped root canals. Introduction phy (CT) was used for the observation of root canal Mandibular second molars with incompletely fused roots systems(15-25). CT can be applied in patients whose often exhibit a C-shaped root. The mesialand distalroots gender and age are identified, and without tooth extraction. appear fused on the buccalside, but are separated by a CT images can be observed not only as two-dimensional longitudinal gutter on the lingual side. When two roots are images including oblique slices, but also reconstructed for fused and C-shaped, the root canals may also exhibit the three-dimensional modeling. The pulp cavity becomes same morphology(1). It is difficult to achieve complete narrow with aging because of secondary and tertiary dentin debridement of the C-shaped root canalsystem due to its formation(26). So the pulp cavities of elders vary morpho- morphological complexity(2); fin and isthmus often appear logically. The pulp cavity of young people showed funda- between the incompletely and / or completely fused root mentalstructures without age-relatedchanges. canals(3). The difficulties in C-shaped root canal treatment The root canal system in mandibular second molars with are thought to be caused by the morphological complication C-shaped roots in Chinese populations was studied morpho- of the root canalsystems. Detailedanatomicaldescriptions logically (19, 23). These two studies analyzed similar of the C-shaped roots and root canals may help in subjects, but reported different results; Min et al.(23) understanding their complicated structure. showed that two root canals at the orifice were common, but Previous studies of C-shaped root canalsystems in Zheng et al.(19) reported fused root canals at the orifice. extracted teeth used teeth samples that were injected with There have been few studies that analyzed serial cross- Indian ink and made transparent by methylsalicy- sectionalstructures from orifice to apex. The present study late(4-12), polyester resin cast replicas(3), and serial cross- analyzed root canal systems with C-shaped roots of sections of roots (1,3,13,14). Recently, computed tomogra- mandibular second molars in young Japanese patients (aged 20 to 29 years old) by Multi-detector row CT (MDCT) Correspondence to : Makoto Suzuki imaging. Specialattention was given to the entire structure E-mail: [email protected] of the canalsystems from orifice to apex. 82 Int J Oral-Med Sci 13(3):81-88, 2015 Materials and Methods We used the MDCT images of 579 patients (281 males, 298 females; age 20-29 years) who underwent 64-row MDCT for diagnostic purposes of oraldiseases in the Department of Radiology at the hospital attached to the Nihon University Schoolof Dentistry at Matsudo, Chiba, Japan, from January 2009 to December 2011. 64-row MDCT was conducted using Aquilion™ 64 (Toshiba Medical Systems Corporation) with 64-detector-row CT in the craniocaudaldirection. Allpatientswere scanned by MDCT Fig.1 Location of measurements in C-shaped root canalof the according to the routine clinical protocol for craniomaxillofa- mandibular second molar cial examination as follows: tube voltage 120 kV, tube CEJ; Cemento-enameljunction, LevelA; floorof pulp chamber 3 mm belowthe CEJ, LevelB; coronalthird part, current 100 mA, field of view 240×240 mm, helical pitch 41, LevelC; middlepart, LevelD; apicalthird part. and 1.0 sec/rotation. The MDCT images of the mandibular second molar region were used in this study, and the slices Type 2: root canals resembling a semicolon (MB-D were 0.3 mm thick and parallel to the occlusal plane. Teeth canaland ML canal) with extensive caries, root canal filling, restorations and Type 3: root canals resembling a semicolon (DB-M metalartifact were excluded.This study was approved by canaland DL canal) the Ethics Committee of Nihon University Schoolof Type 4: two ovalroot canals(M canaland D canal) Dentistry at Matsudo (No. EC11-037). Type 5: two round root canals (M canal and D canal) In this study, if three-quarters or more length of the Type 6: three root canals buccalroot trunk was one root, it was considered as a C- Type 7: a round root canal shaped root; a completely fused root was not included as a C- Type 8: four root canals shaped root. For analysis of the C-shaped root canal, C- The number of root canals at the four levels (A-B-C-D) in shaped roots on the right side of the dentition were used. each patient was determined. The sex differences were MDCT images were reconstructed using 3-D imaging analyzed by chi-square test at a significance level of p<0.05 software (RealiaPro, Cybernet Systems Co., Ltd., Tokyo) on or 0.01 using SPSS 17.0 statisticalsoftware. the personalcomputer, and the axialimage was inclined perpendicular to long axis of the mandibular second molar. Results The present study observed cross-sections at various levels The frequency of C-shaped roots in the mandibular of the root canals. Plane A was within 3 mm below the second molar is shown in Table 1. Among the 281 male cemento-enameljunction (CEJ), because Min et al.(23) patients, 103 (36.7%) had C-shaped roots on either the right reported that the pulp chamber floors of C-shaped root were or left side, or both sides, and 63 (22.4%) of 103 had bilateral 90.91% within 3 mm below the CEJ. The shape of the pulp C-shaped roots, and one had a completely fused root on the cavity of C-shaped root was observed at the following four right side and two root on the left side. Among the 298 levels of the plane; plane A was the pulp chamber floor 3 mm female patients, 161 (54.0%) had C-shaped roots on either below the CEJ, plane B was the coronal third part (one- the right side or left side or both, and 127 (42.6%) of 161 had third the distance between the CEJ and the anatomicalapex bilateral C-shaped roots. C-shaped roots were more fre- below the CEJ), plane C was the middle part (middle part quently found in females than males (p<0.01). from CEJ to apex), plane D was the apical third part (one- Morphological characteristics of the C-shaped root canal third the distance between the CEJ and the anatomicalapex at the four levels are shown in Table 2. There was no above the apex)(Fig. 1). difference between males and females in the frequencies. At The canal shape at each selected level was classified into level A, type 1 was the most frequently found (63.0% in the following criteria modified from that reported by Min et males, 70.6% in females), followed by type 4 (16.0% in al.(23)(Fig. 2). males, 14.0% in females). At level B, type 1 was the most Type 1: a continuous C-shaped root canal frequently found (37.0% in males, 41.2% in females), Int J Oral-Med Sci 13(3):81-88, 2015 83 Fig.2 Classification of the root canal shape on cross-sections Table 1 Root morphology of mandibular second molar Table 2 Type of the C-shaped root canal morphology at different levels followed by type 2 (28.4% in males, 27.2% in females). At of root canals differed with gender. In males, type 2 was level C, type 2 was the most frequently found (33.3% in most frequently found (25.9%), followed by type 6 (22.2%), males, 36.0% in females), followed by type 6 (23.5%) and type 5 (21.0%), and type 1 (17.3%). In females, type 5 was type 1 (21.0%) in males, type 1 (25.0%) and type 6 most frequently found (33.1%), followed by type 1 (20.6%), (16.2%) in females. At level D, the morphological variations type 7 (16.9%), and type 2 (14.7%). 84 Int J Oral-Med Sci 13(3):81-88, 2015 Table 3 The number of C-shaped root canals each patients of C-shaped root The numbers of root canals at the four levels are shown in (18.4%) and A1B2C2 (18.4%) in females. Fig. 4 shows Table 3.
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