C-shaped Root Canal Clinical Trial
Official title:
C-shaped Root Canal System Prevalence and Configurations of Mandibular First and Second Molars in an Egyptian Sub-population Evaluated by Cone-beam Computed Tomography: A Cross-Sectional Observational Study
The aim of this study is to investigate the prevalence and configuration of C-shaped root
canal of mandibular first and second molars among members of an Egyptian sub-population using
cone beam computed tomography (CBCT). The prevalence and distribution of the C-shape canal
configurations with respect to gender and age will be also investigated.
Data regarding the prevalence and configurations of C-shaped root canal in the first and the
second mandibular molars in Egyptian sub-population is lacking which might affect the correct
implementation of chemo-mechanical instrumentation and obturation.
1. Scientific Background:
The main goal of conventional root canal treatment is to prevent or heal apical
periodontitis through cleaning, shaping and three-dimensional obturation of the root
canal system. To establish this goal; recognition of root canal anatomy is required to
minimize the risk of treatment failure.
Studies recorded variations among different ethnicities in the prevalence and
configurations of some root canal systems in particular interest is the root canal
configurations of the mandibular first and second molars. Anatomical variations recorded
include radix entomolaris, radix paramolaris and C-shaped canal. The prevalence of
C-shaped root canal ranges between 2.6% to 44.5% among different ethnicities with the
highest percentage in Asian populations.
C-shaped root canal anatomy has challenges in the diagnosis and endodontic management.
Challenge in diagnosis is attributed to the variations in the root canal anatomy that
may extend along the entire length of the canal. Preoperative identification of C-shaped
root canal and its configurations is difficult by conventional radiographic techniques
due to their inherent limitations. Challenges in endodontic management are attributed to
the presence of complex isthmi, fins and webs connecting the individual root canals that
may complicate the proper cleaning and shaping of the root canal rendering it more
difficult. Therefore, it is important to detect and identify the configuration of
C-shaped canals before root canal treatment.
Preoperative recognition of the prevalence and root canal configurations will direct the
attention of endodontists to its presence and will facilitate the root canal accessing,
negotiation, determining the best three-dimensional instrumentation and obturation
technique.
2. Rationale of the study:
Different methods have been used to investigate the prevalence and configurations of C-shaped
root canal including: microscopic examination of extracted demineralized teeth after black
ink infiltration or microscopic examination for polyester cast resin of the pulp space of
demineralized extracted teeth or microscopic examination of extracted teeth with methylene
blue dye infiltration followed by resin imbibition, conventional radiography, medical CT and
most recently CBCT.
CBCT was reported to be accurate for various root canals morphological analysis because of
the 3-dimensional reconstruction of the internal and external morphology of the tooth and
high spatial resolution in all planes. It has the ability to investigate the morphology of
the root canal system without intervention. Compared to medical CT, CBCT can be accomplished
with a substantially lower effective dose and reduced acquisition time.
According to my knowledge, there is only one study that has investigated the prevalence of
the C-shaped root canal in mandibular first and second molars among members of sub-Egyptian
population, but the configurations of C-shaped root canal have not been studied yet.
Knowledge of the prevalence rate and root canal configurations will direct the attention of
endodontists to its presence and will facilitate the root canal accessing, negotiation,
determining the best instrumentation and obturation technique thus, long term success rate of
the endodontic therapy.
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