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C-shaped canals in mandibular second molars
in the Hong Kong population: a computed
tomographic study
Ruwan Duminda Jayasinghe *, BDS, MS
Thomas Ka-Lun Li †, BDS, MSc, DGDP, DDRRCR, FCDSHK, FHKAM (Dental Surgery)
ABSTRACT Objectives. To investigate the frequency and type of C-shaped root canals in mandibular second
molars of the Hong Kong Chinese population, using spiral computed tomographic images. Methods. Spiral computed
tomographic images belonging to 116 patients were studied. All teeth were examined in axial computed tomographic
sections from pulpal floor to the apex to determine the presence of C-shaped canals. The teeth with C-shaped canals
were classified using Melton’s classification. A total of 207 mandibular second molars were studied; 66 (57%) of the
subjects were females, and subject ages ranged from 15 to 72 years, with a mean of 34 years. Results. Sixty-two teeth
had C-shaped root canals. Of these, 17 (27%) teeth were type I (continuous C-shaped root canals), 28 (45%) were type
II (semicolon-shaped canals), and the rest (27%) were type III (two separate canals). All were grooved lingually. Fourteen
patients had one mandibular second molar with a C-shaped root canal configuration and one normal mandibular second
molar, whereas 24 had bilateral mandibular second molars with C-shaped root canals. Conclusion. The frequency of
C-shaped root canals in mandibular second molars is high in the Hong Kong Chinese patients.
Key words: Asian continental ancestry group; Hong Kong; Tomography, spiral computed; Tooth abnormalities
Results
Table Reported prevalence of C-shaped root canals in mandibular second molars 7,10-20
Study Year Ethnic origin Total no. of mandibular second molars studied
(% with C-shaped canals)
Walker 12 1988 Hong Kong Chinese 100 (52%)
Yang et al. 13 1988 Hong Kong and Taiwan Chinese 581 (32%)
Manning 11
1990 Unknown 149 (13%)
Weine 16
1998 Mixed 811 (8%)
Haddad et al. 17
1999 Lebanese 94 (19%)
Gulabivala et al. 18
2001 Burmese 134 (22%)
Gulabivala et al. 7
2002 Thai 60 (10%)
Lambrianidis et al. 10
2001 Greek 480 (5%)
Al-Fouzan 19
2002 Saudi Arabian 151 (11%)
Seo and Park 20
2004 Korean 272 (clinical; 33%)
96 (in vitro; 31%)
Cimilli et al. 14 2005 Turkish 491 (8%)
Jin et al. 15
2006 Korean 220 (45%)
Present study 2006 Hong Kong Chinese 207 (30%)
molars have demonstrated variations in numbers as well as single-rooted mandibular second molars. Conventional
distribution of root canals, possibly due to differences in radiographs give only a 2-dimensional view of the teeth,
examination methods. Other explanations for differences whereas spiral CT images can show 3-dimensional images,
between studies include: numbers of teeth evaluated, and therefore much detail. For this reason, CT has been
classification systems used, and ethnic background of the used in many aspects of clinical dentistry including
patients. For example, the examination methods varied implantology. Computed tomographic images have been
from extracted teeth, clinical observations, radiographs to used to measure the mesiodistal and buccolingual length
CT scans 9,10,14,15. of teeth as well as their relationship to vital structures 23.
Such images can also be used to assess root canal filling
Most studies on the prevalence and anatomical materials, posts, dental caries, and root fractures 24, and the
characteristics of C-shaped canals in mandibular second morphology of the root canal system can be accurately
molars used extracted teeth or teeth that had been treated visualized 25. Spiral CT imaging can also be used as a
endodontically. Such teeth may have undergone many useful tool for diagnosing the morphology of mandibular
aging changes in the pulpo-dentinal complex, and hence molars 26, but the radiation risk involved must be considered.
in the root canal system 9. Most of the teeth examined
in the present study were relatively young (mean age, 34 In conclusion, the frequency of C-shaped root
years). The value of intraoral periapical radiographs for canals in second mandibular molars in the Hong Kong
diagnosing C-shaped canals is debatable. Cooke and Cox 1 population noted in this study was high, but less than
reported that they were not helpful, but Haddad et al. 17 previously reported, which might be due to the use of
found common characteristics in almost all preoperative CT imaging rather than examination of extracted teeth or
radiographs. Lambrianidis et al. 10 reported that preoperative radiographs. The high frequency of C-shaped root canals
and working length periapical radiographs are of little in the Hong Kong population has important clinical
value in identifying C-shaped root canals, whereas as well as anthropological implications. The findings
simultaneous interpretation of preoperative, working reported here could be regarded as a pilot project for
length, and postoperative radiographs could be helpful. a larger anthropological study with multiple calibrated
In this study and the one by Jin et al. 15, CT images of teeth assessors. The clinical significance of using CT for the
with C-shaped canals were not verified by other means detection of C-shaped canals in different endodontic
(clinical observations or microscopic examination), but cases is yet to be evaluated.
the accuracy of CT imaging is well documented 21.
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