The purpose of this study was to document the characteristics of C-shaped canal systems in permanent mandibular second molars using a combination of orthopantomogram (OPT) and cross-sectional cone-beam computed tomographic (CBCT) imaging.Methods:
Two hundred participants (94 men and 106 women, mean age = 35 years) who underwent both routine CBCT and OPT examinations were enrolled. One endodontist and 1 oral radiologist examined the images of 339 mandibular second molars and described the radiographic features of C-shaped canals from OPT images as confirmed by CBCT imaging. Root morphology was classified as nonfused (NFRI–II) or fused (FRI–III) based on OPT images. Cross-sectional root canal configurations (C1–C5) were identified from CBCT imaging at 3 different levels (coronal, middle, and apical). Frequency distributions of root morphology and root canal configurations were compared at each level, and interobserver reliability was tested using the Cohen kappa test.Results:
Of the 339 teeth, 29 (8.6 %) had C-shaped root canal systems. Most of the root canals were NFR type (86%); only 2% had C-shaped root canals (all NFRII). In the FR category, 23 teeth with C-shaped canals were equally distributed between the FRI and FRII subtypes. Interobserver agreement was almost perfect (κ = 0.89 and κ = 0.91; right and left second molars, respectively). Per CBCT imaging, the most common configuration was C3 at all levels; no C5 case was detected.Conclusions:
OPT usage can assist in recognizing and diagnosing C-shaped root canal systems. Radicular fusion or proximity is a characteristic feature of C-shaped canal systems. However, nonfused root appearances should also be considered suspicious.