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Methods and Materials: After confirming the actual C-shaped anatomy using cone-beam computed tomography (CBCT), 22 extracted C-shaped mandibular second molars were selected and decoronated at the cemento-enamel junction. The actual working length of these canals were determined by inserting a #15 K-file until the tip could be seen through the apical foramen and the working length was established by subtracting 0.5 mm from this length.
The working length was also determined using conventional analog radiography and electronic apex locator (EAL) that were both compared with the actual working length. The data was statistically analyzed using paired t-test and marginal homogeneity test. Introduction Accurate determination of working length is one of the most important steps for successful root canal therapy.
The apical constriction, which is the ideal apical end point for instrumentation in a tooth with complete root formation [], is located within 0.5-1 mm short of the major apical foramen []. The apical foramen is frequently located, in an eccentric fashion, well away from the anatomic or the radiographic apex []. This makes it difficult to localize the apical constriction using the radiographic length determination technique []. A “C-shaped canal”, which was first termed by Cooke and Cox in 1979 [], results from the fusion of the mesial and distal roots either on its buccal or lingual aspects. In general, the C-shaped canal has a single ribbon-shaped orifice with a 180 º.
Materials and Methods The research protocol was approved by the Vice Chancellor of Research of Mashhad University of Medical Sciences (Grant No.: 920409). The actual C-shaped anatomy of 50 extracted human mandibular second molars with fused buccal or lingual roots, was evaluated using cone-beam computed tomography (CBCT) and only in 22 teeth C-shaped anatomy was confirmed. C-shaped canals were included in this study that had an arc connecting mesiobuccal and distal canals and a distinct single mesiolingual canal. Selected teeth were kept in 2.5% sodium hypochlorite for 2 h and then stored in 0.9% saline solution.
The teeth were sectioned at the cemento-enamel junction using a diamond disc to provide unrestricted access to the canal space and to produce a reliable occlusal landmark for length measurement. The patency of the apical foramen was then confirmed using #10 K-file (Maillefer Dentsply, Ballaigues Switzerland). Pulp tissue was removed partially and irrigation was performed with 3 mL of 5.25% sodium hypochlorite, followed by 3 mL saline, in order to remove debris from the canal space. The actual working length (AWL) was measured by inserting a #15 K-file with double silicone stop into the root canal until the file tip was just visible through the apical foramen under 40× magnification using the Microscope (AM413FIT Dino-Lite Pro, Electronics corporation, Taipei, Taiwan). Patch Italiano Gothic 2 Trainer.
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The silicone stopper was also adjusted to occlusal reference plane to this length. The distance between the file tip and the stop was measured with a digital caliper (Mitutoyo, Tokyo, Japan). Eventually, 0.5 mm was deducted from this length to obtain AWL. For radiographic determination of working length (RWL), each tooth was mounted on a wax plate with dimensions corresponding to the size #2 of an intra-oral periapical film (Eastman Kodak Co., Rochester, NY, USA). All radiographies were taken using x-ray generator Flash Dent (Villa Sistemi Medicali, Buccinasco, Italy), which was set at 70 kVp, 8 mA and exposed for 0.4 sec, with the distance from the source to the film set at 20 cm. The preoperative radiography was taken employing the parallel technique.