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Aims:The study was aimed to acquire better understanding of C-shaped canal systems in mandibular second molar teeth through a clinical approach using sophisticated techniques such as surgical operating microscope and cone beam computed tomography (CBCT).Materials and Methods:A total of 42 extracted mandibular second molar teeth with fused roots and longitudinal grooves were collected randomly from native Indian population. Pulp chamber floors of all specimens were examined under surgical operating microscope and classified into four types (Min's method). Subsequently, samples were subjected to CBCT scan after insertion of K-files size #10 or 15 into each canal orifice and evaluated using the cross-sectional and 3-dimensional images in consultation with dental radiologist so as to obtain more accurate results. Minimum distance between the external root surface on the groove and initial file placed in the canal was also measured at different levels and statistically analyzed.Results:Out of 42 teeth, maximum number of samples (15) belonged to Type-II category. A total of 100 files were inserted in 86 orifices of various types of specimens. Evaluation of the CBCT scan images of the teeth revealed that a total of 21 canals were missing completely or partially at different levels. The mean values for the minimum thickness were highest at coronal followed by middle and apical third levels in all the categories. Lowest values were obtained for teeth with Type-III category at all three levels.Conclusions:The present study revealed anatomical variations of C-shaped canal system in mandibular second molars. The prognosis of such complex canal anatomies can be improved by simultaneous employment of modern techniques such as surgical operating microscope and CBCT.

Methylmalonic acidemia (MMA) is most common inherited type of organic acidemia. It has diverse presentation in older infants without any initial apparent symptoms. MMA sometimes present with sudden metabolic decompensation, which may mimics common emergencies like septic shock and diabetic ketoacidosis (DKA) without early recognition can be fatal. In born error of metabolism especially organic acidemia should be suspected in any infant presented with severe high anion gap metabolic acidosis. We report two cases of MMA in infants presented acutely mimicking DKA and septic shock.

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