DR RABIA NAYAB
FCPS RESIDENT
DEPARTMENT OF OPERATIVE DENTISTRY &
ENDODONTICS
SARDAR BEGUM DENTAL COLLEGE & HOSPITAL
WHAT ARE C SHAPED CANALS
It is a single, ribbon-
shaped orifice with an
arc of 180 or more
with canals that may or
may not be separate
ETIOLOGY
Earlier likened to taurodents
Assumed to be because of
age changes, but later refuted
Failure of fusion of the
Hertwigs epithelial sheath on
either the buccal and lingual
root surface
Failure of fusion is attributed
to trauma, radiation, chemical
interference as well as
genetics
HISTORY OF C SHAPED CANALS
Keith and Knowles (1911) were first to depict a C shaped
canal
Nakayama (1941) analyzed the C shaped canal in detail
Tratman (1950) found this form frequently in mandibular
2nd molars of Asians
Cooke (1979) coined the term C shaped root and C
shaped root canal
Melton (1991) described variations in morphology of the
C shaped canals.
INCIDENCE
Frequently reported among Asians
East Asians show a higher prevalence than
other groups (upto 45.5%)
Amongst South Asian states, Burma showed
the highest prevalence as compared to India
and Sri Lanka
One Pakistani study found a 13% prevalence
Found most commonly in mandibular 2nd
molars
Also reported in maxillary first molars
(0.12%), maxillary third molars (4.7%),
mandibular third molars (3.5%-4%) and
mandibular second premolars (1%).
There is 70-80% chance of bilateral
occurrence.
ANATOMIC FEATURES - ROOT
Roots having this
configuration are
usually conical or
square in shape due
to fusion
Lines of fusion are
represented by an
occluso-apical
groove
The shape of such
roots is called
gutter shaped
ANATOMIC FEATURES PULP
CHAMBER
Greater occluso-apical
width as compared to
normal configuration
Bifurcation exists at a
lower level
Connecting slit passes
through area of fusion and
position depends on
which aspect of the roots
is fused
ANATOMIC FEATURES- PULPAL
FLOORS
Type I: peninsula like floor with continuous C shaped
orifice
Type II: A buccal, striplike dentin connection between the
peninsula like floor and buccal wall of the pulp chamber
that seperates the C-shaped groove into mesial and distal
orifices
Type III: Only one mesial, striplike dentin connection
between the peninsula like floor and the M wall which
seperates the the C-shaped groove into a small ML orifice
and a large MB-D orifice
Type IV: Non C-shaped floors. One distal canal orifice and
one oval or two round mesial canal orifices are present
ANATOMIC FEATURES ROOT
CANAL SYSTEM
Fan shaped corono-apically
Does not remain c-shaped corono-apically
throughout the whole length of the root
Accessory and lateral canals, inter-canal
communications and apical delta can be
found in a prevalence of 11-41%
In premolars, deep or shallow radicular
grooves exist on the mesiolingual surface of
the root
CLASSIFICATION
Melton and co (1991)
Category I (C1) - continuous C-shaped root canal
from the orifice to the apex of the root
Category II (C2) -one main root canal and a
smaller one
Category III (C3) two or three root canals
Category IV (C4) - an oval or a round canal
Category V (C5) - no canal lumen or there is one
close to the apex.
FANS CLASSFICATION
1. Type I. Conical or square root with visible
separation of medial and distal part. Medial and distal
canal merge near the apical foramen in a single one
Type II. Conical or square root with visible separation
of medial and distal part. Medial and distal canal have
separate apical foramen but run approximately in
parallel and are almost equal in length
Type III. Conical or square root with visible separation
of medial and distal part. Medial and distal canal have
separate apical foramen, run approximately in parallel
but one of them is longer than the other
DIAGNOSIS
No alteration in crown
morphology Possible to pass instrument from
mesial to distal aspect without
Longitudinal groove on the obstruction
root that leads to periodontal
disease maybe the 1st clue In semi-colon type, instrument
always ends up in the distal foramen
Difficult to diagnose C shaped
canals on a radiograph Instruments are usually clinically
centered
Can be predicted on the basis
of presence of radicular Instruments appear to converge at
fusion, radicular proximity, a the apex
large distal canal or a blurred
image of a third canal in
between Better chance of diagnosis when
radiography is combined with
clinical examination under a
Large and deep pulp microscope
chambers may also hint at C
shaped configuration
FANS CRITERIA FOR C SHAPED
CANALS IN M2M
Fused roots
A longitudinal groove on lingual or buccal
surface of the root
At least one cross-section of the canal
should belong to the C1, C2, or C3
configuration
MANAGEMENT
Difficult to seal and clean the entire canal
due to canal irregularities
Traditional hand instrumentation techniques
usually lead to failed endodontic therapy
Successful treatment requires careful
location and negotiation of the canals and
the meticulous mechanical and chemical
debridement of the pulp tissue
LOCATION AND NEGOTIATION OF
CANALS
Exploration should be carried out with small
size endodontic files, such as a no. 8, 10, 15 K-
file with a small, abrupt apically placed curve
Continous C shape orifice: 3 files
Oval shape: 2 files
Round: 1 file
CLEANING AND SHAPING
Orifice widening with GG burs but avoid
in C1 or C2 types, instead use 25 size
instrument
Anti curvature filling technique as high
risk of root perforation in the thinner
lingual walls
Prevention of strip perforation in MPM
Ni-Ti rotary seem to be
safe in such canals
Further enlargement to
an apical dimension
greater than size 30
(0.06 taper) is not
recommended
The recently developed
self-adjusting file (SAF)
system has been
reported to be more
efficacious than the
protaper system for
shaping of C-shaped
canals
Cleaning of the C-
shaped canal
system with rotary
instruments should
be assisted by
ultrasonic irrigation
Use of calcium
hydroxide as an
intracanal
medicament for a
period of 7-10 days
OBTURATION
Following cleaning and shaping,
the remaining dentin thickness
around the canals is usually 0.2 to
0.3 mm.
The resultant forces of compaction
during obturation can exceed the
dentin canal resistance, which may
result in root fracture and
perforation of the root.
Cold condensation require deep
insertion of condensation
instruments
Thermoplasticized gutta-percha
technique may prove to be more
beneficial
Barnetts technique
Walids technique
Maggiore's modified MicroSeal
technique
POST-ENDODONTIC
RESTORATION
Post placement requires at least 1mm canal
thickness
Prefabricated or cast posts increase the risk
of creating a strip perforation
Chamber-retained, bonded amalgam or
composite is a better choice
