IntematiMMl EiuMmtk ^eanul (1990) 23,40-45
Root canal anatomy of mandibular second molars.
Partn C-shaped canals
S. A. MANNING Department ofRestorative Dentistry, Faculty of Dental Science, Universityof
Melbourne, Melbmme, Victoria, Australia
Summary. The root canal anatomy af 19
dibular second molars with C-^aped canals was
investigated by rendering the roots transparent and
allowing the canal system to be observed by black
ink infiltration. The presence of three root canals
was most frequent, and lateral canals were found
in all roots. Transverse anastomoses were found in
15 of the 19 roots. The apical foramen was most
commonly situated awayfromthe apex, and apical
deltas were found in 16 of the 19 roots. The C-
shaped canals were found more frequently in Asians
than in other racial groups (P < 0.02).
The formation of C-shaped roots and their racial
predilection is discussed. A case report of the root
canal treatment of a C-shaped canal is included and
suggestions are made concerning suitable pro-
cedures for use in root canal treatment of these
complex canal systems.
Introduction
C-shaped roots and root canals were first
docutnented in 1908 (Keith 1913) and 1911
(Keith & Knowles 1911), after examination
of the skeletal remains of members of the
Neanderthal race. The mandibular second
molar showed a C-shaped root and, on sec-
tioning, a C-shaped root canal (Fig. 1). The
roots and canal anatomy of these teeth was
quite different to that found amongst so-called
'modem man'. These findings were cited
in support of the argument that Neanderthal
man was not a predecessor of modem man but
a collateral species that had become extinct
(Keith 1913). During investigations of the
dentition of East Greenland Eskimos, C-
shaped roots and root canals in mandibular
second molars were observed (Pederson 1949).
These findings disproved the theory that
Neanderthal man was a species collateral to
modem man, and it is now thought that the
Correspondence: Mr S. A. Manning, 1 Lister
House, 11-^12 Wimpole Street, London W1M7AB,
UK.
40
Neanderthal race were predecessors of the
Mongoloid race (Tratman 1950), which
includes Asian populations.
Indo-European teeth were compared with
teeth from Asians of Malaysia, and a number
of differences were noted, including the find-
ing of G-shaped roots and root canals in many
mandibular second molars (Tratman 1950);
also noted was a third root in mandibular first
and third molars. Teeth with C-shaped roots
were originally classified as taurodents. The
term taurodontism was invented in 1913
(Keith 1913) to liken teeth with C-shaped
roots to those seen in cud-chewing animals
(taurus is the Latin word for 'bull'). The
definition of teeth that fit this description has
since been changed.
The shape and number of roots is deter-
mined by Hertwig's epithelial sheath, which
bends in a horizontal plane below the ameio-
cemental junction and fuses in the centre
leaving openings for roots (Orban & Mueller
1929). Fused roots may form either by coalesc-
ence due to cementum deposition with time,
or as a result of failure of Hertwig's epithelial
sheath to develop or fuse in the furcation area
(Pederson 1949). Failure to fuse on the buccal
aspect would result in formation of a groove on
the lingual aspect, and failure to fuse on the
lingual would give a buccal grove. Fusion fail-
ure on both the buccal and lingual aspects
would result in formation of a conical or
prism-shaped root.
Investigations ofroot development in mouse
molars showed that roots were formed by the
meeting of dentine leaflets (Flschlschweiger &
Clausnitzer 1988). The fusing of these leaflets
was sometimes irregular, forming accessory
catuls and occasionally, especially in the third
molars, the leaflets failed to form. In the case
of mandibular molars such failure of dentine
leaflet formation resulted in a C-shaped root

A' A'"
Fig. I. Description of Neanderthal and modem English mandibuiar second molars (Keith & Knowles 1919):
A, labial aspect of second lower molar of Brelade dentition (Jersey); A', its chewing surface; A", distal aspect;
JK'", section of root; B, labial aspect ofthe same tooth of a modem English dentition; B', the distal aspect of
the same. (This text is not covered by copyright and the authors are deceased.)
and canal. It was p<Ktulated that trauma, such
as radiation or chemical interference, could
cause this irregular fusion of leaflets
(Fischlschweiger & Ciausnitzer 1988). The
failure of leaflet formation, resulting in the
development of C-shaped roots in the lower
molars, is likely to be of genetic origin rather
than being related to trauma, because of its
previously documented racial predilection.
C-shaped canals were first documented in
the endodontic literature by Cooke & Cox
(1979) in three case reports. Similar reports
have since been published (Wells & Bemier
1984, Rabie 1985, Barnett 1986). Studies of
the root canal anatomy of mandibular second
molars from Japanese (Kotoku 1985), Chinese
(Yang et at. 1988) and Hong Kong Chinese
(Walker 1988) populations have found a high
incidence of C-shaped roots and their canals.
Investigation of the root canal anatomy of
mandibular second molars likely to have orig-
inated from Caucasians found that most were
two-rooted, with an absence (Ainamo & Loe
1968, Tamse & KaflFe 1981, Vertucci 1984) or
near absence (Weine et al. 1988) of C-shaped
roots.
The aim of this investigation of C-shaped
canals was to provide further knowledge of
their root canal anatomy to aid root canal
treatment.
Materials and methods
One hundred and forty-nine mandibular
second molars were collected and stored in
Root canals ofmandibular second molars 41
Table I. Number of teeth with different canal
configurations in C-shaped roots
Canal tj'pe'
Cana! type 1 2-1 1-2-1 2 1-2 3
Number 3 4 1 1 3 7
•Canal type: 1, single canal; 2-1, two canals that
join apically; 1—2—1, one canal that divides but
rejoins apically; 2, two separate canals; 1-2, one
cana! that divides apically; 3, three separate canals.
water immediately after extraction. Infor-
mation concerning the patient's age, sex, race
(Caucasian, Asian, Indian or other), and the
side of the mouth from which the tooth
originated, was recorded at the same time.
Teeth were prepared and rendered trans-
parent using the techniques described pre-
viously by Manning (1990). The roots were
examined with a stereo dissecting microscope
(magnification x 20) and data were collected
according to the following categories: canal
type; apical foramen position; presence and
position of transverse anastomoses; presence
of a delta of canals at the apex.
Results
Of the 149 mandibular second molars
collected, 33 had one root, and of these 19 had
C-shaped canals. A variety of canal types were
found within the G^haped canals, die most
frequent havii^ three canals (Table I). Lateral
canals were found in all 19 roots with C-
 42 5'. A. Manning

Fig. 2. .\n apicai delta. Fig. 3. .\ type 1 canal .system with an apicai delta.

shaped canals, while transverse anastomoses

were found in 15 of these roots. The apicai
foramen was positioned away from the apex in
17 roots, and apical deltas occurred in 16 roots.
Figures 2, 3 and 4 illustrate some ofthe com-
plex shapes of G-shaped root canals that were
observed. C-shaped canals were found more
frequently (P<0.02) in Asians.
Discussion
The root canal anatomy of teeth with C-
shaped canais has only been reported once
previously (Yang et al. 1988), when first and
second mandibular molars from a Chinese
population were examined using a transparent
technique (Robertson et al. 1980). C-shaped
roots occurred in 2.3 per cent of first molars
and 31.5 per cent of second molars. It was
found that roots with separate canal orifices
formed separate canals, and C-shaped orifices
formed separate canals as well as true C-
shaped canals. The latter, which were
described as roots having a C-shaped canal Fig. 4. Transverse anastomoses in the middle and
from the orifice to the apex, occurred in 7.4 per apical third ofthe root.
cent of the sample of mandibular second
molars. result of age changes due to deposition of den-
The observed variation in C-shaped roots tine on the walls of C-shaped canals, forming
described by Yang et al. (1988) is probably a separate canals.

Fig. 5. Preoperative radiograph of lower left second
molar.
Fig. 7. Radiograph following rootfillingofthe type 1 C-shap^J ^i.». .-ilii i-l.J ^tercha and AH26 cement.
In the present study, all root canals that
conformed to the general structure of a ' C and
occurred in a G-shaped root were described as
C-shaped root canals, whether or not a separ-
ate canal or orifice was observed. The classifi-
cation system of canal types described in Part I
(Manning 1990) was also used to describe the
canal system in C-shaped roots. In a type 1
canal, a single canal is present from orifice to
apex. A type 1 canal in a C-shaped root is a
single C-shaped canal from orifice to apex.
This has been described as a true C-shaped
canal (Yang el al. 1988). Other more complex
canal types were found in C-shaped roots; the
type with three canals, which did not necess-
arily combine, occurred most frequently.
The high frequency of transverse anasto-
moses may be explained by the deposition of
Root canals ofmandikular second molars 43
t r
Fig. 6. x it».u«iiw jji^pttFation ofthe canal
system.
dentine with time in a single canal, forming
several canals with channels between them.
Additional precautions are necessary to
clean the entire canal system effectively,
especially if it contains necrotic debris and
bacteria in the canal irregularities. The effec-
tiveness of cleaning procedures in relation to
C-shaped root canals has not been investigated
to date. However, in single rooted teeth the use
of sodium hypochlorite and EDTA irrigants,
ultrasonic acti%'ation of the irrigants and
calcium hydroxide-containing intracanal
medicaments provide a cleaner and more fre-
quently sterile canal sj'stem (Cameron 1983,
Bystrom & Sundqvist 1985, Bystrom et al.
1985, Sjogren & Sondqvist 1987).
The finding of lateral canals is more diffi-
cult to explain. Lateral canals are probably
44
formed by the irregular fusing of dentine leaf-
lets at the root formation stage. If one leaflet
is missing altogether then the formation of
dentine may be more irregular.
Teeth with G-shaped canals requiring root
canal treatment present a challenge to the
clinician. Not only are normal procedures for
canal preparation sometimes unsuitable, but
the presence ofa high incidence of transverse
anastomoses, lateral canals and apical deltas
makes it difficult to clean and seal the canal
system adequately.
Gase report
A 30-year-old Vietnamese lady was referred
to the Endodontic Unit of the Department
of Restorative Dentistry, University of
Melbourne, for a number of root canal treat-
ments. The lower left second molar did not
respond to vitality tests, but was without
symptoms. The tooth was not tender to per-
cussion or palpation and there were no perio-
dontal pockets associated with it. Radiographic
examination showed the presence of radio-
paque material in the pulp chamber and
extending some distance into the canals (Fig.
5). There was a slight widening of the perio-
dontal ligament space in the apicai area, and
the tooth appeared to have two roots, with one
canal in each.
A pulpless tooth with an infected root canal
system was diagnosed and the treatment plan
was to clean, shape, medicate and seal the root
canal system. Because ofthe patient's race and
the radiographic appearance ofthe tooth, a C-
shaped canal was suspected. Radiographically,
teeth with G^haped canals may appear to have
two separate root canals and possibly two
separate roots.
An access cavity was prepared, a C-shaped
canal was observed and a single canal form was
diag^nosed, as the canal could be probed all the
way round the circumference of the ' C . The
working length was established, and the canal
was cleaned and prepared using Hedstrom
files, with 0.9 per cent sodium hypochlorite
and EDTAC irrigating solutions. Ultra-
sound' was used to activate the irrigants in
the canal after hand preparation was complete.
^ Cavitron with PR30 handpiece and smooth
broach. Dentsply, York, PA, USA.
The canal was prepared over two appoint-
ments, and an intracanal dressing of Pulpdent
paste^, a non-setting calcium hydroxide
paste, was used. The canal was filled using
laterally condensed gutta-percha and AH26
cemenr (Figs 6 and 7).
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