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