Review Article Int J Clin Prev Dent 2019;15(1):1-10ㆍhttps://doi.org/10.15236/ijcpd.2019.15.1.

ISSN (Print) 1738-8546ㆍISSN (Online) 2287-6197

C-Shaped Canals: A Review

Meenu Singla, Divyam Girdhar, Palak Wahi
Sudha Rustagi College of Dental Sciences and Research, Haryana, India

C-shaped canal configuration is a variation that has a racial predilection and is commonly seen in mandibular second
molars. The intricacies present in this variation of canal morphology can pose a challenge to the clinician during negotiation,
debridement and obturation knowledge of the C-shaped canal configuration is essential to achieve success in endodontic
therapy. Radiographic and clinical diagnosis can aid in identification and negotiation of the fan-shaped areas and intricacies
of the C-shaped anatomy. Effective management of this anomalous canal configuration can be achieved with rotary and hand
instrumentation assisted with sonics and ultrasonics. Modifications in the obturation techniques will ensure a 3-dimensional
fill of the canal system and chamber retained restorations like amalgam or composites, serve as satisfactory post endodontic
restorations.

Keywords: cone beam computed tomography, Hertwig’s epithelial root sheath, mandibular second molar, root canal config-
uration

Introduction main anatomic feature of C-shaped canals is the presence of a

Knowledge of pulpal anatomy, both the usual and unusual
configurations and possible variations is critical for success in
endodontics and lack of such knowledge may lead to treat-
ment failure [1]. One of the most important anatomic varia-
tions in root canal morphology is ‘C’ shaped configuration of
the canal system [2]. The C-shaped canal configuration was
first reported by Cooke and Cox in 1979. It is termed so be-
cause of the C-shaped cross-sectional anatomical config-
uration of the root and root canal [3]. Instead of having several
discrete orifices, the pulp chamber of the C-shaped canal is a
single ribbon shaped orifice with 180° arc (or more) [2]. The
Corresponding author Meenu Singla
E-mail: meenu_sanjeevsingla@hotmail.com
https://orcid.org/0000-0002-7712-3506
Received December 9, 2018, Revised February 21, 2019,
Accepted March 19, 2019
fin or web connecting the individual root canals [4]. Roots
containing a C-shaped canal often have a conical or square
configuration. Most C-shaped canals occur in the mandibular
second molars, but have also been reported in the mandibular
first molars, maxillary molars, mandibular premolars and
maxillary lateral incisors [5]. The incidence of C-shaped mo-
lars in the Asian ethnic population is 31% while in the general
population it is approximately 8% [6].
Recognition of a C-shaped canal configuration early can
help the clinician in proper negotiation, preparation which
will thus prevent irreparable damage that may put the tooth in
severe jeopardy [3].
This review article is to review and discuss the etiology, in-
cidence, classification, diagnosis and management of the
C-shaped canal configuration.
Definition and Terminology
Keith and Knowles were the first authors to depict a

Copyright ⓒ 2019. Korean Academy of Preventive Dentistry. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/
by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

1
International Journal of Clinical Preventive Dentistry
C-shaped root canal. They noted that ‘on the labial aspect, the
root shows no trace of division, but on the lingual side root be-
gins to separate 7 mm below the crown into mesial and distal
fangs’ [7].
The C-shaped root was first analysed in detail by Nakaya-
ma, who gave it the name ‘gutter-shaped root’. Nakayama and
Toda reported on the ‘gutter-shaped root canal’, focusing on
its morphology and aspects of treatment. Japanese researchers
have used the term ‘gutter-shaped’ primarily to describe the
shape of the root, whilst the term ‘C-shaped’ has been used to
describe the shape of the root canal [7].
Tratman stated that the C-shaped root morphology can fre-
quently be observed in mandibular second molars from Asian
individuals. He termed this morphology the ‘horse-shoe re-
duction form’ [7]. According to Weine [8], the C-shaped con-
figuration refers to a continuous slit between all the canals so
that a horizontal section through the root yields a space in the
shape of a letter ‘C’. According to Kato et al. [7], tooth is usu-
ally defined as having a C-shaped root canal system when any
arbitrary cross section presents a C-shaped root canal config-
uration (Figure 1).
Etiology
Ever since the identification of the C-shaped canal anat-
omy, various causes have been postulated for its formation.
These are as follows.
1. Failure of fusion of Hertwig’s epithelial sheath
The failure of the Hertwig’s epithelial root sheath to fuse on
the lingual or buccal root surface is the main cause of the
Figure 1. Clinical appearance of a C-shaped canal configuration in
mandibular second molar.
2 Vol. 15, No. 1, March 2019
C-shaped roots, which always contain a C-shaped canal. This
fusion failure results in a groove on the opposite side of the
root that is present coronoapically [9].
Earlier, the irregular fusion of the Hertwig’s epithelial
sheath was attributed to trauma, such as radiation or chemical
interference, but following the documentation of racial predi-
lection, it is more likely to be of genetic origin [9].
2. Fusion of roots due to deposition of
cementum
The C-shaped roots may also be formed by coalescence of
roots because of deposition of the cementum with time.
C-shaped canals appear when fusion of either the buccal or
lingual aspect of the mesial and distal root occurs. This fusion
remains irregular and the roots stay connected by an inter-
radicular ribbon. The floor of the pulp chamber is deep and has
an unusual anatomic appearance. Two or three canals may be
found in the C-shaped groove or the C-shape may be con-
tinuous throughout the root length [9].
3. Reduced dentin formation on one side
The dentin on the lingual side of C-shaped roots is thinner
than the dentin on the buccal side. They hypothesized that this
anatomy is due to a reduced dentin formation speed on the lin-
gual side [7].
4. Role of subpulpal lobe and intermediate
furcation ridge
Tanaka et al. doubted that a C-shaped root would develop
through formation of a subpulpal lobe [7]. They reported that
they were unable to identify the intermediate furcation ridge,
which normally should be present between each root in
C-shaped roots.
5. Genetic
The gene(s) causing C-shaped roots in mice are present on
either chromosome 5 or 17. One of the candidate genes caus-
ing C-shaped roots is most likely being located on chromo-
some 5 in mice [7].
Classification
The C-shaped canal system can assume many variations in
its configuration so a comprehensive classification can help in
true diagnosis and management.
Melton et al. [10] examined the root canals of 15 extracted
mandibular second molars and proposed a simplified classi-
fication of C-shaped root canals using three categories based
on their cross-sectional shape.
 Meenu Singla, et al：C-Shaped Canals: A Review

1. Category I 5. Fan’s classification (radiographic classification)

Continuous C-shaped canal running from the pulp chamber
to the apex defines a C-shaped outline without any separation
(i.e., Figure 2A).
2. Category II
The semicolon-shaped (;) orifice in which dentine separates
a main C-shaped canal from one mesial distinct canal (i.e.,
Figure 2B).
3. Category III
Refers to those with two or more discrete and separate ca-
nals (i.e., Figure 2C).
1) Subdivision I: C-shaped orifice in the coronal third that
divides into two or more discrete and separate canals that join
apically;
2) Subdivision II: C-shaped orifice in the coronal third that
divides into two or more discrete and separate canals in the
midroot to the apex;
3) Subdivision III: C-shaped orifice that divides into two or
more discrete and separate canals in the coronal third to the
apex.
(Figure 6) [12]
Fan et al. [12] classified C-shaped roots according to their
radiographic appearance into three types:
1) Type I: Conical or square root with a vague, radiolucent
longitudinal line separating the root into distal and mesial
parts. There was a mesial and a distal canal that merged into
one before exiting at the apical foramen (foramina).
2) Type II: Conical or square root with a vague, radiolucent
longitudinal line separating the root into distal and mesial
parts. There was a mesial and a distal canal, and the two canals
appeared to continue on their own pathway to the apex.
3) Type III: Conical or square root with a vague, radiolucent
longitudinal line separating the root into distal and mesial
parts. There was a mesial and a distal canal, one canal curved
to and superimposed on this radiolucent line when running to-
ward the apex, and the other canal appeared to continue on its
own pathway to the apex.

4. Fan’s classification (anatomic classification)

[11]
Fan et al. [11] modified Melton’s method into the following
categories:
1) Category I (C1): the shape was an uninterrupted “C” with
no separation or division (Figure 2A).
2) Category II (C2): the canal shape resembled a semicolon
resulting from a discontinuation of the “C” outline, but either
angle  or  should be no less than 60° (Figure 3).
3) Category III (C3): 2 or 3 separate canals and both angles
 and  were less than 60° (Figure 4).
Figure 3. Measurement of angles for the C2 canal. Angle  is more
4) Category IV (C4): only one round or oval canal in that
than 60°. A and B: ends of one canal cross-section, C and D: ends
cross section (Figure 5A). of the other canal cross-section, M: middle point of line AD, :
5) Category V (C5): no canal lumen could be observed angle between line AM and line BM, : angle between line CM and
(which is usually seen near the apex only) (Figure 5A). line DM.

Figure 2. Classification of C-shaped

canal configuration. (A) C1, (B) C2,
(C) C3.

www.ijcpd.org 3
International Journal of Clinical Preventive Dentistry
Figure 4. Measurement of angles for the C3 canal. Both angle 
and angle  are less than 60°. A and B: ends of one canal
cross-section, C and D: ends of another canal cross-section, M:
middle point of line AD, : angle between line AM and line BM, :
angle between line CM and line DM.
Incidence and Prevalence (Table 1)
The C-shaped canal configuration is known to be more
common in Asians but is relatively rare amongst Europeans
and Americans [7]. The prevalence of C-shaped canals re-
ported in a Caucasian population is between 2.7% to 7.6%
[13]. Bilateral occurrence of C-shaped canals has been re-
ported in a percentage of 70% [14]. Helvacioglu-Yigit and
Sinanoglu [15] reported that there were no significant differ-
ences in the distribution of C-shaped root canals between
males and females. C-shaped root canals have also been re-
ported to occur in maxillary second deciduous molars [16].
Diagnosis
The C-shaped canal variation of morphology is unusual and
can lead to difficulties during treatment so the proper diag-
nosis of this situation is mandatory before treatment.
Wang et al. [4] reported a higher incidence in the recog-
nition of C-shaped canals using a combination of radiography
and clinical examination under the microscope (41.27%) than
using the radiography (34.64%) or clinical examination
(39.18%) alone.
Accurate diagnosis can also be made by cone beam com-
puted tomography (CBCT), microCT, spiral CT to avoid diffi-
culties during treatment [5].
1. Radiographic diagnosis
1) Intraoral periapical radiographs: preoperative intraoral peri-
apical radiographs
Preoperative and working length periapical radiographs are
4 Vol. 15, No. 1, March 2019
Figure 5. Classification of C-shaped canal configuration. (A) C4,
(B) C5.
Figure 6. Radiographic types; (A) Type I. (B) Type II. (C) Type III.
of little value in identifying C-shaped root canals [17]. A pre-
operative radiograph and an additional radiograph from 20°
mesial or distal projection usually provide various clues in the
identification of any variation in root canal morphology [18].
C-shaped canals are difficult to interpret on radiographs be-
cause of thickness of bony trabeculae [19]. Most intraoral ra-
diographs demonstrated 1) radicular fusion or close prox-
imity, 2) a large distal canal, 3) a narrow mesial canal, and 4)
a blurred image of a third canal in between [20]. Radiographic
techniques have certain disadvantage in which it presented in
only two-dimensional image with possibility of missing some
of the roots and root canals [21].
Preoperative radiographs show close fused roots or images
of two distinct roots (Figure 7). When the communication or
fin connecting the two roots is very thin, it is not visible on the
radiograph and may thus give the appearance of two distinct
roots [12]. This makes clinical recognition of the C-shaped ca-
nal unlikely until access to the pulp chamber has been ach-
ieved [10].
For mandibular second molar to qualify as having a C-shap-
ed canal system, it has to have fused roots [11].
Panoramic radiography has been shown to possess good sensi-
tivity and specificity for the diagnosis of mandibular molars with
C-shaped root canals especially bilateral occurrence [22].
 Meenu Singla, et al：C-Shaped Canals: A Review

Table 1. Incidence and prevalence

Tooth type Investigators Race Total %

Mandibular first premolars Lu et al. (2006) Chinese 18
Velmurugan and sandhya (2009) Indian 1
Khedmat et al. (2010) Iranian 1.38
Mandibular second premolars Yu et al. (2012) Western 0.6
Chinese
Shah dipaliy (2014) Asian Not stated
Mandibular first molars Bolger and schindler (1988) Not stated Not stated
Mandibular second molar Weine et al. (1988) Not stated 2.7
Weine (1998) Mixed 7.6
Peiris et al. (2008) Sri Lankan 3
Sinhalese and tamils
Rahimi et al. (2008) Iranian 7.2
Jung et al. (2010) Not stated 29
Zhang et al. (2011) Chinese 29
Zheng et al. (2011) Chinese 39
Wang et al. (2012) Chinese 39.18
Mandibular third molars Kuzekanani et al. (2012) Iranian 3.5
Maxillary first molar Cleghorn et al. (2006) Mixed 0.12

Figure 7. Series of radiographic ima-

ges and schematic drawings that
illustrate root canal classification ac-
cording to Fan et al. [12] type I (left),
type II (centre), and type III (right).

2) CT
The tuned-aperture CT imaging enabled a statistically sig-
nificant increase in canal detection as compared with conven-
tional radiography [23].
3) MicroCT
The presence of instruments or filling materials in the fur-
cation area in combination with the poorly distinguished floor
of the pulp chamber can lead to radiographic recognition of
“C” configuration [17]. MicroCT permits the examination of

www.ijcpd.org 5
International Journal of Clinical Preventive Dentistry

specimens of limited size, which restrict some analysis.
Instead, CBCT could be used in patients despite its lower reso-
lution [24].
4) Spiral CT
Spiral CT was used in a study to evaluate C-shaped canals
of single rooted mandibular second molars. By this technique,
contiguous 1 mm thick transaxial images of the dental materi-
al can be obtained and there is no possibility for missing dental
structure [25].
5) CBCT
CBCT has been used more routinely than spiral CT due to
its higher resolution and the accompanying reduced radiation
dose [7]. CBCT enables a three-dimensional evaluation of
teeth with complex or abnormal root canal anatomy [26].
2. Pulp chamber examination
Diagnosis of C-shaped canals can be established by follow-
ing access to the pulp chamber [10].
Clinical recognition of C-shaped canals is based on definite
observable criteria (i.e., the anatomy of the floor of the pulp
chamber and the persistence of haemorrhage or pain when
separate canal orifices were found) [17].
The pulpal floor in C-shaped teeth can vary from peninsula
like with a continuous C-shaped orifice to non C-shaped floors
as per the classification given by Min et al. [27].
However, when a C-shaped canal orifice is observed, say,
under the operating microscope, one cannot assume that such
a shape continues throughout its length [11].
The pulp chamber in teeth with C-shaped canals may be
large in the occlusoapical dimension with a low bifurcation.
At the outset, several orifices may be probed that link up on
further instrumentation [9]. When negotiating the C-shaped
canal, instruments may be clinically centered [3]. In a true
C-shaped canal, it is possible to pass an instrument from me-
sial to distal aspect without obstruction [28]. If a file could not
be passed through the isthmus of the pulpal floor during clin-
ical inspection, the practitioner might consider the root canal
as being separated [29].
tive treatment during access cavity preparation [30].
2. Canal system identification
Initial canal system recognition occurs after achievement of
routine endodontic access and removal of tissue from the pulp
chamber [9]. If a C-shaped root is present, two of Melton’s
three categories (category I and II) should be evident [10].
Placing the fiberoptic tip under the rubber dam on the buccal
surface illuminates the pulp chamber. The canal system ap-
pears as a dark line in the area of illuminated field [9]. The in-
creased visibility afforded with the use of surgical operating
microscopes has made treatment more successful [30].
3. Location and negotiation of canals
The necessity for deep-orifice penetration and careful prob-
ing with small files characterize the C-shaped category more
accurately [9]. For continuous C-shape orifice, 3 initial files
are inserted, one at both end and one in the middle. When the
orifice is oval, two files are inserted; one file at each end of the
orifice and when the orifice is round, one initial file is inserted
[31].
4. Cleaning and shaping
While cleaning a C-shaped root canal, attention should be
paid to ‘isthmus’, ‘trough’, and ‘fin’ [32,33]. Debris and pulp
tissue usually remain inside continuously C-shaped canals.
The orifice of the slit must be widened with Gates Glidden
drills during the early phases of treatment, but not too deep to-
wards the apex to prevent perforations [10].
The isthmus should not be prepared with larger than no. 25
files; otherwise, strip perforation is likely. Chances of strip

Management
C-shaped canal configuration is known to present a com-
plex canal anatomy. This has provoked many modified techni-
ques to manage these cases endodontically.

1. Access cavity preparation (Figure 8)

The use of an operating microscope results in more effec- Figure 8. Access cavity of a C-shaped mandibular second molar.

6 Vol. 15, No. 1, March 2019


perforation are high due to small amount of dentin present be-
tween external surface of root and internal canal system espe-
cially on the lingual side. He also suggested that Gates-
Glidden burs should not be used for preparation of the mesio-
buccal and buccal isthmus areas [34].
It was found that the mean dimensions of minimal width of
buccal canal walls were significantly higher than that of lin-
gual canal walls at the coronal, middle and apical thirds of the
roots. There is high risk of root perforation at the thinner lin-
gual walls of C-shaped root canals in mandibular molars and
the mesial walls of C-shaped root canals in mandibular first
premolars during shaping [35].
The anticurvature filing technique was recommended to
avoid danger zones that are frequently presently at mesiolin-
gual walls (Figure 9) [3].
Ni-Ti rotary instruments seem to be safe, further enlarge-
ment to an apical dimension greater than size 30 (0.06 taper) is
not recommended [36].
During the process of root canal enlarging and shaping, ra-
diographs taken with small instruments placed inside the ca-
nals for the purpose of confirming the working length are a
more useful approach [17].
It is difficult to ensure complete removal of diseased pulp or
necrotic tissues from structurally more complex parts of the
root canal system (e.g., isthmus, fin) through instruments
alone; therefore, the cleaning and irrigation of root canals us-
ing chemical solutions is of particular importance [7].
5. Chemical irrigation
Extravagant use of small files and 5.25% NaOCl is a key to
thorough debridement of narrow canal isthmuses [9].
Figure 9. Anticurvature filing technique.
Meenu Singla, et al：C-Shaped Canals: A Review
6. Ultrasonic irrigation
An increased volume of irrigant and deeper penetration
with small instruments using sonics or ultrasonics may allow
for some cleansibility in fan-shaped areas of the C-shaped ca-
nal but aggressive use of ultrasound may result in root canal
perforation and fracture of the ultrasonic file [2,10].
7. Light activated disinfection
Diode laser can eliminate microorganisms existing in main
canal, lateral canals and dentinal tubules which can increase
the success rate of endodontic therapy [37].
8. Canal system obturation
It was found that compaction can be improved while ob-
turating a mandibular molar with a C-shaped canal by using
the EndoTec in what they termed a “zap and tap” maneuvr:
preheating the EndoTec plugger for 4 to 5 seconds before in-
sertion and then moving the hot instrument in and out in short
continuous strokes 10 to 15 times. The plugger was removed
while still hot, followed by a “cold spreader with insertion of
additional accessory points.” [38].
The mesiolingual and distal canal spaces can be prepared
and obturated as standard canals. However, sealing the buccal
isthmus is difficult if lateral condensation is the only method
used. If cold condensation technique is adopted for obturation,
deeper penetration of condensation instruments in several
sites will be necessary. The isthmus may not be prepared with
a sufficient flare which does not permit deep placement of the
spreader, therefore obturation is done by vertical condensa-
tion technique using thermoplasticized gutta-percha [9].
To ensure proper placement of the master cones in C-shap-
ed canals, a large diameter file should be placed in the most
distal portion of the canal, before seating the master cone in
the mesial canal. The file is then withdrawn and the master
cone of the distal canal is seated, followed by placement of ac-
cessory cones in the middle portion of the C-shaped canal
[33].
Walid N described a technique to overcome these problems.
He suggested the use of two pluggers simultaneously to down
pack the main canals in a C-shaped canal [39].
A Touch’N Heat (Sybron Endo/Analytic, Irvine, CA, USA)
was used to sear off gutta-percha at the mesiolingual orifice
level where the largest plugger selected was placed, while
down packing the distal canal with the smallest plugger. Then,
the smallest plugger used in the distal canal was held in place
while packing the mesiolingual canal. Placing two master
points and blocking the canal entrance with a plugger in-
creases the resistance toward the passage of obturating materi-
www.ijcpd.org 7
International Journal of Clinical Preventive Dentistry
al from one canal to another. Single-insertion thermoplasti-
cized gutta-percha condensation devices may not condense
gutta-percha adequately into the long narrow isthmuses [39].
9. Cold lateral condensation
Kim et al. [40] compared warm gutta-percha filling techni-
ques with conventional cold lateral condensation technique
using simulated C-shaped root canals embedded in resin
blocks. They concluded that warm gutta-percha condensation
techniques can be expected to result in favourable canal filling
in C-shaped root canals.
Considering the ease and speed of lateral compaction as
well as the superior elasticity gained by vertical compaction of
warm gutta-percha, Martin developed a device called Endo-
Tec II that appears to achieve the best qualities of both techni-
ques [9].
10. Thermoplasticized gutta-percha injection
technique (Figure 10)
Four gutta-percha filling techniques (cold lateral compac-
tion, ultrasonic compaction, single cone with injectable gutta
TM R
percha [Obtura II ] and core-carrier [Thermafil ]) in a study
were compared in simulated C-shaped canals based on filling
quality at three cross-sectional levels, filling time and the ap-
ical extrusion of gutta-percha. The core-carrier technique was
the most effective technique when assessed by gutta-percha
area in the simulated C-shaped canal [41].
11. Post endodontic restoration
Atleast 1 mm of sound tooth structure should be present
around a post is needed, for resistance to root fracture. If post
placement for a crown core is desired, use of only distal canal
should be considered. Proper post-canal adaptation and stress
distribution is more likely to result in the tubular distal canal.
Placement of posts or antirotational pins in the mesiolingual
Figure 10. Clinical presentation showing C-shape canal orifice (A), obturated C-shaped canal (B), postobturation radiograph (C).
8 Vol. 15, No. 1, March 2019
and mesiobuccal areas of C-shaped root invites perforation
[9]. Prefabricated or cast posts increase the risk of creating a
strip perforation [3]. Also, post width should be minimized
[9].
The floor of the pulp chamber is deep so it can provide am-
ple retention from the available undercuts. Chamber-retained
bonded amalgam or composite is a better choice as the core or
as the final restoration in these teeth [3].
12. Endodontic surgery
When endodontic surgical intervention becomes necessary
for a mandibular molar with a C-shaped root, extraction, root
end filling and intentional replantation are suggested. Due to
their conical shape, C-shaped roots are easy to extract without
fracture [7].
By understanding the anatomical features of this variation
and following the sound principles of biomechanical prepara-
tion, obturation and restoration, the long term prognosis for
C-shaped configuration is appreciable [42].
Conclusion
Proper knowledge of the root canal anatomy and its varia-
tions are essential for the correct diagnosis and successful out-
come of the endodontic treatment. For a dentist it is important
to anticipate the specific anatomy of root canal morphologies.
C-shaped canal being one of such complexities presents a
great challenge to diagnose and manage. The early recog-
nition of C-shaped configuration facilitates cleaning, shaping
and obturation of the root canal system.
The C-shaped root canal configuration has an ethnic predi-
lection and a high prevalence rate in mandibular second
molars. The C-shaped canal system tends to vary considerably
in their anatomical configuration and thus leading to diffi-
culties in debridement, obturation and restoration. Clinical ex-

amination of the floor of the pulp chamber and pre-treatment
radiographs are equally important when attempting to diag-
nose a C-shaped canal configuration.
Magnification and illumination can help to identify these
C-shaped configurations. Use of CBCT is beneficial in the as-
sessment of root canal shape and endodontic treatment of this
root canal morphology. Careful negotiation of the canals, me-
ticulous disinfection of root canal is important in carrying out
successful endodontic treatment of a C-shaped canal configu-
ration. Ultrasonic instrumentation and devices for injectable
thermoplasticized gutta-percha assist greatly with debride-
ment and obturation.
Thus understanding the anatomical presentations of C-
shaped canal will enable the clinician to manage these cases
effectively.
Conflict of Interest
No potential conflict of interest relevant to this article was
reported.
References
1. Chokshi S, Mehta J, Chokshi, P, Vaidya R. Morphological varia-
tions in the root canal system of mandibular second molar: a case
series. Endodontol 2013;25:135-8.
2. Raisingani D, Gupta S, Mital P, Khullar P. Anatomic and diag-
nostic challenges of C-shaped root canal system. Int J Clin
Pediatr Dent 2014;7:35-9.
3. Fernandes M, de Ataide I, Wagle R. C-shaped root canal config-
uration: a review of literature. J Conserv Dent 2014;17:312-9.
4. Wang Y, Guo J, Yang HB, Han X, Yu Y. Incidence of C-shaped
root canal systems in mandibular second molars in the native
Chinese population by analysis of clinical methods. Int J Oral
Sci 2012;4:161-5.
5. Shanthi M, Sireesha CH, Shekar S, Sothy R, Baharuddin.
C-shaped root canal configuration in mandibular second molars:
a review and its prevalence in Indian population. Malays Dent
J 2013;35:26-32.
6. Jerome CE, Hanlon RJ Jr. Dental anatomical anomalies in Asians
and Pacific Islanders. J Calif Dent Assoc 2007;35:631-6.
7. Kato A, Ziegler A, Higuchi N, Nakata K, Nakamura H, Ohno N.
Aetiology, incidence and morphology of the C-shaped root canal
system and its impact on clinical endodontics. Int Endod J
2014;47:1012-33.
8. Weine FS. Endodontic therapy. 5th ed. St. Louis: Mosby; 1996.
9. Jafarzadeh H, Wu YN. The C-shaped root canal configuration:
a review. J Endod 2007;33:517-23.
10. Melton DC, Krell KV, Fuller MW. Anatomical and histological
features of C-shaped canals in mandibular second molars. J
Endod 1991;17:384-8.
Meenu Singla, et al：C-Shaped Canals: A Review
11. Fan B, Cheung GS, Fan M, Gutmann JL, Bian Z. C-shaped canal
system in mandibular second molars: part I−anatomical
features. J Endod 2004;30:899-903.
12. Fan B, Cheung GS, Fan M, Gutmann JL, Fan W. C-shaped canal
system in mandibular second molars: part II−radiographic
features. J Endod 2004;30:904-8.
13. Cantatore G, Berutti E, Castellucci A. Missed anatomy: fre-
quency and clinical impact. Endod Top 2006;15:3-31.
14. Sabala CL, Benenati FW, Neas BR. Bilateral root or root canal
aberrations in a dental school patient population. J Endod
1994;20:38-42.
15. Helvacioglu-Yigit D, Sinanoglu A. Use of cone-beam computed
tomography to evaluate C-shaped root canal systems in man-
dibular second molars in a Turkish subpopulation: a retro-
spective study. Int Endod J 2013;46:1032-8.
16. Ballal S, Gupta T, Kandaswamy D. Management of a retained
primary maxillary second molar with C-shaped canal confirmed
with the help of spiral computed tomography. Endodontol
2006;18:14-9.
17. Lambrianidis T, Lyroudia K, Pandelidou O, Nicolaou A.
Evaluation of periapical radiographs in the recognition of
C-shaped mandibular second molars. Int Endod J 2001;34:458-
62.
18. De Moor RJ. C-shaped root canal configuration in maxillary first
molars. Int Endod J 2002;35:200-8.
19. Barril I, Cochet JY, Ricci C. [Treatment of a canal with a “C” con-
figuration]. Rev Fr Endod 1989;8:47-58. French.
20. Haddad GY, Nehme WB, Ounsi HF. Diagnosis, classification,
and frequency of C-shaped canals in mandibular second molars
in the Lebanese population. J Endod 1999;25:268-71.
21. Al-Fouzan KS. C-shaped root canals in mandibular second mo-
lars in a Saudi Arabian population. Int Endod J 2002;35:499-
504.
22. Jung HJ, Lee SS, Huh KH, Yi WJ, Heo MS, Choi SC. Predicting
the configuration of a C-shaped canal system from panoramic
radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2010;109:e37-41.
23. Nance R, Tyndall D, Levin LG, Trope M. Identification of root
canals in molars by tuned-aperture computed tomography. Int
Endod J 2000;33:392-6.
24. Marciano MA, Duarte MAH, Ordinola-Zapata R, Del Carpio-
Perochena A, Cavenago BC, Villas-Bôas MH, et al. Applicati-
ons of micro-computed tomography in endodontic research. In:
Méndez-Vilas A, ed. Current microscopy contributions to ad-
vances in science and technology. Badajoz: Formatex Research
Center; 2012:782-8.
25. Cimilli H, Cimilli T, Mumcu G, Kartal N, Wesselink P. Spiral
computed tomographic demonstration of C-shaped canals in
mandibular second molars. Dentomaxillofac Radiol 2005;34:
164-7.
26. Solomonov M, Itzhak JB, Levin A, Katzenell V, Shemesh A.
Successful orthograde treatment of dens invaginatus Type 3 with
a main C-shaped canal based on cone-beam computed tomog-
raphy evaluation. J Conserv Dent 2016;19:587-90.
27. Min Y, Fan B, Cheung GS, Gutmann JL, Fan M. C-shaped canal
www.ijcpd.org 9
International Journal of Clinical Preventive Dentistry
system in mandibular second molars part III: the morphology of
the pulp chamber floor. J Endod 2006;32:1155-9.
28. Gulabivala K, Opasanon A, Ng YL, Alavi A. Root and canal mor-
phology of Thai mandibular molars. Int Endod J 2002;35:56-62.
29. Seo MS, Park DS. C-shaped root canals of mandibular second
molars in a Korean population: clinical observation and in vitro
analysis. Int Endod J 2004;37:139-44.
30. Yilmaz Z, Tuncel B, Serper A, Calt S. C-shaped root canal in a
maxillary first molar: a case report. Int Endod J 2006;39:162-6.
31. Fan B, Min Y, Lu G, Yang J, Cheung GS, Gutmann JL.
Negotiation of C-shaped canal systems in mandibular second
molars. J Endod 2009;35:1003-8.
32. Bolger WL, Schindler WG. A mandibular first molar with a
C-shaped root configuration. J Endod 1988;14:515-9.
33. Barnett F. Mandibular molar with C-shaped canal. Endod Dent
Traumatol 1986;2:79-81.
34. Jerome CE. C-shaped root canal systems: diagnosis, treatment,
and restoration. Gen Dent 1994;2:424-7; quiz 433-4.
35. Chai WL, Thong YL. Cross-sectional morphology and mini-
mum canal wall widths in C-shaped roots of mandibular molars.
J Endod 2004;30:509-12.
10 Vol. 15, No. 1, March 2019
36. Cheung LH, Cheung GS. Evaluation of a rotary instrumentation
method for C-shaped canals with micro-computed tomography.
J Endod 2008;34:1233-8.
37. Kaiwar A, Usha HL, Meena N, Ashwini P, Murthy CS. The effi-
ciency of root canal disinfection using a diode laser: in vitro
study. Indian J Dent Res 2013;24:14-8.
38. Liewehr FR, Kulild JC, Primack PD. Obturation of a C-shaped
canal using an improved method of warm lateral condensation.
J Endod 1993;19:474-7.
39. Walid N. The use of two pluggers for the obturation of an un-
common C-shaped canal. J Endod 2000;26:422-4.
40. Kim HH, Cho KM, Kim JW. Comparison of warm gutta-percha
condensation techniques in ribbon shaped canal: weight of filled
gutta-percha. J Korean Acad Conserv Dent 2002;27:277-83.
41. Soo WK, Thong YL, Gutmann JL. A comparison of four gut-
ta-percha filling techniques in simulated C-shaped canals. Int
Endod J 2015;48:736-46.
42. Sinha DJ, Tyagi SP, Gupta S, Singh UP. The C-shaped canal con-
figuration: a challenge in dentistry. Indian J Contemp Dent
2014;2:32-7.