Endodontic management of C-shaped canals: A case series
https://doi.org/10.36377/ET-0113
Abstract
INTRODUCTION. C-shaped root canals represent a complex anatomical variation, primarily seen in mandibular molars. Their intricate morphology poses significant challenges for diagnosis, cleaning, shaping, and obturation in endodontic practice.
AIM. To present a series of clinical cases illustrating the diagnosis and endodontic management of different types of C-shaped canals based on Fan’s classification.
MATERIALS AND METHODS. Four clinical cases involving mandibular molars with C-shaped canal configurations were managed in accordance with CARE and PRICE guidelines. Each case included clinical and radiographic diagnosis, working length determination, cleaning and shaping with either the R2 Reciproc (VDW) or PlexV (Orodeka) system, irrigation with NaOCl and EDTA under ultrasonic activation, and obturation using thermocompaction or single-cone techniques with bioceramic sealers.
RESULTS. All cases demonstrated successful identification and management of C-shaped canal systems (types C1 to C4). Clinical and radiological follow-up at 1 and 3 months showed favorable healing with resolution of symptoms and periapical pathology.
CONCLUSIONS. Early and accurate diagnosis of C-shaped canals, supported by clinical and radiographic examination, is critical for successful endodontic outcomes. The use of magnification, appropriate canal preparation techniques, and bioceramic materials significantly enhances treatment success in such complex anatomical variations.
Supporting agencies: There are no funding and individual acknowledgments to declare.
About the Authors
K. B. Salah
University of Monastir
Tunisia
Competing Interests:
Tunisia
Kawther Belhaj Salah – Faculty of Dental Medicine of Monastir, University of Monastir, Department of Restorative Dentistry and Endodontics, University Hospital of Farhat Hached, University of Sousse, Sousse
Competing Interests:
The authors report no conflict of interest.
H. Boukhris
University of Monastir
Tunisia
Competing Interests:
Tunisia
Hanen Boukhris – Research Laboratory LRSP10, Faculty of Dental Medicine, University of Monastir, Department of Prosthodontics, University Hospital of Farhat Hached, University of Sousse, Sousse
Competing Interests:
The authors report no conflict of interest.
H. Zidani
University of Monastir
Tunisia
Competing Interests:
Tunisia
Hajer Zidani – Faculty of Dental Medicine, University of Monastir, Department of Prosthodontics, University Hospital of Farhat Hached, University of Sousse, Sousse
Competing Interests:
The authors report no conflict of interest.
I. Gnaba
University of Monastir
Tunisia
Competing Interests:
Tunisia
Imen Gnaba – Faculty of Dental Medicine of Monastir, University of Monastir, Department of Restorative Dentistry and Endodontics, University Hospital of Farhat Hached, University of Sousse, Sousse
Competing Interests:
The authors report no conflict of interest.
S. B. Youssef
University of Sousse
Tunisia
Competing Interests:
Tunisia
Souha Ben Youssef – University Hospital of Farhat Hached, University of Sousse, Sousse
Competing Interests:
The authors report no conflict of interest.
References
1. Shihab D.M., Mahdee A.F. Root and root canal morpho- logy: study methods and classifications. J Baghdad Coll Dent. 2021;33(4):11–19. https://doi.org/10.26477/jbcd.v33i4.3014
2. Jafarzadeh H., Wu Y.N. The C-shaped root canal confi- guration: a review. J Endod. 2007;33(5):517–523. https://doi.org/10.1016/j.joen.2007.01.005
3. Fan B., Cheung G.S., Fan M., Gutmann J.L., Fan W. C-shaped canal system in mandibular second molars: Part II – Radiographic features. J Endod. 2004;30(12):904–908. https://doi.org/10.1097/01.don.0000136206.73115.93
4. Fan B., Cheung G.S., Fan M., Gutmann J.L., Bian Z. C-shaped canal system in mandibular second molars: Part I – Anatomical features. J Endod. 2004;30(12):899–903. https://doi.org/10.1097/01.don.0000136207.12204.e4
5. 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(11):1012–1033. https://doi.org/10.1111/iej.12256
6. Cimilli H., Cimilli T., Mumcu G., Kartal N., Wesselink P. Spiral computed tomographic demonstration of C-sha- ped canals in mandibular second molars. Dentomaxillofac Radiol. 2005;34(3):164–167. https://doi.org/10.1259/dmfr/64778606
7. Zheng Q., Zhang L., Zhou X., Wang Q., Wang Y., Tang L. et al. C-shaped root canal system in mandibular second molars in a Chinese population evaluated by cone-beam computed tomography. Int Endod J. 2011;44(9):857–862. https://doi.org/10.1111/j.1365-2591.2011.01896.x
8. Jung H.J., Lee S.S., Huh K.H., Yi W.J., Heo M.S., Choi S.C. Predicting the configuration of a C-shaped canal system from panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(1):E37–E41. https://doi.org/10.1016/j.tripleo.2009.08.024
9. Melton D.C., Krell K.V., Fuller M.W. Anatomical and histological features of C-shaped canals in mandibular se- cond molars. J Endod. 1991;17(8):384–388. https://doi.org/10.1016/S0099-2399(06)81990-4
10. Sutedjo M. C-shaped canal configuration in mandibular second molar. Style Italiano Endodontics; July 28, 2017. Available at: https://endodontics.styleitaliano.org/cshaped-canal-configuration-in-mandibular-secondmolar/ (accessed: 07.06.2025).
11. Seo M.S., Park D.S. C-shaped root canals of mandibular second molars in a Korean population: clinical observation and in vitro analysis. Int Endod J. 2004;37(2):139–144. https://doi.org/10.1111/j.0143-2885.2004.00772.x
12. Aricioğlu B., Tomrukçu D.N., Köse T.E. Taurodontism and C-shaped anatomy: is there an association? Oral Radiol. 2021;37(3):443–451. https://doi.org/10.1007/s11282-020-00476-5
13. Sönmez Kaplan S., Kaplan T., Sezgin G.P. Evaluation of C-shaped canals in mandibular second molars of a selected patient group using cone beam computed tomography: prevalence, configuration and radicular groove types. Odontology. 2021;109(4):949–955. https://doi.org/10.1007/s10266-021-00616-1
14. Ahmed H.M.A., Dummer P.M.H. (eds). Endodontic advances and evidence-based clinical guidelines. Chichester: Wiley-Blackwell; 2022. 832 p.
15. Gomez F., Brea G., Gomez-Sosa J.F. Root canal morphology and variations in mandibular second molars: an in vivo cone-beam computed tomography analysis. BMC Oral Health. 2021;21(1):424. https://doi.org/10.1186/s12903-021-01787-7
16. De Deus G., Silva E.J.N.L., Souza E., Versiani M.A., Zuolo M. (eds). Shaping for cleaning the root canals: A clinical-based strategy. Cham: Springer; 2022. 370 p. https://doi.org/10.1007/978-3-030-84617-6
17. Albuquerque D., Kottoor J., Hammo M. Endodontic and clinical considerations in the management of variable anatomy in mandibular premolars: a literature review. Biomed Res Int. 2014;2014:512574. https://doi.org/10.1155/2014/512574
18. Singhal R., Singla M.G., Wahi P., Bhasin P., Garg A., Nangia D. Sealing ability of three bioceramic sealers using sea- ler-based obturation method after immersion in simulated body fluid. J Conserv Dent Endod. 2025;28(2):199–203. https://doi.org/10.4103/JCDE.JCDE_605_24
Review
For citations:
Salah K.B., Boukhris H., Zidani H., Gnaba I., Youssef S.B. Endodontic management of C-shaped canals: A case series. Endodontics Today. https://doi.org/10.36377/ET-0113
Email this article 