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References 1 CHAPTER 5 Tooth Morphology, Isolation, and Access 205 found that 33% of Koreans had a C-shaped canal morphology diagnosis difficult. However, radiographically a tooth with a in mandibular second molars.105,189 C-shaped canal system always has a fused root with a longitu- Four types of pulpal floors were found in mandibular dinal groove in the middle of the root.63 Furthermore, there are second molars137: three types of C-shaped canal systems in mandibular second Type I: A peninsula-like floor with continuous C-shaped molars (see Fig. 5-175).73 orifice (see Fig. 5-174). Type I (merging type): Canals merge to one main canal Type II: A buccal, striplike dentin connection between the before exiting at the apical foramen peninsula-like floor and the buccal wall of the pulp Type II (symmetric type): Separated mesial and distal canals chamber that separates the C-shaped groove into mesial in each root exit as separate canals (M) and distal (D) orifices. Sometimes the mesial Type III (asymmetric type): Separated mesial and distal orifice is separated into a mesiobuccal (MB) orifice and canals, with the distal canal having a long isthmus across a mesiolingual (ML) orifice by another striplike dentin the furcation area connection between the peninsula-like floor and the The minimal wall thickness in the middle and apical mesial wall of the pulp chamber (most common) (see parts of type III and in the apical part of type II makes these Fig. 5-174). regions danger zones for canal enlargement procedures (see Type III: Only one mesial, striplike dentin connection Fig. 5-176).73 between the peninsula-like floor and the M wall, which Another study on mandibular molars found that there is a separates the C-shaped groove into a small ML orifice higher risk of root perforation at the thinner lingual walls of and a large MB-D orifice. The MB-D orifice was formed C-shaped canals during shaping and after canal preparation by the merging of the MB orifice and the D orifice procedures. Both buccal and lingual canal walls were frequently (second most common) (see Fig. 5-174). narrower at the mesial locations.36 Type IV: Non–C-shaped floors. One distal canal orifice and The access cavity for teeth with a C-shaped root canal one oval or two round mesial canal orifices are present system varies considerably and depends on the pulp morphol- (least common) (see Fig. 5-174). ogy of the specific tooth. Teeth with C-shaped anatomy pose Not all C-shaped mandibular second molars with C-shaped a considerable technical challenge; therefore, use of the DOM canal systems have a C-shaped pulpal floor. This makes during all treatment phases is recommended. REFERENCES 1. Abbott PV: Assessing restored teeth with pulp and canal orifice, Oral Surg Oral Med Oral Pathol Oral Radiol 30. 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Beatty RG, Krell K: Mandibular molars with five canals: minimum canal wall widths in C-shaped roots of treated mandibular first molars in a Saudi Arabian report of two cases, J Am Dent Assoc 114:802, 1987. mandibular molars, J Endod 30:509, 2004. sub-population, Int Endod J 32:49, 1999. 23. Benenati FW: Maxillary second molars with two palatal 37. Chan K, Yew SC, Chao SY: Mandibular premolars with 9. Al-Qudah AA, Awawdeh LA: Root canal morphology of canals and a palatogingival groove, J Endod 11:308, 1985. three root canals: two case reports, Int Endod J 25:261, mandibular incisors in a Jordanian population, Int Endod J 24. Benjamin KA, Dowson J: Incidence of two root canals in 1992. 39:873, 2006. human mandibular incisor teeth, Oral Surg Oral Med Oral 38. Christie WH, Peikoff MD, Acheson DW: Endodontic 10. 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Cooke HG, Cox FL: C-shaped canal configurations in dental operating microscopes in locating the mesiolingual molars, J Endod 28:324, 2002. mandibular molars, J Am Dent Assoc 99:836, 1979. 206 PART I The Core Science of Endodontics 44. Coolidge ED: Anatomy of the root apex in relation to 72. Funato A, Funato H, Matsumoto K: Mandibular central 99. Kartal N, Ozcelik B, Cimilli H: Root canal morphology of treatment problems, J Am Dent Assoc 16:1456, 1929. incisor with two root canals, Dent Traumatol 14:285, maxillary premolars, J Endod 24:417, 1998. 45. Cunningham CJ, Senia ES: A three-dimensional study of 1998. 100. Kartal N, Yanikoglu FC: Root canal morphology of canal curvature in the mesial roots of mandibular molars, 73. Gao Y, Fan B, Cheung GSP, et al: C-shaped canal system mandibular incisors, J Endod 18:562, 1992. J Endod 18:294, 1992. in mandibular second molars. IV. Morphological analysis 101. Kasahara E, Yasuda E, Yamamoto A, Anzai M: Root canal 46. 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