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This is seen most commonly in mandibular second molars. Its prevalence has been associated with ethnicity. Interestingly, the prevalence of this canal in Asian populations has been higher than other populations.

The failure of the Hertwig’s epithelial-root sheath to fuse on the lingual or buccal root surface was the main cause of a C-shaped root.

• They are so named because of the cross-sectional morphology of their roots and root canals. 
• Instead of having several discrete orifices, the pulp chamber of a molar with a C-shaped root canal system is a single, ribbon-shaped orifice with an arc of 180 degrees or more. It starts at the mesiolingual  line angle and sweeps around either to the buccal or the lingual to end at the distal aspect of the pulp chamber.

Clinical significance

• Because of the large area of canal space, it is doubtful that intracanal instruments can reach and debride the entire portion of the continuum, making irrigation procedures more significant
• Ample amount of time should be spent on cleaning and shaping using sodium hypochlorite
• When negotiating the C-shaped canal, instruments may be clinically centered. Radiographically, the instruments may either converge at the apex or may appear to be exiting the furcation, thus adding to the confusion and troublesome task of determining whether a perforation has occurred
• Hand instrumentation is preferred to preserve root canal dentin thickness and prevent root fracture
• Thermoplasticized obturation is preferred to seal all the irregularities in the canal.

Understanding the anatomical presentations of this variation will enable the clinician to manage these cases effectively.

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