S-shaped root canals – a case report
17/10/2026
Warning: Undefined variable $post in /home/styleendo/htdocs/styleitaliano-endodontics.org/wp-content/plugins/oxygen/component-framework/components/classes/code-block.class.php(133) : eval()'d code on line 2
Warning: Attempt to read property "ID" on null in /home/styleendo/htdocs/styleitaliano-endodontics.org/wp-content/plugins/oxygen/component-framework/components/classes/code-block.class.php(133) : eval()'d code on line 2
S-shaped root canals can be one of the most challenging anatomies in endodontics. In this case, a careful treatment approach allowed us to manage a severe multiplanar curvature while preserving the original canal anatomy.
Fig. 1
A 28-year-old male patient was referred to the clinic with pain related to tooth 47.
Clinical and radiographic examination revealed deep distal caries and an intraradicular lesion. The pre-operative radiograph showed a complex anatomy of the mesial root canal system with a severe S-shaped curvature.
Because of the complexity of the root canal anatomy, CBCT examination was performed before starting the endodontic treatment.
Fig. 2
The CBCT images clearly demonstrated the three-dimensional anatomy of the mesial root canal system.
A severe multiplanar S-shaped curvature was present, with the canal changing its direction along the root.
The CBCT was therefore used to understand the direction and length of the canal and to plan the access, glide path and shaping procedure.
Fig. 3
After shaping and irrigation, working length was confirmed and master cones fitted.
The master cone radiograph showed good adaptation to the prepared canal system.
Canals were obturated with bioceramic sealer and gutta-percha using hydraulic condensation.
The postoperative radiograph showed a well-filled mesial canal system, with original anatomy preserved despite the pronounced S-shaped curvature.
Fig. 4
Clinical picture for the treatment steps.
Fig. 5
- Dr. Amin Helani graduated in 2014 from the University of Aleppo in Syria.
- In 2021, he received a specialist degree in Endodontics from the German Society of Endodontics.
- He works as a Microscopic Endodontist for advanced root canal treatment in Berlin, Germany.
- He has been offering lectures, webinars, and hands-on courses to both general dentists and endodontists.
- He is a member of the German Society for Endodontology and Traumatology.
- He is a fellow member of Style Italiano Endodontics.
Conclusions
S-shaped root canals can represent a significant challenge during endodontic treatment.
Understanding the three-dimensional anatomy before instrumentation is an important step in reducing procedural risks. In complex cases, CBCT can provide valuable information about the direction and morphology of the root canal system.
A conservative and controlled shaping approach, together with adequate irrigation and magnification, can help to maintain the original canal anatomy and achieve predictable treatment results.
The key to managing severely curved canals is not to force the instruments through the curvature, but to allow the instruments to follow the natural anatomy of the root canal.
Bibliography
-Chaniotis A, Ordinola-Zapata R. Present status and future directions: Management of curved and calcified root canals. Int Endod J. 2022;55(3):656-684.
-Elayouti A, Dima E, Judenhofer MS, Löst C, Pichler BJ. Increased apical enlargement contributes to excessive dentin removal in curved root canals: a stepwise microcomputed tomography study. J Endod. 2011;37(11):1580-1584.
-Hartmann RC, Fensterseifer M, Peters OA, de Figueiredo JAP, Gomes MS, Rossi-Fedele G. Methods for measurement of root canal curvature: a systematic and critical review. Int Endod J. 2019;52(2):169-180.
-Estrela C, Bueno M, Sousa-Neto MD, Pécora JD. Method for determination of root curvature radius using cone-beam computed tomography images. Braz Dent J. 2008;19(2):114-118.
-Schilder H. Cleaning and shaping the root canal. Dent Clin North Am. 1974;18(2):269-296. Ruddle CJ. Cleaning and shaping the root canal system. In: Cohen S, Burns RC, eds. Pathways of the Pulp. 8th ed. St. Louis, MO: Mosby; 2002.
