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41]

Review Article

A brief review of the methods used

to determine the curvature of root
canals 
Pooja Balani, Fayez Niazi1, Haroon Rashid2
Departments of Conservative Dentistry, 1Oral Biology and 2Fixed and Removable Prosthodontics, College of Dentistry, Ziauddin University, Karachi, Pakistan

Address for correspondence: Dr. Haroon Rashid, College of Dentistry, Ziauddin University, Karachi, Pakistan. E‑mail: drh.rashid@hotmail.com

ABSTRACT Successful endodontic therapy is largely dependent on a triad of access cavity, canal preparation, and
three‑dimensional hermetically sealed obturation of the canals. Canal preparation is the most vital
part of the triad that can be very challenging due to the complex morphology of the root canal system.
Clinicians quite frequently encounter severe canal curvatures of different degrees within the roots that
lead to a variety of problems including ledge formation, separation of instruments, canal blockage,
and tear‑drop transportation at the apex or perforation. Anatomical variations within the complex root
canal morphology are the commonest cause of endodontic treatment failure. It is, therefore, essential
to have a thorough knowledge about the internal and external morphologies of teeth. The aim of the
current paper is to review the methods used to determine the root canal curvature and its management.

Keywords: Canal blockage, curved canals, root canal curvature , root canal morphology

INTRODUCTION
The main purpose of endodontic therapy is to treat
diseased (vital or necrotic) dental pulp so that the
function and appearance of the treated natural tooth
can be maintained.[1] The therapy involves the removal
of diseased dental pulpal tissue, preparing the root
canals along with proper irrigation solutions, and
then sealing them subsequently using an inert filling
material.[2] Once the canals are sealed, a coronal seal
must be provided so that bacterial ingress from the
coronal portion may be prohibited.[3] The literature
states that an ideal canal preparation is one in which
the original canal morphology is maintained during
the preparation procedure, along with the flare taper
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shape from the coronal to the apical region and thus,
preserving the apical foramen.[2] This, however, may not
be always possible due to the complexity of the root canal
morphology. Common challenges that endodontists
usually encounter during endodontic therapy are:
• Accessing all the canals without encountering a
procedural error
• Maintaining the adequate working length and
obturating the canal to its full working length
• Preparing the canals by maintaining the adequate
size and geometries of canals in all directions.
Unfortunately, the root canal morphology is not always
as straight and simple as it appears on the radiographs.
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DOI: How to cite this article: Balani P, Niazi F, Rashid H. A brief review of the
10.4103/2321-4619.168733 methods used to determine the curvature of root canals.
J Res Dent 2015;3:57-63.

© 2015 Journal of Restorative Dentistry | Published by Wolters Kluwer - Medknow • 57

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Balani, et al.: Methods of determining curvature of the root canals
Various curves are present along the length of the canal
and the preparation of these curved root canals becomes
very challenging for a clinician. These curved canals may
also restrict the mechanical and chemical preparation
of the curvature or may lead to some procedural errors
affecting the prognosis. The classification of root canal
curvatures is enumerated in Table  1. Preoperative
assessment of the root canal morphology is thus
necessary so that the complexity, the degree of curvature,
and radius of the root canals are determined to an
extent. This will significantly reduce the occurrence of
the procedural errors and the excess removal of tooth
structure from the inner curvature, resulting in stripping
or zip formation.[4,5]
In the past few decades, only the angle of the canal
curvature was the focus for categorizing the  root canal
morphology and the curvature. The canal was classified
as either straight (if the angle was 5° or less), moderately
curved (if the angle was 10‑20°), or severely curved
(if the angle was >20°). Later, it was proposed that the
degree, position, and severity of the canal curvature also
play an important role.[1]
Also, it is also important to choose the correct instruments
and instrumentation techniques as the final outcome of
endodontic treatment in curved canals depends largely
on the flexibility of the instruments used, diameter of
the instrument, and technique of the instrumentation.[6]
The common challenge that a practitioner may encounter
during the treatment of complex canals are:[7]
• Negotiating the root canal curvature
• Enlarging the canal space by maintaining the original
internal anatomy of the canal
• Creating a taper‑shaped canal to optimize irrigation
and obturation.
DETERMINING THE ROOT CANAL
CURVATURE
Curvature of the root canal system should be determined
preoperatively to avoid procedural errors and subsequent
treatment failure. The following methods can be used for
root canal curvature determination:
Table 1: Classification of root curvature[1,3,4]
According to Schneider’s
anatomic location classification
Apical third curvature Straight
(if angle <5)
Middle third curvature Moderately curve
(if angle is 10-20)
Coronal third curvature Severely curved
(if angle is >20)
58 • Journal of Restorative Dentistry / Vol - 3 / Issue - 3 / Sep-Dec 2015
Periapical radiographs
These can be used to assess the root curvature but may
lead to misinterpretation since the radiographs produce
a two‑dimensional image of a three‑dimensional object[5]
and thus, curvatures that are present buccolingually
may not be visible. The majority of the canals do have
some curvature on the different planes and thus, it is
not possible to demonstrate them solely on the basis of
radiographs.[4]
Cone beam computed tomography
CBCT is a new advancement in the field of radiology
as described by  Atria et al.[8] and Moshiri et al.,[9] and is
specifically used for detailed three‑dimensional imaging
of oral and maxillofacial structures. The technique
reduces the incidence of false negative results as it
overcomes the limitations of the conventional radiograph
such as image distortion, anatomic superimposition,
and the compression of three‑dimensional objects into
two‑dimensional images. CBCT helps in assessing the
true size, extent, nature, and position of the lesions as
compared to conventional radiography, that is, periapical
radiographs or orthopantomogram (OPG).[10] Periapical
pathology can be detected sooner as compared to other
radiological approaches,[10] as the lesions that are present
in the cancellous bone can only be detected using
CBCT.[11]    CBCT can be divided into large, medium,
and small limited units based on the size of the field of
view (describing the scan volume of CBCT machine), and
depends on the detector size and shape, beam projection
geometry, and ability to collimate the beam.[12] Unlike
medial computed tomography (CT) scanner that has
fan‑shaped beam of x‑rays, CBCT projects pyramid‑ or
cone‑shaped x‑ray beam. The position of the patient
depends on the manufacturer of the system and he/she
can be in a supine, standing, or sitting position and
the x‑ray source and scanner makes a complete or
half‑rotation around the patient’s head to capture the
field of view. The images are then visualized using
computer software at different anatomic planes.[10]
The radiation dose of the CBCT is much less than
the medical scanner or conventional radiograph. The
effective dose of one CBCT unit is equivalent to the
Dobo-Nagy Radius-based Shape-based
classification curvature curvature
I shape Severely curved Apical gradual curve
(straight) (r<4 mm)
J shape Moderately curved Sickle-shaped curve
(apical curve) (r>4 mm; <8 mm)
C shape mild curvature Bayonet curve
(entirely curve) (r>8 mm)2
S shape Dilacerated curve
(multicurve)
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Balani, et al.: Methods of determining curvature of the root canals
dose of two or three standard periapical radiographic
exposures. [8] CBCT provides a better view of root
canal morphology as compared to radiographs. For
example, the buccolingual curvatures that are missed in
radiographs can be seen in a CBCT image.
The radius of root curvature can be determined through
CBCT measured by the circumcenter using   Planimp
software  (CDT Informatics, Cuiabá, MT, Brazil, 3D
imaging system) based on the three mathematical points.
Two semi‑straight lines of 6 mm are drawn and the
midpoint of the lines is determined. Perpendicular lines
from the midpoint of each primary semi straight lines are
drawn  until they meet at a central point that is termed
the circumcenter. The distance between the circumcenter
and the midpoint of each semi‑straight line will actually
determine the magnitude of the canal curvature.[2] The
smaller the radius, the greater the curvature and thus
more complex the root canal structure.[13]
According to this method, curvature can be classified as:
• Small radius (r < 4 mm): Severe curvature
• Intermediary radius (r > 4 and r < 8 mm): Moderate
curve
• Large radius (r > 8 mm): Mild radius.[2]
Schneider’s method
Using this method, a mid‑point is marked on the file
at the level of the canal orifice. A straight line is drawn
parallel to the image and that point is labeled as point A.
Another second point is marked where the flare starts to
deviate that is labeled point B. A third point is marked at
the apical foramen and is termed point C and the angle
formed by   the intersection of these lines is measured
[Figure 1]. If the angle is less than 5°, the canal is straight;
if the angle is 5‑20°, the canal is moderately curved; and
if the angle is greater than 20°, the canal is classified as
a severely curved canal.[14,15]
Figure 1: Diagrammatic representation of Schneider’s method
Journal of Restorative Dentistry / Vol - 3 / Issue - 3 / Sep-Dec 2015 • 59
Lutein method
Lutein et al.[16] modified Schneider’s method by using two
lines drawn by the identification of four geometric points.
Point A is first marked at the center of the canal orifices and
then point B is marked 2 mm below the orifices in the long
axis of the canal. A first primary line is drawn joining point
A and point B and then point C is marked 1 mm coronal
to the apical foramen. Point D is marked at the apical
foramen then a second primary line is drawn joining these
two lines [Figure 2]. The angle formed by intersection of
the two lines is measured as in the Schneider method.[17]
Cunningham’s and Senia’s  method
This approach is different as it focuses on multiple root
curvatures, that is, S‑shaped canals, and the angle is
measured separately at the coronal and apical ends.
Point A is first drawn at the center of the orifices and then
Point B is marked where the deviation or curve of the
canal starts and a line is drawn joining these two lines.
Point C is then marked where the canal again changes
its direction or the deviation starts and point C is joined
with point B. Point D is finally marked at the apical area
and joined with point C [Figure 3].
The angle formed by the intersection of lines through
points A and B and then points B and C is named angle X
while the angle formed by the intersection of lines through
points B and C and points C and D is named angle Y.[17]
Weine’s method
Weine[18] described another method for the determination
of root canal curvature similar to Schneider’s
method [Figure 4] but showed the differences in the
angles according to curvature of the canal. In this
method, a straight line is drawn from the canal orifices to
the point of curvature and a second line is drawn from the
apex for the apical curvature and the angle is measured
at the point of intersection between the two lines.[15]
Figure 2: Diagrammatic representation of Lutein method
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Balani, et al.: Methods of determining curvature of the root canals
Figure 3: Diagrammatic representation of Cunningham’s and Senia’s
method
DETERMINING THE HORIZONTAL  that a straight line access is gained into the canals.[20]
DIMENSION
Determining the horizontal dimension of the root canal
is one of the challenging factors since the horizontal
dimension varies at different vertical dimensions.
These dimensions are often known as the “forgotten
dimension” as very few studies have been carried out
for determining the horizontal dimension.
The classification of root canal according to horizontal
dimension is as follows:
• Round (the maximum initial working width is equal
to the minimum initial working width)
• Oval (the maximum initial working width is up to
two times greater than the minimum initial working
width)
• Long oval (the maximum initial working width is up
to four times more than the minimum initial working
width)
• Flattened  (the maximum initial working width is
more than four times greater than the minimum
initial working width)
• Irregular  (cannot be defined by any of the above
types);[19] to maintain the horizontal dimension at
different levels of the root canal, circumferential
filing should be used to prepare the canal.
MANAGEMENT OF ROOT CURVATURES
Managing apical curvatures
The tooth at the apical third area is mostly curved and
it is important to state that an attempt to straighten it
should not be made or else treatment failure may be
the outcome due to direct perforation, formation of
ledges, and creation of teardrop foramen or foraminal
rip.
60 • Journal of Restorative Dentistry / Vol - 3 / Issue - 3 / Sep-Dec 2015
Figure 4: Diagrammatic representation of Weine’s method
To avoid these misfortunes, it is highly recommended
The preparation can then be started using a smaller
diameter K file such as #08 or #10. These smaller
diameter files can also be precurved in the direction
of the apical curvature.[21] A chelating agent such as
ethylenediaminetetraacetic acid (EDTA) must be used,
along with copious irrigation of the canals with sodium
hypochlorite, and once a file is withdrawn from the
canal, it must be cleaned and recurved before it is
reintroduced.[13] Segal[20] suggested that a reamer should
be used instead of K‑file since it is more flexible in nature
and provides a perfect mirror appearance of the canal
curvature. Once removed, it describes the degree, type,
location, and direction of the curvature. However, due
to its flexibility it may also lead to canal transportation.
Once an access cavity is prepared, the root canal
preparation should be started with stainless steel files of
smaller diameter with light passive movement to debride
the pulpal tissues and negotiate the apical area. Stainless
steel files with a larger diameter must be avoided as
they may alter the actual internal anatomy of the canal.
The diameter of the glide path is then increased with
nickel‑titanium (NiTi) hand files before the preparation
of the canal with rotary NiTi file.[13,17] NiTi rotary files are
flexible and very promising; however, multiple curves in
the canals may cause strain in these instruments leading
to instrument separation or ledge formation.
Managing middle curvatures
Mid‑canal curvatures are relatively difficult to handle,
especially if the coronal third of the root is straight
and if this is not adequately dealt with, it may lead to
iatrogenic errors such as file separation, perforations,
ledge formation, and blockage of canals decreasing the
prognosis of the tooth.[4] The relationship between the
degree of curvature and incidence of ledge formation is
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Balani, et al.: Methods of determining curvature of the root canals

enumerated in Table 2.[22] Preoperative assessment and
the usage of correct instrumental technique are highly
recommended. The two steps for better management of
mid‑root curvature are adequate access and good coronal
third preparation. This will ensure greater volume of
irrigant to reach the mid‑portion of the canal and allow
instrumentation without any restriction and thus,
create an ideal platform for the preparation of mid‑root
curvature. Once the coronal third portion of the canal is
prepared, the mid‑portion is prepared using precurved
files. The bend given on the file should be gentle as sharp
acute bends increase the probability of file fracture. The
precurved file helps in negotiating the canal and makes
a glide path before rotary NiTi files are introduced for
cleaning and shaping.[4,13]
DIFFERENT INSTRUMENTAL TECHNIQUES
The instruments used for canal preparation and
instrumentation technique were first described by
Fauchard. [23] Edward Maynard is considered as
the pioneer of endodontic hand instruments while
Oltramare was the first to introduce rotary instruments
for the preparation of root canal.[24‑26] Racer endodontic
Table 2: Relationship between the degree of curvature and
incidence of ledge formation[23]
Angle of canal curvature Incidence of ledge formation (%)
Straight canal (<5°) 12.5
Moderately curved canal (<20°) 49.5
Severely curved canal (<20°) 52.3
handpiece was the first one to be introduced that worked
with vertical filing motion. Later on, Giromatic handpiece
was introduced with a reciprocal 90˚ rotation. NiTi
hand files familiarized by Walia et al.[27] and NiTi rotary
instruments with more flexible file were introduced for
better preparation and to avoid mishaps during canal
preparation.[28] However, mechanical instrumentation
remains an important phase of root canal treatment that
should never be neglected. Several methods/techniques
of canal instrumentation have been proposed.
Schilder[29] described the “concept of flow” and design
objectives according to which the canal should be
tapering with the apical foramen essentially as narrow as
possible without any modification in its original position.
Along with design objectives, he also emphasized the
biological objectives suggesting the adequate removal of
diseased tissue from the canal while making sure that the
necrotic debris is not extruded from the apical foramen.
Also, it was suggested that there should be sufficient
space for irrigation and intracanal medicaments.
Many techniques for canal preparation have been
described. Table 3 shows a summary of the different
instrumental techniques used in endodontics.
Standardized technique, the first formal technique for
canal preparation was described by Ingle.[35] In this
technique, it was recommended that each file should be
introduced up to the full working length of the canals
so that a taper could be created and the canals are then
subsequently filled using a single cone of gutta‑percha.[28]

Table 3: Summary of the different instrumentation techniques[28-34]

Instrumentation Method Merits Demerits
technique
Balanced forced Placement phase (placement of file with a clockwise Better apical control of file High incidence of
technique motion of maximum 180° with apical advancement) Less amount of extrusion of debris procedural errors such
Cutting phase (counterclockwise rotation of 120° from canal as instrument breakage
with apical pressure) Good centering of instrument in and canal stripping
Removal phase (clockwise rotation with coronal the canal Requires more working
movement of file) time
Step back Apical preparation is done with smaller files and Comparatively better than the Increased incidence
technique then the length of file is reduced with increase in file standardized technique of perforation and
size iatrogenic errors in
severely curved canals
Step down The coronal portion of the canal is prepared before Less periapical extrusion of debris Increased incidence of
technique the apical portion and then the apical area is Less apical zip formation ledge formation
prepared with smaller files Less chances of ledge formation
Straight access to the apical region
Better penetration of irrigant
Standardized The file or reamer is inserted to the full working Easy to prepare straight canal Ledge formation,
technique length and the canal is cleaned zipping, and perforation
in severely curved canal
Anticurvature Selective filing in the coronal portion of curved Less incidence of perforation in Requires expertise
technique canals to prevent strip perforations into the curved canals
furcation; the walls on the opposite side from the
curve are instrumented more than the inner walls,
resulting in a decrease of the overall degree of
canal curvature

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Balani, et al.: Methods of determining curvature of the root canals
Roane [36] in 1970 described a new instrumentation
technique for canals with severe curvatures. The technique
was termed as the “balanced forced instrumentation
technique.” Different instrumental motions were carried
out to balance the action and reactions that took place
during the canal preparation with specially designed
stainless steel and NiTi hand files with modified tips. In
balanced forced technique, the instruments are placed
in the canal using very light, inward clockwise rotation
(1/4 turn). Once the file moves in the apical direction, a
counterclockwise movement  (1/2 turn) is given while
holding the file with a slight inward pressure. Cleaning
or removal of the debris is accomplished only by an
outward clockwise motion with no pressure. This
sequence of instrumentation is continued until the
working length is achieved.[37]
Circumferential filing and instrumentation of all walls
are carried out equally during the root canal preparation.
Hedstrom files are very effective for this technique.
Anticurvature filing technique was first described by
Abou‑Rass and Jastrab.[38] Using that technique, the
files are directed away from the danger zone in molars
and toward the bulkiest portion of the root structure.
This technique is very useful in cases where there is
a chance of strip perforation into the furcation. With
this method, the dental practitioner maintains digital
control over the endodontic instrument. The walls
on the opposite side from the curve are instrumented
more than the inner walls, resulting in a decrease of the
overall degree of canal curvature. In severely curved
canals, the instrument should be modified from certain
specific sites to avoid overcutting from the outer curve
in the apical region and from the inner curve in case of
mid‑root curvature.[37]
Ideal canal preparation may not always be possible
due to certain factors including complex root canal
morphology, anatomical variations, microbiological
variations, and iatrogenic mishaps.   Endodontic mishaps
are unfortunate and usually occur during endodontic
procedures. They are either caused by the lack of
skill, poor instrumental techniques, or due to complex
and unpredictable morphology of the root canal. [22]
Weine et al.[39,40] and Gliackman and Dumsha[41] were the
ones who described the iatrogenic mishaps that occur
during the root canal procedure. The most common
complication occurring during poor instrumentation
technique is the formation of the ledge.[28] Ledge is
actually an iatrogenic defect occurring at the outer
surface of the walls of the canal during instrumentation,
preventing access of the instrument toward the
apex of the root. Since ledge formation hinders the
instrumentation and chemical cleaning of the canals,
it increases the probability of treatment failure and
eventually results in periapical pathosis.[22] Ledge can
62 • Journal of Restorative Dentistry / Vol - 3 / Issue - 3 / Sep-Dec 2015
be formed due to a number of reasons that may include
failure of the clinician to assess root canal curvature
preoperatively, failure to use a precurved file, inadequate
irrigation, use of endodontic files of greater diameter
in a curved canal, inadequate technique, and failure to
use root canal instruments in a sequential manner.[30]   In
a study by Jafarzadeh et al., the frequency of ledge
formation was found to usually increase if the canal
curvature was greater than 20˚[22] and the mesiobuccal
and mesiolingual canals are said to be more frequently
involved than distobuccal or distolingual canals. [31]
The role of instrumentation technique and instrument
material is also related to ledge formation and more
incidences of ledge formation with reaming motion and
step back technique have been reported.[42]
Another common mishap is canal perforation that could
be access cavity perforation, furcal perforation, or root
perforation (cervical, mid‑root, or apical). Perforations
usually occur due to over instrumentation or forceful
instrumentation.[32] Cervical perforation occurs when
not using Gates‑Glidden burs properly or when large
instruments are used for coronal flaring. The first sign
that a clinician may encounter is bleeding in the floor
that can be managed by filling the defect with mineral
trioxide aggregate (MTA) and a temporary filling initially
followed by permanent filling. Similarly, in case of a
mid‑root perforation, MTA may be used for the repair.
Apical perforation that is caused by using longer
instruments can be recognized by bleeding or  by sudden
response from the patient. This defect is repaired by
packing a small amount of MTA at the apex to form
a barrier between the gutta‑percha and the periapical
area.[39] Other iatrogenic mishaps include zip formation,
strip formation, instrument separation, and damage to
the apical foramen if correct instrumentation technique
is not used.[33,34]
CONCLUSION
Root canal treatment can be very challenging for an
endodontist due to complex anatomy and the presence of
severe root curvatures that causes hindrance during ideal
preparation of the canal.   The curvature may vary from
gradual curvature of the entire canal, sharp curvature of
the canal near the apex, or a gradual curvature of the canal
with a straight apical ending. S‑shaped canals (double
curvature) may also occur and success in negotiating
these canals depends on the size and construction of
the canal, degree of curvature, size and flexibility of
the instrument, along with the skills of the operator.
Therefore, preoperative assessment of the horizontal and
vertical variations of the canals should be done and a
proper instrumental technique is very necessary to avoid
procedural errors. Moreover, hand instrumentation is a
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Balani, et al.: Methods of determining curvature of the root canals
time‑tested, easy, and economic method for root canal
treatment but care must be taken during their use to
avoid problems like ledge formation, creation of zip,
transportation, and instrument breakage. In severely
curved canals, the use of rotary NiTi files after making a
glide path with hand stainless steel files is recommended.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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