Braz Dent 3 (1991) 2 (1): 45-50 Morphologic Study of the Maxillary Molars Part I; External Anatomy Jesus Djalma PECORA! Julian B. WOELFEL? Manoel Damido SOUSA NETO! "Faculdade de Odontologia de Ribeirdo Preto Universidade de Séo Paulo Ribeirdo Preto, SP, Brasil 2 Ohio State University College of Dentistry Columbus, OH, USA ‘The authors studied the external anatomy, root curvature and degree of root fusion of 744 maxillary first, second and third molars. The root lengths and root curvatures were quite similar on the first and second molaré with their lingual roots curving toward the buccal on 54.6% and 52.3% of them, respectively. Complete separation of all three roots was observed on 86.4% of the first molars, 75.9% of the second molars and on only 18.8% of the third molars Key Words: external anatomy, maxillary molars. Introduction One of the main reasons for the failure of root canal therapy is the lack of sufficient knowledge concerning the anatomy of teeth, both internal and external. Successful endodontic treatment of a tooth demands that the dentist have good knowledge of root canal morphology. Many types of root curvatures cannot be detected on radiographs. The objectives of this investigation were to measure and examine the root curvature on a significant number of maxillary molars (Part I), and then to compiete a thorough examination of internal root canal morphology (Part IT). Material and Methods A total of 140 maxillary first molars, 220 maxillary second molars and 384 maxillary third molars, which had been extracted for various reasons from patients in Ribeirao Preto, Brazil and had been kept in 0.1% thymol solution, comprised the specimens for this study.46 Jesus Djalma Pécora et al. The teeth were measured with a digital pakimeter (TESA, Switzerland) recording distances to the nearest 0.1 mm. The overall tooth length was from the lingual cusp to the lingual root apex, from the mesiobuccal cusp to the mesiobuccal root apex, and from the distobuccal cusp to the distobuccal root apex. Another measurement of just the root length was made from the cervical line to each root apex (lingual, mesiobuccal and distobuccal). We studied the frequency of occurrence of several specific types of root curvatures, i.e. straight or curved, and whether bent toward the buccal, lingual, mesial or distal. The prevalence of fusion of the roots and the occurrence of Carabelli cusps were studied and tabulated. Results The average overall length from the lingual cusp to the lingual root apex on 140 maxillary first molars was 21.3 + 1.6 mm, from the mesiobuccal cusp to the mesiobuccal root apex was 20.1 + 1.6 mm and from distobuccal cusp to distobuccal root apex was. 19.6 + 1.5 mm (Table I). In 220 second molars, the lingual root measurement was 0.2 mmshorter, the mesiobuccal root to cusp distance was 0.2 mm longer and the distobuccal root apex to cusp length averaged exactly the same as for the first molars (Table 1). ‘Table 1 - Length of maxillary molars (mm). ‘Overall iength (cusp tip to apex) Root length (cervical line to apex) Teeth SSS Lingual! Mesiobuccal?Distobuccal* Lingual Mesiobuccal_Distobuccal First molars (140) average 23+16 Wit 16 196415 138414 131415 122413 maximum: AG BS 23.8 16.7 15.9 49 minimum 17.7 16.6 15.1 11.3 98 87 ‘Second molars (220) average 21+16 W318 Wot16 B6+14 BO+16 3414 maximum = 255 ms BI a4 7 162 minimum 16.6 17.0 15.1 95 92 OL ‘Mesiolingual cusp to apex of lingual root. ?Mesiobuccal cusp to apex of mesiobuccal root. 3Distobuccal cusp to apex of distobuccal root.External anatomy of maxillary molars 47 Cervical line to root apex lengths on these first and second molars were also practically the same (within 0.2 mm) comparing the average lengths among these teeth. The root lengths (cervical line to apex) comprised 62 to 65% of the overall tooth length. There was a considerable difference in the degree of root separation and fusion comparing first, second and third molars (Table 2). Complete separation of the three roots was found on 86.4% of the 140 first molars, 75.9% of the 220 second molars and. on only 18.8% of the 384 third molars. Fusion of the buccal roots was found on 7.9% of the first molars, 20.4% of the second molars and on 28,9% of the third molars (Table 2). Table 2 - Frequency of fused roots of maxillary molars (%). First molars Second molars ‘Third molars (140) (220) (384) Roots separated 864 59 188 Roots partially separated (apical third) 00 00 195 Buccal roots fused 79 204 289 Lingual and mesiobuccal roots fused 00 09 29 Lingual and distabuceal roots fused $0 09 29 All roots fused a7 18 74 Dilacerated or atypical roots oo 00 96 The types and direction of root curvature for maxillary first and second molars is shown in Table 3. The lingual root was straight on 36.1% of the first molars and on 31% of the second molars. The lingual roots curved toward the buccal on 54.6% of the first molars and on 52.3% of the second molars (Figure 1). The mesiobuccal root was straight on about 10% and curved toward the distal on 87% of first and sccond molars. In comparison, the distobuccal curvature was much different, being straight on 26.2% and 36.7% of first and second molars, respectively, curving toward the distal on 34.0% and 33.2% of first and second molars, and curving toward the mesial on 32.6% and 26.2% of the first and second molars, Occasionally the buccal roots would have an"S" curvature. Carabelli cusp occurrence beneath the mesiolinguat cusp has been a subject of interest for many years, especially in studying racial characteristics of tooth morphology. The type of Carabelli formation on 143 first and 217 second molars is shown in Table 4. Our data confirm that the absence of any Carabelli characteristic is not an uncommon. finding (35.7% of first molars and 79.3% of second molars had only a smooth enamel surface around the mesiolingual cusp). There was some type of Carabelli cusp formation 0n 64.3% of first molars compared to only 20.7% of the second molars, No large Carabelli cusps were seen on the 217 second molars examined.48 Jesus Djalma Pécora et al. Figure 1 - Maxillary molar with straight lingual root (left) and curved toward the buccal (right). Table 3 - Types of root curvature on 140 first and 220 second maxillary molars. Direction of Lingual root Mesiobuccal root Distobuccal root curvature (apical half, proximal view) (apical third, facial view) (apical third, facial view) in %) — : inst Second First Second First Second molars molars molars molars molars molars None (straight) 6.1 31.0 99 109 26.2 36.7 Toward distal 28 49 865 87.0 340 33.2 ‘Toward mesial 28 $2 00 04 32.6 262 Toward buccal 546 52.3 0.0 0.0 00 0.0 Toward palate 36 66 00 00 00 00 "S* curve 00 00 3.6 09 72 39 (facial view) Table 4 - Frequency of occurrence and type of Carabelli cusp formation (in %) ist molars® Second molars (140) 17) Large Carabelli cusp 178 00 ‘Small Carabelli cusp a4 23 Slight depression 15.0 18.4 None 35.7 93 *64,3% of first molars have some formation.External anatomy of maxillary molars 49 Comparative measurements of the maxillary first and second molars from four widely separated countries made over a span of 120 years are shown in Table 5. Differences between these measurements are small and are probably of no significance even though they were made on teeth from different racial backgrounds. However, a knowledge of the usual length of maxillary first and second molars and of their root length is of great interest and practical valuc in endodontic treatment. Table 5 - Comparative tooth measurements by different authors. ‘Overall enghh (eam) Manila fret molarr Muillay second molars Autor ‘Country ee Number Average Maximum Minimum Number Average Maimurm — Minimum Mubreiter,18 Germany soe aos Black, 1902 usa, wa uo 0 - mo m0 160 Pucci & Reig 1M Uruguay 178213 BS ko m7 m0 ws Worle, 1990 USA 38 mao 200 22 160 De Deus, 1986 Brad » as - : woo - Present study Brazit Mo watis oss 1st 20 nitis us 15 Discussion The endodontist must know internal and external tooth anatomy extremely well before treating the root canal. The complete external anatomy must be well known because the commonly used radiograph only shows a two-dimensional view of the three-dimensional tooth and root. Of the 140 first molars examined, 86.4% had separate roots, 7.9% had fused roots, 5% had fused lingual and distobuccal roots and only 0.7% had all of the roots fused. Of the 220 second molars, we found the following: 75.9% with separate roots, 20.4% with fused buccal roots, 0.9% with the lingual and mesiobuccal roots fused, 0.9% with the lingual and distobuccal roots fused, and 1.8% with all three roots fused. As expected, the maxillary first molars had a greater percentage of separate roots than the maxillary second molars. The maxillary second molars had a higher incidence of fusion of their buccal roots and of all three roots. It is particularly important to know the direction of the curvature of each root, especially curvature toward the lingual or buccal, since the radiograph does not show this fact, projecting a similar image (of a straight canal) for either of the specimens seen in Figure 1. The incidence of lingual root curvature toward the buccal direction (right50 Jesus Djalma Pécora et at, tooth in Figure 1) is quite high (54.6% in maxillary first molars and 52.3% in maxillary second molars). We want to emphasize that this common buccal curvature of the lingual root is not detected on radiographs. Not being aware of this occurrence can cause a serious error by the dentist during his preparation of the lingual root canal. By knowing of the high incidence of these buccal curvatures, the dentist can constantly be alert and thereby clinically detect this common situation, This can be done by observing the direction of the file when exploring the root canal. If such care is not taken, perforation of these buccaily curved roots can readily occur during instrumentation, The differences in the measurements of the upper molars found by numerous authors cited here are smail and probably not clinically significant. The minute differences in average size may be due to racial differences. However, knowledge of average lengths of the maxillary first and second molars is of great interest and practical value in endodontic treatment of the various teeth. Part I of this investigation will report on the detailed internal morphology of these same teeth. Conclusions 4. The external anatomy, root curvature and degree of root fusion was studied on 744 maxillary first, second, and third motars. 2. Root lengths and root curvatures were quite similar on the first and second molars with their linguai roots curving toward the buccal on 54.6% and on 52.3% of them, respectively. 3. Fusion of the buccal roots was found on 0.7% of first molars, 1.8% of second molars, and 17.4% of third molars. 4. Complete separation of all three roots occurred on 86.4% of first molars, 75.9% of second molars, and on only 18.8% of third molars. 5. Carabelli cusp formation was absent on 35.7% of first molars and on 79.3% of second molars. Large Carabelli cusps were not found on second molars. References Black GV: Descriptive anatomy of human teeth, 4th ed. SS White Dental Manufacturing Co. Philadelphia, 1902 De Deus QD: Endodontia. 4th ed. Medsi, Rio de Janeiro, 1986 Muhreiter E: Anatomie des menschlichen gebisses. Arthur Felix, Leipsic, 1870 Pucci FM, Reig R: Conductos Radiculares. Barreiro y Ramos, Montevideo, Vol. 1, 1944 Woelfel JB: Dental anatomy: its relevance to dentistry. 4th ed. Lea and Febiger, Philadelphia, 1990 Correspondence: Professor Jesus Djaima Pécora, Departamento de Odontologia Restauradora, Faculdade de Odontologia de Ribcirao Preto, Universidade de S40 Paulo, 14050 Ribeiréo Preto, SP, Brasil. Accepted December 3, 1990