Root canalmorphologyof the human

maxillary secondpremolar
Frank Tertucci, DX.D., Alexruder Seelig, D.D.S., awl Robert Gillis,
D.D.S., Ph.D., Jersey City, N. J.
COLLEGE OF ;\IEDICIKR AXD DEKTISTRY OF NEW JERSEY, NEW JERSEY DENTAL
SCHOOL

Two hundred human maxillary second premolare were decalcified, injected with dye,
and cleared in order to determine the number of root canals and their different types,
the curvature of the roots and root canals in all directions, the ramifications of the
main root canals, the location of the apical foramina and transverse anastomoses, and
the frequency of apical deltas.

S uccessful endodontic therapy depends to a large extent on the thorough

mechanical cleansing of each root canal. One of the main reasons for failure in
root canal therapy is a lack of knowledge of the anatomy of the pulp cavity.l
According to Inglc,” the most frequent cause of endodontic failure is apical
percolation and subsequent diffusion stasis into the canal. The main reasons for
this failure include incomplete canal obliteration, leaving a canal completely
unfilled, and inadvertently removing a silver point. Often a canal is left
unfilled because the operator has failed to recognize its presence. It is important,
therefore, that the dentist have a thorough knowledge of root canal morphology
I~t’orc he call snccessfull~ treat a tooth endodontically.
\\‘hen one reviews the literature, it becomes apparent that there is a diver-
gence of opinion concerning the anatomic configuration of the pulp cavity of
the maxillary sccontl ln~cmolar. l)ental-anatomy and endodontic textbooks vary
considerably in their description of the canals of this tooth. On the one hand, it
is tlcscribetl as having one canal, with the possibility of two”‘“; and, on the other
hand, this same tooth is described as having two canals, with the single canal
being the csccption.“~ i
The number ant1 type of canals in the maxillary second premolar show wide
variation. The incidence of two canals at the apes is reported as low as 4 per

Based on :I thesis submitted in partial fulfillment of the requirements for a certificate

program, I)epartment of Endodontics, New Jersey Dental School.

456
Volume 58 Root canal morphology of maxillary second premolar 457
Number 3

Table I. Classification and percentage of canal types found in maxillary second

premolars
Per cent
Division I S&division of total
One canal at apex Type 1 Type II Type III
48 22 5 75
Two canals nt apex Type IV Type V Type VI Type VII
11 6 5 2 24
Three canals at apex Type VIII
1

cent and as high as 50 per cent.8-13 These discrepancies are in part, the result of
the marked variation in anatomy present and, in part, the result of the very real
difficulties which are always encountered when root canal anatomy is studied.
Because of the many dissimilarities in selection of material and classification of
canal configurations, the results of most reports cannot be directly compared
with each other.
Since the literature is so inconclusive and variable, and since the maxillary
second premolar is the tooth secondly most often treated endodontically,14 we
decided to conduct a detailed investigation of the normal root canal anatomy of
the extracted human maxillary second premolar and the variations with which
the operator is faced.

METHOD AND MATERIALS

For this investigation, 200 maxillary second premolars were obtained from
various oral surgery practices. All teeth originated from adults ; the age, sex, race,
and reasons for extraction were not recorded. Immediately upon extraction, the
teeth were fixed in 10 per cent formalin and kept in this preservative for ap-
proximately 1 week.
By means of a modification of a clearing technique developed by Seelig,ls
the teeth were decalcified in 5 per cent hydrochloric acid. After decalcification,
the teeth were washed in tap water for 2 hours. The specimens were then placed
in a 5 per cent potassium-hydroxide solution for 24 hours and again washed for
2 hours. A 25-gauge, 2.5 c.c., Luer-Lok, plastic disposable syringe was used to
inject hematoxylin dye into the pulp cavity. Hematoxylin was used because of
its ability to stain fresh pulp tissue, even in the smallest accessory canals, and
because it ,can be removed from the external surface of the tooth, thereby allow-
ing for a clearer specimen.
Prior to injection of the dye, a separate 25-gauge needle was used to enter
the pulp chamber through the occlusal aspect of the tooth. This was done in
order to prevent clogging of the syringe. Following this, the needle was inserted
into this opening, and dye was injected into the pulp cavity until it could be
seen exiting from the apical foramen. The excess dye was then wiped from the
external surface of the tooth with 5 per cent hydrochloric acid. Next, the in-
jected teeth were placed for a period of 5 hours each in successive solutions of
70 per cent, 95 per cent, and absolute alcohol. This dehydration was necessary
because the clearing agent is not miscible with water. The teeth were then
 Fig. 2. Specimens with one canal at apex. A, Type I cases. R, Type II cases. C, Type 111
cases.

Table II. Morphology of maxillary secw~ltl premolar

, I I I I

200 252 150 10 40 194 4

Percentage 59.5 4.0 16.2 78.2 1.6
 Pig. d. Specimens with two canals at apex. A, Type IV cases. B, Type V cases. C, ‘se
VI cases.

Transverse
anastomosis Position of tuznsverse anastomosis Position of apical foramen
between Apical
canals Cervical itfiddle Apical Central I Lateral deltas

32 6 16 56 196 38
30.8 18.8 50 22.2 77.8 15.1
460 Vertucci, Xeelig, and Gillis Oral Burg.
September, 1974

Fig. 3. Specimen with three canals at apex (Type VIII cases).

placed into crystal-clear liquid plastic casting resin” and were completely cleared
within 12 hours.

RESULTS
The transparent specimens were examined under the dissecting microscope,
and the following features were recorded: the number, curvature, and types of
roots and root canals; the number and location of apical foramina and trans-
verse anastomosis; and the frequency of apical deltas. These data are summa-
rized in Tables I and II.
The canal configurations of the maxillary secontl premolar can be classified
into the following eight types (Table I) :
Type I. A single canal from the pulp chamber to the apex.
Type II. Two separate canals leaving the pulp chamber but joining
short of the apex to form one canal.
Type III. On canal leaving the pulp chamber, dividing into two within
the body of the root, and merging again to exit as one canal.
Type IV. Two separate and distinct canals from the pulp chamber to
the apex.
Type V. One canal leaving the pulp chamber and dividing short of
the apex into two separate and distinct canals with separate
apical foramen.
Type VI. Two separate canals leaving the pulp chamber, merging in
the body of the root and redividing into two distinct canals
short of the a.pcx.
l’ype VZZ. One canal leaving the pulp chamber, dividing and then re-
joining within the body of the root, and finally redividing
into two distinct canals short of the apex.
!l’ype VIII. Three separate and distinct canals from the pulp chamber
to the apex.

“Fibre-Glass, Evercoat Co., Inc., Cornell Road, Cincinnati, Ohio.

Volume 38 Root callal morphology of maxillary second premolar 461
Number 3

Fig. 4. Root canal on direct periapical exposure (arrow) shows sudden narrowing; at this
point, canal divides into two parts as shown by buccolingual aspect view. (A’, Direct periapical
exposure. B-L. Buccolingual aspect view.)

Of the 200 teeth studied, 150 (75 per cent) exhibited one canal at the apex
(Fig. l), 48 (24 per cent) had two canals at the apex (Fig. 2), and 2 (7 per
cent) showed three canals at the apex (Fig. 3).
In addition to these variations at the apical foramen, marked differences in
canal form were also present in other regions of the root. In Type II cases, the
two canals leaving the pulp chamber joined at various levels in the root as fol-
lows: 5 per cent merged in the coronal third of the root, 22 per cent joined in the
middle third, 55 per cent came together in the apical third, and 18 per cent
joined at the apical foramen. In all Type III cases, the canal divided into two
in the middle third and rejoined in the apical one third of the root. In the Type
V cases, the canals in 67 per cent branched into two in the middle third of the
root, whereas in the other 33 per cent the canals branched in the apical third.
In Type VII cases, all canals divided into two in the middle third of the root,
and rejoined and branched again in the apical one third.

DISCUSSION
There can be little hope of success in root canal therapy without some under-
standing of the morphology of the pulp cavity. During the past 100 years, there
have been many studies on pulp form.19 *-la, ]+*o Jn earh of these studies, many
difficulties were encountered.
Of the various methods advocated for the anatomic examination of root
canals, a standardized technique that made use of transparent specimens was
employed in the present investigation. The clearing technique has considerable
value in the study of root canal anatomy for it gives a three-dimensional
view of the pulp cavity in relation to the exterior of the tooth.“O In addition,
it was not necessary to enter the specimens with instruments, thereby main-
taining the original form and relationship of the canals.
The technique used in the present study differed from other clearing tech-
 Owl Surg.
Septkmher, 1974

niqucs mainly in the nature of the clearing process. The method described differs
from Seelig’s”’ onl,v in the length of time that the specimens were retained in the
potassium-hydroxide solution---% hours instead of the original 1 hour. The in-
creased time in the alkaline solution made the final specimens more translucent,
ant1 increased the intensity ,of the stain.
The first c*onwitleration that the dentist must have in performing cnclotlontic
t,herapy involves the anatomy trf th(z tooth itself. Prior* to beginning the acc’ess
preparation, he shoultl study radiographs from several cliffrrcnt angles. If, on
the direct periapical exposure, he notes that a root canal shows a sudden narrow-
ing or even disappears, it means that at this point the canal divides into two
parts which either rema.in separate (Type V) or merge (Type II) before rcach-
ing the apex (Fig. 1). Having the information obtained from the radiographs
and knowing what combinations of internal anatomy are possible, the operator
will be able to determint> what type of (danal configuration is present. This in-
formation gained prior to the initiation of preparation will greatly facilitilttl
subsequent treatment.
Failure to find and fill a canal has been dcmcmstratcd to IN? a causative
factor in the breakdown of an endodontic (*ase.:” It is of utmost importanee that
all canals be lorattd and treated, whenever possible, during the course of root
canal therapy. An examination of the Noor of the pulp ehambcr offers clues to
the type of canal (donfiguration present. When thercl is only one canal, it is
usually located rather easily in thr center of the access preparation. If only one
orifice is found, which is not in the ecnter of the tooth, it is probable that another
canal is present; one should be searched for on the opposite side. Radiographs
from various angles, some with a file in place, may be helpful. The relationship
of the two orifices to each other is also significant. If they are greater than 3 mm.
apart, the two canals remain separate throughout their length; if less than 3
mm., the two ,eanals usually join. The closer the orificacs arc to each other, the
more coronal the nniol\.
111the ~:ISP of two c;inals joining into OII<’ (Type I I cases), it was constantly
found that the palatal canal was the one which exhibited straight-line access to
the apex. It was also the one with the highest percentage of lateral canals. Con-
sequently, those situat.ions which are determined to be Type II cases are best
treated by instrumenting ant1 filling the palatal canal to the apex, and the
buccal canal to the point where it joins the palatal. This is because if both canals
are enlarged to the apex, an “hourglass” preparation will result. The point at
which the two canals join will be more constrictetl than the preparation at the
apex. Filling such a. situation will leave a void in the critical apical third of the
root and invite subsequent failure.
Teeth with canal bifurcations in the middle or apical third may present
considerable problems in treatment. Although one of the two canals, the one
most continuous with the large main passage, is usually amenable to adequate
enlarging and filling procedures, the preparation and filling of the other canal
are often extremely difficult. Tf vital tissue remains in the inadequately treated
canal ancl does not bcc~omc inflamed, the result map be s~wcessful. However, if
Volume 38 Root cnlbal mrphology of maxillary second premolar 463
Number 3

this untreated canal contains necrotic tissue or is associated with periapical

pathosis, failure may be the result. The presence of an unfilled canal may explain
some of the endodontic failures associated with maxillary second premolars
even though, radiographically and clinically, the canal seems to have been oblit-
erated.
Sometimes treatment failure occurs despite rigid adherence to basic treat-
ment principles.“’ When either pain or periapical breakdown is noted after ap-
parently effective endodontic treatment, the possible presence of a second canal
should be ronsitlercd before the tooth is condemned or surgical intervention is
scheduled. If an apicoectomy and reverse fill become necessary, a complication
may arise if a bifurcated canal is present; operation may cause a single apical
foramcn ultitnatcly to become two separate foramina. Result,s will be poor if the
second canal is not routinely looked for at the time of operation, because of the
high percentage of double canals in this tooth. Furthermore, it is suggested that,
in all apicocctomy procedures on the tooth, the angle of the bevel be reduced so
that more palatal root structure is removed. This is because of the high incidence
of lntcral canals in this region, which, if left unfilled, can result in further fail-
ure. Once the dentist becomes aware of the tendency of bifurcated canals to occur
in maxillary second premolars, and the possible added complications of apicoec-
tomy, endodontic procedures on this tooth will ultimately be more successful.

SUMMARY
Two hundred maxillary second premolars were decalcified, injected with dye,
cleared, and studied. The canal configurations were categorized as follows: 75
per cent exhibited one canal at the apex, 24 per cent had two canals at the apex,
and 1 per cent showed three canals at the apex.
Of the canals studied, 59.5 per cent exhibited lateral canals. They occurred
equally in all types of can& were located mainly in the apical region, and
exited from the main canal mostly in a palatal direction (59.8 per cent). Fur-
thermore, 1.6 per cent of these canals extended from the floor of the pulp cham-
ber to the furcation area.
The curvature of the roots was found to be, in general, not indicative of the
curvature of the canals present. Only 9.5 per cent of the canals were straight
when viewed from all aspects. Of the remainder, 1.6 per cent were curved in a
mesial direction, 27 pear cent were curved in a distal direction, 12.7 per cent in a
buccal direction, 4 per cent in a lingual direction, and 20.6 per cent were curved
in both a mcsiodistal and buccolingual direction.
An accurate knowledge of the morphology of the pulp cavity is essential be-
fore one can rationally approach any endodontic procedure. The frequency with
which root canals unite should be taken into consideration during the enlarge-
ment and filling procedures. One should also be aware of the common occur-
rence of bifurcated and double canals whenever surgical procedures are plan-
ned and as possible causes for unesplained failure. A knowledge of these vari-
ations will assist the dentist in reaching conclusions in his diagnosis and treat-
ment of endodontic cases.
464 Trertucci, Seelig, and Gillis Oral Surg.
September, 1974

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Reprint requests to :
Dr. Frank J. Vertucci
U.S. Naval Station Mayport
Naval Dental Clinic
.Jacksonville, Fla. 32222