endodontics

Editor:
MILTON SISKIN, D.D.S.
College of Dentistry
The University of Tennessee
847 Monroe Avenue
Memphis, Tennessee 38163

Root canal anatomy of the human

permanent teeth
Frank J. Vertucci, D.iU.D.,*
UNIVERSITY

OF FLORIDA

Gainesville, Fla.

COLLEGE

OF DENTISTRY

Two thousand four hundred human permanent teeth were decalcified, injected with dye, and cleared in
order to determine the number of root canals and their different types, the ramifications of the main root
canals, the location of apical foramina and transverse anastomoses, and the frequency of apical deltas.
(ORAL SURC. 58~589-599, 1984)

he main objective of endodontic therapy is the

thorough mechanical and chemical cleansing of the
entire pulp cavity and its complete obturation with
an inert filling material. According to Seltzer and
Bender, failures in treatment occur despite rigid
adherence to this basic principle. Ingle2 lists the most
frequent cause of endodontic failure as apical percolation and subsequent diffusion stasis into the canal.
The main reasons for this failure are incomplete
canal obturation, an untreated canal and inadvertent
removal of a silver cone. A canal is often left
untreated because the dentist fails to recognize its
presence. The dentist must have a thorough knowledge of root canal morphology before he can successfully treat a tooth endodontically.
In the literature, there is divergence of opinion as
to the anatomy of the pulp cavities of the human
permanent teeth.3-32The incidence of two or more
root canals in the mandibular first premolar, for
example, has been reported to be as low as 2.7% and
as high as 62.5%, whereas the incidence of two or
more root canals in the mandibular second premolar
has been reported to vary between 0% and 34.3%.3-1
The incidence of two canals at the apex of the
maxillary secondpremolar has been reported to be as
low as 4% and as high as 50%.6-13
*Associate Professor and Chairman, Department
tics.

of Endodon-

These discrepancies are, in part, the result of the

marked variations in anatomy that are present and,
in part, the result of the very real difficulties that are
always encountered when root canal morphology is
studied. Becauseof the many dissimilarities in selection of material and classification of canal configurations, the results of most reports cannot be compared
directly with one another.
Becausethe literature is inconclusive, I decided to
conduct a detailed investigation of the anatomy of
the root canals of extracted human teeth. A standardized technique that involved examination of
transparent specimenswas used.
METHODS AND MATERIALS

For this investigation, 2,400 permanent teeth were

obtained from various oral surgery practices. All
teeth were obtained from adults. The age, sex, and
race of the patients and the reasons for extraction
were not recorded. Immediately after extraction, the
teeth were fixed in 10% formalin and decalcified in
5% hydrochloric acid. On completion of this process,
the teeth were washed in tap water and placed in a
5% solution of potassium hydroxide for 24 hours.
The teeth were washed in tap water for 2 hours, and
hematoxylin dye was injected into the pulp cavities
with the use of a 25-gauge needle on a Luer-Lok
plastic disposable syringe. Hematoxylin was used
becauseof its ability to stain fresh pulp tissue, even
589

590

Vertucci

Table

I. Morphology of the maxillary permanent teeth

Oral Surg.
November, I984

Tooth

Central
Lateral
Canine
First premolar
Second premolar
First molar
Second molar

Note:

Root

No. of
teeth

Canals with
lateral canals

MB
DB
P
MB
DB
P

100
100
100
400
200
100
100
100
100
100
100

24
26
30
49.5
59.5
51
36
48
50
29
42

Position

of lateral

canals

Cervical

Middle

Apical

I
I
0
4.1
4.0
10.7
10.1
9.4
IO.1
9.1
8.7

6
8
IO
10.3
16.2
13.1
12.3
11.3
14.1
13.3

93
91
90
74.0
78.2
58.2
59.6
61.3
65.8
67.6
70. I

1 I.2

Furcation

Il.0
1.6
f
18
1
t
IO
1

Figuresrepresentpercentageof the total.

Table

II. Morphology of the mandibular permanent teeth

Root

No. of
teeth

Canals with
lateral canals

Central
Lateral
Canine
First premolar
Second premolar
First molar

Mesial

100
100
100
400
400
100

Second molar

Distal
Mesial
Distal

Tooth

Note:Figures

Teeth

Maxillary central
lateral
canine

Maxillary first premolar*

second premolar

Maxillary first molar

MesiobuccalS
Distobuccal
Palatal
Maxillary

Apical

20
18
30
44.3
48.3
45

3
2
4
4.3
3.2
10.4

12
15
16
16.1
16.4
12.2

85
83
80
78.9
80.1
54.4

100
100

30
49

8.7
10.1

IO.4
13.1

51.9
65.8

100

34

9.1

11.6

68.3

Furcation

0.7
0.3
t
23
1
t
II
i

We I

Type II

Type III

of

2-l

I-2-1

teeth

canal

canals

canals

100
100
100
400
200

100
100
100
8
48

100
100
100

Total with
one canal
at apex

Type IV

Type VI

Type VII

l-2

2-I-2

l-2-1-2

canals

canals

canals

canals

0
0
0

0
0
0

0
0
0

I8
22

100
100
100
26
75

62
II

45
100
100

37
0
0

82
100
100

I8
0
0

71
100
100

I7
0
0

88
100
100

12
0
0

0
0
0

The

0
0
0

second molar

Mesiobuccal
Distobuccal

Palatal

Middle

represent percentage of total.

No.

Maxillary

Cervical

Classification and percentage of root canals of the maxillary teeth

Table III.

Maxillary
Maxillary

Position of lateral canals

0
0
0

*Results published previously in Vertucci, F.J., and Gegauff, A.: Root canal morphology of the maxillary first premolar, J. Am. Dent. Asmc. 99:194,
1919.
tResults published previously in Vertucci, F.J., Seelig, A., and Gillis, R.: Root canal morphology of the human maxillary second premolar, ORAL SIJRG. 58: 456,
1974.
$Results published previously in Vertucci, F.J.: The endodontic significance of the mesiobuccal root of themaxillary first molar, Navy Med. 63: 29, 1974.

Root canal anatomy of human permanent teeth 591

Volume 58
Number 5

Position of transverse anastomosis

Transverse anastomosis
between canals

Cervical

Middle

Apical

Central

Lateral

Apical Deltas

25.6
31.2
15
0
0
20
0
0

12
22
14
12.0
22.2
24
19
18
12
17
19

88
78
86
88.0
77.8
76
81
82
88
83
81

1
3
3
3.2
15.1
8
2
4
3
2
4

16.4
18.8
10
0
0
8
0
0

34.2
30.8
52
0
0
21
0
0

Position of apical foramen

58
50
15
0
0
72
0
0

Note: Figures represent percentage of the total.

Position of transverse anastomosis

Transverse anastomosis
between canals

Position of apical foramen

Cervical

Middle

Apical

Central

Lateral

Apical Deltas

15
80
IO
85
83.9
78

5
6
8
5.1
3.4
10

32.1
30
63

20.6
0
12

52.9
66.1
75

26.5
33.3
13

25
20
30
15
16.1
22

55
31

10
10

72
71

18
13

20
19

80
81

14
6

16

11

74

15

21

79

Now Figures represent percentage of total.

Total with
two canals
at apex

Type VIII
3
canals

Total with
three canals
at apex

0
0
0
69
24

0
0
0
5
1

0
0
0
5
I

18
0
0

0
0
0

0
0
0

12
0
0

0
0
0

0
0
0

in the smallest accessory canals, and because it can

be removed from the external surface of the tooth,
thereby allowing for a clearer specimen. The injected
teeth were then dehydrated in successivesolutions of
70%, 95%, and 100% alcohol for 5 hours each. The
dehydration was necessary because the clearing
agent is not miscible with water. Finally, the specimens were placed in clear liquid plastic casting
resin* and were completely cleared within 24
hours.
RESULTS

The transparent specimens were examined under

the dissecting microscope, and the number and type
of root canals, the number and location of lateral
canals and apical foramina, and the frequency of
apical deltas were recorded. These data are summarized in Tables 1 and II.
*Fibre-Glass

Evercoat Co., Inc., Cincinnati,

Ohio.

592

Vertucci

Oral Surg.
November, I984

Fig. 1. Maxillary anterior teeth. Top row, Maxillary

Bottom row, Maxillary central incisors.

Table IV.

row, Maxillary

lateral incisors.

Classification and percentage of root canals of the mandibular teeth

Teeth

Mandibular
Mandibular
Mandibular
Mandibular
Mandibular
Mandibular
Mesial
Distal
Mandibular
Mesial
Distal

canines. Middle

central incisor*
lateral incisor*
canine*
first premolar+
second premolar?
first molar$

TYP I
1
canal

Type II
canals

Type III
I-2-I
canals

Total with
one canal
at apex

70
75
78
70
97.5

5
5
14
0
0

22
18
2
4
0

97
98
94
74
97.5

100

12

28

100

70

15

40
85

100
100

27
92

38
3

0
0

65
95

No.
Of
terlh

100
100
100
400
400

2-1

Type IV
2
canals

Type V
1-2
canals

Type VI
2-l-2
canals

Type VII
I-2-1-2
canals

0
0
0
24
2.5

0
0
0
0
0

0
0
0
0
0

43
5

8
8

10

26
4

3
2
6
1.5
0

second molar

*Results published previously in Vertucci,

tResults published previously in Vertucci,
$Re.sults published previously in Vertucci,

F.J.: Root canal anatomy of the mandibular anterior teeth, J. Am. Dent. Assoc. 89:369, 1974.
F.J.: Root Canal Morphology of Mandibular Premolar Teeth, J. Am. Dent. Assoc. 97:47, 1978.
F.J., and Williams, R.: Root canal anatomy of the mandibular first molar, J. N.J. Dent. Assoc. 4527-28,

1974

Root canal anatomy of human permanent teeth 593

Volume 58
Number 5

Fig. 2. A, Maxiilary first premolars, one canal at apex. Top row, Type II. Bottom row, Type I. B,
Maxillary first premolars, two canals at apex. Top row, Type V. Bottom row, Type IV. C!,Maxillary first
premolar, three canals at apex (Type VIII).

Total with
two canals
at apex

Type VIII
3 canals

Total with
three canals
at apex

3
2
6
25.5
2.5

0
0
0
0.5
0

0
0
0
0.5
0

59
15

1
0

1
0

35
5

0
0

0
0

The root canal configurations present within the

roots of human permanent teeth can be classified
into eight types:
Type I. A single canal extends from the pulp
chamber to the apex.
Type II. Two separate canals leave the pulp
chamber and join short of the apex to form one
canal.
Type III. One canal leaves the pulp chamber,
divides into two within the root, and then merges to
exit as one canal.
Type IV. Two separate and distinct canals extend
from the pulp chamber to the apex.
Type V. One canal leaves the pulp chamber and
divides short of the apex into two separate and
distinct canals with separate apical foramina.

594

Vertucci

Oral Surg.
November,1984

3. A, Maxillary second premolars, one canal at apex. Top row, Type I. Middle row, Type II. Bottom
row, Type III. B, Maxillary second premolars, two canals at apex. Top row, Type IV. Middle row, Type V.
Bottom row left, Type VI. Bottom row right, Type VII. C, Maxillary secondpremolar, three canals at apex
(Type VIII).
Fig.

Fig.

4. Mesiobuccal root of maxillary first molars. Left, Type I. Middle, Type II. Right, Type IV.

Type VI. Two separate canals leave the pulp

chamber, merge in the body of the root, and redivide
short of the apex to exit as two distinct canals.
Type VII. One canal leaves the pulp chamber,
divides and then rejoins within the body of the root,
and tinally redivides into two distinct canals short of
the apex.
Type VIII. Three separate and distinct canals
extend from the pulp chamber to the apex.
The percentages of human permanent teeth with

these canal configurations are presented in Tables

III and IV. The anatomic variations present in each
tooth are illustrated in Figs. 1 to IO. The most
variable root canal anatomy was found in the maxillary second premolar.
DlSCUSSlON

During the past 100 years, there have been many

excellent studies of pulp morphology. Upon comparing the findings of these studies with those of the

Root canal anatomy of human permanent teeth

Volume58
Number 5

Fig.

5. Mesiobuccal root of maxillary second molars. Left, Type I. Middle, Type II. Right, Type IV.

I( :
*

Fig. 6. Mandibular anterior teeth. Top row, Mandibular central incisors. A, Type I. B, Type II. C, Type
III. D, Type IV. Middle row, Mandibular lateral incisors. A, Type I. B, Type II. C, Type III. D, Type IV.
Bottom row, Mandibular canines. A, Type I. B, Type II. C, Type III. D, Type IV.

595

596

Vertucci

Oral SW&.
November, 1984

Fig. 7. A, Mandibular first premolars. Top row, Type I. Second row, Type III. Third row, Type IV.
Bottom TOW,Type V. B, Mandibular first premolar, three canals at apex (Type VIII),

Fig.

8. Mandibular second premolars. Top row, Type I. Bottom row, Type V.

Volume58
Number 5

Root canal anatomy of human permanent teeth 597

Fig. 9. Mandibular first molars. Top row, Mesial root. A, Type I. B. Type II. C, Type IV. D, Type V. E,
Type VI. F, Type VIII. Bottom row, Distal root. A, Type I. B, Type II. C, Type IV. D, Type V. E,
Type VI.

Fig. 10. Mandibular secondmolars. Top row, Mesial root. A, Type I. B, Type II. C. Type IV. D. Type V.
Bottom row, Distal root. A, Type I. B, Type II. C, Type IV. D, Type V.

598

Vertucci

Oral
November.

Surg.
I984

Fig. 11. Root canal on direct periapical exposure (arrow) shows sudden narrowing; at this point canal
divides into two parts as shown by radiographic view of buccolingual aspect and by transparent specimen.
(D, Direct periapical exposure; B-L, buccolingual aspect; TS, transparent specimen.)

present investigation, one finds that the results

reported by Okumura,* who also used transparent
specimens,and Pineda and Kuttler,l who employed
a radiographic evaluative technique, come closest to
the findings reported here. It appears that the use of
an intact root of a specimen rendered transparent by
decalcification and radiographic examination enables the investigator to view more clearly all of the
ramifications of the root canal system.
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.33 In addition, it is not
necessary to enter the specimens with instruments;
thus, the original form and relationship of the canals
are maintained. The technique used in the present
study differs from other clearing techniques mainly
in the nature of the clearing process;a liquid casting
resin was used rather than an agent such as
xylene.
Slowey34states that the root canal anatomy of
each tooth has certain commonly occurring characteristics as well as numerous atypical ones that can
be road maps to successful endodontics. The expected root canal anatomy dictates the location of the
initial entry of access,it dictates the size of the first
files used, and it contributes to a rational approach to
solving the problems that arise during therapy.
Therefore, a thorough knowledge of the root canal
anatomy from accessto obturation is essential to give
the highest possible chance for success.
The first consideration the dentist must have in
performing endodontic therapy involves the anatomy
of the tooth itself. Prior to beginning the access
preparation, he should study radiographs from several different angles. If, on the direct periapical exposure, he notices that a root canal shows a sudden
narrowing or even disappears, it means that at this
point the canal divides into two parts which either

remain separate (Type V) or merge (Type II) before

reaching the apex (Fig. 11). Having the information
observed from the radiographs and knowing what
combinations of internal anatomy are possible, the
dentist should be able to determine what type of
canal configuration is present. This information,
gained prior to initiation of therapy, will greatly
facilitate subsequent treatment.
Failure to find and fill a canal has been demonstrated to be a causative factor in the failure of
endodontic therapy. 35It is of utmost importance that
all canals be located and treated during the course of
nonsurgical endodontic therapy. An examination of
the floor of the pulp chamber offers clues to the type
of canal configuration present. When there is only
one canal, it is usually located rather easily in the
center of the accesspreparation. If only one orifice is
found, and it is not in the center of the tooth, it is
probable that another canal is present and the
operator should search for it on the opposite side.
Radiographs from various angles, some with a file in
place, may be helpful. The relationship of the two
canal orifices to each other is also significant. The
closer the orifices are to each other, the greater are
the chances that the two canals join at some point
within the body of the root.
Teeth with canal bifurcations in the middle or
apical third may present 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 is
often extremely difficult. The presenceof an unfilled
canal may explain some of the endodontic failures
associated with teeth, even though radiographically
and clinically the canal system seems to be obturated.
When either pain or periapical breakdown is seen
after apparently effective nonsurgical endodontic

Volume 58
Number 5

therapy, the possible presenceof an additional canal

should be considered before the tooth is condemned
or surgery is scheduled. If an apical root resection
and reverse filling procedure becomes necessary, a
complication may result. Surgery may cause a single
apical foramen to become two separate foramina.
Results will be poor if a search for the secondcanal is
not routinely made during the surgical procedure.
An awareness that eight possible canal configurations occur and that complications from a surgical
endodontic procedure can arise should increase the
rate of successful endodontic therapy.
SUMMARY AND CONCLUSIONS

Two thousand four hundred human permanent

teeth were decalcified, injected with dye, cleared,
and studied. The following data were obtained: the
number of root canals and their different types, the
ramifications of the main root canals, the location of
apical foramina and transverse anastomoses,and the
frequency of apical deltas. The findings are summarized in four tables, which have been prepared as a
practical aid for the dentist.
An accurate knowledge of the morphology of the
pulp cavity is essential before an endodontic procedure can be approached rationally. The frequency
with which root canals unite should be considered
during enlargement and filling procedures. The dentist also should be aware of the possible existence of
bifurcated and double canals if root canal therapy
should unexpectedly fail. A knowledge of these
variations will assist the dentist in reaching conclusions when diagnosing and treating endodontic
cases.
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1. Seltzer S, Bender IB: Cognitive dissonance in endodontics.

ORAL SURG 20: 505, 1965.
2. Ingle JI: Endodontics, ed. 2, Philadelphia, 1965, Lea &
Febiger, p. 43.
3. Amos ER: Incidence of bifurcated root canals in mandibular
bicuspids. J Am Dent Assoc 50: 70, 1955.
4. Green D: Double canals in single roots. ORAL SURG 35: 689,
1973.
5. Zillich R, Dowson J: Root canal morphology of mandibular
first and second premolars. ORAL SURG 36: 738, 1973.
6. Hess W: Anatomy of the root canals of the teeth of the
permanent dentition, Part I, New York, 1925, William Wood
& Company, pp. 27-29.
7. Barrett MT: The internal anatomy of the teeth with special
reference to the pulp with its branches. Dent Cosmos67: 581,
1925.
8. Okumura T: Anatomy of the root canals, Tram Seventh Int
Dent Congress 1: 170, 1926.
9. Mueller AH: Anatomy of the root canals of the incisors,
cuspids and bicuspids of the permanent teeth. J Am Dent
Assoc 20: 1361, 1933.

Root canal anatomy of human permanent teeth 599

10. Pineda F, Kuttler Y: Mesiodistal and buccolingual roentgenographic investigation of 7,275 root canals. ORAL SURG 33:
101, 1972.

1I. Vertucci FJ: Root canal morphology of mandibular premolar.

J Am Dent Assoc 97: 47, 1978.
12. Green D: Morphology of the endodontic system, New York,
1969, David Green, pp. 14-15.
13. Vertucci FJ, Seelig A, Gillis R: Root canal morphology of the
human maxillary second premolar. ORAL SURG 58: 456,
1974.
14. Skillen WG: Morphology of root canals. J Am Dent Assoc 19:
719, 1932.
15. Mueller AH: Morphology of root canals. J Am Dent Assoc
23: 1698, 1936.
16. Green D: Morphology of the pulp cavity of the permanent
teeth. ORALSURGS: 743, 1955.
17. Rankine-Wilson RW, Henry P: The bifurcated root canal in
lower anterior teeth. J Am Dent Assoc 70: 1162, 1965.
18. Vertucci FJ: Root canal anatomy of the mandibular anterior
teeth, J Am Dent Assoc 89: 369, 1974.
19. Carns EJ, Skidmore AE: Configurations and deviations of
root canals of maxillary first premolars. ORAL SURG 36: 880,
1973.
20. Vertucci FJ, Gegauff A: Root canal morphology of the
maxillary first premolar. J Am Dent Assoc 99: 194, 1979.
21. Weine FS, Healey HJ, Gerstein H, Evanson L: Canal
configuration in the mesiobuccal root of the maxillary first
molar and its endodontic significance. ORAL SURG 28: 419,
1969.

22. Darnelles P: Consideracoesanatomicas sobre a conformacao

interna da raiz mesiovestibular do primeiro molar superior
permanente. Rev Gaucha Odontol 7: 35, 1959.
23. Vertucci FJ: The endodontic significance of the mesiobuccal
root of the maxillary first molar. Navy Med 63: 29, 1974.
24. Skidmore AE, Bjorndal AM: Root canal morphology of the
human mandibular first molar. ORAL SURG 32: 778, 1971.
25. Vertucci FJ, Williams R: Root canal anatomy of the mandibular first molar. J N J Dent Assoc 45: 27-28, 1974.
26. Cooke HG, Cox FL: C-shaped canal configurations in mandibular molars. J Am Dent Assoc 99: 832, 1979.
27. Seidberg BH, Altman M, Guttuso J, Suson M: Frequency of
two mesiobuccal root canals in maxillary permanent first
molars. J Am Dent Assoc 87: 852, 1973.
28. Pomeranz HH, Fishelberg G: The secondary mesiobuccal
canal of maxillary molars. J Am Dent Assoc 88: 119, 1974.
29. Altman M, Guttuso J, Seidberg BH, Langeland K: Apical
root canal anatomy of human maxillary central incisors. ORAL
SURG30: 694-699, 1970.
30. Green D: A stereomicroscopic study of the root apices of 400
maxillary and mandibular anterior teeth. ORAL SURG 9:
1224-1232, 1956.

31. Nosonowitz DM, Brenner MR: The major canals of the

mesiobuccal root of the maxillary first and second molars.
NY J Dent 43: 12, 1973.
32. Harris WE: Unusual root canal anatomy in a maxillary
molar. J Endod 6: 573, 1980.
33. Barker BCW, Lockett BC, Parsons KC: The demonstrations
of root canal anatomy. Aust Dent J 14: 37-41, 1969.
34. Slowey RR: Root canal anatomy, road map to successful
endodontics. Dent Clin North Am 23: 555, 1979.
35. Stewart GG: Evaluation of endodontics results. Dent Clin
North Am 11: 711, 1967.
Reprinf requests fo:

Dr. Frank J. Vertucci

Department of Endodontics
University og Florida College of Dentistry
Gainesville, FL 32610