Endodontology, Vol.

15, 2003

Endodontic Miscellany : Maxillary first molar

with two canals in the palatal root
*Krishnaprasad P **Goel BR ***Tyagi S

During pre-clinical endodontics on Table 1: Canal Configurations of

extracted teeth, a maxillary first molar was Maxillary First Molar
found to have a palatal root with two canals.
Canal configuration
While locating the canals, because of eccentric Year Author
location of the instrument in the palatal canal, P MB DB
a second canal was suspected. Placement of 1979 Slowey 2P 1 MB 1 DB
another instrument easily verified the presence
1979 Thews 2 PS/J 1 MB 1 DB
of the second canal. The palatal root canal
system was characterized by two canal orifices 1982 Cecic 2 PS 2 MBS 1 DB
and two canals that appeared to unite in the 1983 Martinez- 1P 3 MBS 2 DBS/J
apical third of the root (Photograph 1a and Berna
1b) which constitute type II canal configuration
1984 Beatty 1P 3 MBS 1 DB
according to Vertucci's classification8 (Fig. 1).
1988 Bond 2 PJ 2 MBS 2 DBJ
Most of the clinical literature on the fourth
canal in maxillary molars reports an additional 1991 Wong 3 PS 1 MB 1 DB
mesiobuccal canal (MB2) 3,4,5 . But an 1994 Jacobsen 2 PS 1 MB 1 DB
anomalous root morphology that occurs
infrequently, such as two palatal roots and 1997 Hulsmann 1P 1 MB 2 DBS
canals, in the teeth is infrequently reported6. S: Separate canals with separate foramina.
Unusual root canal system in maxillary first J: Canals joining in the apical one-third.
molar reported so far is presented in Table-1.
Two canals in a single palatal root may
present in one of the following types7;
a. Two separate orifices, two separate canals
and two separate foramina.
b. Two separate palatal roots, each with one
orifice, one canal and one foramen.
c. One palatal root, one orifice, a bifurcated
canal and two foramina.
Discussion
Fig. 1(b). Files placed in MB, DB, MP and DP canals of Having the information observed from the
maxillary first molar (Mesial view). radiographs and knowing what combinations
* P.G. Student of internal anatomy are possible, the dentist
** Professor and Head should be able to determine what type of canal
*** Assistant Professor configuration is present. An examination of the
Department of Conservative Dentistry &
Endodontics, P.M.N.M. Dental College and Hospital, floor of the pulp chamber offers clues to the
Bagalkot-587 101. Karnataka. type of canal configuration present.
30
Krishnaprasad et al. Two-canaled palatal root...

Fig. 1. Vertucci's classification

The most frequent cause of endodontic

failure is the apical percolation and subsequent
diffusion stasis into the canal2. The main
reasons for this failure are incomplete canal
obturation or an untreated canal. A canal is
often left untreated because the dentist fails to
recognize its presence.
When there is only one canal, it is usually
located rather easily in the centre of the access
preparation. If only one orifice is found and it is
not in the centre of the tooth, it is probable that
another canal is present and the operator
should search for it on the opposite side.
The relationship of the two canal orifices
to each other is also significant. The closer the Fig. 1(c). Picture taken on Radiovisiography shows files
placed in MP and DP canals of palatal root of maxillary
orifices are to each other, the greater are the first molar which join in apical 1/3rd of the root (Type II
chances that the two canals join at some point configuration).
within the body of the root.
Among the root canal anomalies of the size of the first file to be used, and it
maxillary molars, the least frequent appears contributes to a rational approach to solve the
to be that of the palatal root. Slowey9 stated problems that arise during therapy.
that root canal anatomy of each tooth has Literature is reviewed regarding the
certain commonly occurring characteristics as presence of extra canals in palatal root of
well as numerous atypical ones that can be maxillary molars. The incidence of two root
road maps to successful endodontics. The canals in the palatal root of maxillary molars
expected root canal anatomy dictates the has been reported to be 2- 5.1%7,10, Christie
location of the initial entry of access, it dictates et al11 speculated that maxillary molars with
31

two palatal roots may be encountered once
every 3 years in a busy endodontic practice.
Although the incidence of a second palatal
canal is not high, it is important to take this
variation into consideration during root canal
therapy of maxillary molars in order to ensure
long term treatment success.
References
1. Cohen S and Burns C. Pathways of the pulp 6th Ed.,
Harcourt Brace and Company, Asia PTE Ltd, 1997.
2. Ingle JI. Endodontics. 2nd Ed., Philadelphia, Lea and
Febiger, 1976 : 66-75.
3. Pomeranz HH and Fishelberg G. The secondary
mesiobuccal canal of maxillary molars. J. Am. Dent.
Assoc. 1974; 88: 119-124.
4. Seidberg BH, Altman M, Guttuso J and Suson M.
Frequency of two mesiobuccal root canals in maxillary
permanent first molar. J. Am. Dent. Assoc. 1973; 87: 852-
856.
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Endodontology, Vol. 15, 2003
5. Vertucci FJ. The endodontic significance of the
mesiobuccal root of the maxillary first molar. Navy
Med.1974; 63: 29.
6. Maggiore F, Jou YT and Kim S. A six canal maxillary
first molar: Case report. Int. Endod. J. 2002; 35: 386-491.
7. Stone HL and Stroner FW. Maxillary molars
demonstrating more than one palatal root canal. Oral Surg.
1981; 51(6) : 649-652.
8. Vertucci FJ, Seelig A and Gillis R. Root canal
morphology of the human maxillary second premolar. Oral
Surg. 1976; 38 : 456.
9. Slowey RR. Root canal anatomy, road map to
successful endodontics. Dent. Clin. North Am. 1979; 23:
555.
10. Saler and Goel BR. Frequency of fourth root canal in
the maxillary first molar, an in-vitro study. Thesis submitted
to Karnataka University. 1995.
11. Christie WH, Peikoff MD and Fogel HM. Maxillary
molars with two palatal roots: A retrospective clinical study.
J. Endod. 199117(2): 80-84.