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.,* Gainesville, Fla.
UNIVERSITY OF FLORIDA 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)
T 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 perco-
lation 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 knowl-
edge of root canal morphology before he can success-
fully 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 of Endodon-
tics.
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 selec-
tion of material and classification of canal configura-
tions, 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 stan-
dardized 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 Oral Surg.
November, I984

Table I. Morphology of the maxillary permanent teeth

Position of lateral canals
No. of Canals with
Tooth Root teeth lateral canals Cervical Middle Apical Furcation

Central 100 24 I 6 93
Lateral 100 26 I 8 91
Canine 100 30 0 IO 90
First premolar 400 49.5 4.1 10.3 74.0 Il.0
Second premolar 200 59.5 4.0 16.2 78.2 1.6
First molar MB 100 51 10.7 13.1 58.2 f
DB 100 36 10.1 12.3 59.6 18
P 100 48 9.4 11.3 61.3 1
Second molar MB 100 50 IO.1 14.1 65.8 t
DB 100 29 9.1 13.3 67.6 IO
P 100 42 8.7 1 I.2 70. I 1
Note: Figuresrepresentpercentageof the total.

Table II. Morphology of the mandibular permanent teeth

Position of lateral canals
No. of Canals with
Tooth Root teeth lateral canals Cervical Middle Apical Furcation

Central 100 20 3 12 85
Lateral 100 18 2 15 83
Canine 100 30 4 16 80 -
First premolar 400 44.3 4.3 16.1 78.9 0.7
Second premolar 400 48.3 3.2 16.4 80.1 0.3
First molar Mesial 100 45 10.4 12.2 54.4 t
23
Distal 100 30 8.7 IO.4 51.9 1
Second molar Mesial 100 49 10.1 13.1 65.8 t
II
Distal 100 34 9.1 11.6 68.3 i
Note:Figures represent percentage of total.

Table III. Classification and percentage of root canals of the maxillary teeth
No. We I Type II Type III Total with Type IV The V Type VI Type VII
of I 2-l I-2-1 one canal 2 l-2 2-I-2 l-2-1-2
Teeth teeth canal canals canals at apex canals canals canals canals

Maxillary central 100 100 0 100 0

Maxillary lateral 100 100 0 100 0
Maxillary canine 100 100 0 100 0
Maxillary first premolar* 400 8 I8 26 62
Maxillary second premolar 3 200 48 22 75 II
Maxillary first molar
MesiobuccalS 100 45 37 82 I8
Distobuccal 100 100 0 100 0
Palatal 100 100 0 100 0
Maxillary second molar
Mesiobuccal 71 I7 0 88 12 0 0 0
Distobuccal 100 0 0 100 0 0 0 0
Palatal 100 0 0 100 0 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.
 Volume 58 Root canal anatomy of human permanent teeth 591
Number 5

Position of transverse anastomosis Position of apical foramen

Transverse anastomosis
between canals Cervical Middle Apical Central Lateral Apical Deltas

12 88 1
- 22 78 3
- - 14 86 3
34.2 16.4 58 25.6 12.0 88.0 3.2
30.8 18.8 50 31.2 22.2 77.8 15.1
52 10 15 15 24 76 8
0 0 0 0 19 81 2
0 0 0 0 18 82 4
21 8 72 20 12 88 3
0 0 0 0 17 83 2
0 0 0 0 19 81 4

Note: Figures represent percentage of the total.

Position of transverse anastomosis Position of apical foramen

Transverse anastomosis
between canals Cervical Middle Apical Central Lateral Apical Deltas

- - - - 25 15 5
- - - - 20 80 6
- - - - 30 IO 8
32.1 20.6 52.9 26.5 15 85 5.1
30 0 66.1 33.3 16.1 83.9 3.4
63 12 75 13 22 78 10

55 10 72 18 20 80 14
31 10 71 13 19 81 6

16 11 74 15 21 79 7

Now Figures represent percentage of total.

in the smallest accessory canals, and because it can

Total with Type VIII Total with
be removed from the external surface of the tooth,
two canals 3 three canals thereby allowing for a clearer specimen. The injected
at apex canals at apex teeth were then dehydrated in successivesolutions of
70%, 95%, and 100% alcohol for 5 hours each. The
0 0 0
dehydration was necessary because the clearing
0 0 0
0 0 0 agent is not miscible with water. Finally, the speci-
69 5 5 mens were placed in clear liquid plastic casting
24 1 I resin* and were completely cleared within 24
hours.
18 0 0
0 0 0 RESULTS
0 0 0
The transparent specimens were examined under
12 0 0 the dissecting microscope, and the number and type
0 0 0 of root canals, the number and location of lateral
0 0 0
canals and apical foramina, and the frequency of
apical deltas were recorded. These data are summa-
rized 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 canines. Middle row, Maxillary lateral incisors.
Bottom row, Maxillary central incisors.

Table IV. Classification and percentage of root canals of the mandibular teeth
No. TYP I Type II Type III Total with Type IV Type V Type VI Type VII
Of 1 2-1 I-2-I one canal 2 1-2 2-l-2 I-2-1-2
Teeth terlh canal canals canals at apex canals canals canals canals

Mandibular central incisor* 100 70 5 22 97 3 0 0 0

Mandibular lateral incisor* 100 75 5 18 98 2 0 0 0
Mandibular canine* 100 78 14 2 94 6 0 0 0
Mandibular first premolar+ 400 70 0 4 74 1.5 24 0 0
Mandibular second premolar? 400 97.5 0 0 97.5 0 2.5 0 0
Mandibular first molar$
Mesial 100 12 28 0 40 43 8 10 0
Distal 100 70 15 0 85 5 8 2 0
Mandibular second molar
Mesial 100 27 38 0 65 26 9 0 0
Distal 100 92 3 0 95 4 1 0 0

*Results published previously in Vertucci, F.J.: Root canal anatomy of the mandibular anterior teeth, J. Am. Dent. Assoc. 89:369, 1974.
tResults published previously in Vertucci, F.J.: Root Canal Morphology of Mandibular Premolar Teeth, J. Am. Dent. Assoc. 97:47, 1978.
$Re.sults published previously in Vertucci, F.J., and Williams, R.: Root canal anatomy of the mandibular first molar, J. N.J. Dent. Assoc. 4527-28, 1974
Volume 58 Root canal anatomy of human permanent teeth 593
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).

The root canal configurations present within the

Total with Total with
two canals Type VIII three canals roots of human permanent teeth can be classified
at apex 3 canals at apex into eight types:
Type I. A single canal extends from the pulp
3 0 0 chamber to the apex.
2 0 0
0 0
Type II. Two separate canals leave the pulp
6
25.5 0.5 0.5 chamber and join short of the apex to form one
2.5 0 0 canal.
Type III. One canal leaves the pulp chamber,
59 1 1 divides into two within the root, and then merges to
15 0 0
exit as one canal.
35 0 0 Type IV. Two separate and distinct canals extend
5 0 0 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

Fig. 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. 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 maxil-
lary second premolar.
DlSCUSSlON
During the past 100 years, there have been many
excellent studies of pulp morphology. Upon compar-
ing the findings of these studies with those of the
Volume58 Root canal anatomy of human permanent teeth 595
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.
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 Root canal anatomy of human permanent teeth 597
Number 5

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
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 en-
ables 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 charac-
teristics as well as numerous atypical ones that can
be road maps to successful endodontics. The expect-
ed 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 sever-
al different angles. If, on the direct periapical expo-
sure, 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
Oral Surg.
November. I984
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 demon-
strated 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 proce-
dures, 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 obtu-
rated.
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 configura-
tions 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 summa-
rized 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 proce-
dure can be approached rationally. The frequency
with which root canals unite should be considered
during enlargement and filling procedures. The den-
tist 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 conclu-
sions 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
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6. Hess W: Anatomy of the root canals of the teeth of the
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7. Barrett MT: The internal anatomy of the teeth with special
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8. Okumura T: Anatomy of the root canals, Tram Seventh Int
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9. Mueller AH: Anatomy of the root canals of the incisors,
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Root canal anatomy of human permanent teeth 599
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ographic investigation of 7,275 root canals. ORAL SURG 33:
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1I. Vertucci FJ: Root canal morphology of mandibular premolar.
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26. Cooke HG, Cox FL: C-shaped canal configurations in man-
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canal of maxillary molars. J Am Dent Assoc 88: 119, 1974.
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SURG30: 694-699, 1970.
30. Green D: A stereomicroscopic study of the root apices of 400
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31. Nosonowitz DM, Brenner MR: The major canals of the
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32. Harris WE: Unusual root canal anatomy in a maxillary
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Reprinf requests fo:
Dr. Frank J. Vertucci
Department of Endodontics
University og Florida College of Dentistry
Gainesville, FL 32610