New Proposal for Classifying Root and Root Canal Morphology

  • Hany M. A. Ahmed
  • Marco A. Versiani
  • Gustavo De-Deus
  • Paul M. H. Dummer


Understanding the anatomy of roots and root canals is fundamental for successful root canal treatment and endodontic surgery. There are numerous reports on anatomical variations of teeth, and several classifications of canal configurations have been proposed. Recently, improved nondestructive digital imaging systems and the use of magnification in clinical practice have further highlighted the complexities of root canal anatomy. This chapter reviews the existing classifications of root and root canal morphology and introduces a new, accurate, simple, and reliable system for research, clinical, and training purposes.


Anatomy Canal configuration Micro-CT Morphology Root Root canal 


  1. 1.
    Cleghorn BM, Goodacre CJ, Christie WH. Morphology of teeth and their root canal systems. In: Ingle JI, Bakland LK, Baumgartner JC, editors. Ingle’s endodontics. 6th ed. Hamilton, ON: BC Decker Inc.; 2008. p. 151–220.Google Scholar
  2. 2.
    Vertucci FJ. Root canal morphology and its relationship to endodontic procedures. Endod Topics. 2005;10:3–29.CrossRefGoogle Scholar
  3. 3.
    Ahmed HMA, Abbott PV. Accessory roots in maxillary molar teeth: a review and endodontic considerations. Aust Dent J. 2012;57:123–31. quiz 248CrossRefGoogle Scholar
  4. 4.
    Ahmed HMA. Anatomical challenges, electronic working length determination and current developments in root canal preparation of primary molar teeth. Int Endod J. 2013;46:1011–22.PubMedGoogle Scholar
  5. 5.
    Versiani MA, Pécora JD, de Sousa-Neto MD. Root and root canal morphology of four-rooted maxillary second molars: a micro-computed tomography study. J Endod. 2012;38:977–82.CrossRefGoogle Scholar
  6. 6.
    Versiani MA, Ordinola-Zapata R, Keleş A, Alcin H, Bramante CM, Pécora JD, et al. Middle mesial canals in mandibular first molars: a micro-CT study in different populations. Arch Oral Biol. 2016;61:130–7.CrossRefGoogle Scholar
  7. 7.
    Ahmed HMA, Hashem AA. Accessory roots and root canals in human anterior teeth: a review and clinical considerations. Int Endod J. 2016;49:724–36.CrossRefGoogle Scholar
  8. 8.
    Ahmed HMA, Cheung GSP. Accessory roots and root canals in maxillary premolar teeth: a review of a critical endodontic challenge. ENDO – Endod Pract Today. 2012;6:7–18.Google Scholar
  9. 9.
    Ahmed HMA. A paradigm evolution shift in the endodontic map. Eur J Gen Dent. 2015;4:98.CrossRefGoogle Scholar
  10. 10.
    Hess W, Zürcher E. The anatomy of root canals of the teeth of the permanent and deciduous dentition. New York: William Wood; 1925.Google Scholar
  11. 11.
    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 Oral Med Oral Pathol. 1969;28:419–25.CrossRefGoogle Scholar
  12. 12.
    Vertucci F, Seelig A, Gillis R. Root canal morphology of the human maxillary second premolar. Oral Surg Oral Med Oral Pathol. 1974;38:456–64.CrossRefGoogle Scholar
  13. 13.
    Weine FS. Endodontic therapy. 3rd ed. St. Louis: Mosby; 1982.Google Scholar
  14. 14.
    Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH. A new system for classifying root and root canal morphology. Int Endod J. 2017;50:761–70.CrossRefGoogle Scholar
  15. 15.
    Christie WH, Peikoff MD, Fogel HM. Maxillary molars with two palatal roots: a retrospective clinical study. J Endod. 1991;17:80–4.CrossRefGoogle Scholar
  16. 16.
    Carlsen O, Alexandersen V. Radix mesiolingualis and radix distolingualis in a collection of permanent maxillary molars. Acta Odontol Scand. 2000;58:229–36.CrossRefGoogle Scholar
  17. 17.
    Baratto-Filho F, Fariniuk LF, Ferreira EL, Pécora JD, Cruz-Filho AM, Sousa-Neto MD. Clinical and macroscopic study of maxillary molars with two palatal roots. Int Endod J. 2002;35:796–801.CrossRefGoogle Scholar
  18. 18.
    Belizzi R, Hartwell G. Evaluating the maxillary premolar with three canals for endodontic therapy. J Endod. 1981;7:521–7.Google Scholar
  19. 19.
    Pomeranz HH, Eidelman DL, Goldberg MG. Treatment considerations of the middle mesial canal of mandibular first and second molars. J Endod. 1981;7:565–8.CrossRefGoogle Scholar
  20. 20.
    Song JS, Choi HJ, Jung IY, Jung HS, Kim SO. The prevalence and morphologic classification of distolingual roots in the mandibular molars in a Korean population. J Endod. 2010;36:653–7.CrossRefGoogle Scholar
  21. 21.
    Kottoor J, Albuquerque DV, Velmurugan N. A new anatomically based nomenclature for the roots and root canals—Part 1: Maxillary molars. Int J Dent. 2012;2012:120565.CrossRefGoogle Scholar
  22. 22.
    Valerian Albuquerque D, Kottoor J, Velmurugan N. A new anatomically based nomenclature for the roots and root canals—Part 2: Mandibular molars. Int J Dent. 2012;2012:814789.CrossRefGoogle Scholar
  23. 23.
    Gulabivala K, Aung TH, Alavi A, Ng YL. Root and canal morphology of Burmese mandibular molars. Int Endod J. 2001;34:359–70.CrossRefGoogle Scholar
  24. 24.
    Gulabivala K, Opasanon A, Ng YL, Alavi A. Root and canal morphology of Thai mandibular molars. Int Endod J. 2002;35:56–62.CrossRefGoogle Scholar
  25. 25.
    Ng YL, Aung TH, Alavi A, Gulabivala K. Root and canal morphology of Burmese maxillary molars. Int Endod J. 2001;34:620–30.CrossRefGoogle Scholar
  26. 26.
    Sert S, Bayirli GS. Evaluation of the root canal configurations of the mandibular and maxillary permanent teeth by gender in the Turkish population. J Endod. 2004;30:391–8.CrossRefGoogle Scholar
  27. 27.
    Versiani M, Ordinola-Zapata R. Root canal anatomy: implications in biofilm disinfection. In: Chavez de Paz L, Sedgley C, Kishen A, editors. Root canal biofilms. Toronto: Springer; 2015. p. 23–52.Google Scholar
  28. 28.
    Verma P, Love RM. A micro CT study of the mesiobuccal root canal morphology of the maxillary first molar tooth. Int Endod J. 2011;44:210–7.CrossRefGoogle Scholar
  29. 29.
    Kim Y, Chang SW, Lee JK, Chen IP, Kaufman B, Jiang J, et al. A micro-computed tomography study of canal configuration of multiple-canalled mesiobuccal root of maxillary first molar. Clin Oral Investig. 2013;17:1541–6.CrossRefGoogle Scholar
  30. 30.
    Lee KW, Kim Y, Perinpanayagam H, Lee JK, Yoo YJ, Lim SM, et al. Comparison of alternative image reformatting techniques in micro-computed tomography and tooth clearing for detailed canal morphology. J Endod. 2014;40:417–22.CrossRefGoogle Scholar
  31. 31.
    Leoni GB, Versiani MA, Pécora JD, Sousa-Neto MD. Micro-computed tomographic analysis of the root canal morphology of mandibular incisors. J Endod. 2014;40:710–6.CrossRefGoogle Scholar
  32. 32.
    Filpo-Perez C, Bramante CM, Villas-Boas MH, Hungaro Duarte MA, Versiani MA, Ordinola-Zapata R. Micro-computed tomographic analysis of the root canal morphology of the distal root of mandibular first molar. J Endod. 2015;41:231–6.CrossRefGoogle Scholar
  33. 33.
    Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol. 1984;58:589–99.CrossRefGoogle Scholar
  34. 34.
    Velmurugan N, Parameswaran A, Kandaswamy D, Smitha A, Vijayalakshmi D, Sowmya N. Maxillary second premolar with three roots and three separate root canals—case reports. Aust Endod J. 2005;31:73–5.CrossRefGoogle Scholar
  35. 35.
    Peiris R. Root and canal morphology of human permanent teeth in a Sri Lankan and Japanese population. Anthropol Sci. 2008;116:123–33.CrossRefGoogle Scholar
  36. 36.
    Briseño-Marroquin B, Paqué F, Maier K, Willershausen B, Wolf TG. Root canal morphology and configuration of 179 maxillary first molars by means of micro-computed tomography: an ex vivo study. J Endod. 2015;41:2008–13.CrossRefGoogle Scholar
  37. 37.
    Gupta SK, Saxena P. Proposal for a simple and effective diagrammatic representation of root canal configuration for better communication amongst oral radiologists and clinicians. J Oral Biol Craniofac Res. 2016;6:59–65.CrossRefGoogle Scholar
  38. 38.
    Oehlers FA. Dens invaginatus (dilated composite odontome). I. Variations of the invagination process and associated anterior crown forms. Oral Surg Oral Med Oral Pathol. 1957;10:1204–18.CrossRefGoogle Scholar
  39. 39.
    Melton DC, Krell KV, Fuller MW. Anatomical and histological features of C-shaped canals in mandibular second molars. J Endod. 1991;17:384–8.CrossRefGoogle Scholar
  40. 40.
    Fan B, Cheung GS, Fan M, Gutmann JL, Bian Z. C-shaped canal system in mandibular second molars: Part I—Anatomical features. J Endod. 2004;30:899–903.CrossRefGoogle Scholar
  41. 41.
    Kato A, Ziegler A, Higuchi N, Nakata K, Nakamura H, Ohno N. Aetiology, incidence and morphology of the C-shaped root canal system and its impact on clinical endodontics. Int Endod J. 2014;47:1012–33.CrossRefGoogle Scholar
  42. 42.
    Shaw JC. Taurodont teeth in South African races. J Anat. 1928;62:476–98.Google Scholar
  43. 43.
    Jafarzadeh H, Azarpazhooh A, Mayhall JT. Taurodontism: a review of the condition and endodontic treatment challenges. Int Endod J. 2008;41:375–88.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Hany M. A. Ahmed
    • 1
  • Marco A. Versiani
    • 2
  • Gustavo De-Deus
    • 3
  • Paul M. H. Dummer
    • 4
  1. 1.Department of Restorative Dentistry, Faculty of DentistryUniversity MalaysiaKuala LumpurMalaysia
  2. 2.Department of Restorative Dentistry, Dental School of Ribeirão PretoUniversity of São PauloRibeirão PretoBrazil
  3. 3.School of DentistryFluminense Federal UniversityNiteróiBrazil
  4. 4.School of Dentistry, College of Biomedical and Life SciencesCardiff UniversityCardiffUK

Personalised recommendations