Root canal systems of the mandibular and
Blackwell Science, Ltd
maxillary first permanent molar teeth of South
Asian Pakistanis
F. Wasti, A. C. Shearer & N. H. F. Wilson
Turner Dental School, Manchester, UK
Abstract
Wasti F, Shearer AC, Wilson NHF. Root canal systems
of the mandibular and maxillary first permanent molar teeth of
South Asian Pakistanis. International Endodontic Journal, 34,
263–266, 2001.
Aim The purpose of the present ex vivo study was
to investigate variations in the root canal systems of
mandibular and maxillary first permanent molar teeth
of South Asian Pakistanis.
Methodology The root canal systems of a sample of
30 mandibular and 30 maxillary first permanent molar
teeth extracted from South Asian Pakistanis were studied
using a clearing technique.
Results The mesial roots of the mandibular molar teeth
typically presented with two canals (97%) of type II, IV
or VI configuration. The distal roots of these teeth pre-
sented with a single canal (50%) of type I or V configura-
tion or with two canals (50%) of type II, IV or VI. The
Introduction
False assumptions about the root canal anatomy of
teeth may lead to misdiagnosis, improper debridement,
step formation and breakage of instrument during root
canal treatment. Problems faced during endodontic
treatment of permanent molar teeth indicate the need
for increased knowledge of the anatomy of root canal
systems.
To date, a number of studies have reported differ-
ences in root canal systems due to racial divergence
Correspondence: Dr F. Wasti, Unit of Operative Dentistry and
Endodontology, Turner Dental School, University Dental Hospital
of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK
(fax: +0161 2756710; e-mail: Nairn.H.F.Wilson@man.ac.uk).
© 2001 Blackwell Science Ltd
prevalence of four root canals in two-rooted mandibular
first permanent molar teeth was 47%. In maxillary
molar teeth the mesial roots with a single canal (47%)
were type I or type V; those with two canals (53%) were
type II, IV or type VI. The distal and palatal roots that
presented as a single canal (100%) were type I or type V
configuration. The prevalence of four root canals in three-
rooted maxillary first permanent molar teeth was 53%.
Conclusion It is concluded that four root canals in
mandibular and maxillary first permanent molar teeth
of South Asian Pakistanis is a common occurrence. The
distribution of the different configurations of root canal
systems in this population differed from that in Cauca-
sian groups, suggesting that variations in root canal
systems may be attributed to racial divergence.
Keywords: mandibular molar, maxillary molar, South
Asian Pakistanis.
Received 26 April 1999; accepted 5 June 2000
(Walker 1988, Salwa et al. 1990, Al-Nazhan 1999, Weine
et al. 1999). A variation that has received particular
attention is the three-rooted mandibular first perman-
ent molar tooth. Surveys of populations of Mongoloid origin
indicate a high prevalence of three-rooted mandibular
molars (Walker 1988). The frequency of this trait ranges
from 6 to 44% (Tratman 1938, Pederson 1949, Tratman
1950, Turner 1967, 1971). Salwa et al. (1990) found the
prevalence of supplementary roots in mandibular first
permanent molar teeth to be 2.3% for a Saudi group of
Asiatic descendants and 0.7% for an Egyptian group of
African descendants. This study also demonstrated a
low prevalence (2.3%) of three-rooted mandibular first
permanent molar teeth amongst the Saudi sample,
compared with 8% for Chinese, 20% for Japanese and
19% for Thais.
International Endodontic Journal, 34, 263 –266, 2001 263
 Root canal systems Wasti et al.

Percentages for types I–VIII

Table 1 Distribution of the root canal
systems of the mandibular first
Investigators Teeth Roots I II III IV V VI VIII VIII permanent molar teeth of Caucasians
Skidmore 45 M 6.7 37.8 55.5 based on Vertucci’s classification
& Bjorndal (1971) D 71.1 17.7 11.2
Pineda & Kuttler (1972) 300 M 12.8 30.2 57.0
D 73.0 12.7 14.3
Vertucci (1984) 100 M 12.0 28.0 51.0 8.0 1.0
D 70.0 15.0 7.0 8.0

The two-rooted mandibular first permanent molar Table 2 Distribution of the root canal systems of mesial root of
tooth usually has three canals. Two root canals are maxillary first permanent molar teeth of Caucasians based on
located in the mesial root with one root canal in the distal Vertucci’s classification
root. Hess (1925) reported the prevalence of three root Percentages for types I–V
canals in mandibular permanent molar teeth was 78%.
Investigators Teeth I II III IV V
In 40 – 45% of two-rooted mandibular first permanent
molar teeth the mesial root has two root canals with Weine et al. (1969) 208 48.5 37.5 14.0
Pineda & Kuttler (1972) 262 39.3 12.2 35.7 12.7
one apical foramen (Skidmore & Bjorndal 1971, Pineda
Pineda (1973) 245 41.0 17.0 42.0
& Kuttler 1972, Vertucci & Williams 1974). In vitro studies Green (1973) 100 64.0 22.0 14.0
by Skidmore & Bjorndal (1971) demonstrated the preval- Seidberg et al. (1973) 100 38.0 37.0 25.0
ence of two root canals in the distal root of permanent Pomeranz 71 72.0 17.0 11.0
mandibular molar teeth was almost 30% (Table 1). A & Fishelberg (1974)
Vertucci (1984) 100 45.0 37.0 18.0
clinical study conducted by Al-Nazhan (1999) on 251
root canal-treated mandibular first permanent molar
teeth of a Saudi Arabian subpopulation reported that
6% of the teeth had three roots, 58% had four root North America, and relate to teeth of predominantly
canals (two mesial and two distal) and 42% had three Caucasian origin (Tables 1 and 2). It is suggested that
root canals (two mesial and one distal). there is a need for further studies of the anatomy of root
Maxillary first permanent molar teeth are generally canal systems of teeth of non-Caucasian origin to estab-
considered to be three-rooted with four root canals, the lished the frequency of root and canal variations that
additional root canal being typically located in the may exist in the dentitions of different racial groups
mesiobuccal root. Hess (1925) reported the prevalence (Walker 1990).
of four root canals in maxillary permanent molar teeth The purpose of the present ex vivo study was to
to be 53%. The root canal systems of the mesiobuccal investigate variations in the root canal systems of the
root have been extensively investigated in both ex vivo mandibular and maxillary first permanent molar teeth
and in vivo studies (Walker 1990). Ex vivo studies indicate of South Asian Pakistanis.
that a second root canal is present in 55–69% of these
roots (Pineda & Kuttler 1972, Pineda 1973, Seidberg
Materials and methods
et al. 1973, Pomeranz & Fishelberg 1974, Vertucci
1974). The root canal configuration, according to the A sample of 30 mandibular and 30 maxillary first
classification of Vertucci (1984), is usually type II (two permanent molar teeth were collected from a large
separate root canals with a single apical exit); however, supply of recently extracted teeth from the Department
the presence of two root canals of type IV configuration of Oral Surgery, Punjab Dental Hospital Lahore, Pakistan.
with two separate apical foramen has been reported to Teeth that demonstrated fully formed roots; intact external
be as high as 42% (Table 2). Weine et al. (1999) reported morphology and were of known racial origin were
on the mesiobuccal roots of the maxillary first perman- selected for inclusion in the study.
ent molar teeth of Japanese subpopulation with two The selected teeth were stored in 10% formalin. Each
root canals (54%) of type II or type IV configuration. tooth was cleaned of any adherent soft tissues, bone
Descriptions of the root and canal forms of perman- fragments and calculus by scaling and polishing. An
ent molar teeth, dating from the work of Hess (1925) endodontic access cavity was then prepared in each
are based largely on studies conducted in Europe and tooth. The pulp chamber was gently dried to allow

264 International Endodontic Journal, 34, 263 –266, 2001 © 2001 Blackwell Science Ltd

Table 3 The root canal systems and configuration of the teeth studied
No. of root canals %
Specimens (No) Position of roots 1 2
Mandibular first 1.Mesial 0 96.7
permanent molar teeth (30) 2.Distal 50 50
Maxillary first 1.Mesial 46.7 53.3
permanent molar teeth (30) 2.Distal 100 0 0
3.Palatal 100 0 0
examination of the pulpal floor. The anatomic dark lines
in the floor of the pulp chamber were examined with a
DG16 endodontic explorer (Hu Freiday, Chicago, IL, USA)
to identify the root canal orifices. After locating the orifices,
the teeth were placed in 0.5% sodium hypochlorite solu-
tion for 48 h to dissolve debris and pulp remnants. All
the specimens were then thoroughly washed in run-
ning water for 4 h to clean the root canals of any debris.
Once washed the teeth were demineralized for 3 days in
5% nitric acid at room temperature (20 °C). The nitric
acid solution was changed every day. After demineraliza-
tion the teeth were rinsed in running water for 4 h.
Indian ink was injected into the root canals before
dehydration of the teeth. The dehydration process con-
sisted of a series of ethyl alcohol rinses starting with
80% solution overnight, followed by 90% for 1 h and
then 100% ethyl alcohol rinses for 1 h. The dehydrated
teeth were placed into methyl salicylate for approx-
imately 2 h to render them transparent. The cleared
teeth were examined under a dissecting microscope at
×10 magnification. The root canal systems were classified
according to the scheme devised by Vertucci (1984) as
follows.
• Type I. A single root canal extending from the pulp
chamber to the apex.
• Type II. Separate root canals leave the pulp chamber
and join short of the apex to form one canal.
• Type III. One root canal leaves the pulp chamber
before dividing into two within the root and then
merges to exit as one single canal.
• Type IV. Two separate root canals extend from the
pulp chamber to the apex.
• Type V. One root canal leaves the pulp chamber and
divides short of the apex into two separate and
distinct root canals with separate apical foramina.
• Type VI. Two separate root canals leave the pulp
chamber, merge in the body of the root, and again
divide short of the root apex to exit as two separate
and distinct canals.
• Type VII. One root canal leaves the pulp chamber,
divides and rejoins within the body of the root canal
© 2001 Blackwell Science Ltd
Wasti et al. Root canal systems
Configuration of root canal systems %
3 I II III IV V VI VII VIII
3.3 23.0 67.7 6.0 3.3
0 30.0 26.7 20.0 20.0 3.3
0 33.3 23.3 23.3 13.3 6.8
83.3 16.7
66.7 33.3
and finally redivides into two distinct canals short of
the apex.
• Type VIII. Three separate and distinct root canals
extend from the pulp chamber to the apex.
Results
Of 30 mandibular first permanent molar teeth studied,
the mesial roots typically presented with two canals of
type II, IV or VI configuration. One tooth was found to
have three canals of type VIII configuration. The distal
root of the mandibular molar teeth presented with a
single canal of type I or V configuration or with two
canals of type II, IV or VI. No type III or VII canal con-
figurations were found in the roots of these teeth. The
percentage distribution is given in Table 3.
Of 30 maxillary first permanent molar teeth studied,
the mesial roots with a single canal were of type I and V
configuration. Those with two canals were of type II, IV
or VI. The distal and palatal roots that presented with
single canal were of type I or V configuration. No type
III, VII or VIII canal configurations were found in the
roots of these teeth. The percentage distribution is sum-
marized in Table 3.
Discussion
An increased number of root canals were found in the
mesial roots of the mandibular first permanent molar
teeth. Other studies detailed in Table 1 have shown that
type I root canal configurations are normally found
in the mesial roots of mandibular first permanent
molar teeth of Caucasians. In contrast to other studies
(Table 1), type VI configurations were found in a small
percentage of the mandibular first permanent molar
teeth examined. In addition, the prevalence of three
canals with separate foramina was found to be higher
in the present study. For the distal roots of the mandib-
ular first permanent molars, the prevalence of two root
canals was also found to be greater. The results for the
30 maxillary first permanent molar teeth, like those for
International Endodontic Journal, 34, 263 –266, 2001 265
 Root canal systems Wasti et al.
the mandibular first molar teeth, differed from those
reported in investigations of samples of Caucasian teeth
(Table 2). These differences relate principally to the
presence of type VI and type V configurations, with a
relatively low incidence, in particular type I configura-
tions in the mesial root. There was a relatively high incid-
ence of type V configuration found in the distal and
palatal roots of the maxillary first permanent molar teeth
(Table 3). These findings, although derived from a relatively
small sample of 60 permanent molar teeth obtained
from a single centre, are considered to be representative.
They demonstrate the complexity of the root canal systems
of mandibular and maxillary first permanent molar
teeth and provide further evidence of racial difference in
root canal configuration.
Conclusion
Notwithstanding the limited nature of the present study,
it is concluded that there is a high incidence of four root
canals in the mandibular and maxillary first permanent
molar teeth of South Asian Pakistanis. The distribution
of the different configurations of the root canal systems in
the mandibular and maxillary first permanent molar
teeth of South Asian Pakistanis differs from that in
Caucasian groups. Many (<33%) of the single-root
canals identified in the teeth investigated were found to
terminate in two apical foramina.
Acknowledgements
The authors sincerely thank Professor Yaqub Baig Mirza
and Dr Javeria Asif of Punjab Dental Hospital Lahore,
Pakistan for their assistance in the collection of teeth
examined in this study.
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