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JOURNALOF ENDODONTICS
Copyright © 1995 by The American Association of Endodontists
CLINICAL AID
Canal Configuration of the Mesiobuccal Root of the
Maxillary Second Molar
Norman Eskoz, DDS, MS and Franklin S. Weine, DDS, MSD
The purpose of this study was to investigate the
canal configuration in the mesiobuccal root of the
maxillary second molar. The canal configuration of
the mesiobuccal root of the maxillary second molar
need not be the same as that of the maxillary first
molar. Several studies have been attempted to clar-
ify the configuration of the second molar, usually via
postoperative evaluation, sectioning, or radiogra-
phy. To follow more closely the clinical procedure,
this study involved access cavity preparation and
radiographs taken with files in place. Of the 73
extracted maxillary second molars investigated, 67
teeth (91.8%) had 3 roots whereas 6 teeth (8.2%)
had 2 roots. In the three rooted teeth, the mesio-
buccal roots of 40 (59.7%) were classified as type I
(single canal from orifice to apex), 14 (20.9%) were
type II (two canals merging short of the apex into a
single canal at the apex), 11 (16.4%) were type III
(two separate and distinct canals from orifice to
apex), and 2 (3%) were type IV (single canal at the
orifice, dividing in midroot into two canals exiting at
the apex).
A major cause of endodontic failure when treating maxillary
molars is the inability to locate, debride, and fill the frequently
present second mesiobuccal canal. Before an article written
by Weine et al. (1) in 1969, virtually all dentists thought of
the mesiobuccal root (MBR) of the maxillary first molar as
having only one canal. Since that article, many papers have
been published concerning the types of canal systems present
in that root and their percentages (2-5). However, few articles
have dealt exclusively with the canal configurations in the
MBR of the maxillary second molar, possibly because of the
assumption that the root is very similar to the first molar.
Some studies have grouped first and second molars together
and reported combined results. Considering the difference in
canal configuration between maxillary first and second
premolars, it is reasonable to expect that a difference may
exist between the MBR of the maxillary first and second
molars.
To categorize the canal systems in each root, Weine (6)
described four different types of configurations as follows:
38
Printed in U.S.A.
VOL. 21, NO. 1, JANUARY1995
type I, single canal from pulp chamber to apex; type II, two
separate canals leaving the chamber, but merging short of the
apex to form a single canal; type III, two separate canals
leaving the chamber and exiting the root in separate foramina;
and type IV, one canal leaving the chamber, but dividing
short of the apex into two separate and distinct canals with
separate foramina.
Using a variety of methods to study canal configurations,
investigators from 1972 to 1984 reported the occurrence of
two canals (Weine types II, III, and IV) in the MBR of the
maxillary second molar to range from 12% to 38% (2-4, 7-
9). In a recent study in which a combination of methods was
used, Kulild and Peters (10) found that 14 of 32 teeth (43.8%)
had two canals in the MBR of the maxillary second molar
when flies were placed in the orifices and radiographed. The
number of two canals increased to 25 of 32 (78.2 %) when the
orifices were counter-sunk with a bur before fries were placed
in the canals. Finally, 30 of the 32 teeth (93.7%) had two
canals when the roots were sectioned horizontally and exam-
ined histologically (Table 1).
The purpose of this study was to determine the canal
configuration percentages in the MBR of the maxillary second
molar using a clinically oriented in vitro study.
MATERIALS AND METHODS
Seventy-three extracted human maxillary second molars
were obtained from oral surgeons in the Chicago area. All
teeth were known to be second molars absolutely. Ifa question
existed, the oral surgeons were told not to include the teeth.
They were stored in a 5.25 % solution of sodium hypochlorite.
The distobuccal and palatal roots were resected to the base of
the furcations and discarded so that unobstructed preoperative
radiographs could be taken of the MBR from buccal-palatal
and mesial-distal directions. Access cavities were prepared
according to Weine (6). Size #8 files were placed into the
canals until they just penetrated the apex. One millimeter was
subtracted from that initial length, which became the working
length.
Glyoxide (Marion Laboratories, Lenaxa, KS) was used as
a lubricant. If an orifice was found, but a size #8 frie could
not be passed into it, a # 1 round long shank bur was used to
a depth of 1 to 2 m m until the file could penetrate well into
the canal. The canals were filed to a size #15 frie. Another set
Vol. 21, No. 1, January 1995 Second Maxillary Molar Configurations 39

TABLE 1. Studies of the canal configuration of the MBR of the maxillary second molar
No. of
Investigator Method of Study Teeth Type I Type II Type III Type IV

Nosonowitz and Brenner Post-op evaluation 161 68.9% 25.5% 5.6% 0%

Pomeranz and Fishelberg Post-op evaluation 29 62.1 13.8 24.1 0
Vande Vorde et al. Post-op evaluation 33 87.9 ,-12.1--,
Pineda and Kuttler Radiographic 294 64.6 8.2 12.8 14.4
Vertucci Injected dye 100 71.0 17.0 12.0 0
Kulild and Peters Access and bur 32 21.8 *
penetration ,-78.2-->

Kulild and Peters Sectioning and mi- 32 6.3 ,--93.7--,

croscopic exam
• Classification considered as accessory canals off main canal, could be off single (major) or second canal.

TAmE 2. Canal configurations of 73 maxillary second molars, DISCUSSION

determined by initial files placed to working length
No. of The results of this study, as listed in Table 2, should be
Teeth Percentage compared with the other studies of this tooth, as listed in
Table 1. Differences that are noted may be related to methods
According to total no. of
roots of study. However, the use of radiographs on extracted teeth
3 rooted teeth 67 91.8% with fries in place is a clinically oriented, acceptable method
2 rooted teeth 6 8.2% for studying canal configuration, and has been used previously
Total teeth 73 in a report on the mandibular second molar ( 1l).
Configuration of the MBR The results reported differ considerably with the study by
of the three rooted Kulild and Peters (10), who found 78.2% of the MBRs had
teeth two canals after access preparation and bur penetration. Our
Type I MBR 40 59.7% study reported 40% with two canals, and the difference may
Type II MBR 14 20.9%
be caused by the fact that they used their burs more aggres-
Type III MBR 11 16.4%
Type IV MBR 2 3% sively for countersinking than we did, and we used a slightly
Total teeth 67 different, more modest, method of classification.
The even higher percentage, determined by sectioning and
microscopic examination (93.7%), in the Kulild and Peters
report would seem to be well beyond the ability of any
clinician to reach. It is obvious to the clinically oriented
of buccal-palatal and mesial-distal radiographs were taken endodontist that, in the past 25 yr, a considerable percentage
with the files in place. of maxillary first molars have been treated with two canals
Roots with type IV configurations were identified by plac- filled in the MBR. However, it is rare to see this same
ing files from the apex in any canal openings found palatal to occurrence in the maxillary second molar, even though most
a more buccally located apical foramen. If the second file of the studies (Table l) have indicated that, in 30% or more
penetrated and joined the first file away from the tip and of these teeth, two canals are present in the MBR.
further into the canal, it was categorized as type IV. When treating this tooth, dentists should assume that there
The molars were categorized as to the number of roots, are two canals present in the MBR. Only after a thorough
and the canal configuration of the MBR was determined search for a second canal and after it is determined that
using the classification according to Weine (6). further preparation would be fruitless or cause a perforation,
should the operator accept treating only one canal. If therapy
fails on the MBR, it may be because the second canal was
not located and treated, and this should be considered care-
RESULTS fully in the retrcatment, either by surgical or nonsurgical
methods.
The results of this study are summarized in Table 2. Of 73 When examining the views from the proximal (Figs. 1 to
molars, 67 (91.8%) had three roots and six (8.2%) had two 3), it is evident that the MBR of the maxillary second molar
roots. The MBR in the 67 three-rooted molars was further is wide buccolingually. This is true even in teeth where only
categorized as to canal configuration. Forty of the MBRs one mesiobuccal canal is present (Fig. IB). This indicates a
(59.7%) had a single canal only (Fig. 1). Fourteen roots morphological tendency for this root to be wide buccolin-
(20.9%) had type II canal systems (Fig. 2), 11 roots (16.4%) gually on a consistent basis, whether one or two canals are
displayed type III configurations (Fig. 3), and 2 (3%) were present. The discovery of a wide root, by radiograph or
classified as type IV, based on the ability to place a second manipulation, does not, by itself, indicate that two canals
file from the apex (Fig. 4). must be present.
40 Eskoz and Weine
FIG 1. A, Radiograph of maxillary second molar with type I canal
configuration (single canal) buccal view, with size #15 file in place.
From this view, it appears that the root is slender, probably similar in
size and shape to the distobuccal root, which has been amputated
in this photo. B, Mesial view of the same root shows the wide
buccolingual dimension of this root, even in this case where only one
canal is present.
Journal of Endodontics
FIG 2. A, Radiograph of maxillary second molar with type II canal
configuration (two canals joining short of apex) buccal view, with size
#10 file in the mesiobuccal canal and #8 file in the mesiolingual
canal From this view the root is slender, but two files are visible. B,
Mesial view; the wide buccolingual dimension of the root is apparent,
but it is only slightly wider than the root with only one canal shown
in Fig. lB.
Vol. 21, No. 1, January 1995
FIG 3. A, Radiograph of maxillary second molar with type III canal
configuration (two separate canals) buccal view, with size #15 file in
the mesiobuccal canal and size #10 file in the mesiolingual canal.
This root also has a slender appearance in this view, but two files go
to the apex in separate canals. B, Near the floor of the pulp chamber,
where the clinician would search for the canals, the root is no wider
than that found in the type I or II canal configurations (compare with
Figs. 1B and 2B). It is a bit wider toward the apex to allow for
separate exiting of the foramens.
Second Maxillary Molar Configurations 41
FIG 4. All teeth that initially seemed to be type I configurations were
explored from the apex with a small file for a second canal opening
and radiographed from the mesial. In several instances, the two files
merged almost instantly, so these were still classified as type I. In
two roots, the two canals merged several millimeters from the apex,
as shown herein, and were classified as type IV.
To treat the maxillary second molar properly, an under-
standing of the morphogenesis of the mesiobuccal canal sys-
tem is mandatory. Initially the canal in the MBR is the shape
of a kidney bean. With a continued deposition of secondary
dentin, the isthmus between the poles becomes narrower and
eventually may even close, resulting in two canals. Because
the mesiolingual segment of the canal surrounds the smaller
of the poles of the kidney bean, it will close offleaving a small
space, thus making it more difficult to locate. Figure 5 dem-
onstrates the apex of an immature MBR. At first, there is one
large ribbon-shaped apex, which, as the tooth matures, begins
to constrict, eventually leaving one or more foramens. There-
fore, depending on the age of the tooth, the MBR may have
a variety of configurations.
The percentage of two-rooted maxillary second molars has
been reported to be anywhere from 0 to 12% (6). In this
study, we found the occurrence to be ~8%. Obviously, 72
teeth are too few to use to derive this statistic accurately, but
further studies could be considered using much larger num-
bers for clarification.
When treating any tooth endodontically, statistics from
nonclinically oriented studies could lead to erroneous conclu-
sions. Also, when treating the maxillary second molar, statis-
42 Eskoz and Weine
FIG 5. Apical view of the MBR of a maxillary second molar from a 14-
yr-old; apical development had not been completed. Note the kidney
bean shape of the canal at this stage of development. With increase
in dentin deposition, the isthmus will narrow (arrows). In some teeth,
the wide canal will become squeezed into two canals, whereas in
others a larger and wider single canal will be present.
tics from articles discussing the configurations of the roots of
the maxillary first molar could be misleading.
A W o r d for the W i s e
There is a person who says the scientific literature contains two, and only two, types of studies. Those which
provide equivocal answers to important questions and those which provide definitive answers to trivial
questions.
Joumal of Endodontics
Dr. Eskoz is a former graduate assistant in Endodontics, and Dr. Walne is
professor emeritus of Endodontics and former professor and director of Post-
graduate Endodontics, Loyola University School of Dentistry, Maywood, IL.
Address requests for repdnts to Dr. Franklin S. Weine, 30 North Michigan
Avenue, Suite 1320, Chicago, IL 60602.
References
1. Weine FS, Healey HJ, Gerstein H, Evanson L. Canal configuration in the
mesiobuccal root of the maxillary first molar and its endodontic significance.
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2. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral
Surg Oral Med Oral Patho11984;58:589-99.
3. VandeVorde HE, Odendahl D, DavisJ. Molar 4th canals: frequent cause
of endodontic failure? III Dent J 1975;44:779--86.
4. PinedaF. Roantgenographicinvestigationof the mesiobuccal root of the
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Zachariah Yeomans