Вы находитесь на странице: 1из 8

[Downloadedfreefromhttp://www.jresdent.orgonFriday,August09,2013,IP:190.232.44.

170]||ClickheretodownloadfreeAndroidapplicationforthisjournal

Review Article

The root and root canal morphology


of the human mandibular premolars:
Aliterature review
Padmanabh Jha, Vineeta Nikhil, Vipin Arora, Mesha Jha
Department of Conservative Dentistry and Endodontics, Subharti Dental College, 718, Rishinagar, Meerut, UttarPradesh, India

Address for correspondence: Dr.Padmanabh Jha, Department of Conservative Dentistry and Endodontics, Subharti Dental College, Subhartipuram, N.H. 58,
Delhi Haridwar Byepass, Meerut, Uttar Pradesh, India. Email:drpadmanabh.jha@gmail.com

Abstract

The objective was to review thoroughly the literature of the root and root canal morphology of the human
mandibular premolars. Published studies were divided into anatomic studies reporting the number of
roots, number of canals, and apical anatomy. Differences caused by gender and ethnicity have also
been reported. Individual case reports of anomalies were included to demonstrate the extreme range
of variation. Almost all of the teeth in the anatomic studies were single rooted(99.6%). The incidence
of two roots(0.3%) and three roots(0.1%) was extremely rare. Anatomic studies of the internal canal
morphology found that a single canal was present in 91.0% of the teeth. Asingle apical foramen was
found in 91.8% of the teeth. However, the root and root canal morphology of the mandibular premolars
can be extremely complex and requires careful assessment.

Keywords: Abnormal morphology, mandibular premolars, number of canals, number of roots,


rootcanal morphology

INTRODUCTION
Knowledge of basic root and root canal morphology as well
as possible variation in anatomy of the root canal system
is important in achieving successful root canal treatment.
This is followed by negotiation, cleaning and shaping, and
obturation of the entire canal system in three dimensions.[13]
Ingle[1] has reported that the most significant cause for
endodontic failures was incomplete canal instrumentation,
followed by incorrect canal obturation. Slowey[4] has
indicated that probably because of the variations in canal
anatomy, the mandibular premolars are the most difficult
Access this article online
Quick Response Code:

Website:

www.jresdent.org

DOI:
***

teeth to treat endodontically. Variation in root canal


morphology was suggested as the most likely reason for
the high frequency of endodontic flareups and failures.
The mandibular premolars are typically described in
textbooks as singlerooted tooth with a single root canal
system.[511] The ovoidshaped root in crosssection normally
has developmental grooves or depressions on the mesial
and distal surfaces. Woelfel and Scheid[11] have described
the depression on the distal surface as being the deeper of
the two. There are also numerous case reports and anatomic
studies that have reported variations.
The incidence of the number of roots[1219] and of the
number of canals [1216,18,2027] reported in anatomic
studies varies greatly in the literature [Tables 1 and
2]. The root morphology and canal morphology of the
mandibular premolars can be extremely complex and
highly variable.[3,6,8,28,29] The factors that can contribute
to differences observed in the various anatomic studies
have been reported previously, [29] and these factors
include ethnicity, [16,28,3054] age, [23,5560] gender, [43,50,61]
Journal of Restorative Dentistry / Vol - 1 / Issue - 1 / Jan-Apr 2013 3

[Downloadedfreefromhttp://www.jresdent.orgonFriday,August09,2013,IP:190.232.44.170]||ClickheretodownloadfreeAndroidapplicationforthisjournal
Jha, etal.: Root and root canal morphology of the mandibular premolars

unintentional bias in the selection of clinical examples


of patients or teeth(specialty endodontic practice
vs. general dental practice), [29] as well as study
design(invitro vs. invivo).[6264]
Normal root and root canal anatomy of the mandibular
premolars are well documented in numerous textbooks,

but there is a great deal of variation in the reporting of


the incidence of anomalies.[2,3,5,611,65,66] As a result, there
is no consensus on the range of variation or possible
anomalies. The purpose of this article was to review
the literature and conduct an analysis of the variations
found in studies that reported on root and root canal
morphology of the human mandibular premolars.

Table1: Number of roots in the mandibular premolars


Reference
Atul Jain and Rachna Bahuguna(2010)[67]
Sayeed Rahimi etal.(2007)[68]
Sert and Bayirti(2004)[43]
Zaatar etal.(1997)[18]
Calikan etal.(1995)[13]
Gelder etal.(1989)[14]

Number of teeth in study


(country and ethnicity
where identified)
138(India)
266(Iran)
100(Turkey)
64(Kuwait)
100(Turkey)
328(France)

Vertucci(1978)[25]
Zillich and Dowson(1973)[27]

400(USA)
906(USA)

Visser(1948)[69]
Barrett(1925)[12]
Total number of teeth in studies

2,089(Germany)
32(USA)
4,423(10 studies)

Type of study

One root
%(No.)

Clearing
Clearing
Clearing
Radiographs of RCT teeth
Clearing
In vitro radiography and
sectioning
Clearing
Radiographic examination
invitro and mechanical probing
Analysis of extracted teeth
Sectioning
Weighted averages

97.1(134)
98.87(263)
100(100)
95.6(61)
100(100)
97.6(320)

Two
roots
%(No.)
2.9(4)
1.13(3)

4.7(3)

0.4(8)

Three
roots
%(No.)

100(400)
96.6(902)

0.4(4)

99.85(2,086)
100(32)
99.43(4398)

0.05(1)

0.43(19)

0.1(2)

0.1(6)

RCT = Root Canal Treatment

Table2: Number of canals and apices in the mandibular premolars


Reference
(chronological order)
Deepak Sharma and
Meetu Mathur(2011)[70]
Atul Jain and Rachna
Bahuguna(2010)[67]
N Velmurugan and R
Sandhaya(2008)[71]
Sayeed Rahimi
etal.(2007)[68]
Tzu Li Lu etal.(2006)[72]
Hasheminia and
Hashemi(2005)[73]
Takatoma Yoshika
etal.(2004)[74]
Sert and Bayirili(2004)[43]
Zaalar etal.(1997)[18]
Calikan etal.(1995)[13]
Gelder etal.(1989)[14]
Miyoshi etal.(1977)[22]
Vertucci(1978)[25]
Green(1973)[21]
Zillich and Dowson
(1973)[27]
Pineda and Kuttler
(1972)[57]
Barrett(1925)[12]
Total number of teeth in
studies

Number of teeth in study Type of study


(country and ethnicity
where identified)
60(India)
Computed tomography study

One canal Two canals One canal Two or more


%(No.)
or more
at apex
canals at
%(No.)
%(No.)
apex %(No.)
73.33(44) 26.67(16) 81.67(49)
18.33(11)

138(India)

Clearing

88.4(122)

11.59(16)

78.99(109)

21.01(29)

100(India)

Decalcification

72(72)

27(27)

81(81)

18(18)

266(Iran)

Clearing

75.94(202)

21.42(57)

80.45(214)

15.79(42)

82(China)
80(Iran)

Sectioning and staining


Clearing and sectioning

54(44)
88.8(71)

46(38)
11.2(9)

59.43(49)
97.5(78)

15.85(13)
2.5(2)

139(Japan)

Radiographic and staining

80.58(112)

19.42(27)

83.45(116)

16.55(23)

200(Turkish population)
64(Kuwait)
100(Turkey)
328(France)

Clearing
Radiograph of RCTtreated teeth
Clearing
In vitro radiography and
sectioning
Radiography in vitro
Clearing
In vitro grinding and examination
under 3 magnification

71(142)
95.3(61)
93.6(94)
86.6(284)

29(58)
4.7(3)
6.4(6)
13.4(44)

81.5(163)
95.3(61)
93.6(94)

18.5(37)
4.7(3)
6.4(6)

97.9(639)
97.5(390)
92(46)

2.1(14)
2.5(10)
8(4)

97.5(390)
96(48)

2.5(10)
4(2)

Radiographic examination
invitro and mechanical probing
Radiographic examination
in vitro
Sectioning
Weighted averages
Weighted averages

87.5(793)

12.5(113)

88.4(801)

11.6(105)

98.8(247)

1.2(3)

98.8(247)

1.2(3)

653(Japan)
400(USA)
50(USA)
96(48) 4(2)
906(USA)
250(Mexico)
32(USA)
3,848(17 studies)
2,835(14 studies)

4 Journal of Restorative Dentistry / Vol - 1 / Issue - 1 / Jan-Apr 2013

65.6(21)
34.4(11)

87.94(3384) 11.85(456)

88.18(2500) 10.72(304)

[Downloadedfreefromhttp://www.jresdent.orgonFriday,August09,2013,IP:190.232.44.170]||ClickheretodownloadfreeAndroidapplicationforthisjournal
Jha, etal.: Root and root canal morphology of the mandibular premolars

MATERIALS AND METHODS


A review of the literature was performed on the
human mandibular premolars with respect to
the number and type of roots and the root canal
morphology. Keywords used in the search included
mandibular premolars, mandibular bicuspid,
number of roots, number of canals, root canal
morphology, extra roots, anomalies, and
abnormal morphology. Peerreviewed studies of the
mandibular premolars were identified first through
PubMed, and then other related articles were added by
hand searching of bibliographies and Internet articles
pre1966 that might be missed in a PubMed search and
articles in which keywords do not match the subject
of the search. Case studies were included to illustrate
anomalies and genetic variation not reported in the
larger anatomic studies. The data were analyzed, and
weighted averages were determined for each of the
following:(1) Number of roots, (2) number of canals
and apical foramina, and (3) summary of case reports
of other anomalies.

DISCUSSION
A great deal of variation can be found in the literature
with respect to the root and root canal morphology of
teeth, and the human mandibular premolars are no
exception. The primary cause of endodontic failure
is overlooked root canals. The presence of extra roots
or canals in mandibular premolars is undoubtedly an
endodontic challenge. Together with diagnosis and
treatment planning, a knowledge of common root
canal morphology and its frequent variations is a basic
requirement for endodontic success.[75] Studies have
emphasized on the fact that a root with tapering canal
and a single foramen is an exception rather than a rule.[67]
The clinician must be familiar with the various pathways
that root canals take to the apex. The pulp canal system
is complex and canals may branch, divide, and rejoin;
according to Ingle, the percentage of two canals and one
foramen in mandibular first premolar is 6.5%.[75]
The anatomies of mandibular premolars have been
examined extensively(Pineda and Kuttler, 1972; ElDeeb,
1982; Shapira and Delivanis, 1982; Vertucci, 1984; Bram
and Fleisher, 1991; Wong, 1991; Kartal and Yankoglu,
1992; Calskan etal., 1995). Vertucci(1984) determined the
incidence of a second canal in mandibular first premolars
to be 26% and 3% for second premolars. The prevalence
of lateral canals was 44% for the first premolar and 48%
for the second premolar. The incidence of an apical
delta in these teeth was 9%, whereas the ratio of apical
foramina was 85% for the first premolar and 84% for the
second premolar.[15]

Calkan etal.(1995) encountered a single canal in 64% of


first premolars and 94% of second premolars. They also
reported 53% and 39% of these teeth had lateral canals,
respectively. Sert etal. reported that 62% of mandibular
first premolars had a single canal, whereas the prevalence
of a single canal in the second premolars was 71%. In
the first premolars, lateral canals existed in 16.5% of the
cases, whereas in the second premolars, the prevalence
was 14%.[15]
Studies by Trope et al.[16] and Sabala et al.[24] reported
their invivo results on root number and internal canal
morphology by the number of patients rather than by
the total number of teeth. Two or more canals were
found in the mandibular second premolar tooth in 5.2%
and 4.4% of the patients, respectively. Reporting data
by number of patients instead of number of teeth leads
to higher incidences of anomalies(more than one root
or canal), unless the anomaly is 100% bilateral. Because
the occurrence of two or more roots also can occur
unilaterally or bilaterally, the results in these studies are
higher than the invitro anatomic studies reporting by the
number of teeth.
The study by Trope etal. compared the number of roots
and number of canals in mandibular premolars between
African American and white patients. The African
American group had an incidence of two or more roots
in the mandibular second premolar tooth at 4.8% of
the time compared with a 1.5% incidence in the white
patient group. Although the incidence of multiple roots
was greater in the African American patients compared
with white patients in both the mandibular first and
second premolar teeth, the differences were statistically
significant only for the mandibular first premolar. Ethnic
differences in internal canal morphology were also found
in this study but were not statistically significant. The
African American group had an incidence of two or more
canals at 7.8% of the time, whereas the white group had
an incidence of 2.8%.[16]
In their study on a Turkish population, Kartal and
Yankoglu(1992) found the incidence of multiple canals
in mandibular premolars to be 28% and that completely
separate and independent two or three canal variations
existed in a single root with a prevalence of 10%. More
than 24% of the teeth with two canals had one root canal
at the apex.[15]
Two studies compared gender differences for number
of roots or canals in a known population. Astudy by
Serman and Hasselgren reported on the incidence
of two canals and two roots for the mandibular
first and second premolars. They found gender
differences with respect to the number of canals
and roots in an analysis of radiographic surveys of
Journal of Restorative Dentistry / Vol - 1 / Issue - 1 / Jan-Apr 2013 5

[Downloadedfreefromhttp://www.jresdent.orgonFriday,August09,2013,IP:190.232.44.170]||ClickheretodownloadfreeAndroidapplicationforthisjournal
Jha, etal.: Root and root canal morphology of the mandibular premolars

547patients. The distribution of men(252patients) and


women(295patients) was approximately equal. In their
study, more women had multiple roots and/or canals
than men(50womenvs.29men) in the mandibular first
premolar, whereas more men exhibited multiple roots
and/or canals(29 men vs. 15 women) in the mandibular
second premolar.[101] The study by Sert and Bayirli
assessed the canal morphology in 100 Turkish male and
100 Turkish female patients. Men(43%) exhibited two
or more canals much more frequently than the female
patients(15%) in the study.[43]
The roots have a more complex structure in patients with
Turner syndrome. The most frequent deformities were:
Tworooted mandibular first and second premolars with
fully developed mesial and distal roots or separate root
apices. Varrela(1990, 1992) in his study in 87patients
with 45, X karyotype reported 83 first premolars
with separate roots(48% of cases) and only two such
premolars in the control group(1% in first premolars).
He also found 39% of premolars with two roots in the 45,
X/46, XX group(mosaics). In this study, most anomalies
were found in the 45, X group with 34% cases with two
roots in mandibular first premolars and 39% cases in
mandibular second premolars.[102]
The interesting finding of the study was the noticeable
prevalence of Cshaped canals(2.4%) in the mandibular
first premolars and the 2% prevalence of Cshaped
canals in the mandibular second premolars. The
prevalence of Cshaped canals in the mandibular
first premolars had only been reported in three
previous studies(Baisden et al., 1992;[14%] Sikri
and Sikri, 1994;[10%] Lu et al., 2006;[18%]). The
differences between the results obtained in various
studies regarding the anatomy of mandibular first
premolars and the prevalence of Cshaped canals
may arise from racial differences and methods of
studying. The location of the Cshaped morphology
in the mandibular first premolar is quite different. In
a study by TzuYi Lu etal., the location of Cshaped
canal was found at apical 3mm and/or 6mm level
crosssections. Coronally, it could be single oval or two
canals. Therefore, Cshaped canals would be difficult
to detect from coronal approach.[72]
Case reports that describe two or more roots or two or
more canal systems in mandibular premolar teeth are
found in the literature. The examples in Table3 include
mandibular premolar teeth. The complex nature of the
root and root canal morphology of the mandibular
premolars has been underestimated. The following
clues from diagnostic information and techniques
might help clinicians to detect additional root(s) and
canal(s). Asecond radiograph from 15 to 20 from
6 Journal of Restorative Dentistry / Vol - 1 / Issue - 1 / Jan-Apr 2013

either mesial or distal from the horizontal long axis of


the root is necessary to accurately diagnose the number
of roots and canals in premolar teeth. Yoshioka etal.[26]
have indicated that sudden narrowing of the canal
system on a parallel radiograph suggests canal system
multiplicity. MartinezLozano et al. have suggested
a 40 mesial angulation of the Xray beam to identify
additional canals. Ageneral guideline is that if the
midroot image diameter appears equal or greater than
the crown image diameter, then the tooth most likely
has a variation in root canal configuration (Miyoshi
et al., 1977). The presence of additional canal should
be suspected whenever an instrument demonstrates
an eccentric direction on deeper penetration into
the canal, termed directional control, as reported by
Green(1973), or if the working length file appears off
center in the radiograph.[81] The use of magnification has
been demonstrated to improve the clinicians ability to
visualize and access canals.[59]
The use of threedimensional imaging methods in future
large anatomic studies would be of value in assessing
the occurrence and the frequency of anomalous canal
morphology. The role of genetics is just being appreciated
in identifying anomalies caused by syndromes and even
ethnicity or gender variation in morphology.
A review of the literature has revealed that the human
mandibular premolar tooth can have an extremely
complex root and root canal morphology; however, the
incidence of both multiple roots and multiple canals in
the mandibular second premolar is lower than that found
in the mandibular first premolar.

CONCLUSION
The incidence of more than one root, more than one
canal, and more than one foramen is less frequent in the
mandibular second premolar than in the mandibular
first premolar, but numerous case reports cite many
variations, and anomalies might occur. Although
reported in only a few studies, variations in incidence
of single canal versus two or more canals might occur
as a result of ethnicity or gender. More research in the
area of gender and ethnic differences is required to arrive
on definite conclusions. When performing root canal
therapy, additional canals might be missed, leading to
a greater failure rate, unless there is constant vigilance
in locating two or more canal systems in the mandibular
premolars.

REFERENCES
1.

IngleJI. Astandardized endodontic technique utilizing newly


designed instruments and filling materials. Oral Surg Oral Med
Oral Pathol 1961;14:8391.

1 mandibular second premolar


(USA; 49yearwhite Jamaican male)

1 mandibular second premolar


(Belgium; 30yearold Caucasian female)
1 mandibular second premolar
(Saudi; 2yearold Saudi male)
1 mandibular second premolar
(Germany; 20yearold female)
1 mandibular second premolar(Nigeria;
17yearold male) 1 mandibular second
premolar(Nigeria; 22yearold female)

Nallapati(2005)[78]

De Moor and
Calberson(2005)[79]
Hussain and
Nazhan(2003)[80]
Rdig and
Hlsmann(2003)[81]
Oginni etal.(2002)[82]

1 mandibular second premolar


(Israel; 29yearold male)
1 mandibular second premolar
(India; 11yearold female)
1 mandibular second premolar
(India; 16yearold female)

Holtzman(1998)[90]

Nandlal and
Ramesh(1998)[91]
Goswami etal.
(1997)[92]

Macri and Zmener


(2000)[88]
Prabhu etal.(1999)[89]

Rhodes(2001)[87]

Koh etal.(2001)[86]

AlFouzan(2001)[85]

Milano etal.(2002)[84]

2 mandibular second premolars


(India; 30yearold male patient)
1 mandibular second premolar
(USA; 7yearold Hispanic male)
1 mandibular second premolar
(Saudi Arabia; 34yearold black male)
1 mandibular second premolar(Singapore)
1 mandibular second premolar(Singapore)
1 mandibular second premolar
(UK; 25yearold Caucasian male)
1 mandibular second premolar
(Argentina; 58yearold female)
2 mandibular second premolars
(India; 13yearold boy)

Kannan etal.(2002)[83]

Lin etal.(2006)[77]

Number of teeth in study


1 mandibular second premolar
(India; 33yearold female patient)
1 mandibular first premolar and 1
mandibular second premolar(Canada;
15yearold east Indian male patient)
1 mandibular second premolar
(China; 34yearold Cantonese male)

Reference
Kishore Raju
Kothapalli(2010)[75]
Cleghorn etal.
(2008)[76]

Table3: Case reports of mandibular premolar anomalies

Extraction and
radiological

Patient extraction done for orthodontic


treatment

Clinical RCT
Clinical RCT Clinical
RCT

Aberrant root morphology associated


with all mandibular premolars.
Aberrant root morphology associated
with all mandibular premolars

Tooth crown was grossly carious and


hypoplastic
This case presents a rare mesiodistal
alignment of root bifurcation (most
premolar root bifurcations occur with
a buccolingual alignment)

2 roots(M and D) and 2 canals

Clinical RCT

(Continued)

2 roots interconnected; weblike appearance

All first and second mandibular premolars


exhibited aberrant root development; multiple
roots were present on each tooth
4 canals

5 canals in a single root

2 roots and 4 canals

Contralateral teeth; each had 2 roots with a


mesiodistal bifurcation
All first and second mandibular premolars
exhibited 2 roots
2 roots and 4 canals(2 canals were present in
each root; MB, MLi, DB, and BIi)
Dens evaginatus Dens evaginatus

2 roots(M and D) 2 roots(M and D)

3 roots(MB, DB, and Li) and 3 canals

Clinical RCT
retreatment
Extraction

Radiographic study

Clinical RCT

Cvek(partial) pulpotomy
Cvek(partial) pulpotomy
Clinical RCT

Clinical RCT

Radiographic study

Clinical exam

3 canals

Clinical RCT

3 canals

3 canals(M canal and 2 distal canals)

Clinical RCT

Clinical RCT

3 roots and 3 canals in mandibular first


premolar. Cshaped canals in mandibular
second premolar
3 canals(MB, ML, and D)

Anatomic variation
2 roots and 2 canals

Patient presented with grossly carious


mandibular right first and second
premolars and first, second, and third
molars; both mandibular first and
second premolars exhibited 3 canals
Both mandibular right first and second
premolars required RCT and both had
3 canals
Root canal aberration present in the
apical third of the root

Clinical RCT

Type of study
Clinical RCT

Other key information

[Downloadedfreefromhttp://www.jresdent.orgonFriday,August09,2013,IP:190.232.44.170]||ClickheretodownloadfreeAndroidapplicationforthisjournal
Jha, etal.: Root and root canal morphology of the mandibular premolars

Journal of Restorative Dentistry / Vol - 1 / Issue - 1 / Jan-Apr 2013 7

[Downloadedfreefromhttp://www.jresdent.orgonFriday,August09,2013,IP:190.232.44.170]||ClickheretodownloadfreeAndroidapplicationforthisjournal

2.

3 roots (Mesiobuccal, Distobuccal, and Lingual)


and 4 canals; Distobuccal root had 2 canals
(Buccal and Lingual) 2 roots (Mesiobuccal and
lingual); each root had 1 canal
3 canals present

3 canals(MB, DB, and Li)

2 roots(M and D) and 4 canals


(2 canals in each root)
2 canals with 2 roots

2 roots(B root with 2 canals and Li root with 1


canal) and 3 canals(MB, DB, and Li)
4 canals(MB, MLi, DB, and DLi) within 1 root

Anatomic variation
3 roots(M, DB, and DLi) and 3 canals

Jha, etal.: Root and root canal morphology of the mandibular premolars

3.
4.
5.
6.
7.
8.
9.
10.
11.

13.
Clinical RCT

Clinical exam and


extraction

Clinical RCT

Clinical RCT

Clinical RCT

Type of study
Clinical exam and
extraction
Clinical RCT
retreatment
Clinical RCT

12.

14.

17.
18.
19.

20.

1(USA; 21yearold Caucasian female)

21.
22.
23.
24.
25.
26.
27.
RCT = Root Canal Treatment

Shapira and
Delivanis(1982)[99]

16.

ElDeeb(1982)[100]

All 4 mandibular second premolars


were extracted for orthodontic
reasons

Bram and Fleisher


(1991)[96]
England etal.
(1991)[97]
Singh etal.(1987)[98]

1 mandibular second premolar


(USA; 48yearold African American female)
1 mandibular second premolar
(USA; 34yearold Caucasian male)
1 mandibular second premolar
(USA; 30yearold African American female)
2 mandibular second premolars
(USA; 10yearold African American female)

Bifurcation occurred at midroot;


recurring flareups due to difficulty in
negotiating all 4 canals
Taurodont premolar with a midroot
bifurcation

Wong(1991)[95]

Reference
Fischer and
Evans(1992)[93]
Chan etal.(1992)[94]

Table3: Continued

Number of teeth in study


1 mandibular second premolar
(USA; 29yearold female)
1 mandibular second premolar
(China; 20yearold male patient)
1 mandibular second premolar
(USA; 19yearold Caucasian male)

Other key information


Mandibular first premolar had similar
root configuration

15.

8 Journal of Restorative Dentistry / Vol - 1 / Issue - 1 / Jan-Apr 2013

28.
29.
30.

IngleJ, BeveridgeE. Text book of Endodontics. 2 nded.


Philadelphia: Lea and Febiger; 1976.
WaltonR, TorabinejadM. Principles and Practice of Endodontics.
2nded. Philadelphia: WB Saunders Co; 1996.
SloweyRR. Root canal anatomy. Road map to successful
endodontics. Dent Clin North Am 1979;23:55573.
IngleJ, BaklandL. Text book of Endodontics. 5thed. Hamilton:
BC Decker; 2002.
AshM, NelsonS. Wheelers Dental Anatomy, Physiology and
Occlusion. 8thed. Philadelphia: Saunders; 2003.
BlackG. Descriptive Anatomy of the Teeth. 4thed. Philadelphia:
SS White Dental Manufacturing Company; 1902.
BrownP, HerbransonE. Dental Anatomy ***and 3D Tooth Atlas
Version3.0. 2nded. Chicago: Quintessence; 2005.
FullerJ, DenehyG. Concise Dental Anatomy and Morphology.
2nded. Chicago: Year Book Medical Publishers, Inc.; 1984.
JordanR, AbramsL, KrausB. Kraus Dental Anatomy and
Occlusion. 2nded. St Louis: Mosby Year Book, Inc.; 1992.
WoelfelJ, ScheidR. Dental Anatomy: Its Relevance to Dentistry.
Philadelphia: Lippincott Williams and Wilkins; 2002.
BarrettM. The internal anatomy of the teeth with special reference
to the pulp and its branches. Dent Cosmos 1925;67:58192.
Calikan MK, PehlivanY, Sepetiolu F, Trkn M, TuncerSS.
Root canal morphology of human permanent teeth in a Turkish
population. JEndod 1995;21:2004.
GeiderP, PerrinC, FontaineM. Endodontic anatomy of
lower premolarsApropos of 669 cases. J Odontol Conserv
1989;115.
SertS, AslanalpV, TanalpJ. Investigation of the root canal
configurations of mandibular permanent teeth in the Turkish
population. Int Endod J 2004;37:4949.
TropeM, ElfenbeinL, TronstadL. Mandibular premolars with
more than one root canal in different race groups. JEndod
1986;12:3435.
VertucciFJ. Root canal anatomy of the human permanent teeth.
Oral Surg Oral Med Oral Pathol 1984;58:58999.
ZaatarEI, alKandariAM, AlhomaidahS, alYasinIM. Frequency
of endodontic treatment in Kuwait: Radiographic evaluation of 846
endodontically treated teeth. JEndod 1997;23:4536.
SchulzeC. Developmental abnormalities of teeth and jaws. In:
GorlinR, GoldmanH, editors. Thomas Oral Pathology. 6thed.
St Louis: CV Mosby Co; 1970. p.1067.
BaisdenMK, KulildJC, WellerRN. Root canal configuration of
the mandibular first premolar. JEndod 1992;18:5058.
GreenD. Double canals in single roots. Oral Surg Oral Med Oral
Pathol 1973;35:68996.
MiyoshiS, FujiwaraJ, Tsuji YNakataT, YamamotoK. Bifurcated
root canals and crown diameter. JDent Res 1977;56:1425.
PinedaF. Roentgenographic investigation of the mesiobuccal
root of the maxillary first molar. Oral Surg Oral Med Oral Pathol
1973;36:25360.
SabalaCL, BenenatiFW, NeasBR. Bilateral root or root canal
aberrations in a dental school patient population. JEndod
1994;20:3842.
VertucciFJ. Root canal morphology of mandibular premolars.
JAm Dent Assoc 1978;97:4750.
YoshiokaT, VillegasJC, KobayashiC, SudaH. Radiographic
evaluation of root canal multiplicity in mandibular first premolars.
JEndod 2004;30:734.
ZillichR, DowsonJ. Root canal morphology of mandibular
first and second premolars. Oral Surg Oral Med Oral Pathol
1973;36:73844.
TaylorR. In: CharlesC, editor. Variations in Morphology of Teeth.
Springfield, IL: Thomas Pub; 1978.
CleghornBM, ChristieWH, DongCC. Root and root canal
morphology of the human permanent maxillary first molar:
Aliterature review. JEndod 2006;32:81321.
Weine FS, Hayami S, Hata G, Toda T. Canal configuration of
the mesiobuccal root of the maxillary first molar of a Japanese
subpopulation. Int Endod J 1999;32:7987.

[Downloadedfreefromhttp://www.jresdent.orgonFriday,August09,2013,IP:190.232.44.170]||ClickheretodownloadfreeAndroidapplicationforthisjournal
Jha, etal.: Root and root canal morphology of the mandibular premolars

31. HsuJW, TsaiPL, HsiaoTH, ChangHP, LinLM, LiuKM, etal.


Ethnic dental analysis of shovel and Carabellis traits in a Chinese
population. Aust Dent J 1999;44:405.
32. CarbonellV. Variations in the frequency of shovelshaped
incisors in different populations. In: Brothwell D, editor. Dental
Anthropology. Oxford: Pergamon Press; 1963. p.21134.
33. DahlbergA. The changing dentition of man. JAm Dent Assoc
1945;32:67690.
34. Dahlberg A. Analysis of the American Indian dentition. In:
Brothwell D, editor. Dental Anthropology. Oxford: Pergamon
Press; 1963. p.14977.
35. NelsonC. The teeth of the Indians of pecos pueblo. Am J Phys
Anthrop 1938;23:26193.
36. TratmanE. Acomparison of the teeth of people(IndoEuropean
racial stock with the Mongoloid race stock). Dent Record
1950;70:434.
37. Walker RT. Root form and canal anatomy of maxillary first
premolars in a southern Chinese population. Endod Dent
Traumatol 1987;3:1304.
38. AokiK. Morphological studies on the roots of maxillary premolars
in Japanese. Shikwa Gakuho 1990;90:18199.
39. Loh HS. Root morphology of the maxillary first premolar in
Singaporeans. Aust Dent J 1998;43:399402.
40. PetersenP. The East Greenland Eskimo Dentition. Copenhagen:
CA Reitzels Forlag; 1949.
41. WalkerRT. Root canal anatomy of mandibular first premolars in a
southern Chinese population. Endod Dent Traumatol 1988;4:2268.
42. Walker RT. Root form and canal anatomy of mandibular first
molars in a southern Chinese population. Endod Dent Traumatol
1988;4:1922.
43. SertS, BayirliGS. Evaluation of the root canal configurations of
the mandibular and maxillary permanent teeth by gender in the
Turkish population. JEndod 2004;30:3918.
44. CurzonME. Miscegenation and the prevalence of threerooted
mandibular first molars in the Baffin Eskimo. Community Dent
Oral Epidemiol 1974;2:1301.
45. GulabivalaK, AungTH, AlaviA, NgYL. Root and canal morphology
of Burmese mandibular molars. Int Endod J 2001;34:35970.
46. Gulabivala K, Opasanon A, Ng YL, Alavi A. Root and canal
morphology of Thai mandibular molars. Int Endod J 2002;35:5662.
47. HaradaY, TominoS, OgawaK, WadaT, MoriS, KobayashiS,
etal. Frequency of threerooted mandibular first molars. Survey
by Xray photographs. Shika Kiso Igakkai Zasshi 1989;31:138.
48. MoritaM. Morphological studies on the roots of lower first molars
in Japanese. Shikwa Gakuho 1990;90:83754.
49. OndaS, MinemuraR, MasakiT, FunatsuS. Shape and number
of the roots of the permanent molar teeth. Bull Tokyo Dent Coll
1989;30:22131.
50. YewSC, ChanK. Aretrospective study of endodontically
treated mandibular first molars in a Chinese population. JEndod
1993;19:4713.
51. ReichartPA, MetahD. Threerooted permanent mandibular first
molars in the Thai. Community Dent Oral Epidemiol 1981;9:1912.
52. de SouzaFreitasJA, LopesES, CasatiAlvaresL. Anatomic
variations of lower first permanent molar roots in two ethnic
groups. Oral Surg Oral Med Oral Pathol 1971;31:2748.
53. HouGL, TsaiCC. The morphology of root fusion in Chinese
adults(I). Grades, types, location and distribution. JClin
Periodontol 1994;21:2604.
54. WalkerRT. Root form and canal anatomy of mandibular second
molars in a southern Chinese population. JEndod 1988;14:3259.
55. HessW. The anatomy of the rootcanals of the teeth of the
permanent dentition, Part 1. New York: William Wood and
Co;1925.
56. N e a v e r t h E J , K o t l e r L M , K a l t e n b a c h R F . C l i n i c a l
investigation(invivo) of endodontically treated maxillary first
molars. JEndod 1987;13:50612.
57. PinedaF, KuttlerY. Mesiodistal and buccolingual roentgenographic
investigation of 7,275 root canals. Oral Surg Oral Med Oral Pathol
1972;33:10110.

58. EskozN, WeineFS. Canal configuration of the mesiobuccal root


of the maxillary second molar. JEndod 1995;21:3842.
59. FogelHM, PeikoffMD, ChristieWH. Canal configuration in the
mesiobuccal root of the maxillary first molar: A clinical study.
JEndod 1994;20:1357.
60. GillesJ, ReaderA. An SEM investigation of the mesiolingual canal
in human maxillary first and second molars. Oral Surg Oral Med
Oral Pathol 1990;70:63843.
61. RossIF, EvanchikPA. Root fusion in molars: Incidence and sex
linkage. JPeriodontol 1981;52:6637.
62. Alavi AM, Opasanon A, Ng YL, Gulabivala K. Root and canal
morphology of Thai maxillary molars. Int Endod J 2002;35:47885.
63. PomeranzHH, FishelbergG. The secondary mesiobuccal canal
of maxillary molars. JAm Dent Assoc 1974;88:11924.
64. SeidbergBH, AltmanM, GuttusoJ, SusonM. Frequency of two
mesiobuccal root canals in maxillary permanent first molars. JAm
Dent Assoc 1973;87:8526.
65. CohenS, BurnsR. Pathways of the Pulp.8thed. St Louis: Mosby;
2002.
66. WeineF. Endodontic Therapy. 6thed. St Louis: Mosby; 2004.
67. JainA, BahugunaR. Root canal morphology of mandibular first
premolar in a Gujarati populationAn invitro study. Dent Res
J(Isfahan) 2011;8:11822.
68. RahimiS, ShahiS, YavariHR, ManafiH, EskandarzadehN.
Configuration of mandibular first and second premolars in
an Iranian population. JDent Res Den Clin Den Prospects
2007;1:2.
69. VisserJ. Beitrag zur Kenntnis der menschlichen Zahnwurzelformen.
Medical dissertation. Zurich, Switzerland: Universitt Zrich; 1948.
70. SharmaD, MathurM. Acomputed tomographic study of canal
variations in maxillary and mandibular first premolar teeth in
Jaipur population: An invitro study. Peoples J Scientif Res
2011;4:15.
71. VelmuruganN, SandhyaR. Root canal morphology of mandibular
first premolars in an Indian population: A laboratory study. Int
Endod J 2009;42:548.
72. LuTY, YangSF, PaiSF. Complicated root canal morphology of
mandibular first premolar in a Chinese population using the cross
section method. JEndod 2006;32:9326.
73. Hasheminia M, Hashemi A. Frequency of canal configuration
in maxillary first premolars and mandibular second premolars.
JIsfahan Dent School 2005;1:5964.
74. YoshiokaT, VillegasJC, KobayashiC, SudaH. Radiographic
evaluation of root canal multiplicity in mandibular first premolars.
JEndod 2004;30:734.
75. KothapalliKR. Tworooted mandibular first premolar: Case report.
Ann Essences Dent 2010;2:935.
76. CleghornBM, ChristieWH, DongCC. Anomalous mandibular
premolars: A mandibular first premolar with three roots and a
mandibular second premolar with a Cshaped canal system. Int
Endod J 2008;41:100514.
77. LinZM, LingJQ, JhugrooA. Mandibular first and second premolars
with three canals. Internet J Dent Sci 2006;4:1. Available from:
http://www. ispub. com/ostia/index. php?xmlFilePath_journals/
ijds/vol4n1/premolar. xml.[Last accessed on 2007May2].
78. NallapatiS. Three canal mandibular first and second premolars:
Atreatment approach. JEndod 2005;31:4746.
79. De MoorRJ, CalbersonFL. Root canal treatment in a mandibular
second premolar with three root canals. JEndod 2005;31:3103.
80. AlAttasH, AlNazhanS. Mandibular second premolar with three
root canals: Report of a case. Saudi Dental J 2003;15:1457.
81. Rdig T, Hlsmann M. Diagnosis and root canal treatment of a
mandibular second premolar with three root canals. Int Endod J
2003;36:9129.
82. Oginni AO, Olusile AO, Bamise CT. Root malformation in
mandibular premolars: An endodontic difficultyreport of two
cases. Niger Postgrad Med J 2002;9:1636.
83. KannanSK, Suganya, SantharamH. Supernumerary roots. Indian
J Dent Res 2002;13:1169.
84. MilanoM, ChavarriaC, HoppeJ. Multirooted mandibular

Journal of Restorative Dentistry / Vol - 1 / Issue - 1 / Jan-Apr 2013 9

[Downloadedfreefromhttp://www.jresdent.orgonFriday,August09,2013,IP:190.232.44.170]||ClickheretodownloadfreeAndroidapplicationforthisjournal
Jha, etal.: Root and root canal morphology of the mandibular premolars

premolars: Report of case. ASDC J Dent Child 2002;69:635.


85. AlFouzanKS. The microscopic diagnosis and treatment of
a mandibular second premolar with four canals. Int Endod J
2001;34:40610.
86. KohET, FordTR, KariyawasamSP, ChenNN, TorabinejadM.
Prophylactic treatment of dens evaginatus using mineral trioxide
aggregate. JEndod 2001;27:5402.
87. RhodesJS. Acase of unusual anatomy: Amandibular second
premolar with four canals. Int Endod J 2001;34:6458.
88. MacriE, ZmenerO. Five canals in a mandibular second premolar.
JEndod 2000;26:3045.
89. PrabhuNT, JohnR, MunshiAK. Aberrant root development of
the mandibular premolars: A case report. Int J Paediatr Dent
1999;9:4951.
90. HoltzmanL. Root canal treatment of mandibular second premolar
with four root canals: Acase report. Int Endod J 1998;31:3646.
91. NandlalB, RameshK. Partial bifurcation and webbed root of
mandibular second premolarAn uncommon variation. JIndian
Soc Pedod Prev Dent 1998;16:78.
92. GoswamiM, ChandraS, ChandraS, SinghS. Mandibular
premolar with two roots. JEndod 1997;23:187.
93. FischerGM, EvansCE. Athreerooted mandibular second
premolar. Gen Dent 1992;40:13940.
94. ChanK, YewSC, ChaoSY. Mandibular premolar with three root
canalsTwo case reports. Int Endod J 1992;25:2614.
95. WongM. Four root canals in a mandibular second premolar.
JEndod 1991;17:1256.

96. BramSM, FleisherR. Endodontic therapy in a mandibular second


bicuspid with four canals. JEndod 1991;17:5135.
97. England MC Jr., HartwellGR, LanceJR. Detection and treatment of
multiple canals in mandibular premolars. JEndod 1991;17:1748.
98. SinghRP, StampsHF, TatumRC. Endodontic considerations
of a tricanaled mandibular second premolar: Case report and
literature review. JMd State Dent Assoc 1987;30:136.
99. ShapiraY, DelivanisP. Multiplerooted mandibular second
premolars. JEndod 1982;8:2312.
100. ElDeebME. Three root canals in mandibular second premolars:
Literature review and a case report. JEndod 1982;8:3767.
101. SermanNJ, HasselgrenG. The radiographic incidence of multiple
roots and canals in human mandibular premolars. Int Endod J
1992;25:2347.
102. VarrelaJ, TownsendG, AlvesaloL. Tooth crown size in human
females with 45, X/46, XX chromosomes. Arch Oral Biol
1988;33:2914.

How to cite this article:


Source of Support: Nil, Conflict of Intrest: Nil.

Author Help: Reference checking facility


The manuscript system (www.journalonweb.com) allows the authors to check and verify the accuracy and style of references. The tool checks
the references with PubMed as per a predefined style. Authors are encouraged to use this facility, before submitting articles to the journal.
The style as well as bibliographic elements should be 100% accurate, to help get the references verified from the system. Even a
single spelling error or addition of issue number/month of publication will lead to an error when verifying the reference.
Example of a correct style

Sheahan P, Oleary G, Lee G, Fitzgibbon J. Cystic cervical metastases: Incidence and diagnosis using fine needle aspiration biopsy.
Otolaryngol Head Neck Surg 2002;127:294-8.
Only the references from journals indexed in PubMed will be checked.
Enter each reference in new line, without a serial number.
Add up to a maximum of 15 references at a time.
If the reference is correct for its bibliographic elements and punctuations, it will be shown as CORRECT and a link to the correct
article in PubMed will be given.
If any of the bibliographic elements are missing, incorrect or extra (such as issue number), it will be shown as INCORRECT and link to
possible articles in PubMed will be given.
10 Journal of Restorative Dentistry / Vol - 1 / Issue - 1 / Jan-Apr 2013