Review Article

The Root and Root Canal Morphology of the Human

Mandibular Second Premolar: A Literature Review
Blaine M. Cleghorn, DMD, MS,* William H. Christie, DMD, MS and
Cecilia C.S. Dong, DMD, BSc, MS
Abstract
The objective was to review thoroughly the literature of
the root and root canal morphology of the human
mandibular second premolar and compare the results
with the mandibular first premolar. Published studies
cite the anatomy and morphology of the mandibular
second premolar tooth for more than 7700 teeth. These
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 2 roots (0.3%) and 3 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. A single apical foramen was found
in 91.8% of the teeth. The incidence of more than 1
root (0.4%), more than 1 canal system (9.9%), and
more than 1 foramen (8.2%) is lower than that of the
mandibular first premolar tooth (2.0%, 24.2%, and
21.1%, respectively). However, the root and root canal
morphology of the mandibular second premolar can be
extremely complex and requires careful assessment. (J
Endod 2007;33:10311037)

Key Words
Abnormal morphology, anomalies, mandibular second
premolar, number of canals, number of roots, root
canal morphology

From the *Department of Dental Clinical Sciences, Dalhousie University, Halifax, Nova Scotia, Canada; Division of
Endodontics, Department of Restorative Dentistry, University
of Manitoba, Winnipeg, Manitoba, and Department of Restorative Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada.
Address requests for reprints to Blaine M. Cleghorn, DMD,
MS, Dalhousie University, Faculty of Dentistry, 1210-5981
University Ave, Halifax, Nova Scotia, B3H 3J5 Canada. E-mail
address: blaine.cleghorn@dal.ca
0099-2399/$0 - see front matter
Copyright 2007 by the American Association of
Endodontists.
doi:10.1016/j.joen.2007.03.020

JOE Volume 33, Number 9, September 2007

nowledge of both basic root and root canal morphology as well as possible variation
in anatomy of the root canal system is important in achieving successful nonsurgical
root canal treatment (NSRCT). This is followed by negotiation, cleaning and shaping,
and obturation of the entire canal system in 3 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 teeth to treat endodontically. Variation in root canal
morphology was suggested as the most likely reason for the high frequency of endodontic flare-ups and failures (Figs. 13) (4 6).
The mandibular second premolar is typically described in textbooks as a singlerooted tooth with a single root canal system (5, 712). The ovoid-shaped root in cross
section normally has developmental grooves or depressions on the mesial and distal
surfaces (Fig. 4). Woelfel and Scheid (12) 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 (1320) and of the number of canals
(1317, 19, 2128) reported in anatomic studies varies greatly in the literature. The
root morphology and canal morphology of the mandibular second premolar can be
extremely complex and highly variable (Figs. 13) (3, 7, 9, 29, 30). The factors that can
contribute to differences observed in the various anatomic studies have been reported
previously (30), and these factors include ethnicity (17, 29, 3155), age (24, 56 61),
gender (44, 60, 62), unintentional bias in the selection of clinical examples of patients
or teeth (specialty endodontic practice versus general dental practice) (30), as well as
study design (in vitro versus in vivo) (63 65).
Normal root and root canal anatomy of the mandibular second premolar is welldocumented in numerous textbooks, but there is a great deal of variation in the reporting of the incidence of anomalies (2, 3, 5, 712, 66, 67). 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 second
premolar. These results were compared with a recent study on the mandibular first
premolar (68).

Materials and Methods

A review of the literature was performed for the human mandibular second premolar with respect to the number and type of roots and the root canal morphology. Key
words used in the search included mandibular second premolar, mandibular second bicuspid, number of roots, number of canals, root canal morphology,
extra roots, anomalies, and abnormal morphology. Peer-reviewed studies of the
mandibular second premolar were identified first through PubMed, and then other
related articles were added by hand searching of bibliographies and internet articles
pre-1966 that might be missed in a PubMed search and articles in which key words do
not match the subject of the search. Pooled data from teeth identified only as premolars or mandibular premolars were avoided. Significant non-English language studies were included when they could be accessed and translated. More than 7700 permanent mandibular second premolar teeth were analyzed in the studies contained in
this review. Case studies were included to illustrate anomalies and genetic variation not

Root and Root Canal Morphology of Human Mandibular Second Premolar

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Review Article

Figure 1. Mandibular left second premolar with incomplete root canal treatment with 1 canal left untreated (left); radiograph on the right is the same case
with both canals treated (unpublished case courtesy of Dr W. H. Christie).

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, (3) ethnic
differences, (4) gender differences, and (5) summary of case reports of
other anomalies.

Results
Number of Roots
Eight anatomic studies that included 4019 teeth report on data
for the number of roots in the mandibular second premolar (Table
1) (1315, 19, 26, 28, 44, 69). The majority of the teeth in these
studies (99.6%) had a single root. Two roots were found in only
0.3% of the teeth studied. Three-rooted (0.1%) teeth were extremely rare in the anatomic studies reported but have been documented in case reports (70 72). The human mandibular first premolar tooth, in comparison, had a higher incidence of more than 1
root (2.1%) in weighted studies (68).
Number of Canals and Apical Foramina
The internal canal morphology of the mandibular second premolar was evaluated in 11 studies that included 3063 teeth (1315,
19, 22, 23, 26, 28, 44, 58, 73). The results of these studies are
shown in Table 2. One canal was present in 2788 (91.0%) teeth
studied. Two or more canal systems were present in 275 (9.0%) of
the teeth studied (Figs. 13). Eight anatomic studies examined the
apical anatomy (14, 19, 22, 26, 28, 44, 58, 73). A single apical
foramen was found in 1882 (91.8%) of the teeth, whereas 2 or more
apical foramina were found in 168 (8.2%) of the teeth. The human
mandibular first premolar tooth, in comparison, had a higher incidence of more than 1 canal system (24.2%) and more than 1 apical
foramina (21.1%) in weighted studies (68).

Summary of Case Reports of Other Anomalies

Other anomalies documented in case reports are shown in Table
3. Twenty-three case reports that included 28 teeth are presented (6,
70 72, 7592). The anomalies reported in the literature include mandibular second premolars with 2 canals in 1 root (several), dens evaginatus (82), 4 canals in 1 root (90), 4 canals and 3 roots (72), 5 canals
in a single root (83), 2 roots (72, 75, 81, 84, 86, 93), 3 roots and 3
canals (70, 71), 3 canals (78, 79, 85, 89, 91), 2 canals and 2 roots (6,
93), 3 canals and 2 roots (77), 2 roots and 4 canals (76, 88), aberrant
root development and multiple roots on all mandibular premolars
(87), and a 4 canal system anomaly (80).

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 second premolar is no exception.
Studies by Trope et al (17), Sabala et al (25), and Amos (94)
reported their in vivo results on root number and internal canal morphology by 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%, 4.4%, and 2.5% of the patients, respectively. Reporting
data by number of patients instead of number of teeth leads to higher
incidences of anomalies (more than 1 root or canal), unless the anomaly is 100% bilateral. Because the occurrence of 2 or more roots also
can occur unilaterally or bilaterally, the results in these studies are
higher than the in vitro anatomic studies reporting by the number of
teeth.
The studies by Serman and Hasselgren (74) as well as the study by
Trope et al (17) reported higher incidences of multiple roots in their
studies (7% and 3.1%, respectively) compared with the averages reported in the anatomic studies (0.4%).
On the other hand, in the 3 studies that examined internal canal
morphology by using data reported by patients, Sabala et al (25), Trope
et al (17), and Amos (94) reported lower incidences of multiple canals
(4.4%, 5.2%, and 2.5%, respectively) than the weighted average of the
anatomic studies (8.9%).
Few studies report morphologic differences with respect to ethnicity. The study by Sert and Bayirli (44) reported a much higher inci-

Ethnic Differences
The only study that attempted to compare ethnic differences for
root number and canal number of the mandibular second premolar in
a known sample size, Trope et al (17), did not show statistically significant differences. Only the mandibular first premolar demonstrated
statistically significant differences for these traits.
Studies that identify ethnicity of the sample population are shown
in Tables 1 and 2.
Gender Differences
Two of the studies reported in this review of the mandibular second premolar found gender differences in their studies. Serman and
Hasselgren (74) found a higher incidence of multiple roots and canals
in the male patients in their study, and Sert and Bayirli (44) reported
higher incidences of more than 1 canal in the Turkish male patients in
their study.
1032

Cleghorn et al.

Figure 2. Mandibular right second premolar exhibiting 1 canal that splits into 2
canals and joins in the apical third, exiting through a single apical foramen (Reprinted with permission from Brown P, Herbranson E. Dental anatomy & 3D tooth
atlas version 4.0. Chicago: Quintessence, 2006: Mandibular second premolar- case
5, x-ray database. Image Brown & Herbranson Imaging, Inc.).

JOE Volume 33, Number 9, September 2007

Review Article
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 2 or more canals 7.8% of the time, whereas
the white group had an incidence of 2.8%.
Two studies compared gender differences for number of roots or
canals in a known population. A study by Serman and Hasselgren (74)
reported on the incidence of 2 canals and 2 roots for the mandibular
first and second premolar. They found gender differences with respect
to the number of canals and roots in an analysis of radiographic surveys
of 547 patients. The distribution of men (252 patients) and women
(295 patients) was approximately equal. In their study, more women
had multiple roots and/or canals than men (50 women vs 29 men) in
the mandibular first premolar, whereas more men exhibited multiple
roots and/or canals (29 men vs 15 women) in the mandibular second
premolar.
The study by Sert and Bayirli (44) assessed the canal morphology
in 100 Turkish male and 100 Turkish female patients. Men (43%)
exhibited 2 or more canals much more frequently than the female
patients (15%) in the study.
Case reports that describe 2 or more roots or 2 or more canal
systems in mandibular premolar teeth are found in the literature. The
examples in Table 3 include mandibular second premolar teeth only.
Dens invaginatus is included in a sample of 2 case reports and
might rarely affect the anomalous formation of a root or canal system
(82). Dens evaginatus (odontome) is a relatively common coronal

Figure 3. Mandibular second premolar exhibiting complex internal canal morphology and accessory canals (Reprinted with permission from Brown P, Herbranson E. Dental anatomy & 3D tooth atlas version 4.0. Chicago: Quintessence,
2006: Mandibular second premolar- 3D models. Image Brown & Herbranson Imaging, Inc.).

dence of more than 1 canal (29%) in a Turkish population, whereas

aliskan et al (14) found the incidence of more than 1 canal (6.4%)
also in a Turkish population to be approximately similar to the average
of the anatomic studies (8.9%) reported here.
The study by Trope et al (17) compared the number of roots and
number of canals in mandibular premolars between African American
and white patients. As noted, their study reported results by number of
patients rather than by the total number of teeth.
The African American group had an incidence of 2 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.

Figure 4. Root cross sections of the mandibular second premolar demonstrating complex nature of root. (Modified with permission from Brown P, Herbranson E. Dental anatomy & 3D tooth atlas version 4.0. Chicago: Quintessence,
2006: Mandibular second premolar- rotations & slices. Image Brown &
Herbranson Imaging, Inc.).

JOE Volume 33, Number 9, September 2007

Root and Root Canal Morphology of Human Mandibular Second Premolar

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Review Article
TABLE 1. Number of Roots in the Mandibular Second Premolar (incidence by number of teeth)
Reference
(chronologic order)
Sert and Bayirti (2004)
(44)
Zaatar et al. (1997)
(19)
Caliskan et al. (1995)
(14)
Geider et al. (1989)
(15)
Vertucci (1978) (26)
Zillich and Dowson
(1973) (28)
Visser (1948) (69)
Barrett (1925) (13)
Total number of teeth
in studies

Number of teeth in study

(Country and ethnicity
where identified)

Type of study

1 Root

2 Roots

3 Roots

4.7% (3)

100 (Turkey)

Clearing

100% (100)

64 (Kuwait)

Radiographs of RCT teeth

95.6% (61)

100 (Turkey)

Clearing

100% (100)

328 (France)

In vitro radiography and

sectioning
Clearing
Radiographic examination
in vitro and mechanical
probing
Analysis of extracted teeth
Sectioning
Weighted averages

97.6% (320)

0.4% (8)

100% (400)
96.6% (902)

0.4% (4)

99.85% (2,086)
100% (32)
99.6% (4001)

0.05% (1)

0.3% (12)

0.1% (2)

0.1% (6)

400 (USA)
906 (USA; teeth with RCT
and open apices were
excluded)
2,089 (Germany)
32 (USA)
4,019 (8 studies)

anomaly found principally in mandibular and maxillary premolar teeth.

It appears to occur most often in Mongoloid populations (37, 95), and
severe attrition might result in pulp exposure and pulpal necrosis. Merrill (95) reported an incidence of 4.3% of this anomaly in a group of
650 Alaskan Indians and Eskimos (indigenous populations). Anomalies
of root form or canal system have not been linked in reported studies of
dens evaginatus. Case reports of this anomaly of the crown have been
included in this study on root anatomy because they include extension of
the pulp into the tubercle. Occlusal interferences and wear of the tubercle can usually lead to pulp exposure, necrosis, and the need for
NSRCT.
Recent case reports of immature mandibular second premolar
teeth with pulpal exposure and partial abscess formation as a result of
exposure of a worn dens evaginatus tubercle have advocated a more
conservative approach to therapy. Apexogenesis treatment to the level of
viable tissue might result in a more complete formation of canal and
root architecture (96).
Case reports of dens invaginatus in the mandibular second
premolar were not found, but this anomaly could occur in a rare
incidence.

The complex nature of the root and root canal morphology of the
mandibular second premolar has been underestimated (Fig. 3). The
following clues from diagnostic information and techniques might help
clinicians detect additional root(s) and canal(s). A second radiograph
from 1520 degrees from 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 et al (27) have indicated
that sudden narrowing of the canal system on a parallel radiograph
suggests canal system multiplicity. Martinez-Lozano et al (97) have suggested a 40-degree mesial angulation of the x-ray beam to identify additional canals. The use of magnification has been demonstrated to
improve the clinicians ability to visualize and access canals (60, 98
100).
The use of 3-dimensional 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 (101, 102).
A review of the literature has revealed that the human mandibular
second premolar tooth can have an extremely complex root and root

TABLE 2. Number of Canals and Apices in the Mandibular Second Premolar (incidence by number of teeth)
Mandibular Second Premolar
Reference
Hasheminia and Hashemi (2005)
(73)
Sert and Bayirli (2004) (44)

Number of teeth in
study (Country and
ethnicity where
identified)
80 (Iran)

Zaalar et al. (1997) (19)

200 (Turkey, Turkish

population)
64 (Kuwait)

aliskan et al. (1995) (14)

Geider et al. (1989) (15)

100 (Turkey)
328 (France)

Miyoshi et al. (1977) (23)

Vertucci (1978) (26)
Green (1973) (22)

653 (Japan)
400 (USA)
50 (USA)

Zillich and Dowson (1973) (28)

906 (USA; teeth with

RCT and open
apices were
excluded)
250 (Mexico)

Pineda and Kuttler (1972) (58)

Barrett (1925) (13)
Total Number of Teeth in Studies

1034

Cleghorn et al.

32 (USA)
3,063 (11 studies)
2,050 (8 studies)

Type of study

1 canal %

Clearing and
sectioning
Clearing

88.8% (71)

Radiographs of RCT
teeth
Clearing
In vitro radiography
and sectioning
Radiography in vitro
Clearing
In vitro grinding and
examination under
3X magnification
Radiographic
examination in vitro
and mechanical
probing
Radiographic
examination in vitro
Sectioning
Weighted averages
Weighted averages

2 or more
canals %

2 or more
canals at
apex %

97.5% (78)

2.5% (2)

29% (58)

81.5% (163)

18.5% (37)

95.3% (61)

4.7% (3)

95.3% (61)

4.7% (3)

93.6% (94)
86.6% (284)

6.4% (6)
13.4% (44)

93.6% (94)

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)

87.5% (793)

12.5% (113)

88.4% (801)

11.6% (105)

98.8% (247)

1.2% (3)

98.8% (247)

1.2% (3)

65.6% (21)
91.0% (2788)

34.4% (11)
9.0% (275)

71% (142)

11.2% (9)

1 canal at
apex %

91.8% (1882)

8.2% (168)

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Review Article
TABLE 3. Case Reports of Mandibular Second Premolar Anomalies
Reference
Lin et al. (2006) (91)

Number of teeth in study

1 mandibular second premolar
(China; 34 year old Cantonese
male)

Nallapati (2005) (85)

Other key information

1 mandibular second premolar

(USA; 49 year white Jamaican
male)
De Moor and
1 mandibular second premolar
Calberson (2005)
(Belgium; 30 year old
(78)
caucasian female)
Rdig and Hlsmann 1 mandibular second premolar
(2003) (71)
(Germany; 20 year old female)
Oginni et al. (2002)
1 mandibular second premolar
Aberrant root morphology
(86)
(Nigeria; 17 year old male)
associated with all mandibular
premolars
1 mandibular second premolar
Aberrant root morphology
(Nigeria; 22 year old female)
associated with all mandibular
premolars
Kannan et al. (2002) 2 mandibular second premolars
(81)
(India; 30 year old male
patient; ethnicity not
identified)
Milano et al. (2002)
1 mandibular second premolar
(84)
(USA; 7 year old hispanic
male)
Al-Fouzan (2001)
1 mandibular second premolar
(75)
(Saudi Arabia; 34 year old
black male)
Koh et al. (2001) (82) 1 mandibular second premolar
(Singapore; age, sex and
ethnicity not identified)
1 mandibular second premolar
(Singapore; age, sex and
ethnicity not identified)
Rhodes (2001) (88)
1 mandibular second premolar
(UK; 25 year old caucasian
male)
Macri and Zmener
1 mandibular second premolar
(2000) (83)
(Argentina; 58 year old
female)
Prabhu et al. (1999) 2 mandibular second premolars
(87)
(India; 13 year old boy)
Holtzman (1998) (80) 1 mandibular second premolar
(Israel; 29 year old male)
Nandlal and Ramesh 1 mandibular second premolar
(1998) (92)
(India; 11 year old female)
Goswami et al.
1 mandibular second premolar
(1997) (93)
(India; 16 year old female)

Fischer and Evans

(1992) (70)

1 mandibular second premolar

(USA; 29 year old female)

1 mandibular second premolar

(China; 20 year old male
patient)
Wong (1991) (90)
1 mandibular second premolar
(USA; 19 year old caucasian
male)
Bram and Fleisher
1 mandibular second premolar
(1991) (76)
(USA; 48 year old african
american female)
England et al. (1991) 1 mandibular second premolar
(6)
(USA; 34 year old caucasian
male)
Singh et al. (1987)
1 mandibular second premolar
(89)
(USA; 30 year old african
american female)
Shapira and
2 mandibular second premolars
Delivanis (1982)
(USA; 10 year old african
(72)
american female)

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)
Mandibular first premolar had
similar root configuration

Chan et al. (1992)

(77)

ElDeeb (1982) (79)

1 (USA; 21 year old caucasian

female)

JOE Volume 33, Number 9, September 2007

Type of study

Patient presented with grossly

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

3 canals
3 canals (M canal and 2 distal canals)

Clinical RCT

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

Clinical RCT

2 roots (M and D)

Clinical RCT

2 roots (M and D)

Clinical exam

Contralateral teeth; each had 2 roots

with a mesiodistal bifurcation

Radiographic
Study

All first and second mandibular

premolars exhibited 2 roots

Clinical RCT

2 roots and 4 canals (2 canals were

present in each root; MB, MLi, DB,
and BIi)
Dens evaginatus

Cvek (partial)
pulpotomy
Cvek (partial)
pulpotomy

Dens evaginatus

Clinical RCT

2 roots and 4 canals

Clinical RCT

5 canals in a single root

Radiographic
Study

All first and second mandibular

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

Clinical RCT
retreatment
Extraction
Clinical RCT

Clinical exam
and
extraction
Clinical RCT
retreatment

Bifurcation occurred at midroot;

Clinical RCT
recurring flareups due to difficulty
in negotiating all four canals
Taurodont premolar with a midroot Clinical RCT
bifurcation

All four mandibular second

premolars were extracted for
orthodontic reasons

Anatomic variation
3 canals (MB, MLi, and D)

2 roots interconnected; weblike

appearance
2 roots (M and D) and 2 canals

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

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
2 roots (M and D) and 4 canals (2
canals in each root)

Clinical RCT

2 canals with 2 roots

Clinical RCT

3 canals (MB, DB, and Li)

Clinical exam
and
extraction

3 roots (MB, DB, and Li) and 4 canals;

DB root had 2 canals (B and Li)
2 roots (M and D); each root had 2
canals (B and Li)
3 canals present

Clinical RCT

Root and Root Canal Morphology of Human Mandibular Second Premolar

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Review Article
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 (68).

Conclusions
Major conclusions that can be drawn from this review article are as
follows:
1. Most mandibular second premolars have a single root. The incidence of 2 or more roots is low at approximately 0.4%. The
incidence of 2 or more roots in the mandibular first premolar is
2.1% (68).
2. The majority of mandibular second premolar teeth have a single
canal, but approximately 9.0% have 2 or more canals. The incidence of 2 or more canals in the mandibular first premolar is
24.2% (68).
3. A single apical foramen might be found in mandibular second
premolar teeth in more than 9 out of 10 cases, but 2 or more
foramina might occur approximately 8.2% of the time. The incidence of 2 or more foramina in the mandibular first premolar is
21.1% (68).
4. The incidence of more than 1 root, more than 1 canal, and more
than 1 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.
5. Although reported in only a few studies, variations in incidence of
single canal versus 2 or more canals might occur as a result of
ethnicity or gender. Additional research in the area of gender and
ethnic differences is warranted.
6. When performing root canal therapy, additional canals might be
missed, leading to a greater failure rate, unless there is constant
vigilance in locating 2 or more canal systems in the mandibular
second premolar.

Acknowledgments
The authors would like to thank Dr. Franklin S. Weine, Professor Emeritus, for his continued interest in root canal anatomy and
for data shared from previous studies.

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