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Review Article Root and root canal morphology of Saudi

Arabian permanent dentition

Ibrahim Ali Ahmad

Department of Restorative Dentistry, College of Dentistry, Riyadh Colleges of Dentistry and Pharmacy,
Riyadh, Kingdom of Saudi Arabia

Key words:
Canal configuration, morphology,
permanent dentition, root canal system,
Saudi Arabia
Address for correspondence:
Dr. Ibrahim Ali Ahmad,
Department of Restorative Dentistry,
College of Dentistry, Riyadh Colleges
of Dentistry and Pharmacy, P.O Box
84891, Riyadh 11681, Kingdom of
Saudi Arabia.
E‑mail: ibrahimali79@yahoo.com
ABSTRACT
The aims of this paper were to review the studies that investigated the root
and root canal morphology of permanent dentition in the Saudi Arabian
population and to compare their results with the findings of international
morphological studies conducted on other populations. An electronic search
using the PubMed and Scopus databases was conducted using combination
of the following keywords: “root canal morphology”, “root morphology”,
“dental anomalies”, and “Saudi Arabian population”. In addition, all issues of
the Saudi Dental Journal (since 1989) and Saudi Endodontic Journal (since
2011) were manually searched for relevant articles. Then, the reference lists
of the articles were screened to identify further eligible publications. A total
of 23 studies met the inclusion criteria and were subjected to data extraction
and analysis. Variations from the normal root and canal morphology may
occur in all populations including the Saudi Arabian population. Therefore,
the clinicians must always take these variations in consideration during root
canal treatment to ensure a successful treatment outcome.

INTRODUCTION root canal treatment, retrospective evaluation

of patients’ records, radiographic examination

T he major objectives of root canal therapy

are to perform adequate biomechanical
preparation and to fill the entire root canal system
three‑dimensionally. Inability to locate, prepare,
or fill all root canals may lead to posttreatment
disease of treated teeth.[1,2] Therefore, clinicians
should have a thorough knowledge of the common
root and root canal morphology and its possible
variations to improve the predictability of root
canal therapy.
Since the beginning of the 20 th  century, the
external and internal anatomy of different teeth
groups has been investigated using a number
of in vivo and in vitro techniques. The in vivo
techniques include clinical evaluation during
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DOI:
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Saudi Endodontic Journal • May-Aug 2015 • Vol 5 • Issue 2
using conventional, and advanced radiographic
techniques such as cone beam computed
tomography (CBCT). The in vitro techniques
include root sectioning, canal staining and
tooth clearing, microscopic examination, and
radiographic examination using conventional
radiographs and three‑dimensional techniques such
as micro‑computed tomography (m‑CT).[3,4]
The findings of morphological studies may
vary according to study methodolog y, study
population, and age and gender of the study
sample.[3] The majority of morphological studies
on per manent dentition were conducted in
Western countries and East Asia and their
results may not be applicable to Saudi Arabian
population. Therefore, the aims of the present
paper were to review the studies that investigated
the root and root canal morpholog y of
permanent dentition in Saudi Arabian population
and compare their results with the findings of
international morphological studies conducted on
other populations.
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Ahmad: Saudi root canal morphology
LITERATURE REVIEW
Search strategy
The PubMed (http://www.ncbi.nlm.nih.gov/pubmed)
and Scopus (http://www.scopus.com) databases (last
accessed August 11th, 2014) were searched for relevant
articles using combination of the following search terms:
“root canal morphology”, “root morphology”, “dental
anomalies”, and “Saudi Arabian population”. After
removal of duplicate articles, the title/abstract of the
remaining articles were screened for their relevance and
potential articles were retrieved in full‑text. In addition,
all issues of the Saudi Dental Journal (since 1989) and
Saudi Endodontic Journal (since 2011) were manually
searched for relevant articles. Finally, the references list
of each article was checked for further eligible articles.
Inclusion criteria
Studies that reported root and/or root canal
morphology of permanent teeth in Saudi Arabian
population and published in peer‑reviewed journals were
included in the current review.
Data extraction
A total of 23 studies were identified: 10 clinical
studies,[5‑14] 3 laboratory studies,[15‑17] 1 clinical/laboratory
study, [18] and 9 case reports. [19-27] From each of the
clinical and laboratory studies [Table 1], the following
information was extracted: (i) the author(s); (ii) the
study sample (tooth type and number); (iii) the
method used to study tooth morphology; and (iv)
key anatomical features (number of roots, number of
root canals, and their configurations). For each clinical
case report [Table 2], the following information was
recorded: (i) the author(s); (ii) the age and gender of
the patient; (iii) the treated tooth; and (iv) the important
anatomical features of the treated tooth.
Next, the morphological features reported in the
clinical and laboratory studies were compared with their
counterparts in international studies [Tables 3 and 4].
For this purpose, all studies that reported a certain
morphological feature (i.e., maxillary premolars with
three roots) in Saudi Arabian population were grouped
together. Then, the weighted average of the given
feature was calculated by dividing the number of
samples that had that feature in the identified studies
by the total number of samples in these studies. The
weighted averages of the corresponding morphological
features in the international studies were calculated in
a same manner from the data presented in a number
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of classical morphological studies. [28‑49] For some
morphological features, comprehensive literature reviews
were identified[3,50,51] and the weighted averages were
calculated from the studies cited in these articles.
Root and canal morphology of anterior teeth
The morphology of anterior teeth was evaluated by one
laboratory study[17] and three case reports.[20,21,24] In 2012,
Al‑Fouzan et al.,[17] investigated the internal morphology
of 80 mandibular incisors using canal staining and
clearing technique and found that the majority (70%)
had one canal while 30% had two canals. All of
the two canalled‑teeth had type III (1‑2‑1) canal
configuration. Al‑Nazhan  (1991)[20] reported a maxillary
central incisor with two canals, while two clinical cases
reported two‑rooted mandibular canine.[21,24]
Root and canal morphology of premolars
The root morphology of maxillary premolars was assessed
by three studies.[13,15,16] Atieh (2008)[15] found that the
majority (80.9%) of maxillary first premolars had two
roots, while one and three roots were found in 17.9%
and 1.2%, respectively. He also found that 37.4% of
multirooted first premolars had root fusion. Recently,
Elkady and Allouba (2013)[13] studied the root morphology
of maxillary premolars using CBCT. They found that
28.3% of maxillary first premolars had one root and
71.7% had two roots, while 76.4% of maxillary second
premolars showed one root and 23.6% showed two roots.
An important anatomical variation in maxillary premolars
is the presence of three roots. This feature was reported
in 0-11.7% of first premolars[13,15,16] and in 0-5% of second
premolars[13,16] in Saudi Arabian population. Furthermore,
two clinical cases of maxillary second premolars with this
anatomical variation were reported.[19,25]
The internal morphology of maxillary premolars was
investigated by three studies. [12,13,15] The majority of
first  (89.9-95%) and second  (59.4-63.7%) premolars had
two root canals. One canal was detected in 3.7-8.9% of
first premolars and 36.3-39.7% of second premolars,
while three canals were evident in 0-2.4% and 0.9% of
first and second premolars, respectively. Al‑Abdulwahhab
et al., (2010)[26] described the clinical retreatment of a
three‑canalled maxillary first premolar with two buccal
canals that joined in the apical third and one palatal canal.
The mandibular premolars may show variations in the
number of roots and/or root canals. Although no
clinical or laboratory study on mandibular premolars was
identified in the Saudi Arabian population, two clinical
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Ahmad: Saudi root canal morphology
Table 1: Summary of clinical and laboratory morphological studies of number of roots, root canals, and
canals' configuration conducted on Saudi Arabian population
Reference Sample Study method
number
Mandibular incisors
Al‑Fouzan et al., 2012[17] 40 CI In vitro (clearing)
40 LI In vitro (clearing)
Maxillary first premolar
Atieh, 2008[15] 246 In vitro (clearing and
cross‑sectioning)
Seif et al., 2008[16] 120 In vitro (radiography and Incidence of three‑rooted/
microscopic examination) three‑canalled premolars
Al‑Nazhan et al., 2012[12] 463 In vivo (radiography)
Elkady and 120 In vivo (CBCT)
Allouba, 2013[13]
Maxillary second premolar
Seif et al., 2008[16] 80 In vitro (radiography and
microscopic examination)
Al‑Nazhan et al., 2012[12] 431 In vivo (radiography)
Elkady and 110 In vivo (CBCT)
Allouba, 2013[13]
Maxillary first molar
Al‑Nazhan, 2005[11] 352 MBR In vivo (radiography)
Al‑Fouzan et al., 2013[14] 154 MBR In vivo (radiography)
Maxillary second molar
Al‑Fouzan et al., 2013[14] 81 MBR In vivo (radiography)
Mandibular first molar
Younes et al., 1990[18] 441 In vitro (inspection
of extracted teeth)
280 In vivo (Radiography)
Al‑Nazhan, 1999[9] 251 In vivo (radiography)
Mandibular second molar
Al‑Fouzan, 2002[10] 151 In vivo (clinical RCT and
radiography)
CBCT: Cone beam computed tomography, CI: Central incisor, DR: Distal root, LI: Lateral incisor, MBR: Mesiobuccal root, MR: Mesial root, RCT: Root canal treatment
cases of two‑rooted mandibular second premolars with
three[23] and four[22] root canals were reported.
Root and canal morphology of molars
The internal morphology of the mesiobuccal root (MBR)
in maxillary first molars was evaluated by two studies.[11,14]
Al‑Nazhan (2005)[11] found that the majority (76.7%) of
the MBRs had one canal, while 23.3% had two canals.
On the other hand, Al‑Fouzan et al., (2013)[14] found one
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Anatomical feature Important findings (%)
Number of root canals One (70), two (30)
Canals configuration 1‑1 (70), 1‑2‑1 (30)
Number of root canals One (70), two (30)
Canals configuration 1‑1 (70), 1‑2‑1 (30)
Number of roots One (17.9), two (80.9), three (1.2)
Incidence of root fusion (37.4)
Number of root canals One (8.9), two (89.9), three (1.2)
Canals configuration 1‑1 (8.9), 2‑1 (26.8), 2‑2 (63), 3‑3 (1.2)
(11.7)
Number of root canals One (3.7), two (94), three (2.4)
Number of roots One (28.3), two (71.7)
Number of root canals One (5), two (95)
Canals configuration 1‑1 (5), 2‑1 (5), 1‑2‑1 (10),
2‑2 (70), 1‑2 (6.7), 1‑2‑1‑2 (3.3)
Incidence of three‑rooted/ (5)
three‑canalled premolars
Number of root canals One (39.7), two (59.4), three (0.9)
Number of roots One (23.6), two (76.4)
Number of root canals One (36.3), two (63.7)
Canals configuration 1‑1 (36.3), 2‑1 (10.9), 1‑2‑1 (13),
2‑2 (23.6), 1‑2 (10.9), 1‑2‑1‑2 (5.4)
Number of canals One (76.7), two (23.3)
Canals configuration 1‑1 (76.7), 2‑1 (17), 2‑2 (6.3)
Number of canals One (48.7), two (51.3)
Canals configuration 1‑1 (48.7), 2‑1 (33.1), 2‑2 (18.2)
Number of canals One (80.2), two (19.8)
Canals configuration 1‑1 (80.2), 2‑1 (13.6), 2‑2 (6.2)
Incidence of three roots (2.49)
Incidence of three roots (2.14)
Number of roots Two (94), three (6)
Number of root canals Three (42.2), four (57.8)
Number of canals per root MR: Two (100)
DR: One (42.2), two (57.8)
Incidence of C‑shaped canals (10.6)
Type of C‑shaped canals Type I (31.3), type II (18.7), type III (50)
and two canals in 48.7% and 51.3% of their sample,
respectively. In both studies, the most common canal
configurations in two‑canalled MBRs were Vertucci’s
types II (2‑1) and IV (2‑2). Al‑Fouzan et al., (2013)[14]
evaluated the internal morphology of MBR in maxillary
second molars and found that 80.2% had one canal and
19.8% had two canals. About two‑thirds (13.6%) of the
two‑canalled root canal systems ended in a common
apical foramen and the rest (6.2%) had two separate
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Ahmad: Saudi root canal morphology

Table 2: Summary of case reports showing morphological variations in permanent teeth of Saudi Arabian
population
Reference Gender Age Tooth number Type of study Important findings
Anterior teeth
Al‑Nazhan, 1991[20] Female 15 #11 Clinical RCT Tooth had enamel hypoplasia and two canals (type 2‑1)
Rahmatulla and Wyne, 1993[21] Female 28 #43 Radiographic Bifid root at the apical third
examination Normal contralateral tooth
Balto and Al‑Wakeel, 2007[24] Female 50 #33 Clinical re‑RCT Two roots and two canals
Maxillary premolars
Al‑Nazhan, 1991[19] Male 25 #25 Clinical Re‑RCT Three roots and three canals (mesiobuccal, distobuccal,
and palatal)
Pattanshetti et al., 2007[25] Female 32 #25 Clinical RCT Three roots and three canals
Al‑Abdulwahhab et al., 2010[26] Female 32 #24 Clinical re‑RCT Three canals (two buccal canals joining apically and one
palatal canal)
Mandibular premolars
Al‑Fouzan, 2001[22] Male 34 #35 Clinical RCT Two roots and four canals (type 2‑2 in MR and type 1‑2
in DR)
Al‑Attas and Al‑Nazhan, 2003[23] Male 20 #35 Clinical re‑RCT Two roots and three canals (buccal, middle, and lingual)
Maxillary molars
Alenazy and Ahmad, 2015[27] Female 45 #27 Clinical re-RCT Four roots (two buccal and two palatal) and four canals
DR: Distal root, MR: Mesial root, RCT: Root canal treatment, re‑RCT: Orthograde root canal retreatment, #11: Maxillary right central incisor, #24: Maxillary left first
premolar, #25: Maxillary left second premolar, #27: Maxillary left second molar, #33: Mandibular left canine, #35: Mandibular left second premolar, #43: Mandibular
right canine

foramina. The maxillary second molars may also show
variations in the number of their roots. Recently, Alenazy
and Ahmad (2015)[27] reported a clinical case of four-
rooted second molar with four root canals.
The root and canal morphology of the mandibular
first molars was evaluated by one clinical study that
included 251 teeth. [9] The results showed that 94%
had two roots and 6% had three roots. About 42% of
the study sample had three canals and 58% had four
canals. The additional fourth canal was always present
in the distal root (s). Younes et al., (1990)[18] compared
the incidence of three‑rooted mandibular first molars
in the Saudi Arabian and Egyptian populations. The
authors examined teeth extracted from Saudi Arabian
and Egyptian patients and found an incidence of 2.5%
and 0.8%, respectively. The authors also evaluated
radiographs of randomly selected patients and found
that 2.1% of Saudi Arabian and 1.0% of Egyptian
patients had three roots.
Al‑Fouzan (2002) [10] investigated the incidence of
C‑shaped canals in 251 root canal‑treated mandibular
second molars. C‑shaped canals were evident in 10.6%
of these molars and the majority (50%) of these
canals were classified as type  III  (C‑shaped orifice that
divided into two or more canals), while 31.3% had
type I (continuous C‑shaped throughout the canal)
and 18.7% had type  II  (semicolon-shaped orifice with
a main C‑shaped canal separated by dentine from a
mesial distinct canal). Figure 1 illustrates some of the
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anatomical variations that were reported in the Saudi
Arabian population.
Dental anomalies
The permanent dentition may be affected by a
number of development anomalies including dens
invaginatus, dens evaginatus, developmental grooves,
and taurodontism. Teeth with these anomalies usually
have abnormal root and/or canal morphology and
require careful diagnosis and treatment planning. Three
studies[5,7,8] investigated the incidence of taurodontism
in the Saudi Arabian population clinically and
radiographically. The incidence ranged from 8.5% to
11.2% and it was not affected by patient’s gender. In
addition, maxillary molars were more commonly affected
than mandibular molars. Saini et al.,(1990) [6] studied
periapical radiographs of 3,960 maxillary incisors in
990 Saudi Arabian patients and found that 29 (0.7%)
of them had dens invaginatus. The lateral incisors
were more commonly affected than the central
incisors (75.9% and 24.1%, respectively).
Factors affecting root and canal morphology
None of the clinical and laboratory studies evaluated the
effect of age on tooth anatomy, while three studies[9,11,12]
evaluated the effect of gender on the number of root
canals. Two studies[9,11] reported that gender did not
affect the number of canals. Al‑Nazhan et al.,(2012)[12]
studied the effect of gender on the number of canals
in maxillary premolars and found that while males
had significantly more canals in second premolars, no
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Table 3: Comparison of selected anatomical features of permanent anterior teeth and premolars in Saudi
and non-Saudi populations
Morphological feature Saudi Arabian population International population
Total sample [ref. no.] Mean and range (%) Total sample [ref. no.] Mean and range (%)
Mandibular incisors
Number of root canals 80[17] 1,971[28‑33]
One 70.0 65.4 (32.5-86.2)
Two 30.0 33.8 (13.8-63.3)
Maxillary first premolar
Number of roots 366[13,15] 3,060[33‑42]
One 21.3 (17.9-28.3) 45.3 (30.8-66.0)
Two 77.9 (71.7-80.9) 53.6 (33-68.4)
Three 0.8 (0.0-1.2) 1.1 (0.8-6.0)
Number of root canals 829[12,13,15] 1,288[28,30‑33,43]
One 5.4 (3.7-8.9) 12.3 (1.3-26.2)
Two 92.9 (89.9-95.0) 83.8 (70.0-96.0)
Three 1.7 (0.0-2.4) 3.9 (0.5-6.2)
Root canal configurations 366[13,15] 1,288[28,30‑33,43]
Type I 7.6 (5.0-8.9) 10.6 (1.3-26.2)
Type II 19.7 (5.0-26.8) 18.2 (6.0-29.6)
Type III 3.3 (0.0-10.0) 1.5 (2.0-5.5)
Type IV 65.3 (63.0-70.0) 58.5 (41.7-78.0)
Types V, VI, VII 3.3 (0.0-10.0) 7.9 (0.7-8.6)
Type VIII 0.8 (0.0-2.4) 2.0 (3.0-5.0)
Maxillary second premolar
Number of roots 110[13] 1,012[33,37,38,44]
One 76.4 82.8 (69.6-96.7)
Two 23.6 16.9 (3.3-29.7)
Three 0.0 0.3 (0.0-0.7)
Number of root canals 541[12,13] 1,724[28,30‑33,37,38,43,44]
One 39.0 (36.3-39.7) 52.6 (27.7-67.3)
Two 60.3 (59.4-63.7) 46.6 (32.0-72.3)
Three 0.7 (0.0-0.9) 0.8 (0.0-4.0)
Root canal configurations 110[13] 1,321[28,30‑33,43]
Type I 36.3 44.2 (27.7-64.0)
Type II 10.9 18.2 (6.3-40.0)
Type III 13.0 6.7 (0.0-20.0)
Type IV 23.6 19.9 (6.7-51.0)
Types V, VI, VII 16.3 10.3 (0.0-13.2)
Type VIII 0.0 0.5 (0.0-3.0)

gender differences were reported for first premolars.
Elkady and Allouba (2013)[13] studied the effect of tooth
location on the morphology of maxillary premolars by
comparing the bilateral symmetry of the number of
roots and types of canal configurations. They found
that among patients with bilateral first premolars,
88.5% had similar number of roots and 77% had
similar types of canal configurations. For patients with
bilateral second premolars, 84% and 76% had the same
roots number and canal configurations, respectively.
In clinical case reports, the anatomical variations were
reported in patients with different ages without apparent
gender predilection [Table 2]. Further studies using
larger samples are needed to explore the effect of age,
gender, and tooth position on the internal and external
morphology of different teeth groups.
Comparison with international studies
Tables 3 and 4 show comparison of some anatomical
features reported in the Saudi Arabian population with
previously published international studies. Although the
findings of the studies in the Saudi Arabian population
were generally comparable with their international
counterparts, some differences were evident. These
differences may be attributed to variations in the
number of study sample, used methodology (clinical
versus laboratory), or may reflect real differences
between the studied populations. For example, the

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Ahmad: Saudi root canal morphology

Table 4: Comparison of selected anatomical features of permanent molars in Saudi and non-Saudi
populations
Morphological feature Saudi Arabian population International population
Total sample [ref. no.] Mean and range (%) Total sample [ref. no.] Mean and range (%)
Maxillary first molar
Number of root canals in MBR 506[11,14] 8,939[3]
One 68.2 (48.7-76.7) 40.5 (4.0-80.7)
≥Two 31.8 (23.3-51.3) 59.5 (18.6-93.5)
Canals configuration in MBR 506[11,14] 4,105[3]
Type I 68.2 (48.7-76.7) 34.1 (6.5-75.0)
Type II 21.9 (17.0-33.1) 27.5 (12.2-54.0)
Type IV 9.9 (6.3-18.2) 38.4 (7.5-64.5)
Maxillary second molar
Number of root canals in MBR 81[14] 896[28,30‑33,43]
One 80.2 53.5 (27.0-82.0)
Two 19.8 45.1 (18.0-69.0)
Canal configurations in MBR 81[14] 796[28,30‑33,43]
Type I 80.2 56.8 (41.0-82.0)
Type II 13.6 14.4 (7.1-26.5)
Type III 0.0 3.3 (5.9-10.7)
Type IV 6.2 11.0 (6.0-17.9)
Types V, VI, VII, VIII 0.0 14.4 (0.1-18.8)
Mandibular first molar
Number of roots 251[9] 1,647[33,37,45‑49]
Two 94.0 94.2 (68.4-97.3)
Three 6.0 5.6 (2.7-31.6)
Incidence of three‑rooted molars 972[9,18] 2.1 (2.14-6.0) 17,951[50] 13.5 (0.7-32.0)
Number of canals per tooth 251[9] 4,389[50]
Three 42.2 63.8 (46.6-85.5)
Four 57.8 35.3 (6.4-49.3)
Mandibular second molars
Incidence of C‑shaped canals 151[10] 10.6 7,249[51] 12.4 (1.9-44.5)
MBR: Mesiobuccal root

Saudi Arabian population had a low (2.1%) incidence
of three‑rooted mandibular first molars.[9,18] According
to de Pablo et al., (2010) [50] this anatomic feature is
directly related to ethnicity of the studied population
and is more commonly found in the Mongoloid,
Native American, Eskimo, and Chinese populations.
Another example is the presence of C‑shaped canals in
mandibular second molars which is known to be more
common in Asians as compared to other populations
including the Saudi Arabian population.[51]
DISCUSSION
The aims of this paper were to review the available
literature on the internal and external anatomy of
permanent teeth in Saudi Arabian population and to
compare it with international studies that investigated
other populations. This will help to draw a “road map”
of the common morphology of different teeth groups in
Saudi Arabian population to guide the dental practitioners
while performing root canal treatment. Nevertheless, the
104
clinicians should always remember that variations in tooth
morphology may occur making the root canal treatment
more challenging. In such cases, clinicians should utilize
his/her knowledge and the available tools to locate and
treat the whole root canal system to improve treatment
outcome. There are several clinical guidelines and tools
that may be used before or during root canal treatment to
locate and negotiate root canals including:[1,2,52]
• Careful interpretation of conventional radiographs
taken at different horizontal angulations. Advanced
radiographic techniques such as CBCT can be also
used to evaluate cases with complex root canal system
• Proper design of access cavity to visualize the entire
pulp chamber floor
• Use of magnifying tools such as eye loupes and
dental operating microscope to enhance the vision
in the operating field
• Careful inspection of the pulpal floor to locate
canal orifices. This may include exploring the floor
with an endodontic explorer and troughing it with
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Ahmad: Saudi root canal morphology

a b c d

e f g
Figure 1: Examples of anatomical variations reported in the Saudi Arabian population (a) Maxillary right central incisor with two canals
(Reproduced with permission from Al-Nazhan S. Two root canals in a maxillary central incisor with enamel hypoplasia. J Endod 1991;17:469-71).
(b) Mandibular central incisor with two canals (Reproduced with permission from Al-Fouzan KS, AlManee A, Jan J, Al-Rejaie M. Incidence of
two canals in extracted mandibular incisors teeth of Saudi Arabian samples. Saudi Endod J 2012;2:65-9). (c) Mandibular right canine with two
roots (Reproduced with permission from Rahmatulla M, Wyne AH. Bifid roots in a mandibular canine: report of an unusual case. Saudi Dent J
1993;5:77-8). (d) and (e) Mandibular left second premolar with two roots and four canals (Reproduced with permission from Al-Fouzan KS. The
microscopic diagnosis and treatment of a mandibular second premolar with four canals. Int Endod J 2001;34:406-10). (f) C-shaped mandibular
left second molar (Reproduced with permission from Al-Fouzan KS. C-shaped root canals in mandibular second molars in a Saudi Arabian
population. Int Endod J 2002;35:499-504). (g) Maxillary left second molar with four roots (Reproduced with permission from Alenazy MS, Ahmad
IA. Double palatal roots in maxillary second molars: A case report and literature review. Saudi Endod J 2015;5:56-60).

burs or ultrasonic tips. Other useful aids in locating
canal orifices are staining the pulpal floor with a
dye, performing the champagne test with sodium
hypochlorite, the red line test (visualizing bleeding
points), the white line test (detection of debris in
orifices or developmental grooves between them),
and applying the laws of canals' symmetry
• Allocation of sufficient treatment time for each
case and referral of complicated cases for more
experienced operators.
There are some limitations in the studies that were included
in the current review: small sample size and collection of
the sample from one area. Increasing the study sample
and collecting it from different areas and types of practice
can result in more consistent and reliable data, leading to a
clear conclusion about the common morphological features
as well as their variations. Furthermore, the use of recent
technological advances in the field such as CBCT and
m‑CT will help in exploring the root and canal morphology
of the various teeth in this population.
CONCLUSIONS
The root and root canal morphology of Saudi Arabian
population was, in general, comparable to that of other
populations. The dental practitioners should have a
sound knowledge of common anatomy of permanent
teeth and its possible variations and use the available
tools to locate and treat the whole root canal system to
ensure a successful treatment outcome.
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How to cite this article: Ahmad IA. Root and root canal morphology
of Saudi Arabian permanent dentition. Saudi Endod J 2015;5:99-106.
Source of Support: Nil. Conflict of Interest: None declared.
Saudi Endodontic Journal • May-Aug 2015 • Vol 5 • Issue 2