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JOURNAL OF ENDODONTICS
Copyright © 1994 by The American Association of Endodontists
CLINICAL ARTICLE
Canal Configuration in the Mesiobuccal Root of the
Maxillary First Molar: A Clinical Study
Howard M. Fogel, DMD, MS, Marshall D. Peikoff, DMD, MScD, and William H. Christie, DMD, MS
Surgical telescopes, headlamps, and a modified ac-
cess preparation were used clinically to aid in the
search for mesiolingual canals in the mesiobuccal
roots of 208 maxillary first molars. In 148 (71.2%) of
the mesiobuccal roots two canals were located and
treated. Of these, 66 (31.7%) had two separate
apical foramina (Weine Type III) and 82 (39.4%) had
two canals that joined (Weine Type II). In 60 (28.9%)
cases only one canal was located.
A number of studies have reported the presence of two canals
in the mesiobuccal (MB) root of the maxillary first molar.
The frequency of mesiolingual (ML) canals has ranged from
19 to 95% (1-13). The incidence varies with the method used
in the study. Methods used have included grinding extracted
teeth (2-7, 13), injection of dye (7, 9), study of radiographs
(1-4), light (12) and scanning (1 I) microscopy, and clinical
case reviews (3, 8, 10). Pomeranz and Fishelberg (6) demon-
strated a great discrepancy between clinical and laboratory
results in the incidence of mesiolingual canals. Although the
in vitro studies concur that the incidence of mesiolingual
canals is extremely high, there is no consensus on the number
of ML canals that are amenable to clinical endodontic treat-
ment.
The purpose of this clinical study was to investigate the
canal configuration in the mesiobuccal root of consecutive
maxillary first molars which were undergoing endodontic
treatment by two endodontists in private practice.
MATERIALS AND METHODS
Two hundred eight consecutive maxillary first molar treat-
ments were reviewed. Access preparations were modified to a
more rhomboidal shape to facilitate the search for a mesiol-
ingual canal (8). A groove was made on the floor of the pulp
chamber lingual to the mesiobuccal canal orifice. This groove
followed the subpulpal groove between the mesiobuccal and
135
Printed in U.S.A.
VOL. 20, NO. 3, MARCH1994
palatal orifices. This was usually slightly mesial to an imagi-
nary line connecting the orifices of the mesiobuccal and
palatal canals (12). This groove was continued until the me-
siolingual orifice was found or until the subpulpal groove
between the mesiobuccal and palatal orifices disappeared
(generally a depth of approximately 1 mm) (6). Irrigation with
2.5% sodium hypochlorite and the use of a fine (1 mm)
suction tip (Quality Aspirators, Duncanville, TX) to dry the
chamber floor prior to inspection aided in the visualization
of the canal orifice. Surgical telescopes (x2.5 magnification)
were used routinely. Fiberoptic headlamps (Designs for Vi-
sion, Ronkonkoma, NY) were also used where additional
illumination was required. The use of an endodontic explorer
(Starlite DG16) directed from the distal toward the mesial
(11) helped in uncovering and locating the ML orifice.
Standard straight-on and distal angle radiographs were
taken of each working length instrument. A second canal was
suspected if a working length instrument appeared to be off
center in the root on a distal projection radiograph.
The mesiobuccal root was determined to have two treatable
canals with two separate apical foramina (Weine Type III)
when two separate files or gutta-percha points could be placed
and could be seen at the radiographic working length. The
MB root was said to have two treatable canals that joined
together (Weine Type II) when two files or gutta-percha points
could be seen to join together on the radiograph (13). This
was confirmed clinically when a file in one canal impeded the
placement of a file in the other canal, or when a gutta-percha
point placed at the working length in one canal could be
scored by a file placed in the other canal.
Data were analyzed using t tests, chi-square, one-way analy-
sis of variance, and stepwise discriminant analysis. A proba-
bility level of p = 0.05 was considered to be statistically
significant.
RESULTS
Table 1 shows that 148 of 208 (71.2%)mesiobuccal roots
had two treatable canals. Sixty-six (44.6%) of these 148 teeth
or 31.7% of all maxillary first molars studied had two separate
136 Fogel et al.
TABLE 1. Number and percentage of canal types treated in the
mesiobuccal root of the maxillary first molar
Type I Type 11 Type III Total
60 (28.9%) 82 (39.4%) 66 (31.7%) 208 (100%)
treatable apical foramina. If a canal orifice was located but
was too small to treat, it was not counted as a canal.
There was no significant difference in the results between
the two operators with respect to incidence of canal type (x 2,
p = 0.174). The age of the male patients was not significantly
different from that of the female patients (t test, p = 0.44).
The position of the tooth on the left or right side of the mouth
did not have a significant correlation with canal configuration
(x 2, p = 0.364). Both age and sex were found to be independ-
ent predictors of canal type. Females were found to have only
one treatable canal in the MB root more frequently than
males (stepwise discriminant analysis, p = 0.001). Older pa-
tients were found to have only one treatable canal in the MB
root more frequently than younger patients (stepwise discrim-
inant analysis, p = 0.001). When age and sex versus canal
type was analyzed, we found that most frequently both older
males (one-way analysis of variance, p = 0.0179) and older
females (one-way analysis of variance, p = 0.022) had only
one treatable canal. The mean age of males with one canal
was 50.26 yr versus a mean of 41.78 yr for males with two
treatable canals. The mean age of females with one canal was
46.32 yr versus a mean of 39.78 yr for females with two
treatable canals.
DISCUSSION
The average number of maxillary first molars with two
canals in the MB root from previous studies (1-13) ranges
from 19 to 95% with a mean of 59.1%. The incidence of
maxillary first molars with two canals in the MB root agrees
closely with the results of Acosta Vigouroux and Trugeda
Bossans (7) and is similar to the results of Neaverth et at. (10)
and Kulild and Peters (12).
The finding that older patients had one treatable canal in
the MB root more frequently than younger patients agrees
with the findings of other authors (10, 11). Gilles and Reader
(11) point out that although it is probable that canals become
smaller with age, it is unlikely that they disappear completely.
Therefore, it is likely that many more ML canals exist than
can be treated clinically or that many of the Type I canals in
this study were in fact Type II or III canals (1 l, 12).
Our finding of a significant gender difference with respect
to number of canals conflicts with the findings of Neaverth et
al. (10). The present finding of 31.7 % of maxillary first molars
with two separate apical foramina in the MB root is very
similar to the average of 30.6% reported in previous studies
(1-6, 9-11, 13). The clinical study of Neaverth et al. (10)
reported finding 61.8% of maxillary first molars with two
canals and two apical foramina.
The study by Acosta Vigouroux and Trugeda Bossans (7)
found that 93% of maxillary first molars had a tetragonal
shaped pulp chamber. Only 6% were found to be triangular.
Therefore, various authors (8, 10, 12) have recommended
Journal of Endodontics
modifying the traditional access preparation for maxillary
molars by creating a more heart-shaped form and by counter-
sinking the floor of the chamber. This countersinking should
be done in a direction directly lingual from the MB orifice,
and slightly mesial to an imaginary line between the MB and
palatal orifices. In normal development, or in response to
carious or restorative insult, the ML canal orifice becomes
hidden by an overhanging mesial dentinal shelf (7, 12). Thus,
the search for this canal should be directed mesially as well as
lingually from the MB orifice. The overhanging dentin shelf
is removed by planing the whole mesial wall of the chamber
in a mesial direction (12). Careful use of a bur on the floor of
the chamber should not lead to an increase in perforations
(12). The mean distance of the ML orifice from the MB orifice
shows a wide range (6, 1 l, 12). Therefore, the full extent of
the grooves on the floor of the chamber from the mesiobuccal
orifice to the palatal orifice must be explored.
In two recent studies (1 l, 12) a measuring microscope and
a scanning electron microscope were used to examine ex-
tracted teeth whose crowns had been removed. Access and
visibility were unrestricted under these laboratory conditions.
These two in vitro studies reported an incidence of ML canals
of 90% and 95%, respectively. The factors which these studies
have in common are unrestricted access and the use of mag-
nification. It appears the clinical search for a ML canal may
be aided by magnification, proper illumination, and an access
preparation that allows maximum visibility. The use of sur-
gical telescopes, headlamps, and modified access preparations
in this study may account for the higher incidence of treatable
ML canals compared with most previous clinical studies.
Perhaps future use of an operating microscope might further
reduce the discrepancy between the in vivo and in vitro
studies.
The high incidence (71.2%) of two treatable canals in the
MB root of maxillary first molars is significant. Failure to
locate and treat the ML canal may lead to clinical failure (13).
This is especially true in those cases with two separate apical
foramina. Endodontic treatment, retreatment, and periapical
surgical procedures should be performed with this finding in
mind (11).
Dr. Fogel is a demonstrator, Dr. Peikoff is an associate professor, and Dr.
Christie is associate professor and head of the Section of Endodontics, De-
partment of Restorative Dentistry, Faculty of Dentistry, Universityof Manitoba,
Winnipeg, Manitoba, Canada. Address requests for reprints to Dr. Howard
Fogel, 301-400 St. Mary Avenue, Winnipeg, Manitoba, Canada R3C 4K5.
References
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5. Seidberg BH, Altman M, Guttuso J, Suson M. Frequencyof two mesio-
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Vol. 20, No. 3, March 1994 Maxillary First Molar Canals 137

8. Hartwell G, Bellizzi R. Clinical investigation of in vivo endodontically
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10. Neaverth EJ, Kotler LM, Kattenback RF. Clinical investigation (in vivo)
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A Word for the Wise

Would you believe that there is something we all use hundreds of times every day but cannot name? Do you
regret that English words don't sport such interesting fellows as the tilde and the umlaut? Meet the schwa!!
The schwa is the phonetic notation, depicted by a sort of backward lower case e (~), which signals the "uh"
sound for all vowels at one time or another--for example, the second "a" in paradox or the third 'T' in infinity.
Never heard of it? Well clearly it's used in America (think about it).

Roger Wills