Accessory roots and root canals in human anterior teeth: a review and clinical considerations

By Ahmed HM, Hashem AA

Date: 01/2017
Journal: JOE


•Purpose: to summarize prevalence and etiology of accessory roots and root canals in anterior teeth, clinical and radiographical detection by conventional and contemporary tools, and treatment modifications and clinical outcome. 


•Electronic search for articles published in Jan. 1970 to Nov. 2014 in 5 major endodontic journals; Australian Endodontic Journals, Dental Traumatology; International Endodontic Journal, Journal of Endodontics, and Oral Surgery Oral Medicine Oral Pathology.

•n: 86  Inclusion criteria; exclusion criteria:



•Maxillary anterior teeth:

•Most common root canal configuration is type IV (2-2) mostly  in M-D direction

•Mandibular anterior teeth:

•More complex root canal configuration than their maxillary counterparts •Most common root canal configuration is type IV (2-2) and type V (1-2) mostly in labiolingual direction

•Dense invaginatus: 

•invagination of the enamel organ into the dental papilla prior to calcification Prevalence: ranges from<1% to > 26%


•1- Type I: Most common; confined enamel form to the crown and do not extend to the CEJ

•2- Type II: Confined enamel form extend to the root as a blind sac ± pulp communication. Radiographic appearance is a RL tear drop shape surrounded by RO border

•3- Type III: The invagination perforate the root showing a second foramen; cementum is frequently found; no immediate communication to the pulp. Radiographic appearance is a  blunderbuss opening to the PDL (pseudo canal)

•Found mostly maxillary lateral > maxillary central > mandibular incisors and canine


•Palato-gingival groove (radicular lingual groove; disto-lingual groove): •Prevalence: ranges from  <1% to >18% •Primary maxillary canine has more prevalence of Double roots than their mandibular counterparts

Strengths: Overview of accessory roots’ prevalence, canal configuration type, radiographic appearance and treatment options.

  Weakness:  Did not state the sample   size directly instead presented it in tables and inter/intra   reviewer  reliability were not mentioned.