This month’s Endo Newsletter topic: Effect of Age On Root Canal Configurations

Studies of patients ≤20 to ≥40 years of age have shown that both pulp chamber size and root canal diameter decrease as people age. Such changes may also result from carious lesions, deep restorations and periodontal disease. Although many studies appear to support these conclusions, their applicability is limited due to studies’ restriction to a single type of tooth, a single root, a specific extra canal in a specific root or a specific root canal configuration. Additionally, small sample size has been a problem with these studies.

Martins et al from the University of Lisbon, Portugal, used cone beam computed tomography (CBCT) to analyze the prevalence of root canal systems in a large population of various ages (mean age, 51 years). They evaluated CBCT examinations performed over a 5-year period in 670 patients (243 males, 421 females).

All teeth were included in their study except for third molars, teeth with previous endodontic treatment, and teeth with immature apices or root resorption, for a total of 12,325 teeth. Root canal systems were classified by Vertucci type. Patients were divided into 4 groups by age: ≤20 years; 21 to 40 years; 41 to 60 years; and ≥61 years.

Information for only 151 teeth was available for the patient group that was ≤20 years old; because of the scarcity of data, that group was not included in the statistical analysis.

The second maxillary molar showed the greatest variation of all the maxillary teeth, with a progressive decrease in Vertucci type I configuration (single canal from crown to apex) and a corresponding increase in Vertucci type II configuration (2 canals near the crown reuniting into 1 canal near the apex).

The distal root of the mandibular first molar showed a decrease in Vertucci type I prevalence in patients ≥61 years old. Several other mandibular teeth showed a similar pattern of decrease in Vertucci type I configurations, but the differences were not as substantial. The root canal configurations of most anterior teeth did not vary greatly by age.


This study demonstrated a tendency for a greater prevalence of Vertucci type I configuration in younger people than in older people. The older population also showed a large increase in the number of root canals, primarily in the maxillary and mandibular second molars and in the distal root of mandibular first molars. These considerations must be taken into account when planning endodontic treatment for older patients.

Martins JNR, Ordinola-Zapata R, Marques D, et al. Differences in root canal system configuration in human permanent teeth within different age groups. Int Endod J 2018;doi:10.1111/iej.12896.