doi:10.1111/iej.
12800
REVIEW
A new system for classifying accessory canal
morphology
H. M. A. Ahmed1 , P. Neelakantan2 & P. M. H. Dummer3
1
Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia; 2Faculty of
Dentistry, The University of Hong Kong, Hong Kong SAR; and 3School of Dentistry, College of Biomedical and Life Sciences,
Cardiff University, Cardiff, UK
Abstract
Ahmed HMA, Neelakantan P, Dummer PMH. A new
system for classifying accessory canal morphology.
International Endodontic Journal, 51, 164–176, 2018.
Thorough knowledge of anatomical complexities of
the root canal system has a direct impact on the
effectiveness of canal preparation and filling, and is
an essential prerequisite for successful root canal
treatment. A wide range of complex variations in root
canal anatomy exists, including root canal configura-
tion type, developmental anomalies and minor canal
morphology such as accessory canals and apical del-
tas. Accessory canals and apical deltas have been
associated with pulp disease, primary canal infection,
Introduction
Adequate knowledge of the complexity of root canal
systems is essential for successful root canal treatment
(Vertucci 2005). This topic has been the subject of
numerous studies and clinical reports, and several
systems for classifying root canal configurations have
been proposed (Weine et al. 1969, Vertucci et al.
1974, Vertucci 2005, Versiani & Ordinola-Zapata
2015). With an increasing range of imaging methods
being used, many previously unreported anatomical
complexities are being identified (Leoni et al. 2014,
Zhang et al. 2014, Filpo-Perez et al. 2015, Gao et al.
Correspondence: Hany Mohamed Aly Ahmed, Department of
Restorative Dentistry, Faculty of Dentistry, University of
Malaya, 50603 Kuala Lumpur, Malaysia
(e-mail: hany_endodontist@hotmail.com).
164 International Endodontic Journal, 51, 164–176, 2018
canal reinfection and post-treatment disease. The cur-
rent definitions of accessory canal anatomy are not
standardized and potentially confusing. Given their
role in endodontic disease and their impact on treat-
ment outcomes, there is a need to have a simple clas-
sification of their anatomy to provide an accurate
description of their position and path from the canal
to the external surface of the root. The purpose of this
article is to introduce a new system for classifying
accessory canal morphology for use in research, clini-
cal practice and training.
Keywords: accessory canals, accessory canal mor-
phology, classification.
Received 26 February 2017; accepted 14 June 2017
2016, Xu et al. 2016). To address the shortcomings
of previous systems and to provide a logical and sim-
ple solution, a new system for classifying root and
canal morphology was recently proposed, which pro-
vides detailed information on tooth notation, number
of roots and root canal configuration (Ahmed et al.
2017).
Root canal infections are biofilm mediated, and the
presence of residual microbes within the root canal
system is an important cause of persistent infection
and post-treatment endodontic disease (Nair 2006).
The propagation of microbes and their by-products
occurs not only within the main root canal but also
in complex anatomical features that communicate
with periradicular tissues, resulting in periodontitis
anywhere along the length of the root, apex or furca-
tion (Nicholls 1963, Seltzer et al. 1963, Weine 1984,
Zolty 2001, Dammaschke et al. 2004, Iqbal et al.
© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd

2005, Silveira et al. 2010, Ahmed 2012, Jang et al.
2015). Such anatomic features include accessory
canals, apical delta/ramifications as well as dentinal
tubules (Nicholls 1963, Gutmann 1978, Dam-
maschke et al. 2004, Ricucci & Siqueira 2008a,b,
2010, Vieira et al. 2012, Arnold et al. 2013, Versiani
& Ordinola-Zapata 2015).
Justification for a new classification
system
Existing terminology of accessory canal
morphology
The terminology of accessory canals is inconsistent.
De-Deus (1975) categorized accessory canal morphol-
ogy into:
1. the lateral canal which extends from the main
canal to the periodontal ligament (mainly in the
body of the root);
2. the secondary canal which extends from the main
canal to the periodontal ligament in the apical
region; and
3. the accessory canal which is derived from the sec-
ondary canal branching off to the periodontal
ligament in the apical region.
Other terms, such as auxiliary, reticular and recur-
rent canals, have also been used (Rubach & Mitchell
1965, De-Deus 1975, Barbosa et al. 2009).
Cheung et al. (2007) defined an accessory canal as
a fine branch of the pulp canal that diverged at an
oblique angle from the main canal to exit into the
periodontal ligament space, whilst a lateral canal was
defined as a branch diverging at almost right angles
from the main canal. According to the American
Association of Endodontists (AAE) Glossary of
Endodontic Terms (AAE 2016), ‘an accessory canal is
a branch of the main pulp canal or chamber that
communicates with the external root surface’. By this
definition, a lateral canal is also a type of accessory
canal, located in the coronal or middle third of the
root, usually extending horizontally from the main
canal space, whilst a furcation canal is an accessory
canal located in the furcation. Others have defined
lateral canals as accessory canals located in the coro-
nal, middle as well as apical third of the root
ß alisßkan et al. 1995, Sert et al. 2004, Al-Qudah &
(C
Awawdeh 2006).
Green (1955) referred to ‘accessory apical foram-
ina’ for those within 3.5 mm of the apex (more than
three accessory foramina were considered as ‘multiple
© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd
Ahmed et al. New classification for accessory canals
foramina’). Foramina located beyond this limit were
referred to as ‘lateral canal foramina’. Cheung et al.
(2007) defined an auxiliary/accessory foramen as
the exit of any accessory and lateral canal, or of an
apical delta. An ‘apical delta’ was defined as a com-
plex ramification of branches of the pulp canal
located near the anatomical apex with the main
canal not being discernible (Cheung et al. 2007).
According to the AAE glossary of terms (AAE 2016),
‘an accessory foramen is an orifice on the surface of
the root communicating with a lateral or accessory
canal’, ‘apical deltas are multiple accessory canals
that branch out from the main canal at or near the
root apex’. The term ‘ramification’ includes furcation,
lateral and apical accessory canals as well as any
unusual intracanal anatomy formed by the localized
fragmentation of the epithelial root sheath (AAE
2016).
Existing classifications of accessory
canal morphology
The anatomy of root canals in the human dentition
including the finer, accessory branches of the root
canal system has been appreciated for some time
(Hess 1917). At first, there was no system to define
accessory canal morphology but then Yoshiuchi
et al. (1972), with the aid of a staining and clear-
ing method, created a system based on their posi-
tion along the root length. They divided the root
length into tenths from the root apex to the cervi-
cal margin (Fig. 1a). When the level of an acces-
sory canal was at 5/10–9/10, 4/10–2/10, 1/10 or
less of the root length, it was defined as being in
the cervical, middle or apical location, respectively
(Fig. 1a). The authors also defined the orientation of
the accessory canals. With the use of a hypothetical
cross-section of a root with an accessory canal, the
centre of the buccal (labial) surface was defined as
12 o’clock and the centre of palatal (lingual) sur-
face as 6 o’clock. The buccal (labial) surface was
defined as the span between 11 and 1 o’clock; the
mesiolabial – between 1 and 2 o’clock, the mesial
between 2 and 4 o’clock and so on (Fig. 1b). Others
have also proposed similar concepts of categorization
based on the region of the root (Kasahara et al.
1990, Miyashita et al. 1997, Adorno et al. 2010)
(Fig. 1c). However, the practicality of defining the
location of accessory canals according to tenths or
sixths of the root length in clinical situations is a
concern.
International Endodontic Journal, 51, 164–176, 2018 165
 New classification for accessory canals Ahmed et al.

(a) (b) (c)

1/6
1 / 10
2 / 10 11 1 2/6
o'clock o'clock
3 / 10
3/6
4 / 10
5 / 10 B 4/6
10 DB 2
6 / 10 o'clock MB
o'clock 5/6
7 / 10
8 / 10 D M 6/6
9 / 10

8 DP MP 4
o'clock
P o'clock

7 5
o'clock o'clock

(d) (e)
Canals in apex
Apical (3 mm)

Canals in body
Middle of the root

Coronal Canals in base

of the root

Figure 1 (a, b) Location and orientation of accessory canals as described by Yoshiuchi et al. (1972). (c) Similar approach was
followed by Kasahara et al. (1990) and Miyashita et al. (1997) but with fewer divisions of the root. (d) Vertucci et al. (1974).
(e) De-Deus (1975). Modifed from Ahmed et al. 2017, reproduced with permission from Wiley.

Vertucci et al. (1974) and Vertucci (1984) catego-
rized lateral canals according to their location (coro-
nal, middle, apical or furcation) (Fig. 1d), which was
also adopted in other reports (Gulabivala et al. 2002,
Sert et al. 2004, Al-Qudah & Awawdeh 2006).
De-Deus (1975) examined the accessory canal mor-
phology of 1140 human teeth and categorized lateral,
secondary or accessory canals according to their loca-
tion (base of the root and furcation, body of the root
and apical portion of the root) (Fig. 1e). Others added
details on the concurrent existence of lateral canals in
the coronal/middle, coronal/apical, middle/apical,
coronal/middle/apical thirds of the root to the existing
systems (Cß alisßkan et al. 1995).
A classification for accessory canals in the furcation
region has also been proposed (Yoshida et al. 1975)
(Fig. 2):
Type 1 (periodontium and pulpal chamber com-
municate through patent accessory canals);
Type 2 (accessory canals that originate from the
pulp chamber and end in dentine);
Type 3 (accessory canals that originate from the
periodontium and end in dentine);
Type 4 (accessory canals that originate from the
pulp chamber go through dentine, and return to
the pulp chamber);
Type 5 (accessory canals that originate from the
periodontium go through dentine and cementum,
and return to the periodontium); and
Type 6 (accessory canals found in dentine and/or
cementum, but with no exit).
Others (Paras et al. 1993) have re-categorized the
above-mentioned six types into four categories (true,
blind, loop or sealed accessory canals) (Fig. 2). There

166 International Endodontic Journal, 51, 164–176, 2018 © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Ahmed et al. New classification for accessory canals

(a) (b)

(c) (d)

Figure 2 Classification of furcation canals introduced by Yoshida et al. (1975) and Paras et al. (1993). (a) Type 1 canals (peri-
odontium and pulpal chamber communicate through ‘real’ accessory canals). (b) Types 2 and 3 canals (‘blind’ accessory
canals that originate from the pulp chamber (RED) and/or periodontal surface (YELLOW) and end in dentine). (c) Types 4 and
5 canals (‘loop’ accessory canals that originate from the pulp chamber (RED) and/or periodontium (YELLOW), go through den-
tine, and return to the pulp chamber and periodontium). (d) Type 6 canals (‘sealed’ accessory canals found in dentine and/or
cementum, but with no exit).

are some concerns, however, when using a single
term ‘accessory canals’ to define canals originating
from either the pulp or periodontal tissues because
the origin comes from two different tissue types.
High resolution micro-computed tomography (mi-
cro-CT) has been widely used for the three-dimensional
analysis of anatomical variations within the root canal
system (Verma & Love 2011, Matsunaga et al. 2014,
Versiani et al. 2016). Matsunaga et al. (2014) intro-
duced a classification for accessory canal morphology
to supplement Weine’s classification for root canal mor-
phology (Weine 1982). The authors divided each root
canal configuration type into four subtypes:
1. no accessory canals;
2. with apical ramifications;
3. with lateral canals;
4. both apical ramifications and lateral canals
observed at the same time (Fig. 3).
However, no information was provided on the location,
number or configuration of the accessory/lateral canal(s).
New classification system for accessory
canal morphology
Despite previous efforts, a simple and practical classifi-
cation addressing the number, location and configura-
tion of accessory canals has not been achieved. The
new system suggested in this article provides students/
trainees, clinicians and researchers with a standardized
approach to classify accessory canal morphology. For
simplicity, the classification does not address the diam-
eter, length nor the orientation of accessory canals. In

© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd International Endodontic Journal, 51, 164–176, 2018 167
 New classification for accessory canals Ahmed et al.

Type I Type II
(a) (b) (c) (d) (a) (b) (c) (d)

Type III Type IV

(a) (b) (c) (d) (a) (b) (c) (d)

Figure 3 Classification of accessory canals proposed by Matsunaga et al. (2014) (accessory canals types added to Weine’s clas-
sification). (a) no accessory canals; (b) with apical ramifications; (c) with lateral canals; (d) both apical ramifications and lateral
canals observed at the same time. Modifed from Ahmed et al. 2017, reproduced with permission from Wiley.

addition, it does not address complex characteristics of

accessory canals (such as tortuosity) investigated in (a) (b)
recent studies (Gao et al. 2016, Xu et al. 2016).
Root
canal Pulp
New classification – Terminology chamber
Coronal
Pulp chamber single canal

Pulp Root
The portion of the pulp space within (or extending to chamber canal Root
just below) the anatomic crown of the tooth. In single- bifurcaƟon

rooted teeth and double/multirooted teeth with middle

or apical root bifurcations with a single canal coronally,
it extends to the most apical portion of the cervical mar-
gin of the crown, and in double/multirooted teeth with
coronal root and/or canal bifurcations (no single canal
coronally), it extends to the floor of pulp chamber
located in the coronal third of the root (Fig. 4).
Chamber canal
A small canal leaving the ‘pulp chamber’ that (usu-
ally) communicates with the external surface of the
root (including the furcation) (Fig. 5). It can be of
any type (patent, blind or loop).
Root canal
A passage or channel in the root of the tooth extending
from the most apical portion of the pulp chamber (i.e.
root canal orifice) to the apical foramen (Fig. 4).
(c) (d)
Root
canal
Pulp
chamber
Figure 4 Criteria for defining the borders of the pulp cham-
ber; (a, b) most apical portion of the cervical margin (in case
of single-rooted teeth and double/multirooted teeth with mid-
dle or apical root bifurcations with a common canal coro-
nally). (c, d) Floor of the pulp (double/multirooted teeth with
coronal root and canal bifurcations (no common canal
coronally). Modifed from Ahmed et al. 2017, reproduced
with permission from Wiley.

168 International Endodontic Journal, 51, 164–176, 2018 © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Ahmed et al. New classification for accessory canals

Table 1 A summary of the codes of root and root canal

morphology allocated for single-, double- and multirooted
teeth (Ahmed et al. 2017).

Pulp
Tooth type Code
chamber
1 O-C-F
Chamber canal Single-rooted TN
2
Pulp Double-rooted TN R1O-C-F R2O-C-F
chamber n
Multirooted TN R1O-C-F R2O-C-F RnO-C-F

TN, tooth number; R, root; O, orifice; C, canal; F, foramen. ‘n’

refers to three roots or more.
Accessory canal(s)

Apical
delta

Figure 5 Diagrammatic representations showing accessory
and chamber canals and the apical delta. Modifed from
Ahmed et al. 2017, reproduced with permission from Wiley.
Apical delta (or apical ramifications)
The region at or near the root apex where the main
canal divides into multiple accessory canals (more
than two) (Fig. 5).

Accessory canal
A small canal leaving the ‘root canal’ that (usually)
communicates with the external surface of the root
or furcation (Fig. 5). Hence, it can be located any-
where along the length of the root (coronal, middle
or apical third) and can be any type (patent, blind,
loop). It also includes what have been in the past
termed lateral canals. For simplicity, only the term
‘accessory’ should be used for such canals, and terms
such as ‘lateral’ are not necessary to avoid any
potential confusion.
Accessory foramen
The opening of an accessory or a chamber canal on
the external surface of the root or furcation. It is
essential to appreciate that not all accessory canals
terminate in accessory foramina as they may be blind,
looped etc. (Fig. 2).
Tooth number and root configuration
The tooth number (TN) can be written using any
numbering system; root abbreviations and configura-
tions should be written as described previously
(Ahmed et al. 2017) (Table 1).
Location of accessory/chamber canals
Accessory canals: the length of the root is divided
into thirds (T): the coronal third (C), which starts
from an imaginary line from the most apical por-
tion of the pulp chamber, middle third (M) and api-
cal third (A) ending at the root apex (Fig. 6). Each
third is identified as a superscript within parenthesis
after the tooth number [TN(T)], for example [TN(C),
TN(M), TN(A)], or after the individual roots if the
tooth is double/multirooted, for example [2TN R1(T)
R2] (R: Root). If the accessory canal branches from
a single canal coronal to a root bifurcation, then

Apical Apical Apical

Root Root
canal Middle Middle Middle
canal

Coronal
Coronal Coronal

Pulp
Pulp chamber
chamber

Figure 6 Criteria for defining the location of accessory canals in (a) single-rooted, (b) double-rooted and (c) multirooted teeth.
Modifed from Ahmed et al. 2017, reproduced with permission from Wiley.

© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd International Endodontic Journal, 51, 164–176, 2018 169
 New classification for accessory canals Ahmed et al.

3
TN R1 R2 R3(D)

3
2
TN (T1) R1 R2 TN (1)R1 R2 R3

2
TN R1(T1) R2 2
TN R1 R2(T1)

Figure 7 Diagrammatic representations showing the codes for accessory and chamber canals and the apical delta. Modifed
from Ahmed et al. 2017, reproduced with permission from Wiley.

Table 2 A summary of the codes for accessory canal
morphology
Configuration
Accessory canal(s) located in
one of the three-thirds
of the root
An accessory canal starts
with an aO in one-third,
and aF in another third
of the root
Accessory canals located in
two of the three-thirds
of the root
Accessory canals located in
all thirds of the root
C, coronal; M, middle; A, apical; aO-C-aF, acessory Orifice-
Canal-accessory Foramen.
Accessory/chamber canal configuration
Details of accessory canal(s) should define the
Code continuous course of the accessory canal starting from
(CaO-C-aF) OR the accessory orifice(s) (aO), through the canal (C)
(MaO-C-aF) OR to the accessory foramen (foramina) (aF) – (aO-C-aF)
(AaO-C-aF) (Table 2) (Fig. 8). If the aO of an accessory canal is in
(C,MaO-C-aF) OR
one-third of the root but the aF is located in another
(M,AaO-C-aF)
third, then a comma is added between the two regions
of the root (e.g. TN(M,AaO-C-aF)). An apical delta is
(CaO-C-aF,MaO-C-aF) OR identified by the letter ‘D’ (Fig. 7). In some instances,
(CaO-C-aF,AaO-C-aF) OR the accessory/chamber canal may not end in a fora-
(MaO-C-aF,AaO-C-aF)
men and in that situation, the notation aO-C-0 will be
(CaO-C-aF,MaO-C-aF,AaO-C-aF)
used, for example 1-0 describes an accessory/chamber
canal that has one aO, one C but with no aF, whilst 2-
1-0 describes a looped accessory/chamber canal (Fig. 8).

Accessory canals located in one of the

the superscript is written before the root notation,
three-thirds of the root
for example 2TN (T)R1 R2 (Fig. 7).
Chamber canals: the superscript is written before the
Single-rooted teeth
root notation, for example 3TN ( )R1 R2 R3. As chamber
canals originated from the pulp chamber, the description If the tooth has an accessory canal(s) in one of the
of the thirds (C, M, A) is not required (Fig. 7). three-thirds of the root, then the code TN(TaO-C-aF) will

Figure 8 Codes for accessory canals having one aO, C and aF (configuration type 1), when they do not end in an aF (1-0),
and when the accessory canal forms a loop (2-1-0). Modifed from Ahmed et al. 2017, reproduced with permission from Wiley.

170 International Endodontic Journal, 51, 164–176, 2018 © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd

be used. For any accessory canal, if the numbers of
aO, C and aF are the same, then a single code is used.
Thus, 111(A1) describes a single-rooted maxillary right
central incisor having an accessory canal located in
the apical third of the root with one aO, one C and
one aF (Fig. 9a). 111(M2) describes a single-rooted
maxillary right central incisor having two accessory
canals in the middle third of the root with two aOs,
two Cs and ending up with two aFs (Fig. 9b), whilst
1
11(A1-2) refers to the same tooth having one acces-
sory canal in the apical third of the root starting with
one orifice (aO) and one C initially but then dividing
Figure 9 (a-j) Diagrammatic representations for the codes allocated for accessory canals in one of the three-thirds of the root.
Modifed from Ahmed et al. 2017, reproduced with permission from Wiley.
© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd
Ahmed et al. New classification for accessory canals
into two and ending up with two accessory foramina
(aF) (Fig. 9c). 111(D) describes a central incisor having
an apical delta (Fig. 9d).
Double- and multirooted teeth
If one of the roots has an accessory canal(s) in one
of the three-thirds of the root, then the code
2
TN R1(TaO-C-aF) R2 or nTN R1(TaO-C-aF) R2 Rn will be
used in double- and multirooted teeth, respectively.
Indeed, if more roots have accessory canals, then the
aO-C-aF will be applied as listed in Table 2. 233 B(A1)
International Endodontic Journal, 51, 164–176, 2018 171
 New classification for accessory canals Ahmed et al.

Figure 10 (a–f) Diagrammatic representations for the codes allocated for accessory canals in two of the three-thirds of the root.
Modifed from Ahmed et al. 2017, reproduced with permission from Wiley.

Figure 11 (a–c) Diagrammatic representations for the codes allocated for accessory canals in all thirds of the root. Modifed
from Ahmed et al. 2017, reproduced with permission from Wiley.

L (B: buccal, L: lingual) describes tooth 33 having one
accessory canal in the apical third of the buccal root
with a configuration type 1 (Fig. 9e). 233 B L(M1)
means that tooth 33 has an accessory canal in the mid-
dle third of the lingual root with a configuration type 1
(Fig. 9f). 233 B(A1) L(D) describes tooth 33 having one
accessory canal configuration type 1 in the apical third
of the buccal root, whilst the lingual root has an apical
delta (Fig. 9g). 326 MB(M2-1) DB P describes tooth 26
having two accessory canals in the mesiobuccal (MB)

172 International Endodontic Journal, 51, 164–176, 2018 © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Ahmed et al. New classification for accessory canals

Figure 12 Micro-CT 3D models of different groups of teeth classified according to the new system for classifying the root and
root canal (first column), accessory canal morphology (second column) and combined codes (third column). Modifed from
Ahmed et al. 2017, reproduced with permission from Wiley.

root starting with two orifices (aOs) that progress along

two accessory canals (Cs) in the middle of the root
initially, which then merge and end in one foramen
(aF) (Fig. 9h). 326 MB(A1) DB P(M1) describes tooth 26
having one accessory canal configuration type 1 in the
apical third of the MB root and in the middle third of
the P (palatal) root (Fig. 9i). 326 (1)MB DB P(A1)
describes tooth 26 having one chamber canal configu-
ration type 1, and one accessory canal configuration
type 1 in the apical third of the P root (Fig. 9j).
Accessory canals located in two of the
three-thirds of the root
Single-rooted teeth
If the tooth has accessory canal(s) in two of the three-
thirds of the root, then the code TNTaO-C-aF,TaO-C-aF will
be used. 111(M1,A1) describes tooth 11 having an
accessory canal located in the middle third of the root
and another one in the apical third; both with a

© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd International Endodontic Journal, 51, 164–176, 2018 173
 New classification for accessory canals Ahmed et al.
configuration type 1 (Fig. 10a). 111(M2-3,A1) describes
tooth 11 having three accessory canals, two in the
middle third and one in the apical third of the root,
with a configuration type 2-3 (two canals, three
foramina) and one, respectively (Fig. 10b). 111(M,A1)
describes tooth 11 having an accessory canal with
configuration type 1 located in both apical and middle
thirds of the root (Fig. 10c).
Double- and multirooted teeth
If one of the roots has an accessory canal(s) in two
of the three-thirds of the root, then the code
2
TN R1(TaO-C-aF,TaO-C-aF) R2, nTN R1(TaO-C-aF,TaO-C-aF)
R2 Rn will be used for double- and multirooted teeth,
respectively. If more roots have accessory canals, then
the aO-C-aF will be applied accordingly. 233 B(M1,A1)
L describes tooth 33 having one accessory canal con-
figuration type 1 in the middle and apical thirds of
the buccal root but none in the lingual root
(Fig. 10d). 326 MB DB P(M1,A2) means that tooth 26
has three accessory canals in the palatal root – one
in the middle third (configuration type 1) and two in
the apical third (configuration type 2) (Fig. 10e).
3
26 MB(M1-0,D) DB(A1) P(A1) describes tooth 26 having
one accessory canal configuration type 1-0 (1 orifice
but ending in dentine with no foramen) in the middle
third and an apical delta in the MB root, whilst the
DB (distobuccal) and palatal roots have type 1 acces-
sory canals in the apical third (Fig. 10f).
Accessory canals located in all thirds
Single-rooted teeth
If the tooth has accessory canal(s) in all thirds of the
root, then the code TNTaO-C-aF,TaO-C-aF, TaO-C-aF will be
used (Table 2). 111(C1,M1,A2) describes a single-rooted
tooth 11 having one accessory canal configuration type
1 located in the coronal and middle thirds of the root
and configuration type 2 in the apical third (Fig. 11a).
Double- and multirooted teeth
If one of the roots has an accessory canal(s) in all thirds
of the root, then the code 2TN R1(CaO-C-aF,MaO-C-aF,AaO-C-aF)
R2 or nTN R1(CaO-C-aF,MaO-C-aF,AaO-C-aF) R2 Rn will be
used for double- and multirooted teeth, respectively. If
more roots have accessory canals, then the aO-C-aF
will be applied accordingly. 233 (C1)B(M1,A1) L
describes tooth 33 having three configuration type 1
174 International Endodontic Journal, 51, 164–176, 2018
accessory canals in the coronal (branching from the
coronal single canal in double/multirooted teeth),
middle and apical thirds of the buccal root (Fig. 11b).
3
26 MB(C1,M1,D) DB(A1) P(A1) describes tooth 26 hav-
ing two type 1 configuration accessory canals in the
coronal and middle thirds of the root and an apical
delta, whilst the DB and P roots have type 1 acces-
sory canals in the apical third (Fig. 11c).
Clinical implications, practicability and
application
Dividing the root into thirds (coronal, middle and api-
cal) has several clinical implications. Patent accessory
or chamber canals located in the coronal third of the
root can cause pulp disease secondary to periodontal
disease, and vice versa (Rubach & Mitchell 1965,
Weine 1984). It is also possible for a blood vessel
within accessory and chamber canals to be severed
during periodontal treatment procedures that may
result in subsequent irreversible inflammatory
changes in the pulp (Abbott & Salgado 2009). Defin-
ing chamber canals is advantageous as they can be
linked to bony lesions occurring in the furcation area
of posterior teeth in both permanent and primary
dentitions (Weine 1984, Dammaschke et al. 2004,
Vertucci 2005, Ahmed 2013).
Lateral radiolucent areas are related usually to
accessory canals located in the middle third of the
root (Silveira et al. 2010). Accessory canals located in
the apical third, as well as apical deltas, are one of
the main causes for persistent apical periodontitis
(Iqbal et al. 2005, Arnold et al. 2013). Therefore, a
root-end resection of at least 3 mm has been advised
to remove the majority of accessory canals and any
potential apical delta, thus, reducing the risk of peri-
apical inflammatory responses and eventual failure
(Kim & Kratchman 2006). Defining the accessory
canal configuration (aO-C-aF) reflects its complexity
in a simple yet accurate manner.
For practicability and simplicity, the codes for
accessory/chamber canal morphology presented in
this system can serve as complimentary codes to the
recently described system for classifying root and root
canal morphology (Ahmed et al. 2017) (Fig. 11).
Combining both codes would provide more detailed
information on the root, root canal as well as acces-
sory canal morphology of a given tooth (Fig. 12).
Appendix S1 shows several examples of codes allo-
cated for various teeth having accessory canals with
a variety of configurations.
© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Ahmed et al. New classification for accessory canals

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Conflict of interest
Duarte MA, Versiani MA, Ordinola-Zapata R (2015)
The authors have stated explicitly that there are no Micro-computed tomographic analysis of the root canal
conflicts of interest in connection with this article. morphology of the distal root of mandibular first molar.
Journal of Endodontics 41, 231–6.
Gao X, Tay FR, Gutmann JL, Fan W, Xu T, Fan B (2016)
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Supporting Information
Additional Supporting Information may be found in
the online version of this article:
Appendix S1. Supplementary powerpoint presenta-
tion describing the new proposed classification for
accessory canal morphology.
© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd