Root canal configurations of maxillary first molar in different populations.
The success of endodontic treatment depends on the precise knowledge of root and root canal anatomy and morphology, which is an important challenge due to the complexity of the root canal system and the anatomical variations [1, 2]. This knowledge helps the clinicians in endodontic treatment planning and decreases the percent of endodontic failure. The root canal contains the dental pulp, which occupies the internal cavity of the tooth [3].
Root canal system varies among the teeth, especially in molar teeth. Recent studies have demonstrated that root canal system is very complex due to splitting and union of canals during their way to the apex [4, 5]. The root canal starts from the orifice in the pulp chamber and ends apically with an open orifice into the periodontium. The root canals present different configurations between the teeth and among different populations [6]. Many techniques have been used to study the root canal system from clearing and radiographs to microcomputed tomography and cone-beam computed tomography scanning, which has the advantage of the high-quality three-dimensional slices [2, 5, 7].
The root canal system has been classified by different authors to set terms for communication, diagnosis, and treatment planning. The ideal classification of root canal system is to define a number of roots, number of canals in each root, and the canal configurations [8]. Different configurations of root canals have been identified in numerous studies. Weine et al. [9] in 1969 were the first who studied the root canal configuration of maxillary second molars and defined four types as follows (Figure 1):
Type I (1-1): single canal runs from the orifice to the apex.
Type II (2-1): two canals start from the pulp chamber and join in one closer to the apex.
Type III (2-2): two canals run separately from the orifice to the apex.
Type IV (1-2): one canal starts from the pulp chamber floor and divides into two canals when coming closer to the apex.
Weine’s classification of root canal configuration.
In 1984, Vertucci [10] presented another classification for root canal configurations in maxillary first molars, and it has been commonly used in different studies. The classification was as follows (Figure 2):
Type 1 (1-1): single canal runs from the orifice to the apex.
Type II (2-1): two canals begin from the pulp chamber and join in one at the apex.
Type III (1-2-1): one canal runs from the pulp chamber, splits into two canals during its way, and then unites into one canal at the apex.
Type IV (2-2): two canals run separately from the orifice to the apex.
Type V (1-2): one canal runs from the pulp chamber and splits into two canals when coming closer to the apex.
Type VI (2-1-2): two canals run from the pulp chamber; during its way they unite into one canal and then again split into two canals at the apex.
Type VII (1-2-1-2): one canal starts from the pulp chamber, then divides into two canals, again unites into one canal, and finally at the apex divides into two canals.
Type VIII (3-3): three canals run from the orifice to the apex.
Vertucci’s classification of root canal configuration [11].
In the last decade, some authors studied the root canal configurations all over the world and added new types to Vertucci’s classification, which demonstrates the complexity of root canal system. Kartal and Yanıkoğlu [12] identified two root canal configurations in mandibular anterior teeth: type (1-2-1-3) and type (2-3-1). In 2001 Gulabivala et al. [13] added seven new configurations to Vertucci’s classification: type (3-1), type (3-2), type (2-3), type (2-1-2-1), type (4-2), type (4-4), and type (5-4) (Figure 3).
Gulabivala’s classification of root canal configurations.
Also, in 2004, Sert and Bayirli [14] added 15 configurations (Figure 4), which have been observed in maxillary and mandibular teeth in Turkey. They were classified in the following order: type IX (1-3), type X (1-2-3-2), type XI (1-2-3-4), type XII (2-3-1), type XIII (1-2-1-3), type XIV (4-2), type XV (3-2), type XVI (2-3), type XVII (1-3-1), type XVIII (3-1), type XIX (2-1-2-1), type XX (4), type XXI (4-1), type XXII (5-4), and type XXIII (3-4).
Sert and Bayirli classification of root canal configurations [11].
Peiris et al. in 2008 observed two additional root canal configurations (1-2-3) and (3-1-2) in their study (Figure 5A) on mandibular first molar of a Sri Lankan population [15]. In 2008, Al-Qudah added four new types for root canal configurations of mandibular molars in Jordan population [16]: type XX (2-3-1), type XXI (2-3-2), type XXII (3-2-1), and type XXIII (3-2-3) (Figure 5B).
Root canal configurations according to (A) Beiris and (B) Al-Qudah [8].
In addition to describing root canal system, many authors studied the root canal shape and the presence of isthmus (which is a narrow ribbon-shaped communication between two root canals that contain pulp tissue). The isthmus was found in 15% in maxillary anterior teeth, for maxillary premolars—it was identified in 16% at a 1-mm level of the apex and in 52% at a 6-mm level of the apex. The prevalence of the isthmus was high in mesiobuccal root of maxillary first molars (about 30–50%) in the apical third of the root. For mandibular first molars, 80% of mesial roots have connection in the middle and apical third of the root. Root canal shape varies between round, oval, and C-shaped. Kim et al. [17] classified root canal shape and the presence of connections between canals into five types (Figure 6):
Type I: incomplete isthmus between two canals
Type II: two canals with a definite connection between them
Type III: very short complete isthmus between two canals
Type IV: a complete or incomplete isthmus between three or more canals
Type V: two or three canals without visible connection between them.
Kim’s classification of root canal shape [17].
In 2018, a review was conducted to study classification of root canal configuration to find a simple, reliable, accurate, and easy nomenclature system to identify the root canal depending on the tooth type, the number of roots, the course of the canal in each root, and the number of foramens [8].
The maxillary first molar is the earliest permanent tooth that appears in the oral cavity and that makes it vulnerable to caries and furthers to the need of endodontic treatment. It has three roots [mesiobuccal (MB), distobuccal (DB), and palatal (P)] with four canals. Despite this, in some populations these variations were observed: one, two, or four roots in the maxillary first molar [18, 19, 20]. Root fusion of this tooth was observed in about 0.9–3% [20, 21, 22, 23]. The root canal system of the maxillary first molar is complex and has many variations among races; due to that it has the highest rate of endodontic failure. The palatal root is the longest and has the largest diameter; in most cases, it contains one round canal from the orifice of the pulp chamber to the apex. The presence of two or three canals in this root has been reported; in some population as in India, two canals were found in 5% [24]. The distobuccal root is conical and has one canal in most cases. The presence of the second distobuccal canal (DB2) has been documented in some studies, and its prevalence ranged from 0.5 to 9.5% (Figure 7) [25, 26]. The most common root canal morphology of the palatal and distobuccal roots is type I (1-1) (Table 1). The mesiobuccal root contains two canals (MB1, MB2) with a ribbon form type I by Kim et al. in most cases (Figure 8). The MB2 is one of the mysteries in endodontics; its orifice is located mesially or in the pulpal groove between the main mesiobuccal canal and palatal canal, 3.5 mm palatally and 2 mm mesially from the main mesiobuccal canal [27]. The prevalence of MB2 ranged from 48 to 88%, for example, in Russia MB2 was found in 59.8% [25], in Poland 59.5% [28], in Japan 88.2% [29], and in Portugal 71% [30]. The root canal system of the mesiobuccal root has significant variations among populations. The most common canal configuration is type I (1-1) followed by type II (2-1) and then type IV (2-2) by Vertucci [20, 24, 25, 30, 31, 32, 33, 34, 35, 36, 37]. Many recent studies have been conducted to analyze the morphology of root canal configuration of three rooted maxillary first molars among different populations as shown in Table 1. The most common root canal configuration of one and four rooted maxillary first molars is type 1 (one canal) [31].
A case of five canals in maxillary first molar. (A and B) Coronal and middle third: MB1, MB2, DB1, DB2, P. (C) Apical third: MB1 + MB2 + DP + P.
Author(s) | Country (year) | Root | Type (1-1) | Type (2-1) | Type (1-2-1) | Type (2-2) | Type (1-2) | Type (2-1-2) | Type (1-2-1-2) | Type (3-3) | Type (3-1-2) | type (1-3) | Type (3-2) | Type (2-3) | Type (2-1-2-1) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Neelakantan et al. [31] | India | MB | 51.8 | 5.5 | – | 38.6 | – | – | – | – | – | – | – | 1 | – |
DB | 90.4 | 2.7 | 1.8 | 1.8 | – | – | – | – | – | – | – | – | – | ||
P | 88.1 | 1.8 | – | 4 | 1.4 | – | – | – | – | – | – | – | – | ||
Singh and Pawar [24] | South India (2015) | MB | 69 | 24 | – | 4 | 2 | – | – | 1 | – | – | – | – | – |
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
Alrahabi and Sohail Zafar [19] | Saudi Arabia (2015) | MB | 29.4 | 47 | 11.8 | 11.8 | – | – | – | – | – | – | – | – | – |
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
Martins et al. [30] | Portugal (2017) | MB | 29 | 44.1 | 1 | 16.4 | 2 | 5.7 | 0.2 | – | 0.4 | – | – | – | 1.2 |
DB | 98 | 1.4 | 0.2 | – | 0.2 | 0.2 | – | – | – | – | 0.4 | – | – | ||
P | 98.2 | 0.4 | 1.4 | – | – | – | – | – | – | – | – | – | – | ||
Tian et al. [20] | China (2016) | MB | 42.2 | 15.2 | 2.1 | 36.2 | 2 | 0.6 | 0.07 | 0.13 | 1.4 | ||||
DB | 98.2 | 0.3 | 0.6 | 0.3 | 0.5 | – | – | – | – | – | – | – | – | ||
P | 99.3 | 0.3 | 0.3 | – | 0.1 | – | – | – | – | – | – | – | – | ||
Ghobashy et al. [32] | Egypt (2017) | MB | 25.4 | 45.6 | 0.99 | 27.2 | 0.5 | – | – | – | – | – | – | – | – |
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
Pérez-Heredia et al. [33] | Spain (2017) | MB | 13.8 | 56.5 | – | 23.2 | – | 4.3 | – | – | – | – | 0.7 | – | 1.4 |
DB | 97.1 | 1.4 | – | – | 1.4 | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
Ratanajirasut et al. [34] | Thailand (2018) | MB | 36.4 | 28.8 | 2.7 | 25.3 | 5.3 | 1.1 | – | – | – | – | – | – | – |
DB | 99 | – | – | 0.2 | 0.8 | – | – | – | – | – | – | – | – | ||
P | 99.8 | 0.2 | – | – | – | – | – | – | – | – | – | – | – | ||
Rezaeian et al. [35] | Iran (2018) | MB | 38.7 | 16.2 | 13.7 | 8.7 | 7.5 | 1.2 | – | – | 5 | 3.7 | 2.5 | 2.5 | |
DB | 98.7 | – | – | – | 1.2 | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
Razumova et al. [25] | Russia (2018) | MB | 40.2 | 22.4 | 37.3 | – | – | – | – | – | – | – | – | – | |
DB | 99.5 | 0.5 | – | – | – | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | – |
Root canal configurations of maxillary first molar in different populations.
A case of four canals in maxillary first molar. (A–C) Coronal, middle and apical third: MB1, MB2, DB, P.
The maxillary second molar is smaller and shorter than the first molar. It has three separated roots in the most common form (MB, DP, and P). Available studies show this tooth can have from one to five roots [37, 38]. Moreover, fusion of roots of maxillary second molars is observed from 5.90 to 42.25% [39]. The fusion of palatal root with mesiobuccal root is the most prevalent form followed by fusion of buccal roots, and the least spread form is the fusion of the three roots (Figure 9) (Video 1) [39]. Root canal morphology of this tooth varies among population and races. The most common root canal morphology of three-rooted second molar is four canals (MB1, MB2, DB, and P) (Figure 10). The incidence of MB2 ranged from 11.53 to 93.7% [40], in Russia—51.5%[41], and in Portugal—44% [30]. MB2 is located mostly 1 mm from the orifice of the mesiobuccal canal [39]. Root canal configuration of MB is so complex; type I (1-1) is common in MB root, followed by type II (2-1). Other types of root canal configurations were observed in some population like India, Portugal, and China [20, 30, 31]. Clinicians should pay attention to the presence of MB2 during endodontic treatment to avoid failure. The shape of the root canal in MB root could be ribbon-shaped when two canals exist or oval when just one canal (Figure 11).
A case of root fusion (MB + P) of maxillary second molar (A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
A case of four canals in the coronal, middle and apical third of the maxillary second molar (A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
Three canals of maxillary second molar. The shape of MB canal is oval while the shape of DB is round (A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
For DB and P roots, they have one canal in most cases. Two canals in DB root were observed in some studies, and the prevalence of DB2 ranges from 0.6 to 4% [40]. Its orifice is located near the DB1. The most common root canal configuration in these roots is type 1 (1-1) (Table 2). The root canal shape of these roots is mostly round.
Author(s) | Country (year) | Root | Type (1-1) | Type (2-1) | Type (1-2-1) | Type (2-2) | Type (1-2) | Type (2-1-2) | Type (1-2-1-2) | Type (3-3) | Type (2-1-3) | type (3-1) | Type (3-2-1) | Type (2-1-2-1) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Weng et al. [41] | China (2009) | MB | 82 | 8 | – | 6 | 4 | – | – | – | – | – | – | – |
DB | 92 | 2 | – | – | 6 | – | – | – | – | – | – | – | ||
P | 94 | – | 6 | – | – | – | – | – | – | – | – | – | ||
Neelakantan et al. [31] | India | MB | 62 | 6.3 | 24.4 | – | – | – | – | – | – | – | 0.5 | |
DB | 84.9 | 1.5 | 2.4 | 4.4 | – | – | – | – | – | – | – | – | ||
P | 87.8 | – | – | 3.4 | 0.9 | – | – | 0.5 | – | 0.5 | – | – | ||
Martins et al. [30] | Portugal (2017) | MB | 56.2 | 27.1 | 0.7 | 7.6 | 3.4 | 4.2 | 0.2 | – | – | – | 0.2 | 0.4 |
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | ||
P | 98.8 | 0.4 | 0.7 | – | – | – | – | – | – | – | – | – | ||
Tian et al. [20] | China (2016) | MB | 70.3 | 12.9 | 5.3 | 6.8 | 3 | 0.4 | 0.3 | 0.1 | 0.9 | |||
DB | 99.5 | 0.2 | – | 0.1 | 0.2 | – | – | – | – | – | – | – | ||
P | 99.7 | 0.2 | 0.1 | – | – | – | – | – | – | – | – | – | ||
Kalender et al. [42] | Turkey (2016) | MB | 76.1 | 20.8 | – | 2.8 | – | – | – | 0.3 | – | – | – | – |
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | ||
Ghobashy et al. [32] | Egypt (2017) | MB | 42.06 | 47.1 | – | 8.03 | 1.87 | 0.93 | – | – | – | – | – | – |
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | ||
Pérez-Heredia et al. [33] | Spain (2017) | MB | 52.7 | 33 | – | 9.8 | – | 2.7 | – | 0.9 | 0.9 | – | – | – |
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | ||
Ratanajirasut et al. [34] | Thailand (2018) | MB | 70.6 | 14.6 | 2.3 | 7.5 | 3.5 | 1.5 | – | – | – | – | – | – |
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | ||
P | 99.7 | 0.3 | – | – | – | – | – | – | – | – | – | – | ||
Naseri et al. [43] | Iran (2018) | MB | 23.5 | 18.5 | 3.2 | 11.5 | 7.6 | 26.8 | – | – | – | – | – | – |
DB | 94.3 | – | 0.6 | – | 3.8 | 1.3 | – | – | – | – | – | – | ||
P | 93.6 | – | 0.6 | – | 4.5 | 1.3 | – | – | – | – | – | – |
Root canal configurations of maxillary second molars in different populations.
For one-, two-, and four-rooted maxillary second molars, type 1 (1-1) is mostly common [31]. Table 2 presents the root canal configurations of three-rooted maxillary second molars in recent studies in different countries [20, 30, 31, 32, 33, 34, 35, 42, 43, 44].
It is also known as wisdom tooth and generally erupts between the ages of 17 and 25 years old. The anatomy of the maxillary third molar is unpredictable and varies among populations, even in individuals in same populations [45, 46, 47]. A few studies were conducted to analyze the anatomy and root canal morphology of this tooth. It may have from one to five roots. Root fusion is common in this tooth, whereas Alavi et al. reported root fusion from 2 to 26.5% in Thai population [45]. Ahmad et al. found root fusion in 70% in Jordan population [46]. The fusion of three roots was the most common form. Regarding the number of root canals, it varies per root and generally ranges from one to six canals (Figure 12) [47]. Table 3 shows the number of roots and root canals of maxillary third molar among different populations [41, 42, 45, 46, 47, 48, 49, 50, 51]. The most common root canal configuration for maxillary third molar is type I (1-1) followed by type II (2-1) (Table 4) [42, 47, 50, 51]. The incidence of C-shaped canals in this tooth was reported in two studies: in the USA (2.2%) [45] and in China (8.5%) [51]. The shape of the root canal in the coronal, middle, and apical thirds varies per root such as, when the third molar has one root with one canal from the orifice to the apex, the shape of the canal may be oval or long oval in all parts (Figure 13). If the one-rooted tooth has two canals, the shape of the canal could be like a ribbon, type I, II, IV, or V by Kim et al. (Figure 14). A clinician should pay attention to the root canal shape when preparing and filling the root canal.
Maxillary third molar with three roots and four canals (A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
Author(s) | Country (year) | Type of study | Number of teeth | Number of roots | Number of canals | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 | 5 | 6 | ||||
Sidow et al. [44] | USA (2000) | Clearing | 150 | 15 | 32 | 45 | 7 | 7.4 | 3.3 | 57.3 | 27.3 | 2.7 | 0.7 |
Ng et al. [48] | Burmese (2001) | Clearing | 72 | 19.4 | 19.4 | 55.6 | 5.6 | 5.6 | 25 | 47.2 | 22.2 | – | – |
Alavi et al. [45] | Thai (2002) | Clearing | 151 | 1.3 | 6.6 | 88.1 | 4 | 9.9 | 11.3 | 48.3 | 29.1 | 1.3 | – |
Weng et al. [41] | China (2009) | Clearing | 43 | – | – | – | – | 27.9 | 11.6 | 44.2 | 16.3 | – | – |
Sert et al. [49] | Turkey (2011) | Clearing | 290 | 35.5 | 28.6 | 34.1 | 1.7 | 12.4 | 29.7 | 46.9 | 11 | – | – |
Cosić et al. [47] | Croatia (2013) | Sectioning | 56 | 8.9 | 5.4 | 83.9 | 1.8 | 7.1 | 7.1 | 75 | 10.8 | – | – |
Ahmad et al. [46] | Jordan (2016) | Clearing | 89 | 13.5 | 5.6 | 74.2 | 6.7 | 9 | 6.7 | 55.1 | 27 | 2.2 | – |
Zhang et al. [50] | China (2018) | Micro KT | 130 | 51.5 | 19.2 | 25.4 | 3.8 | – | – | – | – | – | – |
Razumova et al. [40] | Russia (2018) | CBCT | 238 | 47.9 | – | 52.1 | – | 13.8 | 11.8 | 72.3 | 2.1 | – | – |
Number of roots and root canals of maxillary third molars in different populations.
Author(s) | Country (year) | Root | Type (1-1) | Type (2-1) | Type (1-2-1) | Type (2-2) | Type (1-2) | Type (2-1-2) | Type (3-3) | Type (1-2-3) | Type (1-3) | Type (3-2-1) | Type (1-3-2) | Type (3-2) | Type (3-1) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Weng et al. [41] | China (2009) (HAN) | Single | 63.2 | 21 | – | – | – | 5.3 | 10.5 | – | – | – | – | – | – |
MB | 62.5 | 20.8 | 4.2 | 8.3 | 4.2 | – | – | – | – | – | – | – | – | ||
DB | 87.5 | – | 4.2 | – | 8.3 | – | – | – | – | – | – | – | – | ||
P | 91.6 | – | 4.2 | – | 4.2 | – | – | – | – | – | – | – | – | ||
Sert et al. [49] | Turkey (2011) | Single | 63.1 | 12.3 | 7 | 12.2 | 3.5 | – | – | – | – | – | – | – | 1.75 |
MB | 77.8 | 13.1 | – | 5.1 | 4 | – | – | – | – | – | – | – | – | ||
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
Ahmad et al. [46] | Jordan (2016) | Single | 66.8 | – | 8.3 | – | 8.3 | 8.3 | – | – | 8.3 | – | – | – | – |
MB | 55 | 5 | – | 20 | 15 | – | – | 5 | – | – | – | – | – | ||
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
P | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
Zhang et al. [50] | China (2018) | Single | 51.4 | 12.8 | 5.7 | 1.4 | 12.8 | – | – | – | 1.4 | 5.7 | 1.4 | 1.4 | 1.4 |
MB | 72.7 | – | – | 12.1 | 12.1 | – | 3 | – | – | – | – | – | – | ||
DB | 100 | – | – | – | – | – | – | – | – | – | – | – | – | ||
P | 93.9 | – | – | 6.1 | – | – | – | – | – | – | – | – | – |
Root canal configuration of maxillary third molar in different populations.
Maxillary third molar with one root and one long oval canal (A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
Maxillary third molar with one root and two canals (A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
This tooth is the most common tooth exposed to caries and frequently requires root canal treatment. It has two roots in the most common form (mesial and distal); occasionally, it has three roots. The mesial root is characterized by a flattened mesiodistal surface and widened buccolingual surface. The distal root is mostly straight. The morphology of mandibular first molar has been investigated in different studies among different populations. The incidence of three-rooted teeth has been reported in some populations: Korea (25.8%) [51], Spain (4.1%) [33], and Turkey (3.6%) [52]; this third root is mostly located distolingually, and it is smaller than the distobuccal root. Root canal system varies from two canals to four canals. The incidence of four canals was reported in some races: in Russia (20.9%) [40], Turkey (15.3%) [52], Spain (52.9%) [33], and Korea (24.3%) (Figure 15) [51]. The fourth canal is usually located in the distal root. The mesial root has two separated canals in about 90% of cases (type IV), and in 10 % the two canals are joined into one canal at the apex (type II), while the distal root usually contains one straight oval canal (type I) (Figure 16). The incidence of C-shaped root canal is low in this tooth and about 2% [60] (Table 5 shows the root canal configurations for mandibular first molar in recent studies [30, 33, 51, 52, 53, 54, 55, 56, 57, 58, 59]).
Mandibular first molar with four canals (two mesial and two distal) (A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
Mandibular first molar with three canals (two mesial and one distal) the mesial canals shape have the ribbon type I by Kim, while the distal canal shape is long oval (A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
Author(s) | Country (year) | Root | Type (1-1) | Type (2-1) | Type (1-2-1) | Type (2-2) | Type (1-2) | Type (2-1-2) | Type (1-2-1-2) | Type (2-3-1) | Type (2-1-2-1) | Type (3-2) | Type (2-3-2) | Type (3-2-1) | Type (1-2-1-2-1) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Chourasia et al. [52] | India (2012) | M | – | 36.6 | – | 54 | 0.6 | 8 | 0.6 | – | – | – | – | – | – |
D | 65.3 | 20.6 | 1.3 | 9.3 | 3.3 | – | – | – | – | – | – | – | – | ||
Muriithi et al. [54] | Kenya (2012) | M | 3.3 | 7.9 | – | 87.3 | – | 1.1 | – | – | – | – | – | – | – |
D | 50.3 | 18.5 | 1.6 | 22.2 | 5.3 | – | – | – | – | – | – | – | – | ||
Kim et al. [51] | Korea (2013) | M | 1.8 | 20.2 | 0.3 | 76.9 | 0.5 | – | – | – | – | 0.1 | 0.2 | – | – |
D | 66.6 | 19 | 0.3 | 11.8 | 2.1 | – | – | – | – | – | – | – | – | ||
Zhang et al. [59] | China (2015) | M | 0.9 | 5.6 | 4.8 | 87.7 | 0.9 | – | – | – | – | – | – | – | – |
D | 65.9 | 2.4 | 0.3 | 9.2 | – | – | – | – | – | – | – | – | – | ||
Torres et al. [56] | Chile 2015 | M | 2.9 | 19 | 28.5 | 21.9 | 21.9 | 21.9 | 3.6 | – | – | – | – | – | – |
D | 78.8 | – | 12.4 | – | 5.8 | – | 2.9 | – | – | – | – | – | – | ||
Torres et al. [56] | Belgium (2015) | M | 1.4 | 5 | 33.6 | 16.4 | 42.9 | – | 0.7 | – | – | – | – | – | – |
D | 72.9 | – | 17.1 | – | 9.3 | – | 0.7 | – | – | – | – | – | – | ||
Celikten et al. [53] | Turkey (2016) | M | 2.4 | 34.9 | – | 62.7 | – | – | – | – | – | – | – | – | – |
D | 84 | 11.8 | 0.3 | 3.4 | 0.3 | 0.3 | – | – | – | – | – | – | – | ||
Madani et al. [57] | Iran (2017) | M | 7.3 | 31.5 | 2 | 57 | 2 | – | – | – | – | – | – | – | – |
D | 79.8 | 10.7 | 4.6 | 3.3 | 1.3 | – | – | – | – | – | – | – | – | ||
Martins et al. [30] | Portugal (2017) | M | 1.1 | 46.5 | – | 41.9 | – | 4.1 | – | – | 0.9 | 2.1 | 0.2 | 3.2 | – |
D | 70.9 | 12.4 | 9.6 | 2.3 | 3.2 | 0.9 | – | – | 0.5 | – | – | – | 0.2 | ||
Pérez-Heredia et al. [33] | Spain (2017) | M | – | 51.3 | – | 37.8 | 0.8 | 1.7 | – | 1.7 | – | 5.9 | – | – | – |
D | 72.3 | 18.5 | 5.9 | 2.5 | – | – | – | – | – | – | 0.8 | – | – | ||
Gambarini et al. [58] | West Europe (2018) | M | 41 | 59 | |||||||||||
D | 100 | – | – | – | – | – | – | – | – | – | – | – | – |
Root canal configurations of mandibular first molars in different populations.
This tooth is similar to the mandibular first molar. Usually, it has two roots (mesial and distal), although it may have one or three roots. The extra root is usually located lingually. The incidence of three-rooted teeth was found in some populations: in Chinese (1.27%) [59], Indian (7.5%) [61], Turkish (0.4%) [52], Spain (6.25%) [33], and Korean (1.1%) [62]. The prevalence of one-rooted mandibular second molar was observed in Russia (0.5%) [40], Spain (16.5%) [33], and Turkey (1.6%) [52]. The most frequent root canal system is three canals (two mesial and one distal) (Figure 17). The prevalence of three canals in various populations was in Russia (82.2%) [40], Turkey (86.4%) [52], India (53.5%) [61], and Spain (81.25%) [33]. The mesial root usually has two canals that tend to lie much closer together. The most common root canal configurations in the mesial root are type II (2-1) and type IV (2-2) (Table 6). The distal root has one straight canal with type I (1-1), and the incidence of two canals is less and ranged from 3.5 to 20% [61]. The incidence of C-shaped root canals is higher in this tooth than the other teeth (Figure 18). Several studies have reported the C-shaped canals among various populations: India (13.12%) [61], Korea (40%) [62], Brazil (3.5–15.3%) [63, 64], China (29–39%) [59, 65, 66], Russia (8.5%) [67], Saudi Arabia (9.1%) [60], and Jordan (21.6%) [16]. This variation could be related to ethnic groups. Regarding the root canal shape, mesial roots tend to have ribbon-shape type I or V by Kim et al., and the distal root canal in most cases has an oval shape and round in some cases (Figure 19). Table 6 represents the root canal configurations of two-rooted mandibular second molars.
Mandibular second molar with three canals (two mesial + one distal) (A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
Author(s) | Country (year) | Root | Type (1-1) | Type (2-1) | Type (1-2-1) | Type (2-2) | Type (1-2) | Type (2-1-2) | Type (1-2-1-2) | Type (3-1) | Type (2-1-2-1) | Type (3-2) | Type (2-3-2-1) | Type (3-2-1) | Type (3-2-3-2-1) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Al-Qudah and Awawdeh [16] | Jordan (2009) | M | 16.1 | 32.6 | 3.5 | 40.3 | 3.5 | 1 | 0.3 | – | – | 0.3 | – | 0.3 | – |
D | 79 | 7.7 | 2.6 | 4.5 | 5.5 | – | – | – | – | – | – | – | – | ||
Neelakantan et al. [68] | India (2010) | M | 8.4 | 2 | 1.4 | 63.1 | 5.2 | – | – | 2 | – | 1.1 | – | – | – |
D | 64.9 | 4.6 | 0.6 | 11 | 1.7 | – | – | – | – | – | – | – | – | ||
Ceperuelo et al. [69] | Spain (2014) | M | 12.5 | 56.2 | 18.7 | – | 6.2 | – | – | – | – | – | – | – | – |
D | 81.2 | 6.2 | – | 6.2 | – | – | – | – | – | – | – | – | – | ||
Torres et al. [56] | Chile (2015) | M | 17.5 | 7.2 | 48.4 | 4.1 | 20.6 | – | 2.1 | – | – | – | – | – | – |
D | 99 | – | – | – | 1 | – | – | – | – | – | – | – | – | ||
Torres et al. [56] | Belgium (2015) | M | 11.7 | 5.3 | 37.2 | 14.9 | 28.78 | – | 2.13 | – | – | – | – | – | – |
D | 98.4 | – | – | – | 1.06 | – | – | – | – | – | – | – | – | ||
Celikten et al. [52] | Turkey (2016) | M | 7.1 | 32.3 | 0.2 | 60.3 | – | – | – | – | – | – | – | – | – |
D | 96.3 | 2.5 | – | 1 | – | 0.2 | – | – | – | – | – | – | – | ||
Kim et al. [62] | Korea (2016) | M | 13.9 | 37.7 | 1.2 | 44.5 | 2.6 | – | – | – | – | – | – | – | – |
D | 96.6 | 2.1 | – | 0.9 | 0.4 | – | – | – | – | – | – | – | – | ||
Pérez-Heredia et al. [33] | Spain (2017) | M | 3 | 78.2 | – | 14.9 | 1 | – | – | 1 | – | 2 | – | – | – |
D | 92.1 | 2 | 3 | 3 | – | – | – | – | – | – | – | – | – | ||
Martins et al. [30] | Portugal (2017) | M | 8.1 | 63.9 | 5.2 | 18.1 | 0.5 | 1.6 | – | – | 0.4 | 0.2 | 0.4 | 1.4 | 0.2 |
D | 93.5 | 0.5 | 4.2 | 0.4 | 1.4 | – | – | – | – | – | – | – | – | ||
Madani et al. [57] | Iran (2017) | M | 18.1 | 28 | 5.7 | 42.9 | 3.3 | 0.8 | – | – | – | – | – | – | – |
D | 91.7 | 3.3 | 0.8 | 1.6 | 1.6 | – | – | – | – | – | – | – | – | ||
Pawar et al. [61] | India (2017) | M | 7.2 | 32.5 | 0.9 | 45.2 | 1 | – | – | – | – | – | – | – | – |
D | 61.1 | 18.2 | – | 7.5 | – | – | – | – | – | – | – | – | – |
Root canal configurations of mandibular second molars in different populations.
Mandibular second molar with C-shaped canal (A) Sagittal view of mandibular second molar, (B) coronal third of root canals, (C) middle third of root canal, (D) apical third of root canals.
Mandibular second molar two canals (one oval mesial + one round distal)(A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
This tooth erupts between the ages of 17 and 25 years old. It has morphological radicular variations. Many dental treatment plans work on maintaining this tooth to use it as a strategic abutment when the first and second molars are missed, especially when there is sufficient room in the dental arch. Frequently, it has two roots (mesial and distal). A few studies in various populations found that mandibular third molar could have from one to four roots (Figures 20 and 21), which could be related to genetics and race differences; as in Croatia and China, one-rooted third molar was reported in 56% [47] and 48% [50] of cases, respectively (Figure 22) (Table 7). The root canal system of this tooth is unpredictable; it could have from one to six canals [44]. The most common form is to have three canals (two mesial canals and one distal canal). Table 7 presents the root and canal number in different populations. Regarding root canal configurations, type (1-1) prevailed mostly in mesial and distal roots of two-rooted teeth and in single-rooted third molars (Table 8) [46, 49, 50, 71]. The incidence of C-shaped canals was reported in Thailand (11%) [70], Iran (3.3%) [71], and China (3.3%) (Figure 23) [50]. Root canal shape of mandibular third molar varies per root.
Mandibular third molar with two roots and two canals(A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
Mandibular third molar with three roots and three canals(A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
Mandibular third molar with one root and two canals(A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
Author(s) | Country (year) | Type of study | Number of teeth | Number of roots | Number of canals | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 | 5 | 6 | ||||
Sidow et al. [44] | USA (2000) | Clearing | 150 | 17 | 77 | 5 | 1 | 7.3 | 16.7 | 55.3 | 16.7 | 3.3 | 0.7 |
Gulabivala et al. [13] | Burmese (2001) | Clearing | 58 | – | 100 | – | – | 1.7 | 51.7 | 44.8 | 1.7 | – | – |
Gulabivala et al. [70] | Thai (2002) | Clearing | 173 | 11.6 | 86.7 | 21.2 | 0.6 | 6.4 | 64.1 | 28.3 | 5.2 | – | – |
Sert et al. [49] | Turkey (2011) | Clearing | 370 | 24.9 | 69.5 | 5.4 | 0.3 | 10.8 | 52.7 | 17.3 | 18.6 | 0.5 | – |
Kuzekanani et al. [71] | Iran (2012) | Clearing | 150 | 21.4 | 72.6 | 5.3 | 0.7 | 10 | 52 | 32.7 | 5.3 | – | – |
Cosić et al. [47] | Croatia (2013) | Sectioning | 50 | 56 | 44 | – | – | 4 | 6 | 90 | – | – | – |
Ahmad et al. [46] | Jordan (2016) | Clearing | 70 | 14.3 | 74.3 | 8.6 | 2.9 | 7.1 | 38.6 | 45.7 | 8.6 | – | – |
Zhang et al. [50] | China (2018) | Micro KT | 130 | 47.7 | 46.1 | 5.4 | 0.8 | – | – | – | – | – | – |
Razumova et al. [40] | Russia (2018) | CBCT | 210 | 20 | 80 | – | – | 0.5 | 40.9 | 58.6 | – | – | – |
The number of roots and root canals of mandibular third molars in different populations.
Author(s) | Country (Year) | Root | Type (1-1) | Type (2-1) | Type (1-2-1) | Type (2-2) | Type (1-2) | Type (2-1-2) | Type (3-3) |
---|---|---|---|---|---|---|---|---|---|
Sert et al. [49] | Turkey (2011) | Single | 65.6 | 14.7 | – | 9.8 | 9.8 | – | – |
Mesial | 59 | 24.2 | 2.7 | 9.8 | 3.9 | – | – | ||
Distal | 99.2 | 0.8 | – | – | – | – | – | ||
Kuzekanani et al. [71] | Iran (2012) | Single | 31.2 | 21.9 | 9.4 | 25 | 3.1 | – | 3.1 |
Mesial | 54.1 | 17.4 | 13.8 | 3.7 | 7.4 | – | – | ||
Distal | 92.7 | 1.8 | 2.7 | – | – | – | – | ||
Ahmad et al. [46] | Jordan (2016) | Single | 55.6 | 22.2 | 11.1 | – | – | 11.1 | – |
Mesial | 40.6 | 18.8 | 3.1 | 28.1 | 9.4 | – | – | ||
Distal | 93.8 | – | – | 3.1 | 3.1 | – | – | ||
Zhang et al. [50] | China (2018) | Single | 42.7 | 3.6 | – | 2.4 | 2.4 | – | – |
Mesial | 68.3 | 5 | 8.3 | 3.3 | 11.7 | – | – | ||
Distal | 100 | – | – | – | – | – | – |
Root canal configuration of maxillary third molar in different populations.
Mandibular third molar with C-shaped canal(A) coronal third of root canals, (B) middle third of root canal, (C) apical third of root canals.
This chapter summarized the root canal system of the maxillary and mandibular molars in different populations. Root canal system of the molar teeth is so complex and unpredictable. It varies among populations and even in individuals in same population. The maxillary first and second molars have in the most common form three roots with four canals. The maxillary third molar may have from one to five roots with different numbers of canals ranging from one to six canals. Mandibular molars in the most common form have two roots with three canals. C-shaped canals are mostly common in mandibular second molars. Clinicians should pay attention to the additional canals and additional configurations when preparing for the root canal treatment, since knowledge of the basic root and root canal morphology as well as possible variation in anatomy of the root canal system is an important factor to achieve successful root canal treatment.
The global economy knowshow to build nearly anything, but it does not know what to build to solve our pressing social, economic, and environmental challenges. This is evident in the persistence of problems like inequality and unsustainability. Our modern economy has not solved these problems because nearly everything we know about economics and commerce was inherited from an era of scarcity, which drives win-lose competition over money, a grow-or-die business imperative, economic disparities, and damage to the natural environment [1].
\nThis win-lose competition over money creates a dilemma. Businesses seek more customers, while people seek more of the very goods and services that businesses want to sell, with money often the only missing ingredient for commerce to occur, even though we invented money to promote needed commerce. At the same time, many people have useful skills for community economic development, with no way to put those people to work because of a lack of money to make that happen. This “lack of money” dilemma hits economically disadvantaged communities especially hard, and increases the challenges of closing economic disparities.
\nWhile this dilemma is accepted as normal by economists—as well as by business, community and government leaders—it makes no sense. These problems may seem solvable by issuing more money, but the more we issue money, the more competitive startups and businesses grow, generating more downward pressure on each enterprise’s market share, prices, and profits. It also impacts employee wages, which affect family purchasing power [2].
\nModern economies have more wealth producing ability—measured in underutilized capacity – than the money to distribute it. Many of our economic problems—from affordable housing and healthcare to world hunger and clean water to education, training and employment—can be solved not by issuing more money, but by questioning the assumption that win-lose competition over money is the most efficient way to provide the greatest economic good for the greatest number. Turning currently underutilized business capacity into profitable production and sales—at the marginal cost of production—is the win-win foundation for a needed update to free-enterprise economic thinking.
\nUnbridled competition over money is a double-edged sword. Free-enterprise competition is a powerful engine of economic growth. It increases customer traffic to a given destination, while improving consumer choice, quality and service, all while holding down prices. Competition is also our model for economic growth, creating jobs and expanding the tax base by rewarding entrepreneurs for hard work, risk and innovation. However, extreme competition over money puts downward pressure not only on a company’s ability to perform, but also on employee wages, which stall or decrease when unbridled competition increases. That creates a large and growing gap between what a normal economy can produce and what employees, families and communities can afford to buy with their artificially restrained wages.
The cycle of innovation, growth, maturity and decline applies to most products and industries, and is well understood. The hidden anomaly is that our wealth-producing capabilities constantly improve with advances in technology, infrastructure and human skill, knowledge and creativity. Yet the standard of living and quality of life go up and down with the money-driven boom and bust cycles of the business cycle. Economists insist that falling prices benefit everyone in the end, and that new jobs created by ongoing innovation replace old jobs that are lost. Yet, downward pressure on market share from local-to-global proliferation of competitive duplication causes the growth of excess or underutilized business capacity, creating wasted wealth [3].
\nThis wasted wealth stems from a flaw in how we think about and use money. We have made money the object of competition and the goal of the economic game. The simple yet mysterious fact is that economics, commerce and the popular culture all confuse money (our tool of wealth creation) with wealth (the goods and services). Of course, money is a critical tool in the equation, but it should not itself be the objective of economics. This confusion of money and wealth begins to explain our seemingly intractable social, economic and environmental challenges, even as all the other factors of production are only improving rapidly [4].
\nConfusing money and wealth is akin to confusing a map with the terrain the map represents. Economics will take a great leap forward when we distinguish money from wealth and introduce a next generation of money to mobilize real and available economic wealth wherever the dollar fails to do so. This is an enormous business opportunity, because there is so much untapped wealth in the world, side-by-side with so much unmet need. This serves no one: not businesses, individuals, communities, or society. This is not just an issue for the poor. Many individuals and families are just a paycheck or a layoff away from dire economic circumstances.
\nThis is a societal problem, not a personal failing; it reflects a repairable shortcoming in our free enterprise system. And no one is to blame for this: not the rich, the poor, the banks, foreign competition, the government, the political left or right, or human nature. We all suffer from outmoded ways of thinking and outdated economic tools and practices. Blaming one group or another - all of them equally caught in a system they did not invent - gets in the way of a solution.
\nIf we look across the economy, it is overflowing with excess productive capacity. College desks are empty more than they are full; restaurant tables are empty more than they are full. There are extensive off hours at fitness clubs, movie theaters, oil change shops, beauty salons and elsewhere. We are living in a world of wasted capacity and yet we are already overbuilt to meet the needs of everyone on the planet. For example, food is an abundant renewable resource, yet people go hungry across the world. Meanwhile, global agrobusiness is one of the most powerful industries on the planet and they want more customers. Business wants more customers and people need more goods and services, and yet, while humans invented money to match buyers with sellers and work to do with people who need jobs, all that’s missing is money [5].
\nThe automotive industry offers another example of excess capacity. While numerous people are driving old and perhaps dangerous vehicles, and others can afford no vehicle at all, thousands of auto dealerships are awash in high quality new and used cars. Only money or purchasing power is missing to match eager sellers with eager buyers. The same is true of education. While there is much agreement on the need for a more educated workforce, we do not know how to make college education affordable for all. Many people, young and old, desire a college education that they simply cannot afford (and affordability is a money issue not a wealth production and distribution issue). Colleges and universities have enormous numbers of unfilled desks and compete for student tuition dollars. For the most part, they each have enough infrastructure, instructors and staff to serve many more students, and could easily increase teachers and staff if a source of funding was available for everyone who wants to go to school. Scholarships are a means of discounting tuition, yet many youth leave college saddled in debt—again a money issue!
\nThe hidden lessons of the 2008–9 US housing market crash and subsequent global economic downturn are revealed in the movie The Big Short [6]. The movie ends with three revealing statistics: in the US alone, $5 trillion in wealth disappeared; 8 million people lost their jobs; 6 million families lost their homes. We also know that many millions of people lost some or all of their life savings and large numbers of businesses failed. Why are these well-known figures critical for repairing the US and global economies? Because the simple fact is that no real wealth disappeared: no buildings, no technology or global economic infrastructure, no labor skill, management knowhow or human creativity disappeared, no products disappeared off retail shelves, and not a single ounce of materials or a joule of energy disappeared. So what disappeared causing the devastating economic consequences on people and communities?
\nTechnically, only valuations fell. Valuations are the price in dollars that one might expect to receive when selling stock, a company, a home, or other real and valuable material assets. In other words, during an economic downturn, numbers in computers, called money or stock, shrink. Nothing in the material world that constitutes wealth nor any of the factors of production, described above, disappear or diminished. In fact, the factors of production continue to improve during economic downturns, which ultimately help to set the stage for eventual recoveries. In truth, once again, only money goes missing to put people back to work and turn idle productive capacity into new consumable wealth for society.
\nThis is, in part, what makes life in the modern world so stressful. Advances in technology cause us to chase money at an ever-increasing rate, rather than allowing us to enjoy time in nature, family and community time, personal growth and development time, religious and spiritual time, and so forth. It is outside our sense of possibility that technology could do the lion’s portion of the work, leaving people to enjoy ever-shorter working hours by sharing what is left. Instead, people are today chasing after a living at the ever-increasing, 24–7-365 pace of technology. And we are paying the price with our health, and the health of our families, workplaces and communities. Technology could eliminate most repetitive, boring, and dangerous work, allowing people to enjoy life more. Why instead are ever-growing numbers of people feeling anxious about their economic futures and depressed about their situations? Put bluntly, the dynamics of the economy have hard-wired us to chase money for survival (and, of course, for many to get ahead).
\nAs a solution to the dilemma of businesses with desirable goods and services existing side-by-side with eager customers lacking purchasing power, we propose creating a next generation of money—backed by the underutilized wealth of society—to stretch purchasing power in fiat currencies beyond what is available today. Fiat currencies have a critical role to play as a means of exchange, but a single currency does not efficiently distribute both what is abundant and what is scarce. A new accounting protocol can stretch current financial resources to distribute evermore available wealth. Pairing the dollar with a second currency, as a measure of wealth, addresses this dilemma, expanding production and distribution for what is already or could easily be in sufficient supply, e.g., food, shelter, healthcare, education, and so forth. In such a system, the ratio between dollars and the second currency in the price of an item would denote its relative scarcity or sufficiency.
\nConsider how the sharing economy accomplished rapid economic growth when mobile apps and social media had a fraction of the economic impact that they have today. A decade ago, it exploded onto the scene creating millions of jobs and billions of dollars of new wealth. On the one hand, the sharing economy demonstrated how to capture, monetize and distribute the excess productive capacity of solopreneurs—an empty room in someone’s home or an idle car and driver. On the other hand, filtered through win-lose competition over money, someone had to take the hit for all this economic growth. Hotels, motels and their employees took the hit from the rise of Airbnb, while cab drivers, limo drivers and their companies took the hit from the rise of Uber and Lyft. This showed how the outdated economics of scarcity, based in win-lose competition over money, can stifle efforts to monetize excess capacity.
\nWe need, instead, to move toward “Continuous Economic Improvement”, where every advance in the factors of production—technology; infrastructure; human skill, knowledge and creativity; our ever-growing access to nature’s abundant and free renewable resources—raises the standard of living and quality of life for everyone, shortens working hours across-the-board and, ultimately, eliminates traditional economic growth and creates a Circular Economy.
\nWhen we monetize excess capacity, as in the sharing economy, not with dollars, since the lack of dollars has created the problem to begin with, but with another measure of wealth, a second currency, we can address the paradox of our having excess wealth and insufficient cash. It also enables us to close disparities, whether it’s for women or communities of color or youth, which is hard to do in a cash economy because of a lack of dollars. In a dual currency system, if somebody pays you in the second currency, you can pay for things on a part cash/part second-currency basis, stretching your purchasing power and get more of what you need.
\nThe traditional approach to closing disparities include: local, state and national government programs; philanthropy and volunteerism; corporate social responsibility and social entrepreneurship; cooperative enterprises; women and minority owned businesses; public education campaigns; wellness campaigns; green products and services; microlending; collective impact initiatives and so forth. Just as millions of businesses compete over market share with their products and services, millions of government agencies, schools and community programs compete for tax allocations, and millions of non-profit and community organizations compete for philanthropic funding and volunteer time. In the end, this proliferation of competitive duplication within and across sectors creates immense inefficiency. Greater efficiency is at the heart of economic progress and environmental sustainability.
\nContinuous Economic Improvement would operate not by holding down production to the level of available purchasing power, but by raising the purchasing power for individuals, families and communities by capturing he ever-increasing productive capacity in the world. In order not to disrupt what was already working well in the economy, Continuous Economic Improvement would not raise employer labor costs, increase taxes or increase debt. It has three cornerstone premises:
Business innovation and the profit motive is more effective than politics to solve social, economic and environmental challenges. When joined with institutional power and resources and community wisdom and mobilization (empowered by social media and other modern information technologies), it would be an unstoppable force for the common good.
Modern technology, global economic infrastructure, renewable resources and eco-sustainable business practices can now produce more than enough food, housing, education, healthcare, travel and entertainment options for everyone on the planet to enjoy a high quality of life and a healthy balanced lifestyle.
Money, commerce and citizen empowerment could be immediately brought into the 21st Century with another step in the history of money innovation. We would go from barter to coins to paper currency to electronic commerce to ledgers as part and parcel of economic history.
An economics based on ledgers recognizes that transactions that once involved exchanging tokens – cash and coins – are now increasingly done through credit and debit cards, which amounts to digital bits moving from one ledger to another. This represents a transformation in the history of money. Unlike cash and coin tokens, ledgers do not crash or inflate in value, do not experience scarcity or hoarding, and do not lend themselves to speculation or theft. Moreover, ledgers allow us to measure not just the exchange of cash, but other currencies as well, accounting not only for money, but also for other forms of capital that we have not tallied before [7].
\nThe role of ledgers as a measure of untapped wealth has broad implications for many of the chronic challenges we face. Impoverished communities, for example, may lack money, but they often have extraordinary amounts of social and cultural capital, which, if accounted for, can enable these communities to address their own problems and meet their own needs without depending upon government programs or non-profit charity. Ledgers also enable us to have economic activity that does not destroy the natural environment in the process by accounting for work that has environmental benefits as equally as that which does not. Likewise, ledgers provide a way for businesses that have excess capacity and owners who have under-utilized goods and services to put those assets to work meeting the unmet needs of customers and consumers.
\nLedgers measure wealth, while U.S. dollars – and the national currencies in other nations –remain primarily units of exchange. But there are also other features that distinguish these two types of currencies. A ledger currency – let us call them Ledger Dollars (L$) – could stretch U.S. dollars through dual currency transactions. For example, a $20.00 restaurant meal might cost $12.00 and L$ 8.00, much like the economics of senior discounts or ‘2 for 1’ dining. Or a $20 fitness club pass might cost $4.00 and L$ 16.00, based on the much lower marginal cost of production at a club than at a restaurant.
\nBank-issued dollars – or other national currencies – are government money, backed by debt and taxes. Ledger Dollars are more like loyalty rewards (frequent flyer miles, Hilton Honors, Starbuck Points, etc.) which are business-issued currencies backed by real business products and services. But unlike loyalty rewards, L$ are not rewarded for consumer spending and do not promote the competitive advantage of one business over another. National currencies are scarce by their very nature and therefore they command interest and dividends in the market. They are also party to the ups and downs of speculation and part-and-parcel of inflationary and recessionary problems as well. In contrast, Ledger Dollars are purely symbols—mere entries in a ledger—used to match production of goods and services with business, employee, customer, family and community wants and needs. There can never be a shortage of symbols—inches, gallons, pounds or numbers— to get needed work done in communities. And through the efficient match of customer purchasing power to available products and services, we can finally solve the pesky problems of inflation and recession.
\nU.S. dollars or other national currencies are a blunt instrument to address economic inequity, as traditional money chases the highest rate of return and as interest and dividends bring evermore money to those who already have money. Ledger Dollars, instead, encourage a more level economic playing field through smarter production and distribution of real wealth. Finally, U.S. dollars encourage consumerism to promote traditional economic growth, which has negative social and environmental consequences. In contrast, Ledger Dollars promote a higher quality of life by engaging everyone in greater economic efficiency and voluntary sharing of currently idle resources, advancing better living, with less consumption [8].
\n\nTraditional Economics and Commerce versus\n \nDual Currency Commerce and Ledger Economics\n | \n||
---|---|---|
\nCategory\n | \n\nFiat-based Economic\n \nand Commerce\n | \n\nDual Currency Commerce\n \nand Ledger Economics\n | \n
Philosophy | \nCompetition over scarce resources—in the face of unlimited wants and needs—creates the greatest good for the greatest number. | \nPeople and planet-centered economics and social entrepreneurship. Breaks no laws of free enterprise economics; fiat/dollars distribute what is scarce; Ledger Dollars distribute what is sufficient/abundant. Business-led, market-based, profit driven, yet immediate not trickle down. | \n
Economic Driver(s) | \nMaximize shareholder value through increased profits (not a bad thing, just an incomplete approach) | \nTriple bottom line: people, profits, planet; seeks an equitable win for all stakeholders, while protecting the environment | \n
Currency Innovation | \nNot a field of economics; latest design innovation was paper tokens to digital tokens riding banking and Automated Clearinghouse (ACH) ledgers | \nTransitions economics and commerce from solely using a fiat token currency to a dual currency combination of a fiat currency and a ledger currency | \n
Economic domain(s) | \nRevolves around what is measured in fiat currency | \n3 domains: fiat economy; non-fiat monetized economy; unrecognized and nonmonetized excess productive capacity economy | \n
Price setting | \nSupply and Demand sets prices in fiat currencies only leaving extensive underutilized productive capacity side-by-side with extensive unmet needs | \n\n
| \n
Competition vs. Cooperation | \nCompetition over money leaves wealth on the table and drives win-lose results | \nDual Currency Commerce balances competition and cooperation to lift everyone up together | \n
Impacts of labor-saving technology, outsourcing, mergers and acquisitions | \nMany people lose their jobs, while other people are left working longer and harder. | \nAdvances in technology and sharing work globally raises everyone’s standard of living and quality of life, while shortening working hours, and reducing damage to the natural environment | \n
Quality of life considerations | \nDrives longer working hours and business versus labor workplace dynamics; degrades the natural environment; social issues (crime, workplace stress, addiction) are considered “personal problems” | \nContinuous economic improvement drives: ever-higher quality of life; ever-shorter working hours; ever-less damage to the natural environment by thoughtful and cooperative distribution of work, material sufficiency, and leisure; social problems (crime, workplace stress, addictions) are addressed as social issues | \n
Diversity, Equity and Inclusion | \nDisparities remain and expand because fiat money seeks the highest rate of return and results in money flight from communities | \nDisparities become relatively easy to close at the marginal cost of production through the monetization of excess productive capacity | \n
Governance | \nGovernment banking regulations and one-size-fits-all civil legislation | \nGovernance by protocol (akin to the Internet, Visa/MC, and the 12 Step program of Alcoholics Anonymous). Algorithms govern currency distribution based upon available resources. Mass customization allows all network stakeholders to determine rules and regulations within customized communities | \n
Relationship to growth | \nBased on consumerism and the inherited “grow-or-die” business imperative | \nSeeks to build a Circular Economy with a values-based economic engine; recognizes extensive underutilized productive capacity and replaces growth imperative with efficiency; does not need consumerism, so focuses on quality-of-life considerations | \n
Healthcare | \nFocus is on institutional care and treatment, not prevention; highly profitable activities include: treating cancer and diabetes; diagnostics and pharmaceuticals; cardiovascular medicine (a heart attack is a major economic event, while quitting smoking lowers the GDP) | \nFocus is on individual, family and community health and wellness through addressing the Social Determinants of Health and Health Disparities. Wellness investments are low-cost, including healthy diet, moderate exercise, economic stability and wellness education, etc. | \n
Ledger economics represent a paradigm shift in how we think about money and look at wealth. Consider that nothing in the physical universe changed when human perception shifted from the earth at the center of the universe to the sun at the center of the solar system. Yet, that shift in perception opened the door to enormous advances in science and society. Using the solar system as a metaphor, money has long stood at the center of society’s economic universe. This has led us to subordinate all that we do to the availability of money, including much that communities value: families, education and healthcare, God and spirituality, hobbies, healthy balanced lives, culture, the natural environment and more.
\nLedger Dollars put those values, rather than cash, at the center of the economic universe. Money should revolve around values and not the other way around, especially since money is just a means to our ends, something that we designed and that we can redesign if it no longer helps us achieve what we most value. The redesign of money may sound odd, but we have done this before, innovating new tokens of exchange when necessary.
\nHistorically, money innovation has been technology-driven, following the accelerating pace of economic evolution. In the 1800s, the United States transitioned from gold and silver coins to paper currency, as the dominant form of money. During that time, virtually every state and every bank issued their own paper money. The system was unworkable, and thousands of banks failed. In response, the equivalent of an industry standard was set for paper currency. It consisted of a single national currency and a Federal Reserve System. Then, a hundred years later the phenomenon was repeated.
\nIn the early years of the credit-card-industry banks, department stores, gas stations and others each issued and processed their own credit cards. The young industry had operating losses of tens of millions of dollars. An industry standard was set that provided workability and profitability for the banks. It was the VISA platform (followed quickly by MasterCard) [9]. We can learn a great deal from the standard that was set, because it included a new financial instrument (the electronic debit and credit), a new payment platform and a cooperative network of banks and retail merchants. Virtually everything proposed here can be created rapidly through a cooperative network made up of banks (and the payment systems industry), retail merchants and cardholders, which was the original vision of VISA’s Founder. Money innovation has also enabled the democratization of wealth:
The agricultural era brought the transition from bartering to gold coins over a 3,000 to 5,000 year period, with coins made possible by the technologies of smelting and metal casting
The industrial era, over a period of 300 to 500 years, saw the transition to paper currency and checks, all made possible by printing and paper making
Today’s high-tech global era, fueled by the transition to electronic banking, credit cards, e-commerce, and now mobile apps, has matured over a mere 30 to 50 years, all made possible by computers, plastics, and the Internet.
That increasing pace, from millennia to centuries to decades, has demonstrated not only the growing rapidity of money innovation, but also its feasibility as a way to address unmet needs. And if that pace continues, we think that it could be just a matter of 3 to 5 years to see the emergence of a monetary system that revolves around and supports what communities most value: a second currency, enabled by mobile apps, social media and blockchain and able to absorb excess assets, compensate voluntary work, and increase the quality of life of everyone.
\nWe cannot solve society’s greatest challenges with a tool – money – that is insufficient for the tasks we want it to do. But this is not impractical or overly idealistic at all when you realize that society operates at only a fraction of its social, economic and environmental potential. We have all the tools that we need to make a rapid and sustainable economic transformation happen and a universally high quality of life available to everyone.
\nOver 70 years ago, with no computers or global economic infrastructure - and with only on-the-job training for the so-called unskilled members of society - the U.S. went from the depths of the depression to full employment and global war production in a mere 18 months. The three key ingredients of this extraordinary economic feat were a common cause, a funding source, and a cooperative mobilization in contrast to everyday competition over money. A common vision, modern technology, a new wealth accounting protocol, and cooperative mobilization could enable a 21st century ledger-economic system that works at the pace of mobile apps and social media.
\n\nLedger Dollars integrate the best features of many popular currencies\n | \n||
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\nMoney Type\n | \n\nMost useful features\n | \n\nLeast useful Features\n | \n
\nFiat/national currencies\n | \n\n
| \n\n
| \n
\nBarter\n | \n\n
| \n\n
| \n
\nLoyalty\n \nRewards\n | \n\n
| \n\n
| \n
\nCommunity Currencies and Time Dollars\n | \n\n
| \n\n
| \n
\nCryptocurrencies\n | \n\n
| \n\n
| \n
\nAnticipated results by combining the best features of multiple currencies and platforms\n | \n||
\nLedger Dollars used within a Dual Currency Ledger Economics Network\n | \n\n
| \n
The Dual-Currency Ledger-Dollar (DCLD) system has four main stakeholder groups: Individuals, Merchants, Sponsors, and System Operators.
\nIndividuals download the DCLD app and receive a first monthly dividend on their smart phones or other digital device. The app reveals where to earn and where to spend Ledger Dollars. It helps people to find community organizations, schools, employers and government agencies offering L$ to volunteers, students, employees, and government benefit recipients who seek to earn additional Ledger Dollars above their monthly allocation. For participants in the system, it not only has the tangible benefit of increasing their purchasing power at participating merchants, but also intangible advantages like feeling valued for contributing to thriving communities, meeting like-minded people, and helping create a better world that works for everyone.
\nSponsors are the community-oriented organizations that aggregate and report the rewardable activities of network participants. A public school, for example, could reward parents or local residents who tutor struggling students. It could also reward those students for putting in the effort to improve their academic performance or engage in service learning in the community. Employers would do the same for participating employees who join company volunteer groups, wellness teams or green teams. Community organizations reward volunteers. Healthcare systems reward patient compliance, donating blood, and better health outcomes. Government agencies distribute L$ to benefits recipients. Indeed, any socially valuable activities can lead to earning extra Ledger Dollars. In this way, Sponsors can improve volunteer recruitment and retention, advance community wellbeing, increase their impact, attract funder attention and support, and reward the engagement of their own employees.
\nMerchants determine the ratio of U.S. dollars to Ledger Dollars to accept and any restrictions on when they will accept the second currency. Merchants benefit by increasing the number of customers, while selling targeted excess capacity at the marginal cost of production plus an incremental cash profit. They pay a modest marketing fee on dual currency sales and receive useful demographic data on community participation, free L$ employee benefit, and excellent community PR.
\nSystem Operators include payment processors and merchant services organizations; consultants to the private, public, nonprofit, cooperative, and social impact sectors; algorithm architects who see that the L$ supply makes a good match between monetized excess capacity and unmet family and community needs and others who help to aid the transition from a dollars-only economy to a dual-currency ledger system.
Stakeholder Benefits in a Dual CurrencyLedger Economics Network (DCLEN) | \n|
---|---|
\nIndividuals\n | \n\n
| \n
\nMerchants\n | \n\n
| \n
\nSponsors\n | \n\n
| \n
\nSystem Operators\n | \n\n
| \n
Sonya is a nurse in a community clinic who hears about recovery dollars from a coworker. She downloads the mobile app and receives a first monthly dividend of L$ 100.00. That dividend is determined by an algorithm based upon the volume of merchants in the network and their redemption patterns: The more merchants who join and the more people seek their products and services, the larger the dividend grows to over time.
\nUsing the merchant directory and location map, Sonya finds a local gym where a standard $99.00 membership now costs her $50.00 plus L$ 49.00, which would be akin to the gym offering a 50% discount to attract new members. This stretches Sonya’s cash and brings in extra revenue to the gym, given the low marginal cost of accommodating another customer on underused equipment and facilities.
\nEager to earn more recovery dollars, Sonia uses the app to locate community sponsors who could use volunteers. When she spends two hours a week volunteering with a sponsor in the network, Sonya earns L$ 20.00/hour, which adds an additional L$ 160.00 per month to her account. Sonya also finds that a local food co-op allows customers to pay 10% of their total shopping bills in recovery dollars, which not only increases their purchasing power, but also builds a more cooperative economy by incentivizing customers to volunteer.
\nOn the weekend, Sonya notices that the app continually highlights new merchant offers in her neighborhood and she finds a “L$ Deal” at a hair salon (shampoo and cut for $30.00 and L$30.00 for new customers). She meets some of her volunteer friends at a restaurant where their $80.00 tab is $55.00 and L$25.00 (tax and tip in cash). Sonya also donates L$20.00 to a teen group raising money for a local sports team. Spending L$ help her save cash on every day purchases and support her favorite causes from the savings.
\nThe system can also incorporate a feature to help close social and economic disparities without resorting to tax dollars. A bit like rounding-up for a cause or paying-it-forward at the drive-through, economically well-off participants voluntarily pay further up the US dollar side of Dual Currency transactions, making it possible for economically disadvantaged participants to transact in fewer dollars and more Ledger Dollars. For example: on a $20.00 meal that was priced at $12.00 and L$8.00, a more financially well-off person can voluntarily pay $18.00 cash and L$ 2.00 (or tithe and pay $22.00), which would allow a lower-income person, to pay $6.00 cash and L$ 14.00 for their $20.00 meal. In both cases, merchants gets the dollars that they contracted for, but unlike when everyone pays the same price, some people voluntarily pay with more cash allowing others to pay with more Ledger Dollars. This is a market-based, people-helping-people model that could grow up and reduce the need for so many tax-funded government programs.
\nOne use of currently wasted wealth is intended to increase employee compensation without raising cash labor costs for employers. The process improves employee wages and benefits by utilizing empty restaurant tables, off-hours at fitness clubs, excess retail inventory, and so on. Instead of downsizing companies to match money-based demand in the market, it raises people’s purchasing power up to the level of available business capacity.
\nMany employers know how to use a portion of their excess capacity as a perk or a benefit for their own employees. Employees who work for an airline enjoy free or discounted flights. Those who work at universities generally enjoy free or discounted classes. Fitness club employees enjoy free or discounted memberships, while restaurant employees enjoy free or discounted food. This is true across the private sector, as well as in the public sector (public universities) and the nonprofit sector (YM/YWCAs). It is noteworthy that if businesses operated at full-capacity, with 100 percent cash customers, this common form of employee benefits would not exist, confirming the existence of underutilized business capacity.
\nLedger economics makes the excess capacity of employers available to all employees as a perk or benefit for working within a network of cooperating businesses, government agencies and nonprofit organizations. Imagine the pooling of all this excess capacity into a “virtual community warehouse” for sustainable economic development, accessed not only by employees, but also by all those earning rewards within the community.
\nThe warehouse would be virtual because none of the products need to be purchased in advance or stored somewhere special, as with traditional bricks-and-mortar retail. Instead, they remain where they are normally produced and sold—at the airlines, the university, the fitness club or the restaurant. This system simply captures currently underutilized business capacity to offer people new purchasing power, to attract more customers, and to give communities new economic resources.
\nThe free-enterprise system manages excessive competition, easily and without government regulation, by setting needed standards across any given industry. Capitalist countries have yet to apply this principle to proliferation of competitive duplication within the economy, whether at the local, state or national levels. Why set industry standards? Consider how impractical it would be if there were 15 different types of electrical outlets to accommodate 15 different styles of electrical plugs on consumer products. To avoid this mess, an industry standard is set to which all manufacturers of both electrical outlets and consumer products adhere. The same is true of Internet Protocol on the World Wide Web, which did not require government regulation, but instead grew out of collaborative development and agreed upon design principles.
\nThe virtual warehouse would work in the same way. The participating merchants would establish a standard that everyone would agree to follow as part of the mobile app, with instructions to participating customers and sponsors on how to access the excess capacity and how to document the community hours that volunteers have donated in exchange for additional recovery dollars. When everyone has something to gain from a system, the participants involved in it have a strong incentive to agree on an industry standard so that all can benefit.
\nWill people have to pay income taxes on the Ledger Dollars they receive as a dividend or earn through their community work? While it is not possible to know the answer ahead of a formal ruling, there are useful precedents. Since the merchant is simply taking less cash and not keeping and spending a circulating currency, then Ledger Dollars are clearly not a barter dollar. Barter dollars are considered commercial in nature and taxable (with taxes due in US dollars). This system operates, instead, like a universal employee discount network, and discounts are not taxable income.
\nLedger Dollars are similar to the discounts that employees enjoy from their own employers’ excess capacity: discount flights for airline employees, discount classes for university employees, discount meals for restaurant employees, etc. And by awarding Ledger Dollars to volunteers and others, participating employees and non-employees benefit from discounts at businesses everywhere in the network. A third precedent is a community currency know as Time Dollars [10]. Time Dollars are a people-helping-people, noncommercial, community economic development currency, and they are not taxable as income. There was a ruling many years ago by the Minnesota Department of Revenue that state welfare recipients who earned Community Service Dollars (a predecessor currency) through volunteerism would not have their welfare benefits reduced, which is one more positive precedent.
\nWhile cryptocurrencies are taxable if there are capital gains from the sale of an investment in crypto, Ledger Dollars, taken off the books as soon as they are redeemed, is not an investable or speculative instrument, which is yet another reason why Ledger Dollars might not be taxed as income. Ultimately the issue is not whether this second currency will be taxable, but rather how much can this system upgrade the economy and help to create a universally high quality of life. A mature system could fund many of the community economic development needs that taxes are used for today, with the idea that an ever-more efficient economy will result in less need for government services paid for through taxation.
\nThe factors of wealth production are all at hand and continuously improving: technology, global infrastructure; human knowledge and creativity, innovative business models, access to the earth’s free and abundant renewable resources. Yet large numbers of people in the US and around the world still face a low and/or deteriorating quality of life. This can be seen in poverty and widespread economic insecurity, poor public health and safety, workplace stress, social and economic disparities, crime, addictions, youth at risk, pollution, and so forth… all of it based on an outdated paradigm of economic scarcity. We can immediately begin to move beyond all of these age-old problems by recognizing the enormous amount of untapped wealth that exists in the world and leveraging it to everyone’s advantage. Once we see that we are drowning in wealth, while searching for money (our own invention), we can begin to create more sensible and sustainable economies the world over.
\nIf, in fact, our inherited framework for economics—scarce resources and unlimited wants and needs—is outdated, then so, perhaps, are other theoretical and practical inheritances from that earlier era where that framework came from. Today’s cultural obsession with blaming the rich, the poor, the right, the left, the military, foreign competition and the like prevents thoughtful and intelligent discourse toward new solutions. A common vision of Continuous Economic Improvement for all can transcend the current left-versus-right polarization and the tendency to blame anyone, when in fact this inherited system is overdue for a 21st Century update.
\nLedger economics can help us call a truce between the political left and right and the stalemate that prevents innovative solutions from emerging. For Conservatives and Libertarians, ledger economics is completely voluntary and self-funded, as well as business-led, market-based, and profit-driven. For Liberals and Socialists, it offers immediate rather than trickle down benefits and environmentally sustainable rather than growth-based commerce, while closing rather than increasing disparities. By combining this new financial resource with a mobilization of business-community stakeholders, we can end the blame and create a dual-currency, ledger-based, equitable-and-sustainable economy, based on continuous economic improvement [11].
\n\nEconomics and Politics beyond Left–Right-Compromise\n | \n|
---|---|
\nFor Conservatives and Libertarians\n | \n\nFor Liberals, socialists and greens\n | \n
\n100% voluntary: No forced participation by government or other authorities; breaks no rules of free enterprise economics | \n\nImmediate not trickle down: the available underutilized business community resources | \n
\n100% self-funding: no need for higher taxes or deeper debt to raise everyone up with the engine of dual currency efficiency | \n\nEquitable: closing disparities through the mobilization of massive underutilized productive capacity is rapid and inexpensive rather than attempting to close disparities with ever elusive fiat resources | \n
\nBusiness-led, market-based and profit-driven: Dual Currency Commerce is purely a social entrepreneurial business innovation entering the market making use of new technologies to create greater efficiencies | \n\nEcologically sustainable: there is no need for traditional growth when the world is already overbuilt to meet all need across the planet. For example, short-term, food is an abundant renewable resource and global agribusiness wants more customers. This is purely a matter of money and will; not at all about skills, infrastructure, lack of demand, etc. Long-term, we can make communities everywhere self-sustaining and interdependent through shared technologies and sustainability best practices. | \n
\nFor everyone\n \nMass Customization: There is no need to fight and suffer over who gets their way regarding controversial issues. The Internet demonstrates that in the high-tech era, a shared platform can also allow everyone to pursue their own interests. In the same way that porn-blocker can be applied to a phone, a computer, or a television, communities of common values can voluntarily choose to participate in customized economies that are “for or against” abortions, drugs; marriage equality; guns; vegan lifestyles; prostitution, and so forth. Why? Because akin to the Internet, if you are willing to follow the protocol to get on, you can do what you want whether it is: e-commerce; pornography; charitable fundraising; art; sports; pro or against environmentalism, free speech, etc. | \n
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