Internal Anatomy of Pulp cavity

1. INTERNAL
ANATOMY OF PULP
• Presented by
• Dr. Arshad Mohammed A
• II year Pg

2. INTRODUCTION
The knowledge of
common root canal
morphology and
its
frequent
variations is a basic
requirement for
success during
root canal
procedures.

3. DEFINITION
CLASSIFICATION OF ROOT CANAL MORPHOLOGY
ISTHMUS
CLASSIFICATION OF C-SHAPED CANALS
METHODS OF DETERMINING PULP ANATOMY
FACTORS AFFECTING INTERNAL ANATOMY
ANATOMY OF PULP CAVITY OF MAXILLARY & MANDIBULAR TEETH
CLINICAL SIGNIFICANCE
CONCLUSION

4. PULP CAVITY

6. CLASSIFICATION

7. VERTUCCI’S CLASSIFIACTION

8. SERT AND BAYIRIL CLASSIFICATION

9. Gulabivala
supplemental
canal
configurations

10. Weine
classification

11. Walker classification

12. ISTHMUS

13. “A narrow passage or anatomic part connecting two
larger structures (root canals) “
-Identified using METHYLENE BLUE DYE
-Contains pulp or pulpally derived tissue and acts as
store house for bacteria
-Identification and treatment of isthumi are vital to success of
surgical procedure
-Investigators identified 5 types of isthumi that can be found on
a beveled root surface

14. CLASSIFICATION
OF ISTHUMI
Kim et al
1
Yeung Yi Hsu
2

15. Kim et al

16. Yeung Yi Hsu

17. CLASSIFICATION OF C-SHAPED CANALS

18. Melton’s classification

19. FAN’S CLASSIFICATION

20. METHODS OF DETERMINING PULP ANATOMY

21. 1. Clinical methods:
• a. Anatomic studies
• b. Radiographs
• c. Exploration
• d. Visualization endogram
• e. Fiberoptic endoscope
• f. Magnetic resonance imaging (MRI)
• g. Dental operating microscope

22. • a. Clearing study
• b. Scanning electron microscope (SEM)
• c. Sectioning
• d. Microcomputed tomography
• e. Cone beam computed tomography (CBCT)
2. In vitro methods:

23. ANATOMIC STUDIES
The knowledge of anatomy gained from various studies and books
is commonly used method.
RADIOGRAPHS
They are also useful in assessing the root canal anatomy.
Since , it is a two dimensional picture of three dimensional object ,
one has to analyse the radiograph carefully.

24. HIGH RESOLUTION COMPUTED TOMOGRAPHY
It shows three- dimensionl picture of root canal system using computer
image processing.
FIBER OPTIC ENDOSCOPE
It is used to visualize canal anatomy. It is a new method of magnified intra
canal visualization using fibro-optic endoscopes (orascope) or rod lens
endoscopes.
VISUALIZATION ENDOGRAM
In this technique , an irrigant is used which helps in visualization of the
canals on radiograph. This solution is called Ruddle’s solution. After
injecting this solution into canal system ,radiograph is taken to visualize
the canal anatomy.

26. MAGNETIC RESAONANCE IMAGING
It produces data on computer which helps in knowing canal
morphology.
EXPLORATION
On reaching pulpal floor one finds the grooves and anatomic dark
lines which connect the canal orifices , this is called dentinal map.

27. SECTIONING
In this, teeth are sectioned longitudinally for visualization of root
canal system.

28. CLEARING OF ROOTS
In this roots are initially decalcified using either 5 percent nitric
acid or 10 percent hydrochloric acid and then dehydrated using
different concentrations of alcohols and immersed in different
clearing agents like methyl salicylate or xylene.
By this treatment , tooth becomes transparent , then a dyes is
injected and anatomy is visualized.

29. HYPAQUE/CONTRASTING MEDIA
It is iodine containing media which is injected into root canal
space and visualized on radiograph.
SCANNING ELECTRON MICROSCOPIC (SEM) ANALYSIS
It also helps in evaluating root canal anatomy

30. FACTORS AFFECTING INTERNAL ANATOMY

31. Internal anatomy of teeth ,reflects the tooth form ,yet various
environmental factors whether physiological or pathological affect its
shape and size because of pulpal and dentinal reaction to them.
• AGE
• IRRITANTS
• CALCIFICATIONS
• RESORPTION

32. AGE
With advancing age , there is continued dentin formation causing
regression in shape and size of pulp cavity. Clinically it may pose
problems in locating the pulp chamber and canals.
IRRITANTS
Various irritants like caries, periodontal disease , attrition, abrasion,
erosion, cavity preparation and other operative procedures may
stimulate dentin formation at the base of tubules resulting in change
in shape of pulp cavity.

33. CALCIFICATIONS
pulp stones or diffuse calcifications are usually present in chamber and
the radicular pulp. These alter the internal anatomy of teeth and may
make the process of canal location difficult.
RESORPTION
Chronic inflammation or for unknown cause internal resorption may
result in change of shape of pulp cavity making the treatment of such
teeth challenging.

34. VARIATIONS IN INTERNAL ANATOMY

35. Variation in shape
 Gradual curve
 Apical curve
 C-shaped
 Bayonet shaped
 Sickle shaped

36. Variations because of pathology
 Pulp stones
 Internal resorption
 External resorption

37. Variations in apical third
 Different position of apical foramen
 Open apex
 Lateral and accessory canals

38. Variations in development
 Gemination
 Fusion
 Concrescence
 Taurodontism
 Talon’s cusp
 Dilaceration
 Extra root canal
 Dens invaginatus
 Dens evaginatus

39. Variations in size of root
• MACRODONTIA
In this condition , pulp space and teeth are enlarged throughout
the dentition .
• MICRODONTIA
In this condition , pulp space and teeth appear smaller in size .

40. ANATOMY OF PULP CAVITY OF MAXILLARY
TEETH

41. MAXILLARY CENTRAL
INCISOR

42. PULP CHAMBER:
• The pulp chamber of the maxillary central incisor is located in
the centre of the crown equidistant from the dentinal walls
• The pulp chamber usually follows the contours of the crown and
has three pulp horns.
• It is broad mesiodistally than buccolingually, with its broadest part
incisally

43. ROOT CANAL
• Central incisor has one root with one canal.
• Coronally the root canal is wider buccopalatally.
• Lateral canals may be present (24% ) usually in the apical third.
• Most of the time canal is found to be straight

44. Maxillary lateral
incisor

45. PULP CHAMBER
• The shape of the pulp chamber of the maxillary lateral incisor
is similar to that of the maxillary central incisor but smaller.
• It has two pulp horns, corresponding to the developmental
mammelons.
• It is broad mesiodistally, with its broadest part incisally.
• The incisal outline of the pulp chamber tends to be more
rounded.

46. ROOT CANAL
• Root canal has finer diameter than that of central incisor
though the shape is similar to that.
• Labiopalatally the canal is wider.
• Canal is ovoid labiopalatally in cervical third, ovoid in the
middle third and round in apical third.
• Apical region of the canal is usually curved
in a palatal direction.

47. MAXILLARY CANINE

48. PULP CHAMBER
• The pulp chambers of the maxillary cuspids are the largest of any
single-rooted teeth.
• Labiopalatally, the chamber is triangular in shape, with the apex
pointed incisally.
• Mesiodistally it is narrow.
• In cross section, the chamber is ovoid in shape, with the greater
diameter labiopalatally.
• One pulp horn is present, corresponding to one cusp.
• The external access outline form is oval or slot shaped because no
mesial or distal pulps horns are present

49. ROOT CANAL
• There is single root canal which is wider labiopalatally
than in mesiodistal aspect.
• Cross section at cervical and middle third show its oval
shape, at apex it becomes circular.
• Canal is usually straight but may show a distal apical
curvature.

50. MAXILLARY FIRST
PREMOLAR

51. PULP CHAMBER
• The pulp chamber is wider buccopalatally with two pulp horns, one
under each cusp.
• The buccal pulp horn is more prominent than the palatal.
• The floor of the pulp chamber is convex, usually with two canal
orifices, Palatal orifice is larger and is kidney shaped.
• In cross section, the pulp chamber is wide and ovoid in a
buccopalatal dimension.
• Roof of the pulp chamber is coronal to the cervical line.

52. ROOT CANAL
• Most commonly two roots and two root canals (buccal &
palatal), three canals can also occur rarely(palatal, mesiobuccal &
distobuccal)
• The palatal canal is generally the larger of the 2 canals.
• Buccal canal is directly under the buccal cusp and palatal canal
under the palatal cusp.
• The root canals are usually straight and divergent.

53. MAXILLARY SECOND
PREMOLAR

54. PULP CHAMBER
• It is wider buccopalatally than the maxillary first premolar. It
also has two pulp horns and is narrow mesiodistally.
• The buccal pulp horn is larger.
• In cross section, the pulp chamber has a narrow, ovoid shape.

55. ROOT CANAL
• In cross section, the canals in the cervical third are ovoid and
narrow In the middle third, when 1 canal is present it is
ovoid,and when 2 canals are present they are round; in the
apical third, the cross section is round regardless of whether 1
or 2 canals are present.
• Lateral canals are present in 59.5% of cases; 1.6% occur in the
furcation area.
• Canal is wider buccopalatally forming ribbon like shape.

56. MAXILLARY FIRST
MOLAR

57. PULP CHAMBER
• largest in the dental arch, with four pulp horns.
• The arrangement of the four pulp horns gives the pulp roof a
rhomboidal shape in cross section.

58. ROOT CANAL
• Maxillary first molar has generally three roots with three canals.
• Two canals in mesiobuccal root are closely interconnected and
sometimes merge into one canal.
• The palatal root is the longest and has the largest diameter. It
contains mostly only one canal, though two or three root
canals can also occur. From its orifice the palatal canal is flat,
ribbon like, and wider in a mesiodistal direction.
• The distobuccal root is conical and may have one or two canals.

59. MAXILLARY SECOND
MOLAR

60. PULP CHAMBER
• It is similar to that of the maxillary first molar, except it is
narrow mesiodistally.
• Roof of pulp chamber is more rhomboidal in cross-section and
floor is an obtuse triangle.

61. ROOT CANAL
• Similar to first molar except that in maxillary second molar
roots tend to be less divergent and may be fused.
• Fewer lateral canals are present in roots and furcation area
than in first molar.

62. MAXILLARY IIIrd
MOLAR

63. PULP CHAMBER
• Anatomically resembles the second molar.
• The pulp chamber can be similar to that of the maxillary second
molar with three canal orifices, but it may also have an odd-shaped
chamber with four or five root canal orifices or a conical chamber
with only one root canal.

64. ROOT CANAL
• The maxillary third molar may have three well- developed roots that
are closely grouped.
• It may also have fused roots, one conical root, or four or more
independent roots.
• The roots may be straight, curved, or dilacerated, and may be fully
or partially developed.
• Root canals vary from one to four or even five in number, depending
on the number of roots.
• One may find a “C-shaped” pulp chamber with a “C-shaped” root
canal.

65. ANATOMY OF PULP CAVITY OF MANDIBULAR
TEETH

66. MANDIBULAR INCISOR

67. PULP CHAMBER
• Smallest tooth in the arch.
• The pulp chamber is small and flat mesiodistally

68. ROOT CANAL
• One root.
• Which is flat and narrow mesiodistally but wide labiolingually.
• The root is straight in 60% of cases. The canal configuration varies from.
• One canal exiting in one apical foramen, as in 70% of these teeth.
• One canal bifurcating into two canals, coming together, and exiting into one
apical foramen (22%)

69. MANDIBULAR LATERAL
INCISOR

70. PULP CHAMBER
• The configuration of the pulp chamber of the mandibular lateral
incisor is similar to that of the mandibular central incisor, but the
lateral incisor has larger dimensions.

71. ROOT CANAL
• Larger than that of the mandibular central incisor,
• Distal curve of the lateral incisors is sharper.

72. MANDIBULAR CANINE

73. PULP CHAMBER
• Resembles the maxillary canine, but it is smaller in all dimensions.
• The pulp chamber is narrow mesiodistally.

74. ROOT CANAL
• Although the tooth usually has a single root, it may have two (2.3%).
• Most of these teeth have a straight root (68%), but some have distal
curvatures (20%).
• The mandibular canine usually has one canal exiting in one apical
foramen (78%).

75. MANDIBULAR Ist
PREMOLAR

76. PULP CHAMBER
• The mesiodistal width of the pulp chamber is narrow.
• Buccolingually, the pulp chamber is wide, with a prominent buccal
pulp horn that extends under a well-developed buccal cusp.

77. ROOT CANAL
• Usually has a short, conical root.
• This root may divide in the apical third into two or three roots.
• The root is usually straight (48%), but some roots curve distally (35%).
• One canal and one foramen are present in 70% of cases.
• One canal bifurcates into two canals and exits in two foramina in 24% of
cases.
• Two canals exit in two foramina in 1.5% of cases.
• One canal bifurcates into two canals uniting into one canal in the apical
third and then exiting in one foramen in 4% of cases.
• Three canals exit in three foramina in 0.5% of cases.

78. MANDIBULAR IInd
PREMOLAR

79. PULP CHAMBER
Similar to the mandibular first premolar, except that the lingual horn is
more prominent under a well-developed lingual cusp.

80. ROOT CANAL
• Usually has a single root, but on rare occasions two to three roots are
present.
• The root of the mandibular second premolar may curve distally (40%),
although in 39% of cases it is straight.

81. MANDIBULAR Ist
MOLAR

82. PULP CHAMBER
• The roof of the pulp chamber of the mandibular first molar is often
rectangular in shape.
• The mesial wall is straight, the distal wall round, and the buccal and
lingual walls converge to meet the mesial and distal walls and form
a rhomboidal floor. The roof of the pulp chamber has four pulp
horns: mesiobuccal, mesiolingual, distobuccal, and distolingual.

83. ROOT CANAL
• Usually, two well-differentiated roots are present in the mandibular first
molar, one mesial and one distal.
• Both roots are wide and flat buccolingually, with a depression in the
middle of the root buccolingually.

84. MANDIBULAR IInd
MOLAR

85. PULP CHAMBER
• Smaller than that of the mandibular first molar, and the root canal
orifices are smaller and closer together.

86. ROOT CANAL
• The majority of the mandibular second molars have two roots (71%),
but teeth with one root (27%) and teeth with three roots (2%) are also
seen.

87. MANDIBULAR IIIrd
MOLAR

88. PULP CHAMBER
• Anatomically resembles the pulp chamber of the mandibular first and
second molars.
• It is large and possesses many anomalous configurations such as C-
shaped root canal orifices.

89. ROOT CANAL
• The mandibular third molar usually has two roots and two canals, but
occasionally one root and one canal or three roots and three canals.
The root canals are generally large and short.

90. Conclusion
A thorough knowledge of the root canal anatomy, careful
interpretation of radiographs, and adequate access to exploration of
the tooth’s interiors are the prerequisites for a successful endodontic
treatment.
With recent advances, studying the pulp morphology has become
much more efficient. The clinician must be aware of the latest
developments so that he/she can render quality treatment to the
patient.

91. REFERENCES
Grossman’s ENDODONTIC PRACTICE-13th Edition
Cohen’s PATHAWAYS of the PULP-11th Edition
Determination of the internal anatomy of a permanent dentition: A review
{International Journal of Contemporary Dental and Medical Reviews (2015)}
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