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Root Canal Morphology & Access Preparation

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Root Canal Morphology & Access Preparation

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Root Canal Morphology & Access Preparation

  1. 1. Dr. Nithin Mathew Root Canal Morphology & Access Cavity Preparation
  2. 2. CONTENTS • Introduction • Root canal system • Classification • Guidelines for cavity preparation • Principles of Endodontic cavity preparation • Anomalies to Pulp Cavity • Root Morphology and Access Cavity preparation of Each tooth • Conclusion • References 3 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  3. 3. INTRODUCTION • Major factors for development of pulpal and periradicular diseases: • Loss of integrity of coronal tooth substance • Entry of microorganisms into the dentin and pulpal space • Aim of Root canal treatment: • Chemomechanical removal of microorganisms, their substrate and products from the dentin and pulp space. • 3D obliteration and sealing of the pulp space to prevent bacterial contamination. 4 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  4. 4. • One must have a thorough understanding of the tooth anatomy, an essential prerequisite to achieve the objectives of access preparation through cleaning, disinfection and obturation of the pulp space. • Problems encountered during the treatment occur because of inadequate understanding of the pulp space anatomy. • Clinician must familiarize himself with the irregularities, complexities and aberrations which are likely to occur within the pulp space. 5 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  5. 5. OBJECTIVES OF RCT 6 Mechanical Objectives Biologic Objectives • Prepare a sound anatomical matrix • Create a continuously tapering funnel shaped preparation • Avoid overzealous instrumentation • Precurve files when necessary • Remove all residues from the canal • Maintain patency through the apical foramen • Establish an exact working length • Confine instrumentation to canal • Remove all irritants from the canal • Avoid pushing debris past the apical constriction • Create a significant width in the coronal half of the canal to allow for copious irrigation Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  6. 6. ROOT CANAL SYSTEM • The entire space in the dentin where the pulp is housed - Cohen 7 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  7. 7. PULP CHAMBER • Roof of pulp chamber • Dentin covering the pulp chamber occlusally or incisally. • Pulp horn • Accentuation of the roof of the pulp chamber directly under a cusp or developmental lobe. • Floor of pulp chamber • Runs parallel to the roof and consists of dentin bounding the pulp chamber near the cervical area of the tooth. • Canal orifices • Openings in the floor of pulp chamber leading in to root canals 8 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  8. 8. ANATOMY OF THE APICAL ROOT (Kuttlers) 1. The Apical constriction 2. The Cementodentinal junction 3. The Apical Foramen 9 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  9. 9. • Part of the root canal with the smallest diameter • Reference point for apical termination • Distance ranges from 0.5mm -1.5mm inside the apical foramen Apical Constriction (Minor Apical Diameter) 10 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  10. 10. Cementodentinal Junction • Point in the canal where cementum meets dentin • Approximately 1mm from the apical foramen 11 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  11. 11. Apical Foramen (Major Apical Diameter) • Differentiate the terminal of cemental canal from the exterior surface of the tooth. • Rounded edge like a funnel / crater • Not necessarily always at the centre of root apex • Average 0.4 – 0.7 mm away from the anatomic apex 12 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  12. 12. • Space between major and minor apical diameter - FUNNEL SHAPED, HYPERBOLIC or having the shape of a MORNING GLORY • Mean distance between major and minor diameter: • 0.5mm in young individual • 0.67mm in older individual 13 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  13. 13. • Apical third : highest percentage of ramifications and accesory canals. • These ramifications and accesory canals were increasingly eliminated by • 1mm root end resection - 52% • 2mm root end resection - 78% • 3mm root end resection - 98% • Reason for removing the apical 3mm during apicoectomy. - Cohen 14 • Apical Delta : • Describes the primary or secondary canal that terminates short of the apex with lateral canals fanning out from this point to the end of root surface. Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  14. 14. Complexity of Apical Root • After the tooth erupts the HERS is still active in the formation of the root. • Occlusal loading at this stage can cause a discontinuity of this sheath which results in the formation of accessory foramen and lateral canals. • Mesial migration of the tooth due to loading is the reason for the curvatures at the apex - dilacerations • After the formation of the roots are complete the location of the apical foramen and the apical anatomy keeps changing constantly because of continuous cementum apposition. 15 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  15. 15. Accessory Canals • Minute canals that extend in a horizontal, vertical, or lateral direction from the pulp to the periodontium. • 73.5% - apical third • 11.4% - middle third • 15.1% - cervical third. - Cohen • Contain connective tissue and vessels but do not supply the pulp with collateral circulation. • Formed by the entrapment of periodontal vessels in Hertwig's epithelial root sheath during calcification. - Grossman 16 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  16. 16. Lateral Canals • An accessory canal that branches to the lateral surface of the root. • Opening of accessory and lateral canals in the root surface. 17 Accessory Foramena Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  17. 17. • There are always two apices recognized for any tooth: • Radiographic Apex • Anatomic Apex • Radiographic Apex: • It is the external border of the root tip which is seen radiographically. • Anatomic Apex: • Natural apical constriction formed by the cemento- enamel junction 18 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  18. 18. Course of Root Canals 19 Curved root canals with apical foramen distant from the apex Curved root canals with apical foramen near the apex Constricted root canal as the apical foramen is approached Double curvature of root canal with the foramen at a distance from the root apex Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  19. 19. Shape of the Canals - Torabineajad • Six different shapes have been noted • Round • Oval • Deep oval • Bowling pin • Kidney bean • Hour glass 20 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  20. 20. Classification of Endodontic Treatment based on the degree of difficulty - Ingle • Type I Insignificant curvature of root canal • Type II Anatomic problems like severe dilaceration, complex apical region with divergence of canal, with numerous foramina • Type III Open foramen, incomplete root formation • Type IV Decidous teeth, resorption of root tip 21 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  21. 21. Canal Isthmus • Narrow, ribbon-shaped communication between two root canals that contains pulp or pulpally derived tissue. • It was found that the percentage of occurrence of isthmus increases continuously for every 1mm from the apex for the first 4mm. 22 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  22. 22. Types • Type I Incomplete isthmus; faint communication between two canals. • Type II Characterized by two canals with definite connection between them. • Type III Very short complete isthmus between two canals. 23 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  23. 23. • Type IV Complete or incomplete isthmus between two or more canals. • Type V Marked by two or three canal openings without visible connections 24 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  24. 24. According to Melton et al (1991) Category 1 : Continuous C-shaped canal from pulp chamber to apex Category 2 : One canal was separated by dentin from the C-shaped canal(semi colon) Category 3 : C-shaped orifice with 2 or more distinct and separate canals 25 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  25. 25. According to Hsu & Kim • Type I Two or three canals with no notable communication between them • Type II Two canals with definite communication • Type III Differs from Type II due to presence of three canals instead of two. Incomplete C shaped canals with 3 canals included 26 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  26. 26. • Type IV Canals extending to isthmus area • Type V True connection or corridor throughout section 27 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  27. 27. CLASSIFICATION OF ROOT CANAL SYSTEM Dr. Nithin Mathew - Root Canal Morphology & Access Preparation 28
  28. 28. According to Weine 29 Type I Type II Type III Type IV Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  29. 29. According to Vertucci 30 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  30. 30. According to Gulabiwala 31 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  31. 31. Root Canal Curvatures SCHNEIDER‘s classification on the basis of degree of curvature Straight• : 5 ̊ or less Moderate• : 10° - 20° Severe• : 25° - 70 ̊ 32 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  32. 32. Guidelines for Cavity Preparation • CEJ is the most important anatomical landmark for determining the location of pulp chamber and root canal orifices – Krasner & Rankow • Laws of Pulp Chamber Anatomy: • First law of symmetry • Second law of symmetry • Law of color change • First law of orifice location • Second law of orifice location • Third law of orifice location 33 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  33. 33. Laws of Pulp Chamber Anatomy – Krasner & Rankow First• law of symmetry Except• for maxillary molars, orifices of the canals are equidistant from a line drawn in a mesio-distal direction through the floor of the pulp chamber. Second• law of symmetry Except• for maxillary molars, orifices of the canals lie on a line perpendicular to to a line drawn in a mesiodistal direction across the center of the floor of the pulp chamber 34 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  34. 34. Laws of Pulp Chamber Anatomy • Law of color change • Color of the pulp chamber floor is always darker than the walls 35 • First law of orifice location • Orifices are always located at the junction of the walls and the floor. Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  35. 35. Laws of Pulp Chamber Anatomy • Second law of orifice location • Orifices are located at the angles of the wall-floor junction. 36 • Third law of orifice location • Orifices are located at the terminus of the root developmental fusion lines. Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  36. 36. Laws of Pulp Chamber Anatomy • Law of CEJ • Distance from external surface of clinical crown to the wall of pulp chamber is same throughout the circumference of the tooth at the level of CEJ. 37 Law• of Concentricity External• root surface anatomy reflects the internal pulp chamber anatomy Law• of Centrality floor• of pulp chamber always located in the centre of tooth at the level of CEJ. Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  37. 37. • Champagne Bubble Test • Use of sodium hypochlorite in the pulp chamber to check for bubbles 38 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  38. 38. 39 Tests• For Locating Canals Vital• cases bleed - blood can be visualized as a small droplet above an orifice or a "RED LINE" within a groove that emanates off an orifice / system. Additionally,• a spot of blood on the side of a paper point that is placed within a shaped canal may suggest a LATERAL CANAL or the entrance to a deeply branching system. In• necrotic cases, a "WHITE LINE" can be visualized as the clinician troughs along a groove. Eg• : Following a white line off the MB1 system towards the palatal often times leads to the MB2 orifice / canal system. Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  39. 39. Objectives of Access Cavity Preparation 40 I. To remove all caries II. To conserve sound tooth structure III. To completely deroof the pulp chamber IV. To remove all coronal pulp tissue (vital or necrotic) V. To locate all root canal orifices VI. To achieve straight- or direct-line access to the apical foramen or to the initial curvature of the canal VII. To establish restorative margins to minimize marginal leakage of the restored tooth Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  40. 40. Principals of Endodontic Cavity Preparation 41 Coronal Cavity Preparation Radicular Cavity Preparation I. Outline Form II. Convenience Form III. Removal of remaining carious dentin IV. Toilet of cavity I. Outline & Convenience Form II. Toilet of Cavity III. Retention Form IV. Resistance Form Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  41. 41. PRINCIPLE I – Outline Form • Must be correctly shaped and positioned to establish complete access for instrumentation from the cavity margin to apical foramen. • To achieve the optimal preparation, the following factors of internal anatomy must be considered i. Size of the pulp chamber ii. Shape of the pulp chamber iii. Number of individual root canals, their curvature and position. 43 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  42. 42. Size of the pulp chamber Young• patients – more extensive than older patients Quite• apparent while preparing anterior tooth in youngsters, whose large root canals require larger instruments. 44 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  43. 43. Shape of the pulp chamber • Finished outline form should accurately reflect the shape of the pulp chamber. • Eg: floor of pulp chamber in maxillary molar is triangular in shape • This shape is extended outwards occlusally to the surface, hence final occlusal cavity outline form is generally triangular 45 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  44. 44. Number, Position and Curvature of root canals To• prepare each canal efficiently without interference, cavity walls must be extended to allow an unstrained instrument approach. Often• cavity walls have to be extended to improve instrumentation. Hence,• outline form in materially affected. This• change is for convenience in preparation hence, convenience form partly regulates the ultimate outline form. 46 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  45. 45. PRINCIPLE II – Convenience Form • Convenience form in endodontics makes more convenient and accurate preparation and filling of the root canal. • 4 important benefits gained through convenience form modification are i. Unobstructed access to the canal orifice ii. Direct access to apical foramen iii. Cavity expansion to accommodate filling technique iv. Complete authority over the enlarging instrument. 47 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  46. 46. i. Unobstructed access to the canal orifice Enough• tooth structure must be removed to allow instrument to be placed easily into the orifice of each canal without interference from the overhanging walls. 48 • Failure to observe this principle not only endangers the successful outcome of the case, but also adds materially to the duration of the treatment. • But precautions must be followed in case of certain tooth like mandibular incisors. Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  47. 47. • Leubke said that an entire wall need not be extended in case of a severely curved canal to prevent instrument impringment or to access an extra canal. • Here only that area of the wall need to be prepared to free the instrument. • Finally a cloverleaf appearance of the outline form. • Hence, Leubke has termed it as “SHAMROCK PREPARATION”. 49 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  48. 48. ii. Direct access to Apical Foramen Enough• tooth structure must be removed to allow the instruments freedom within the coronal cavity. 50 • So that they extend down into the canal in an unstrained positioned. • This is true when the canal is severely curved or when the canal leaves the chamber at an obtuse angle Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  49. 49. iii. Extension to accommodate filling techniques • Often necessary to expand outline form to make certain filling techniques more convenient or practical. • Eg: Thermoplastic obturation techniques requires use of heavy instruments, hence outline form must be widely extended to accommodate them. 51 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  50. 50. iv. Complete Authority over enlarging instrument • Failure to properly modify the access cavity outline by extending the convenience form will ultimately lead to failure by either • Root perforation • Ledge or shelf formation within the canal • Instrument breakage • Incorrect shape of completed canal preparation • Apical transporation 52 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  51. 51. PRINCIPLE III – Removal of remaining carious dentin & defective restorations I. To eliminate mechanically as many bacteria as possible from the interior of the tooth. II. To eliminate discoloured tooth structure that may ultimately lead to staining of the crown. III. To eliminate the possibly of any bacteria laden saliva leaking into the prepared cavity. • After the caries is removed, if carious perforation of the wall is allowing salivary leakage, the area must be repaired with cement, preferably from inside the cavity. 53 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  52. 52. If• caries is soo extensive, that the lateral walls are destroyed, or if a defective restoration is in place, then entire wall is removed and later restored. Restoration• is postponed until the radicular preparation is completed since it is much easier to complete radicular preparation through an open cavity than through a restored crown. 54 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  53. 53. PRINCIPLE IV – Toilet of Cavity • All caries, debris & necrotic material must be removed from the chamber before the radicular preparations begins. • If calcified / metallic debris is left in the chamber & carried to the canal, it may act as obstruction. • Soft debris carried to the canal might increase the bacterial population in the canal. • Coronal debris may also stain the crown (anteriors) • Toilet of the cavity makes a significant portion of the radicular preparation 55 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  54. 54. Instruments used in Access Preparation BURS• No• . 2, 4 & 6 round burs Fissure• / carbide burs for axial wall extension EndoAccess• burs Combination• of round and tapered fissured bur For• preparation of pulp chamber & flaring of walls 56 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  55. 55. • BURS • Endo Z bur • Long tapered • Create funnel shape for easier access to chamber • Round non cutting safe ended tip • Gates Glidden Drills 57 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  56. 56. • Endodontic Explorer • DG-16 • To identify canal orifices • To determine canal angulation • CK-17 • To identify calcified canals • Endodontic spoon excavator 58 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  57. 57. • # 17 Operative Explorer • Detecting any remaining pulp chamber roof, particularly in the area of pulp horn • Ultrasonic Unit & Tips • Used to trough & deepen developmental grooves to remove tissues & explore for canals • BUC tips (1-3) 59 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  58. 58. Anomalies of Pulp Cavity • Dentinogeneis Imperfecta • Pulp cavities may be small or even obliterated • Hyperparathyroidism • Cause pulp calcification and loss of lamina dura • Hypofunction of Pituitary Gland • Lead to retarded eruption of teeth and to open apices 60 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  59. 59. Dentinal• dysplasia Obliteration of pulp chamber and defective root formation Taurodontism• Short root and larger than normal pulp chamber Dens• Invaginatus  Malformation due to an invagination of enamel epitelium resulting in a chanel or lumen surrounded by hard tissues within the tooth.  Frequently occurs in the palatal surface of max. lateral incisor 61 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  60. 60. • Dens Evaginatus  Is an extra cusp, usually in the central groove or ridge of a posterior teeth and in the cingulum of the central or lateral incisor • Fusion  Union in dentin and/or enamel between two or more normal teeth • Gemination  Incomplete division of a tooth germ or a union between normal and a supernumerary tooth 62 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  61. 61. • Rhizomicry  Length of the root is shorter than the height of the crown  Associated with osteoporosis  Predominantly affecting maxillary incisors and premolars 63 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  62. 62. Maxillary Central Incisor • Single rooted, straight root trunk • Triangular / ovoid in cross section, tapers towards lingual • Single root canal system • Mid root and apical lateral canals are common • Root apex & apical foramen are located distolabially. 64 Av. Tooth Length 23.5 mm Av. Crown Length 10.5 mm Av. Root Length 13 mm Maxillary Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  63. 63. 65 PULP CHAMBER • Located in the centre of crown equidistant from dentinal walls • Broad mesiodistally – broadest part incisally • Follows contours of crown & has 3 pulp horns which correspond to mammelons Cross-Section • Cervical Large in young • Middle Ovoid to round shaped • Apical Round shaped Maxillary Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  64. 64. • Roots • Majority are straight - 75% • Distally curved - 8% • Mesially curved - 4% • Palatally curved - 4% • Labially curved - 9% • Lateral Canals - 23% • Apical Ramifications - 9% 66 Anomalies • Talon’s Cusp • Dens invaginvatus • Fusion • Gemination • Palatogingival Groove Maxillary Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  65. 65. Maxillary Lateral Incisor • Single rooted • Root trunk smaller than central incisor • Circular / ovoid in cross section, tapers towards lingual • Single root canal system • Root apex & apical foramen are displaced distolingually. 67 Av. Tooth Length 22.5 mm Av. Crown Length 9 mm Av. Root Length 13 mm Maxillary Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  66. 66. 68 PULP CHAMBER • Similar to maxillary central incisor (smaller) • 2 pulp horns corresponding to developmental mammelons Cross-Section • Cervical Slightly ovoid becomes progressively round • Middle Slightly ovoid to round • Apical Round Maxillary Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  67. 67. • Roots • Distally curved - 53% • Others are straight - 30% • Lateral Canals (frequently) - 26% • Apical Ramifications - 12% 69 Anomalies • Dens invaginvatus • Peg laterals (Gardner’s syndrome) • Fusion (with Central Incisor) • Gemination • Palatogingival Groove Maxillary Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  68. 68. Maxillary Canine • Single rooted, largest tooth in dentition • Root is wider labiolingually • Developmental depressions present in mesial & distal surfaces • Ovoid in cross section • Usually single root canal system • Root apex & apical foramen are displaced distolabially. 70 Av. Tooth Length 26 mm Av. Crown Length 10 mm Av. Root Length 17 mm Maxillary CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  69. 69. 71 PULP CHAMBER • Triangular in shape with apex towards single cusp & broad base in cervical third of crown • Mesiodistally : narrow resembling a flame Cross-Section • Cervical Slightly ovoid • Middle Canal is smaller and remains ovoid • Apical Round Maxillary CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  70. 70. • Roots • Straight - 39% • Distally curved - 32% • Mesially curved - 0% • Palatally curved - 7% • Labially curved - 13% • Lateral Canals - 24% • Apical Ramifications - 8% 72 Anomalies • Dilaceration • Dens evaginvatus • Dens invaginvatus • Supernumery Canine • 2 canals / 2 roots Maxillary CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  71. 71. Access Cavity Preparation In MAXILLARY ANTERIOR TEETH 73 Initial penetration is made at the exact center of lingual surface Round pointed tapering fissure bur in an accentuated speed handpiece at right angle to the long axis of the tooth Rotate the handpiece to the incisal so that the bur is parallel to the long axis of tooth Preliminary cavity outline funnelled and fanned incisally with a fissure bur Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  72. 72. 74 No: 2 or 4 round bur in a slow speed handpiece is used to penetrate the pulp chamber Working from inside to outside, a round bur is used to remove the lingual & labial walls of the pulp chamber Working from inside the chamber to outside, long tapering diamond point is used to remove the lingual shoulder No: 1 or 2 round bur used laterally and incisally to eliminate pulp horn debris Cavity Preparation In MAXILLARY ANTERIOR TEETH Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  73. 73. 75 Final preparation: triangular internal anatomy in young teeth Cavity preparation in adult- ovoid Cavity Preparation In MAXILLARY ANTERIOR TEETH Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  74. 74. ERRORS In Cavity Preparation In MAXILLARY ANTERIOR TEETH 76 Perforation at the labiocervical Gauging of Labial wall Pear shaped preparation of apical canal Gauging of Distal wall Discoloration of crown Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  75. 75. ERRORS In Cavity Preparation In MAXILLARY ANTERIOR TEETH 77 Ledge formation at apical distal curve Perforation at apical distal curve Ledge formation at apical labial curve Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  76. 76. Mandibular Central Incisor • Single rooted • Broader labiolingually than mesiodistally • Developmental depressions present in mesial & distal root surfaces • Ovoid to hourglass in cross section • Usually single root canal system, ovoid/ribbon 78 Av. Tooth Length 20.8 mm Av. Crown Length 9 mm Av. Root Length 12.5 mm Mandibular Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  77. 77. 79 PULP CHAMBER • Small & flat – mesiodistally • Wide labiolingually • Tapers incisally Cross-Section • Cervical Slightly ovoid • Middle Round • Apical Round Mandibular Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  78. 78. • Roots • Straight - 60% • Distally curved - 23% • Mesially curved - 0% • Labially curved - 13% • Lingually curved - 0% • Lateral Canals - 5.2% 80 Anomalies • Fusion • Gemination • Dens invaginvatus • Talon’s Cusp Canals One canal, one foramen 70.1% 2 canals, 1 foramen 23.4% 2 canals, 2 formina 6.5% Mandibular Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  79. 79. Additional Canal Configurations – Mandibular Incisors By Kartal et al 81 Type I • Two separate canals extended from the pulp chamber to midroot • Lingual canal divided into two • All three canals joined in the apical third of the root and exited as one canal Type II • One canal left the pulp chamber • Divided into two in the middle third of the root, then rejoined to form one canal, • Which again split and exited as three separate canals with separate foramina Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  80. 80. Mandibular Lateral Incisor • Similar to Central Incisor • Major difference is incisal edge anatomy • Slight angulation to mesiolabial & distolingual of crown • Usually single root canal system, round/ribbon shaped 82 Av. Tooth Length 22.6 mm Av. Crown Length 9.5 mm Av. Root Length 14 mm Mandibular Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  81. 81. 83 PULP CHAMBER • Similar to central incisor but slightly larger dimension • Small & flat – mesiodistally • Wide labiolingually • Tapers incisally Cross-Section • Cervical Slightly ovoid • Middle Round • Apical Round Mandibular Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  82. 82. • Roots • Straight - 60% • Distally curved - 23% • Mesially curved - 0% • Labially curved - 13% • Lingually curved - 0% • Lateral Canals - 13.9% 84 Anomalies • Fusion • Gemination • Dens invaginvatus • Talon’s Cusp Canals One canal, one foramen 56.9% 2 canals, 1 foramen 14.7% 2 canals, 2 formena 29.4% Mandibular Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  83. 83. Mandibular Canine Single• rooted Broader• labiolingually Developmental• depressions are present in mesial and distal root surface. Usually• single canal system 85 Av. Tooth Length 25 mm Av. Crown Length 11 mm Av. Root Length 16 mm Mandibular CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  84. 84. 86 PULP CHAMBER • Resembles maxillary canine but smaller • Narrow mesiodistally • One pulp horn Cross-Section • Cervical Ovoid • Middle Ovoid (smaller) • Apical Round Mandibular CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  85. 85. • Roots • Straight - 68% • Distally curved - 20% • Mesially curved - 1% • Labially curved - 7% • Lingually curved - 0% • Bayonet curve - 2% 87 Anomalies • Dilaceration • 2 canals, 2 roots • 2 canals in single root • 2 canals in single apical foramen • Dens evaginvatus Canals One canal, one foramen 94% 2 canals, 2 formena 6% Variation – Vertucci Type II & III Mandibular CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  86. 86. Cavity Preparation In MANDIBULAR ANTERIOR TEETH 88 Initial penetration is made at the exact center of lingual surface Round pointed tapering fissure bur in an accentuated speed handpiece at right angle to the long axis of the tooth Rotate the handpiece to the incisal so that the bur is parallel to the long axis of tooth Preliminary cavity outline funnelled and fanned incisally with a fissure bur Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  87. 87. 89 No: 2 round bur in a slow speed handpiece is used to penetrate the pulp chamber Working from inside to outside, a round bur is used to remove the lingual & labial walls of the pulp chamber Working from inside the chamber to outside, long tapering diamond point is used to remove the lingual shoulder No: 1 round bur used laterally and incisally to eliminate pulp horn debris Cavity Preparation In MANDIBULAR ANTERIOR TEETH Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  88. 88. 90 Final preparation: triangular internal anatomy in young teeth Cavity preparation in adult- ovoid Cavity Preparation In MANDIBULAR ANTERIOR TEETH Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  89. 89. ERRORS In Cavity Preparation In MANDIBULAR ANTERIOR TEETH 91 Gouging at the labiocervical Gauging of Labial wall Failure to explore the second canal Gauging of Distal wall Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  90. 90. ERRORS In Cavity Preparation In MANDIBULAR ANTERIOR TEETH 92 Ledge formation at apical labial curve Discoloration of crown Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  91. 91. Maxillary 1st Premolar • Prominent developmental depressions on mesial and distal root surfaces (mesial root concavity more prominent) • Broader buccopalatally & narrow mesiodistally • Kidney shaped cross section at CEJ 93 Av. Tooth Length 21.5 mm Av. Crown Length 8.5 mm Av. Root Length 14 mm Maxillary 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  92. 92. 94 PULP CHAMBER • Narrow mesiodistally, wider buccopalatally • Pulp horn under each cusp, buccal pulp horn more prominent • Floor is convex • 2 canal orifices (lies deep in coronal third of root below cervical line) Cross-Section • Cervical Ovoid • Middle Round • Apical Round Maxillary 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  93. 93. 95 Anomalies • Dens evaginvatus • Gemination (rare) • Taurodontism (rare) Canal System • 2 roots • When fused roots, a groove running in occlusso- apical direction divides the root into buccal & palatal portions each containing a single root canal Maxillary 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  94. 94. Maxillary 2nd Premolar Single• rooted form – most common Broader• buccopalatally & narrow mesiodistally Prominent• developmental depressions on mesial and distal root surfaces Single• canal system – 50.3% 96 Av. Tooth Length 21.6 mm Av. Crown Length 8.5 mm Av. Root Length 14 mm Maxillary 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  95. 95. 97 PULP CHAMBER • Narrow mesiodistally • Wider buccopalatally than Maxillary 1st premolar • Pulp horn under each cusp, buccal pulp horn more prominent Cross-Section • Cervical Ovoid • Middle Round • Apical Round Maxillary 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  96. 96. 98 Anomalies • Dens invaginvatus • Taurodontism • Deep distal root concavity • 2 roots, 3 canals Canal System • Single root – 90.3% • 2 well developed roots – 2% • 2 roots partially fused – 77% • When 2 canals are present, they’ll be distinct & separated along the entire length of root Maxillary 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  97. 97. Access Cavity Preparation In MAXILLARY PREMOLARS 99 Access starting location point is on central groove between cusp tip Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  98. 98. Access Cavity Preparation In MAXILLARY PREMOLARS 10 0 Initial penetration made with bur parallel long axis of tooth No. 2/4 round bur, drop is felt when pulp chamber is reached Canal orifices located using endodontic explorer Removal of roof of pulp chamber Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  99. 99. Access Cavity Preparation In MAXILLARY PREMOLARS 10 1 Buccolingual extension and finish of cavity walls using fissure bur Final preparation should provide unobstructed access to canal orifice Outline form of final cavity preparation – ovoid Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  100. 100. ERRORS In Cavity Preparation In MAXILLARY PREMOLARS 10 2 Under extended preparation Overextented preparation Faulty alignment of access cavity Perforation at mesiocervical indentation Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  101. 101. 10 3 Failiure to explore 3rd canal/ 2nd canalBroken instrument ERRORS In Cavity Preparation In MAXILLARY PREMOLARS Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  102. 102. Mandibular 1st Premolar • Single rooted • Broader buccolingually • Developmental depressions on distal root surface is deeper than mesial surface • Ovoid / hourglass shape in cross section 10 4 Av. Tooth Length 21.9 mm Av. Crown Length 8.5 mm Av. Root Length 14 mm Mandibular 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  103. 103. 10 5 PULP CHAMBER • Narrow mesiodistally • Wider buccolingually with prominent buccal pulp horn • Prominent buccal cusp & small lingual cusp Cross-Section • Cervical Very narrow and ovoid • Middle 2 branches of canals are Round • Apical Round Mandibular 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  104. 104. 10 6 Anomalies • Dens invaginvatus/ evaginatus • Gemination • H-shaped canal single canal can split into 2 of which the buccal is straight & the lingual canal splits at a right angle, this gives the appearance of the letter ‘h’ Canal System • Single root • Usually 1 canal – 70% • 1 canal bifurcates into 2 and ends in 2 foramina – 24% • 2 canals exit in 2 foramina – 1.5% • 1 canal may bifurcate into 2, uniting into 1 canal in the apical third and exiting in one foramen – 4% • 3 canals exit in 3 foramina – 0.5% Mandibular 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  105. 105. Mandibular 2nd Premolar • Single rooted • Mesial surface of root is flat / convex • Developmental depressions on distal root surface • Ovoid in cross section 10 7 Av. Tooth Length 22.3 mm Av. Crown Length 8 mm Av. Root Length 14.5 mm Mandibular 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  106. 106. 10 8 PULP CHAMBER • Narrow mesiodistally • Wider buccolingually • Prominent Lingual pulp horn Cross-Section • Cervical Very narrow and ovoid • Middle Less ovoid • Apical Round Mandibular 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  107. 107. 10 9 Anomalies • Dens evaginatus • 2 roots Canal System • Single canal – 97.5% • Some roots bifurcates exiting in 2 foraminas – 2.5% Mandibular 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  108. 108. Access Cavity Preparation In MANDIBULAR PREMOLARS 11 0 2ND PREMOLAR 1/3rd way up the lingual incline of buccal cusp on a line connecting buccal cusp tip and lingual groove between the lingual cusps Ist PREMOLAR Halfway up the lingual incline on a line connecting cusp tips Mandibular premolar-tilted lingually to root and must be adjusted to this tilt Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  109. 109. Access Cavity Preparation In MANDIBULAR PREMOLARS 111 Initial penetration made through occlusal surface No. 4 round bur, drop is felt when pulp chamber is reached Canal orifices located using endodontic explorer Removal of roof of pulp chamber Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  110. 110. 112 Buccolingual extension and finish of cavity walls using fissure bur Final preparation should provide unobstructed access to canal orifice Outline form of final cavity preparation – ovoid Access Cavity Preparation In MANDIBULAR PREMOLARS Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  111. 111. ERRORS In Cavity Preparation In MANDIBULAR PREMOLARS 113 Perforation at the mesiogingival Incomplete preparation & instrument breakage Bifurcation of a canal missed Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  112. 112. 114 Perforation of apical curvature Apical perforation ERRORS In Cavity Preparation In MANDIBULAR PREMOLARS Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  113. 113. Maxillary 1st Molar • Mesiobuccal Root : • Broad buccolingually • Developmental depressions in both mesial & distal root surfaces • Distobuccal Root : • Round / ovoid in cross section • Palatal Root : • Broad mesiodistally • Ovoid in cross section • Buccal curvature at the apical third 115 Av. Tooth Length 21.3 mm Av. Crown Length 7.5 mm Av. Root Length 13 mm Maxillary 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  114. 114. 116 PULP CHAMBER • Largest in the arch • 4 pulp horns : MB, MP, DB, DP • Roof – Rhomboidal in shape • Roof converges, lingual wall disappears and forms a triangular form • Anatomic dark lines in the floor connect the orifices • Orifices are located in the 3 angles of the floor • Mesiobuccal orifice under mesio-buccal cusp • May have a depression in the palatal end of the mesiobuccal orifice where a 4th canal may be present • MB2 canal is located mesial to or directly on a line between the MB and palatal orifice Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  115. 115. Canal System Mesiobuccal Root • Have distal curvature – 78% • Straight – 21% • Bayonet – 1% • Narrowest of 3 canals • Apical foramen centrally located Distobuccal Root • Small • Straight – 54% • Distal curve – 17% • Mesial curve – 19% • Bayonet – 10% • Apical foramen centrally located Palatal Root • Largest root & diameter, ovoid mesiodistally, tapers apically • May curve buccally in the apical third 117 Maxillary 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  116. 116. • Locating MB2 orifice – • Difficult as its buried under • dentine bridge formed as a result of aging • reparative dentin formation as result of caries /restoration • Canal located mesial to or directly on a line between the MB1 and palatal orifices ,within 3.5mm palatally and 2mm mesially of MB1 orifice. 118 Maxillary 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  117. 117. 119 Anomalies • Taurodontism • Root fusion • 2 palatal canals • Single root and single canal • 2 distal canals • 2 palatal roots • C-shaped canals Maxillary 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  118. 118. Maxillary 2nd Molar • Similar to maxillary 1st molar • Roots have a distal inclination • Normally has 3 roots • Roots tends to close together, higher tendency towards fusion of 2/3 roots 12 0 Av. Tooth Length 17.1 mm Av. Crown Length 7 mm Av. Root Length 12 mm Maxillary 2nd MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  119. 119. 121 PULP CHAMBER • Similar to maxillary 1st molar, except narrower mesiodistally • Roof – Rhomboidal in shape • Floor – obtuse triangle • Mesiobuccal and distobuccal canals closer together Maxillary 2nd Molar Canal System Mesiobuccal Root • Broad buccolingually • Prominent depression in mesial and distal surfaces • 1 or 2 canals Distobuccal Root • Rounded / ovoid, single canal • Orifice appears on same line joining mesiobuccal & palatal canals Palatal Root • Broad mesiodistally • Ovoid, Single canal Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  120. 120. 12 2 Anomalies • Taurodontism • Root fusion • Single root, single canal • 2 palatal canals in double palatal root • Incidence of pulp stones Maxillary 2nd MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  121. 121. Access Cavity Preparation In MAXILLARY MOLARS 12 3 • Mesial and Distal boundary should be established • Mesial boundary for maxillary molars is the line connecting mesial cusp tips • Distal boundary for maxillary-oblique ridge Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  122. 122. Access Cavity Preparation In MAXILLARY MOLARS 12 4 Initial penetration made at the center of occlusal pit with bur directed palatally No. 4 round bur directed to the palatal canal orifice or mesiobuccal orifice Endodontic explorer used to locate canal orifices Round bur is used to remove roof of the pulp chamber Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  123. 123. 12 5 Final finish & funnelling of cavity walls with tapered diamond point Final preparation provide ease of access improved by leaning the preparation to the buccal Outline form of final cavity preparation – Triangular Access Cavity Preparation In MAXILLARY MOLARS Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  124. 124. ERRORS In Cavity Preparation In MAXILLARY MOLARS 12 6 Underextended / Over extended preparation Perforation into furcation Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  125. 125. 12 7 Disoriented occlusal outline form Inadequate vertical preparation - severe buccal inclination ERRORS In Cavity Preparation In MAXILLARY MOLARS Ledge formation Perforation of palatal root Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  126. 126. Mandibular 1st Molar • Typically 2 rooted • Roots are broader buccolingually which are widely separated • Mesial & distal roots separated with a furcation level • Buccally – 3mm • Lingually – 4mm • Mesial root concavities on both mesial and distal surfaces • Distal root – ovoid in cross section 12 8 Av. Tooth Length 21.9 mm Av. Crown Length 7.5 mm Av. Root Length 14 mm Mandibular 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  127. 127. 12 9 PULP CHAMBER • 4 pulp horns : MB, ML, DB, DL • 3 distinct orifices : MB, ML & distal • Roof – Rectangular in shape • Walls converge to form a rhomboidal floor • Pulp horns recede with age and so decrease in chamber size • Roof is located on the cervical 3rd of the crown just above the cervix of tooth, floor is located on cervical third of root Mandibular 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  128. 128. Canal System Normally 2 mesial and 1 distal canal Mesial Root • 2 canals exit in 2 foramina – 41% • 2 canals exit in 1 foramina – 28% • 2 canals form 1 canal & bifurcate & exit in 2 foramina – 13% • 1 canal in 1 foramina – 12% • 1 canal bifurcates & exits in 2 foramina – 8% • Rare cases – 3 canals exit in 3 foramina ( 3rd canal is the middle mesial canal) Distal Root • 1 canal exiting in 1 foramen – 70% • 2 canals exiting in 1 foramen – 15% • 1 canal bifurcating & exiting in 2 foramina – 8% • 2 canals in 2 foramina – 5% 13 0 Mandibular 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  129. 129. 131 Anomalies • Taurodontism (most common) • Supernumery Roots – Radix Entomolaris • C-shaped canals Mandibular 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  130. 130. Mandibular 2nd Molar • 2 rooted • Mesial & distal roots close together • Roots are broader buccolingually • More frequently roots are fused 13 2 Av. Tooth Length 21.4 mm Av. Crown Length 7 mm Av. Root Length 13.5 mm Mandibular 2nd MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
  131. 131. 13 3 PULP CHAMBER • Similar to 1st molar but smaller in size Canal System • Mesial root – higher incidence of 1 canal – 14% • Higher incidence of root fusion • C-shaped canals are frequent Mandibular 2nd Molar • In a mandibular second molar with two canals, both orifices are in the mesiodistal midline. If• two orifices are not directly in the mesiodistal midline, a search should be made for another canal on the opposite side using Krasner and Rankow's laws of anatomy Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  132. 132. 13 4 Mandibular 2nd Molar Anomalies • C-shaped canals • Taurodontism • Fused or single canal • Supernumery roots – Radix Entomolaris Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  133. 133. Access Cavity Preparation In MANDIBULAR MOLARS 13 5 • Mesial and Distal boundary should be established • Mesial boundary for mandibular molars are line connecting mesial cusp tips • Distal boundary is the line connecting buccal and lingual grooves Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  134. 134. Access Cavity Preparation In MANDIBULAR MOLARS 13 6 Initial penetration made at the center of mesial pit with bur directed towards distal No. 4/No.6 round bur is used, directed towards the orifice of mesiobuccal or distal canal Endodontic explorer used to locate canal orifices Round bur is used to remove roof of the pulp chamber Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  135. 135. 13 7 Final finish & funnelling of cavity walls with tapered diamond point Final preparation provide ease of access improved by leaning the preparation to the buccal Access Cavity Preparation In MANDIBULAR MOLARS Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  136. 136. ERRORS In Cavity Preparation In MANDIBULAR MOLARS 13 8 Over-extended preparation Perforation into furcation Disoriented occlusal outline form Perforation at mesiocervical – tilted to mesial Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  137. 137. ERRORS In Cavity Preparation In MANDIBULAR MOLARS 13 9 Failure of finding 2nd distal canal Perforation of distal rootLedge formation Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  138. 138. Access Cavity Preparation In Teeth with Calcified Canals 14 0 Mandibular first molar with a Class I restoration, calcified canals, and periradicular radiolucencies Excavation of a restoration and base material Long-shank #2 or #4 round bur to remove dentin Endodontic explorer is used to probe the pulp floor Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  139. 139. 141 The smallest instrument (i.e., a #.06 or #.08 file) should be introduced into the canal A small hand K-file negotiates the canal to its terminus Access Cavity Preparation In Teeth with Calcified Canals Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  140. 140. • Color is also a critical indicator when chasing a receded or calcified canal. • Typically,a small dark brown dot is visualized and represents the position where the canal used to be. • Chasing apically along this colored route typically leads to a more open canal that can be negotiated. 14 2 Access Cavity Preparation In Teeth with Calcified Canals Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  141. 141. Apical Diameter - Cohen 14 3 Teeth Mean Value (µm) Maxillary incisors 289.4 Mandibular incisors 262.5 Maxillary premolars 210 Mandibular premolars 268.25 Maxillary molars Palatal 298 Mesiobuccal 235.05 Distobuccal 232.2 Mandibular molars Mesial 257.5 Distal 392 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  142. 142. Suggested Preparation Sizes - Ingle 14 4 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  143. 143. 14 5 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  144. 144. CONCLUSION Thorough• Knowledge of root canal anatomy & cavity preparation will enable the clinician to produce endodontic treatments of high quality and considerable longevity. • A successful treatment outcome depends on the complete debridement and disinfection of all canals. 14 6 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
  145. 145. REFERENCES • Text book of Endodontics-Ingles( 5th edition) • Text book of Endodontics—Mahmood Torabinajad, Richael E.Walton (4th edition) • Grossman’s Endodontic Practice (12th Edition) • Endodontic Therapy – Franklin S. Weine (6th Edition) • Pathways of pulp –Cohen 14 7 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
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