Endodontic treatment Anatomy and morphology of pulp 59543314 root-canal-anatomy-lecture-by-dr-hatem-al-hadainy-am cofam (1)

1. Anatomy and morphology of pulpAnatomy and morphology of pulp
Dr. Mohammed Walid Abu-HassiraDr. Mohammed Walid Abu-Hassira

2. -The pulp cavity is the centralThe pulp cavity is the central
space within a tooth that enclosedspace within a tooth that enclosed
by dentin except at the apicalby dentin except at the apical
foramenforamen..
--It is divided into a coronalIt is divided into a coronal
portion (the pulp chamber) and aportion (the pulp chamber) and a
radicular portion (the root canalradicular portion (the root canal(.(.
--Other features include pulpOther features include pulp
horns, canal orifices, accessoryhorns, canal orifices, accessory
(lateral) canals, and apical(lateral) canals, and apical
foramenforamen..

3. Pulp HornsPulp Horns
Although pulp horns may vary in height and
location, a single pulp horn tends to be
associated with each cusp in a posterior
tooth, and mesial and distal horns tend to be
found in incisors.
Pulp horn may extends occlusally and
exposure may occur as a result of caries or
routine cavity preparation. Such abnormally
high pulp horns may or may not be visible on
radiographs.

6. Pulp ChamberPulp Chamber
-The pulp chamber occupies the center of the crown and
trunk of the root.
-Its shape depends on the shape of the crown and trunk;
this configuration varies with tooth age or irritation.
Floor of pulp chamber
Roof of pulp chamber
Pulp Chamber
Pulp horn
Canal Orifice opening

7. Root canalsRoot canals
Root canals extend from orifice to the apical
foramen.
Root canals vary according to root shape,
size, degree of curvature, age, and condition
of the tooth.
The shape of root canals mainly irregular, not
straight and other variations in root canals
may occur.

8. Accessory canalsAccessory canals
Accessory (or lateral) canals are branches of
the main canal.
They contain connective tissue and may be
located at any level from furcation to apex but
tend to be more frequent in the apical third.
They contribute little to pulp function and
probably represent an anomaly that occurred
during root formation.

9. Apical RegionApical Region
Apical Foramen:
It varies in size and configuration with maturity. It
usually does not exit at the anatomic root apex but
deviates an average of 0.5 mm of true apex.

10. Apical Constriction
• Apical Constriction:
The cementodentinal junction forms the
apical constriction. The intra-canal extent of
cementum is variable.

11. Types of rootsTypes of roots
Type I
Mature straight roots (having closed apex
with apical constriction(
Slightly Curved Severely Curved Dilacerated Bayonet
Type II
Mature but not straight root canals, which may be:

12. A. Tubular root apex
B. Blunderbus apex
Type III
Immature (open apex) canals
)Straight or curved(

13. Types of Canal System
Type I: Single canal with single
orifice and single apical foramen
Type II: Two canals with two orifices
and single apical foramen

14. Type III: Two canals with two
orifices and two apical foramen
Type IV: Single canal with single
orifice and two apical foramina

15. Type V: A canal with a single orifice
that divided into two canals and exit
with a single apical foramen
Type VI: Single canal with two orifices
and two apical foramen

16. Tooth demineralization and
cross Section of teeth
showing relationship
between Pulp and external
surface morphology
Anatomy of Pulp SystemAnatomy of Pulp System

17. Average Tooth Length: 23.3 ± 2.3 mm
Pulp chamber: wider MD Than Labio-palatal
One root: One Root Canal (100%)
Straight, round, tapered, cylindrical
 Apical Distal curvature: (8%)
Cross section: Ovoid/Ovoid/round
Maxillary Central
Incisor
C.S
A
M
C

18. MaxillaryMaxillary LateralLateral
IncisorIncisor
 Average Tooth Length: 22.8 ± 2.3 mm
 Pulp chamber: wider Labio-palatal Than MD
 One root: one canal
 Apical distal curvature: (53 %)
 Lateral root canals: Occasional
 Apical root canal delta: Frequent
 Cross section Ovoid, Ovoid round

19.  Average Tooth Length: 26 ± 3 mm
 Pulp chamber: wide LP than MD
 One Root: one canal
 Apical distal curvature: 32%
 Lateral root canals: Infrequent
 Apical root canal delta: Occasional
 Cross section: Ovoid/Ovoid/Round
 Access: oval
Maxillary Canine

20. Tooth
Total
length
Crown
length
Root
length
Number of
roots
Types of
canals
Maxillary
central
incisor
A = 23.0
L = 28.0
S = 18.0
10.5
12.0
8.0
12.5
16.0
8.0
One I
Maxillary
lateral
incisor
A = 22.5
L = 27.0
S = 17.0
9.0
10.5
8.0
16.5
16.5
8.0
One I
Maxillary
canine
A = 27.0
L = 32.0
S = 20.0
9.5
12.0
8.0
16.5
20.5
11.0
One I
Tooth lengths, number of roots. and canal
configuration for upper anterior teeth
A: average L: largest S: smallest

21. Mandibular CentralMandibular Central
IncisorIncisor
Average Tooth Length: 21.5 ± 2 mm
Pulp Chamber: wide bL than MD
One Root : One RC 70%
Two RCs with one Ap. For. 25%
Two RCs with two Ap. For. 5%
Apical Distal Curvature: 23%
Cross section: Ovoid/Round/Round

22. Mandibular LateralMandibular Lateral
IncisorIncisor
Average Tooth Length: 22.5 ± 2 mm
Pulp Chamber wide LL than MD
One Root One RC > 55%
Two RCs with one ApF 30%
Two RCs with two ApF 15%
Lateral root canals: Occasional
Apical root canal delta: Infrequent
Apical Distal Curvature: 23%
Cross section Ovoid/Round/Round

23.  Average Tooth Length: 25.5 ± 2.5 mm.
 Pulp Chamber Wide bL than MD (One Pulp Horn)
 One Root One canal (94 %), Two canal (6 %)
 Lateral root canals: Occasional
 Apical root canal delta: Infrequent
 Apical Distal Curvature: 20 %
 Cross section Ovoid/Ovoid/Round
Mandibular Canine

24. Tooth lengths, number of roots. and canal
configuration for lower anterior teeth
Tooth
Total
length
Crown
length
Root
length
Number of roots Types of canals
Mandibular
incisors
A =
21.0
L =
25.0
S = 16.0
9.0
10.5
7.0
12.0
14.5
9.0
One
I most frequent
II less frequent
III least frequent
Mandibular
cuspid
A =
24.0
L =
30.5
S = 20.0
10.0
12.0
8.5
15.0
20.5
11.5
Two;
one buccal and
one
lingual (rare)
I most frequent
II less frequent
III least frequent
A: average L: largest S: smallest

25. Average Tooth Length: 22 ± 2.5 mm
Pulp Chamber: Wide LP than MD
Two Roots 72 %: 2 RCs (B&P(
One Root (22%): 2 RC (13 %),1 RC (9(%
Three Roots: 3 RCs 6 % (2 B & 1 P(
Apical Distal Curvature: 37%
Lateral root canals: Infrequent
Apical root canal delta: Infrequent
Cross section: Oval
Maxillary
First Premolar

26. Average Tooth Length: 21 ± 2 mm
Pulp Chamber: Wide LP than MD Av
One Root: (90%) 1 RC 75%
2RCs 15 % III
Two Roots: 2 RCs 10%
Apical Distal Curvature: 27%
Bayonet Curv: 20%
Lateral root canals: Infrequent
Apical root canal delta: Infrequent
Cross section: Round
Maxillary
Second Premolar

27. Typical tooth lengths. number of roots, and
canal configuration for bicuspids
Tooth lengths. number of roots, and canal
configuration for upper premolars
Tooth
Total
length
Crown
length
Root
length
Number of roots Types of canals
Maxillary
first
premolar
A = 21.0
L = 24.0
S = 17.5
8.5
10.0
7.0
12.5
14.5
10.0
Two, most frequent
(60%), buccal and
palatal
Each, 1
One (40%)
III most frequent
II less frequent
I rare
Three rare Each, I
Maxillary
second
premolar
A = 21.0
L = 25.0
S= 17.0
8.5
10.5
7.0
12.5
15.0
9.5
one (85%)
I most frequent
11 less frequent
III least frequent
may have Type IV
Two (15%), buccal
and palatal
Each, I

28. Average Tooth Length: 22 ± 2 mm
Pulp Chamber Wide LL than MD
1Canalwith 1 Foramen 73.5%
2Canalswith 2 Foramina 19.5%
with 1 Foram … 6.5%
3Canals 0.5%
Apical Distal Curvature: 35%
Lateral root canals: Occasional
Apical root canal delta: Occasional
RC Cross Section: Round
Crown has Lingual inclinationCrown has Lingual inclination
Mandibular
First Premolar

29. Average Tooth Length: 21 ± 2 mm
Pulp Chamber: Wide LL than MD
One Canal 85%
Two Canals with 2 F 14.5%
Three Canals 0.5%
Apical Distal Curvature 4o%
Lateral root canals: Occasional
Apical root canal delta: Occasional
CrossSection:Round
Mandibular
Second Premolar

30. Tooth lengths. number of roots, and canal
configuration for lower premolars
Tooth
Total
length
Crown
length
Root
length
Number of roots Types of canals
Mandibular
first bicuspid
A = 21.5
L = 25.0
S = 17.0
7.5
9.0
6.5
14.0
17.0
11.5
One See previous
Two, buccal and
lingual
Each, I
Mandibular
second
bicuspid
A= 22.0
L = 25.0
S = 17.0
8.0
10.0
6.0
14.0
17.0
11.5
One
1 most frequent
11 or III rare
IV very rare
Two, buccal and
lingual. very rare
Three, two buccals
and one lingual
Each, I

31.  Average Tooth Length:
Buc roots : 20 ± 2 m
Palat. root : 22 ± 3m
 Three Rooted Tooth
(MB, DB, PAL)
• 3 canals in 3 roots: 43 %
• 4 Canals in 3 roots: 57 %
4th
canal (MB2)
Maxillary First
Molar

33.  Average Tooth Length:
Buccal roots : 20 ± 2 m
Palatal root : 21 ± 2m
 Three Rooted Tooth: 44 %
63 % 3 Canals ( MB ,DB , PAL)
37 % 4 Canals 4th
canal (MB2)
Maxillary Second
Molar

35. Tooth
Total
length
Crown
length
Root
length
Number of
roots
Types of canals
Maxillary
first
molar
A= 20.5
L=24.0
S = 17.0
7.5
9.0
7.0
13.0
16.0
10.0
Three.
two buccal and
one palatal
Distobuccal and palatal:
each I
Maxillary
second
molar
A = 20.0
L=21.0
S = 17.0
7.0
8.5
7.0
13.0
15.5
10.0
Three. two
buccal and
one palatal
(90%)
Distobuccal and palatal:
each I.
Two. one
buccal and
Each I most frequent;
buccal root
Tooth Lengths, number of roots. and canal
configuration for upper molars

36. • Average Tooth Length: 21 ± 2 mm
• Roots are FLAT wider B-L
• 2 rooted tooth: (M & D).
3 root canals: 70 %
M. Root 2 canals.
D. Root 1 canal.
4 root canals: (30 %)
(2 canals in Distal root)
Mandibular First
Molar

38.  Average Tooth Length: 20 ± 2 mm
Roots are FLAT wider BL
M. root wider BL than D. root
 2 rooted tooth: (M&D).
3 root canals:70 %
4 root canals: 10 %.
2 root canals: 20 %
Mandibular
Second Molar

40. Tooth
Total
length
Crown
length
Root
length
Number of roots Types of canals
Mandibular
first
molar
A = 21.0
L = 24.5
S = 18.0
7.5
10.0
6.0
13.5
15.0
11.5
Two,
most common.
mesial and distal
Mesial: 1II most frequent
II less frequent
Distal: I most frequent
II less frequent
III least frequent
Three.
one mesial and
two distal
Mesial: same as above
Distal: distolingual very
curved
Mandibular
second
molar
A = 20.0
L = 24.0
S= 17.0
7.0
8.5
6.0
13.0
15.5
12.0
Two,
most common.
mesial and distal
Mesial: same as above
Distal: I most frequent
II or ill rare
One
II most frequent
I less frequent
III least frequent
Tooth Lengths, number of roots. and canal
configuration for lower molars

41.  The root canals of third molars are completely
unpredictable because they are frequently short,
tortuous, multiple & branching.
 There is no patterns or rules to follow when treating
this unpredictable tooth.
 May have only one single canal.
Third Molars

42. MandibleMandible MaxillaMaxilla
PremolarsPremolars

43. MolarsMolars

44. Third molars can present problems, which are
related to accessibility and anatomy.
 Reaching the most posterior teeth with hand
piece and hand instruments can be difficult
because of poor visibility and restricted jaw
opening.
 Often these molars are tipped or mal-
positioned.

45. • Dentin formation tends to occur in the roof and floor
of the chamber pulp chamber are reduced in size,
eventually making the chamber almost disc-like in
configuration.
• The orifices of the canals become smaller in
diameter.
• A pronounced curve in the canal might result
from the newly formed secondary dentin.
• A sharp curvature in the coronal area of the root
canal might result from the secondary dentin
formation.
Age Changes

46. • Anything that exposes dentin to the oral cavity canAnything that exposes dentin to the oral cavity can
potentially stimulate increased dentin formation atpotentially stimulate increased dentin formation at
the base of tubules in the underlying pulp.the base of tubules in the underlying pulp.
• Vital pulp therapy such as pulpotomy, pulp capping,Vital pulp therapy such as pulpotomy, pulp capping,
or placement of irritating materials in a deep cavityor placement of irritating materials in a deep cavity
may cause occlusion, calcific metamorphosis,may cause occlusion, calcific metamorphosis,
resorption, or other unusual configurations in theresorption, or other unusual configurations in the
chamber or canals.chamber or canals.
Secondary
dentin
Reparative dentin
Irritants

47. Pulp StonesPulp Stones
Although pulp stones are usually found in the chamber andAlthough pulp stones are usually found in the chamber and
diffuse calcifications within the radicular pulp, the reverse maydiffuse calcifications within the radicular pulp, the reverse may
also occuralso occur..
Stones in the chamber may reach considerable size and canStones in the chamber may reach considerable size and can
alter the internal chamber anatomyalter the internal chamber anatomy..
Chamber stones may be attached or free and are usuallyChamber stones may be attached or free and are usually
removed during access preparationremoved during access preparation..
Pulp stones are NOT common in canals, they are usuallyPulp stones are NOT common in canals, they are usually
attached or embedded in the canal wall in the apical region.attached or embedded in the canal wall in the apical region.
Rarely do they form a barrier to instrument passageRarely do they form a barrier to instrument passage..

48. ResorptionResorption
Resorptions are less frequent than dentinResorptions are less frequent than dentin formationformation
or calcifications and when present are usually notor calcifications and when present are usually not
extensiveextensive..
Resorptions are a response to irritation that isResorptions are a response to irritation that is
sufficient to cause inflammationsufficient to cause inflammation..
When visible radiographically, they are usuallyWhen visible radiographically, they are usually
extensive and may create operative difficultiesextensive and may create operative difficulties