INTERNAL ANATOMY OF PERMANENT TOOTH concepts, review, techniques for missed canals. Advancements.

1. 1
GOOD
MORNING

2. 2
GUIDED BY
Dr. P.V. KARTEEK VARMA
READER
PRESENTED BY
V.SINDHU
1st MDS

3. 3
MIND MAP
INTRODUCTION
ROOT CANAL
SYSYTEM
ROOT CANAL SYSYTEM
CLASSIFICATIONS
-APICAL
CONSTRICTION
-APICAL FORAMEN
-ACCESSSORY
FORAMEN
-ROOT CANAL
RAMIFICATIONS
-CANAL CURVATURES
-ISTHMUS
-APICAL DELTA
INDIVIDUAL TOOTH
ANATOMY
CONCLUSION
REFERENCES
-TOOTH
MORPHOLOGY
- ACCESS
OPENING
-VARIATIONS &
MANAGMENT
-CASE REPORTS
METHODS FOR
DETERMINING EXTRA
CANALS
-WEINS
-VERTUCCI
-NEWER SYSTEM

4. CONTENTS
• Introduction
• Root canal anatomy
• Classifications of root canal
• Individual tooth anatomy & Variations
• Tooth morphology and access opening
• Case reports
• Methods to determine extra canals
• Conclusions
• References
4

5. INTRODUCTION
• “Of all the phases of anatomic study in the human system, one of the
most complex is the pulp cavity morphology” –
M.T.BARRETT
The knowledge of root canal architecture will help us in
• Effective debridement
• To know the apical termination of instrumentation
• 3d obturation of canal
5

6. ROOT CANAL ANATOMY
• Root canal system : It is the space within the
tooth that contains pulp tissue.
• It is divided into 2: Coronal – Pulp chamber
Radicular – Root canal
6
The pulp chamber in the
coronal part of the tooth
consists of a single
cavity with projections
(pulp horns) into the
cusps of the tooth.

7. 7
• Occupies the coronal portion of pulp cavity.
PULP CHAMBER:
1. Roof of pulp chamber - Dentin covering the pulp chamber
occlusally or incisally.
2. Pulp horn -Accentuation of the roof of the pulp chamber
directly under a cusp or developmental lobe.
3. Floor of pulp chamber- Runs parallel to the roof and
consists of dentin bounding the pulp chamber near the
cervical area of the tooth.
4. Canal orifices- Openings in the floor of pulp chamber
leading in to root canals.

8. 8
Law of Centrality: the floor of the pulp chamber is always located in the center of the
tooth at the level of the CEJ (cemento-enamel junction).
Law of the CEJ: The CEJ is the most consistent, repeatable landmark for locating the
position of the pulp-chamber.
Based on relationship of pulp chamber to the clinical crown:
KRAUSNER AND RANKOW LAWS

9. 9
Law of symmetry 1: except for maxillary molars, the orifices of the canals are
equidistant from a line drawn in a mesial-distal direction through the pulp
chamber floor.
Law of symmetry 2: except for the maxillary molars, the orifices of the canals lie
on a line perpendicular to a line drawn in a mesial-distal direction across the
center of the floor of the pulp chamber.
Law of Color Change: the color of the pulp chamber floor is always darker than the
walls.
Based on relationship of pulp chamber floor to root canal orifices

10. 10
Law of orifice location 1: the orifices of the root canals are always located at the
junction of the walls and the floor.
Law of orifice location 2: the orifices of the root canals are located at the angles in
the floor wall junction.
Law of orifice location 3: the orifices of the root canals are located at the terminus
of the root developmental fusion lines.

11. 11
DENTINAL MAP
• Dark developmental lines may be identified linking canal entrances.
• The location of an undetected canal entrance may be indicated by tracking
along the developmental line.

12. 12
1. Tooth apex (radiographic apex)
2. Apical foramen (major foramen)
3. Apical constriction (minor foramen)
ANATOMY OF THE ROOT APEX
(KUTLER’S STUDIES)
COHEN PATHWAYS OF PULP 10TH EDITION

13. 13
Apical foramen:
• Apical foramen is the "circumference or
rounded edge, main opening of the root
canal that differentiates the termination of
the cemental canal from the exterior surface
of the root “
• It does not normally exit at the anatomic
apex but rather is offset 0.5 to 3 mm.
• It may undergo changes due to functional
influences on the teeth like tipping forces.
• Foramen gradually shifts its position with
aging, mesial drift, cementum deposition
COHEN PATHWAYS OF PULP 10TH EDITION
Diameter is
502um in younger
(18to25)
Diameter is
681um in old
(above 55)

14. Apical constriction/ minor apical
foramen:
• Apical part of the root canal with the
narrowest diameter.
• 0.5–1 mm from the major apical
foramen (Vertucci 2005).
• The distance is greater in older
individuals because of the buildup of
cementum.
• Often used as the reference point of
apical termination of canal
instrumentation and filling procedures
14
COHEN PATHWAYS OF PULP 10TH EDITION

15. • With increase in age minor diameter
becomes narrower and major
diameter becomes wider with
deposition of dentine and cementum
• Sometimes apical opening is found on
the lateral side of the apex, although
root is not curved itself.
15
COHEN PATHWAYS OF PULP 10TH EDITION

16. 16
Various types of the apical constriction
“Current Challenges and Concepts in the Preparation of Root Canal Systems: A Review” Ove A. Peters ,JOE -2004 ,30 , 559 -67

17. • Space between major and minor apical
diameter – FUNNEL SHAPED, HYPERBOLIC
or having the shape of a MORNING GLORY
• Distance between major and minor diameter
is :
0.5mm in younger individuals
0.67 mm in older individuals
so it is advisable to restrict the working length
1 to 2 mm short of apex in older individuals
17

18. THE CEMENTODENTINAL JUNCTION :
• The region where the dentin and
cementum are united.
• CDJ does not always coincide with the
apical constriction.
• The location of the CDJ ranges from 0.5 to
3.0 mm short of the anatomic apex
18

19. 19
Weine recommends the following termination points for therapy
• 1 mm from the apex when there is no bone or root resorption
• 1.5 mm from the apex when there is only bone resorption
• 2 mm from the apex when there is bone and root resorption.

20. ROOT CANAL RAMIFICATIONS :
20
The ramifications found in the region of the
dental root , according to PUCCI & REIG, are:
1.Main canal
2.Collateral canal
3.Lateral canal
4.Secondary canal
5.Accessory canal
6.Intercanal
7.Recurring canal

21. LATERAL AND ACCESSORY CANALS
21
-A channel leading from the root pulp
laterally through the dentin to the
periodontal tissue; may be found
anywhere in the tooth root but is more
common in the apical third of the root.
- Incidence is more in posteriors than anteriors
teeth
- Mean diameter is 6 to 60 Um ( Hess et al 1983)
COHEN PATHWAYS OF PULP 10TH EDITION

22. 22
COHEN PATHWAYS OF PULP 10TH EDITION

23. APICAL DELTA:
• The presence of dichotomy or
branching of the root canal near the
apex, giving a Y shaped structure
forming a delta at the apex
• Following endodontic therapy , the pulp
tissue in the uninstrumented delta may
inflammed leading to re infection
23

24. ISTHMUS
An isthmus is a narrow, ribbon-shaped communication between two root canals
that contains pulp or pulpally derived tissue.
24
Classification by KIM et al

25. CANAL CURVATURES:
25
According to the Schneiders
method, considering both the
angle of curvature together with
the radius of the curve is
supposedly the exact method of
describing the canal curvature.
 Mild curvature – 5 degree or less
 Moderate curvatures – 10- 20 degree
 Severe curvature -25-70 degree
 Sharp curves with a short radius and S-shaped curvatures are always very
demanding and easily result in transportation, ledges and even perforations

26. CLASSIFICATIONS OF
ROOT CANAL SYSTEMS
26

27. WEINE’S CLASSIFICATION
27

28. Vertucci’s
classification
28

29. 29
Int Endod J. 2017 Aug;50(8):761-770 A new system for classifying root and root canal morphology.

30. 30
Int Endod J. 2017 Aug;50(8):761-770 A new system for classifying root and root canal morphology.

31. 31
Int Endod J. 2017 Aug;50(8):761-770 A new system for classifying root and root canal morphology.

32. 32
Int Endod J. 2017 Aug;50(8):761-770 A new system for classifying root and root canal morphology.

33. INDIVIDUAL TOOTH
ROOT CANAL ANATOMY
33

34. MAXILLARY CENTRAL INCISOR
Average Length 22.5 mm
No. of Roots 01
No. of Canals 01 (99.4%)
02 (0.6%)
34
COHEN PATHWAYS OF PULP 10TH EDITION
Variations and anomalies:
Fusion-2.6%
Gemination-0.94%
Radicular grooves-0.9%

35. MAXILLARY LATERAL INCISOR
Average Length 22.0 mm
No. of Roots 01
No. of Canals 01 (93.4%)
02 (6.6%)
35
COHEN PATHWAYS OF PULP 10TH EDITION
Variations and anomalies
Radicular grooves – 3%
Dens invaginatus
Fusion, Gemination
Peg shaped lateral incisor

36. 36
DENS INVAGINATUS/DENS IN DENTE/TOOTH WITHIN TOOTH has been
classified into three types based on severity, from simple to more complex.
 Type 1 is an invagination that is confined to the crown.
 Type 2 is an invagination that extends past the cementoenamel junction but does
not involve the periradicular tissues.
 Type 3 is an invagination that extends beyond the cementoenamel junction and can
have a second apical foramen. Often surgical and orthograde root canal therapy is
necessary to treat this condition.*
COHEN PATHWAYS OF PULP 10TH EDITION

37. DENS INVAGINATUS
37
An update on the diagnosis and treatment of dens invaginatus
J Zhu, X Wang, Y Fang, JW Von den Hoff, L Meng, Australian Dental Journal https://doi.org/10.1111/adj.12513

38.  Treatment for Type I dens invaginatus includes minimally invasive procedures and
sealing of the defect with restorative materials. Bishop (2008) indicated that minor
debridement with ultrasonic instruments and use of sealants may be successful in
Type I and Type II cases
 In cases where pulpal involvement is foreseen, the treatment could range from
conservative pulpotomy to a full-fledged root canal treatment. Use of aqueous
intracanal medicaments and thermoplasticizing techniques have been seen to
provide successful results.
 Surgical treatments may be indicated in cases of dens invaginatus with extensive
infection in the periapical region as well as in cases of Type III with complex root
canal anatomy and incomplete root canal development. Methods that have been
utilised include: intentional reimplantation and removal of invaginated portion. A
tooth with dens invaginatus having severe mobility, pulpal and periapical infection
may need to be extracted.
38
Kallianpur, Shreenivas & Sudheendra, Us & Kasetty, Sowmya & Joshi, Prathamesh. (2012). Dens invaginatus (Type III B).
Journal of oral and maxillofacial pathology : JOMFP. 16. 262-5. 10.4103/0973-029X.99084.

39. PALATO GINGIVAL GROOVE
39
Attam K, Tiwary R, Talwar S, Lamba AK. Palatogingival groove: endodontic-periodontal management—case report.
Journal of endodontics. 2010 Oct 1;36(10):1717-20.
Palato-radicular
Groove
Disto-lingual
Groove
Radicular
Lingual Groove
 Corono-
radicular
Groove
Cingulo-
radicular Groove
 Vertical
developmental
Radicular Groove
and Interruption
Groove

40. 40

41. MAXILLARY CANINE
41
Average Length 26.5 mm
No. of Roots 01
No. of Canals 01 (96.5%)
02 (3.5%)
COHEN PATHWAYS OF PULP 10TH EDITION

42. MAXILLARY FIRST PREMOLAR
Average Length 20.6 mm
No. of Roots 2-3
No. of Canals 1 – 06%
2 – 95%
3 – 01%
42
COHEN PATHWAYS OF PULP 10TH EDITION

43. 43
Examples of upper premolars with
three roots.
The roots of upper first
premolars are very delicate and
may curve quite sharply
buccally,palatally, mesially or
distally, so instrumentation needs
to be carried out with great care.
Cross-sections
taken at different
levels in a maxillary
first premolar showing
the division of the
buccal canal.

44.  Because of the mesial concavity of the root,
the clinician must take care not to overextend
the preparation in that direction, as this could
result in perforation.
 Possibility of isthmus is 16% at 1mm from the
apex
 They have the 48% of multiple foraminas at
the apex
 largest accessory foramina of diameter 53um
mean value, and most complicated root
morphology, so possible reason for failure
44
COHEN PATHWAYS OF PULP 10TH EDITION

45. MAXILLARY SECOND PREMOLAR
Average Length 21.5 mm
No. of Roots 1 – 3
No. of Canals 1 – 75%
2 – 24%
3 – 01%
45
COHEN PATHWAYS OF PULP 10TH EDITION

46. MAXILLARY FIRST MOLAR
Average Length 20.8 mm
No. of Roots 03
No. of Canals 04 – 93%
03 – 07%
46
The maxillary first molar is the largest tooth in volume and one of the most
complex in root and canal anatomy .
The three individual roots of the maxillary first molar (i.e., mesiobuccal root,
distobuccal root, and palatal root) form a tripod
A line drawn to connect the three main canal orifices—the mesiobuccal (MB) orifice,
distobuccal (DB) orifice, and palatal (P) orifice—forms a triangle, known as the molar
triangle.

47. 47
 The clinician must always keep in mind
that the location of the MB-2 canal
varies greatly; Usually 54.3% increased
to 62%) this canal generally is located
mesial to or directly on a line between
the MB-1 and palatal orifices, within 3.5
mm palatally and 2 mm mesially of the
MB-1 orifice These authors found that
not all MB-2 orifices lead to a true canal.
A true MB-2 orifice was present in only
84% of molars in which a second orifice
was identified.
COHEN PATHWAYS OF PULP 10TH EDITION

48. 48
 Troughing or countersinking with
ultrasonic tips mesially and apically
along the mesiobuccal pulpal groove .
This procedure causes the canal, when
present, to shift mesially, meaning
that the access wall must be moved
farther mesially. Troughing may need
to be 0.5 to 3 mm deep. Care must be
taken to avoid furcal wall perforation
of this root.
COHEN PATHWAYS OF PULP 10TH EDITION

49. 49

50. 50
The average distance between MB1 and
P was 6.91 ± 1.47 mm, between MB1 and
MB2 2.61 ± 0.64 mm and MB2-T 1.26 ±
0.36 mm. There were no statistically
significant differences in the presence
and/or absence of the MB2 canal in terms
of age or gender
CBCT technique for location of the MB2 canal of maxillary first molar. Pablo Betancourt* , Pablo Navarro, Ramon
Fuentes Biomedical Research 2017; 28 (16): 6937-6941

51. 51
Kottoor J, Velmurugan N, Surendran S. Endodontic management of a maxillary first molar with eight root canal systems evaluated using
cone-beam computed tomography scanning: a case report. Journal of endodontics. 2011 May 1;37(5):715-9.
The MB2 is notoriously challenging to locate and negotiate, but with the
correct magnification, light, equipment, knowledge and experience it can be
treated predictably.

52. MAXILLARY SECOND MOLAR
Average Length 20.0 mm
No. of Roots 03
No. of Canals 04 – 37%
03 – 63%
52
Coronally, the maxillary second molar closely resembles the maxillary first molar. The root
and canal anatomy are similar to those of the first molar, although differences occur.
The distinguishing morphologic feature of the maxillary second molar is that its three roots
are grouped closer together and are sometimes fused. Also, they generally are shorter than
the roots of the first molar and not as curved.

53. 53
When four canals are present, the access
cavity preparation of the maxillary second
molar has a rhomboid shape and is a smaller
version of the access cavity for the maxillary
first molar . If only three canals MB, DB, and P)
usually form a flat triangle and sometimes
almost a straight line . The mesiobuccal canal
orifice is located more to the buccal and mesial
than in the first molars present, the access
cavity is a rounded triangle with the base to the
buccal.
COHEN PATHWAYS OF PULP 10TH EDITION

54. MAXILLARY THIRD MOLAR
Average Length 17.0 mm
No. of Roots 1 - 3
No. of Canals -
54
CBCT images of maxillary 3rd
molar (18) with 5 root canals

55. MANDIBULAR CENTRAL INCISOR
Average Length 20.7 mm
No. of Roots 01
No. of Canals 01 – 58%
02 – 42%
55
Kashid V, Baonerkar H. Mandibular Incisors with Type II Anatomy in a Single Patient: Report of Two Cases. Indian J Oral Health Res 2015;1:74-8

56. MANDIBULAR LATERAL INCISOR
Average Length 20.7 mm
No. of Roots 1 – 2
No. of Canals 01 – 58%
02 – 42%
56

57. MANDIBULAR CANINE
Average Length 25.6 mm
No. of Roots 01
No. of Canals 01 – 94%
02 – 06%
57
Lower canines may
Occasionally(14%) be
found with two
separate roots.
Lateral canals are
seen in 30% of cases
Book ASABDJ. Endodontics: Part 4 Morphology of the root canal system. 2004;197(7):379–83.

58. MANDIBULAR FIRST PREMOLAR
Average Length 21.6 mm
No. of Roots 01
No. of Canals 01 – 73%
02 – 27%
58
 mandibular premolars are difficult to treat.
They have a high flare-up and failure rate.
44% of accessory canals are present
 A possible explanation may be the extreme
variations in root canal morphology in these teeth.
COHEN PATHWAYS OF PULP 10TH EDITION

59. 59
Crowns of mandibular premolars are tilted
lingually relative to their roots , and the starting
location must be adjusted to compensate for
this tilt .
Crown is having 30’ lingual inclination with
that of the root.
In mandibular first premolars the starting
location is halfway up the lingual incline of the
buccal cusp on a line connecting the cusp tips.
Mandibular second premolars require less of an
adjustment because they have less lingual
inclination
COHEN PATHWAYS OF PULP 10TH EDITION

60. MANDIBULAR SECOND PREMOLAR
Average Length 22.3 mm
No. of Roots 01
No. of Canals 01 – 85%
02 – 15%
60
A lower second
premolar with a
severe distal curve at
the apex.

61. MANDIBULAR FIRST MOLAR
Average Length 21.0 mm
No. of Roots 2 – 3
No. of Canals 03 – 67%
04 – 33%
61
It often is extensively restored, and it is subjected to heavy
occlusal stress. Therefore the pulp chamber frequently has
receded or is calcified
The tooth usually has two roots, but occasionally it has
three, with two or three canals in the mesial root and one,
two, or three canals in the distal root.
The canals in the mesial root are the MB and ML canals; a
middle mesial (MM) canal sometimes is present in the
developmental groove between the MB and ML canals

62. RADIX ENTOMOLARIS , RADIX PARAMOLARIS
• The radix entomolaris (RE) is a supernumerary root located distolingually in
mandibular molars prevalence is 3 to 9 % , whereas the radix paramolaris (RP) is an
extra root located mesiobuccally prevalence is 1 to 5 %.
• Each root usually contains a single root canal. The orifice of the RE is located disto-
to mesiolingually from the main canal or canals of the distal root; the orifice of the
RP is located mesio- to distobuccally from the main mesial root canals. A dark line or
groove from the main root canal on the pulp chamber floor leads to these orifices.
62
COHEN PATHWAYS OF PULP 10TH EDITION

63. A - first molar with a radix entomolaris
B - radix entomolaris on a third molar
C - first molar with a separate radix paramolaris
D - first molar with a fused radix paramolaris
63

64. 64
Radix entomolaris Radix paramolaris

65. TAURODONTISM
65

66. 66
Variable dimensions for establishing the
taurodontism index: vertical height of the pulp
chamber (V1),
1. distance between the lowest point of the roof of
the pulp chamber to the apex of the longest root
(V2),
2. and distance between the baseline connecting
the two CEJ and the highest point in the floor of
the pulp chamber (V3).
3. Establishing a condition of taurodontism is made
when V1 is divided by V2 and multiplied by 100
(V1/V2) * 100 .
4. Taurodontic index (TI) =V1/V2 X100.
5. Taurodontism is diagnosed in molars in which TI is
above 20 and variable 3 exceeds 2.5 mm.
Degrees of taurodontism
hypotaurodontism: TI 20–30,
mesotaurodontism: TI 30–40,
hypertaurodontism: TI 40–75.

67. 67
Tsesis I, Shifman A, Kaufman AY. Taurodontism: an endodontic
challenge. Report of a case. Journal of endodontics. 2003 May
1;29(5):353-5.
 In this case, TI equaled 56 and variable 3
equaled 10 mm, clearly indicating
hypertaurodontism.

68. MANDIBULAR SECOND MOLAR
Average Length 19.8 mm
No. of Roots 02
No. of Canals 02 – 13%
03 – 79%
04 – 08%
68

69. C- SHAPED CANALS
 C-shaped canals ( 8-30%)
 The main cause for C-shaped roots and canals is the failure of Hertwig’s epithelial
root sheath to fuse on either the buccal or lingual root surface. The C-shaped canal
system can assume many variations in its morphology
69

70. 70
C shaped canal configuration in mandibular 2nd molar
Jafarzadeh H, Wu Y. The C-shaped Root Canal Configuration : A Review. 2007;33(5):517–23.

71. 71
Mrinalini, Dr & Sodvadia, Urvashi B. & Hegde, Mithra. (2023). Endodontic management of a C-shaped root
canal using thermoplasticised obturation with a modified gutta-percha cartridge design. Case report. The New
Zealand dental journal. 119. 91-94.

72. MANDIBULAR THIRD MOLAR
Average Length 18.5 mm
No. of Roots 1 - 2
No. of Canals -
72
The developmental anatomy of lower third
molars may be quite bizarre.

73. METHODS
FOR DETERMINING
EXTRA CANALS
73

74. Over the period of years, certain techniques have been devised to identify aberrant
anatomy and locating extra canals. These can be summed up as:
1. Multiple radiographs: Well angulated radiographs should be taken. (Mesio-angular,
disto-angular, straight) when evaluating an endodontic failure.
2. Digital radiography: This offers a variety of software features, significantly enhancing
radiographic diagnostics in identifying hidden, calcified or untreated canals.
74
Batra, Dr. (2023). The Six In Six: Management Of A Mandibular First Molar With 4 Distal And 2 Mesial Canals.
Journal of Pharmaceutical Negative Results. 167-172. 10.47750/pnr.2023.14.03.23.

75.  Visual enhancers: Magnifying loupes, head-lamps, transilluminating devices, dental
operating microscopes are used to improve visualization.
75

76.  Micro-Openers (DENTSPLY Maillefer, Tulsa, OK) are excellent instruments for
locating canal orifices when a dental dam has not been placed.
-These flexible, stainless steel hand instruments have #.04 and #.06 tapered tips.
They also have offset handles that provide enhanced visualization of the pulp
chamber.
76

77. 5. Piezoelectric ultrasonic. Troughing of grooves with-ultrasonic tips (CPR tips)
77

78. 6. White line test: Shelf of dentin meets the pulpal floor and forms a groove. Necrotic
tissue and debris forms a white line adjacent to the MB1 canal which can be used to
trace MB2
78

79. 7. Red line test: In vital cases, blood flows into the orifices, fins and isthmus areas, this
appears red adjacent to the MB1 thus serving as a road map for identification of
MB2 canal orifice.
79

80. 8. Dyes: 1% methylene blue dye is irrigated into the pulp chamber and subsequently
rinsed thoroughly with water, dried and visualized to see where the dye has been
absorbed. Frequently the dyes will be absorbed into the orifices, fins and isthmus
areas
80

81. 9.Champagne bubble test using Sodium Hypochlorite: After cleaning and shaping
procedures, the access cavity is flooded with NaOCl and the solution is observed to
see if bubbles are emanating toward the occlusal table from canal orifice. A positive
bubble reaction signifies that NaOCl is -reacting with residual tissue within the
instrumented or the missed canal or with the residual chelator present within the
prepared canal.
81

82. 10.Ruddle‘s solution: This irrigant is a "cocktail" containing 5% sodium hypochlorite
(NaOCl), Hypaque and 17% EDTA. Hypaque is a water-soluble, radiopaque, contrast
solution which can be utilized to visualize root canal system anatomy, monitor the
remaining wall thickness during preparation procedures, detect pathological defects
and manage iatrogenic mishaps. The composition of the Ruddle Solution
simultaneously provides the "solvent action" of fullstrength NaOCl, "visualization" as
its radiopacity closely matches that of gutta-percha .
82
Batra, Dr. (2023). The Six In Six: Management Of A Mandibular First Molar With 4 Distal And 2 Mesial Canals.
Journal of Pharmaceutical Negative Results. 167-172. 10.47750/pnr.2023.14.03.23.

83. CONCLUSION
• Root canal system is extraordinarily complex with numerous intricacies , including
accessory canals and isthami.
• A clinician should open his/her mind to the various possible canal morphologies and
should not stick only to a limited and standard number of canal patterns. These
undetected extra roots or root canals are a major reason for the failure.
• To avoid this, the endodontist must consider the judicious use of high-end diagnostic
imaging techniques for successful management of complicated cases.
• “The eyes can only see what the mind knows”; therefore, the endodontist should be
well-versed with the anatomic variations before and during performing the root canal
therapy.
83

84. REFERENCES
 GROSSMAN -13th EDITION
 COHEN- pathways of pulp 10th EDITION
 INGLE’S – 6th EDITION
 MORPHOLOGY OF ROOT CANAL SYSTEM BRITISH DENTAL JOURANL VOLUME 197.
 Int Endod J. 2017 Aug;50(8):761-770 A new system for classifying root and root canal
morphology.
 http://intranet.tdmu.edu.ua.
 Jafarzadeh H, Wu Y. The C-shaped Root Canal Configuration : A Review.
2007;33(5):517–23.
 Calberson FL, Moor RJ De, Deroose CA. The Radix Entomolaris and Paramolaris :
Clinical Approach in Endodontics. 2007;33(1):58–63
 Book ASABDJ. Endodontics: Part 4 Morphology of the root canal system.
2004;197(7):379–83.
84

85.  Batra, Dr. (2023). The Six In Six: Management Of A Mandibular First Molar With 4
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