Access To Root Canal

System :Anterior Teeth

BDS 8126
Aims:
The educational aims of this lecture are to explain the pulp space
morphology of anterior teeth to establish an understanding of the
shape of access to root canals in those teeth.

Objectives:
On completion of this lecture, the student should have an
understanding of how to assess the root canal system in anterior
teeth keeping in mind the pulp space morphology.
Pulp Space Morphology
Each tooth in the dental arch contains pulp
tissue

The pulp is a connective tissue that is encased within hard

tooth structure
It is located within the center of the tooth and is entirely
enclosed within dentin except at the apical foramen
The pulp space is divided:

1- Coronal pulp space: it is the space

occupied by the pulp tissue within the
crown

A- pulp chamber:
It is the pulp that lies within the
crown of the tooth, the shape of the
pulp chamber usually reflects the
external form of the crown.

B- Pulp horns:
These are accentuations in the roof of
the pulp chamber that lie directly
below cusps and developmental lobes
2-Radicular Pulp:

It is the space occupied by the

pulp tissue within the root
A-Root canal:
It is the part of the pulp space
that lies within the root of the
tooth. It starts by an orifice and
ends by the apical foramen.

B- Accessory canal:
These are lateral branches of the
main root canal communicating
the pulp space with the
periodontium and ending with
accessory foramina
Apical foramen:
It is an aperture near or at the apex of the
root through which blood vessels and nerves
of the pulp would enter or leave the pulp
cavity
 Root Canal Classes
• Root canals can be classified according to
maturity ( completion of root formation) and
curvatures into:
➢ Class I
➢Class II
➢Class III
 Mature:
CLASS I

Straight
CLASS II Curved
Slight Severe Dilacerated Bayonet
CLASS III
Immature
Tubular Blunder Buss
 Types Of Root Canal
Configurations

• Developed by Weine to describe the

different possible configurations of
the root canal systems within the
single root
Root canal system may take one of these
forms: Wiene’s classification

Type I :
•Single orifice
•Single canal
•Single apical foramen
Type II :

 Two orifices.
 Two root canals.
 One apical foramen.
Type III :

 Two orifices
 Two root canals
 Two apical foramina.
Type IV:

 One orifice.
 Single root canal.
 Two apical foramina.
Type V

 One orifice with single canal

 Splits into two canals then
join to exit
 One apical foramen
Type VI
 Two orifices
 Two canals join into on canal
and then split into two canals
with
 Two apical foramina
 Types Orifice Root canal Apical foramen

Type I 1 1 1

Type II 2 2 1
Type VI
Type III 2 2 2

Type IV 1 1 2

Type V 1 2 1

Type VI 2 1 2
Pulp Space Morphology of
Anterior Teeth
Pulp anatomy:
1-Number of roots.
2- Number of root canals.
3- Number of pulp horns.
4- Access cavity and outline form
5-Mesiodistal dimension and bucco-lingual dimension.
6- Cross section of the root.
Maxillary Central
Incisor
1-Number of roots: one root (100%)
2-Number of root canals: One root
canal (Type I)
3-Number of pulp horns:
Three pulp horns in newly erupted
teeth.
4-Outline form:
From palatal surface & triangular in
shape
5- MD--BL dimension:
Wider mesiodistally than
buccolingually.
 6- Root canal cross-section:
•Cervical, nearly triangular with base labially and apex
lingually.
•Middle, is ovoid.
•Apical, round in shape.
Apical

Middle

Cervical
Maxillary lateral
Incisor
Similar to morphology of maxillary central incisor
with very little differences.
1-Number of roots:
One root 100%
2-Number of root canals:
One root canal (Type I)
3-Three pulp horns
4-Outline form:
From palatal surface &
triangular in shape
The external access outline form for the
maxillary lateral incisor may be a rounded
triangle or an oval, depending on the
prominence of the mesial and distal pulp
horns
 5-Mesiodistal view
Same as the maxillary central incisor except for 3 differences:

a- Wider buccolingually than mesiodistally

b- Crown is smaller
c- The root has a curvature in a distal and palatal direction
6-Root cross-section:
•same as the maxillary central incisor.
•Cervical triangular or oval in labiolingual direction

ApicaL

middle

cervical
Maxillary Canine
1-Number of roots: One root 100%
2-Number of root canals: One root
canal Type I.
3- No of pulp horn: one pulp horn
4-Access cavity preparation &
outline form:

From palatal surface Oval in shape

5- MD-BL dimension:
• The pulp chamber is very wide
BL than MD
6-Root cross-section
Apical

Middle

Cervical
Mandibular Incisors
1-Number of roots:
•One root usually
2-Number of root canals:
•One canal 60-70% Type I
•Two canals 30-40%
• Type II
• Type III
3- Three pulp horns
4-Access cavity preparation & outline
form:
•From lingual surface & triangular in
shape
•5-MD-BL
•The pulp chamber is wide BLthan MD
6-Cross section

Apical

Middle

Cervical
Mandibular Canine
1-Number of roots : 1 root (rarely 2
roots can be found buccal and
lingual)

2-Canal type: type I 94%

type II or III 6 %
3-Access cavity & outline form:
From lingual surface Oval in
shape (incisocervical direction)
4- MD-BL dimension:
• The pulp chamber is very wide BL
than MD
6-Root canal cross-section
•Cervical, cross section of the root is oval labiolingually.
•Middle, cross-section is oval to ovoid.
•Apical, the canal is round in cross-section

Apical

middle

cervical
 Presented by:

Shaimaa Gawdat
Lecturer Of Endodontics, Cairo University
 Endodontic Cavity Preparation

IntraCoronal IntraRadicular
cavity preparation cavity preparation
(Access Cavity ) (Cleaning and
Shaping)
 Access is the key that opens the door to
maximize cleaning, shaping and obturation
 Access Leads to Success

Creation of an opening from the

external surface of the tooth to the
pulp chamber projecting out its
side walls and internal
anatomy to the outside
Principals Of Access
Cavity Preparation
 Outline form

Removal
Convenience of
form carious
dentine

Toilet of the
cavity
 Principle I: Outline Form:

It should be correctly shaped to project the

internal anatomy of the pulp to the outer surface
& positioned to establish complete access for
instrumentation from cavity margin to the apical
foramen.
 Factors affecting Outline Form
1) Shape of the pulp chamber.
e.g.
* Incisor ---} Triangular in shape
based incisally & apex
cervically.
* Canines ---} Oval Inciso-cervically
2) Size of the pulp chamber
(age)
3) Number, Position &
Curvature/ Direction of root canals
(accommodate all canals to be prepared
without interference).
 Principle II: Convenience Form:

Modification of the cavity

outline form to establish
greater convenience (visibility
and accessibility) in the
preparation
as well as obturation of the
root canals
 Benefits of Convenience Form:

1) Unobstructed (Straight line)

access to the canal orifice &
searching for extra canal

Without interference
2) Direct access to the apical
foramen
Without strain
3) Complete authority
over the enlarging
instruments.

4) Cavity expansion to
accommodate filling
techniques.
Principles III: Removal of the Remaining Carious
Dentin & Defective Restorations:
Benefits:
1) To eliminate mechanically as many micro-organisms as possible
from the interior of the tooth.
2) To eliminate the discolored tooth structure.
3) To eliminate the possibility of micro-organisms entrance with
saliva leakage through defective restoration.
4) To avoid detached tooth or restoration particles from entering &
occluding the RCs.
5) To assess the restorability of the tooth.
Removal of Unsupported Tooth Structure:

Unsupported tooth structure should be removed to prevent

tooth fracture during or between procedures.
 Principle IV: Toilet of the cavity:
(Irrigation of the Cavity)

All the detached carious dentin, debris & necrotic

material must be flushed away from the pulp
chamber before Radicular preparation to avoid:

1) Obstruction of the canal during enlargement.

2) Increase bacterial population within the canal

3) Discoloration of the crown.

 Endodontic Coronal cavity preparation of maxillary and mandibular
anteriors :
1- Point of entry:
- On the lingual surface at the middle-middle third
- If there is incisal attrition and you are unable to divide the lingual
surface into thirds so → above the cingulum

2- Steps:
i- Gaining access
ii- Deroofing
iii- Flaring
 2- Steps:
i- Gaining access
- Initial penetration is made with round bur.
- Bur is held perpendicular to long axis to create an indentation or until
reaching the dentine to avoid slippage
- Then it is directed 45 degree to the long axis of the tooth till penetration
of pulp chamber
- The operator will feel two drops during gaining access.

Two Drops

Drop into the

Drop into dentin pulp chamber
 Can we start with the 45° angle?
Are the 2 drops felt in all teeth or not?
2- Steps:
ii- Deroofing
Carried out using round bur or tapered stone with round end using
motion from inside pulp chamber to outside (brushing motion) to
remove the pulp horns.
 2- Steps:
iii- Flaring
• It is done using tapered stone with round end for smoothening and finishing for
cavity dentinal walls and margins.
• Tapered diamond stone then penetrates to the pulp chamber parallel to tooth
long axis.
Errors In Access Cavity
Preparation
 Discolouration
Gouging
Ledge

Perforation
Aims:
The educational aims of this lecture are to explain the pulp space
morphology of anterior teeth to establish an understanding of the
shape of access to root canals in those teeth.

Objectives:
On completion of this lecture, the student should have an
understanding of how to assess the root canal system in anterior
teeth keeping in mind the pulp space morphology.
Reading material:

-The dental reference manual, Geraldine M. Weinstein, springer 2017 (Chapter 12)
-Essential skills for dentists, Peter A.Mossey et al, Oxford, 2006 (Chapter 2.6)
-Endodontics, Kishor Gulabivala and Yuan-Ling NG, Mosby Elsevier 2014
-Harty`s endodontics in clinical practice, Bun San Chong, Elsevier 2017
-Clinical endodontics, Lief Tronstad, Thieme 2009 (main reference)
 Thank you

Date : xx / xx / xxxx