Good morning

contents
◦ Introduction
◦ Learning objectives
◦ Normal tooth structure
◦ Components of pulp system
◦ Comparative study of deciduous and
permanent tooth structure
◦ Techniques for visualization of internal
anatomy
Detailed study of internal anatomy of
permanent tooth
Detailed study of internal anatomy of
deciduous teeth
Variation in normal pulpal structure and its
significance
◦ Physiological
◦ Pathological
◦ Development
◦ Others
Conclusion
References
 INTRODUCTION
introduction
Learning objectives

tooth
Normal tooth structure
 Components of pulp system

Coronal pulp

Radicular
pulp
 Coronal pulp
Located centrally
Six surfaces
Dentinal maps are present in the floor

Pulp horns- these are the

projections/prolongations of roof of the
pulp corresponding to major cusps or
lobes
Radicular pulp
Radicular pulp is that pulp extending
from cervical region of the crown to root
apex

Canal cofigurations
Accessory canals
Furcation canal
isthmus
According to wiene
According to vertucci
According to gulabiwala &
coworkers
According to grossman
Type 1-single canal from pulp chamber to
apex
Type 2-two separate distinct canals
leaving the chamber
Type 3-one canal leaving the pulp
chamber but dividing short of apex into
separate canals
Type 4-two canals leaving the pulp
chamber to merge short of apex into one
canal
Accessory canals

73.5% - apical 1/3rd

11.4% - middle 1/3rd
15.1% - cervical 1/3rd

These canals contain connective tissue

and vessels but do not supply pulp with
collateral circulation.
 formation
 Size - 6-60 microns
 Detection Thickening of periodontal ligament
 frank leisons on the lateral wall of root
 post obturation radiograph

 Clinical significance
acts as avenues for exchange /passage of irritants
Furcation canals

Named by vertucci & williams

Formation = entrapment of periodontal

vesels during fusion of the diaphragm
diameter= 4-720 microns
 More common in
mandibular molars
 Three distinct patterns

 Clinical significance
 Cause for primary
endodontic leisons in
furcation area
ISTHMUS

Also known as
Transverse anastomosis(vertucci 1984)
Corridor(green 1973)
Lateral connection (pineda 1973)
Kim et al has identified
Clinical significance

Isthmus must be suspected when multiple

canals are seen on resected root surface

These must be prepared and filled during

surgery as these act as reservoir of bacteria
 Anatomy of apical root
Apical constriction

Cementodentinaljunction

Apical foramen
 Apical constriction
 Considered as part of root canal with smallest
diameter/minor apical diameter
 Reference point for clinicians
 Generally 0.5-1.5 mm inside of apical foramen/major
apical diameter
 Morning glory appearance
 Age cosiderations(0.5-0.67)
Apical foramen
It is the circumference/rounded edge like
a funnel/crater that differentiates the
termination of cemental canal from
external surface of root
Diameter-) 502microns(18-25 yrs
681microns(over 55yrs)
 0.5-3mm offset to anatomic apex
Cementodentinal junction
Considered a variable junction where two
histologic tissues meet in root canal

1 mm from apical foramen

Extent of cemental deposition varies with

wall
Apical delta
 Pulpal tissue
Coronal pulpal tissue Apical pulpal tissue
Contains mainly cellular Fewer cellular connective
connective tissue tissue

Fewer collagen fibres More collagen fibres

Yamashi et al (1986)
showed large
concentration of
Glycogen
Comparative study of structure of
permanent & deciduous teeth
Techniques for visualization of internal
anatomy
Diagnostic measures
Radiography
Dyes, (India ink, Haematoxylin )
Clearing agents (using xylene,benzene).
SEM (scanning electron microscope).
Dental operating microscope.
Fiberoptic endoscopy
 Diagnostic measures

Ultrasonic tips Champagne bubble test

Endodontic explorer
Radiography

Two or more periapical

radiograph at different
horizontal angulations for
assesing the number and
position
Scanning electron microscope
 determine the number and size of main apical foramen
 distance from the anatomic apex
 size of accessory foramina.

Dental operating microscope

effective for locating MB-2 canals
 DOM makes canal easier to locate
 by magnifying and illuminating the grooves in the pulpal
floor
.  distinguishing the color differences of the dentin of floor and
walls.
Fiberoptic endoscopy

currently there exists two diameter sizes of flexible fiberoptic probes used
in endodontic

.
1.8 mm (30,000 visual fiber).
0.7 mm (10000 visual fiber).
Maxillary central incisor
 Average tooth length-
22.5 mm
 Pulp chamber
 wider mesiodistally
than labiolingually
widest part incisaly
 lingual shoulder
 pulp horns
 Root
 Crosssection
 Anatomic relationship in situ
 The labial surface of the root lies
under the labial cortical plate of
maxilla
 Relationship to nasal floor

 Maxillarycentral incisor 2
mesioaxial.

29palatoaxial
 Clinical significance
 Lingual shoulder should be removed for
straight line access.

 Outline of access cavity changes to more

oval shape as tooth matures and pulp
horns recede

 it serve as guide for palatine injection

Maxillary lateral incisor
 Average tooth length-
22mm
 Pulp chamber
 The outline chamber is
similar to central
except it is smaller.
 Two or no pulp horns
 Root
 Cross section
 Anatomic relationship in situ
 The labial surface of root of the maxillary
lateral under the cortical plate of maxilla.

 Location in alveolus - 16mesioaxial

 29palatoaxial
Clinical significance
In cases of Dens invaginatus, peg lateral,
Talons cusp require modification in
access opening.
Two or three canals have been reported
Maxillary canine
 Aeverage tooth length-
26.5mm
 Pulp chamber
 are largest of any
single rooted teeth
 wider labiolingually
than mesiodistally
 No pulp horns
 Root –wider labiopalatally
 Cross sections
 Anatomic relationship in situ
 An abscess usually perforates labial
cortical plate.

 If
below the insertion of levatormuscle –
Buccal vestibule.

 Itabove the insertion – canine space 

cellulites.
 Clinical significance
Buccal bone over canine eminence
disintegrates leading to fenestration.

 Slight permanent apical sensitivity

occasionally occurs after root canal therapy.
This can be corrected by apical root surgery.

Apical curettage may be difficult.

 Maxillary first premolar
 Average tooth length-
20.6mm
 Pulp chamber
 wider bucco lingually
and narrow mesiodistally.
 two pulp horns
 buccal>palatal
Roots 2 roots in 54.6% cases.
 separated (21.9%)
 partially fused(32.7%)

 Irrespective or whether it has one root / two root it has 2
canals at the apex in 69% cases.

 The palatal canal is larger of the two and is directly under

palatal cusp and its orifice can be penetrated by following the
palatal wall of pulp chamber.
 Cross sections

 Anatomic relations in situ

 Relationship of the socket with alveolar process
varies with the number of roots.
 If one root then the socket is in close
relationship to buccal cortical plate.
 If two roots buccal is close to buccal cortical
plate and palatal is centrally located.
 Clinical significance
 The outline form of cavity preparation
varies with the number of canals.

 two canals--- access opening is oval / slot

shaped wide buccolignually.
 three canals outline form---- triangular

Prone to mesio distal fracture so full coverage

restoration is required after root canal
treatment.
 Maxillary second premolar
 Average tooth length-21.5mm
 Pulp chamber
 more wider buccopalatally than
the first premolar.
 if one root canal present then
the canal orifice may be
indistinct but if two canals are
present the two orifices will be
visible.
 Root canals
 Single root – 90.3%
 2 well developed roots – 2%
 Partially fused 2 roots – 7.7%.

 CROSS SECTION :
 Cervical – Ovoid and narrow
 Middle 1/3 – Ovoid (1 canal); round (2 canal)
 Apical 1/3 – Round.

 Anatomical relations in situ

close relationship with maxillary sinus
Clinical significance
 Depending on the number of canals
the external outline form varies.
One canal : Buccolingual width
corresponds to width between buccal and
palatal pulp horns.
Two canals : Access preparation is nearly
identical to first premolar.
Three canals : The access outline form is
same triangular shape.
Maxillary first molar
 Aeverage tooth length-
20.8mm
 Pulp chamber
 Largest in the arch
 Roof– rhomboidal
 floor triangular in
cross section
 Orifices
 Palatal-largest round

 Mesiobuccal-under the
mesiobuccal cusp
long buccopalatally

 Distobuccal- distal and to

palatal mesiobucal orifice
 Dilemma of mb2

 generally present mesial

to or directly on a line
joining MB – 1 and
palates orifice

.
 20 distal eccentric
angulation be used
Negotiation of MB-2 is often difficult is

 a ledge or dentin covers its orifice.

 orifice has a mesiobuccal inclination on the pulpal
floor
canal’s pathway often takes one or two abrupt curves
in coronal part of the root.

These can be eliminated by troughing and

countersinking by ultrasonic tips.
Roots
Palatal-largest, flat ribbon like wider
mesiodistaly

Distobuccal-small, narrow,flattenned
mesiodistally

Mesiobuccal –narrowest ,flattened in

mesiodistal direction at orifice ,but round in
apical 3rd
Anatomical relationship in situ
Close proximity to maxillary sinus

Clinical significance
Pulp stones may be present
 concavity exists on the distal aspect or mesiobuccal
root
Maxillary second molar
 Average tooth length-
20 mm
 Pulp chamber

 Similar to maxillary
first molar except it is
narrower mesiodistally
Root
maxillary second molar has 3 roots which are
closely grouped.
fourth canal is less frequent
If the buccal roots fuse -2 canals (1 buccal, 1
palatal).
A tooth with only 1 root -1 conical root canal

Anatomic relationship in situ

 Clinical significance
Access cavity varies number of canals
Four – Rhomboidal
Three – Triangular
Two – Ovoid widest in buccopalatal direction

Mesial marginal ridge should not be involved.

To enhance radiographic visibility especially

when interferences arises from malar process
Maxillary third molar
Tooth length – 17 mm
Pulp chamber : anatomically resembles
the second molar.
The pulp chamber may vary greatly. This
may have odd shaped chamber with four
or five root canal orifices or a conical
chamber with only on root canal.
Roots
It may have three well developed roots

Root canals vary from 1 to 4 or even five

depending on the number of roots. One may
find a C-shaped pulp chamber with a C-shaped
root canal.
Anatomic Relationship In situ :
The maxillary third molar is closely related to
maxillary sinus and maxillary tuberosity.
 Mandibular central incisor

 Average tooth length-20.7mm

 Pulp chamber:
 Smallest tooth in the arch.
 flat mesiodistally.

 Pulp horns-The three distinct pulp

horns present in recently erupted
tooth
 Roots
 The mandibular central incisor has 1 root flat
and narrow mesiodistaly but wide
labiolingually.
 Cross sections
 Anatomic relationship in situ
 The roots of the anterior teeth are broad
labiolingually occupy most of the alveolar
process

 Location alveolus – 2 mesioaxial

 20 linguoaxial
Clinical significance
Because of small size and internal
anatomy may be most difficult tooth for
access opening.

 Complete removal of lingual shoulder

critical often the second canal is present.
For this one should extend preparation
into lingulum gingivally.
Mandibular lateral incisor
Average tooth length-20.7 mm
Pulp chamber-
configuration similar to mandibular
central except larger dimensions

Roots also show similarity but with

increased dimensions
Location in alveolus – 17 mesioaxial
20 linguoaxial

Root curvature – Straight (Majority)

Distal (sharper)

Clinicalsignificance :
Gemination and fusion are common in
mandibular anterior teeth.
 Mandibular canine
 Average tooth length-25.7mm
 Pulp chamber-
 resembles maxillary canine but it
is smaller in dimensions

 labiolungually chamber narrows to

a point in the incisal third of crown
but it is wide in the cervical third
 Roots
usually has a single root
it may have two (2.3%) cases and two canals
(‘labially; lingually). These canals are narrow
mesiodistally wider labiolingually.

 Cross sections

 Anatomic relationship insitu

Location in alveolus – 13 mesioaxial
15 linguoaxial
Clinical significance
Lingual shoulder must be removed to
gain access to second canal / lingual wall.

Incisal extension can approach incisal

edge for straighten access
Mandibular first premolar
 Average tooth length-
21.6mm

 Itis a transitional
tooth between
anterior and posterior
 Enigma to endodontist
 Root canals :
 The mandibular first
premolar has a short
conical root.
 A single root canal
may divide in apical
third into 2 or 3 root
canals.
.
 Cross sections

 Anatomic relationship insitu

 mental canal and foramen close to root apex .
radiographic appearance may suggest periapical
pathoses.
 Location in alveolus : 14 distoaxial
10 linguoaxial
Mandibular second premolar

 Average tooth length-

22.3mm
 Pulp chamberss

 similar to 1st premolar

except the lingual horn
is more prominent
under a well developed
lingual cusp
 Root
 usually 1 canal exists in 1apical foramen in
97.5%
 In 2.5% cases a single canal may bifurcate
exiting in 2 foramina.

 Cross section

 Anatomic relationship in situ

 Mandibular second premolar is
 in close relationship to mental
 foramen.
Clinical significance
 crown has less lingual inclination----
less extension up the buccal cusp

 lingual half well developed---- access

extension is halfway up the lingual cusp
incline.

In case two lingual cusps

Mandibular first molar
 Average tooth length-
21mm
 Pulp chamber

 Roof –rectangular
 Floor- rhomboidal
 Pulp horns -four
Mesiobuccal -under the
mesiobuccal cusp.
 long shank starlite D-11 explorer is
inserted in mesiobucco apical
inclination
 mesiolingual- a depression
formed by mesial and lingual wall
Distal -is oval in shape with the
widest diameter buccolingually. The
opening is generally located distal to
the buccal groove.
Roots
Usually 2 well differentiated roots
 1 mesial and 1 distal

 wide and flat buccolingually

 a depression in the middle of the root
buccolingually
 Crosssections
 Anatomical relationship in situ

 The mesial root of the mandibular

 molar is in close proximity to buccal
cortical plate
 distal root is centrally located.
 58 buccoaxial in alveolous

 Clinical significance
Mandibular second molar
 Average tooth length-
19.8mm
 Pulp chamber
 The pulp chamber is
smaller than that or
mandibular first molar
and the root canal
orifices are smaller and
closer together.
 Roots
 Majority of mandibular second molars have
 2 roots (71%)
 1 root (27%)
 3 roots (2%)
 Three root canals are usually present in
mandibular second molars.
 Cross section
 Anatomic relationship in situ
 mesial root - more centrally located distal
root - closer to lingual cortical plate.
 52 buccoaxial inclination
Clinical significance
This tooth very close to mandibular canal

The clinician must take care not to allow

instruments or filling material to invade
this space because paresthesia may result.
Mandibular third molar
 Average tooth length-
18.5mm
 Pulp chamber-
 resembles the pulp
chamber of mandibular
first and second molar
. possess many
anomalous
configuration
Roots-
usually has two roots and two canals

Anatomic relationship in situ

alveolar socket may project onto the lingual
plate of the mandible.
 The apex of the root may be in close
proximity to mandibular canal.

Clinical significance
Detailed structure of Deciduous dentition
Maxillary first primary molar
 The pulp cavity
 3-4 pulp horns

 are more sharply pointed

than the corresponding
cusps.

 sizes

 MB>ML>DB
Roots
Usually Maxillary first molar consists of three
roots.
 Mesiobuccal
 Distobuccal – shortest
 Lingual – longest diverages in lingual
direction.
 Maxillary second primary molar

 Pulp cavity
 A pulp chamber & three canals
 Four pulp horns &a fifth one
projecting lingually
 Sizes
 MB>ML>DB>DL
ROOTS

 There are three pulp canals corresponding to the three roots.

 These leave the floor of the chamber at the mesiobuccal and

distobuccal corners and from the lingual area.

 The root canals follow the general contour of the roots.

Maxillary primary incisor
Pulp cavity

Tapers cervically in mesiodistal direction

Widest at cervical labiolingually

No distinct demarcation between pulp

chamber and canal
Maxillary lateral differs from central as

Mesiodistally less wider

Labial surface more flatter
Cingulum not so flattened
Slight demarcation exists

Roots
Single and conical
 Mandibular first primary molar

Pulp chamber

Occlusally rhomboidal

Four pulpal horns

Sizes
MB>DB>ML>DL
Roots
A mesiobuccal and mesiolingual are confluent and leave the
chamber widened buccolingually

 Distal pulp canal projects from the floor of the chamber in the
distal aspect.

 This canal is wide buccolingaully and may be constricted in

center reflecting the outside contour of the root.
 Mandibular second primary molar
Pulp cavity

Pulp chamber and three root canals

Five pulp horns

Roof of the pulp chamber extremely

concave towards
Apices

Sizes
MB>ML>DB>DL>D
Roots

 The two mesial pulp canals are confluent

 common orifice that is wide buccolingually but narrow

mesiodistally

 soon divide into largerMB& smallerML

 Distal is constrictted in the center

 All taper towards the apical foramen

 Mandibular primary incisor
Pulp cavity
 widest mesiodistally at the roof

 Labiolingually the is widest at the cingulum.

 definite demarcation

roots
 Slightly flattened on its mesial and distal aspects and tapres
towards apex
Maxillary cuspids
Pulp cavity
Central pulp horn projecting incisally
No demarcation

Roots
Long thick in diameter
Flattened md
Rounded apex
Mandibular cuspids
Pulp cavity
Follows the external contour
As wide md as labiolingually
No demarcation

Roots
Broader labially
Flattened mesial &distal surfaces
 Variations to normal pulpal structure

Factors

Physiological

Development
al

Pathological

Others
 Physiological factors
Age
 predominantly in certain areas.
molars the roof and floor of the chamber show
more dentin
 making the chamber almost disc like in
configuration.

Clinicalsignificance
Locating canals &chamber more difficult
 Pathological factors
Irritants
Caries, periodontal disease
Abrasion,erosion, attrition
cavity preparation,
 root planning and cusp fractures.
 Vital pulp therapy such as pulpotomy pulp
capping or placement of irritating materials
 calcifications
difffuse

calcifications
true

Pulp stones

false
 Internal resorption
 Most resorption are small and
not detectable on radiograph or
during canal preparation.
 When visible radiographically
they are usually extensive and
often perforate.

 Clinical significance
Developmental factors
 Densin dente
 Formation

 Causes

 common in lateral incisor

 Clinical significance
Dens evaginatus
 Pathogenesis
 Clinical significance
 High pulp horns

 Lingual grooves

 Dilacerations
 C shaped canals
 The C-shaped canal was
first reported in 1979
 mandibular second molar.
 cross sectional
morphology of their roots
and root canals is a single
ribbon orifice with an arc
of 180 or more.
 classification
Meltons classification

Fans classification
 Diagnosis
 Preoperative radigraph +20 mesial/distal projection
 Fiberoptic illumination

 Clinical diagnosis
 Persistance of pain & haemorrhage ----separate canals
found
 Pulp chamber large in occlusoapical dimension with low
bifurcation
 Several orifices at the outset----------link up on futher
instrumentation
 Must be suspected roots are close / fused
 Endodontic considerations

 Neccesity of deep orifice preparation

 Extravagant use of small files & irrigants

 Alternative canal cleaning techniques(ultrasonics)

 Absenecof furca containdicates hemisection & root

Amputation

 For post placement distal canal should be considered

Conclusion

The eyes do not see what

The mind doesn’t know
REFERENCES
Pathways of the pulp; 9th edition;
Cohe
Endodontic therapy;Weine; 6th edition
Endodontic practice; Grossman;11th
edition
JOE; 2001; vol 27; N0 2; 128.
JOE; 2007; No 5; Vol 33; 517-
524.509-511
Textbook of pedodontics finn

Ingle 5th edition

Textbook of oral histology orbans