VARIATION OF PULP SPACE Dr.

Ahmed Albittar
Lecturer at Al-Azhar University
MORPHOLOGY *4* (Gaza/Palestine)
 Methods of studying morphology:
 
• In Vivo…… clinical examination
 
• In Vitro…..
 
1. Ground section
2. Radiography: ( periapical radiographs - CBCT - microcomputed tomography (μCT)
scanning of teeth)
3. Clearing Method : Clearing started by demineralization by immersion in 5% nitric
acid* until teeth become completely decalcified and rubbery. Then teeth are washed
under running water to remove any acid residues.

Then teeth are dehydrated in alcohol. Teeth then immersed clearing solution
which is methyl salicylate solution*, until becoming completely transparent.
 
Finally, Indian ink** is injected into the pulp chambers.
 
The teeth are then viewed using transmitted light to observe the number of root canals,
their configurations, lateral canals, inter-canal communications, deltas and apical foramina.
μCT scans of maxillary central incisors

.
A, Common anatomic presentation B, Central incisor with a lateral canal, which is common
 COMPONENTS OF THE ROOT CANAL SYSTEM:
 
 The root canal system is divided into two portions: the pulp chamber, located in the anatomic crown of the tooth,
and the root canal found in the anatomic root.

 Other notable features are the pulp horns; accessory, lateral, and furcation canals; canal orifices; apical
deltas; and apical foramina.

 The pulp horns are important because the pulp in them is often exposed by caries, trauma, or mechanical invasion,
which usually necessitates vital pulp or root canal procedures.

 Accessory canals are minute canals that extend in a horizontal or a vertical direction from the pulp space to the
periodontium.
 In 74% of cases they are found in the apical third of the root, in 11% in the middle third, and in 15% in the
cervical third.
 Accessory canals contain connective tissue and vessels but do not supply the pulp with sufficient
circulation to form a collateral source of blood flow.
 They are formed by the entrapment of periodontal vessels in Hertwig’s epithelial root sheath during
calcification.
 They play a significant role in the communication of disease processes, serving as avenues for the passage
of irritants, primarily from the pulp to the periodontium, although communication may occur from either
tissue.
 Accessory canals that are present in the bifurcation or trifurcation of multirooted teeth are referred to as
furcation canals .These channels form as a result of the entrapment of periodontal vessels during the fusion
of the diaphragm.

Pulpal inflammation can communicate to the periodontium via these canals, and the result is furcation lesions in the absence
of demonstrable periodontal disease..
 Clinical Determination of the Root Canal Configuration

 Examination of the pulp chamber floor can reveal clues to the location of orifices and to
the type of canal system present. It is important to note that if only one canal is present, it
usually is located in the center of the access preparation. All such orifices, particularly if
oval shaped, should be explored thoroughly with small, stiff K-files that have a smooth to
sharp bend in the apical 1 to 2 mm.

 If only one orifice is found and it is not in the center of the root, another orifice probably
exists, and the clinician should search for it on the opposite side.

 The relationship of the two orifices to each other is also significant. The closer they are,
the greater the chance the two canals join at some point in the body of the root. As the
distance between orifices in a root increases, the greater is the chance the canals will
remain separate. The more separation between orifices, the less the degree of canal
curvature.

 The direction a file takes when introduced into an orifice is also important. If the first file
inserted into the distal canal of a mandibular molar points either in a buccal or lingual
direction, a second canal is present. If two canals are present, they will be smaller than a
single canal.
CLASSIFICATION :
FACTORS AFFECTING
INTERNAL ANATOMY
Internal anatomy of teeth ,reflects the tooth form ,yet various
environmental factors whether physiological or pathological
affect its shape and size because of pulpal and dentinal reaction to
them.
• AGE
• IRRITANTS
• CALCIFICATIONS
• RESORPTION
AGE With advancing age , there is continued dentin formation causing regression in shape and size of pulp cavity.
Clinically it may pose problems in locating the pulp chamber and canals.

IRRITANTS Various irritants like caries, periodontal disease , attrition, abrasion, erosion, cavity preparation
and other operative procedures may stimulate dentin formation at the base of tubules resulting in change in shape of
pulp cavity.

CALCIFICATIONS pulp stones or diffuse calcifications are usually present in chamber and the radicular
pulp. These alter the internal anatomy of teeth and may make the process of canal location difficult.

RESORPTION Chronic inflammation or for unknown cause internal resorption may result in change of
shape of pulp cavity making the treatment of such teeth challenging.
RADIX ENTOMOLARIS
 Molars are frequently affected by caries at an early
age and require successful endodontic treatment

 Mandibular molars can have an additional root located

lingually (the Radix Entomolaris) or buccally (the Radix
Paramolaris)
 Failure to diagnose and treat the extra roots in molars may lead to the endodontic
treatment failure
 Radix entomolaris (RE) is one of the anatomical variant found in a permanent Mandibular molar

 First described by carabelli in 1844 and described by various terms, such as “extra third root” or
“distolingual root” or “extra distolingual root”

 It can be found in the first, second and third mandibular Molars, occurring the least frequently in
the second molar
 Radix entomolaris (RE) Characterized by the presence
of an additional or extra third root, which is typically
found disto-lingually
 Radix paramolaris (RP) is known as the “mesiobuccal
root” (Carlsen et al, 1991) and was first described by Bolk in 1915
 Radix paramolaris is seen buccally to the mesial root and may found separate or fused with the
mesial root
 Endodontic success in the presence of Radix entomolaris depends on its diagnosis, anatomy or morphology,
canal configuration and clinical approach employed

 An accurate diagnosis of Radix entomolaris can avoid complications like missed canal which is a common
reason for endodontic Failure

 Detection of Radix entomolaris can be based on clinical examination, radiographic and imaging techniques

 It was reported that the radiographs were successful in over 90% of the cases while identifying additional
roots but superimposition of the distal roots can be limiting factor
 An angled radiograph (25-30°) can be more useful in this regard and it is said that a mesial angled
radiograph is better than a distal angled radiograph for Radix entomolaris detection. (Saudi Endodontic
Journal 2014;4(2):77-82)

 Apart from a radiographical diagnosis, clinical inspection of the tooth crown and analysis of the
cervical morphology of the roots by means of periodontal probing can facilitate identification of an
additional root

 Three-dimensional imaging techniques based on computed tomography (CT) and cone beam computed
tomography (CBCT) are useful for visualizing or studying the true morphology of an Radix
entomolaris in a noninvasive manner using less radiation
 Extra roots and extra canals:
1. Trifurcated maxillary premolars "molarized" having 2b & 1p roots (6%)
2. Maxillary first molars: each root shows different canal number;
- MB root: 2-3 canals
- DB root: 1-2 canals
- Palatal root: 1-2 canals
3. Maxillary canines: 3% have canals.
4. Mandibular incisors: 2 root canals (30-40%) of which type II > type III.
5. Furcated mandibular premolars: 2 canals.
6. Mandibular first molar.
3 rooted: extra root is called; "radio endomolaris"
3 RC in the mesial root (MB, ML& middle mesial)