MACROSCOPIC ANATOMY AND

PULP SPACE MORPHOLOGY

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  The pulp is a connective tissue that is surrounded by dentin.

 The pulp space is the central cavity within a tooth that is entirely
enclosed by dentin except at the apical foramen.

Components of the pulp space:

 The pulp space is divided into coronal pulp and radicular pulp.

1. Coronal pulp: a) Pulp chamber

b) Pulp horns

2. Radicular pulp: a) Root canal

b) Accessory (lateral) canals

Major anatomic components of the pulp

1. Coronal pulp
It is the space occupied by the pulp tissue within the crown.
a. Pulp chamber
 It occupies the crown and trunk of the root.
 The shape reflects the external form of the crown.
 It has a roof, floor and side walls.

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b. Pulp horn
 It is an accentuation in the roof of the pulp chamber.
 Single pulp horn associated with each cusp in posterior tooth.

2. Radicular pulp
It is the space occupied by the pulp tissue within the root.
a. Root canal
 It starts by a funneled orifice and ends by an apical foramen.
 Its narrowest diameter is found at the apical constriction in the majority
of the cases.
b. Accessory (lateral) canals
 An accessory canal is any branch of the main canal or pulp chamber
that communicating the pulp with the periodontium (is a minute canal
that extends in a horizontal, vertical or lateral direction from the pulp
to the periodontium).
 A distinction sometimes could be made between the accessory and
lateral canals in that the lateral canal is an accessory canal located
in the coronal or middle third of the root, usually extending
horizontally from the main root canal.
 Accessory canals may also occur in the bifurcation or trifurcation of
multirooted teeth and they are called furcation canals.
 Etiology:
a. Early degeneration of the epithelial root sheath of Hertwig before
the differentiation of the odontoblasts (root dentin formation).
b. Lack of complete union of the epithelial diaphragm which become
the floor of the pulp chamber.
c. Entrapment of blood vessel within the epithelial root sheath of
Hertwig.
 Accessory canals can be present anywhere along the root but the
majority are found in:
- The apical third of the root than the coronal thirds.

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 - The posterior teeth than in anterior teeth.
- Furcation area of molars.
 Clinical significance:
- The accessory canals contain connective tissues and blood vessels
that connect the circulatory system of the pulp with the
periodontium.
- Patent accessory canals are potential pathways for spread of
microorganisms and their toxic byproducts and other irritants
primarily from the pulp to the periodontium and vice versa.
- Furcation canals in molars may also be a direct pathway of
communication between the pulp and the periodontium.
 Alterations in the pulp space:
The pulp and dentin react to their environment, so changes in the
shape and size of the pulp cavity occur with increasing age and in
response to irritation.

Age:
Dentin formation tends to occur with age on all surfaces. In molars, the roof
and floor of the chamber show more dentin formation.
Irritants:
Anything that exposes dentin to the oral cavity can potentially
stimulate increased dentin formation at the base of dentinal tubules in the
underlying pulp, such as caries, erosion, attrition or cavity preparation.

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 Secondary dentin deposition with time and tertary dentin due to irritation

Calcification:
Calcification take two basic forms within the pulp: pulp stone
(denticles) and diffuse calcification. These calcifications may form in response
to irritation. Pulp stones in the chamber may reach considerable size and can
markedly alter the internal chamber anatomy.

Pulp stone on the left and complete calcification on the right

Internal resorption:
Resorption is a response to irritation that is sufficient to cause
inflammation. Internal resorption results in change of the pulp space
making the treatment of such teeth challenging.

Internal resorption

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Root canal classes:
Root canals may be classified according to maturity of the canals and
curvature into:

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 Root canal system:
It describes the different possible configurations of the root canals
within the single root.
Apical
Orifice Root canal
foramen

Type I Single Single Single

1-1-1

Type II Two Two Single

2-2-1

Type III Two Two Two

2-2-2

Type IV Single Single Two

1-1-2

Single but

Type V branched at the middle Single

Single third with dentin island
between two branches
1-2-1

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 Apical
Orifice Root canal
foramen

Type VI Two but Two

Two they united at cervical
1/3 up to apical 1/3
2-1-2

To describe the pulp space morphology of any tooth, 5

points should be fulfilled:
1. Average tooth length.
2. Number of roots and their curvature.
3. Types of root canal systems.
4. The clinical view (buccal view) /lingual view (M.D section).
5. The proximal view (mesial / distal) (L.P section).
6. Cross sectional view at 3levels: cervical, middle and apical.
7. Outline form of the access cavity.

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 Maxillary anterior teeth
Maxillary central Maxillary lateral Maxillary canine
incisor incisor

Average 23 mm 22.5 mm 26 mm
length

Number of One root

Roots

Root Straight Distal

curvature Labial Straight
(most
common to
Rootleast
canal Type I root canal system
common)
system
Palatal view  Pulp chamber has3 pulp horns.  The longest tooth in
(M-D section)  Pulp chamber wider MD than the oral cavity.
labiolingually.  Pulp chamber has
 Maxillary lateral incisor is similar to single pulp horn.
maxillary central incisor except in the  Narrow MD width of
following points: the pulp chamber.
*Smaller in size.
*Has more frequent distal curvature.
Proximal view  Lingual shoulder: is a lingual shelf of  Pulp chamber wider
(L-P section) dentin that extends from the cingulum to labiolingually than
a point approximately 2mm apical to the MD.
orifice.  Prominent Lingual
 Lingual shoulder usually is present and shoulder usually is
it must be removed to gain access to the present.
lingual wall of the canal.
Cross sections Cervical ------- triangular Cervical------ oval
Middle -------- ovoid Middle ------ oval
Apical -----------round Apical ------round
Outline form Triangular with its base toward the incisal Oval
of access edge and apex cervically
cavity N.B. The outline form changes to oval
shape in old age (pulp horns recede)

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Maxillary central incisor

Maxillary canine

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 Mandibular anterior teeth
Mandibular incisors Mandibular canine

Average 21.5 mm 22.5mm 25 mm

length

Number of One root One root

Roots Rarely, two roots (5.2%)
(labial & lingual)
Root Straight
curvature Distal
Root canal  60-70% of the cases show type I In case of one root
system root canal system.  96% of the cases
 30-40% has 2 root canals (labial & show type I.
lingual), either type II or III.  4% of the cases
show type II or III
In case of two root
 Each root has type I
Palatal view  They are the smallest human adult
(M-D section) teeth.
 Narrow pulp chamber with 3 pulp
horns.
Similar to maxillary
Proximal view  Pulp chamber pointed incisally
canine but smaller in size
(L-L section)
 Pulp chamber wider labiolingually
than MD.
 Lingual shoulder usually is
present and it must be removed to
gain access to the lingual wall of
the canal.
Cross sections Cervical ------- oval Cervical------ oval
Middle -------- ovoid Middle ------ oval
Apical -----------round Apical ------round
Outline form Similar to maxillary incisors Similar to maxillary
of access canine
cavity

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Mandibular incisors

Mandibular canine

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 Maxillary premolars

Maxillary 1st premolar Maxillary 2nd premolar

Average 22 mm 21 mm
length

Number of  Two roots ---- 60%  One root ---- 85%

Roots (Buccal & palatal)  Two roots --- 15%
 One root ----- (34 -40%) (Buccal & palatal)
 Three roots ----- (0-6%)
(Mesiobuccal,
distobuccal & palatal)

Root  B root: Palatal, straight. Distal

curvature
 P root: Straight, B. Bayonet
 Single root: Straight, D.

Root canal In case of two roots & three In case of one root
system roots Type I .. most frequent
 Each root has type I Type II ... less frequent
In case of one root
Type III..the least frequent
Type III ….. most frequent
Type I < II <III
Type II .….. less frequent In case of two roots
Type I ….. the least frequent  Each root has type I
Type III < II <I
Buccal view
(M-D section)  Narrow mesio-distal width of the pulp chamber
Proximal view
(B-P section)  Broad buccolingual dimension of the pulp chamber.
 2 pulp horns (buccal and palatal) where the buccal pulp
horn usually is larger and at a higher occlusal level.

 The palatal orifice and the palatal canal are slightly

larger than the buccal orifice and the buccal canal.

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 Maxillary 1st premolar Maxillary 2nd premolar

Cervical-------oval, kidney shaped, figure 8.

Cross sections Middle -------- ovoid.
Apical ----------round.
Outline form
of access Oval bucco-lingually
cavity
In case of 3 roots with 3 root
canals (MB, DB, P) the
outline form becomes
triangular with its base
toward the buccal aspect.

Maxillary first premolar

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 Maxillary second premolar

Mandibular premolars

Mandibular 1st premolar Mandibular 2nd premolar

Average 22 mm 21.5 mm
length

Number of  One root ……. most frequent.

Roots  Two roots (buccal & lingual) ……rare.
 Three roots (2 buccal & 1 lingual)…. extremely rare.

Root Straight
curvature Distal
Root canal In case of one root
system  Type I ...... most frequent
(75% in1st premolar & 91% in 2nd premolar).

 Type IV, II, III ... less  Type II, III, IV ... less
frequent. frequent.
Type IV < II <III Type II < III <IV

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 Mandibular 1st premolar Mandibular 2nd premolar
In case of two roots & three roots
 Each root has type I
Buccal view  Narrow mesio-distal width of the pulp chamber
(M-D section)
Proximal view  Broad buccolingual dimension of the pulp chamber.
(B-L section)  2 pulp horns (buccal and lingual) where the buccal pulp
horn usually is prominent and a small lingual pulp horn.
Cervical------- ovoid.
Cross sections Middle -------- ovoid.
Apical ----------round.
Outline form Ovoid bucco-lingually
of access
cavity

B L

B L

Mandibular premolars

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 Maxillary molars

Maxillary 1st molar Maxillary 2nd molar

Average 21 mm 20 mm
length

Number of Three roots

Roots Mesiobuccal (MB): It initially curves to the mesial near the mid-
root then curved distally. A concavity exists on the distal aspect of the
root which makes this wall very thin, so instrumentation of this wall
excessively may result in strip perforation.
Distobuccal (DB): It is conical in shape.
Palatal (P): The longest root & has the largest diameter.

May have two roots (B and P) (10%)

Root MB root: D, straight.

curvature DB root: Straight, M.
P root: B, straight. P root: Straight, B.

Root canal In case of three roots

system
Mesiobuccal root
 Over 95% it contains 2 root canals (MB1, MB2) either
with type II or type III root canal system (less likely to be
present in the second molar).
 Less frequently contains 1 root canal (MB).

Type II < III <I

Distobuccal root
 Contains 1 root canal (DB) type I.
Palatal root
 Contains 1 root canal (P) type I.
N.B: DB & P roots may have two root canals in each root.

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 In case of two roots Buccal root
 It contains most frequently1 root canal (B) type I.
 Sometimes it contains 2 root canals (MB, DB)
either with type II or type III.
Type I < II <III
Palatal root
 It contains 1root canal (P) type I.

Buccal view
 MB & DB pulp horns are extended under their cusps.
(M-D
section)  Narrow mesio-distal width of the pulp chamber.
Palatal view
 MP & DP pulp horns are extended under their cusps.
(M-D
section)  The palatal canal is wide.
Proximal
view  Broad buccolingual dimension of the pulp chamber.
(B-P section)

Cross Cervical------- Quadrilateral or rhomboid.

sections Middle -------- ovoid.
Apical ----------round.
Outline form
of access  Because the maxillary first molar almost always has 4
cavity root canals the outline form is quadrilateral or
rhomboid with the corners corresponding to the four
orifices (MB1, MB2, DB, and P).

 MB1 orifice is located under the MB cusp tip, DB orifice

is located 2mm distal and palatal to the MB1 orifice, P
orifice is centered palatally and MB2 orifice is located
palatal and mesial to the MB1.
N.B. The access cavity is entirely within the mesial 2/3 of the
crown.

 In case of 4 root canals, the outline

form is similar to the maxillary 1st
molar (quadrilateral).

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  In case of 3 root canals (MB, DB,
and P) the outline form becomes
triangular with its base toward the
buccal (the buccal wall of the
access cavity should be parallel to
a line connecting the MB1 and DB
orifices not to the buccal surface of
the tooth).

 In case of 2 root canals (B and P),

the outline form becomes oval in
buccolingual dimenssion.

Maxillary first molar

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Maxillary second molar

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 Mandibular molars

Mandibular 1st molar Mandibular 2nd molar

Average 21.5 mm 20 mm
length

 Two roots……. most frequent

(Mesial & Distal)
-Mesial & distal roots are broader BL than MD.
Number of - Root concavities are usually present on the D surface of the mesial
Roots root and on the M surface of the distal root which makes these walls
very thin, so instrumentation of these walls excessively may result in
strip perforation.
-In the mandibular second molar, the roots are usually closer together.

 Three roots (14.6%)  Single root …less frequent

(M, DL & DB roots)  Three roots (2.2%)
The extra root called
"Radix entomolaris"
which found on the
distoligual side.

Root Mesial root: D, straight

curvature Distal root: Straight, D

One root: Straight, D

In case of two roots In case of two roots

Mesial root Mesial root
 It contains 2 root canals  It contains 2 root canals
(MB, ML) either with (MB, ML) either with type
Root canal type III or type II. II or type III.
system Type III <II  Less frequently contains 1
N.B: Middle Mesial canal root canal (M).
(MM) may be present with Type II < III <I
incidence (1-15%). It is
present in the developmental
groove between MB,ML.

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 Distal root
 Most frequently it contains 1 root canals (D) type I.
 Sometimes it contains 2 root canals (DB, DL) either with
type II or type III.
Type I < II <III

In case of three roots In case of single root

Mesial root
It may contain:
 Similar to the mesial root  2 root canals (M&D)
in case of two roots. either with type II or type
III.
Type III <II  One large root canal, type I
Distolingual root  C-shaped canals.
It refers to the cross-
Distobuccal root
sectional morphology of the
 Each root has 1 root canal root & root canals.
type I. It starts at the ML line
angle & sweeps around
either to the buccal or
lingual to end at the distal
aspect of the pulp chamber.
It may be:
(a) A single, ribbon like, C-
shaped canal from the
orifice to apex.
(b) Three distinct canals below
the C-shaped orifices.
Buccal view
 MB & DB pulp horns are extended under their cusps.
(M-D
section)  Pulp chamber is wider MD than BL.
Proximal  The pulp ch amber is in the center of the crown.
view  The mesial canals are narrow, while the distal canal is
(B-L wide.
section)

Cross Cervical------- Triangular, trapezoid or rhomboid.
sections Middle -------- ovoid.
Apical ----------round.

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Outline
form of  In case of 3 root canals (MB, ML and D) the outline form
access is triangular with its base toward the mesial and the apex
cavity toward the distal.
MB orifice is located under the MB cusp tip, ML orifice is
just lingual to the central groove (2mm lingual to the MB
orifice) and D orifice is located distal to the buccal groove.

 In case of 4 root canals (MB, ML and DB, DL), the

outline form is trapezoidal.
N.B. The access cavity is entirely within the mesial 2/3 of the
crown.

 In case of 2 root canals

(M,D) the outline form is
rectangular (i.e wide
mesiodistally & narrow
buccolingually).

 In case of 1root canal, the

outline form is oval & in the
center of the occlusal surface.

MB

D
M ML
D

MB

D Radix MM D
MB ML entomolaris ML
Buccal view

DL DB

MB DB

ML DL
Type III >II

Mesial view Type I > II >III

Outline form of access cavity
Distal view

Mandibular first molar

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Mandibular second molar

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