‰.

Buccal curvature of palatal canal (56% of cases) may not

be visible on radiographs, leading to procedural errors
‰. MB2 should be approached from distopalatal angle since
the initial canal curvature is mesial
‰. Sometimes isthmus is present between mesiobuccal canals,
and should be cleaned properly for successful treatment
‰. Fundus of the alveolar socket of maxillary first molar may
protrude into the maxillary sinus, producing a small,
bony prominence in the floor of sinus
‰. Because of close proximity to sinus, pulpal inflammation
can result in sinusitis.
‰. Since pulp chamber lies mesial to oblique ridge, pulp
cavity is made mesial to oblique ridge
‰. Perforation of palatal root is commonly caused by assuming
canal to be straight
Maxillary Second Molar (Fig. 14.51)
It has three roots with three to four canals almost similar
to first molar.
‰. Average length: 17.5 mm
‰. Average crown length: 7 mm
‰. Average root length: 12.5 mm
‰. Average pulp volume: 44.3 mm3
Pulp Chamber
‰. Similar to first molar except that it is narrower
mesiodistally
‰. Roof is more rhomboidal in cross-section and floor is an
obtuse triangle
‰. Mesiobuccal and distobuccal canal orifices lie very close
to each other, sometimes all the three canal orifices lie
in a straight line
Root Canal
Similar to first molar except that roots tend to be less divergent
and may be fused.
Anomalies present
‰. Two palatal canals and two palatal roots
‰. Fusion of roots
‰. Taurodontism
Clinical Considerations
‰. Similarto maxillary first molar
‰. Maxillary second molar lies closer to the maxillary
sinus than first molarSingle canal
‰. Radix entomolaris
Clinical Considerations
‰. C-shaped canals should be treated with proper care
‰. Perforationcan occur at mesiocervical region if one fails
to recognize the mesially tipped molar
Mandibular Third Molar
Average Tooth Length
‰. Average length: 17.5 mm
‰. Average crown length: 6 mm
‰. Average root length: 11.5 mm
‰. Average pulp volume: 44.4 mm3
Pulp Chamber and Root Canals
Pulp cavity resembles the first and second molar but with
enormous variations, that is, presence of one, two, or three
canals and “C-shaped” root canal orifices
Clinical Considerations
‰. Root
apex is closely related to the mandibular canal
‰. Alveolar
socket may project onto the lingual plate of the
mandible
Conclusion
For successful and predictable endodontics, apart from
correct diagnosis and treatment planning, the clinician
must have knowledge of internal anatomy of the tooth.
The populations around the world have some peculiarities
which must be taken care of. Anatomical variations can
occur in any tooth. This necessitates the use of more precise
technology to complete evaluation and treatment planning.
The frequencies of root, root canals and apical foramina
should be taken care of for individual teeth because outcomes
of non-surgical and surgical endodontic procedures
are influenced by highly variable anatomic structures.
Therefore clinicians should be aware of complex root canal
structures, dimensions and alterations of canal anatomy
Questions
1. Define root canal anatomy. Classify root canal
configuration.
2. What are the different factors affecting root anatomy?
3. Discuss the importance of internal anatomy of permanent
teeth in relation to endodontic treatment.
4. Discuss root canal anatomy and its corelation for success
in endodontic treatment.
5. Discuss structure of root apex and its significance in
endodontics.
6. Write short notes on:
• Root canal anatomy of maxillary first molar
• Principles of preparing access cavity
• Root canal apex
• Root canal anatomy of central incisor
• Blunderbuss root canal
• Root canal types
• Access cavity design in maxillary molar teeth
• Morphology and access cavity design in anterior teeth
• Access cavity design in mandibular molar teeth
• Accessory canals
• Apical delta
• Clinical significance of the apical third.
Bibliography
1. Bellizi R, Hartwell G. Radiographic evaluation of root canal
anatomy of in vivo endodontically treated maxillary premolars.
J Endod 1985;11:37–9.
2. Fan B, Yang J, Gutmann JL, Fan M, “Root canal systems in
mandibular first premolars with C-shaped root configurations.
Part I: microcomputed tomography mapping of the radicular
groove and associated root canal cross-sections,” Journal of
Endodontics, 2008;34(11)1337–41.
3. Melton DC, Krall KV, Fuller MW. Anatomical and histological
features of C-shaped canals in mandibular second molars. J
Endod 1991; 17: 384–8.
4. Skidmore AE, Bjorndal AM. Root canal morphology of the
human mandibular first molar. Oral Surg 1971;32:778–84.
5. Stropko JJ. Canal morphology of maxillary molars: clinical
observations of canal configurations. J Endod 1999; 25: 446–50.
6. Tikku AP, Pandey PW, Shukla I. Intricate internal anatomy of
teeth and its clinical significance in endodontics: A review.
Endodontology 2012;24:160–9.
7. Vertucci FJ, Seeling A, Gillis R. Root canal morphology of the
human maxillary second premolar. Oral Surg 1974;38: 456–64.
8. Vertucci FJ, “Root canal morphology and its relationship to
endodontic procedures,” Endodontic Topics, 2005;10:3–29.
9. Vertucci FJ. Root canal morphology of mandibular premolars.
J Am Dent Assoc 1978; 97: 47–50.
10. Weine F. Endodontic therapy. 3rd edition St Louis: CV Mosby;
1982.pp.256–340. wing scaling, additional steps may be taken to disinfect the periodontal tissues. Oral
irrigation of the periodontal tissues may be done using chlorhexidine gluconate solution, which has
high substantivity in the oral tissues. This means that unlike other mouthwashes, whose benefits end
upon expectorating, the active antibacterial ingredients in chlorhexidine gluconate infiltrate the tissue
and remain active for a period of time. However effective, chlorhexidine gluconate is not meant for
long-term use. A recent European study suggests a link between the long-term use of the
mouthrinse and high blood pressure, which may lead to a higher incidence of cardiovascular events.
In the United States, it is available only through a doctor's prescription, and in small, infrequent
doses it has been shown to aid in tissue healing after surgery. Current research indicates the
irrigation of CHX after SC/RP may inhibit the re-attachment of periodontal tissues. Specifically
preventing the formation of fibroblasts. An alternate irrigation with povidone-iodine may be used - if
no contra-indications exist.
Site specific antibiotics may also be placed in the periodontal pocket following scaling and root
planing in order to provide additional healing of infected tissues. Unlike antibiotics which are taken
orally to achieve a systemic effect, site specific antibiotics are placed specifically in the area of
infection. These antibiotics are placed directly into the periodontal pockets and release slowly over a
period of time. This allows the medication to seep into the tissues and destroy bacteria that may be
living within the gingiva, providing even further disinfection and facilitation of healing. Certain site
specific antibiotics provide not only this benefit, but also boast an added benefit of reduction in
pocket depth. Arestin, a popular site specific brand of the antibiotic minocycline, is claimed to enable
regaining of at least 1 mm of gingival reattachment height.
In cases of severe periodontitis, scaling and root planing may be considered the initial therapy prior
to future surgical needs. Additional procedures such as bone grafting, tissue grafting, and/or gingival
flap surgery done by a periodontist (a dentist who specializes in periodontal treatment) may be
necessary for severe cases or for patients with refractory (recurrent) periodontitis. [10]
Patients who present with severe or necrotizing periodontal disease may have further steps involved
in their treatment. These patients often have genetic or systemic factors that contribute to the
development and severity of their periodontitis. Common examples include diabetes type I and type
II, a family history of periodontal disease, and immunocompromised individuals. For such patients,
the practitioner may take a sample from the pockets to allow for culture and more specific
identification and treatment of the causative organism. Intervention may also include discontinuation
of medication that contributes to the patient's vulnerability or referral to a physician to address an
existing but previously untreated condition if it plays a role in the periodontal disease process.

Full mouth treatment[edit]

The "traditional" debridement procedure involves four sessions spaced two weeks apart, doing one
quadrant (one quarter of the mouth) each session. In 1995 a group in Leuven proposed doing the
whole mouth in about 24 hours (two sessions).[11] When done using ultrasonic instruments this is
called full mouth ultrasonic debridement (FMUD). The rationale for full mouth debridement is that
quadrants that have been cleaned will not be reinfected with bacteria from quadrants that have not
yet been cleaned. Other advantages of full mouth ultrasonic debridement include speed/reduced
treatment time, and reduced need for anaesthesia, with equivalent results to scaling and planing.
One study found that the average time to treat each pocket with full-mouth ultrasonic debridement
was 3.3 minutes, whereas it took 8.8 minutes per pocket for quadrant scaling and root planing
(SRP). Differences in improvement were not statistically significant. [12] Studies by the Leuven group,
using somewhat different protocols, found that the one-stage treatment (i.e. in 24 hours) gave better
results than the quadrant-by-quadrant approach (taking six weeks). They also had the patients
use chlorhexidine for two months after the treatment.[13]

Depth of planing[edit]
Another question in dental cleaning is how much cementum or dentine should be removed from the
roots. Bacterial contamination of root surfaces is limited in depth, so extensive planing away of
cementum – as advocated by traditional scaling and root planing – is not necessary to allow
periodontal healing and the formation of new attachment. [14][7] In contrast to traditional scaling and root
planing, the aim of some FMUD procedures is to disturb the bacterial biofilm within the periodontal
pocket, without removing cementum.[12] Typically, root planing will require the use of hand
instruments such as specialized dental curettes instead of the scaler tips used in FMUD to debride
the root surface and periodontal pocket.