Chapter 13 Anatomy of Pulp Cavity and its Access Opening 231

These changes are much more distinct when the operator The clinically significant features that a clinician should
employs some form of magnification in the form of either a take into consideration before preparing the endodontic
magnification loupe or a dental operating microscope access in maxillary teeth are given in Table 13.2.

Table 13.2 Clinically Significant Features During Access Preparation of Maxillary Teeth

Tooth Average Tooth Shape of Pulp Roots and Root Clinically Shape of Access Most Common
Length Chamber Canals Significant Preparation Anomalies
Attributes
Maxillary central • 22.5–24 mm • Ovoid • One root • Majority of • Rounded • Talon Cusp
incisors (average: mesiodistally • One root roots are triangular shape (Dens
23.5 mm) • Three pulp canal straight (base of triangle evaginatus)
horns • Broad • Labial perfo- toward incisal • Two roots and
labiopalatally, ration most edge) two canals
large, conical, common
centrally iatrogenic
located error
Maxillary lateral • 21.5–23 mm • Similar to • Conical • Majority of • Similar to • Dens
incisors (average: maxillary • Finer diam- roots have central incisors invaginatus
22 mm) central incisor eter than that distal curve • Talon cusp
• Two pulp of maxillary (53%); others (Dens
horns central incisor have straight evaginatus)
(30%) • Palato-
• Labial perfo- gingival
ration most groove
common iatro-
genic error
Maxillary canine • 26–28 mm • Largest of any • Single root • Straight root • Circular to • Two roots in
(average: single-rooted large • Lateral canal ovoid rare cases
27 mm) tooth • Wider present
• Labiopalatally labiopala-
triangular, tally than
mesiodistally mesiodistally
narrower
Maxillary first • 21.5–23 mm • Narrower • Two roots and • Two distinct • Ovoid bucco- • Three roots
premolar (average: mesiodistally two canals canals palatal diameter and three
22.5 mm) • Wider wider while canals
buccopalatally mesiodistal
• Pulp horn diameter
under each narrower
cusp
• Floor pulp
chamber
convex
• Two canal
orifices (buccal
and palatal)
Maxillary second • 21.5–23 mm • Narrow • Single root • If one root, • Ovoid bucco- • Three roots
premolar (average: mesiodistally with two one orifice palatal diameter and three
22.5 mm) • Wider canals in most but 50% cases wider while canals
buccopalatally cases will have two mesiodistal
• Rarely two canals and diameter
roots 46% cases narrower
have single
canal
• If two roots,
two orifices

(continued)

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 232 Grossman’s Endodontic Practice

Table 13.2 Clinically Significant Features During Access Preparation of Maxillary Teeth (continued)

Tooth Average Tooth Shape of Pulp Roots and Root Clinically Shape of Access Most Common
Length Chamber Canals Significant Preparation Anomalies
Attributes
Maxillary first • Buccal canals: • Largest in • Three roots • Tooth with • Rhomboid • Three roots
molar 18–20 mm dental arch with three highest shape and four
(average: • Four pulp to four root anatom- • Floor triangular canals
19 mm) horns canals ical canal in shape in • One root, one
• Palatal canal: – Mesiobuccal variations cross-section canal
19–21 mm canal 1 (MB1) • Tooth with • Two distal
(average: – Meisobuccal highest canals
20.5 mm) canal 2 (MB2) incidence of • Two palatal
– Distobuccal missed canals roots
canal (DB1) seen clinically • Three mesio-
– Palatal Canal during buccal canals
(P) retreatment

Maxillary second • Buccal canals: • Similar to • Three root • Distobuccal • Rhomboid • Four rooted
molar 17.5–19 mm maxillary first canal orifices canal has high shape. Floor molar with
(average: molar closely incidence of obtuse. two palatal
18 mm) • Narrow grouped asymmetrical Triangular in roots
• Palatal canal: mesiodistally location cross-section
18.5–19.5 mm • Smaller in
(average: dimension than
19 mm) maxillary first
molar
Maxillary third • 16.5–18 mm • Resembles • Three root • Tooth that • Rhomboid • Anomalies are
molar (average: second molar canal orifices is most shape common
17.5 mm) • C-shaped closely challenging • Smaller in
pulp chamber grouped to access dimension
and work on than maxillary
clinically second molar

MAXILLARY CENTRAL INCISOR
Average Tooth Length: The average length of this tooth is
23.5 mm.
Pulp Chamber: The pulp chamber of the maxillary central
incisor is located in the center of the crown equidistant from
the dentinal walls. It is broad mesiodistally, with its broadest
part incisally aligned. The pulp chamber usually follows the
contours of the crown and has three pulp horns that corre-
spond to the developmental mamelons in a young tooth. The
chamber is ovoid mesiodistally. The division between the
root canal and the pulp chamber is indistinct.
Root and Root Canal: The maxillary central incisor has one
root with one root canal. The root canal is broad labiopal-
atally, large and simple in outline, conical in shape, and
centrally located. A definite apical constriction is present in
the mature root canal. In cross-section, the canal is ovoid
mesiodistally in the cervical third, ovoid to almost round in
the middle third, and round in the apical third.
Clinical Significance:
• Although the majority of the roots are straight (75%),
some may curve labially or palatally (17%). The root canal
usually follows the direction of the curved root. The palatal
and labial curvatures may not be seen in a routine radio-
graph unless taken at different horizontal angulations.
• Lateral canals may be present (24% of specimens), usually
in the apical third.
• The labial surface of the root of the maxillary central
incisor lies under the labial cortical plate of the maxilla
and may fuse with it. Because of the proximity of the labial
root surface to the cortical plate, fenestrations and dehis-
cence may be present, and abscesses may perforate the
labial cortical plate.
• The relationship between the apex of the maxillary central
incisor and the osseous plate in the floor of the nasal cavity
depends on the height of the face and the length of the
root. Usually, the nasal fossa and the root apex are sepa-
rated sufficiently so that curettage of granulomatous tissue
within the surrounding cancellous bone does not result in
perforation of the floor of the nasal fossa. In some patients,
the apex of the root is close to the nasal floor and hence an
abscess may drain into the nasal fossa or a cyst may bulge
into the inferior nasal meatus.
• Labial perforations are the most common iatrogenic
errors committed during access preparation.

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