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Tooth and Root Morphology

By: Endodontics team

‫بالتوفيق‬
Dr.Bashaer Al-Noman
BDS, MS, RCSED
Outlines
• Introduction.
• Components of the pulp system.
• Root canal anatomy.
• Pulp morphology of individual teeth.
• Dental anomalies.
Introduction
• The dental pulps presents with a variety of configurations and shapes throughout the
dentitions. Knowledge of the complexity of the root canal system is essential to
understand the principles and problems encountered in access preparation.

• Initial anatomical evaluation of the pulpal anatomy is achieved with careful evaluation
of two or more periapical radiographs exposed at different angulations. The detailed
reading and interpretation of each radiograph before and during root canal treatment is
necessary because many teeth present with unusual canal morphology.

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Components of The Pulp System
The pulp cavity is divided into two main portions:

:
1- coronal- the pulp chamber, located in or extending
to just below the anatomic crown of the tooth.

2- radicular- root canal found in the anatomic root.

* pulp cavity ①
②
pulp Chamber
Root canal
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below anatomic Root"

· in the anatomic
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Components of The Pulp System

Coronal portion of the pulp: -

• Pulp chamber: the roof of pulp chamber consists of dentin covering the pulp chamber occlusally or
incisally.
• The floor of pulp chamber merges into the root canal at the orifices. Thus, canal orifices are the
openings in the floor of pulpechamber leading into the root canals.
• Pulp Horns: pulp horns are landmarks present occlusal to pulp chamber. They may vary in height
and location.
Pulp horn tends to be single horn associated with each cusp of posterior teeth and mesial and distal
in anterior teeth.
The occlusal extent of pulp horn corresponds to the height of contour in young permanent teeth.
Other notable features are the pulp horns; accessory, lateral, and furcation canals;
• Canal Orifice: canal orifices are openings in the floor of pulp chamber leading into root canals.
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Components of The Pulp System
Radicular portion of the pulp:
• Root Canal
• The root canal extends from canal orifice to the apical foramen.
• in most cases, the number of root canals corresponds to the number of roots; however, an
-

oval root may have more than one canal.

• In anterior teeth, the pulp chamber merges into the root canal but in multirooted posterior
-

teeth, this division becomes quite obvious.

• Usually a root canal has curvature or constriction before terminating at apex. A curvature
can be smooth or sharp, single or double in form of letter ‘S’.
- -

straight or merged 05
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Components of The Pulp System

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Radicular portion of the pulp: · 3

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• Apical Root Anatomy: minor diameters)
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It is based on following anatomic and histological landmarks in the apical part of the root canal.
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• Apical ConstrictionS (Minor Diameter) : the AC generally is considered the part of the root canal with
a
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the smallest diameter short of the apical foramina or radiographic apex.

I ; it also is the reference point clinicians most often use as the apical termination for enlarging,
wa shaping, cleaning, disinfecting, and filling. Violation of this area with instruments or filling materials
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is not recommended for long-term, successful outcomes. It may or may not coincide with CDJ.
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Components of The Pulp System

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Radicular portion of the pulp: ↑ Radiograph
Radiographic apex
• Apical Foramen (Major Diameter) : the AF is the “circumference or rounded edge,
like a funnel or crater that differentiates the termination of the cemental canal from
the exterior surface of the root. It is main apical opening on the surface of root canal
through which blood vessels enter the canal.
• Kuttler’ studied the average distance between the major and minor diameters of the
apical foramina: – 0.507 mm in 18 to 25-year-old subjects and – 0.784 mm in
patients older than 55 years.
when we do the workinglength
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MINOR Not in the major

Components of The Pulp System
• The diameter of major apical foramen increase with age due to the apposition of
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cementum layers.
· Root II
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• Cementodentinal Junction: the CDJ is the point in the canal where cementum meets
dentin; it is also the point where pulp tissue ends and periodontal tissues begin. The
location of the CDJ in the root canal varies considerably. It generally is not in the
same area as the AC, and estimates place it approximately -
1 mm from the AF.

Major
-
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Components of The Pulp System
Radicular portion of the pulp:
Accessory canal
Canals anastomoses or ramifications:
multiple foramina, delta, isthmus, c-shaped canal.
Ramifications are found in:
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73.5% in the apical part
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11% in the middle part rcanal

15% in the coronal third

apical coronal middle

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Components of The Pulp System
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Radicular portion of the pulp: A

main Ilig
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canal majorcanal
Accessory canals: are minute canals that extend in a horizontal, vertical, or lateral 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. The diameter, length,
and shape, may vary among accessory canals.
# Anterior apical
*
posterior -> A furcation

Accessory canals that are present in the bifurcation or trifurcation of multirooted teeth are
referred to as furcation canals (or chamber canals). These channels form as a result of the
entrapment of periodontal vessels during the fusion of the diaphragm, which becomes the
pulp chamber floor.
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• Apical Delta: are multiple accessory canals that branch out from the main canal at or near the
root apex .It is a triangular area of root surrounded by main canal, accessory canals and
periradicular tissue. j1 *
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Components of The Pulp System
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Radicular portion of the pulp:

-
-

·
Isthmus: narrow, ribbon- shaped communications between two root canals that
contain pulp tissue, or they may midroot portion of the canal.

– It is also known as a corridor (Green 1973)

– a lateral interconnection (Pineda 1973). & *
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– or transverse anastomosis (Vertucci 1984). ~Sell li
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Isthmuses are found in 15% of anterior teeth; in maxillary premolar teeth, they are
found in 16% at the 1-mm level from the apex and in 52% at the 6-mm level, which
puts them primarily in the middle third of the canal.
15% in anterior teeth.

16% near the apex of maxillary premolar teeth.

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52% in the middle third of the canal of maxillary premolar teeth.
6mm
To make it easier to remember:

“Anterior teeth have a 15% chance of isthmuses, while maxillary premolar teeth may have 16% near the apex and a higher 52%
chance in the middle third.”

1. Mesiobuccal Root of Maxillary First Molar:

At the junction of the middle and apical thirds of this root, the prevalence of an isthmus increases.

Initially, it’s found in 30% of cases, but this percentage rises to 50% near that junction.

2. Mandibular First Molars (Mesial Roots):

About 80% of the time, these communications are found at the junction of the apical and middle thirds of the root.

3. Mandibular First Molars (Distal Root):

In the distal root of mandibular first molars, isthmuses are primarily located in the apical third of the root.
Components of The Pulp System
The prevalence of an isthmus increases in the mesiobuccal root of the maxillary first
molar, from 30% to 50% near the junction of middle and apical thirds of the root. Eighty
percent of the mesial roots of mandibular first molars have these communications at the
apical to middle third junction, with the distal root display more in the apical third.
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Identification:
An isthmus can be identified by using methylene blue dye.

specifically
Mesiobuccal root
Components of The Pulp System
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Clinical significance of isthmus: reservior

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• Commonly isthmus is found between two canals present in one root like mesial
root of mandibular molars.
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• Isthmus has shown to be main causative agent responsible for failed root canals
(bacterial reservoir). So, it is always mandatory to clean, shape and fill the isthmus
area by orthograde or retrograde filling of root canals.

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Isthmus Classification
Classification AN
(classifications described by Kim and colleagues)

• Type I is an incomplete isthmus; it is a faint communication between two canals.

• Type II is characterized by two canals with a definite connection between them
(complete isthmus).
• Type III is a very short, complete isthmus between two canals.
• Type IV is a complete or incomplete isthmus between three or more canals.
• Type V is marked by two or three canal openings without visible connections.
Clinical Significance of Apical Third
• Accessory canals contain connective tissue and vessels but may 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 mineralization.They may 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.
• Pulpal inflammation can communicate to the periodontium via these canals (furcal
canals) and result in furcation lesions in the absence of demonstrable periodontal
disease . Likewise, the long-term presence of periodontal furcation lesions may
influence the viability of the coronal or radicular pulp tissue when these aberrant
channels are present.
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1. Accessory Canals in the Apical Third:

Tiny passages in the bottom part of teeth.

Contain vessels but may not supply enough blood to the pulp.

2. Formation of Accessory Canals:

Form when gum vessels are trapped during tooth development.

3. Role in Disease Spread:

Act as pathways for irritants to move from pulp to gum area.

4. Clinical Significance:

Can lead to inflammation spreading even without gum disease.

This can cause furcation lesions.

Over time, these lesions can affect the tooth’s pulp.

 There are two ways of determining pulp anatomy of
teeth:
1-Clinical methods:
• Anatomy studies researches
Root Canal • Radiographs
• Exploration CT scan
• High resolution computed tomography
Anatomy • Visualization endogram
• Fiber optic endoscope
(Methods of determining pulp • Magnetic resonance imaging
MRI
anatomy)
2-In vitro methods
• Sectioning of teeth
• Use of dyes
• Clearing of teeth
• Contrasting media
• Scanning electron microscopic analysis.
Root Canal Anatomy
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• Various researches have been conducted to study normal and variations in normal
anatomy of pulp cavity, Vertucci established eight different forms of pulp anatomy
in 1984.
• A supplemental root canal configurations to those of vertucci represented by
Gulabivala et al 2001.

1 : -190 *
 Type I: A single canal extends from the pulp chamber to the apex (1).
Type I
ago Type II
Type II: Two separate canals leave the pulp chamber and join short of the apex to
form one canal (2-1).

Root Canal Type III

Type III: One canal leaves the pulp chamber and divides into two in the root; the two
then merge to exit as one canal (1-2-1).

Anatomy Type IV
Type IV: Two separate, distinct canals extend from the pulp chamber to the apex (2).

Type V: One canal leaves the pulp chamber and divides short of the apex into two
Type V separate, distinct canals with separate apical foramina (1-2).

Root canal configurations Type VI

Type VI: Two separate canals leave the pulp chamber, merge in the body of the root,
and redivide short of the apex to exit as two distinct canals (2-1-2).
by Vertucci 1984
Type VII: One canal leaves the pulp chamber, divides and then rejoins in the body of
Type VII the root, and finally redivides into two distinct canals short of the apex (1-2-1-2).

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Type VIII: Three separate, distinct canals extend from the pulp chamber to the apex
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Type VIII (3).
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 1. Type I: One straight canal from the pulp chamber to the tip (1).

2. Type II: Two canals from the pulp chamber merge before the tip (2-1).

3. Type III: One canal divides in the root, then merges again before the tip (1-2-1).

4. Type IV: Two separate canals from the pulp chamber to the tip (2).

5. Type V: One canal divides before the tip into two separate canals (1-2).

6. Type VI: Two canals from the pulp chamber merge, then split again before the tip (2-1-2).

7. Type VII: One canal divides, rejoins, and splits again before the tip (1-2-1-2).

8. Type VIII: Three separate canals from the pulp chamber to the tip (3).
Root Canal Anatomy
Factors affecting the shape and size of the root
canal:
• Age of the patient
• Irritating factors such as: caries, attrition, abrasion,
erosion, periodontal disease, cavity preparation or
other operative procedure that may stimulate dentin
formation.
• Resorption
• Calcification old
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Pulp Morphology of Individual Teeth
Maxillary Central Incisor

• Average time of eruption: 7-8 years. .

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⑮ Pulpchamper
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• Average Tooth Length: the average length of the maxillary central incisor is 22.5 mm. andthe
rootcanal
• Pulp Chamber: it is located in the center of the crown.
Mesiodistally, pulp chamber follows outline of the crown and it is ovoid in shape.

*MD is broader than BP.

• Buccopalatally the pulp chamber is narrow as it transforms into the root canal with a constriction just
apical to the cervix. In young patient, central incisor has three pulp horns that correspond to enamel
mamelons on the incisal edge.
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 Pulp Morphology of Individual Teeth
K Maxillary Central Incisor
⑪

Root Canal
type I vertuci
• Central incisor has one root with one root canal (100%) - & *
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• Coronally or cervically, the canal shape is large ovoid in cross-
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section, middle is ovoid and in apical region, the canal is round.
• Usually lateral canals are found in apical third.
• Most of the time, the root of central incisor is found to be straight (75%).
• Root apex and apical foramen are located distolabially.
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 Pulp Morphology of Individual Teeth
② Maxillary lateral incisor

• Average time of eruption: 7-8 years.

• Average Tooth Length: the average length of the maxillary central incisor is 22 mm.

Pulp Chamber:

• The shape of pulp chamber of maxillary lateral incisor is similar to that of maxillary central incisor but there are few differences.

• The incisal outline of the pulp chamber tends to be more rounded.

*MD is broader than BP

*

• Lateral incisor has two pulp horns or no pulp horns, corresponding to the development mammelons.

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Pulp Morphology of Individual Teeth
Maxillary lateral incisor

Root Canal

• Central incisor has one root with one root canal

• Root canal has finer diameter than that of central incisor though shape is similar to that.

• Canal is slightly ovoid labiopalatally in cervical third, ovoid in middle third and round in apical third. -
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• Apical region of the canal is usually curved in a palatal direction.

• Root apex and apical foramen are located distolabially.

• Most of the root have distal curvature (53%).

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 Pulp Morphology of Individual Teeth
⑤ Maxillary Canine
• Average time of eruption is 10-12 years.
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• Average Tooth Length Longest tooth: It is the longest tooth with an average length of 26.5 mm

Pulp chamber:

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• Labiopalatally, the pulp chamber is almost triangular shape with apex pointed incisally.

• Mesiodistally it is narrow, sometimes resembling a flame.

• larger diameter labiopalatally.

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Lateral
• Usually one pulp horn is present corresponding to one cusp.
Pulp Morphology of Individual Teeth
Maxillary Canine

Root Canal

• Normally there is single root canal which is wider labiopalatally than in mesiodistal
aspect.

• Cross-section at cervical and middle third show its oval shape, at apex it becomes
round.

• Canal is usually straight but may show a distal apical curvatur (32%)
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Pulp Morphology of Individual Teeth
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· 2 Roots

⑭ Maxillary First Premolar · 2 canals

• Average eruption time is 10-11 years.

• Average Tooth Length: this tooth has generally two roots with two canals (90%)
and average length of 20.5 mm.
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Pulp Chamber:
->
• Pulp chamber is wider buccopalatally with two pulp horns, corresponding to
buccal and palatal cusps.
• Palatal canal is usually larger than buccal canal.
• Roof of pulp chamber is coronal to the cervical line.
• Floor is convex generally with two canal orifices.
Pulp Morphology of Individual Teeth
Maxillary First Premolar

Root Canal in theradio

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• Prominent developmental depression on the Mesial and distal root surfaces.
• Buccal canal is directly under the buccal cusp and palatal canal is directly under the
palatal cusp
• Cross-section of root canals shows ovoid or kidney shape in cervical third with
larger dimensions buccopalatally. At middle and apical third, canals show rounded
shape in cross-section
• The root canals are usually straight and divergent.
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Pulp Morphology of Individual Teeth
Maxillary First Premolar

Anatomical variations of the maxillary first premolar:

• cases with single root or three roots have been reported.
• Two canals have fused then re divided again.
 Variation

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 Pulp Morphology of Individual Teeth
⑤ Maxillary Second Premolar

• Average eruption time is 11-12 years

• Average length of maxillary second premolar is 21.5 mm.

Pulp Chamber:

• Maxillary second premolar usually has one root with a single canal, with 2 or 3 root canals.

• Pulp chamber is wider buccopalatally and narrower mesiodistally.

Pulp Morphology of Individual Teeth
Maxillary Second Premolar

Root Canal

• Prominent developmental depression on the Mesial and distal root surfaces.

• In more than 90 percent of cases single root with single canal is found. 77% fused root palatally and
2% with well developed roots

• If there are two canals, they may be separated or distinct along the entire length of the root or they
may merge to form a single canal as they approach apically.

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• Canal is wider buccopalatally forming a ribbon like shape.

• At cervix, cross-section shows ovoid and narrow shape, at middle third and apical third are round.
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 Pulp Morphology of Individual Teeth - - *

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⑥ Maxillary First Molar on
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• Average eruption time is 6-7 years.

• Average Tooth Length: the average tooth length of Buccal roots is 20.5 mm and
23mm for platal root. ->* paltal root

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Pulp Chamber

• Largest pulp chamber: Maxillary first molar has the largest pulp chamber with
near four pulp horns (mesiobuccal, mesiopalatal, distobuccal and distopalatal).

• Rhomboid or triangular in shape with the base in the buccal side and apex at the
palatal side.
 Pulp Morphology of Individual Teeth
Maxillary First Molar

• Bulk of pulp chamber lies mesial to the oblique ridge across the surface of the tooth

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• Orifices of root canals are located in the three angles of the floor

• Palatal orifice is largest and easiest to locate and appears funnel like in the floor of
pulp chamber.
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* • MB2 is located 2 to 3 mm palatal to the MB1 canal, on an imaginary line connecting
* MB1 and palatal canal.
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Pulp Morphology of Individual Teeth
Maxillary First Molar

Root Canal

• Maxillary first molar has generally three roots with three or four canals.

of
• The Mesial root is broad buccopaltally.

• Two canals in mesiobuccal root are closely interconnected and sometimes merge into one canal.
4
• Mesiobuccal canal is the narrowest of the three canals, flattened in mesiodistal direction at
cervix but becomes round as it reaches apically.

• Distobuccal canal is narrow, tapering canal, generally it is round in cross-section.

Pulp Morphology of Individual Teeth
Maxillary First Molar

• The palatal root is broad mesiodistally.

• The palatal root canal has largest diameter, ovoid in cross section.

• Palatal canal can curve buccally in the apical one-third.

• Lateral canals are found in 40 percent of the molars at apical third and at
trifurcation area (furcal canals).
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MB II

paltal Canal
 Pulp Morphology of Individual Teeth
7 Maxillary Second Molar

• Average eruption time is 11-13years.

• Average Tooth Length: the average tooth length of Buccal roots is 20.5 mm and 22-23mm for platal
root.

Pulp champer: first -

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molar *
• It is similar to maxillary first molar except that it is narrower mesiodistally

• Mesiobuccal and distobuccal canal orifices lie very close to each other
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• Rhomboid in shape (4 canals), triangular in shape (3 canals), oval in shape (2 canals).
2canals J E B
But molar Zanels
Pulp Morphology of Individual Teeth
Maxillary Second Molar

• Similar to first molar except that in maxillary second molar roots tend to be less
divergent and may be fused

• Roots have distal inclination.

Pulp Morphology of Individual Teeth
Mandibular Central Incisor

• Average eruption time is 6-8 years.

• Average Tooth Length is 21 mm.
Pulp Chamber:
• Smallest tooth in the arch: Mandibular central incisor is the smallest tooth in the
arch.
• Pulp chamber is similar to maxillary central incisor being wider labiolingually and
pointed incisally with three pulp horns.
Pulp Morphology of Individual Teeth
Mandibular Central Incisor

Root Canal

• Developmental depression present in the Mesial and distal root surface.

• Various root canal formations have been seen in mandibular incisors. There can be a single
canal from orifice to apex or a single canal by bifurcate into two canals or sometimes two
separate canals are also found. Incidence of two canals can be as high as 41 percent.

• Cross-section of root canals show wider dimension in labiolingual direction making it ovoid(
hourglass) shape whereas round in the middle and apical third.

• Since canal is flat and narrow mesiodistally and wide buccopalatally, tapered incisally.
Pulp Morphology of Individual Teeth
Mandibular Lateral Incisor

• Average eruption time is 6-8 years

• Average Tooth Length is 21 mm.

Pulp Chamber:

The configuration of pulp chamber is similar to that of mandibular central incisor

except that it has larger dimensions.
Pulp Morphology of Individual Teeth
Mandibular Lateral Incisor

Root Canal

• It is almost similar to that of mandibular central incisor.

• Usually the root is straight or curved distally or labially, but distal curve is sharper
than that of mandibular central incisors.
Pulp Morphology of Individual Teeth
Mandibular Canine

• Average time of eruption is 9-10 years.

• Average tooth length is 25.5mm.

Pulp chamber:

• On viewing labiolingually, the pulp chamber tapers to a point in the incisal third of the crown.

• In cervical third of tooth, it is wider in dimensions and ovoid in cross-section.

• Pulp chamber appears narrower mesiodistally and broad labiolingual.

Pulp Morphology of Individual Teeth
Mandibular Canine

• Cervical constriction is present.

• Developmental depression are present in Mesial and distal root surfaces.
• Mandibular canine usually has one root and one canal but can occasionally have
two (14% cases)

• Coronally, the root canal is oval in cross-section, becomes round in the middle and
apical region.

• One pulp horn

Pulp Morphology of Individual Teeth
Mandibular First Premolar

• Average eruption time is 10-12 years.

• Average tooth length is 21.5mm.

Pulp chamber:

Mesiodistally, the pulp chamber is narrow.

• Pulp chamber has two pulp horns, the buccal horn being
more prominent.

• Buccolingually, the pulp chamber is wide.

• Crown inclined lingually with prominent buccal cusp.

Pulp Morphology of Individual Teeth
Mandibular First Premolar

Root canal:

• Developmental depression is deeper on distal surface than Mesial surface.

• Mandibular first premolar has one root and one canal. Sometimes presence of second canal can be
seen. Moreover, mandibular first premolar may present with three roots trifurcating at mid root and
it’s appeared to occur with different racial groups.

• Mesiodistally, the canal is narrower.

• Cervical cross-sections tend to be oval, but in middle the two branches are round and apical area, it
become round.
Pulp Morphology of Individual Teeth
Mandibular Second Premolar

• Average eruption time is 11-12 years.

• Average tooth length is 22.5mm.

Pulp chamber:
• It is similar to that of mandibular first premolar
except that lingual pulp horn is more prominent.
 Pulp Morphology of Individual Teeth
Mandibular Second Premolar

Root Canal:

• Usually has one root and one canal but in some cases, a second canal can be seen.
• Buccolingually, it is wider than that of mandibular first premolar.

t • Root canal cross-sections tend to be oval coronally and round apically.

Pulp Morphology of Individual Teeth
Mandibular First Molar

• Average time of eruption is 6-7 years.

• Average tooth length is 21mm.

Pulp chamber:

• There may be presence of four or five pulp horns. Three distinct orifices (MB,ML, D).

• The shape is triangular (with three orifices), and rhomboid (with four orifices).

• Mesiobuccal orifice is present under the mesiobuccal cusp.

• The mesiolingual orifice is located in a depression formed by mesial and the lingual walls.
Usually a connecting groove is present between mesiobuccal and mesiolingual orifices.
Pulp Morphology of Individual Teeth
Mandibular First Molar

• A middle mesial canal (MMC) sometimes is present in the developmental groove

between the other mesial canals, but it may only represent a wide anastomosis
between the two mesial canals, or in some cases it may actually be a separate
canal from orifice to apex.

• Distal orifice is the widest of all three canals. It is oval in shape with greater
diameter in buccolingual direction.
Pulp Morphology of Individual Teeth
Mandibular First Molar

Root Canal:

• Mandibular first molar has two roots with three canals. But teeth with three roots and four
or five canals have also been reported.

• Mesial root has two canals, mesiobuccal and mesiolingual which may exit in two foramina
(> 41% cases), single foramen (30%) and in different pattern.

• Mesial root is usually curved distally.

• Distal root generally has one canal (> 70% cases), but two canals are also seen in some
cases.
Pulp Morphology of Individual Teeth
Mandibular First Molar

• A single distal canal is ribbon shaped and has larger diameter buccolingually. But
when two canals are present in distal root, they tend to be round in the cross-
section.
• A variation in root morphology is the presence of an extra distolingual root. The
radix entomolaris (RE) is a supernumerary root located distolingually in
mandibular molars, whereas the radix paramolaris (RP) is an extra root located
mesiobuccally.
Pulp Morphology of Individual Teeth
Mandibular Second Molar

• Average time of eruption is 11-13 years.

• Average tooth length is 20mm.

Pulp chamber:
• It is similar to that of mandibular first molar except that it is smaller in size.
• Root canal orifices are smaller and lie closer.
Pulp Morphology of Individual Teeth
Mandibular Second Molar

Root canal:

• Usually mandibular second molar has two roots with three canals but variations are also
seen.

• There may be only one mesial canal. The mesial and distal canals may lie in midline of
the tooth.

• C-shaped canals are also seen, i.e. mesial and distal canals become fused into a fin.