Buổi2 B1 CôTriển MORPHOLOGY OF THE ROOT CANAL SYSTEM

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MORPHOLOGY
OF THE ROOT
CANAL
SYSTEM
LAM KIM TRIEN DDS
Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

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Terminology
• Pulp cavity/ root canal system : hốc tủy/ hệ thống ống tủy
• Pulp chamber: buồng tủy/ tủy buồng
• Root canal: ống tủy/ tủy chân
• Roof of pulp chamber: trần tủy
• Floor of pulp chamber: sàn tủy
• Pulp horn: sừng tủy
• Root canal orifice: lỗ ống tủy
• Apical foramen/ major diameter: lỗ chóp/ đường kính lớn
• Apical constriction/ minor diameter: chỗ thắt chóp /đường kính nhỏ

Terminology
• Apical deltas: vùng chóp delta
• Cementodentinal Junction: đường nối ngà xê măng
• Tooth apex/ anatomic apex: đỉnh chóp/ chóp chân răng giải
phẫu
• Radiographic apex
• Isthmus: eo nối



CONTENT
1. Introduction
2. Components of the root canal system /pulp cavity
3. Root canal Classification
4. Abnormalities in the internal anatomy of teeth
5. Factors Affecting Internal Anatomy

INTRODUCTION
- Major factors for development of

- Aim of Root canal treament:
pulpal and periradicular diseases:
• Loss of integrity of coronal tooth • Chemomechanical removal of
substance microorganisms, their substrate and
• Entry of microorganisms into the products from the dentin and pulp
dentin and pulpal space space
• Obturation and sealing of the pulp
space to prevent bacterial
contamination

§ A clear understanding of the anatomy of human

teeth is an essential prerequisite to achieving the
objectives of adequate access, thorough cleaning,
effective disinfection, and complete obturation of
the pulp space
§ Many of the problems encountered during
endodontic treatment occur because of the pulp
response to irritation and an inadequate
understanding of the pulp space anatomy
§ Both students and clinicians need to familiarize
themselves with the intricacies, complexities and
aberrations that are likely to occur within the
pulp space
àdeveloping a visual picture of the expected
locations and numbers of canals in a particular
tooth
- “The dental pulp is often referred to as the root

canal system, as opposed to a simple tube or
circular space, due to its complexity”
- The outline of this system generally corresponds
COMPONENTS to the external contour of the tooth.
Cohen’s Pathways of the pulp
OF THE ROOT - “The pulp space is the central cavity within a
CANAL tooth and is entirely enclosed by dentin except at
the apical foramen”
SYSTEM Grossman’s Endodontic Practice
- However, factors such as physiologic aging,
pathosis, trauma, and occlusion all can modify its
dimensions through the production of dentin or
reparative (irregular secondary, and tertiary) dentin

PULP CAVITY:
- is the central cavity within a tooth
and is entirely enclossed by dentin
except at the apical foramen
• A coronal portion → Pulp chamber
• A radicular portion → Root canal
- Other some components:
§ pulp horns
§ accessory, lateral, and furcation
canals
§ canal orifices
§ apical deltas
§ apical foramina

• Roof of the pulp chamber

• Pulp horn
Pulp chamber • Floor of the pulp chamber
• The canal orifices
• Roof of the pulp chamber: dentin covering the pulp

chamber occlusally or incisally
• Pulp horn: accentuation of the roof of the pulp
chamber directly under a cusp or development lobe
• Floor of pulp chamber: runs parallel to the roof and
consists of dentin bounding the pulp chamber near
the cervical area of the tooth
• Canal orifices: opening in the floor of pulp chamber
leading in to root canals

In young teeth, the outline of the pulp chamber

resembles the shape of the exterior of the
dentine.
canal
orifice
Source: https://pocketdentistry.com/3-problem-solving-in-
interpretation-of-dental-radiographic-images/
With age, the dentinal tubules and the pulp chamber become
reduced in size by the laying down of intratubular dentine,
secondary dentine and tertiary dentine, particularly in areas
where there has been caries, tooth wear and exposure to
operative treatment
Flexcil - The Smart Study Toolkit & PDF,Source:
Annotate, Textbook
Note of Endodontics, Figs. 14.3
• Accessory canals, or lateral canals

• Apical foramen
Root canal • Accessory foramina
• Usually a root canal has curvature or constriction before terminating at the apex
• Accessory canals are lateral branching of the

main root canal generally occurring in the apical
third or furcation area of a root
• Lateral canal is an accessory canal that branches
to the lateral surface of the root and may be
visible on a radiograph
• Apical foramen is an aperture at or near the apex
of a root through which the blood vessels and
nerves of the pulp enter or leave the pulp cavity.
• Accessory foramina are the openings of the
accessory and lateral canals in the root surface


Accessory canals
Apical Root Anatomy

• Apical Constriction
(Minor Diameter)
• Cementodentinal
Junction
• Apical Foramen (Major
Diameter)
• Apical Delta
• Tooth apex
2
3
1
Source:
Flexcil Cohen’s
- The Smart Pathway
Study Toolkit ofAnnotate,
& PDF, Pulp, Fig.
Note5.20
Apical Constriction
(Minor Apical
Diameter)
• Apical part of root canal with
the narrowest diameter
short of apical foramina or
radiographic apex
• Within the dentin or at CDJ
and rarely in cementum
• Reference point for apical
termination
• Apical constrictions are
found 0.5–1.0 mm away
from the root apex.

Cementodentinal
Junction
• Point in the canal

where cementum
meets dentin
• Usually lies 0.5-1

mm from the apical
foramen

Apical Foramen
(Major Diameter)
• The main apical opening on
the surface of root canal
through which blood vessels
enter the canal
• Its diameter is almost
double the apical
constriction giving it a
funnel shape appearance
• Not always at the centre of
root apex. It may exit
mesial, distal, buccal, or
lingual

5
4
3
2
Sources: https://pocketdentistry.com/root-canal-anatomy/

APICAL DELTA Source: Textbook of

Endodontics, Figs. 14.7,8,9

Apical constriction acts as a natural stop for filling

materials. Presence of accessory and lateral canals, pulp
stones à Root canal treatment of apical part is difficult
Most of the curvatures à very careful during canal

preparation
Significance of
Apical Third Size and shape of foramen should always be maintained.
During endodontic surgery: apical 3 mm of root is

generally cut

Curved root canal and location of apical foramina:
Apical Root • (a) Curved root canal with the apical foramen distant from the root apex.
• (b) Curved root canal with the foramen near the apex.
Anatomy
• (c) Constricted root canal as the apical foramen is approached.
• (d) Double curvature of the root canal with the foramen at a distance from the root apex.
à The apical foramen is not always located in the center of the root apex.

Success in negotiating a narrow,
Curved curved canal depends on :
root • Degree of curvature
• Size and constriction of the root
canal canal
• Size and flexibility of the
endodontic instrument blade
• Skill of the operator

Anatomical Apex VS Radiograhic Apex
Radiographic apex—The highest point or tip of the root as seen on the x-ray.
Anatomic apex—The point where the neurovascular bundle enters the root apex.

(A) Radiographic representation of a file that was placed at a distance that is 1 mm short of the radiographic apex
(B) In the apical area of the tooth (B), the file can be seen extending past the apical foramen (note that the apical foramen is
located on the side of the root and not at the apex).
(C) Because the canal exits to the side of the apex, the file is in the correct position
Radiograph of a molar with the

measuring file in place. Same
measuring file from different
angles
Short but long
Gutta-percha extending past the anatomic

apex and short of the radiographic apex
isthmus
- Isthmus is narrow, ribbon-shaped communication between two root
canals encompassing the pulp tissue
- Hsu and Kin in 1997 classified isthmus:
Source: Textbook of Endodontic, Fig. 14.10

Clinical significance of isthmus
- Present between two

canals in one root
- Main causative agent

responsible for root canal
failures
à it is always mandatory
to clean, shape and fill
the isthmus area

ROOT CANAL CLASSIFICATION:

According to the number of canals, intracanal branching and fusion,
and exit from the canal.
I. Weine’s classification:
II. Vertucci’s classification:
III. Classification based on canal cross-section

I. Weine’s classification:
• Type I: Single canal from pulp

chamber to apex.
• Type II: Two separate canals
leaving the chamber but exiting as
one canal.
• Type III: Two separate canals
leaving the chamber and exiting as
two separate foramina.
• Type IV: One canal leaving the
chamber but dividing into two
separate canals and exiting in two
separate foramina.

II. Vertucci’s classification:

• Round (circular)
• Oval
• Long oval
• Flattened (flat/ribbon)
III. • Irregular
Classification
based on canal
cross-section

- Root canal treatment may fail if the root canal

system is not fully identified and treated.
- Lack of knowledge of the variability of human
root morphology, misadventure, and weakening
of root structure may result in a search for a
nonexistent canal.
à Therefore, a thorough knowledge of both
normal and abnormal morphologic variations is
required.

ROOT CANAL
ANOMALIES:

Taurodontism (Răng bò mộng)

- Enlargement of coronal
tooth and the roots are
reduced in length
- Molars or rarely premolars. (A–B) Taurodont
- Can be uni- or bilateral maxillary second molar
presenting a large pulp
à complete filling of the root chamber (yellow
canal system is challenging arrow) with apical
displacement of the
pulpal floor and
furcation of the roots
Source: https://pocketdentistry.com/root-canal-
anatomy/
Dens
Invaginatus
(răng trong răng)
- This condition must

be recognized early
and the tooth
prophylactically
restored
Dens in Dente
A maxillary lateral incisor with dens invaginatus (arrows)
or Dens Invaginatus

A mandibular second premolar with dens evaginatus

(arrows).
Talon’s cusp in maxillary left lateral incisor
Dens Evaginatus (Núm phụ/nhô răng)

Dens evaginatus
- recognize and treat the entity soon after affected
teeth have erupted into the oral cavity in order to
avoid the development of pathologic conditions.

Lingual Groove
§ maxillary lateral incisors
§ Deep lingual groove
§ deep narrow periodontal pocket
à causing endodontic-periodontal
relationship
Preoperative images:
(a)Clinical palatal view showing swelling of
marginal gingival
(b)probing depth of 10mm
(c)periapical radiograph showing lateral peri
apical radiolucency with a thin radiolucent
line superimposed on the canal space
(d)periapical radiograph showing gutta
percha cone tracing
Radix/Extra
Root
In maxillary molars:
§ Radix mesiolingualis
§ Radix distolingualis
In mandibular molars:
§ Radix entomolaris the external and internal morphologies of mandibular second molars
§ Radix paramolaris radix
showing
Flexcil - The Smart Study Toolkitentomolaris
& PDF, Annotate, Note(yellow arrows)
Extra Root
- The orifice of the radix
entomolaris is located disto-
to mesiolingually from the
main canal or canals of the
distal root, whereas the
orifice of the radix
paramolaris is located
mesio- to distobuccally from
the main mesial canals.
- A dark line or groove from
the main root canal on the
pulp chamber floor leads to
these orifices
à avoid missed canals
Mandibular 1st molar with Radix entomolaris
Radiographic views of a mandibular left second molar showing a radix paramolaris (arrows)
Presence of
extracanals
(OT phụ)
- More than
90% of
maxillary first
molar show the
occurrence of
second
mesiobuccal
canal (MB2)


C-Shaped Canals
- Most commonly in
mandibular second molars
- Irregular areas in a C-shaped
canal that may house soft
tissue remnants or infected
debris may escape thorough
cleaning and may be a source
of bleeding and severe pain
- So, the C-shaped canal
anatomy increases the
difficulty in root canal therapy
and percent of endodontic
failure on this tooth The external and internal morphologies of mandibular second molars showing
different C-shaped canal configurations.
Other Anomalies
• Fusion (răng dung hợp): pulp

chambers and canals may
be linked or separated
• Gemination (răng sinh đôi): has
a double or “twin” crown,
usually not completely
separated, and sharing a
common root and pulp space
à The root and pulp are also
irregular in morphology.
Fusion (răng dung hợp)

Gemination (răng sinh đôi)

- Anexcessive deposition of
nonneoplastic cementum over
normal root cementum
- Paget disease, acromegaly, or
vitamin A deficiency
Hypercementosis (tăng sản xê măng chân răng)
CBCT images from a distal root of a mandibular first molar presenting hypercementosis (arrow)

Variations in size of tooth
Macrodontia (răng to)
Microdontia (răng nhỏ/răng hình chêm)

FACTOR AFFECTING INTERNAL

ANATOMY
Various physiological or pathological factors affect pulp cavity of shape and
size because of pulpal and dentinal reaction to them. These factors can be
listed as:
1. Age
2. Irritants
3. Calcific metamorphosis
4. Calcifications
5. Resorption

Age

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.
• Response or defense reactions of the
pulp: tubular sclerosis, tertiary dentin
formation, pulp inflammation
Figure:Formation of secondary and tertiary dentin in
response to caries and attrition results in narrowing of pulp
cavity and decreases in dentin permeability
Calcific
Metamorphosis
§ Traumatic injury
§ Calcific metamorphosis is
characterized by deposition
of hard tissue within the
root canal space and yellow
discoloration of the clinical
crown
§ Resulting in partial or
complete obliteration of
the root canal space.


Internal
Resorption

THANKS
FOR YOUR
ATTENTION

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This Document has been modified with Flexcil app (Android) https://www.fexcil.

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

- Major factors for development of

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

§ A clear understanding of the anatomy of human

- “The dental pulp is often referred to as the root

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

• Roof of the pulp chamber

• Roof of the pulp chamber: dentin covering the pulp

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

In young teeth, the outline of the pulp chamber

• Accessory canals, or lateral canals

• Accessory canals are lateral branching of the

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Apical Root Anatomy

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

• Point in the canal

• Usually lies 0.5-1

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

APICAL DELTA Source: Textbook of

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Apical constriction acts as a natural stop for filling

Most of the curvatures à very careful during canal

During endodontic surgery: apical 3 mm of root is

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Anatomical Apex VS Radiograhic Apex

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Radiograph of a molar with the

Short but long

Gutta-percha extending past the anatomic

Source: Textbook of Endodontic, Fig. 14.10

Clinical significance of isthmus

- Present between two

- Main causative agent

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

ROOT CANAL CLASSIFICATION:

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

• Type I: Single canal from pulp

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

II. Vertucci’s classification:

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

- Root canal treatment may fail if the root canal

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

Taurodontism (Răng bò mộng)

- This condition must

Flexcil - The Smart Study Toolkit & PDF, Annotate, Note

A mandibular second premolar with dens evaginatus

Talon’s cusp in maxillary left lateral incisor

Dens Evaginatus (Núm phụ/nhô răng)