Access To Root Canal

System :Posterior teeth

BDS 8127

Date : xx / xx / xxxx
Aims:
The educational aims of this lecture are to explain the pulp space
morphology of posterior teeth to eastablish an understanding of the
shape of access to root canals in those teeth
Objectives:
On completion of this lecture, the student should have an
understanding of how to assess the root canal system in posterior
teeth keeping in mind the pulp space morphology
Pulp Space Morphology of
Premolar Teeth
Pulp anatomy:

1-Number of roots.
2- Number of root canals.
3- Number of pulp horns.
4- Access cavity and outline form
5-Mesiodistal dimension and bucco-lingual dimension.
6- Cross section of the root.
Maxillary 1st Premolar
1- Number of roots:
•Two roots 60%
•One root 38%
•Three roots 2%
2- Root canal type:
Two roots : each has type I
One root: type III most frequent
type II less frequent
type I the least frequent
Three root each has type I
3- Number of pulp horns:
Two pulp horns (buccal more prominent than palatal)
4-Access cavity preparation & outline form:
Oval in shape on the occlusal surface.
 5-Mesiodistal dimension and buccolingual dimension
• Buccolingual view is wider than mesiodistal one.

• Mesio distal direction narrow resembling the upper canine.

6- Root Cross-section
Cervical third: oval, kidney shape or figure 8 shape being wider
B-L than M-D.
Middle third :slightly ovoid.
Apical third: round cross section .
•With two roots (type I):

Apical

Middle

Cervical
Maxillary 2nd
Premolar
1-Number of roots:
One root 85%
Two roots 15%
2-Number of root canals:
• One root: type I most frequent(50%)
type II less frequent
type III least frequent
•Two roots: each has type I
3- Number of pulp horns:)
2 pulp horns( 1buccal and 1 palatal)
4- Access cavity preparation &
outline form:
Oval in shape on the occlusal surface.
5-Mesiodistal dimension and buccolingual dimension
•Pulp chamber narrow mesiodistally .
•Two pulp horns one buccal & one palatal.
6- Root cross section:

Cervical third: oval, being wider B-L than M-D.

Middle third :slightly ovoid.
Apical third: round cross section .
Apical

middle

cervical
 Mandibular
1st Premolar
1- Number of roots :
• Mainly single root rarely two roots 1 buccal and 1 lingual.
2- Canal type
One root 75% (type I)
25% (Type II,III,IV)
Two roots one canal is present
in each root
3- Number of pulp horns:
Two pulp horns (buccal more
prominent than lingual)

4- Outline form& access cavity:

Ovoid on the occlusal surface
slightly towards the buccal cusp.
5-Mesiodistal dimension and buccolingual dimension
•Mesiodistally: Narrow simulating lower canine
•Buccolingually: wide with prominent buccal pulp horn.
6-Root cross section
Cervical third: oval, being wider B-L than M-D.
Middle third :slightly ovoid or round.
Apical third: round cross section.
Type I
cervical

middle

Apical
 Mandibular
2nd Premolar
1- Number of roots :
•Mainly single root rarely two roots one buccal and lingual

2- Canal type:
One root 85% (Type I)
•type III, Type II ,Type IV 15%
Two roots type I
3- Number of pulp horns:
Two pulp horns
(buccal more prominent than lingual)

4- Outline form & access cavity:

Ovoid on the occlusal surface
5-Mesiodistal dimension and buccolingual dimension
•Similar to mandibular first premolar except that lingual pulp
horn is more prominent under well developed lingual cusp
6-Root cross section
Cervical third: oval, being wider B-L than M-D.
Middle third :slightly ovoid or round.
Apical third: round cross section
Type I

cervical

middle

Apical
 Access Cavity
Preparation
for Premolar Teeth
(Step by Step)
 Coronal cavity preparation of maxillary and
mandibular premolars:

• The initial penetration is carried out on the occlusal

surface in the center of the central groove.
• A regular length round bur is aligned parallel to long access of
the tooth.
• Deroofing and extending the cavity buccolingually is then
carried out using a round bur or tapered stone with round end
or EndoZ bur.
• Working from inside the chamber to the outside
• Flaring, smoothening and finishing of the cavity are achieved
using tapered stone or EndoZ bur.
• Care should be given to keep the mesiodistal dimension
narrow to avoid perforation at the cervical region
Oval

Ovoid
Errors in Access cavity
Preparation
Pulp Space Morphology
of Molar Teeth
Maxillary 1st Molar
1-Number of roots.
2- Number of root canals.
3- Number of pulp horns
4- Access cavity and outline form
Shape triangle base buccally or quadrilateral
MB orifice: under MB cusp tip
DB orifice: 2mm distal & palatal to MB
P orifice: base of ML cusp (same straight line palatal to DB orifice
Extra canal: MB2 (in a groove mesial and palatal to MB1 tail of a
coma)
5-Mesiodistal dimension and bucco-lingual dimension.
6- Cross section of the root.
 P
MB
DB

D 96% II, M
III
Mesial 2/3 Mesial 2/3
Triangular Rhomboid
 MB orifice

DB orifice

MB2 orifice

P orifice
Maxillary 2nd Molar
1-Number of roots.
2- Number of root canals.
3- Number of pulp horns.
4- Access cavity and outline form
Shape triangle base buccally
MB orifice: under MB cusp tip
DB orifice: 2mm distal & palatal to MB
P orifice: Base of ML cusp (same straight line palatal to DB
orifice)
5-Mesiodistal dimension and bucco-lingual dimension.
6- Cross section of the root.
3 Roots: 90% ,2 Roots: 10% B & P
1 Root: extremely rare
Mandibular 1st Molar
1-Number of roots.
2- Number of root canals.
3- Number of pulp horns
4- Access cavity and outline form
Shape triangle base mesially or quadrilateral
MB orifice: under MB cusp tip
ML orifice: 2mm lingual to MB
D orifice: 1mm distal to central fossa
Extra canal: 2 distal canals (DB & DL)
5-Mesiodistal dimension and bucco-lingual dimension.
6- Cross section of the root.
 2Roots (M+D)
Mesial root: 90%III , 10%II (MB, ML)
Distal root: 60% I , 40%II, III (DB, DL)

M D

MB
ML
Mandibular 2nd Molar
1-Number of roots.
2- Number of root canals. ( 3R.C, 4 R.C, 2 R.C, or rarely 1 R.C)
3- Number of pulp horns
4- Access cavity and outline form
Shape triangle base mesially or quadrilateral
MB orifice: under MB cusp tip
ML orifice: 2mm lingual to MB
D orifice: 1mm distal to central fossa
5-Mesiodistal dimension and bucco-lingual dimension.
6- Cross section of the root.
Two roots: 76%
Mesial root II or III (most frequent) I (least)
Distal root: I
One root: 21.8%
Three roots: 2.2%

D
C-shaped canal:
Most commonly occur in Md 2nd molar
Ribbon shaped orifice
 Access Cavity
Preparation
for Molar Teeth
(Step by Step)
 Practical steps

Shape:

Upper Mainly in the Mesial 2/3

Site:
Lower Mainly in the Mesial 2/3

Size: Ridges
P
Whatever the tooth type was, the
Basic steps are the same

Gaining De-Roofing Flaring

Access
Cervical triangle
 Extra canals in upper and lower first molars

MB2 96%

2 distal canals 40%

Detection
Troughing Clinically & Radiographically
 How can you differentiate between

2- mesial from distal

1- roof and floor
Cervical line MMR is higher than DMR
Convex Roots are curved towards the
Color
Dentine map distal
Errors in Access cavity
Preparation
Underextended

Overextended
Perforation

Underextended
Aims:
The educational aims of this lecture are to explain the pulp space
morphology of posterior teeth to eastablish an understanding of the
shape of access to root canals in those teeth
Objectives:
On completion of this lecture, the student should have an
understanding of how to assess the root canal system in posterior
teeth keeping in mind the pulp space morphology
Reading material:
The dental reference manual, Geraldine M. Weinstein, springer
2017 (Chapter 12)
Essential skills for dentists, Peter A.Mossey et al, Oxford, 2006
(Chapter 2.6)
Endodontics, Kishor Gulabivala and Yuan-Ling NG, Mosby
Elsevier 2014
Harty`s endodontics in clinical practice, Bun San Chong, Elsevier
2017
Clinical endodontics, Lief Tronstad, Thieme 2009 (main reference)
 Thank you

Date : xx / xx / xxxx