Tooth space morphology and

access cavity preparation

 Definition:
The pulp space is the central cavity within a tooth that is
entirely enclosed by dentin except at the apical foramen
 PULP SPACE MORPHOLOGY

 the pulp space is divided into:

1. Coronal pulp: it is the space occupied by
the pulp tissues within the crown.
a. pulp chamber.
b. pulp horns.
They are accentuations in the roof of the
pulp chambers that lie directly below
cusps.
2. Radicular pulp: it is the space occupied by the pulp tissues
within the root.
a. root canals:
It starts by an orifice and ends by the apical foramen
Its narrowest diameter is at the apical constriction.
 b. Accessory canals:
Lateral branches of the main root canal
communicating the pulp space within the
periodontium.
Site: mainly at the apical third of the canal, the
furcation area in the multi-rooted teeth.
Cause:
• Periodontal blood vessels entrapped within the
epithelial root sheath of hertwig.
• Disintegration of a segment of the epithelia root sheath
of hertwig before the induction of dentin formation
inhibiting dentin or cementum formation.
• Failure of fusion of tongue like projection of the
diaphragm in multi rooted teeth resulting in accessory
canals in the furcation areas.
The apical foramen:
it is an aperture at or near the apex of the
root through which the blood vessels and
nerves of the pulp would enter or leave the
pulp cavity.
Site: 17-46% within the anatomical apex.
0.4- 0.7 mm away from the
anatomical apex (on the mesial, distal,
labial or lingual surfaces)
apical foramen= major diameter= radiographic apex.
apical constriction= minor diameter= anatomical
apex (CDJ)
 Classification of root canals
 According to the maturity of the canals and curvature :
Class I: Mature, straight root canals.
Class II: Mature, curved root canals the could be:
• Slightly curved.
• Severely curved.
• Dilacerated.
• Bayonet.
Class III: Immature with open apex that could be:
• Tubular.
• Blunderbuss.
  According to root canal configuration by Weine:
Type I Type II Type III Type IV Type V Type VI

1 orifice 2 orifices 2 orifices 1 orifice 1 orifice 2 orifice

1 root 2 root canals 2 canals 1 root canal 1 root canal divides 2 root canals that
canal 1 apical 2 apical foramen 2 apical into 2 canals within unite within the root
1 apical foramen foramina the body of the root into one canal then
foramen forming apical forming a dentin divide again at the
delta island then reunite to apical third into 2
exit with 1 apical canals with 2 apical
foramen foramina.
Type VII: 1 canal leaves the pulp chamber, divides and rejoins in the
body of the root, then re-divides into 2 canals.
Type VIII: 3 separate canals from the orifice to the apex.
 Vertucci’s is classification:
 Gulabivala classification:
 Isthmus :
Is a narrow, ribbon shaped communication between two or
more root canals.
It contains pulp tissues or pulpally derived tissue it should
be cleaned, shaped and obturated as they can function as
bacterial reservoir.
Classification of isthmus by Kim et al in 1997:

• Type I: 2 or 3 canals with no visible

communication
( incomplete isthmus)
• Type II: 2 canals showing definite connection
with two main canals.
• Type III: three canals showing definite connection
with main canals.
• Type IV: similar to type II or III with canals
extending to the isthmus area.
• Type V: it is the true connection throughout the
section of root.
 Maxillary central incisor
 Average length: 23mm
 Root number and form: 1 and bulky (type I).
 Labio-lingual view: -narrow near the incisor edge then widens as it
approaches the cervical line and then tapers towards the apex.
The pulp chamber is wider MD than LL.
 Mesio-distal view: 3 pointed pulp horns.
chamber tapers uniformly toward the apex.
 Cross section:
• cervical 1/3 triangular in shape with apex lingually and base
labially.
• Mid-root: ovoid MD
• Apical: round
 Outline form: Triangular in the middle one third of the palatal
surface with base incisally and apex cervically
 Maxillay lateral incisor
 Average length: 22.5mm.
 Root length and form: 1 slender root, frequently with
distal or palatal curvature (Type I).
 Labio-lingual view: same as maxillay central incisor
PLUS lingual developmental groove, dense
invaginatus.
 Mesio-distal view: same as maxillary central.
 Cross section:
• cervical: oval in LL direction.
• Mid-root: ovoid.
• Apical: round.
 Outline form: same as central incisor.
 Mandibular central and lateral incisors
 Average length: 21mm.
 Root number and form:
• One root that has distal and/or lingual curvature.
• Sometimes 2 roots; labial and lingual.
 Canal type:
• Type I 60%-70%.
• Type II,III 30%-40%.
 Labio-lingual:
• Chamber strats as a point incisally then widens.
• N.B 1 canal : wide, 2 canals : narrow.
 Mesio-distal section: 3 pulpal horns
the chamber tapers towards a very narrow canal that follows the root curve.
 Cross-section:
• Cervical: oval in BL direction and narrow in MD direction.
• Mid-root: ovoid
• Apical round
 Outline form: triangular, or oval ( due to aging)in the middle third of the lingual
 Maxillay cannine Mandibular canine
Average length • 26mm, the longest root in the • 24mm.
Root number oral cavity. • 1 root, rarely 2 roots(labial-
canal type • 1 root, distal/labial curvature lingual).
may present. • Type I 94%
• Type 1, 3% 2 canals. • Type II,III 6%

Labio-lingual section Begin as a point incisally and widens cervically, with a prominent
lingual shoulder.

Mesio-distal section LL is wider than MD with one pulp horn under the cusp and nearly
uniform taper to the apex.

Cross-section • Cervical: oval in LL • Oval

direction • Ovoid
• Mid-root: oval • round
• Apical: round

Outline form Oval in the middle third of the lingual surface.

 Maxillay first premolar Maxillay second premolar
Average length 21mm. 21mm.
Root number 2 roots: 85% buccal and palatal (type I). 85%: 1 root (type I>II>III).
Canal type 1 root: 15% ( type III>II>I). 15%: 2 root(type I).
3 roots : < 2% (type I) 2B, 1P(molarization) 20%: bayonet curve.
1%: 3 canals (rare).
Bucco-lingual • Wide, 2 pulp horns under each cusp. If single canal is present, it is large
• Buccal horn is more prominent in young teeth. and centered inside the root.
• Roof of the pulp chamber is coronal to the
cervical line.
• The floor is convex and lies below the cervical
line, with 2 orifice buccal and palatal

Mesio-distal Narrow resembling the upper canine Similar to maxillary first premolar.

Cross section Cervical: 1 canal (oval bucco-palatally), 2 canals ( ribbon shaped)

Mid-root: oval apical: round
Outline form Oval in BL, in the center of the occlusal surface.
 Mandibular first premolar Mandibular second premolar
Average length • 22mm. • 22mm.
Root number • 1 root: type I most frequent 75%, • 1 root: type I most frequent 85%, type II
Canal type type II or III or IV less frequent or III or IV less frequent 15%
• Rarely 2 roots buccal and lingual • Rarely 2 roots (type I)
( type I each) • 3 roots extremely rare.

Bucco-lingual • Wide, with prominent buccal horn, a Similar to mandibular first premolar except
small lingual pulp horn is present that the lingual pulp horn is more prominent
which may disappear by age giving under a well developed lingual cusp.
the pulp chamber the appearance of
mandibular canine.
• The crown shows a lingual
inclination of 300 to the long axis of
the root.

Mesio-distal Narrow simulating mandibular canine

Cross section Cervical: ovoid mid-root: ovoid apical: round
Outline form Ovoid BL , located in the occlusal surface slightly towards the buccal cusp.
 Maxillay first molar
 3 roots; 2 buccal ( mesiobuccal MB, distobuccal DB) and one
palatal.
Palatal: the broadest root, may have an apical buccal
curvature.
 Outline : ( the cavity is in the mesial half of the tooth).
• Triangular with the base toward the buccal and the apex towards
the lingual in the case of 3 root canals.
• Quadrilateral in the case of 4 canals.
 Orifices:
• MB orifice: under the MB cusp tip.
• DB orifice: 2mm distal and palatal to the MB orifice.
• P orifice: on the same straight line palatal to the DB orifice
at the base of MP cusp.
• Second mesiobuccal canal MB2: detected in a groove
palatal to the MB1 as a tail of coma.
 Canal type:
• MB root: type II, III most frequent 90%, type I least
frequent.
• DB root: type I, narrow.
• P root: type I, wide and broad.
 Cross section:
• Cervical: quadrilateral or triangular.
• MB: ribbon shaped or 2 separate canals.
• DB: small and round.
• P: wide and oval in MD direction
Maxillay second molar

 Similar to maxillary first molar. BUT:

• Root are less divergent and my be fused (one root with 3
canals).
• May have 2 roots, one buccal and one palatal 10%
• One root extremely rare which may include one, two or
three canals.
 Mandibular first molar
 Average length: 21mm.
 2 roots: mesial and distal.
Mesial root usually curves distally.
Distal root is either straight or with slight mesial
curvature.
The pulp chamber is broader MD than BL.
 Outline: lie in the mesial 2/3 of the crown.
Triangular in case of 3 root canal with base toward the
mesial and apex towards the distal.
Trapezoidal in case of 4 root canals.
 Orifices:
• MB orifice: located under the MB cusp tip.
• ML orifice: 2mm lingual to the MB orifice.
• D orifice: 1mm distal to the central fossa ( distal canal is wide,
kidney shaped or ribbon shaped).
• In case of fourth canal detected DB or DL.
• Third mesial canal is sometimes present in the developmental
groove between MB & ML.
 Canal type:
• Mesial root: always has 2 canals type III 90%. Type II
10%
• Distal root: type III,II 60%-70% (DB&DL), type I 30%-
40%
Mandibular second molar

 Similar to mandibular first molar, BUT:

Roots are convergent and close to each other.
 May have:
• 2 canals mesial and distal.
• One large canal (type I).
• Rarely C-shaped canal.