Internal Anatomy of Pulp cavity

Internal Anatomy of Pulp cavity

1. INTERNAL ANATOMY OF PULP Presented by Dr. Arshad Mohammed A II year Pg

2. INTRODUCTION The knowledge of common root canal morphology and its frequent variations is a basic requirement for success during root canal procedures.

3. Definition Classification of root canal morphology Isthmus Classification of C-shaped canals METHODS OF DETERMINING PULP ANATOMY FACTORS AFFECTING INTERNAL ANATOMY ANATOMY OF PULP CAVITY OF MAXILLARY & MANDIBULAR TEETH CLINICAL SIGNIFICANCE CONCLUSION

4. PULP CAVITY

5. CLASSIFICATION

6. VERTUCCI’S CLASSIFIACTION

7. Sert and Bayiril classification

8. Gulabivala supplemental canal configurations

9. Weine classification

10. Walker classification

11. ISTHMUS

12. “A narrow passage or anatomic part connecting two larger structures (root canals) “ -Identified using METHYLENE BLUE DYE -Contains pulp or pulpally derived tissue and acts as store house for bacteria -Identification and treatment of isthumi are vital to success of surgical procedure -Investigators identified 5 types of isthumi that can be found on a beveled root surface

13. Classification of isthumi

14. Kim et al

15. Yeung Yi Hsu

16. Classification of C-shaped canals

17. Melton’s classification

18. Fan’s classification

19. METHODS OF DETERMINING PULP ANATOMY

20. 1. Clinical methods: a. Anatomic studies b. Radiographs c. Exploration d. Visualization endogram e. Fiberoptic endoscope f. Magnetic resonance imaging (MRI) g. Dental operating microscope

21. a. Clearing study b. Scanning electron microscope (SEM) c. Sectioning d. Microcomputed tomography e. Cone beam computed tomography (CBCT) 2. In vitro methods:

22. ANATOMIC STUDIES The knowledge of anatomy gained from various studies and books is commonly used method. RADIOGRAPHS They are also useful in assessing the root canal anatomy. Since , it is a two dimensional picture of three dimensional object , one has to analyse the radiograph carefully.

23. HIGH RESOLUTION COMPUTED TOMOGRAPHY It shows three- dimensionl picture of root canal system using computer image processing. FIBER OPTIC ENDOSCOPE It is used to visualize canal anatomy. It is a new method of magnified intra canal visualization using fibro-optic endoscopes ( orascope ) or rod lens endoscopes. VISUALIZATION ENDOGRAM In this technique , an irrigant is used which helps in visualization of the canals on radiograph. This solution is called Ruddle’s solution. After injecting this solution into canal system ,radiograph is taken to visualize the canal anatomy.

24. MAGNETIC RESAONANCE IMAGING It produces data on computer which helps in knowing canal morphology. EXPLORATION On reaching pulpal floor one finds the grooves and anatomic dark lines which connect the canal orifices , this is called dentinal map.

25. SECTIONING In this, teeth are sectioned longitudinally for visualization of root canal system.

26. CLEARING OF ROOTS In this roots are initially decalcified using either 5 percent nitric acid or 10 percent hydrochloric acid and then dehydrated using different concentrations of alcohols and immersed in different clearing agents like methyl salicylate or xylene. By this treatment , tooth becomes transparent , then a dyes is injected and anatomy is visualized.

27. HYPAQUE/CONTRASTING MEDIA It is iodine containing media which is injected into root canal space and visualized on radiograph. SCANNING ELECTRON MICROSCOPIC (SEM) ANALYSIS It also helps in evaluating root canal anatomy

28. FACTORS AFFECTING INTERNAL ANATOMY

29. Internal anatomy of teeth ,reflects the tooth form ,yet various environmental factors whether physiological or pathological affect its shape and size because of pulpal and dentinal reaction to them. • AGE • IRRITANTS • CALCIFICATIONS • RESORPTION

30. AGE With advancing age , there is continued dentin formation causing regression in shape and size of pulp cavity. Clinically it may pose problems in locating the pulp chamber and canals. 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.

31. CALCIFICATIONS pulp stones or diffuse calcifications are usually present in chamber and the radicular pulp. These alter the internal anatomy of teeth and may make the process of canal location difficult. RESORPTION Chronic inflammation or for unknown cause internal resorption may result in change of shape of pulp cavity making the treatment of such teeth challenging.

32. VARIATIONS IN INTERNAL ANATOMY

33. Variation in shape Gradual curve Apical curve C-shaped Bayonet shaped Sickle shaped

34. Variations because of pathology Pulp stones Internal resorption External resorption

35. Variations in apical third Different position of apical foramen Open apex Lateral and accessory canals

36. Variations in development Gemination Fusion Concrescence Taurodontism Talon’s cusp Dilaceration Extra root canal Dens invaginatus Dens evaginatus

37. Variations in size of root • MACRODONTIA In this condition , pulp space and teeth are enlarged throughout the dentition . • MICRODONTIA In this condition , pulp space and teeth appear smaller in size .

38. ANATOMY OF PULP CAVITY OF MAXILLARY TEETH

39. MAXILLARY CENTRAL INCISOR

40. PULP CHAMBER : • The pulp chamber of the maxillary central incisor is located in the centre of the crown equidistant from the dentinal walls • The pulp chamber usually follows the contours of the crown and has three pulp horns. • It is broad mesiodistally than buccolingually, with its broadest part incisally

41. ROOT CANAL • Central incisor has one root with one canal. • Coronally the root canal is wider buccopalatally . • Lateral canals may be present (24% ) usually in the apical third. • Most of the time canal is found to be straight

42. Maxillary lateral incisor

43. PULP CHAMBER • The shape of the pulp chamber of the maxillary lateral incisor is similar to that of the maxillary central incisor but smaller. • It has two pulp horns, corresponding to the developmental mammelons . • It is broad mesiodistally , with its broadest part incisally . • The incisal outline of the pulp chamber tends to be more rounded.

44. ROOT CANAL • Root canal has finer diameter than that of central incisor though the shape is similar to that. • Labiopalatally the canal is wider. • Canal is ovoid labiopalatally in cervical third, ovoid in the middle third and round in apical third. • Apical region of the canal is usually curved in a palatal direction.

45. MAXILLARY CANINE

46. PULP CHAMBER • The pulp chambers of the maxillary cuspids are the largest of any single-rooted teeth. • Labiopalatally , the chamber is triangular in shape, with the apex pointed incisally . • Mesiodistally it is narrow. • In cross section, the chamber is ovoid in shape, with the greater diameter labiopalatally . • One pulp horn is present, corresponding to one cusp. • The external access outline form is oval or slot shaped because no mesial or distal pulps horns are present

47. ROOT CANAL • 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 circular. • Canal is usually straight but may show a distal apical curvature.

48. MAXILLARY FIRST PREMOLAR

49. PULP CHAMBER • The pulp chamber is wider buccopalatally with two pulp horns, one under each cusp. • The buccal pulp horn is more prominent than the palatal. • The floor of the pulp chamber is convex, usually with two canal orifices, Palatal orifice is larger and is kidney shaped. • In cross section, the pulp chamber is wide and ovoid in a buccopalatal dimension. • Roof of the pulp chamber is coronal to the cervical line.

50. ROOT CANAL • Most commonly two roots and two root canals (buccal & palatal), three canals can also occur rarely(palatal, mesiobuccal & distobuccal) • The palatal canal is generally the larger of the 2 canals. • Buccal canal is directly under the buccal cusp and palatal canal under the palatal cusp. • The root canals are usually straight and divergent.

51. MAXILLARY SECOND PREMOLAR

52. PULP CHAMBER • It is wider buccopalatally than the maxillary first premolar. It also has two pulp horns and is narrow mesiodistally . • The buccal pulp horn is larger. • In cross section, the pulp chamber has a narrow, ovoid shape.

53. ROOT CANAL • In cross section, the canals in the cervical third are ovoid and narrow In the middle third, when 1 canal is present it is ovoid,and when 2 canals are present they are round; in the apical third, the cross section is round regardless of whether 1 or 2 canals are present. • Lateral canals are present in 59.5% of cases; 1.6% occur in the furcation area. • C anal is wider buccopalatally forming ribbon like shape.

54. MAXILLARY FIRST MOLAR

55. pulp chamber • largest in the dental arch, with four pulp horns . • The arrangement of the four pulp horns gives the pulp roof a rhomboidal shape in cross section.

56. ROOT CANAL • Maxillary first molar has generally three roots with three canals. • Two canals in mesiobuccal root are closely interconnected and sometimes merge into one canal. • The palatal root is the longest and has the largest diameter. It contains mostly only one canal, though two or three root canals can also occur. From its orifice the palatal canal is flat, ribbon like, and wider in a mesiodistal direction. The distobuccal root is conical and may have one or two canals.

57. MAXILLARY SECOND MOLAR

58. PULP CHAMBER • It is similar to that of the maxillary first molar, except it is narrow mesiodistally . • Roof of pulp chamber is more rhomboidal in cross-section and floor is an obtuse triangle.

59. ROOT CANAL • Similar to first molar except that in maxillary second molar roots tend to be less divergent and may be fused. • Fewer lateral canals are present in roots and furcation area than in first molar.

60. MAXILLARY IIIrd MOLAR

61. PULP CHAMBER Anatomically resembles the second molar. The pulp chamber can be similar to that of the maxillary second molar with three canal orifices, but it may also have an odd-shaped chamber with four or five root canal orifices or a conical chamber with only one root canal.

62. ROOT CANAL The maxillary third molar may have three well- developed roots that are closely grouped. It may also have fused roots, one conical root, or four or more independent roots. The roots may be straight, curved, or dilacerated, and may be fully or partially developed. Root canals vary from one to four or even five in number, depending on the number of roots. One may find a “C-shaped” pulp chamber with a “C-shaped” root canal.

63. ANATOMY OF PULP CAVITY OF MANDIBULAR TEETH

64. MANDIBULAR INCISOR

65. PULP CHAMBER Smallest tooth in the arch. The pulp chamber is small and flat mesiodistally

66. ROOT CANAL One root. Which is flat and narrow mesiodistally but wide labiolingually. The root is straight in 60% of cases. The canal configuration varies from. One canal exiting in one apical foramen, as in 70% of these teeth. One canal bifurcating into two canals, coming together, and exiting into one apical foramen ( 22 %)

67. MANDIBULAR LATERAL INCISOR

68. PULP CHAMBER The configuration of the pulp chamber of the mandibular lateral incisor is similar to that of the mandibular central incisor, but the lateral incisor has larger dimensions.

69. ROOT CANAL Larger than that of the mandibular central incisor, Distal curve of the lateral incisors is sharper.

70. MANDIBULAR CANINE

71. PULP CHAMBER Resembles the maxillary canine, but it is smaller in all dimensions. The pulp chamber is narrow mesiodistally .

72. ROOT CANAL Although the tooth usually has a single root, it may have two (2.3%). Most of these teeth have a straight root (68%), but some have distal curvatures (20%). The mandibular canine usually has one canal exiting in one apical foramen (78%).

73. MANDIBULAR Ist PREMOLAR

74. PULP CHAMBER The mesiodistal width of the pulp chamber is narrow. Buccolingually, the pulp chamber is wide, with a prominent buccal pulp horn that extends under a well-developed buccal cusp.

75. ROOT CANAL Usually has a short, conical root. This root may divide in the apical third into two or three roots. The root is usually straight (48%), but some roots curve distally (35%). One canal and one foramen are present in 70% of cases. One canal bifurcates into two canals and exits in two foramina in 24% of cases. Two canals exit in two foramina in 1.5% of cases. One canal bifurcates into two canals uniting into one canal in the apical third and then exiting in one foramen in 4% of cases. Three canals exit in three foramina in 0.5% of cases.

76. MANDIBULAR IInd PREMOLAR

77. PULP CHAMBER Similar to the mandibular first premolar, except that the lingual horn is more prominent under a well-developed lingual cusp.

78. ROOT CANAL Usually has a single root, but on rare occasions two to three roots are present. The root of the mandibular second premolar may curve distally (40%), although in 39% of cases it is straight.

79. MANDIBULAR Ist MOLAR

80. PULP CHAMBER The roof of the pulp chamber of the mandibular first molar is often rectangular in shape. The mesial wall is straight, the distal wall round, and the buccal and lingual walls converge to meet the mesial and distal walls and form a rhomboidal floor. The roof of the pulp chamber has four pulp horns: mesiobuccal , mesiolingual , distobuccal, and distolingual .

81. ROOT CANAL Usually, two well-differentiated roots are present in the mandibular first molar, one mesial and one distal. Both roots are wide and flat buccolingually, with a depression in the middle of the root buccolingually.

82. MANDIBULAR IInd MOLAR

83. PULP CHAMBER Smaller than that of the mandibular first molar, and the root canal orifices are smaller and closer together.

84. ROOT CANAL The majority of the mandibular second molars have two roots (71%), but teeth with one root (27%) and teeth with three roots (2%) are also seen.

85. MANDIBULAR IIIrd MOLAR

86. PULP CHAMBER Anatomically resembles the pulp chamber of the mandibular first and second molars. It is large and possesses many anomalous configurations such as C-shaped root canal orifices.

87. ROOT CANAL The mandibular third molar usually has two roots and two canals, but occasionally one root and one canal or three roots and three canals. The root canals are generally large and short.

88. Conclusion A thorough knowledge of the root canal anatomy, careful interpretation of radiographs, and adequate access to exploration of the tooth’s interiors are the prerequisites for a successful endodontic treatment. With recent advances, studying the pulp morphology has become much more efficient. The clinician must be aware of the latest developments so that he/she can render quality treatment to the patient.

89. REFERENCES Grossman’s ENDODONTIC PRACTICE-13 th Edition Cohen’s PATHAWAYS of the PULP-11 th Edition Determination of the internal anatomy of a permanent dentition: A review {International Journal of Contemporary Dental and Medical Reviews (2015)} Google