PULP SPACE (Dr. SONA)

ENDODONTICS

2. Goodmorning

3. ANATOMY OF PULP SPACE
Dr. Sona Joseph
READER
Dept. Of Conservative Dentistry And Endodontics
MAHE INSTITUTE OF DENTAL SCIENCES & HOSPITAL

4. Introduction
Objectives
Components of pulp space –terminology
Classification of pulp space
Techniques for visualization of internal
anatomy
contents

5. Detailed study of internal anatomy of permanent tooth
Comparative study of deciduous and permanent tooth
structure
Variation in normal pulpal structure and its significance
Physiological
Pathological
Development
Conclusion
References

6. INTRODUCTION

8. Why???
.
learning objectives
-.

9. STAGES OF TOOTH DEVELOPMENT

10. COMPOSITION OF THE PULP
Cells Fibers Ground substance
Odontoblasts
Fibroblasts
Undifferentiated
mesenchymal cells
Macrophages
Immunocompetent cells
Collagen –Type I
Type III
Oxytalan
Water
Glycosaminoglycans
Glycoproteins
Proteoglycans

11. Morphology and anatomy

12. Components of pulp system
Coronal pulp
Radicular pulp

14. Coronal pulp
Located centrally with pulp horns
Six surfaces
Dentinal maps are present in the floor
Pulp horns-these are the
projections/prolongations of roof of the pulp
corresponding to major cusps or lobes

15. Radicular pulp
Radicular pulp is that pulp extending from
cervical region of the crown to root apex
Canal configurations
Accessory canals ,
lateral canals ,
apical delta
Furcation canal
Isthmus

16. Terminologies:
Root canal system:
The entire space in the dentine where the pulp
is housed is called the root canal system.
Pulp chamber:
It is the part of the root canal system located in
the anatomic crown of the tooth.
Pulp canal :
It is the part of the root canal system located in the anatomic root of the
tooth.
Pulp horn:
It is an accentuation of the roof of the pulp chamber directly under the
cusp or the development lobe
Canal orifices:
They are openings in the floor of the pulp chamber
leading into the root canals or pulp space.

17. Accessory canals:
They are minute canalsthat extend in a horizontal ,
lateral ,or vertical direction from the pulp to the
periodontium.
Furcation canals :
Accessory canals seen in the bifurcation or
trifurcation of the multirooted teethare called
furcation canals.
Apical foramen: ( Major apical diameter)
It is an aperture at or near the apex of the root through which the blood
vessels and nerves enter or leave the pulp cavity. (Grossman)
It 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. (Cohen)
Apical constriction: (Minor apical diameter)
It is the part of the root canal with the smallest apical diameter; it also is the
reference pointthe clinician use most often as the apical termination for
cleaning shaping and obturation.

18. CDJ:
It is a point in the canal where cementum meets dentine; it
is a point where the pulp tissue ends and periodontal tissue
begins. (Approximately 1mm from the apical foramen).
Isthmus:
It is a narrow ribbon shaped communicationbetween two
root canals that contain pulp or pulpally derived tissue.

19. Anatomy of apical root
Apical constriction
Cementodentinaljuncti
on
Apical foramen

20. Classification of canal configurations:
 According to Gross man :
 One canal existing as one canal
 Two canal exiting as one canal
 Two canals exiting as two canals
 One canal exiting as two canals
 According to Wiene :
 Type I:One canal exiting at one foramina
 Type II :Two canals exiting at one foramina
 Type III:Two canals exiting into two foramina
 Type IV:One canal exiting at two foramina.

21. According to Vertucci (1984)
One canal at apex
Type I : Single canal extending from pulp chamber to the apex.
Type II : Two canals leave the pulp chamber and joins short of the apex
to form one canal.
Type III: One canal leaves the pulp chamber, divides into two, within
the root and then merges to unite as one canal.

22. Two Canals at apex
Type IV : Two separate canals from chamber to apex.
Type V : Leaves pulp chamber as one and divides short of the apex into 2
separate apical foramina.
Type VI: Two separate canals leave the pulp chamber and merge in the
middle body of the root then re-divides short of the apex.
Type VII: One canal leaves the pulp chamber divides and then rejoins
within the canal and finally re-divides into 2 distinct canals short of the
apex.
Three canal at apex.
Type VIII: Three separate and distinct canals extend
from pulp chamber to the apex.

23. Maxillary central incisor
Average tooth length-22.8 mm
Pulp chamber
centre of the tooth
wider mesiodistally than
labiolingually widest part
incisaly
3 pulp horns
Chamber continuous with the
root canal

24. Root canal
Cross section
Clinical significance
The labial surface of the root lies under the
labial cortical plate of maxilla
Relationship to nasal floor
75% straight, 17% curve labially or palatally

25. Access opening
Internal anatomy dictates the Access
cavity –refer diagnostic radiograph
Slightly triangular with base towards
incisal aspect
Outline of access cavity changes to
more oval shape as tooth matures
and pulp horns recede

26. Maxillary lateral incisor
Average tooth length-
22.5mm
Pulp chamber
The outline chamber is
similar to central except
it is smaller.
Two or no pulp horns

27. Root
Cross section
Anatomic relationship in situ
The labial surface of root of the
maxillary lateral under the cortical plate
of maxilla
Palatal inclination

28. Clinical significance
Distal and palatal curvature
In cases of Dens invaginatus, peg lateral,
Talons cusp require modification in access
opening.
Two or three canals have been reported

29. Maxillary canine
Average tooth length-26 mm
Pulp chamber
are largest of any single
rooted teeth
wider labiolingually than
mesiodistally
One or No pulp horns

30. Root –wider labiopalatally
Straight 39%, distal curvature 32%
Cross sections
Anatomic relationship in situ
 An abscess usually perforates labial
cortical plate.
If below the insertion of levatormuscle –
Buccal vestibule.
It above the insertion –canine space 
cellulitis.

31. Clinical significance
Longest tooth, canine eminence
Apical curettage may be difficult.
Buccal bone over canine eminence
disintegrates leading to fenestration.

32. Mandibular central incisor
Average tooth length-20.8mm
Pulp chamber:
Smallest tooth in the arch.
flat mesiodistally.
Pulp horns-The three distinct
pulp horns present in recently
erupted tooth, disappear later

33. Roots
The mandibular central incisor has 1 root
flat and narrow mesiodistaly but wide
labiolingually.
1 canal :70%,2 canals : 41%, 1*2*1 :22%
Straight 60%
Cross sections
Anatomic relationship in situ
The roots of the anterior teeth are broad
labiolingually occupy most of the alveolar
process

34. Clinical significance
Because of small size and internal anatomy
may be most difficult tooth for access
opening.( smaller)
Avoid overpreparation
Complete removal of lingual shoulder critical,
often the second canal is present. For this
one should extend preparation lingually

35. Mandibular lateral incisor
Average tooth length-22.6 mm
Pulp chamber-
configuration similar to mandibular central
except larger dimensions
Roots also show similarity but with increased
dimensions

36. Root curvature – Straight (Majority)
Distal (sharper)
Clinical significance :
2
nd
canal
Gemination and fusion are common in
mandibular anterior teeth.

37. Mandibular canine
Average tooth length -25.mm
Pulp chamber-
resembles maxillary canine but
it is smaller in dimensions
labiolingually chamber narrows
to a point in the incisal third of
crown but it is wide in the
cervical third

38. Roots
usually has a single root and canal (78%)
it may have two roots (2.3%) and two canals
(14%). These canals are narrow
mesiodistally wider labiolingually
Straight 68%, distal curvature 20%
Cross sections

39. Clinical significance
Lingual shoulder must be removed to gain
access to second canal / lingual wall.
Incisal extension can approach incisal edge
for straighten access

40. Maxillary first premolar
Average tooth length-
21.5 mm
Pulp chamber
wider bucco lingually
and narrow
mesiodistally.
two pulp horns
buccal>palatal

41. Roots 2 roots in 54.6% cases.
separated (21.9%)
partially fused(32.7%)

Irrespective or whether it has one root / two root it has2
canals at the apex in 69% cases.
The palatal canal is larger of the two and is directly
under palatal cusp and its orifice can be penetrated by
following the palatal wall of pulp chamber.
buccal canal is under the buccal cusp

42. Cross sections
Anatomic relations in situ
Relationship of the socket with alveolar
process varies with the number of roots.
If one root then the socket is in close
relationship to buccal cortical plate.
If two roots buccal is close to buccal
cortical plate and palatal is centrally located
sinus.
concavity

43. Clinical significance
 The outline form of cavity preparation
varies with the number of canals.
(2/3)
straight or distally curved (38%:36% )
Radiograph with angle (SLOB)
Prone to mesio distal fracture so full
coverage restoration is required after root
canal treatment.

44. Maxillary second premolar
Average tooth length-21.6mm
Pulp chamber
more wider buccopalatally
than the first premolar.
if one root canal present
then the canal orifice may be
indistinct but if two canals are
present the two orifices will
be visible.

45. Root canals
Single root –90.3% (1/2 canals)
2 well developed roots –2%
Partially fused 2 roots –7.7%.
CROSS SECTION :
Cervical –Ovoid and narrow
Middle 1/3 –Ovoid (1 canal); round (2 canal)
Apical 1/3 –Round.
Anatomical relations in situ
close relationship with maxillary sinus

46. Clinical significance
 Depending on the number of canals the
external outline form varies.
One canal :Buccolingual width corresponds to width
between buccal and palatal pulp horns.
Two canals :Access preparation is nearly identical to
first premolar.
Three canals :The access outline form is same
triangular shape.
Presence of isthmus

47. Mandibular first premolar
Average tooth
length-21.9mm
It is a transitional
tooth between
anterior and
posterior
Buccal pulp horn

48. Enigma to endodontist
Root canals :
The mandibular first
premolar has a short
conical root.
A single root canal may
divide in apical third
into 2 or 3 root canals.
Straight (48%)

49. 1*1 : 70%
1*2 : 24%
2*2 : 1.5%
1*2*1 : 4%
3*3 : 0.5%
Cross sections
Anatomic relationship insitu
mental canal and foramen close to root
apex . radiographic appearance may
suggest periapical pathoses.

50. Mandibular second premolar
Average tooth length-
22.3mm
Pulp chamber
similar to 1st premolar
except the lingual horn
is more prominent
under a well developed
lingual cusp

51. Root
usually 1 canal exists in 1apical foramen
in 97.5%
In 2.5% cases a single canal may
bifurcate exiting in 2 foramina.
Straight or distally curved (39%;40%)
Cross section
Anatomic relationship in situ
Mandibular second premolar is in closer
relationship to mental foramen.

52. Clinical significance
crown has less lingual inclination----less
extension up the buccal cusp
lingual half well developed----access
extension is halfway up the lingual cusp
incline.

53. Maxillary first molar
Average tooth length-
21.3mm
Pulp chamber 4 pulp
horn
Largest in the arch
Roof–rhomboidal
floor triangular in cross
section

54. Orifices
Palatal-largest round
Mesiobuccal-under the
mesiobuccal cusp
long buccopalatally
Distobuccal-distal and
to palatal mesiobucal
orifice

55. Dilema of mb2 (84%)
generally present
mesial to or directly on
a line joining MB –1
and palates orifice
.
20 distal eccentric
angulation be used

56. Roots
Palatal-largest, flat ribbon like wider
mesiodistaly, 40%straight
Distobuccal-small, narrow,flattenned
mesiodistally
Mesiobuccal –narrowest ,flattened in
mesiodistal direction at orifice ,but round in
apical 3
rd

57. Anatomical relationship in situ
Close proximity to maxillary sinus
Clinical significance
Pulp stones may be present
concavity exists on the distal aspect or
mesiobuccal root

58. Maxillary second molar
Average tooth length-
21.7 mm
Pulp chamber
Similar to maxillary first
molar except it is
narrower mesiodistally

59. Root
maxillary second molar has 3 roots which are
closely grouped.
fourth canal is less frequent
If the buccal roots fuse -2 canals (1 buccal, 1
palatal).
A tooth with only 1 root -1 conical root canal
Anatomic relationship in situ

60. Clinical significance
Access cavity varies number of canals
Four –Rhomboidal
Three –Triangular
Two –Ovoid widest in buccopalatal direction
Mesial marginal ridge should not be involved.
To enhance radiographic visibility especially
when interferences arises from malar process

61. Maxillary third molar
Tooth length –17.1 mm
Pulp chamber :anatomically resembles the
second molar.
The pulp chamber may vary greatly. This may
have odd shaped chamber with four or five
root canal orifices or a conical chamber with
only on root canal.

62. Mandibular first molar
Average tooth length-
21.9mm
Pulp chamber -
Pulp horns -four
Roof –rectangular
Floor-trapezoidal
/rhomboidal

63. Roots
Usually 2 well differentiated roots with 3
canals
wide and flat buccolingually
a depression in the middle of the root
buccolingually

64. Distal -is oval in shape with the
widest diameter buccolingually. The
opening is generally located distal to
the buccal groove.
Mesiobuccal-under the
mesiobuccal cusp.
long shank starlite D-11 explorer
is inserted in mesiobucco apical
inclination
mesiolingual-a depression
formed by mesial and lingual wall

65. Clinical significance
Mesial root-
2* 2 (41%), 2*1 (28%),
2*1*2 (13%), 1*1 (12%),
3*3 -midmesial -rare
Distal root-
1*1(70%), 2*1(15%), 1*2 (8%)
2*2 (5%), 2*1*2 (2%)
slob
Avoid overpreparation

66. Mandibular second molar
Average tooth length-
20.4mm
Pulp chamber
The pulp chamber is
smaller than that or
mandibular first molar
and the root canal
orifices are smaller and
closer together.

67. Roots
Majority of mandibular second
molars have
 2 roots (71%)
 1 root (27%)
 3 roots (2%)
 Three root canals are usually
present in mandibular second
molars.
Cross section
Anatomic relationship in situ

68. Clinical significance
This tooth very close to mandibular canal
The clinician must take care not to allow
instruments or filling material to invade this
space because paresthesiamay result.
C shaped canal

69. C shaped canals
The C-shaped canal
was first reported in
1979
mandibular second
molar.
cross sectional
morphology of their
roots and root canals is
a single ribbon orifice
with an arc of 180 or
more.

70. classification
Meltons classification
Fans classification

71. Mandibular third molar
Average tooth length-
18.5mm
Pulp chamber-
resembles the pulp
chamber of mandibular
first and second molar
. possess many
anomalous
configuration

72. Comparison of permanent and
deciduous teeth

73. Variations to normal pulpal structure
Factors
Physiological
Development
al
Pathological
Others

75. Variation of pulp space
1. Variation in development.
 Dentinogenesis imperfecta
 Dens Invaginatus
 Dens Evaginatus
 Fusion
 Gemination
 Concrescence
 Taurodontism
 Talons cusp
 Dentine dysplasia (rootless teeth)
 Regional odontodysplasia (ghost teeth)
 Palatogingival groove
 Extra root
 Missing root

76. 2. Variation in size of length
 Microdontia
 Macrodontia
 Idiopathic
3. Variation in shape of the pulp space
 Apical curve
 Gradual curve
 Sickle shape
 ‘C’ shaped
 Bayonet shaped
 Dilaceration

77. 4. Variation caused by pulp pathology
 Internal resorption
 External resorption
 Pulp stones
 Calcified canals
5. Variation in Apical third
 Open apex
 Variation in location of apex
 Apical ramification
 Lateral canal

78. Internal resorption

79. External resorption

80. GEMINATION (Twinning)
Attempt at division of a single tooth germ
by invagination resulting in incomplete
formation of two teeth.
Two completely or incompletely formed
crown with single root canal.
Differentiate gemination with fusion

81. FUSION
By levitas
Fusion of two separate tooth germs
It may be complete or incomplete
depending on stage of development
Caused due to physical force or
pressure
Separate or fused root canal
It may fuse with supernumerary tooth

82. Taurodontism

83. DILACERATION
Angulation, sharp bend, or
curve in the root
It depends on the stage of
root formation
Common with maxillary
lateral incisor and maxillary
first molar

84. Open apex (Incomplete Rhizogenesis)
Refers to the absence of sufficient root development to provide a
conical taper to the canal and is referred to as a blunderbuss canal (This
means that the canal is wider toward the apex than near the cervical area)

85. Introduction
Objectives
Development, histology of pulp
Components of pulp space –terminology
Classification of pulp space
Techniques for visualization of internal
anatomy
summary

86. Detailed study of internal anatomy of permanent tooth
Comparative study of deciduous and permanent tooth
structure
Variation in normal pulpal structure and its significance
Physiological
Pathological
Development
Conclusion
References

87. Conclusion
The eyes do not see what
The mind doesn’t know

88. references