Root canals morphology and configurations - maxillary teeth

endodontic treatment

1. http :// rootcanalanatomy.blogspot.com Maxillary Teeth Dr.Abdelazim Mohamed Badreldin G.V.Black dental center- khartoum –Sudan Feb.16- 2012

2. -Dental anatomy is the only fact in dentistry that will not change - If you have a good knowledge in dental anatomy you can do many procedures in dentistry azma [email protected]

3. Maxillary Central Incisor The cross-sectional root anatomy of the maxillary central incisor is triangular or ovoid in shape and tapers toward the lingual.

4. Maxillary Central Incisor The maxillary central incisor is usually a single-rooted & a single- canal system . The overall average length of the maxillary central incisor is 23.5 mm with an average crown length of 10.5 mm and an average root length of 13 mm.

5. Maxillary Central Incisor lateral canals and apical delta usually found at mid and apical -third of the root The average diameter of the major foramen is 0.4 mm while the accessory foramina were 0.2 mm in diameter. Green (study of root apices) The average distance of the major apical foramen from the anatomical root apex was found to be 0.3 mm. Approximately 12% of the maxillary central incisors exhibited accessory foramina Ingle ( Endodontic 6 )

6. Maxillary Central Incisor Apical ramifications were found in 12.3% . Lateral canals were present in 49.1% .38.6% have a simple main canal without lateral canals or apical ramifications. 90 % of the apical foramina were located within 1.0mm of the anatomical apex. Kasahara et al.75 The maxillary central incisor had the highest incidence of fusion and gemination of all permanent teeth (fusion 2.6%, while gemination was found in 0.94% … Hamasha and Al- Khateeb Study in a Jordanian population

7. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p.

8. Maxillary Central Incisor Access Cavity Preparation Ingle …ENDODONTIC 6

9. Maxillary Central Incisor

10. Maxillary Central Incisor

11. Maxillary Central Incisor

12. Maxillary Central Incisor

13. Maxillary Lateral Incisor

14. The maxillary lateral incisors are single-rooted . The cross-sectional root anatomy of the maxillary lateral incisor is described as being circular, oval, or ovoid in shape and tapers toward the lingual The root trunk is generally smaller than a central incisor and has a finer root tip. often terminating in a curve to the distal or the lingual. The overall average length of the maxillary lateral incisor is 22 mm with an average crown length of 9 mm and an average root length of 13 mm. Maxillary Lateral Incisor

15. Maxillary Lateral Incisor The maxillary lateral incisor usually presents with a single canal. The root apex and the apical foramen usually were displaced distolingually . The apical foramen and the root apex are not coincided ,therefore, the exploration of the apical foramen and the constriction, with a fine precurved #10 size file tip and the electronic apex locator, is essential to locate the foramen.

16. Maxillary Lateral Incisor VARIATIONS AND ANOMALIES Maxillary lateral incisors often present anatomic anomalies resulting in diagnostic and treatment challenges. Pecora and Cruz Filho The incidence of radicular grooves is 3.0% . There are reports of maxillary lateral incisors with fusion with a supernumerary tooth, fusion with a maxillary central incisor, gemination two roots, dens evaginatus , or dens invaginatus .

17. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p.

18. Maxillary Lateral Incisor

19. Maxillary Lateral Incisor

20. Maxillary Canine

21. Maxillary Canine The root of the maxillary canine is oval in shape and tapers toward the lingual The root is wider labiolingually and is the longest root in the dentition, approximately 17 mm in length. Prominent developmental depressions can be present on both its mesial and distal surfaces, especially in the middle third of the root. The root tip may be blunt or it may end in a fine, often curved tip The overall average length of the maxillary canine is 27 mm with an average crown length of 10 mm and an average root length of 17 mm

22. Maxillary Canine Most studies have found that the maxillary canine has a single root 100% of the time, The maxillary canine usually has a single canal , 3.5 % have two canals . those having two canals, the majority join in the apical third and exit through a single foramen. Accessory (lateral) canals are not uncommon and the majority of these occur in the apical third of the tooth , and less in midroot . The root apex and the apical foramen were displaced distolabially In the most cases the apical foramen and the root apex was not coincided , therefore the use of the electronic apexlocator is more reliable than the radiograph in root canal treatment.

23. Maxillary Canine The average distance of the major apical foramen from the anatomical root apex was found to be 0.3 mm. Approximately 12% of the maxillary canines exhibited accessory foramina.

24. Maxillary Canine The maxillary canine usually presents few anatomical variations. When variations do occur, the root is more frequently affected than the crown The total incidence of dens evaginatus has been shown to be approximately 1% in an extensive literature review and usually take the form of a tubercle or a talon cusp, and is most frequently found on the lingual surface of the crown , there are also reports of labial tubercles. Other variations reported in the literature include case two canals in a single root, dens invaginatus .

25. Maxillary Canine

26. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p.

27. Maxillary Canine Access Cavity Preparation

28. Maxillary Canine Errors in access Cavity Preparation

29. Maxillary Canine

30. Maxillary Canine

31. Maxillary First Premolar

32. Maxillary First Premolar Maxillary first premolar may have one, two (which is more common ), or three roots . There are some common features to the various form overall length of the maxillary first premolar is 22 mm with an average crown length of 8.5 mm and an average root length of 14 mm. Prominent root concavities are present on both the mesial and the distal surfaces of the root. Buccal view Palatal mesial Distal

33. Maxillary First Premolar The incidence of three-rooted maxillary first premolars ranged from 0% to 6%. The studies identifying ethnic background have demonstrated distinct differences between Asian and Caucasian populations. Single-rooted maxillary first premolars are the dominant form in Asian population, and three-rooted forms are rare

34. Maxillary First Premolar Ethnicity was a factor in canal number. The incidence of a single canal was significantly higher in Asian populations compared to the mixed non-Asian population. All of the three-rooted first premolars in the anatomical studies were found to have a single canal in each root. Regardless of the number of roots, the majority of maxillary first Premolars had two separate canals and foramina at the apex Ingle 6

35. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p.

36. Maxillary First Premolar Access Cavity Preparation

37. Maxillary First Premolar Errors in Access Cavity Preparation

38. Maxillary First Premolar

39. Maxillary First Premolar

40. Maxillary Second Premolar

41. Maxillary Second Premolar Oval- or kidney-shaped root cross-section. Developmental depressions are often present on the mesial and the distal aspects of the root. The single root trunk is broad buccolingually and is narrower mesiodistally . The root tip ends as a single blunt apex, but it may be fine and divide into two or more, rarely three, apices. The curvature in the apical third is also not uncommon. The overall average length is 22.5 mm with an average crown length of 8.5 mm and an average root length of 14 mm. The most Common form of the maxillary second premolar is a single root , 5.5% to 20.4% the incidence of two roots ,while the three-rooted form was a rare finding and ranged from 0% to 1% . many patients as this anomaly is quite e. Ingle ( Endodontic 6 )

42. Maxillary Second Premolar The maxillary second premolar has a single canal in approximately 50% of the 2743 teeth examined in 10 anatomical studies, Ingle ( Endodontic 6 ) Even though over 90% of these teeth have a single root, a high proportion will have two canals present. Canal exploration of maxillary second premolar teeth should be done with fine curved files, keeping in mind the Vertucci or Weine classification of two canals in one root that may not be apparent on the radiograph. The incidence of three canals in the maxillary second premolar was low in each of the anatomical studies.

43. Maxillary Second Premolar Three-rooted maxillary second premolar teeth do not seem to be as common as in first premolars. This anomaly is often bilateral and should be considered by exposing radiographs taken at different angles. Ingle ( Endodontic 6 )

44. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p.

45. Maxillary Second Premolar Access Cavity Preparation

46. Maxillary Second Premolar

47. Maxillary Second Premolar Errors in Access Cavity Preparation

48. Maxillary Second Premolar

49. Maxillary Second Premolar

50. Maxillary Second Premolar

51. Maxillary Second Premolar

52. Maxillary Second Premolar

53. Maxillary Second Premolar

54. Maxillary First Molar

55. Maxillary First Molar The maxillary first molar normally has three roots The mesiobuccal root is broad buccolingually and has prominent depressions or flutings on its mesial and distal surfaces. The distobuccal root is generally rounded or ovoid in cross section The palatal root is more broad mesiodistally than buccolingually and ovoidal in shape . The palatal root generally appears straight on radiographs,but there is usually a buccal curvature in the apical third. The overall average length of the maxillary first molar is 20.5 mm with an average crown length of 7.5 mm and an average root length of 13mm.

56. Maxillary First Molar The internal canal morphology is highly variable, but the majority of the mesiobuccal roots contain two Canals. The distobuccal root is usually contains a single canal. The palatal root is normally contains only a single canal.

57. Maxillary First Molar The internal root canal system morphology reflects the external root anatomy. The mesiobuccal root contains a double root canal system more often than a single canal according to most of the anatomical studies . The incidence of two canals in the mesiobuccal root was 57.1 and of one canal was 42.9% in a weighted average of all reported studies. The incidence of two canals in the mesiobuccal root was higher in laboratory studies (61.1%) compared to clinical studies The distobuccal root had only one canal in 98.3% of teeth studied, while the palatal root had only one canal in over 99% of the teeth studied.

58. Maxillary First Molar The incidence of location of a two-canal system in clinical studies appears to be increasing with the routine use of the SOM and other aids during the modified endodontic access opening procedure. The two-canal system of the mesiobuccal has a single apical foramen roughly twice as often (66.0%) in proportion to the two-canal and two-foramen morphology, in weighted laboratory studies . The single-canal system and single apical foramen in the palatal and the distobuccal root is the most predominant form, as reported in all studies, but multiple canals and more than one apical foramen variation do exist in 1–3% of these roots in the weighted studies reported.

59. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p. Sudanese dental center Sudanese dental center Maxillary First Molar Ingle ( Endodontic 6 )

60. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p.

61. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p.

62. Maxillary First Molar Access Cavity Preparation

63. Maxillary First Molar Access Cavity Preparation

64. Maxillary First Molar Access Cavity Preparation

65. Maxillary First Molar Errors in Access Cavity Preparation

66. Maxillary First Molar

67. Maxillary First Molar

68. Maxillary First Molar

69. Maxillary First Molar

70. Maxillary First Molar

71. Maxillary Second Molar

72. Maxillary Second Molar The maxillary second molar normally has three roots. The relative shape of each of the roots is similar to the maxillary first molar, but the roots tend to be closer together and there is a higher tendency toward fusion of two or three roots. There is also usually more of a distal inclination to the root or roots of this tooth compared to the maxillary first molar. The mesiobuccal root is broad buccolingually and has prominent depressions or flutings on its mesial and distal surfaces. The distobuccal root is generally rounded or ovoid in cross section The palatal root is more broad mesiodistally than buccolingually and ovoidal in shape The overall average length is 19 mm with an average crown length of 7 mm and an average root length of 12 mm.

73. Maxillary Second Molar The internal canal morphology is variable and the closer proximity of the roots results in a higher incidence of root fusion and C-shaped canals. Anatomical studies indicate that the mesiobuccal root has almost an equal incidence of one or two canals . The distobuccal and the palatal roots are usually contains a single canal.

74. Maxillary Second Molar The shape of the root provides an indication of the shape of the internal canal morphology. The mesiobuccal root is broad buccolingually and narrow mesiodistally and may have contain may have one or two canals. The anatomical studies found a wide range of canal incidence in the mesiobuccal root. The single canal is usually described as being kidney- or ribbon-shaped. Eskoz and Weine suggest that age and continued deposition of secondary dentin in the isthmus can cause narrowing and possible occlusion resulting in two canals. There was a single apical foramen found in the mesiobuccal root over 68% of the time. The distobuccal and palatal roots exhibited a single canal over 99% of the time in the 10 anatomical studies reported

75. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p.

76. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p.

77. Maxillary Second Molar Access cavity Preparation

78. Maxillary Second Molar Errors of Access cavity Preparation

79. Maxillary Second Molar

80. Maxillary Second Molar

81. Maxillary Second Molar

82. Maxillary Third Molar

83. From Vertucci FJ, Haddix JE. Tooth morphology and access cavity preparation . In: Hargreaves KW, Cohen S. Cohen’s pathways of pulp . 10th ed. Mosby Elsevier , 2011. 1026 p.