ACCE

SSCAV
ITI
ES
Dr. Begüm BERKMEN
 ROO
TCAN
ALAN
ATOMY
Typically, root canals take variable pathways from the orifice
to the apex.

The root canal system is divided into two portions: the pulp
chamber, located in the anatomic crown of the tooth, and the
pulp or root canal (or canals), found in the anatomic root.
PULP HORNS are important because the pulp is often exposed by
caries, trauma, or mechanical invasion, which usually needs vital
pulp or root canal treatments.

Also, the pulp horns undergo rapid mineralization, along with

reduction of the size and shape of the pulp chamber because of the
formation of reparative dentin over time.
The root canal begins as a funnel-
shaped canal orifice, generally at or just
apical to the cervical line, and ends at
the apical foramen, which opens onto
the root surface at or within 3 mm of the
center of the root apex.
ACCESSORY CANALS are minute canals that extend in
a horizontal, vertical, or lateral direction from the pulp
space to the periodontium.

74% Api
cal
thi
rd
11% Mi
ddl
eth
ird
15% Cerv
ical
thi
rd
ACCESSORY CANALS
Accessory canals that are present in the bifurcation or
trifurcation of multirooted teeth are referred to
as furcation canals.

Accessory canals contain connective tissue and

vessels but do not supply the pulp with sufficient
circulation to form a collateral source of blood flow.
VERTUCCİ CLASSIFICATION
 1 2-
1 1-
2-1 2 1-
2 2-
1-2 1-
2-1-
2 3

Type I: A single canal extends from the pulp chamber to the apex (1).
Type II: Two separate canals leave the pulp chamber and join short of the apex
to form one canal (2-1).
Type III: One canal leaves the pulp chamber and divides into two in the root;
the two canal then merge to exit as one canal (1-2-1).
Type IV: Two separate, distinct canals extend from the pulp chamber to the apex
(2).
Type V: One canal leaves the pulp chamber and divides short of the apex into
two separate, distinct canals with separate apical foramina (1-2).
Type VI: Two separate canals leave the pulp chamber, merge in the body of the
root, and separate short of the apex to exit as two distinct canals (2-1-2).
Type VII: One canal leaves the pulp chamber, divides and then rejoins in the body
of the root, and finally separates into two distinct canals short of the apex (1-2-1
-2).
Type VIII: Three separate, distinct canals extend from the pulp chamber to the
apex (3).
Coronal Considerations

It is important to note that if only

one canal is present, it usually is
located in the center of the
access preparation.
Midroot Considerations
Isthmus !!!

narrow, ribbon-shaped communications between two root

canals that contain pulp or pulpally derived tissue, or they may
represent a communication between two canals that split in
the midroot portion of the canal.
 Apical Considerations

MINOR APICAL DIAMETER (APICAL CONSTRICTION):

The AC generally is considered the part of the root canal

with the smallest diameter; it also is the reference point
clinicians use most often as the apical termination for
enlarging, shaping, cleaning, disinfecting, and filling.

Violation of this area with

instruments or filling materials is
not recommended for long-term,
successful outcomes.
The Cemento Dentinal Junction ( CDJ) is the point in the canal where
cementum meets dentin; it is also the point where pulp tissue ends and
periodontal tissues begin.

From the AC, or minor apical diameter, the canal widens as it approaches
the , Apical Foramen or major apical diameter.

The space between the major and minor diameters has been described as
funnel shaped or hyperbolic, or as having the shape of a morning glory
The mean distance between the major and minor apical diameters is
0.5 mm in a young person and 0.67 mm in an older individual. The
distance is greater in older individuals because of the buildup of
cementum.
Endodontic treatment essentially depends on three factors:

Cl
ean
ing an
dsh
api
ng

Di
si
nf
ect
i
on

3-D obt
urat
i
onoft
he
rootcan
al
 OB
JECTI
VESAND
G
U ID
ELI
N E
SFOR ACCE
SS
CAVI
TYPREP
ARATION
Access to the complex root canal system is the first and the most
important phase of root canal procedure

The objectives of access cavity preparation are to:

(1) remove all caries when present,

(2) conserve sound tooth structure,
(3) unroof the pulp chamber completely,
(4) remove all coronal pulp tissue (vital or necrotic),
(5) locate all root canal orifices, and
(6) achieve straight- or direct-line access to the apical foramen or
to the initial curvature of the canal.
A properly prepared access cavity creates a smooth, straight-
line path to the canal system and ultimately to the apex or
position of the first curvature.
• Straight-line access provides the best chance of debridement
of the entire canal space;

• It reduces the risk of instrument breakage;

• It results in straight entry into the canal orifice, with the line
angles forming a funnel that drops smoothly into the canal (or
canals)
 KEY STEPS TO CONSIDER IN ACCESS
PREPARATION

1. Internal tooth anatomy dictates access shape; therefore, the

first step in preparing an access cavity is visualization of the
position of the pulp space in the tooth.
2.Centrality: The floor of the pulp chamber is always located
in the center of the tooth at the level of the CEJ.

3.Concentricity: The external root surface anatomy reflects

the internal pulp chamber anatomy.
4.Symmetry: Except for the maxillary molars, canal orifices are
equidistant from a line drawn in a mesiodistal direction through
the center of the pulp chamber floor.

5.Color change: The pulp chamber floor is always darker in

color than the walls.
6.Location of the CEJ: making the CEJ landmark for locating the
position of the pulp chamber

7.Orifice location: The orifices

of the root canals are always
located at the junction of the
walls and the floor
 Tapering of Cavity Walls

A proper access cavity generally has tapering walls,

with its widest dimension at the occlusal surface.
The preparation of an access cavity requires the following
equipment:

•Magnification and illumination

•Handpieces

•Burs

•Endodontic explorers

•Endodontic spoon

•Ultrasonic unit and tips

• Endodontic explorers
Access cavities on anterior teeth usually
are prepared through the lingual tooth
surface, and those on posterior teeth are
prepared through the occlusal surface.
Anterior Teeth
Inadequate access preparation.

The lingual shoulder was not removed,

and incisal extension is incomplete.

The file has begun to deviate from the

canal in the apical region, creating a
ledge.
Posterior Teeth
 MAXILLARY CENTRAL
INCISOR

Definitive shape of the access cavity for upper central incisor.

 MAXILLARY LATERAL
INCISOR
The pulp chamber outline of the maxillary lateral
incisor is similar to that of the maxillary central
incisor; however, it is smaller.
 MAXILLARY
CANINE

The root canal system of the maxillary canine is similar

in many ways to that of the maxillary incisors. A major
difference is that it is wider labiolingually than
mesiodistally.
 MAXILLARY FIRST MAXILLARY SECOND
PREMOLAR PREMOLAR
Most maxillary first premolars have The root canal system of the maxillary
two root canals, regardless of the second premolar is wider buccolingually
number of roots than mesiodistally
 MAXILLARY FIRST
MOLAR

The maxillary first molar is the largest

tooth in volume and one of the most
complex in root and canal anatomy!!!

The pulp chamber is widest in the

buccolingual dimension, and four pulp
horns are present (mesiobuccal,
mesiopalatal, distobuccal, and
distopalatal).
The three individual roots of the
maxillary first molar (i.e., mesiobuccal
root, distobuccal root, and palatal root)
form a tripod. The palatal root is the
longest, has the largest diameter. The
palatal root often curves buccally at
the apical one third
The orifice of the palatal canal is located beneath the
mesiopalatal cusp.
 MAXILLARY SECOND
MOLAR
three roots are grouped closer together and are
sometimes fused
 MANDIBULAR CENTRAL AND
LATERAL INCISOR
As with the maxillary incisors, a lingual shoulder must be
eliminated to allow direct-line access.
Unlike the maxillary incisors, the pulp outline of the
mandibular incisors is wider labiolingually.
 MANDIBULAR
CANINE

The root canal system of the mandibular canine is

very similar to that of the maxillary canine, except
that the dimensions are smaller, the root and root
canal outlines are narrower in the mesiodistal
dimension
 MANDIBULAR MANDIBULAR
FIRST PREMOLAR SECOND PREMOLAR
The root canal system of the
mandibular first premolar is wider
buccolingually than mesiodistally
The mandibular second premolar
is similar to the first premolar, with
the following differences: the
lingual pulp horn usually is larger
 MANDIBULAR FIRST
MOLAR
The earliest permanent posterior tooth to erupt, the mandibular
first molar seems to be the tooth that most often requires an
endodontic procedure.
The tooth usually has two roots, but occasionally it has three,
with two or three canals in the mesial root and one, two, or three
canals in the distal root
 MANDIBULAR
SECOND MOLAR

The pulp chamber and canal orifices

of the mandibular second molar
generally are not as large as those of
the first molar. This tooth may have
one, two, three, or four root canals.
THIRD MOLAR

The radicular anatomy of the third molars are completely

unpredictable.
This teeth may have one to four roots and one to six canals.