Download - Root Canal Morphology & Access Preparation
Dr. Nithin Mathew
Root Canal Morphology &
Access Cavity Preparation
CONTENTS
• Introduction
• Root canal system
• Classification
• Guidelines for cavity preparation
• Principles of Endodontic cavity preparation
• Anomalies to Pulp Cavity
• Root Morphology and Access Cavity preparation of Each tooth
• Conclusion
• References
3 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
INTRODUCTION
• Major factors for development of pulpal and periradicular diseases:• Loss of integrity of coronal tooth substance• Entry of microorganisms into the dentin and pulpal space
• Aim of Root canal treatment:• Chemomechanical removal of microorganisms, their substrate and products
from the dentin and pulp space.• 3D obliteration and sealing of the pulp space to prevent bacterial
contamination.
4 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• One must have a thorough understanding of the tooth anatomy, an essentialprerequisite to achieve the objectives of access preparation through cleaning,disinfection and obturation of the pulp space.
• Problems encountered during the treatment occur because of inadequateunderstanding of the pulp space anatomy.
• Clinician must familiarize himself with the irregularities, complexities andaberrations which are likely to occur within the pulp space.
5 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
OBJECTIVES OF RCT
6
Mechanical Objectives Biologic Objectives
• Prepare a sound anatomical matrix• Create a continuously tapering funnel
shaped preparation• Avoid overzealous instrumentation
• Precurve files when necessary
• Remove all residues from the canal• Maintain patency through the apical
foramen
• Establish an exact working length
• Confine instrumentation to canal
• Remove all irritants from the canal• Avoid pushing debris past the apical
constriction• Create a significant width in the
coronal half of the canal to allow for copious irrigation
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ROOT CANAL SYSTEM
• The entire space in the dentin where the pulp is housed - Cohen
7 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
PULP CHAMBER
• Roof of pulp chamber• Dentin covering the pulp chamber occlusally or incisally.
• Pulp horn• Accentuation of the roof of the pulp chamber directly
under a cusp or developmental lobe.
• Floor of pulp chamber• Runs parallel to the roof and consists of dentin
bounding the pulp chamber near the cervical area of thetooth.
• Canal orifices• Openings in the floor of pulp chamber leading in to root
canals8 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ANATOMY OF THE APICAL ROOT (Kuttlers)
1. The Apical constriction
2. The Cementodentinal junction
3. The Apical Foramen
9 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Part of the root canal with the smallest diameter
• Reference point for apical termination
• Distance ranges from 0.5mm -1.5mm inside theapical foramen
Apical Constriction (Minor Apical Diameter)
10 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Cementodentinal Junction
• Point in the canal where cementum meets dentin
• Approximately 1mm from the apical foramen
11 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Apical Foramen (Major Apical Diameter)
• Differentiate the terminal of cemental canal from the exterior surface of the tooth.
• Rounded edge like a funnel / crater
• Not necessarily always at the centre of root apex
• Average 0.4 – 0.7 mm away from the anatomic apex
12 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Space between major and minor apical diameter - FUNNEL SHAPED, HYPERBOLICor having the shape of a MORNING GLORY
• Mean distance between major and minor diameter:• 0.5mm in young individual• 0.67mm in older individual
13 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Apical third : highest percentage of ramifications and accesory canals.
• These ramifications and accesory canals were increasingly eliminated by• 1mm root end resection - 52%• 2mm root end resection - 78%• 3mm root end resection - 98%
• Reason for removing the apical 3mm during apicoectomy.- Cohen
14
• Apical Delta :• Describes the primary or secondary canal that
terminates short of the apex with lateral canals fanningout from this point to the end of root surface.
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Complexity of Apical Root
• After the tooth erupts the HERS is still active in the formation of the root.
• Occlusal loading at this stage can cause a discontinuity of this sheath which results inthe formation of accessory foramen and lateral canals.
• Mesial migration of the tooth due to loading is the reason for the curvatures at theapex - dilacerations
• After the formation of the roots are complete the location of the apical foramen andthe apical anatomy keeps changing constantly because of continuous cementumapposition.
15 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Accessory Canals
• Minute canals that extend in a horizontal, vertical, or lateral direction from the pulp tothe periodontium.
• 73.5% - apical third• 11.4% - middle third• 15.1% - cervical third. - Cohen
• Contain connective tissue and vessels but do not supply the pulp with collateralcirculation.
• Formed by the entrapment of periodontal vessels in Hertwig's epithelial root sheathduring calcification. - Grossman
16 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Lateral Canals
• An accessory canal that branches to the lateral surface ofthe root.
• Opening of accessory and lateral canals in the root surface.
17
Accessory Foramena
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• There are always two apices recognized for any tooth:• Radiographic Apex• Anatomic Apex
• Radiographic Apex:• It is the external border of the root tip which is seen
radiographically.
• Anatomic Apex:• Natural apical constriction formed by the cemento-
enamel junction
18 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Course of Root Canals
19
Curved root canals with apical foramen
distant from the apex
Curved root canals with apical foramen
near the apex
Constricted root canal as the apical foramen is
approached
Double curvature of root canal with the
foramen at a distance from the root apex
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Shape of the Canals - Torabineajad
• Six different shapes have been noted
• Round
• Oval
• Deep oval
• Bowling pin
• Kidney bean
• Hour glass
20 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Classification of Endodontic Treatment based on the degree of difficulty - Ingle
• Type IInsignificant curvature of root canal
• Type IIAnatomic problems like severe dilaceration, complex apical region withdivergence of canal, with numerous foramina
• Type IIIOpen foramen, incomplete root formation
• Type IVDecidous teeth, resorption of root tip
21 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Canal Isthmus
• Narrow, ribbon-shaped communication between two rootcanals that contains pulp or pulpally derived tissue.
• It was found that the percentage of occurrence of isthmusincreases continuously for every 1mm from the apex for thefirst 4mm.
22 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Types
• Type IIncomplete isthmus; faint communication betweentwo canals.
• Type IICharacterized by two canals with definite connectionbetween them.
• Type IIIVery short complete isthmus between two canals.
23 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Type IVComplete or incomplete isthmus between two ormore canals.
• Type VMarked by two or three canal openings withoutvisible connections
24 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
According to Melton et al (1991)
Category 1 : Continuous C-shaped canal from pulpchamber to apex
Category 2 : One canal was separated by dentin from theC-shaped canal(semi colon)
Category 3 : C-shaped orifice with 2 or more distinct andseparate canals
25 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
According to Hsu & Kim
• Type ITwo or three canals with no notable communicationbetween them
• Type IITwo canals with definite communication
• Type IIIDiffers from Type II due to presence of three canalsinstead of two.Incomplete C shaped canals with 3 canals included
26 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Type IVCanals extending to isthmus area
• Type VTrue connection or corridor throughout section
27 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
CLASSIFICATION OF ROOT CANAL SYSTEM
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation 28
According to Weine
29
Type I Type II Type III Type IV
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
According to Vertucci
30 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
According to Gulabiwala
31 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Root Canal Curvatures
SCHNEIDER‘s classification on the basis of degree of curvature
Straight• : 5 ̊ or less
Moderate• : 10° - 20°
Severe• : 25° - 70 ̊
32 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Guidelines for Cavity Preparation
• CEJ is the most important anatomical landmark for determining the location of pulpchamber and root canal orifices – Krasner & Rankow
• Laws of Pulp Chamber Anatomy:• First law of symmetry• Second law of symmetry• Law of color change• First law of orifice location• Second law of orifice location• Third law of orifice location
33 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Laws of Pulp Chamber Anatomy – Krasner & Rankow
First• law of symmetryExcept• for maxillary molars, orifices of the canalsare equidistant from a line drawn in a mesio-distaldirection through the floor of the pulp chamber.
Second• law of symmetryExcept• for maxillary molars, orifices of the canalslie on a line perpendicular to to a line drawn in amesiodistal direction across the center of the floorof the pulp chamber
34 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Laws of Pulp Chamber Anatomy
• Law of color change• Color of the pulp chamber floor is always darker
than the walls
35
• First law of orifice location• Orifices are always located at the
junction of the walls and the floor.
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Laws of Pulp Chamber Anatomy
• Second law of orifice location• Orifices are located at the angles of the wall-floor
junction.
36
• Third law of orifice location• Orifices are located at the terminus of the root
developmental fusion lines.
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Laws of Pulp Chamber Anatomy
• Law of CEJ• Distance from external surface of clinical crown to the
wall of pulp chamber is same throughout thecircumference of the tooth at the level of CEJ.
37
Law• of ConcentricityExternal• root surface anatomy reflects the internalpulp chamber anatomy
Law• of Centralityfloor• of pulp chamber always located in the centre oftooth at the level of CEJ.
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Champagne Bubble Test• Use of sodium hypochlorite in the pulp chamber to
check for bubbles
38 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
39
Tests• For Locating Canals
Vital• cases bleed - blood can be visualized as a small droplet above anorifice or a "RED LINE" within a groove that emanates off an orifice /system.
Additionally,• a spot of blood on the side of a paper point that is placedwithin a shaped canal may suggest a LATERAL CANAL or the entrance to adeeply branching system.
In• necrotic cases, a "WHITE LINE" can be visualized as the clinician troughsalong a groove.
Eg• : Following a white line off the MB1 system towards the palataloften times leads to the MB2 orifice / canal system.
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Objectives of Access Cavity Preparation
40
I. To remove all cariesII. To conserve sound tooth structureIII. To completely deroof the pulp chamberIV. To remove all coronal pulp tissue (vital or necrotic)V. To locate all root canal orificesVI. To achieve straight- or direct-line access to the apical foramen or to the
initial curvature of the canalVII. To establish restorative margins to minimize marginal leakage of the
restored tooth
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Principals of Endodontic Cavity Preparation
41
Coronal Cavity Preparation Radicular Cavity Preparation
I. Outline Form
II. Convenience Form
III. Removal of remaining carious dentin
IV. Toilet of cavity
I. Outline & Convenience Form
II. Toilet of Cavity
III. Retention Form
IV. Resistance Form
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
PRINCIPLE I – Outline Form
• Must be correctly shaped and positioned to establish complete access forinstrumentation from the cavity margin to apical foramen.
• To achieve the optimal preparation, the following factors of internal anatomy must beconsidered
i. Size of the pulp chamberii. Shape of the pulp chamberiii. Number of individual root canals, their curvature and position.
43 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Size of the pulp chamber
Young• patients – more extensive than older patients
Quite• apparent while preparing anterior tooth in youngsters, whose large root canalsrequire larger instruments.
44 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Shape of the pulp chamber
• Finished outline form should accurately reflect the shape of the pulp chamber.
• Eg: floor of pulp chamber in maxillary molar is triangular in shape
• This shape is extended outwards occlusally to the surface, hence final occlusalcavity outline form is generally triangular
45 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Number, Position and Curvature of root canals
To• prepare each canal efficiently without interference, cavity walls must be extendedto allow an unstrained instrument approach.
Often• cavity walls have to be extended to improve instrumentation.Hence,• outline form in materially affected.
This• change is for convenience in preparation hence, convenience form partlyregulates the ultimate outline form.
46 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
PRINCIPLE II – Convenience Form
• Convenience form in endodontics makes more convenient and accurate preparationand filling of the root canal.
• 4 important benefits gained through convenience form modification are
i. Unobstructed access to the canal orificeii. Direct access to apical forameniii. Cavity expansion to accommodate filling techniqueiv. Complete authority over the enlarging instrument.
47 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
i. Unobstructed access to the canal orifice
Enough• tooth structure must be removed to allow instrument to be placed easily intothe orifice of each canal without interference from the overhanging walls.
48
• Failure to observe this principle not only endangers the successfuloutcome of the case, but also adds materially to the duration of thetreatment.
• But precautions must be followed in case of certain tooth likemandibular incisors.
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Leubke said that an entire wall need not be extended in case of a severely curvedcanal to prevent instrument impringment or to access an extra canal.
• Here only that area of the wall need to be prepared to free the instrument.
• Finally a cloverleaf appearance of the outline form.
• Hence, Leubke has termed it as “SHAMROCK PREPARATION”.
49 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ii. Direct access to Apical Foramen
Enough• tooth structure must be removed to allow the instruments freedom withinthe coronal cavity.
50
• So that they extend down into the canal in an unstrainedpositioned.
• This is true when the canal is severely curved or when the canalleaves the chamber at an obtuse angle
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
iii. Extension to accommodate filling techniques
• Often necessary to expand outline form to make certain filling techniques moreconvenient or practical.
• Eg: Thermoplastic obturation techniques requires use of heavy instruments, henceoutline form must be widely extended to accommodate them.
51 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
iv. Complete Authority over enlarging instrument
• Failure to properly modify the access cavity outline by extending the convenienceform will ultimately lead to failure by either
• Root perforation• Ledge or shelf formation within the canal• Instrument breakage• Incorrect shape of completed canal preparation• Apical transporation
52 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
PRINCIPLE III – Removal of remaining carious dentin & defective restorations
I. To eliminate mechanically as many bacteria as possible from the interior of thetooth.
II. To eliminate discoloured tooth structure that may ultimately lead to staining ofthe crown.
III. To eliminate the possibly of any bacteria laden saliva leaking into the preparedcavity.
• After the caries is removed, if carious perforation of the wall is allowing salivaryleakage, the area must be repaired with cement, preferably from inside the cavity.
53 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
If• caries is soo extensive, that the lateral walls are destroyed, or if a defectiverestoration is in place, then entire wall is removed and later restored.
Restoration• is postponed until the radicular preparation is completed since it is mucheasier to complete radicular preparation through an open cavity than through arestored crown.
54 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
PRINCIPLE IV – Toilet of Cavity
• All caries, debris & necrotic material must be removed from the chamber before theradicular preparations begins.
• If calcified / metallic debris is left in the chamber & carried to the canal, it may act asobstruction.
• Soft debris carried to the canal might increase the bacterial population in the canal.
• Coronal debris may also stain the crown (anteriors)
• Toilet of the cavity makes a significant portion of the radicular preparation
55 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Instruments used in Access Preparation
BURS•
No• . 2, 4 & 6 round burs
Fissure• / carbide burs for axial wall extension
EndoAccess• bursCombination• of round and tapered fissured burFor• preparation of pulp chamber & flaring of walls
56 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• BURS
• Endo Z bur• Long tapered• Create funnel shape for easier access to chamber• Round non cutting safe ended tip
• Gates Glidden Drills
57 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Endodontic Explorer
• DG-16• To identify canal orifices• To determine canal angulation
• CK-17• To identify calcified canals
• Endodontic spoon excavator
58 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• # 17 Operative Explorer
• Detecting any remaining pulp chamber roof,particularly in the area of pulp horn
• Ultrasonic Unit & Tips
• Used to trough & deepen developmental grooves toremove tissues & explore for canals
• BUC tips (1-3)
59 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Anomalies of Pulp Cavity
• Dentinogeneis Imperfecta• Pulp cavities may be small or even obliterated
• Hyperparathyroidism• Cause pulp calcification and loss of lamina dura
• Hypofunction of Pituitary Gland• Lead to retarded eruption of teeth and to open apices
60 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Dentinal• dysplasiaObliteration of pulp chamber and defective rootformation
Taurodontism•Short root and larger than normal pulp chamber
Dens• Invaginatus
Malformation due to an invagination of enamelepitelium resulting in a chanel or lumen surroundedby hard tissues within the tooth.
Frequently occurs in the palatal surface of max. lateralincisor
61 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Dens Evaginatus
Is an extra cusp, usually in the central groove orridge of a posterior teeth and in the cingulum of thecentral or lateral incisor
• Fusion
Union in dentin and/or enamel between two ormore normal teeth
• Gemination
Incomplete division of a tooth germ or a unionbetween normal and a supernumerary tooth
62 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Rhizomicry
Length of the root is shorter than the height of thecrown
Associated with osteoporosis
Predominantly affecting maxillary incisors andpremolars
63 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Maxillary Central Incisor
• Single rooted, straight root trunk
• Triangular / ovoid in cross section, tapers towards lingual
• Single root canal system
• Mid root and apical lateral canals are common
• Root apex & apical foramen are located distolabially.
64
Av. Tooth Length 23.5 mmAv. Crown Length 10.5 mmAv. Root Length 13 mm
Maxillary Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
65
PULP CHAMBER• Located in the centre of crown equidistant from
dentinal walls• Broad mesiodistally – broadest part incisally• Follows contours of crown & has 3 pulp horns which
correspond to mammelons
Cross-Section• Cervical Large in young• Middle Ovoid to round shaped• Apical Round shaped
Maxillary Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Roots• Majority are straight - 75%• Distally curved - 8%• Mesially curved - 4%• Palatally curved - 4%• Labially curved - 9%
• Lateral Canals - 23%• Apical Ramifications - 9%
66
Anomalies• Talon’s Cusp• Dens invaginvatus• Fusion• Gemination• Palatogingival Groove
Maxillary Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Maxillary Lateral Incisor
• Single rooted
• Root trunk smaller than central incisor
• Circular / ovoid in cross section, tapers towards lingual
• Single root canal system
• Root apex & apical foramen are displaced distolingually.
67
Av. Tooth Length 22.5 mmAv. Crown Length 9 mmAv. Root Length 13 mm
Maxillary Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
68
PULP CHAMBER• Similar to maxillary central incisor (smaller)• 2 pulp horns corresponding to developmental mammelons
Cross-Section• Cervical Slightly ovoid becomes progressively
round• Middle Slightly ovoid to round• Apical Round
Maxillary Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Roots• Distally curved - 53%• Others are straight - 30%
• Lateral Canals (frequently) - 26%• Apical Ramifications - 12%
69
Anomalies• Dens invaginvatus• Peg laterals (Gardner’s syndrome)• Fusion (with Central Incisor)• Gemination• Palatogingival Groove
Maxillary Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Maxillary Canine
• Single rooted, largest tooth in dentition
• Root is wider labiolingually
• Developmental depressions present in mesial & distalsurfaces
• Ovoid in cross section
• Usually single root canal system
• Root apex & apical foramen are displaced distolabially.
70
Av. Tooth Length 26 mmAv. Crown Length 10 mmAv. Root Length 17 mm
Maxillary CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
71
PULP CHAMBER• Triangular in shape with apex towards single cusp &
broad base in cervical third of crown• Mesiodistally : narrow resembling a flame
Cross-Section• Cervical Slightly ovoid• Middle Canal is smaller and remains ovoid• Apical Round
Maxillary CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Roots• Straight - 39%• Distally curved - 32%• Mesially curved - 0%• Palatally curved - 7%• Labially curved - 13%
• Lateral Canals - 24%• Apical Ramifications - 8%
72
Anomalies• Dilaceration• Dens evaginvatus• Dens invaginvatus• Supernumery Canine• 2 canals / 2 roots
Maxillary CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In MAXILLARY ANTERIOR TEETH
73
Initial penetration is made at the exact center
of lingual surface
Round pointed tapering fissure bur in an
accentuated speed handpiece at right angle to the long axis of the tooth
Rotate the handpiece to the incisal so that the bur is parallel to the long axis
of toothPreliminary cavity outline
funnelled and fanned incisally with a fissure bur
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
74
No: 2 or 4 round bur in a slow speed handpiece is
used to penetrate the pulp chamber
Working from inside to outside, a round bur is used
to remove the lingual & labial walls of the pulp
chamber
Working from inside the chamber to outside, long
tapering diamond point is used to remove the
lingual shoulder No: 1 or 2 round bur used laterally and incisally to
eliminate pulp horn debris
Cavity Preparation In MAXILLARY ANTERIOR TEETH
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
75
Final preparation: triangular internal anatomy in young
teeth
Cavity preparation in adult- ovoid
Cavity Preparation In MAXILLARY ANTERIOR TEETH
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ERRORS In Cavity Preparation In MAXILLARY ANTERIOR TEETH
76
Perforation at the labiocervical
Gauging of Labial wall
Pear shaped preparation of apical canal
Gauging of Distal wall
Discoloration of crown
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ERRORS In Cavity Preparation In MAXILLARY ANTERIOR TEETH
77
Ledge formation at apical distal curve
Perforation at apical distal curve
Ledge formation at apical labial curve
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Mandibular Central Incisor
• Single rooted
• Broader labiolingually than mesiodistally
• Developmental depressions present in mesial & distal rootsurfaces
• Ovoid to hourglass in cross section
• Usually single root canal system, ovoid/ribbon
78
Av. Tooth Length 20.8 mmAv. Crown Length 9 mmAv. Root Length 12.5 mm
Mandibular Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
79
PULP CHAMBER• Small & flat – mesiodistally• Wide labiolingually• Tapers incisally
Cross-Section• Cervical Slightly ovoid• Middle Round• Apical Round
Mandibular Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Roots• Straight - 60%• Distally curved - 23%• Mesially curved - 0%• Labially curved - 13%• Lingually curved - 0%
• Lateral Canals - 5.2%
80
Anomalies• Fusion• Gemination• Dens invaginvatus• Talon’s Cusp
CanalsOne canal, one foramen 70.1%2 canals, 1 foramen 23.4%2 canals, 2 formina 6.5%
Mandibular Central IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Additional Canal Configurations – Mandibular IncisorsBy Kartal et al
81
Type I
• Two separate canals extended from the pulpchamber to midroot
• Lingual canal divided into two• All three canals joined in the apical third of
the root and exited as one canal
Type II
• One canal left the pulp chamber• Divided into two in the middle third of the
root, then rejoined to form one canal,• Which again split and exited as three separate
canals with separate foramina
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Mandibular Lateral Incisor
• Similar to Central Incisor
• Major difference is incisal edge anatomy
• Slight angulation to mesiolabial & distolingual of crown
• Usually single root canal system, round/ribbon shaped
82
Av. Tooth Length 22.6 mmAv. Crown Length 9.5 mmAv. Root Length 14 mm
Mandibular Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
83
PULP CHAMBER• Similar to central incisor but slightly larger dimension• Small & flat – mesiodistally• Wide labiolingually• Tapers incisally
Cross-Section• Cervical Slightly ovoid• Middle Round• Apical Round
Mandibular Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Roots• Straight - 60%• Distally curved - 23%• Mesially curved - 0%• Labially curved - 13%• Lingually curved - 0%
• Lateral Canals - 13.9%
84
Anomalies• Fusion• Gemination• Dens invaginvatus• Talon’s Cusp
CanalsOne canal, one foramen 56.9%2 canals, 1 foramen 14.7%2 canals, 2 formena 29.4%
Mandibular Lateral IncisorDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Mandibular Canine
Single• rooted
Broader• labiolingually
Developmental• depressions are present in mesial and distal rootsurface.
Usually• single canal system
85
Av. Tooth Length 25 mmAv. Crown Length 11 mmAv. Root Length 16 mm
Mandibular CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
86
PULP CHAMBER• Resembles maxillary canine but smaller• Narrow mesiodistally• One pulp horn
Cross-Section• Cervical Ovoid• Middle Ovoid (smaller)• Apical Round
Mandibular CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Roots• Straight - 68%• Distally curved - 20%• Mesially curved - 1%• Labially curved - 7%• Lingually curved - 0%• Bayonet curve - 2%
87
Anomalies• Dilaceration• 2 canals, 2 roots• 2 canals in single root• 2 canals in single apical foramen• Dens evaginvatus
CanalsOne canal, one foramen 94%2 canals, 2 formena 6%Variation – Vertucci Type II & III
Mandibular CanineDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Cavity Preparation In MANDIBULAR ANTERIOR TEETH
88
Initial penetration is made at the exact center
of lingual surface
Round pointed tapering fissure bur in an
accentuated speed handpiece at right angle to the long axis of the tooth
Rotate the handpiece to the incisal so that the bur is parallel to the long axis
of toothPreliminary cavity outline
funnelled and fanned incisally with a fissure bur
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
89
No: 2 round bur in a slowspeed handpiece is usedto penetrate the pulpchamber
Working from inside tooutside, a round bur is usedto remove the lingual &labial walls of the pulpchamber
Working from inside thechamber to outside, longtapering diamond point isused to remove thelingual shoulder No: 1 round bur used
laterally and incisally toeliminate pulp horndebris
Cavity Preparation In MANDIBULAR ANTERIOR TEETH
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
90
Final preparation: triangular internal anatomy in young
teeth
Cavity preparation in adult- ovoid
Cavity Preparation In MANDIBULAR ANTERIOR TEETH
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ERRORS In Cavity Preparation In MANDIBULAR ANTERIOR TEETH
91
Gouging at the labiocervical
Gauging of Labial wall
Failure to explore the second canal
Gauging of Distal wall
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ERRORS In Cavity Preparation In MANDIBULAR ANTERIOR TEETH
92
Ledge formation at apical labial curve
Discoloration of crown
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Maxillary 1st Premolar
• Prominent developmental depressions on mesial and distal rootsurfaces (mesial root concavity more prominent)
• Broader buccopalatally & narrow mesiodistally
• Kidney shaped cross section at CEJ
93
Av. Tooth Length 21.5 mmAv. Crown Length 8.5 mmAv. Root Length 14 mm
Maxillary 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
94
PULP CHAMBER• Narrow mesiodistally, wider buccopalatally• Pulp horn under each cusp, buccal pulp horn more
prominent• Floor is convex• 2 canal orifices (lies deep in coronal third of root below
cervical line)
Cross-Section• Cervical Ovoid• Middle Round • Apical Round
Maxillary 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
95
Anomalies• Dens evaginvatus• Gemination (rare)• Taurodontism (rare)
Canal System• 2 roots
• When fused roots, a groove running in occlusso-apical direction divides the root into buccal &palatal portions each containing a single rootcanal
Maxillary 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Maxillary 2nd Premolar
Single• rooted form – most common
Broader• buccopalatally & narrow mesiodistally
Prominent• developmental depressions on mesial and distal rootsurfaces
Single• canal system – 50.3%
96
Av. Tooth Length 21.6 mmAv. Crown Length 8.5 mmAv. Root Length 14 mm
Maxillary 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
97
PULP CHAMBER• Narrow mesiodistally• Wider buccopalatally than Maxillary 1st premolar• Pulp horn under each cusp, buccal pulp horn more
prominent
Cross-Section• Cervical Ovoid• Middle Round • Apical Round
Maxillary 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
98
Anomalies• Dens invaginvatus• Taurodontism• Deep distal root concavity• 2 roots, 3 canals
Canal System• Single root – 90.3%
• 2 well developed roots – 2%
• 2 roots partially fused – 77%
• When 2 canals are present, they’ll be distinct &separated along the entire length of root
Maxillary 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In MAXILLARY PREMOLARS
99
Access starting location point is on central groove between cusp tip
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In MAXILLARY PREMOLARS
100
Initial penetration made with bur parallel long axis
of tooth
No. 2/4 round bur, drop is felt when pulp chamber is
reached
Canal orifices located using endodontic
explorer
Removal of roof of pulp chamber
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In MAXILLARY PREMOLARS
101
Buccolingual extension and finish of cavity walls
using fissure bur
Final preparation should provide unobstructed access to canal orifice
Outline form of final cavity preparation –
ovoid
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ERRORS In Cavity Preparation In MAXILLARY PREMOLARS
102
Under extended preparation
Overextentedpreparation
Faulty alignment of access cavity
Perforation at mesiocervical
indentation
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
103
Failiure to explore 3rd canal/ 2nd canalBroken instrument
ERRORS In Cavity Preparation In MAXILLARY PREMOLARS
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Mandibular 1st Premolar
• Single rooted
• Broader buccolingually
• Developmental depressions on distal root surface is deeper thanmesial surface
• Ovoid / hourglass shape in cross section
104
Av. Tooth Length 21.9 mmAv. Crown Length 8.5 mmAv. Root Length 14 mm
Mandibular 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
105
PULP CHAMBER• Narrow mesiodistally• Wider buccolingually with prominent buccal pulp horn• Prominent buccal cusp & small lingual cusp
Cross-Section• Cervical Very narrow and ovoid• Middle 2 branches of canals are Round• Apical Round
Mandibular 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
106
Anomalies• Dens invaginvatus/ evaginatus• Gemination• H-shaped canal
single canal can split into 2 of which the buccal is straight& the lingual canal splits at a right angle, this gives theappearance of the letter ‘h’
Canal System• Single root• Usually 1 canal – 70%• 1 canal bifurcates into 2 and ends in 2 foramina – 24%• 2 canals exit in 2 foramina – 1.5%• 1 canal may bifurcate into 2, uniting into 1 canal in the
apical third and exiting in one foramen – 4%• 3 canals exit in 3 foramina – 0.5%
Mandibular 1st PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Mandibular 2nd Premolar
• Single rooted
• Mesial surface of root is flat / convex
• Developmental depressions on distal root surface
• Ovoid in cross section
107
Av. Tooth Length 22.3 mmAv. Crown Length 8 mmAv. Root Length 14.5 mm
Mandibular 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
108
PULP CHAMBER• Narrow mesiodistally• Wider buccolingually• Prominent Lingual pulp horn
Cross-Section• Cervical Very narrow and ovoid• Middle Less ovoid • Apical Round
Mandibular 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
109
Anomalies• Dens evaginatus• 2 roots
Canal System• Single canal – 97.5%• Some roots bifurcates exiting in 2 foraminas – 2.5%
Mandibular 2nd PremolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In MANDIBULAR PREMOLARS
110
2ND PREMOLAR1/3rd way up the lingual incline of buccal cusp on a line connecting buccal cusp tip and lingual groove between the lingual
cusps
Ist PREMOLARHalfway up the lingual incline on a line
connecting cusp tips
Mandibular premolar-tilted lingually to root and must be adjusted to this tilt
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In MANDIBULAR PREMOLARS
111
Initial penetration made through occlusal surface
No. 4 round bur, drop is felt when pulp chamber is
reached
Canal orifices located using endodontic
explorer
Removal of roof of pulp chamber
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
112
Buccolingual extension and finish of cavity walls
using fissure burFinal preparation should
provide unobstructed access to canal orifice
Outline form of final cavity preparation – ovoid
Access Cavity Preparation In MANDIBULAR PREMOLARS
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ERRORS In Cavity Preparation In MANDIBULAR PREMOLARS
113
Perforation at the mesiogingival
Incomplete preparation & instrument breakage
Bifurcation of a canal missed
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
114
Perforation of apical curvature
Apical perforation
ERRORS In Cavity Preparation In MANDIBULAR PREMOLARS
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Maxillary 1st Molar
• Mesiobuccal Root :• Broad buccolingually• Developmental depressions in both mesial &
distal root surfaces
• Distobuccal Root :• Round / ovoid in cross section
• Palatal Root :• Broad mesiodistally• Ovoid in cross section• Buccal curvature at the apical third
115
Av. Tooth Length 21.3 mmAv. Crown Length 7.5 mmAv. Root Length 13 mm
Maxillary 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
116
PULP CHAMBER• Largest in the arch• 4 pulp horns : MB, MP, DB, DP• Roof – Rhomboidal in shape• Roof converges, lingual wall disappears and forms a triangular
form• Anatomic dark lines in the floor connect the orifices• Orifices are located in the 3 angles of the floor• Mesiobuccal orifice under mesio-buccal cusp• May have a depression in the palatal end of the mesiobuccal
orifice where a 4th canal may be present• MB2 canal is located mesial to or directly on a line between the
MB and palatal orifice
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Canal SystemMesiobuccal Root• Have distal curvature – 78%• Straight – 21%• Bayonet – 1%• Narrowest of 3 canals• Apical foramen centrally locatedDistobuccal Root• Small• Straight – 54%• Distal curve – 17%• Mesial curve – 19%• Bayonet – 10%• Apical foramen centrally locatedPalatal Root• Largest root & diameter, ovoid mesiodistally, tapers apically• May curve buccally in the apical third
117 Maxillary 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Locating MB2 orifice –• Difficult as its buried under
• dentine bridge formed as a result of aging• reparative dentin formation as result of caries
/restoration
• Canal located mesial to or directly on a line between the MB1and palatal orifices ,within 3.5mm palatally and 2mm mesiallyof MB1 orifice.
118 Maxillary 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
119
Anomalies• Taurodontism• Root fusion• 2 palatal canals• Single root and single canal• 2 distal canals• 2 palatal roots• C-shaped canals
Maxillary 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Maxillary 2nd Molar
• Similar to maxillary 1st molar
• Roots have a distal inclination
• Normally has 3 roots
• Roots tends to close together, higher tendency towards fusion of2/3 roots
120
Av. Tooth Length 17.1 mmAv. Crown Length 7 mmAv. Root Length 12 mm
Maxillary 2nd MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
121
PULP CHAMBER• Similar to maxillary 1st molar, except narrower mesiodistally• Roof – Rhomboidal in shape• Floor – obtuse triangle• Mesiobuccal and distobuccal canals closer together
Maxillary 2nd Molar
Canal SystemMesiobuccal Root• Broad buccolingually• Prominent depression in mesial and distal surfaces• 1 or 2 canalsDistobuccal Root• Rounded / ovoid, single canal• Orifice appears on same line joining mesiobuccal & palatal canalsPalatal Root• Broad mesiodistally• Ovoid, Single canal
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
122
Anomalies• Taurodontism• Root fusion• Single root, single canal• 2 palatal canals in double palatal root• Incidence of pulp stones
Maxillary 2nd MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In MAXILLARY MOLARS
123
• Mesial and Distal boundary should be established
• Mesial boundary for maxillary molars is the line connecting mesial cusp tips
• Distal boundary for maxillary-oblique ridge
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In MAXILLARY MOLARS
124
Initial penetration made at the center of occlusal
pit with bur directed palatally No. 4 round bur directed to
the palatal canal orifice or mesiobuccal orifice
Endodontic explorer used to locate canal orifices
Round bur is used to remove roof of the pulp
chamber
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
125
Final finish & funnelling of cavity walls with
tapered diamond pointFinal preparation provide
ease of access improved by leaning the preparation to
the buccal
Outline form of final cavity preparation – Triangular
Access Cavity Preparation In MAXILLARY MOLARS
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ERRORS In Cavity Preparation In MAXILLARY MOLARS
126
Underextended / Over extended preparation Perforation into furcation
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
127
Disoriented occlusal outline form
Inadequate vertical preparation - severe
buccal inclination
ERRORS In Cavity Preparation In MAXILLARY MOLARS
Ledge formation Perforation of palatal root
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Mandibular 1st Molar
• Typically 2 rooted
• Roots are broader buccolingually which are widely separated
• Mesial & distal roots separated with a furcation level• Buccally – 3mm• Lingually – 4mm
• Mesial root concavities on both mesial and distal surfaces
• Distal root – ovoid in cross section
128
Av. Tooth Length 21.9 mmAv. Crown Length 7.5 mmAv. Root Length 14 mm
Mandibular 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
129
PULP CHAMBER
• 4 pulp horns : MB, ML, DB, DL
• 3 distinct orifices : MB, ML & distal
• Roof – Rectangular in shape
• Walls converge to form a rhomboidal floor
• Pulp horns recede with age and so decrease in chamber size
• Roof is located on the cervical 3rd of the crown just above the cervix of tooth, floor is located on cervical third of root
Mandibular 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Canal SystemNormally 2 mesial and 1 distal canalMesial Root• 2 canals exit in 2 foramina – 41%• 2 canals exit in 1 foramina – 28%• 2 canals form 1 canal & bifurcate & exit in 2 foramina – 13%• 1 canal in 1 foramina – 12%• 1 canal bifurcates & exits in 2 foramina – 8%• Rare cases – 3 canals exit in 3 foramina ( 3rd canal is the middle
mesial canal)Distal Root• 1 canal exiting in 1 foramen – 70%• 2 canals exiting in 1 foramen – 15%• 1 canal bifurcating & exiting in 2 foramina – 8%• 2 canals in 2 foramina – 5%
130 Mandibular 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
131
Anomalies• Taurodontism (most common)• Supernumery Roots – Radix Entomolaris• C-shaped canals
Mandibular 1st MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
Mandibular 2nd Molar
• 2 rooted
• Mesial & distal roots close together
• Roots are broader buccolingually
• More frequently roots are fused
132
Av. Tooth Length 21.4 mmAv. Crown Length 7 mmAv. Root Length 13.5 mm
Mandibular 2nd MolarDr. Nithin Mathew - Root Canal Morphology & Access Preparation
133
PULP CHAMBER• Similar to 1st molar but smaller in size
Canal System• Mesial root – higher incidence of 1 canal – 14%• Higher incidence of root fusion• C-shaped canals are frequent
Mandibular 2nd Molar
• In a mandibular second molar with two canals,both orifices are in the mesiodistal midline.
If• two orifices are not directly in themesiodistal midline, a search should be madefor another canal on the opposite side usingKrasner and Rankow's laws of anatomy
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
134 Mandibular 2nd Molar
Anomalies• C-shaped canals• Taurodontism• Fused or single canal• Supernumery roots – Radix Entomolaris
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In MANDIBULAR MOLARS
135
• Mesial and Distal boundary should be established
• Mesial boundary for mandibular molars are line connecting mesial cusp tips
• Distal boundary is the line connecting buccal and lingual grooves
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In MANDIBULAR MOLARS
136
Initial penetration made at the center of mesial pit with bur directed towards
distal No. 4/No.6 round bur is used, directed towards the orifice of mesiobuccal or
distal canal
Endodontic explorer used to locate canal orifices
Round bur is used to remove roof of the pulp
chamber
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
137
Final finish & funnelling of cavity walls with
tapered diamond point
Final preparation provide ease of access improved by leaning the preparation to
the buccal
Access Cavity Preparation In MANDIBULAR MOLARS
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ERRORS In Cavity Preparation In MANDIBULAR MOLARS
138
Over-extended preparation
Perforation into furcation
Disoriented occlusal outline form
Perforation at mesiocervical – tilted to
mesial
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
ERRORS In Cavity Preparation In MANDIBULAR MOLARS
139
Failure of finding 2nd
distal canalPerforation of distal rootLedge formation
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Access Cavity Preparation In Teeth with Calcified Canals
140
Mandibular first molar with a Class I restoration,
calcified canals, and periradicular
radiolucenciesExcavation of a restoration
and base material
Long-shank #2 or #4 round bur to remove
dentin
Endodontic explorer is used to probe the pulp
floor
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
141
The smallest instrument (i.e., a #.06 or #.08 file)
should be introduced into the canal
A small hand K-file negotiates the canal to its
terminus
Access Cavity Preparation In Teeth with Calcified Canals
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
• Color is also a critical indicator when chasing a receded or calcified canal.
• Typically, a small dark brown dot is visualized and represents the position where thecanal used to be.
• Chasing apically along this colored route typically leads to a more open canal that canbe negotiated.
142
Access Cavity Preparation In Teeth with Calcified Canals
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Apical Diameter - Cohen
143
Teeth Mean Value (µm)Maxillary incisors 289.4Mandibular incisors 262.5Maxillary premolars 210Mandibular premolars 268.25Maxillary molars
Palatal 298Mesiobuccal 235.05Distobuccal 232.2
Mandibular molarsMesial 257.5Distal 392
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
Suggested Preparation Sizes - Ingle
144 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
145 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
CONCLUSION
Thorough• Knowledge of root canal anatomy & cavity preparation will enable theclinician to produce endodontic treatments of high quality and considerable longevity.
• A successful treatment outcome depends on the complete debridement anddisinfection of all canals.
146 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
REFERENCES
• Text book of Endodontics-Ingles( 5th edition)
• Text book of Endodontics—Mahmood Torabinajad, Richael E.Walton (4th edition)
• Grossman’s Endodontic Practice (12th Edition)
• Endodontic Therapy – Franklin S. Weine (6th Edition)
• Pathways of pulp –Cohen
147 Dr. Nithin Mathew - Root Canal Morphology & Access Preparation
148