10 - Anatomical variations of importance in endodontics

What are the 2 different types of root canal morphlogy classification

Weine's

Vertucci's

Weine’s classification

With endo of maxillary central incisor, what may prevent direct access, and what can make access difficult?

Lingual shoulder

Calcific metamorphosis

What is calcific metamorphosis and what appearance can it give the crown?

Tooth’s trauma response - canal partially/completely filled with hard tissue

Yellow discoloration of crown

What are dilacerations?

Sharp bend in root - from trauma or bony interference during root formtation

What cases require extra attention?

Wide open apex (blunderbuss teeth)

Calcific metamorphosis

Dilacerations

What is the first cause of failure in root canal treatment of upper incisors?

Apical curvature in root (disto-palatal direction). In lateral incisor.

Files straigten canal and leave apical 3rd uninstrumented

What is dens in dente?

Invagination of enamel (enamel lined cavity in crown or root).

On xray looks like tooth within tooth

Mainly in maxillary lateral incisors

Dens invaginatus (den in dente) Oehlers classification

Why is Palatal groove a major cause of rct failure? Where is it found and what is its origin

Creates large permanent and irreparable periodontal bag - extraction needed

Is a developmental groove mainly found in maxillary lateral incisor lingual surface

Describe what Gemination and fusion are, and in what teeth do they occur?

Mandibular anteriors (also maxillary)

Fusion - 2 tooth germs forming one large tooth.

Gemination - When one tooth bud tries to divide. mainly primary teeth. usually disfigured from enamel irregularities

differentiate between the 2 - fusion causes reduced number of teeth

How may the pulpal space of fused teeth appear?

Separated pulpal space

One pulp chamer and 2 canals

Large bifid crown with one pulpal space

How long may it take for high radiolucency cases take to resolve after RTC?

Up to 2- years

If minimal bone formation after a few months - successful treatment

What are the 4 signs of Celsos inflammation?

Pain, Heat, Redness, Swelling

Anomalies of Maxillary canine (longest tooth) and mandibular canine in rare cases?

Maxillary - 2 roots

Mandibular - more than one canal and root

Anomalies of Maxillary and Mandibular first premolars?

Maxillary - 3 root canals

Mandibular - Bi/trifurcations of roots/canals

Anomalies of Maxillary and Mandibular 2nd premolars?

Maxillary - 3 roots

Mandibular - 2 roots

Anomalies of Maxillary first molar?

Single root and canal

2 distal canals

2 palatal roots

3 MB caals

8 canals

Anomalies of Maxillary 2nd molar?

Two most frequent:

• One root and canal

• Pulp stones

other:

5 roots and 5 canals

3 MB canals

In what tooth are anomalies common rather than exceptions?

Maxillary 3rd molars

Complex anatomy common in mandibular 3rd molars

Bayonet root image. From trauma. Can lead to necrotic pulp from intrapulp pressure increase

Mandibular first molar anomalies?

3 roots

3rd root called Radix entomolaris

Mandibular second molar anomalies?

3rd root

One conical root with one conical canal

C shaped canal

Melton’s method for classifying C shaped canal (mandibular molars)?

C1 - uninterrupted C

C2 - semicolon shape

C3a - 2 seperate canals

C3b - 3 seperate canals

C4 - One round or oval canal