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Author: Frank J. Vertucci
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Rootcanalmorphologyandits
relationshiptoendodontic
proceduresFRANKJ.VERTUCCI
ThehardtissuerepositoryofthehumandentalpulptakesonnumerousconÞgurationsandshapes.Athorough
knowledgeoftoothmorphology,carefulinterpretationofangledradiographs,properaccesspreparationanda
detailedexplorationoftheinteriorofthetoothareessentialprerequisitesforasuccessfultreatmentoutcome.
MagniÞcationandilluminationareaidsthatmustbeutilizedtoachievethisgoal.Thisarticledescribesand
illustratestoothmorphologyanddiscussesitsrelationshiptoendodonticprocedures.Athoroughunderstandingof
thecomplexityoftherootcanalsystemisessentialforunderstandingtheprinciplesandproblemsofshapingand
cleaning,fordeterminingtheapicallimitsanddimensionsofcanalpreparations,andforperformingsuccessful
microsurgicalprocedures.
Itisimportanttovisualizeandtohaveknowledgeof
internalanatomyrelationshipsbeforeundertaking
endodontictherapy.Carefulevaluationoftwoormore
periapicalradiographsismandatory.Theseangled
radiographsprovidemuchneededinformationabout
rootcanalmorphology.Martinez-Lozanoetal.(1)
examinedtheeffectofx-raytubeinclinationon
accuratelydeterminingtherootcanalsystempresent
inpremolarteeth.Theyfoundthatbyvaryingthe
horizontalangle20
1and40
1thenumberofrootcanals
observedinmaxillaryÞrstandsecondandmandibular
Þrstpremolarscoincidedwiththeactualnumberof
canalspresent.Inthecaseofmandibularsecond
premolarsonlythe40
1horizontalangleidentiÞedthe
correctmorphology.Thecriticalimportanceofcare-
fullyevaluatingeachradiographtakenpriortoand
duringendodontictherapywasstressedbyFriedmanet
al.(2).InacasereportofÞvecanalsinamandibular
Þrstmolar,theseauthorsemphasizedthatitwasthe
radiographicappearancewhichfacilitatedrecognition
ofthecomplexcanalmorphology.Theycautioned
Ôthatanyattempttodeveloptechniquesthatrequire
fewerradiographsrunstheriskofmissinginformation
whichmaybesigniÞcantforthesuccessoftherapyÕ.
Radiographs,however,maynotalwaysdeterminethe
correctmorphologyparticularlywhenonlyabucco-
lingualviewistaken.Nattressetal.(3)radiographed
790extractedmandibularincisorsandpremolarsin
ordertoassesstheincidenceofcanalbifurcationina
root.UsingtheÔfastbreakÕguideline(Fig.1)that
disappearanceornarrowingofacanalinfersthatit
dividesresultedinfailuretodiagnoseone-thirdof
thesedivisionsfromasingleradiographicview.The
evaluationoftherootcanalsystemismostaccurate
whenthedentistusestheinformationfrommultiple
radiographicviewstogetherwithathoroughclinical
explorationoftheinteriorandexteriorofthetooth.
Themainobjectiveofrootcanaltherapyisthorough
shapingandcleaningofallpulpspacesanditscomplete
obturationwithaninertÞllingmaterial.Thepresence
ofanuntreatedcanalmaybeareasonforfailure.A
canalmaybeleftuntreatedbecausethedentistfailsto
recognizeitspresence.Itisextremelyimportantthat
cliniciansuseallthearmamentariaattheirdisposalto
locateandtreattheentirerootcanalsystem.Itis
humblingtobeawareofthecomplexityofthespaces
weareexpectedtoaccess,shape,cleanandÞll.Wecan
takecomfortinknowingthatevenunderthemost
3EndodonticTopics2005,10
,3Œ29Allrightsreserved
CopyrightrBlackwellMunksgaard
ENDODONTICTOPICS2005
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