VARIATIONS IN THE INTERNAL

ANATOMY OF TEETH
VARIATIONS IN THE INTERNAL ANATOMY OF TEETH

• The canal configuration can vary in some cases because of

numerous reasons like development anomalies, hereditary
factors, trauma, etc. Usually the variations in root
morphologies tend to be bilateral.
A. developmental abnormalities
1. Gemination
2. Fusion
3. Ankylosis
4. Concrescence
5. Taurodontism
6. Talon’s cusp
7. Dilacerations
8. Dentogenesis imperfects
9. Dentin dysplasia
10. Lingual groove
11. Missing root
12. Supernumery roots
13. Dens evaginatus
14. Dens invaginatus
A.Variation in the development:
• Gemination: It arises from division of a single tooth germ by an
invagination resulting in incomplete formation of two teeth.
affects on access cavity

• Fusion: : it arise from union of two normally separated tooth

germ. Fused teeth may show separate or fused pulp space.
affects on access cavity

• Concrescence
In this fusion occurs after the root formation has completed. Teeth
are joined by cementum only. It may causes misinterpretation.
Gemination Concrescence
• Talon’s Cusp
it is extra cusp resembling an eagle’s talon.it projects lingually
from cingulum area of maxillary or mandibular permanent
incisors and extend to the incisal edge. It composed of normal
enamel and dentin and contain pulp horn

• Ankylosis:
bone is fused to cementum and dentin so it causes difficulty to
locate apex and misinterpretation of x-ray.
 • Taurodontism: (affect the size of access cavity)
• In this, body of tooth is enlarged at the expense of roots
(also called bull like teeth). Pulp chamber of this tooth
is extremely large with a greater apico-occlusal height.
Bifurcation/trifurcation may be present only few
millimeters above the root apex. Pulp lacks the normal
constriction at cervical level of tooth. This condition is
commonly seen associated with syndromes like Down
syndrome.
• Dilaceration
• It is an extraordinary curving of the roots of the teeth.
• Etiology is usually related to trauma during root
development in which movement of the crown and a part of
root may result in sharp angulation after tooth completes
development.
• It affects the preparation technique, so preparation is done
with flexible instrument or separated surgically.
• Dentinogenesis Imperfecta
This is an inherited disorder of dentin formation. The teeth
have small bulbous crown while the roots are short, blunted
and may be fractured. The pulp shows numerous pulp stone
and obliteration of pulp chamber and root canal by poor
formed dentin.
• Dentin Dysplasia
This is a hereditary disorder of dentin formation. The crown are
normal in color and shape, the roots are very short and conical.
Premature loss of the tooth may occur early because of short roots
or periapical inflammatory lesions.
The pulp are almost completely obliterated by defective dentin, So
need special care while instrumentation.
• Lingual Groove
It is a deep narrow periodontal defect that occasionally
communicates with pulp, causing an endodontic/ periodontal
problem. It is frequently seen in maxillary lateral incisors.
Prognosis of such teeth is poor and treatment is difficult.
Dens in Dente or Dens Invaginatus
This condition represents an exaggeration of the lingual pit. It is caused by
invagination of all layers of enamel organ into the dental papilla during
odontogenesis, resulting in formation of an enamel-lined cavity which
communicates with surface.
Most commonly involved teeth are permanent maxillary lateral incisors. This
condition may range from being superficial that is involving only crown part to a pit
in which both crown and root are involved. It has tendency for plaque
accumulation which predisposes it to early caries and then pulpitis.
dens evaginatus
Most common in mandibular premolars. Clinically, dens evaginatus
initially appears as a small tubercle “bulge” on the occlusal surface,
but it may not be obvious radiographically.
When these fragile tubercles fracture off, the pulp is exposed and
will become necrotic. the tretment for that, is to remove the
tubercle with a bur and then cap, followed by a good sealing
restoration.
• Missing and Extra Root
Rare condition which affects less than 2 % of permanent teeth, most commonly
seen in mandibular premolars, canines and third molar
.Mandibular molar can have an additional root located lingually (the radix
entomolaris) or buccally (the radix paramolaris).
Radix entomolaris (RE) is located disto-lingually, with its coronal third completely or
partially fixed to the distal root. The dimensions of RE can vary from a short conical
extension to a mature root with normal length while, radix paramolaris additional
root located distobuccal in mandibular molars.
2.Variation in root canal system
1.Complex morphology:
• Cross sectional variation: C-shaped canal.
• Curvature variation: S-shaped canal.
• Lateral and accessory canals.
2. Extra root canals
• Trifurcation maxillary premolars.
• Furcated mandibular premolars.
• Three rooted mandibular molar.
• Four canaled maxillary molar.
3. Variation of internal anatomy
• Calcified root canal and pulp stones.
• Root resorption.
• Tooth with open apex (immature apex).
 1.COMPLEX MORPHOLOGY:
C-SHAPED CANALS

• The C- shaped canal is a special feature of some lower second

molars. Approximately 1% of lower second molars have C-
shaped canals. The names comes from the appearance of the
pulp chamber floor when viewed from above. Some or all the
canals orifices are joined in the form of groove or isthmus with
the shape of the letter C. The prognosis of root canal treatment
of C shaped is questionable because of complex internal
anatomy.
2.Curvature variation: severely curved S-shaped (bayonet).

3. Lateral & accessory canals.

2.Presence of Extracanals
More than 70 percent of maxillary first molar have shown the
occurrence of second mesiobuccal canal, and this is found to be
the most common reason for retreatment of maxillary molars.
• In mandibular molars extracanals are found in 38 percent of
the cases. A second distal canal is suspected when distal
canal does not lie in midline of the tooth.
• Two canals in mandibular incisors are reported in 41% of the
cases. And 11% among mandibular premolars. Three canals
maxillary premolars can be seen in trifurcated maxillary
premolars (premolar with 3 roots similar to upper molar)

Mandibular premolars with 2 and 3 canals

3.Variation of internal anatomy
1. Pulp Stones and Calcified root canal:
Pulp stones are nodular calcified masses present in either
coronal and radicular pulp or both of these. They may be
from aging or in response of irritation. Presence of pulp
stones may alter the internal anatomy of the pulp cavity,
making the access opening of the tooth difficult and difficult
in orifice location.
2.Resorption:
it is a process which affect on cementum and or dentin of root
surface of tooth . Destruction of cementum or dentin will done by
cementoclast or osteoclastic activity. this resorption originates
either from pulp tissue or periodontal tissues. It classified according
to site of origin:
A.Internal Resorption
“It is an unusual form of tooth resorption that begins centrally
within the tooth, initiated in most cases by a peculiar inflammation
of the pulp”. It is characterized by oval shaped enlargement of root
canal space.
B.External Resorption
It is initiated in the periodontium and it affects the external or
lateral surface of the root.
Open Apex
It occurs when there is periapical pathology before completion
of root development or as a result of trauma or injury causing
pulpal exposure. In this, canal is wider at apex than at cervical
area. It as also referred as Blunderbuss canal. In vital teeth
with open apex, treatment should be apexogenesis and in non
vital teeth, it is apexification.
FACTORS AFFECTING INTERNAL ANATOMY:
• Age: with advancing age, there is continued dentin formation
causing regression in shape and size of pulp cavity.
• Irritants :Various irritants like caries, periodontal disease,
attrition, abrasion, erosion, cavity preparation and other
operative procedures may stimulate dentin formation at the base
of tubules resulting in change in shape of pulp cavity.
• Calcific metamorphosis: It commonly occurs because of
trauma to a recently erupted tooth.
• Calcifications: Pulp stones or diffuse calcifications are usually
present in chamber and the radicular pulp.
• Resorption: Chronic inflammation or for unknown cause
internal resorption may result in change of shape of pulp cavity.
Pulp changes due to age

CALCIFICATION
Resorption