ENDODONTOLOGY

Review Article

Intricate internal anatomy of teeth and its clinical

significance in endodontics - A review
A.P. Tikku * #
W. Pragya Pandey ** #
Ivy Shukla***

ABSTRACT
Beyond the simple perception is often the intricate internal tooth anatomy and a complex root canal system. Root
canal treatment has transformed remarkably since the hollow tube theory was postulated in 1930. Research into
the morphology of the pulp has revealed that the dental pulp takes many intricate shapes and configurations
before reaching the tooth apex. The prospect of the treatment depends on accurate diagnosis followed by location,
cleaning and shaping and finally obturation of the root canal system. As a professional, one should be aware of all
the probable nooks and crannies of the complex root canal, its protean permutations and combinations, to render
the finest possible treatment. As is the case with any other treatment, endodontic therapy; if performed in the
properly delineated and precise manner spells more than 99% success rate. This review article attempts to bring
out the possible nuances of the complex root canal system and various methods of reckoning with these significantly
essential details.
Keywords: Intricate, internal, tooth anatomy, complex, root canal system

Introduction

depends on the clinicians knowledge and ability

Dental professionals conventionally have

to comprehend, visualize, perceive and prepare the

referred to the main/large passage lying at the core

root canal system. From the early work of Hess and

of the tooth as the pulp space and all effort was

Zurcher[1] to the contemporary studies regarding the

made to ensure debridement from that area only..

anatomic complexities of the root canal system, it

Factually, as we know now the root canal is a

has been well established that the root with a

complex system of finely tuned and synchronized

graceful tapering canal and a single apical foramen

small tributaries running all through the length and

is an exception rather than the rule. Investigators

breadth of the tooth dentine. Hence, it becomes

have very commonly encountered bifurcating

imperative for a clinician to fully understand this

canals, multiple foramina, fins, deltas, loops, cud-

system. Seasoned clinicians very aptly say - what

le-sacs, inter-canal links, C-shaped canals and

we cannot see, we cannot negotiate and what we

accessory canals in most teeth. The student and

cannot negotiate we fail to prepare! A good

the clinician must approach the tooth presuming,

obturation is possible only after meticulous cleaning

that these Aberrations occur so often that they must

and shaping which eventually and ultimately

be considered normal anatomy

* Professor, ** Reader, ***

***Private Practice, # Dept. of Conservative Dentistry & Endodontics, King Georges Medical University, Lucknow, India, Chandra Dental College
and Hospital, Barabanki, India, Lucknow, India.

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ENDODONTOLOGY

A.P TIKKU, W. PRAGYA PANDEY, IVY SHUKLA

Anatomy of the pulp-chamber floor

Law of Concentricity: The walls of the pulp

A thorough investigation of the sulcus, coronal

chamber are always concentric to the external

clefts, restorations, tooth angulation, cusp position,

surface of the tooth at the level of the CEJ.

occlusion, and contacts is mandatory before access

Law of the CEJ: The CEJ is the most consistent,

is begun. Before tooth entry the clinician must

repeatable landmark for locating the position of the

visualize the expected location of the coronal pulp

pulp-chamber.

chamber and canal orifice position. Past literature

describing pulp-chamber anatomy has been very
general and undefined in determining the location
and number of root canal orifice. Krasner and
Henry2 in 2004 studied the pulp chamber of 500
extracted teeth and their consistent observation
regarding the pulp chamber anatomy in all teeth
led to the formulation of new laws, forming
guidelines for locating the pulp chamber and root

Figure-1: Cross-section of mandibular molar, showing

equality of distance of the pulp chamber walls from the
external root surfaces (arrows).

canal orifice. If specific, consistent landmarks exist

and are quantifiable, assessable and reproducible

2) Relationships of the root canal orifice on

then surely the task of locating orifices becomes

the pulp chamber floor:

easier, systematic and much more certain. This is

especially beneficial in challenging cases like

Law of symmetry 1: except for maxillary

heavily restored teeth, carious broken down teeth,

molars, the orifices of the canals are equidistant

malposed teeth, teeth with calcified canals and

from a line drawn in a mesial-distal direction

teeth gouged from previous access openings, where

through the pulp chamber floor.(Figure-2)

locating orifices becomes an onerous task. The

Law of symmetry 2: except for the maxillary

anatomic laws/patterns observed 2 are categorized

molars, the orifices of the canals lie on a line

into two groups:

perpendicular to a line drawn in a mesial-distal

1) Relationships of the pulp-chamber to the clinical

direction across the center of the floor of the pulp

crown.

chamber.(Figure-2)

Law of Color Change: the color of the pulp-

2) Relationships of the root canal orifice on the pulp-

chamber floor is always darker than the walls.

chamber floor.

Law of orifice location 1: the orifices of the

1) Relationships of the pulp chamber to the clinical

root canals are always located at the junction of

crown:

the walls and the floor.

Law of Centrality: the floor of the pulp

chamber is always located in the center of the tooth

Law of orifice location 2: the orifices of the

at the level of the CEJ (cemento-enamel-

root canals are located at the angles in the floor-

junction).(Figure-1)

wall junction.
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INTRICATE INTERNAL ANATOMY OF TEETH AND ITS CLINICAL SIGNIFICANCE IN ENDODONTICS - A REVIEW

Law of orifice location 3: the orifices of the

canal; four canals joining into two; four canals

root canals are located at the terminus of the root

extending from orifice to the apex and five canals

developmental fusion lines.(Figure-2)

joining into four at the apex.

Figure-3: Classification showing Vertucci root canal system.

Over the past two decade there have been a

plethora of published in-vitro studies and case
reports depicting a variety of canal configurations.

Figure-2: Cross-section of mandibular molar showing: Equidistance

of orifices (AB=AC) from the mesiodistal line (M-N); Orifices
perpendicular to the mesiodistal line (M-N); Orifices located at the
terminus of Developmental root fusion lines (D).

It was seen that gender, race and ethnic origin all

play a role in determining the canal morphology

Even the most proficient clinician cannot

and hence should be considered during the

always prophesize the exact site and number of

preoperative evaluation stage of the root canal

root canals present in any tooth before the

therapy 6. Divisions of the canals may not be

beginning of the treatment. Even if a small part of

obvious, especially if they are fine. A tell-tale feature

the canal is left unclean, it significantly jeopardizes

is the narrowing of canal when they divide. The

the success of the treatment. With the formulation

sudden radiographic disappearance of a canal

of these anatomic laws, the practitioners can now

might indicate a dividing canal. Simple tubular

locate the site and number of root canals present,

(Types I, IV and VIII) canals may be cleaned

with greater predictability and much more ease.

satisfactorily by mechanical preparation alone.

Classification of the root canal system

Preparation of such canals could probably be

effectively achieved using nickel-titanium rotary

There are multitude pathways connecting the

instruments, but they have a tendency to break in

root canal orifice and the apex of the tooth running

certain clinical situations. This includes (i) broad

through the root dentine. Weine 3 categorized the

canal with abrupt apical curve (ii) wide canal

root canal system in any root into four basic types.

suddenly becoming narrow. In these situations the

Vertucci et al. 4 categorized the root canal system

nickel-titanium rotary instruments should be

into a more complex eight configurations

preceded by hand files to avoid buckling and

(Figure-3). Interestingly the only tooth to

instrument separation

demonstrate all eight configurations is the maxillary

second premolar. 4 Gulabivala et al.

. Branched canal

configurations and inter-canal ramifications may

examined

render complete debridement of canal systems

mandibular molars in a Burmese population and

difficult. The use of sodium hypochlorite, preferably

found additional canal configurations. These

agitated by ultrasonic may help to clean the un-

include three canals joining into one or two canals;

instrumented parts of the root canal system 8. The

two canals separating into three canals; two canals

obturation of simple tubular or tapered canals may

joining, re-dividing into two and terminating as one

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ENDODONTOLOGY

A.P TIKKU, W. PRAGYA PANDEY, IVY SHUKLA

be achieved satisfactorily with cold lateral

The implication of an isthmus was taken into

condensation of gutta-percha points. However,

consideration first in 1971; however, it was in 1983

irregular canals or those with complex ramifications

that Cambruzzi and Marshall

are more satisfactorily obturated using the

significant finding in molar surgery. The tissue left

thermoplasticized gutta-percha techniques .

over in the isthmus can serve as a nidus for recurrent

Isthmus

infections and lead to failures of orthograde

13

first reported this

endodontic treatment and endodontic surgery. The

An isthmus is defined as a ribbon shaped inter-

incidence of isthmus at different level section of

canal connection 10 or transverse anastomosis or a

the root were seen and reported by several

corridor 11 between two root canals encompassing

authors10,11,13,14,15,16. It was found to be 16% in

dental pulp and pulp related tissue. An isthmus can

maxillary premolar at 1mm resection level, 52%

be observed between any two root canals within

in maxillary premolar at 6mm resection level, 32%

the same root. As the isthmus houses the dental

in mandibular premolar at 2mm resection level,

pulp, it might serve as a potential site for bacterial

40% in mandibular premolar at 3mm resection

growth and thus, making complete debridement

level, nearly 50% at 4 mm resection level in

of this area indispensible. Whenever two or more

mesiobuccal root of maxillary first molar and 15%

root canals are present, an isthmus should be

in the distal roots of mandibular molar at 3mm

suspected and all attempts should be made in

resection level.The highest incidence was reported

detecting and debriding it.

in the mesial root of the mandibular first molar,

Classification of the isthmus:

Isthmus

classification was described by Hsu & Kim et al.

which was 80% at 4 mm resection level.

Identification, debridement and filling of the

12

(Figure-4)

isthmus is essential but challenging. Cambruzzi and

Type I

Marshall17 recommended the use of methylene blue

- is two or three canals with no notable

communication.

dye to visualize the isthmus on a resected root

Type II - is two canals that possess a definite

surface. The conventional way of cleaning this

anatomic complexity with the use of full strength

connection between the two main canals.

sodium

Type III- is three canals that possess a definite

hypochlorite

and

mechanical

instrumentation was found to be limited in its

connection between them.

action 18. However the introduction of surgical

Type IV- is when the canals extend into the isthmus area.

operating microscope and ultrasonic has taken

Type V- is the true connection or corridor

endodontic procedures to another level of

throughout the section.

sophistication

19,20

. Under the high magnification

of microscope, anatomic structures like isthmi, fins,

deltas, accessory canals, C-shaped canals and apical
micro-fractures can easily be identified. The
Type I

Type II

Type III

Type IV

ultrasonic tips can be used to prepare the isthmus

Type V

and subsequently fill the preparation with a suitable

Figure-4: Classification of Isthmus.

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INTRICATE INTERNAL ANATOMY OF TEETH AND ITS CLINICAL SIGNIFICANCE IN ENDODONTICS - A REVIEW

material 21. The introduction of micro-ultrasonic has

Radiographic appearance of a C-shaped root

greatly increased the endodontic success rates.

in mandibular second molars may be diverse,

C-shaped canal

depending on the exact nature and orientation of

the root. It may present as a single fused root or as

Cooks and Cox 22 first discovered the C-shaped

two distinct roots with a communication, the latter

anomaly in mandibular second and third molars in

of which may not be very obvious at first glance.

1979. The presence of a C-shaped canal prevents

Haddad et al. 27 considered them to form a typical

effective cleaning, shaping and obturation during a

radiographic image revealing fusion, root proximity,

root canal therapy. There are two common possible

large distal canal or the blurred image of a third

outcomes for the C-shaped mandibular molar (1)

canal in the middle of two roots. The canal orifice

those that exhibit a single, ribbon like, C-shaped

may present with a C-shape, but not always, and

canal from orifice to apex and (2) those with three

when it does, it is no guarantee that it continues

distinct canals below the C-shaped orifice, the more

common form

23

spicily as a single canal. Fused roots and C-shaped

. The C-shaped canal has been

roots may present with narrow root grooves that

observed in mandibular first premolars, mandibular

predispose to localized periodontal disease, which

first, second and third molars, maxillary first molars

and maxillary second molars. Newton et al.

may, in fact be the first diagnostic indication of

24

such anatomical variance. Moreover it must be kept

illustrated C-shape canal configuration in maxillary

in mind that very little dentin separates the external

first molars. Yang et al. described C-shaped canal in

surface from the C-shaped canal system, increasing

mandibular molars as a ribbon shaped canal that

the probability of stripping or lateral perforation

includes the mesiobuccal and distal canals, and

during endodontic and restorative procedures.

sometimes the mesiolingual. 25 (Figure-5). Melton and

colleagues

26

AbouRass et al. 28 described an anti-curvature filing

discovered this phenomenon in

technique in which the bulkier root structure was

maxillary second molars where the C-shape joins

filed away from the curvature and the thinner

the distobuccal root with the palatal root. The

danger zone. An evaluation of the actual thickness

occurrence of a C-shaped canal and its improper

of canal walls in C-shaped roots should identify

negotiation can lead to failure in endodontic therapy

which walls are in danger zones for anti-curvature

and hence should be gingerly examined.

filing. Studies have been designed to evaluate the

cross-sectional morphology of C-shaped canals and
to identify the location and measure the minimum
widths (MWs) of buccal and lingual walls.29

Canal curvatures
A straight root canal extending the entire
length of the root is uncommon The curvature may
be a gradual curvature of the entire canal, a sharp
curvature of the canal near the apex, or a gradual

Figure-5: Cross-section of a mandibular molar showing a C-shaped canal.

A: mesiolingual canal, B: ribbon shape C-shaped canal including the
mesiobuccal and distal canals.

curvature of the canal with a straight apical ending.

164

ENDODONTOLOGY

A.P TIKKU, W. PRAGYA PANDEY, IVY SHUKLA

Double curvatures in the form of S may also occur.

canal.(Figure-6) The curved part of the canal

Success in negotiating a narrow curved canal

between the points M and N is the circular arc of

depends on the degree of curvature, the size and

the hypothetical circle, which is specified by its

constriction of the root canal, the size and flexibility

radius (r). The radius is calculated on the basis of

of the endodontic instrument and most important,

the measured length of the chord (S) between points

the skill of the operator. Only few studies have

M and N31 .The chord (S) was measured by using

actually measured the canal curvature. Canal

the computer program. Henceforth the radius can

curvature

be calculated using the following formula:-

can

be

Berbert&Nishiyamas

30

measured

either

by

method or by Schneiders

31

Radius of curvature (r) =

method. The most common method used to

2 sin S

describe canal curvature was published by

Schneider. According to the Schneiders method,
considering both the angle of curvature together
with the radius of the curve is supposedly the exact
method of describing the canal curvature. Whereas
the angle of curvature is independent of the radius,
a more abrupt curve of the canal corresponds to a
smaller radius of curvature. It is quite challenging
to enlarge a canal with a great angle in degree and
an abrupt short curve without any transportation
regardless of whether rotary nickel-titanium or
stainless steel hand instruments are used.
Angle of curvature: A straight line (a) was drawn

Figure-6: Angle of Curvature ( )

along the silver point, size 08(introduced into the

The preparation of curved canals is

canal prior to instrumentation) in the coronal straight

challenging and has an increased likelihood for

portion of the canal; this line was parallel to the long

iatrogenic damage. To avoid any procedural errors

axis of the canal. The point where the canal deviated

the clinicians generally tend to under prepare these

from this line to begin the canal curvature was

canals. The key to dealing with severely curved

marked as point M. A second line (b) was drawn to

canals is to pre-curve the instrument prior to

intersect the apical foramen (point N) with the point

instrumentation and try to negotiate the entire root

where the canal began to leave the long axis (Point

canal length at the first attempt, using push-pull

M), The angle of curvature() is formed by lines a

movements rather than twisting movements until a

and b 31 .(Figure-6)

more straightened guide path is created before any

Radius of curvature: The line (S) between the

attempt is made of taking rotary files around these

points M and N is the chord of the hypothetical

abrupt curves. Such procedures significantly reduce

circle that defines the curved part of the

the chances of ledge formation.

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INTRICATE INTERNAL ANATOMY OF TEETH AND ITS CLINICAL SIGNIFICANCE IN ENDODONTICS - A REVIEW

Horizontal shapes and dimension of

root canal

levels of the canal. In a maxillary cuspid, Min IWW

The horizontal dimension of the root canal

Max IWW at working length (Max IWW0). But 12

system is not only more complicated than the vertical

mm short of working length, Max IWW 12 is

dimension (working length) but is also more difficult

probably three to four times larger than Min

to investigate, because the horizontal dimension

IWW12 32. In long oval /flat canals reaming action

varies greatly at each vertical level of the canal. Very

may lead to in-complete debridement of the root

few clinical attempts and studies have been done to

canal system. Circumferential filing can better

determine the working width of the canal and hence

conform to the outline of the horizontal dimension

it is very aptly referred to as the Forgotten

of the root canals at different levels of the canal.

Dimension.Enlarging of the canal during root canal

Comprehending the concepts of working width can

treatment is known to all but how large is large

reduce the underestimation of the minimum initial

enough is a question that still needs serious attention.

working width at working length (Min IWW0) and

Ideally during root canal preparation the instruments

consequently incomplete cleaning of the root canal

and the techniques used should always conform to

system 32. The dogma of enlarging the canal three

and retain the original shape of the canal to maximize

sizes larger than the first file that binds to the apex

the cleaning and minimize unnecessary weakening

might not be applicable in all the cases.

of the tooth structure .

Apical anatomy

at working length (Min IWW0) may be the same as

32

Current descriptions of the horizontal

The anatomy of the root apex was first

dimensions (cross-sections) of the root canal :

described by Kutler

1)Round: Max IWW** equals Min IWW*

features that constitute the root apex (Figure-7) are

32

33

. Anatomic and histologic

apical constriction (minor apical foramen),

2)Oval : Max IWW is greater than Min IWW (Up

cementodentinaljunction (CDJ) and apical foramen

to two times more)

(major apical foramen). Apical limit of canal

3)Longoval : Max IWW is two or more times greater

instrumentation and obturation is the apical

than Min IWW(up to 4 times more)

constriction which is not only the narrowest part

4)Flattened: Max IWW is four or more times greater

of canal but a morphologic landmark that can help

than Min IWW.

to improve the apical seal when the canal is

5)Irregular: Cannot be defined by 1-4.

obturated 34. CDJ the point where cementum meets

* Minimum Initial working width.

dentine, is where the pulp tissue ends and the

** Maximum Initial working width.

periodontal tissue begins. From the apical

In a relatively round canal, the lesser and the

constriction the canal widens as it exits the roots at

greater initial horizontal dimensions are

the apical foramen or major diameter. The space

approximately the same. In an oval, long-oval, or

in between the major and minor foramen is funnel

flat canal, the maximal initial horizontal dimensions

shaped. (Figure-7)

(Max IWW) may be several times larger than the

minimal initial dimension (Min IWW) at different
166

ENDODONTOLOGY

A.P TIKKU, W. PRAGYA PANDEY, IVY SHUKLA

Few tips to see the unseen:

1. When the radiograph shows that the root
canal shadow suddenly stops in the radicular region
it can safely be assumed that it has bifurcated or
trifurcated into finer diameter tributaries at that
point. To confirm this dichotomy a second
radiograph may be exposed from a mesial
angulation of 10 to 30 degrees. This diagnostic clue
as pointed out by Slowey, 36 called the Fast Break,
is usually seen in maxillary first premolars.

Figure-7: Morphology of the root apex.

Dummer et al. 35 classified (Figure-8) the apical

2. Whenever the outline of the root is unclear,

constriction into four main types: (A) Traditional

has an unusual contour, or strays in any way from

single constriction (B) Tapering constriction (C) Multi-

the expected radiographic appearance, one should

constricted (D) Parallel constriction which need to

suspect an additional root canal 36.

be analyzed, to prevent under and over preparation.

3. It is imperative that radiographs should be

Failure to accurately determine the working length

taken, from minimum two angulations before

may lead to perforation through the apical

attempting endodontic treatment. Angled views of

constriction, together with overfilling, overextension,

teeth can better reveal the anatomic variances.

incomplete debridement or short fillings. All these

Mesial angulation technique is used for identifying

procedural errors will increase the incidence of

two canals wherein the lingual root always appears

postoperative pain and failure of the root canal

mesially on the film (SLOB rule same lingual

treatment. Thus the focus should be to accurately

opposite buccal) 37.

measure the working length maintaining it throughout

4. The radiograph also gives several clues to

the entire procedure and avoiding extravagant apical

anatomic aberration: lateral radiolucency indicates

enlargement, transportation, zipping, ledging and

the presence of lateral or accessory canals, an

perforation of the apical foramen.

abrupt ending of a large canal signifies a bifurcation,

a knob like image indicates an apex that curves
towards or away from the X-ay beam (Bulls eye),
multiple vertical lines indicates thin root which may
be hourglass shaped in cross section, hence
susceptible to strip or lateral perforations 36.
5. If an extra dark line is apparent in the
coronal third of the root, running parallel to the
test file in the radiograph, particularly in the coronal
part of the root, one should suspect a second canal.
This is especially helpful in detecting the fourth

Figure-8: Types of Apical Constriction

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ENDODONTOLOGY

INTRICATE INTERNAL ANATOMY OF TEETH AND ITS CLINICAL SIGNIFICANCE IN ENDODONTICS - A REVIEW

Conclusion

canal in the mesiobuccal root of the maxillary first

It would be quite erroneous to refer to this

molars and in the distal roots of the mandibular

first molars 36.

complex system simply as the Root Canalbecause it actually is a very complex system of

6. Knowledge of normal root curvatures may

finely tuned small tributaries running through the

be quite helpful in interpretation of the radiographs.

entire length and breadth of the tooth. It is crucial

For example, palatal roots of permanent maxillary

to be aware and admire the various complexities

molars often have sharp apical curvatures towards

of the spaces we are expected to clean and fill.

the buccal.

Since during endodontic treatment we cannot see

7. Ethnicity has a significant influence on

much inside the area we work, we must keep in

aberrant anatomy. Radix Entomolaris, an extra distal

mind the various laid down guidelines and laws to

root in a mandibular molar, is often seen in Oriental

comprehend and perceive the unseen complexities

. Similarly C-shaped

and details to efficiently clean, shape and obturate

anatomy is seen more commonly in Chinese,

the root canal to ensure an acceptable endodontic

and Eskimo population

38

Korean and Indian population

39,40

success rate.

8. The endodontic pathfinder inserted into the

References :

orifice openings will reveal the direction that the

1. Hess W, Zurcher E. The Anatomy of Root Canals of the

teeth
of
the
Permanent
and
Deciduous
dentitions.1925;NewYork:William Wood & Co.

canal takes in leaving the pulp chamber.

9. Tactile perception with a hand instrument

2. Krasner P, Rankow HJ. Anatomy of the pulp chamber floor.

J Endod 2004;30:5-16.

can identify curvatures, obstructions, root divisions,

3. Weine FS. Endodontic Therapy, 5thedn. St.Louis:MosbyYearbook Inc.,1996:243.

and additional canal orifices including apical

constrictions.

4.Vertucci FJ, Seelig A, Gilles R. Root canal morphology of

the human maxillary second premolar. Oral Surg Oral Med
Oral Pathol Oral RadiolEndod 1974;38:456-464.

10. Fiberoptic transillumination can reveal

calcifications, orifice locations, abfractions and

5. Gulabivala K, Aung TH, Alavi A, Mg Y-L. Root and canal

morphology of Burmese mandibular molars. IntEndod J
2001;34:359-370.

fracture lines.
Radiography is needed, first as an aid to the

6. Vertucci FJ. Root canal morphology and its relationship to

endodontic procedures. Endod Top 2005;10:3-29.

diagnosis, then periodically during treatment.

Surgical operating microscopes, magnifying optical

7. Ruddle C. Cleaning and shaping the root canal system. In:

Cohen S, Burns RC, eds. Pathway of the pulp. 8th ed. St.
Louis: Mosby,2002:231-92.

loupes, endodontic endoscopes help us to further

search and find the normal structures, variations

8. Iqbal MK. Nonsurgical ultrasonic endodontic instruments.

Dent Clin N Am 2004;48:19-34.

and components of unprepared as well as prepared

root canal morphology. Unfortunately radiographs

9. Kratchman SI. Obturation of the root canal system. Dent

Clin N Am 2004;48:203-215.

provide only two dimensional blueprint of the

actual three dimensional pulp anatomy. It is the

10. Weller RN, Niemczyk SP, Kim S: Incidence and position

of the canal isthmus: Part 1. Mesiobuccal root of the maxillary
first molar. J Endod 1995;21:380-383.

third dimension that the clinician must visualize to

achieve success in Endodontic treatment.
168

ENDODONTOLOGY

A.P TIKKU, W. PRAGYA PANDEY, IVY SHUKLA

27. Haddad GY, Nehme WB, Ounsi HF. Diagnosis,

classification and frequency of C-shaped canals in mandibular
second molars in the Lebanese population. J
Endod1999;25:268-271.

11. Green D: Double canals in single roots . Oral Surg

1973;35:689-696.
12. Hsu Y, Kim S. The resected root surface: the issue of canal
isthmuses. Dent Clin N Am 1997:3:529-540.

28. Abou-Rass M, Frank AL, Glick DH. The anticurvature filing

method to prepare the curved root canal. J Am Dent Assoc
1980;101:792-4.

13. CambruzziJV, Marshall FJ: Molar endodontic Surgery J

Can Dent Assoc.1983;1:61-66.
14. Vertucci FJ: Root canal anatomy of the human permanent
teeth. Oral Surg 1984;58:589-599.

29. Chai WL, Thong YL: Cross-sectional Morphology and

Minimum canal widths in C-shaped roots of Mandibular
Molars J Endod2004;30:509-512.

15. Pineda F, Kuttler Y: Mesiodistal and

buccolingualroentgenographic investigation of 7,275 root
canals. Oral Surg1972;33:101.

30. Berbert A, Nishiyama CK. Curvaturasradiculares:uma nova

metodologiapara a mensuracado e localizacao. Rev
GauchaOdontol 1994;42(6):356-8.

16. Skidmore AE, Bjornal AM: Root morphology of the human

mandibular first molar.Oral Surg 1971;32:778.
17. Cambruzzi JV, Marshall FJ, PappinJB.Methylene blue dye.
An aid to endodontic surgery. Endo Report 1985;11:311-314.

31. Schneider SW. A comparison of canal preparations in

straight and curved root canals. Oral Surg Oral Med Oral
Pathol1971;32:271-5.

18. Senia ES, Marshall FJ, Rosen S: The solvent action of

sodium hypochlorite on pulp tissue of extracted teeth. Oral
Surg1971;31:96.

32. Jou YT, Karabucak B, Levin J, Donald Liu. Endodontic

working width: current concepts and techniques. Dent Clin
North Am2004;48:323-35.

19. Carr GB: Microscopes in endodontics. J Calif Dent

Assoc1992;11:55.

33. Kutler Y. Microscopic investigation of root apexes. J Am

Dent Assoc 1955;50:544-552.

20. Engle TK, Steiman HR: Preliminary investigation of

ultrasonics root end preparation.J Endod1995;21:443.

34. Riccuci, Langeland. Apical limit of root canal

instrumentation and obturation, part 2. A histologic study.
IntEndodJ1998;31:394-409.

21. Rubinstein R. The anatomy of the surgical operating

microscope and operating position.Dent Clin of N Am
1997;41:391-413.

35. Dummer PM, McGinn JH, Rees DG. The position and
topography of the apical canal constriction and apical
foramen. IntEndod J1984;17:192-8.

22. Cooke HG, Cox FL: C-shaped canal configuration in

mandibular molars. J Am Dent Assoc 1979;99:836.

36. Slowey RR. Radiographic aids in the detection of extra

root canals. Oral Surg 1974;37:762.

23. Cohen S, Burns R: Pathways of the Pulp, ed 6 .St Louis,

Mosby Year Book, 1994.
th

37. Georig AC, Neaverth EJ. A simplified look at the buccal

object rule in endodontics. J Endod1987;13:570.

24. Newton CW, McDonald S. A C-shaped canal configuration

in a maxillary first molar. J Endod 1984;10:397-9.

38. Demoor, Deroose, Calberson. The radix entomolaris in

mandibular first molars an endodontic challenge. IntEndod J
2004 Nov;37(11):789-99.

25. Yang ZP, Yang SF, Lin YC, Shay JC, Chi CY. C-shaped
root canals in mandibular second molars in a Chinese
population.Endod Dent Traumatol 1988;4:160-3.

39. Nallapati S. Three canal mandibular first and second

premolars: a treatment approach. J Endod 2005;31(6):474-6.
Trope M, Elfenbein L, Tronstad L. Mandibular premolars with
more than one root canal in different race groups. J Endod
1986;12(8):343-5.

26.Melton DC, Krell KV, Fuller MW: Anatomical and

histological features of C-shaped canals in mandibular second
molars. J Endodon1991;17:384-8.

169