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For the dentist it is essential to bear in mind that, with the certain exception that dentin is a rigid structure, the dentin walls do not isolate the pulp content of its interior from the periodontium, since it is well known that there are many lateral ducts, accessories or other communications that put the pulp content and the periodontium in intimate relationship.
Lateral and accessory canals are an anatomical variation of the root canal system that is observed in premolars and molars with significant frequency. Their knowledge is of particular importance because the inability to locate and treat all these ramifications is one of the causes of endodontic failure.
Lateral canals are anatomical components of many teeth, located especially in the apical third of the root and in the bifurcation area of molars.
It is defined that the lateral canals extend from the main canal to the periodontal ligament, especially in the apical or middle third of the root.
Dentinal canal
The dentinal canal runs from the coronary pulp to the root apex in such a way that its coronary limit is in the pulp chamber in uniradicular teeth and in multirooted teeth at the level of the floor of the pulp chamber.
It is important to take into account a number of particularities:
- As mentioned above, the dentinal canal is not a simple canal, but one must always consider the possibility that this canal may have multiple branches that the clinician must identify, clean, widen and obturate.
- Likewise, if the canal is fully formed, the apical termination is always narrower than the coronary zone. This is why the canal is conical with the narrowest zone at the apical level.
- It is at this narrower point that the vasculonervous bundle it contains must be removed and subsequently obturated (cemento-dentinous boundary).
- If the root formation is not completely finished, the conical shape of the canal is cylindrical or even inverted conical and it is much more difficult to get the obturation in the correct position.
- In the apical zone the dentinal canal continues with the cementary canal, which is never located on the same axis as the previous one. There is always an angulation between the axis of the dentinal canal and the cementary canal. The existence of this angulation together with the fact that at this point the canal caliber is the narrowest, is what leads to choose it as the limit of the preparation and obturation of the canal.
- The walls of the dentinal canal are made of dentin.
- Inside the dentinal canal is located the pulp vasculonervous bundle or root pulp and therefore the cells it contains are those of the pulp itself, i.e. odontoblasts (dentin-forming), fibroblasts (collagen and ground substance-forming), undifferentiated cells or reserve cells or stem cells that would be the precursors, among others, of the odontoclasts in case there is a process of dentin destruction, undifferentiated cells or reserve cells or stem cells that would be the precursors of odontoclasts, among others, in the event of a process of dentin destruction, defense cells such as macrophages and lymphocytes and blood, lymphatic and nervous vessels. Therefore, in all the processes of repair or destruction of the dentin wall these cells will be involved and not others (no cementoblasts, osteoblasts, etc).
Cementary canal
The cementary canal is the continuation of the dentinal canal thanks to which the latter opens to the apical periodontium. As indicated, its walls are made of root cementum and not dentin. It has already been mentioned in the previous section, as it is the apical continuation of the dentinal canal and it is up to this limit, as already mentioned, where the preparation and obturation of the canal is carried out.
It is important to take into account a series of particularities:
- The cementary canal has a truncated conical shape with the lesser foramen continuing into the dentinal canal and with its larger opening into the apical periodontium.
- It is a short duct that has been the subject of a large number of studies both histological and anatomical having to highlight at this time the studies conducted by Yury Kuttler (the book was published in 1980) that made extremely accurate measurements. Based on these studies it can be determined that the length of this cement duct is in the order of 0.5 to 0.7 mm, but it is necessary to take into account that these measurements are variable, since the length of the duct is conditioned to the greater or lesser apposition of cement on its walls and on the root apex.
- When the cemental canal is in formation, its caliber is so wide as to allow a large vascular supply to the root and chamber pulp bundle, which confers to the infantile and juvenile pulp a great capacity for repair that should induce caution in the differential diagnosis of irreversible involvement of the dental pulp at these ages. It should be noted that in the early stages of root formation there is no apparent angulation between the axis of the dental canal and the cementum, which allows a very fluid vascular supply. The angulation is produced as the periapical root cement begins to be generated, which also closes the lumen of this canal and strangles the vasculonervous supply to the interior of the root pulp. In these cases the difficulty to determine where the cementum-dentinal limit is located is easily understood and it is, therefore, extremely difficult to reach a limit up to where to remove the root pulp and obturate.
At TECH Technological University we have created a Master’s Degree in Endodontics and Apical Microsurgery in which you will acquire the necessary skills to apply the latest and most efficient teaching methods with your patients. Among our most successful study programs, the Master in Implantology and Oral Surgery and the Master in Periodontics and Mucogingival Surgery, which are equivalent to 60 ECTS credits and are completed in one year, are also noteworthy.
